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Health and Social Care

Health and Social Care

Column Number: 125

Standing Committee E

Thursday 15 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 proposed [this day]: No. 206, in

    schedule 1, page 93, line 20, leave out paragraph 4.—[Dr. Harris.]

2.30 pm

Question again proposed, That the amendment be made.

The Chairman: I remind the Committee that with this we are taking the following:

Amendment No. 68, in

    schedule 1, page 93, line 20, after first 'of', insert '50'.

Amendment No. 176, in

    schedule 1, page 93, line 20, after first 'of', insert '500'.

Amendment No. 177, in

    schedule 1, page 93, line 20, leave out 'each' and insert 'the public'.

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I intend to deal specifically with amendment No. 206. It would remove the requirement to specify a minimum number of members in each constituency, and that would completely undermine the different arrangements for NHS foundation trusts. If no minimum is necessary, an NHS foundation trust could theoretically choose to have no membership at all. The election of a board of governors and a board of directors—a membership—is a fundamental requirement of the provision.

In recognition of the fact that the position of each NHS foundation trust will be different, we have not specified the number of members that ought to be in the constitution. That does not mean that specifying the minimum number of members is unnecessary. Every NHS foundation trust constitution must specify a minimum number of members in its public constituency and in its staff constituency. This is an important provision, and the minimum number of members in each constituency, together with other matters that must be included in the constitution—in particular the specification of the area of the foundation trust—will be an important guide for the Secretary of State for Health and the independent regulator in assessing whether an NHS foundation trust membership, and consequently its governance arrangements, is representative, fair and appropriate.

Dr. Andrew Murrison (Westbury): I do not think from what the Under-Secretary says that there is any controversy about the need for a minimum number of members in each constituency. The question is whether that minimum number is set by statute, or left to the discretion of the Secretary of State.

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Ms Blears: The minimum is actually left for the local community to decide and recommend. National health service foundation trusts will prepare draft constitutions when they make their second stage applications. The trusts must consult the local community, the primary care trusts, their partner organisations, and perhaps the local university and medical school, to assess whether they have judged the situation correctly. A trust then submits the constitution to the Secretary of State and the independent regulator. That early buy-in is more robust than the Government defining a minimum number of members in the Bill. The correct balance has been struck in the Bill to get maximum buy-in from the local community.

Dr. Murrison: Will the hon. Lady give way?

Ms Blears: I am loth to give way. I should like to make some progress on these clauses; otherwise we will not have enough time to discuss the remainder of schedule 1. However, if the hon. Gentleman has a specific point to make, I shall give way.

Dr. Murrison: To what extent will the submission of the constitution to the independent regulator and the Secretary of State result in their overturning locally made decisions? If the answer is ''very rarely'', what is the point in making a submission?

Ms Blears: The hon. Gentleman is not only being hypothetical but he is anticipating events way down the line between now and next April, when the first wave of foundation trusts will be up and running. There is plenty of time for those trusts to consult locally, gain maximum support and get everything absolutely right. This is about building consensus; perhaps the hon. Gentleman does not have much experience of building consensus in local communities. We are trying to pull together as many partners as possible to sign up to the vision of a community-owned organisation, at the heart of a local neighbourhood, that everyone supports and wants to succeed. This is an important provision, and it is up to NHS foundation trusts to introduce it into their constitutions.

The purpose of amendments Nos. 68 and 176 is to specify a minimum number of members. Amendment No. 68 specifies a minimum of 50 members, which would not ensure a genuinely representative membership. The figure of 50 members is too low. The Secretary of State has expressed concern about the number of members for NHS trusts that become NHS foundation trusts. The figure of 50 may also be too low for NHS foundation trusts that are established as new organisations.

Chris Grayling (Epsom and Ewell): The Under-Secretary will recall that I said that this is simply a probing amendment that seeks the Government's clarification on what they consider to be an appropriate number of members. The Committee would like to have some idea about the guidance that will be issued to trusts to ensure that the entryism that I spoke about this morning cannot take place.

Ms Blears: The hon. Gentleman has talked about entryism, as have a number of other hon. Members. Entryism is a legitimate cause for concern, and we

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must ensure that it is guarded against in the constitution. On Tuesday, I explained that, in their constitution, the NHS foundation trusts will set out what they envisage will be the make-up of their boards of governors and how they intend to ensure that the membership of the boards is not dominated by one specific interest group. It is possible, within constitutional arrangements and frameworks, to ensure good and robust governance.

Some hon. Members, including my hon. Friend the Member for Ealing, North (Mr. Pound), have said that the trusts would be made up of a small number of committed individuals. I ask my hon. Friend and other hon. Members to have more faith in democracy in their local communities and to realise that there will be myriad opportunities for people to become members of trusts. I envisage that people will be invited to join a trust by their general practitioner when they go for appointments or receive an out-patients appointment. They will also be able to respond to advertisements in the local press or return their application forms.

We are also considering how the patient advice and liaison services that are being established in trusts, as well as the independent complaints and advocacy service set up to act for people in complaints processes, can encourage people to join the trust. People may also be able to join by using the techniques that we are exploring to increase people's participation in democracy in the local government elections. By that I mean new technology such as the internet and text messages.

I assure hon. Members that the trusts will not be made up of a small group of the sharp-elbowed bourgeoisie, as my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) said. The trusts will not comprise a small group of committed people; we are looking for a mass membership for the organisation. That is why setting such a low minimum of 50 members is inappropriate. Equally, the amendment that would provide for 500 members would not necessarily guarantee a generally representative membership. That number may be too low for the public constituency of an NHS foundation trust that was previously an NHS trust. On the other hand, an NHS foundation trust established as a new organisation might initially have very few members. That should not be an impediment, provided that their application sets out their proposals for engaging an increasing number of people in their membership and staff membership.

The amendment tabled by the hon. Member for Oxford, West and Abingdon (Dr. Harris) states that there should be a minimum of 500 members in the organisation, and his subsequent amendments, particularly amendment No. 213, seek to do away with the public constituency. Perhaps that is another example of his wanting to have his cake and eat it—a phrase used by the hon. Member for Epsom and Ewell (Chris Grayling). The amendments suggest that local public constituencies should be abolished and replaced by local government, thus reducing the direct democracy that can be had by people joining the

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trust as members of the public constituency. In a phrase that will stay with me for ever, the hon. Member for Cheadle (Mrs. Calton) said that the Liberal Democrats can tailor their principles to suit local circumstances. I am sure that many hon. Members will remember that phrase for a long time.

Mr. Stephen Pound (Ealing, North): I am very grateful to the Minister for giving way, and I am glad that the opportunity for that extraordinary expression about the Liberal Democrats tailoring their principles to suit local circumstances was given another chance to resonate around the Room. I suspect that we may hear of it again. The Under-Secretary's presentation and preparation of her case and her enthusiasm are so intoxicating that it would seem caddish not to rush in behind her. However, some hon. Members have severe reservations about the issue, and that is in no way a criticism of the principle or the ideal, but a reflection of the bitter experience that many of us have had.

This could be the first time that a mass-membership participatory system has grown from the top down, and I should like to see it. My right hon. Friend the Member for Holborn and St Pancras cited Tawney when he said that, in his opinion, the sharp elbows of the middle classes would propel them to the head of the queue. I think that that was the exact expression used.


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