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Sixth Standing Committee
on Delegated Legislation
Wednesday 5 November 2003
[Mr. Roger Gale in the Chair]
Strategic Health Authorities
(Consultation on Changes)
Mr. Paul Marsden (Shrewsbury and Atcham): I beg to move,
That the Committee has considered the Strategic Health Authorities (Consultation on Changes) Regulations 2003 (S.I. 2003, No. 1617).
I thank London health link, the regional association for community health councils, which represents 29 bodies and 500 individuals who will be made redundant in the next four weeks or so. It has conveyed those people's concerns about the regulations. I hope that the Minister accepts my constructive criticism in a fair-minded way, and that he will respond to my points. I also hope that, after today's Committee, he will meet representatives from London health link to allay their fears.
Those fears existed way back during the passage of the National Health Service Reform and Health Care Professions Act 2002, when the Government's initial plan was to remove the consultation requirement on the Secretary of State in relation to establishment, merger and changes to boundaries for health authorities. Only after suitable points were made in debate did the Government concede the point and amend section 8 of the National Health Service Act 1977 to preserve the requirement on the Secretary of State to consult.
The Minister of State, Department of Health (Mr. John Hutton): I shall, of course, respond positively to any criticisms that the hon. Gentleman makes. It may help him and the Committee, however, if I explain that the 1977 Act, which created health authorities, did not put any statutory obligation to consult on the Secretary of State. It is therefore not the case that the 2002 Act sought to remove consultation requirements. As the hon. Gentleman said, that Act introduced statutory requirements for the first time.
Mr. Marsden: I thank the Minister for that. However, following introduction of the regulations, we face enormous confusion and additional complexity. We need a new framework for consultation throughout the national health service.
The regulations mean that NHS trusts and primary care trusts will be able to proceed without consulting those who represent the patient interest. I ask the Minister to focus on what is meant by the patient interest. I am talking about consulting those on the front line, such as CHCs, as opposed to what the Government plan to do, which is to hand things over to the overview and scrutiny committees of local authorities, which, although they have a role, cannot,
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with the best will in the world, do the same job as that undertaken by CHCs.
Complexity is being introduced because NHS trusts and PCTs will be able to proceed without consultation, but strategic health authorities will require prior consultation. We could argue about who is the best representative of patients, but there seems to be an unfortunate imbalance in the way that the Government are approaching this subject. That point is important because the boundaries covered by strategic health authorities will include definitions of clinical networks for services such as cancer and renal treatment. I know from my constituency the importance of the SHAs that link Shropshire and Staffordshire for cancer services. Changing SHA boundaries would have an enormous impact on the clinical links between the two hospitals, which have joint cancer service status. It would likewise affect geographical areas that are scrutinised by local authority joint committees. Being managed by the strategic health authority will have an impact on an organisation's performance.
Consultation on organisational change is essential because boundaries must be synchronised if the health and social care divide is to be minimised and local democratic accountability maintained. Communities must have a say in organisational changes because those changes could be a precursor to service changes. Patients and the public will be fundamentally concerned about such matters if their services are changed. There has been a history of erosion of accountability, and I hope that the Minister can allay my fears about that. For example, I understand that, before 1999, the Secretary of State was required to consult if an NHS trust wished to operate services from a site that it did not own. That requirement was removed under the Health Act 1999.
As a result of the abolition of the CHCs on 1 December 2003, the requirement to consult patient interests on the establishment, dissolution and mergers of NHS trusts will lapse, leaving only a requirement to consult staff interests. Although the same consultation requirements for PCTs are far more extensive and involve local authorities and the voluntary sector, as well as CHCs, as statutory consultees, the question, once the CHCs have been abolished, will remain whether there will be the same form of consultation as there was when the CHCs existed.
Organisations that represent patients must have a say. We are at one on that. As for matters affecting patients, will the overview and scrutiny committees play the same important role that the CHCs did? Will they have the same insider view? Clearly, they will have a role, but it will not be the same role, and nor will it be the role that the patients forums will have. Local authorities will not be consulted, per se, on such matters. I stand to be corrected by the Minister, but I understand that the reason why there will be no requirement to consult local authorities is that new regulations would be needed to put such a requirement in place. Such regulations have not been put before the House. Given that CHCs will be abolished in one month's time, we need those regulations. Will the Minister explain when they will be brought forward? It
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seems that there is no intention to consult patient forums, but perhaps the right hon. Gentleman can allay our fears about that.
There is much inconsistency in the regulations. They are certainly confusing and complex. While there is a requirement for prior approval of the consultation by the Secretary of State, there is confusion about what is meant by
''unless the consultation has been approved by the Secretary of State''.
It is not clear whether that means the consultation process proposed by a strategic health authority or whether all the documentation must be approved by the Secretary of State. What does the provision mean? It could be argued that it would be more straightforward if the Secretary of State undertook the consultation and, if he did not, to have, at least, a level playing field in terms of what is required.
The Cabinet Office code on consultation states that it must be built into the development of an initiative at the beginning of the process. As happened with foundation trusts, however, there was no consultation with groups that represented patient interest. That is why I want the Minister to go back to the drawing board and think again about consultation in general.
Tim Loughton (East Worthing and Shoreham): After the opening speech by the hon. Member for Shrewsbury and Atcham (Mr. Marsden) on behalf of the Liberal Democrats, I am still slightly in the dark about the point of his objection to the regulations. If I understood it correctly, I wish to reinforce it by making a few comments.
There is confusion about who does what, who is responsible for what and who is accountable to whom in health services in this country. That has been a problem for a number of years, but it is becoming increasingly complex, given reorganisation in the health service, the increasing unity of activities—involving social service departments and social care trusts, for example—and Ministers' disgraceful reneging on certain undertakings with regard to community health councils and the supposedly seamless transition from what they were to the pale shadow that is supposedly taking over from them.
An average constituent of any hon. Member would be hard pressed to say definitively who is responsible for what activities in the health service, let alone who is accountable and how constituents may hold to account officials elected through councils or any other elected or unelected body. Those officials will now be responsible, through scrutiny and overview committees, as a response to local government legislation of a few years ago.
I want the Minister to give us assurances about how the bodies that are taking over from community health councils are to be responsive to patients. The most important part of the health service is the patients for which it exists: it does not exist to serve itself—it exists to serve its patients.
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I wish to make a few specific points about the regulations. Who will be consulted, under regulation 2(2)? Can the Minister explain how the consultation process will work? How are we to be assured that equal weight will be given to all consultees? I presume that they will come under the NHS trust section in paragraph (2)(b), but that is not explicitly mentioned. What credence will be given to representations from mental health trusts—stand-alone trusts, or those that are part of social care trusts—and from the users in that part of the national health service? Will we will be amending these regulations again before very long, if the Bill to establish foundation trusts that is currently being discussed in the other place is passed—although I gather that there is a question mark about that, according to pronouncements made by the Secretary of State through the Labour party office rather than the Department of Health? Will these regulations have to be amended again to include the new status of foundation trust hospitals as potential consultees, and everything that goes with that?
Can the Minister also give us some ideas about the costings of these consultations? I am all for consultation, where necessary: what I and my constituents would hate to think is that the cost is to be met from the pot of money that has to go towards patient care. Are we ploughing yet more money into additional bureaucracy and paperwork in the NHS that could be better used employing health professionals to give real health care to real constituents where that is really needed?
As we are talking about strategic health authorities, can the Minister state whether his Department has any plans to change the number of SHAs—let alone some boundaries? These SHAs are not that old: they resulted from the re-organisation of the 90 health authorities down to what was estimated to be about 30—I think that that figure currently stands at 28. Do the Government have any plans to reduce or increase the number of SHAs? Is the Minister concerned by the big discrepancies in the numbers of patients that SHAs look after? My local SHA, Surrey and Sussex, is one of the largest in the country, catering for more than one and a half million people. Does he think that there are any pitfalls in the disproportionate size of that SHA? Some cater for much fewer people. Do the Government have any intention of regularising the numbers, in which case we will be back yet again to look at more legislation on reorganising the health service?
Paragraph (2) in regulation 4, which is headed ''Reference to the Secretary of State'', says that within a period that
''the Secretary of State may determine, the Strategic Health Authority which has carried out the consultation must—
(a) send to the Secretary of State such documents or information as the Secretary of State may require''.
What sort of documents are we talking about? Paragraph (2)(b) says that the SHA must
''report the results of the consultation to the Secretary of State and, if the Secretary of State so requires, provide copies of any written responses to the consultation.''
Can the Secretary of State give an undertaking that all the responses to such a consultation will be put in the
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public domain, unless the respondent specifically requests otherwise?
At the moment, there is a big question mark over the consultation on the draft Mental Health Bill, which has excited an enormous amount of responses—in excess of 2,000, apparently. The consultation period has long since closed, but those responses have not been published. We still await an undertaking from the Government as to when—indeed, if—they will be published and put into the public domain. Can the Minister give us some assurance that, in this case, all consultation responses will be put into the public domain, so that when Members of Parliament make representations on behalf of concerned parties who disagree with the form that reorganisations take, those views are properly taken into account, and not just ignored?
I have made a number of detailed points on which I hope that the Minister can give assurances. Having said that, I am still at something of a loss as to what the main concern was that led the Liberal Democrats to pray against the regulations.