Strategic Health Authorities (Consultation on Changes) Regulations 2003 (S.I., 2003, No. 1617)

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Sir Sydney Chapman (Chipping Barnet): Regulation 2(2)(g) mentions community health councils. It may be tangential to what the hon. Member for Shrewsbury and Atcham said, but I thought that Barnet community health council had ceased functioning; certainly, it had its last meeting last month. I pay tribute to its work under the chairmanship of Mr. Roger Chapman, who bears my surname but certainly does not bear my prejudices and is no relation. Barnet community health council worked extremely well, and I am sorry that it is about to disappear. I can only hope that what replaces it is as effective in looking after patients' interests as it was.

I want to ask the Minister one simple question. I am sure that he will be able to answer it and put my mind at rest. It says in footnote (d) at the bottom of page 2 of the regulations that CHCs are abolished by section 22 of the 2002 Act, but the footnote goes on to say that that Act

    ''is not yet in force.''

I do not quite understand why it is not yet in force if the CHCs are going. Will its provisions be triggered in the next few days, before 1 December, and are the Government just waiting until a few days prior to that? Could the Minister explain the background? I understand why the Government are leaving in reference to the CHCs, in case they are not abolished by the time the regulations come into force. I did not play a leading part in considering the Bill that presaged the 2002 Act, but I would be grateful if that little point could be explained to me, because it seems a bit mysterious.

2.49 pm

Mr. Hutton: I am grateful for the opportunity to try to reassure Opposition Members on their points on what I would describe—fairly, I think—as a modest set of regulations, which are designed to give effect to

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commitments that Ministers made when the National Health Service Reform and Health Care Professions Act 2002 went through the House. I was the Minister who agreed, in principle, with the point, made at the time by my hon. Friend the Member for Leigh (Andy Burnham), that parts of the Act should require statutory consultation.

The regulations are modest. I should explain to the hon. Members for Shrewsbury and Atcham and for East Worthing and Shoreham (Tim Loughton) that we consulted a wide variety of interests about the structure and content of the regulations before we produced them, including the Local Government Association, the Association of Community Health Councils for England and Wales, the patients forum—not to be confused with the statutory patients forums—which represents a number of voluntary organisations, the British Medical Association, and many others. The regulations are in line with the advice that we received from the NHS, local government and other agencies.

The hon. Member for Shrewsbury and Atcham made a number of points. His argument, as I understood it, was that it was wrong for strategic health authorities to consult on changes to their own organisations, and that it would be better if some other body were responsible for those consultations. However, there are many precedents in the national health service for organisations responsible for changes organising consultations. The question is what guarantees we can have, as citizens and NHS patients, that that consultation will be objective and properly conducted. The regulations will guarantee precisely that. There is a comprehensive list of the organisations that need to be consulted in the regulations, from which the hon. Gentleman has quoted.

Under regulation 4, the Secretary of State has responsibility for overseeing the consultation, and must satisfy himself that the strategic health authority's proposals are sensible and will ensure wide-ranging and effective consultation with people who may be affected by the proposals. The hon. Gentleman is right; some of the proposals may have a significant impact.

There are a number of failsafes in the system. All organisations have a duty to act in a fair and even-handed way as public bodies. I am sure that the hon. Member for Shrewsbury and Atcham would not suggest for a second that strategic health authorities would do other than that. For example, if there were a suggestion locally that a significant service change had been proposed that might affect the local NHS, the primary care trust would have the job of organising the consultation and would commission services locally; that would be one example of the precedent that I referred to earlier.

That point also rebuts the second of the hon. Gentleman's arguments—that the Government acted in a way that relieved PCTs and NHS trusts of their responsibility to consult locally when significant changes are proposed. We have not done that at all. There will still be, and there is still, a statutory obligation to consult local communities and

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organisations when significant services changes are proposed by the NHS.

Far from diluting the obligations that we want to apply to the NHS, the Government have entrenched them in the statutes and in the organisation of the NHS. New arrangements are in place to secure the wider involvement of patients in the running and organisation of the NHS. In those regards, the hon. Member for Shrewsbury and Atcham was wrong to criticise the regulations.

Mr. Marsden: Will the Minister explain when there will be a statutory obligation to consult with organisations that directly represent patients' interests?

Mr. Hutton: There are examples of that in the regulations—the patient forums and community health councils.

The hon. Gentleman made a point about regulations that extend to consultation when a change is proposed—dissolution or establishment—to a primary care trust or an NHS trust. I want to refer to that point, which is a genuine issue that he was right to draw the Committee's attention to.

This is not the best opportunity to reopen the debate about the reforms to community health councils—or their abolition, to be more precise—or about the wider role of securing the active engagement of patients and the public in the work of the national health service. The House has made its decisions on those matters, which are not directly the subject of the regulations, or are so only to the extent that we are ensuring that those new bodies are properly consulted when a strategic health authority makes a change to its boundaries, or when other matters, covered by the primary legislation—section 8 of the 1977 Act—are involved.

I understand the debating points that the hon. Member for East Worthing and Shoreham wanted to detain the Committee with, but I am not going to go down that path as I do not believe that they are covered by these regulations. However, I strongly believe that there must be proper accountability in the NHS. The money comes from the taxpayer and, as the hon. Gentleman rightly said, the service that we provide is designed to benefit patients—and no one else.

I wish simply and politely to point out to the hon. Gentleman that although he and I might agree on the need for accountability, it is hard to understand how his proposals for a new quango to be set up to distribute money throughout the NHS would improve the lines of accountability in this House with regard to the use of large amounts of taxpayers' money. That would not be in the interests of good governance and government, and it would not be a way to improve accountability in the NHS.

Tim Loughton: I am sure, Mr. Gale, that if any of the points that I made had not been the subject of the regulations, you would have brought me quickly to order. Therefore, I want the Minister to address my points, and especially the one about the costs of the consultation and where the money is coming from. In

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particular, could that money have been spent elsewhere, on health care for the patients in whose interests we are supposedly acting?

Mr. Hutton: I do not intend to ignore the hon. Gentleman's contribution: I will address it in a moment. I am currently trying to confine my remarks to the criticisms made by the hon. Member for Shrewsbury and Atcham.

The Chairman: Order. I was going to let this point go, but as it has been raised, I will address it. I listened carefully to the question that the Minister highlighted about the possibility of a wide discussion on community health councils: when I am in the Chair, I have an unpleasant habit of listening to the debate. What was said was entirely in order. It would be improper for this Committee to engage in a wide debate. However, it was perfectly reasonable for the hon. Member Chipping Barnet (Sir Sydney Chapman) to raise the issue of the commencement because that date is mentioned in a footnote.

Mr. Hutton: Thank you, Mr. Gale. I am happy that you have clarified that. The hon. Member for Chipping Barnet raised a fair point about the commencement of section 22 of the National Health Service Reform and Health Care Professions Act 2002. For his peace of mind—and so that we can all get on with the rest of our lives—section 22 will commence on 1 December to correspond with the creation of the new bodies and the abolition of the CHCs.

The hon. Member for Shrewsbury and Atcham confused a number of issues. The regulations put on a proper statutory basis for the first time the need for consultation in relation to changes in the boundaries of SHAs, and other significant changes. That is an advance for democracy, rather than a retreat. The regulations—I am glad that the hon. Gentleman did not raise any specific technical concerns about them—are a sensible, fair and balanced piece of secondary legislation.

The hon. Member for East Worthing and Shoreham raised a number of points about the regulations. I have dealt to my satisfaction—if not to his—with his point about accountability in the NHS. He raised several other points. He is right about NHS foundation trusts: I fear that we probably will have to amend the regulations to take account of them. I am sure that the hon. Gentleman is aware that secondary legislation cannot refer to NHS organisations that do not yet exist. That is a matter of law. As he rightly said, the legislation to establish NHS foundation trusts has not completed its passage in this House: there are no such organisations at present, so the regulations cannot refer to them. We will have to address this matter again—I am sure that many of my hon. and right hon. Friends who are present will look forward to that.

I hope that the costs involved in this sort of consultation will be modest. They will not come from resources that have been devoted to patient care. They will have to be met from the SHA management budgets. There is no question about that. The hon. Gentleman asked whether we had plans to change the SHAs, or their boundaries or names; we do not. As he

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rightly said, they are only just coming into existence, and they would welcome a period of stability.

The hon. Gentleman also asked about publishing responses to the consultation. I am very much in favour of that, but there would probably have be a caveat about publishing information that consultees would prefer not to be in the public domain. That is an entirely sensible proposal, and I shall raise it with my right hon. Friend the Secretary of State and the SHAs.

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