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Seventh Standing Committee on Delegated Legislation
Wednesday 12 November 2003
[Mr. Joe Benton in the Chair]
Patients' Forums (Membership and Procedure) Regulations 2003
Mr. Paul Burstow (Sutton and Cheam): I beg to move,
That the Committee has considered the Patients' Forums (Membership and Procedure) Regulations 2003 (S.I., 2003, No. 2123).
The Chairman: With this it will be convenient to consider the Patients' Forums (Functions) Regulations 2003.
Mr. Burstow: I wish to raise a number of points about how well the introduction of public and patient involvement into the national health service is progressing. We have the opportunity today to explore not so much what has already happened, although some of that laid foundations for the future, but how the arrangements set out in the orders will work in practice.
Some of the points that I wish to raise were touched on in a similar debate in the other place, but although the Minister there attempted to respond to many of the points his response was not sufficient. One concern is about the establishment of patients forums. The arrangements that the Commission for Patient and Public Involvement in Health has put in place to establish and support patients forums, through a system of local network providers rather than through directly recruited and employed staff provided by the commission, has been a source of some anxiety.
I understand that about £25,000 is the going rate for conducting the business of a patients forum. Some bidders for local network provider contracts have succeeded in securing responsibility for a large number of patients forums. For example, the College of Health was successful in securing responsibility for providing services for 33 forums, and it was trying to find 23 staff. However, I understand that the business is now being liquidated. I hope that the Minister can tell us what happens to such forums and how rapidly they can be set up.
There seems to be some inconsistency about the level of staff available to support the work of patients forums. We must ask how dedicated to a particular patients forum the staff of local network providers will be, given that they will be responsible for a large geographical area, often straddling more than one primary care trust area or, in some cases, more than one strategic health authority area.
Another problem, and a cause of concern to many, is that some of those who have been successful in securing contracts from the commission do not seem to have the local knowledge necessary quickly and
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smoothly to manage the transition from the old arrangements to the new ones. Indeed, during the passage of the legislation that set up patients forums and the other arrangements, clear undertakings were given by the two former Under-Secretaries of State for Health, the hon. Members for Salford (Ms Blears) and for Tottenham (Mr. Lammy), and by the Government spokesman for health in the other place, Lord Hunt of Kings Heath, which appear not to have been fulfilled. For example, the commission does not employ the staff directly but uses an elaborate and complicated process of contracting and tendering.
I hope that the Minister can say a little about how the arrangements will work to ensure that local network providers have at an early stage the ability to understand particular local health economies and the needs of particular local groups of patients. For example, Harrow Age Concern has secured a contract to provide a range of patients forum services, including children's services and mental health services. Although Age Concern's core business might touch tangentially on some of those issues, I cannot readily see how it can automatically step into that role. I hope that the Minister can explain how that will happen.
Regulation 8(2) in the first statutory instrument provides for patients forums to direct how staff conduct their business on behalf of a forum. Will the Minister explain how staff working for a local network provider will deal with what appears on the face of it to be a tension or conflict of interest? The staff are contracted and performance managed by the commission, but at the same time they are, according to the regulations, to take directions from a patients forum. What happens in a situation where, through the performance management route, a contractor is obliged to take an action that is completely contrary to one that they are required to take under regulation 8(2)? How would that be resolved? Is there a mechanism to resolve such disputes as and when they arise? I hope that the Minister can indicate what will happen.
Another area of concern about which I hope that the Minister can say a little is the co-ordination of patients forums. It has been put to me that a range of patients forums in a locality may have an interest in how the ambulance service is provided, in which case they may need to co-ordinate their activities. They may also need to act independently, and there is a phrase in the regulations that could be interpreted as meaning that no patients forum can act unless it has the agreement of all patients forums. That particularly applies to national institutions such as Great Ormond Street hospital for children, but it can apply to other entities such as regionally based ambulance services. It would be useful if the Minister were to say a bit about that.
When the legislation that set up the system was introduced, I welcomed the establishment of the overview and scrutiny function of local authorities, although I had some questions about precisely how it would work. Will the Minister explain why regulation 7 does not require, or at the very least encourage, patients forums to consider referring matters on where they think that there is a general public health
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provision issue that goes beyond their remit? The word used in the regulation is ''may'', but surely it should be ''shall''. I hope that she can explain why the Government felt it inappropriate to place on forums a clearer duty to act.
Similarly, regulation 8(3) lists a range of bodies to which the patients forums are meant to send their reports. The list does not include overview and scrutiny committees, which is odd given the need to knit together all the new bodies with responsibility for patient involvement and for reflecting on, respecting and dealing with the concerns of NHS patients. Overview and scrutiny committees certainly have such a role.
When the Minister responds, it would be helpful if she could say a little about the findings of the Joint Committee on Statutory Instruments, which has raised serious concerns about the technical drafting of the statutory instruments. Indeed, the Committee has found that both statutory instruments are defective and that new statutory instruments will need to be laid before this House quite quickly. As they stand, and as they will undoubtedly be passed today, they are ambiguous, unclear and misleading. That is not my view, but the view of the Joint Committee. Can the Minister tell us what the timetable will be for putting those defects right at the earliest possible opportunity? It would be helpful to know precisely when that will be.
I want to pick up on matters related to finance. I was looking earlier today at the accounts for the commission, which were interesting reading. In the accounts for the period that closed on 30 September 2003, which went to the commission's board in October, it was found that the central office costs for running the whole commission involved overspend to the tune of £129,000. In addition, regional office costs involved overspend to the tune of £31,000 but the whole business of setting up patients forumsówhich is what the process was meant to be aboutówas underspent by £439,000. I am sure that the Minister will tell us that that is partly because of the delay in setting up patients forums, but surely to have overspend in the centre through the creation of more bureaucratic costs, while the job of involving patients in the NHS is behind schedule and underspent, is a cause for concern. Can the Minister comment on that?
Another point that I want to take up with the Minister concerns the exchanges on the regulations that took place in another place, particularly the notable contribution made by the noble Lord Hunt. He was very much involved as a Minister during the passage of the legislation in the other place, and gave specific undertakings. He expressed some fears over what he described as the Commission's growing arrogance and, in particular, concerns over the regulations' inclusion of specific powers for the commission to give direction to patients forums. In his response in the other place, Lord Warner said that those were intended to be on a narrow basis to ensure consistency of standards and approach; but for a Minister to say that when it is not explicit in the regulations seems a great missed opportunity to provide clarity. Given that the Government will have
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to come back with amendments to the regulations, can they also provide clarification that the commission is not the entity that controls patients forums but the body that facilitates them? The Government seemed to understand and champion that important distinction during the legislation's passage, but in these regulations they are in danger of undermining that.
Lord Hunt has asked a number of written questions on that matter, which are yet to be answered. I hope that they will be answered shortly. Not the least of those was by what statutory authority the Commission for Patient and Public Involvement in Health changed the name of patients forums. He felt strongly that Parliament had come to a view on what they were and what they were to be called, but that the commission had sought to exercise its independence by giving them a completely different name.
I have another question for the Minister on the commission, which concerns its responsibility to consult patients and to be informed about their views in formulating local provider networks and all the other policies that it has responsibility for producing. There is currently no statutory duty on the commission to consult. It might have been assumed that the commission would be an exemplar of consultation, but it has not been. Many have expressed to me the concern that it has not successfully involved many stakeholders in its management of the transition from community health councils to patients forums. Why do the Government think that there is no need to place such a statutory duty on the commission? Is that not something that could be considered for the future?
The filling of vacancies on patients forums is important because I understand that there is now some question as to whether those that cover PCTs will be established by 1 December. Can the Minister tell us whether the establishment of such forums is on track? Will they be established on time? Will they have their full complement of members by that date? If not, why not?
In conclusion, I wish to pick up on something that Lord Hunt said in the other place. The matter has been put on the record in other ways as well. There is a concern that the commission has been obsessed and more concerned with negotiations with the Department about the resources that would be allocated to it to do its job than it has been with working out how it would get the new system in place. As a consequence, the ''innovative approach'' of establishing local provider networks was rather slow to get started, and, because of that, there are now a variety of providers in the field, some of whom bring a great deal of expertise, knowledge and value to the table but who perhaps do not at present have all the skills that they need to discharge the functions even as well as CHCs did. It is a cause for concern that a former Minister who had responsibility for the legislation in the past has expressed anxieties.
I hope that the Minister can give us some assurances and that they will translate into action by the commission and real change that will result in patients being genuinely at the heart of the NHS and
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genuinely involved in the decisions that affect their lives.