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Session 2002 - 03
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Standing Committee Debates
Health and Social Care (Community Health and Standards) Bill

Health and Social Care (Community Health and Standards) Bill

Standing Committee E

Tuesday 13 May 2003


[Mr. Peter Atkinson in the Chair]

Health and Social Care (Community Health and Standards) Bill

Schedule 1

Constitution of public benefit corporations

Amendment moved [this day]: No. 97, in

    schedule 1, page 93, line 9, at end insert

    'and shall define ''public constituency''.'.—[Sir George Young.]

The Chairman: With this it will be convenient to discuss the following:

Amendment No. 125, in

    schedule 1, page 93, line 12, leave out from 'area' to end of line 13 and insert

    'covered by a primary care trust or primary care trusts for which the corporation is the principal provider of hospital based services, or'.

Amendment No. 175, in

    schedule 1, page 93, line 15, leave out 'may' and insert 'shall'.

Amendment No. 118, in

    schedule 1, page 93, line 17, after 'including', insert

    'their family members involved in their attendance and care as patients or other'.

Amendment No. 144, in

    schedule 1, page 93, line 17, at end insert—

    '(2A) A ''carer'', for the purposes of subparagraph (2), means an individual aged 16 or over who provides or intends to provide substantial care on a regular basis for the patient and does not provide the care in question.

    (a) by virtue of a contract of employment or other contract with any person; or

    (b) as a volunteer for a voluntary organisation as defined in the National Assistance Act 1948.'.

Amendment No. 119, in

    schedule 1, page 93, line 18, leave out 'Subparagraph (1)(a) does' and insert

    'Subparagraphs (1)(a) and (2) do'.

Sir George Young (North-West Hampshire): I welcome you to the Chair, Mr. Atkinson. You will read in Hansard how a wave of excitement ran through the Committee when we heard the news of your appointment.

Before we adjourned, I was speaking to my amendment on defining the constituency for the purpose of electing a foundation trust. I posed a number of questions not from a troublesome Opposition Back-Bencher, but from the Select Committee, which examined the Bill, the Secretary of State and others and concluded that the Bill is fragmented, confusing and inequitable. The Select Committee made a clear recommendation to resolve some of the issues that I was talking about this morning. It said that

    ''it is imperative that the Government safeguards democracy throughout the NHS by providing a national set of guidelines specifying the rules for defining membership constituencies and the

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    process for managing elections so that NHS patients, and the public at large, can have full confidence in transparent and consistent standards of involvement.''

I want to know whether the Minister will be responding positively to the Select Committee's recommendation, which was couched in strong language and referred to safeguarding democracy and so on.

The Government's response so far has been to say that all the issues concerning defining constituencies is a matter for the trusts. However, the Select Committee said in its report that there is no reason why foundation trusts should be experts in community involvement. Fiona Campbell of the Democratic Health Network was quoted in paragraph 41 as saying that

    ''trusts have no idea of what is involved in real community engagement''.

The Select Committee made the point that they may not have a track record in community and patient engagement so far.

I am worried about all the tasks that we are imposing on foundation trust managements. They are supposed to run a quality service for the NHS, but we discovered this morning that the vehicle that they will have to drive has not been built and is still in the process of being designed. The Under-Secretary can provide no precedent for the corporate vehicle that is envisaged in the Bill. The Government will also have to push back the frontiers of democracy by finding a new way of involving people in running the NHS and inventing new constituencies.

I hope that the Under-Secretary will tell us that on the slender shoulders of the management will not be placed some of the burdens that I have described and that there will be clear guidelines. She may like to invite the Electoral Commission to shed some light on how to get that right. We have not touched on the voting process—how people will vote and so on—and we may come to that later.

I shall draw my comments to a close by saying that there is an important issue here. The Select Committee is not happy with the way in which the Government responded. I and others who have tabled amendments expect the Government to go further and we wait with mounting anticipation to hear how the Under-Secretary will respond to the case that my colleagues and I will make.

Dr. Andrew Murrison (Westbury): I rise in support of my right hon. Friend's comments. I alluded to one constituency which needed special consideration and is a good exemplar of the sort of dilemmas that my right hon. Friend touched upon; the military constituency. We must give some thought to unusual groups such as those who use military district general hospital units, MDHUs. A good example is that in Selly Oak. The patient base for Selly Oak is many miles from Selly Oak and Birmingham and may be in Portsmouth or Aldershot. It is difficult to see from the Bill how patients from the military constituency will be represented at such hospitals. I hope that Ministers will focus on that specific example because the matter

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is of great concern to me as the Member of Parliament for a fairly military constituency.

I hope that they will also examine the more general point of how to deal with non-straightforward constituencies. I suspect that once we scratch a little further at the conundrum, we will find that many hospitals have an unusual and not dissimilar patient base. We need to ensure that they, too, are properly represented. The example that I gave is quite a good one; for instance, if Selly Oak hospital became a foundation hospital, its governing body would have an interest in excluding that group of patients.

Something of a dialogue is always going on between the military and the NHS in the running of MDHUs. Indeed, I seem to remember that when they were being set up, the NHS had no great appetite for establishing MDHUs within their hospitals. I can foresee foundation hospitals seeking to exclude that particular part of its business, and they would have no incentive to include the military, as the constituency is defined by the hospital. The Health Committee's report on foundation hospitals was right to identity that problem, and it is for the Government to set the parameters when defining what is meant by ''constituency'' rather than leaving it to foundation hospitals.

Mr. Stephen McCabe (Birmingham, Hall Green): I, too, take the opportunity to welcome you to the Chair, Mr. Atkinson.

I have talked to a lot of people about how we should define ''public constituency'', and I have a great deal of sympathy with the amendment tabled by the right hon. Member for North-West Hampshire. The Government's intentions may be good. I have no problem with the idea of decentralising hospitals and with giving them greater scope to innovate, to expand their capacity and to improve the care and treatment of patients; I am all for that. However, I wonder exactly how we can ensure that such public constituencies are genuinely representative.

The right hon. Gentleman alluded to the problems that might arise if particular groups were to attempt to pack the membership. He cited the example of people with radical health perspectives, but that could apply also to religious sects. Indeed, in one of the weekend newspapers, I read how the Socialist Workers party has been able to block reforms in some secondary schools by manipulating the views of certain teachers. I dare say that if Lady Olga Maitland, the erstwhile colleague of Opposition Members, were still alive and kicking, she would be happy to resurrect a militant Mothers Union in pursuit of something similar. [Interruption.] I always remember her being fairly robust.

We need to be clear that the public constituency will be fair in representing people, and that it will not be possible for groups to combine with the deliberate aim of subverting the health service's values and intentions. I hope that the Minister will be able to offer some reassurance, but nothing in the Bill suggests that it will.

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The hon. Member for Westbury (Dr. Murrison) was right about the centre for defence medicine. The university trust's initial submission points out that the RCDM air commodore is currently part of the management executive of the trust. It would be a peculiar state of affairs if a military man were to be part of the existing management executive, but that the military had no significant status in the sort of public constituency defined in the Bill. We should be given an answer to that question.

Two other amendments struck me as interesting. Amendment No. 118 seeks to extend the provision to family members. That, too, seems appropriate, but we could end up with the bizarre situation in which the family member who regularly travelled from another part of the country to provide care and attention would be part of the public constituency but, were the amendment to be accepted, someone living a few miles down the road could be excluded. It is important that we cater for family members and those who provide direct care, but the amendment throws up the fact that we need greater clarity on how to define the public constituency and how to ensure that those involved have a say.

I am intrigued by amendment No. 119, which suggests that staff members would need to live in the area. I can see that that might be suggested if we were using a definition used elsewhere—the requirement to reside in a specified area—but it seems absurd to say that the staff should have a stake and an interest in the hospital, and therefore a right to participate, but only those who live within a defined area. That suggests that we do not have clarity on what constitutes a public constituency.


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