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Lord Clement-Jones: I support what has been said by the noble Earl, Lord Howe, and the noble Lord, Lord Rea. Clearly, we need to inject some certainty into the situation. It would be grossly unsatisfactory if any gap were allowed to develop between the passing of the Bill and the appointed day for the relevant clauses, and indeed the setting up not only of scrutiny committees but also of patients' forums and patients' councils. I hope that the Minister can accept the amendments or dispel any uncertainty about the way in which the transition will take place, so that those who are employed and those who have a considerable interest in the effective development of patient representation at heart will be able to understand what the future holds.

The Earl of Listowel: On the continuity between the two services, can the Minister make an apology to the 5,000 volunteers of the community health councils for the handling of the CHCs and a statement to the effect that the new arrangements, if they are to be up and running quickly and effectively, will greatly benefit from the experience that the volunteers in the previous organisation have to offer? That would be most welcome.

Lord Hunt of Kings Heath: I hope that I can reassure noble Lords that I accept the point that we should have no intention of abolishing CHCs before the new

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arrangements are up and running. We intend there to be a well-managed transition between the existing system and the new system. The NHS has experience of restructuring so we understand how the process operates. We would seek to ensure that good, administered principles operate in relation to the phasing out of CHCs and the introduction of the new arrangements. Our intention is that the bulk of the new arrangements will have to be up and running before the existing arrangements are taken out of play.

The Secretary of State has a commitment to provide alternative services to those of CHCs before they are abolished. CHCs in an area will not be abolished until all the following arrangements are established: the OSCs, the patients' forums and patients' councils, which we intend should be established from April 2002. We want to ensure that PALS are established in every trust and primary care trust by April 2002. We also intend that the transition should be handled effectively so that there is no gap in relation to support for patients who need it from CHCs as of now and in the future from the new arrangements.

The noble Earl, Lord Howe, raised the matter of records. We shall need to consider carefully what should happen to those records. Clearly, it is important that the valuable work that has been undertaken should be passed on to successor organisations. We shall also have to reflect on how to deal with the paperwork in relation to individual members of the public who have raised issues with the CHC and which the CHC is pursuing so that such matters can be handed over in an orderly fashion. Support given now by CHCs would be given in the future through the new arrangements one way or another.

In relation to the members of the CHCs, I pay tribute to their voluntary and dedicated work. From personal experience I know how hard CHC members have worked over the years. I am anxious that we should be able to use that commitment and talent in the future. I have no doubt that when it comes to the appointment of patients' forums we shall look closely at the contribution that CHC members may have to make. It is also worth making the point that many of our current non-executive directors on the boards of health authorities and trusts have undertaken service with CHCs, which has proved to be valuable.

Employees of CHCs will be dealt with in a similar way to NHS staff who are the subject of a re-organisation or restructuring. However, I believe that the bulk of CHC staff will find that there are greatly increased opportunities for their expertise in the new arrangements. One has only to think of the possibilities in relation to PALS, to the secretariat which will support the patient forums and patient councils, to the establishment of independent advocacy services and to the servicing role of the local authorities' overview and scrutiny committees in order to recognise that there will be many opportunities for the highly skilled staff of CHCs. They will also find that there is a more effective career pattern for them. In the past, on becoming a chief officer of a CHC one reached a glass ceiling unless one moved into a

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different part of the NHS. The new arrangements will bring many more opportunities to move into different jobs in the area of patient and user involvement. Some Members of the Committee will be aware that a trust in Southampton has already advertised for the chief of its PALS at a salary of around £40,000, which is considerably more than chief officers earn.

Baroness Cumberlege: Will the Minister reply to the question asked by the noble Earl, Lord Listowel? There are many bruised people who feel they have been treated most shabbily.

Lord Hunt of Kings Heath: I paid tribute to the work of CHC members. However, the Government have decided that CHCs should be replaced by the new arrangements. I do not believe that in reaching that decision and making these proposals we are causing offence to the current members of CHCs. I believe that we shall use many of their skills in future. Equally, government have the right to make such decisions.

Baroness Cumberlege: I accept that. However, it is a tradition within the health service that on the whole one consults with people before one goes forward with a scheme. Problems have been caused because, although the proposal appeared in the NHS Plan, there had been no consultation as there had been with other measures. The element of surprise hurt people, so perhaps the matter could have been dealt with a little more graciously.

Earl Howe: In supporting the comments made by my noble friend Lady Cumberlege, perhaps I may add another dimension. CHCs and ACHCEW are still in being and they need to know what is happening. I am conscious that they feel that they do not know what is happening and it would be advisable for the department to institute a little more regular communication so that they know how to plan for the exit.

Nevertheless, I am grateful to the Minister for his comments, which were largely reassuring. They filled in a number of important gaps. The fear expressed to me was that CHCs might be left nominally in being but with none of their statutory powers. That would be a waste of time for all concerned and, more to the point, detrimental to the public interest.

I shall read carefully what the Minister said but I believe that it largely dispelled the doubts. With that, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 77 not moved.]

Earl Howe moved Amendment No. 78:

    Page 10, line 6, after "carers" insert "and such other organisations as the Secretary of State considers appropriate"

The noble Earl said: In moving Amendment No. 78, I shall speak also to Amendments Nos. 79 and 83. They are designed to replicate one element of the status quo with regard to community health councils; that is, their duty to represent not only patients but also the

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wider community. I believe that patients' forums should be required to canvas the views not only of patients and their carers, although those groups must be a prime focus, but also potential patients; in other words, the community generally.

It is a matter not only of breadth of vision but of balance. The perspective of patients and carers is vital, but it is inevitably confined to a subjective viewpoint. Others who are not so closely bound up with local health services but who could be have an equal claim to be heard. I hope that if nothing else the Minister will recognise that there is an important point of principle at issue; that is, whether the remit and purview of patients' forums should be relatively narrow or a broad one like that of the CHCs. I beg to move.

The Earl of Listowel: I raised this point earlier. I remind the Committee of the past work of the Community Health Council for the City, East London and Hackney with groups dealing with the homeless, sufferers of sickle cell disease and members of ethnic minorities who have difficulties with English. That work is perhaps not concerned with particular complaints but the requirement for special services which the CHC has helped to obtain.

Baroness Barker: I add my support to the noble Earl, Lord Howe. I listened with interest to the Minister's words about CHCs a few moments ago. From conversations that I have had, perhaps the greatest blow suffered by people in CHCs is the devaluing of their strategic work on health, which is extremely important to the remainder of the Government's plans to make sure that health and social services become integrated. This is a forum in which one is not just talking about patients. Therefore, I echo the comments of the noble Earl about community involvement, which is very important.

9.15 p.m.

Lord Hunt of Kings Heath: Surely the point here is that much of the wider community role passes to the local authority in terms of the overview and scrutiny committee. That is the whole point of the changes that we are making. In gaining a wider community perspective, what better vehicle is there than the democratically elected local authority? That is the whole point of setting up the arrangement. As the noble Baroness, Lady Cumberlege, said earlier, we are dealing with the problem of the democratic deficit which has affected the health service for so long. That does not mean that the forums will not bring to the table at trust level concern for patients and the public. I believe that that will be a very forceful vehicle to take those views right to the heart of trust board decision-making machinery.

But there must be a focus on the patients and public who are served by that trust, informed by the very membership of the patients' forum itself, which will include representatives of local voluntary and patients' organisations. That will ensure that the forum activities are informed by the wider view to which the

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noble Earl referred. But it is very important to focus on the prime purpose of the patients' forum, which is concerned about the activities of the trust. At the same time, we must not discount the major leadership role which the local authority will play in future in the arrangements for the NHS.

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