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Lord Hunt of Kings Heath: From what I have said I believe that the noble Baroness will understand that I am fully sympathetic to the need to ensure that there is a consistency of approach between the NHS and social services, particularly where joint services are provided. However, I cannot go any further tonight in terms of what I have said. There are some genuine difficulties in taking the independent advocacy service that we suggest for the NHS and saying that it should apply to social services. I understand that the noble Baroness is saying that we should be brave and that we should knock away the statutory barriers, but some issues would have to be confronted. Also in relation to complaints, we should see the outcome of the work that is being undertaken at the moment.

The noble Earl, Lord Howe, asked about the issue of independence as far as is practical in relation to advocacy services. That rests on the possibility that patients' councils could provide independent advocacy services. As such a council would be formed of representatives of the patients' forum, it may be argued that it has a relationship with a trust in the area from which a complaint has come. We would not want to rule that out as being insufficiently independent. In those circumstances, we would want to have some room for manoeuvre.

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Baroness Northover: After six hours of sustained battering, perhaps the Minister might like an advocate or perhaps a CHC or two to assist his case. I was comforted by some of his comments and would welcome the movement that has been suggested. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 97 not moved.]

Clause 13 agreed to.

[Amendments Nos. 98 and 98A not moved.]

Earl Howe moved Amendment No. 99:

    After Clause 13, insert the following new clause--

( ) Health Authorities shall extend observer status, with voice but no vote, to representatives of Patients' Forums, Patients' Councils and overview and scrutiny committees for its area."

The noble Earl said: This is a short, simple amendment. Its purpose is to give the patient involvement bodies which are to be established the right to observer status at health authority meetings. I find it odd that the Bill does not make provision for patient representation at health authority meetings. At meetings of health authorities, CHCs currently have observer status with a voice but no vote. It would therefore seem to be logical to extend that right to the new patient representative bodies. I beg to move.

Lord Hunt of Kings Heath: There is a simple answer. Health authorities, like trusts, are obliged to conduct their meetings in public. At present, health authorities and trusts are encouraged to extend speaking rights to CHC members. That is very much down to local arrangement. We believe that it works well in practice and believe that there is no reason to assume that the best practice will not continue in respect of members of patients' forums and patients' councils.

I do not believe that it is necessary to enshrine the procedure in legislation. I believe that health authorities will do the sensible thing and that in the spirit of decentralisation we should allow them to do that.

Earl Howe: I am grateful to the Minister. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 14 [Entry and inspection of premises]:

Earl Howe moved Amendment No. 100:

    Page 11, line 29, leave out subsection (1) and insert--

"(1) Authorised members of a Patients' Forum shall be permitted (subject to subsection (2) below) to enter and inspect for the purposes of any of the Patients' Forum's functions, premises owned or controlled by--
(a) a Health Authority,
(b) a Primary Care Trust,
(c) an NHS trust, or
(d) a person providing services under Part II of the 1997 Act or under arrangements under section 28C of that Act."

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The noble Earl said: In moving Amendment No. 100, I shall speak also to Amendments Nos. 101 to 106. This group of amendments is designed to effect some subtle changes to Clause 14, which relates to the powers of entry granted to members of patients' forums into NHS premises. Instead of permitting the Secretary of State to make regulations with regard to rights of entry, the amendments would place that right on the face of the Bill and require the Secretary of State to make regulations governing the way in which the powers could be exercised.

My reason for proposing this buttressing is simple. I believe that the right of patients' forums to enter the premises of NHS trusts, PCTs and so forth is essential to the proper performance of their functions. For that reason it needs to be enshrined in primary legislation rather than relegated to a statutory instrument.

It is then important to ensure that the regulations pursuant to those powers are framed correctly. Perhaps the key issue, which we debated during the passage of the Care Standards Bill, is the extent to which the powers should be exercisable without prior warning.

Unannounced visits, as CHCs have often found, are an excellent way of uncovering a picture of how the NHS is really performing. However, it must be said that even where there is prior warning, such as happens with casualty watch, what emerges can be immensely revealing. I should be glad of the Minister's confirmation that, subject to there being no risk to the clinical effectiveness of the premises being visited, unannounced visits by patients' forums will be possible.

I want to raise another issue. When the matters were debated in another place, the Minister, Mr Hutton, resisted the suggestion that powers of entry into GPs' premises, as something which might appear on the face of the Bill, would pose human rights difficulties. I should like to ask the Minister why that should be when under the Care Standards Act the right of the National Care Standards Commission to enter freely any care home in the middle of the day or night did not pose any human rights problem. In any case, my amendment explicitly leaves it to regulations to determine the precise rule which would govern the powers of entry. I shall be interested to receive a rather clearer explanation from the Minister as to why this particular part of my proposal does not find favour with him or the Government's lawyers, if that is the case. I believe that the NHS should be subject to no less stringent requirements for inspection than private sector care homes. I beg to move.

10.30 p.m.

Lord Hunt of Kings Heath: Amendments Nos. 100, 101, 103 and 104 would confer a right of access directly on authorised members of patients' forums rather than leave it to regulations. I start by assuring the Committee that the Government fully intend to make such regulations as are provided for within Clause 14. We are determined that wherever NHS patients go there should be a means by which those services may

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be monitored and reviewed by patients. It was made clear in the NHS plan that patients' forums should be able to visit and inspect any aspect of care provided to patients, and this clause is a vital part of the framework which enables us to meet that commitment. Health services will be placed under an obligation to allow patients' forums to visit their premises and, in the case of GPs, right of access will be made a term of service.

I believe that the issue whether these matters should be on the face of the Bill or in regulations is a clear one. The noble Earl, Lord Howe, said in his introductory remarks that we needed to ensure that we had got it right. Access arrangements are surely best left to regulations so that we can be as flexible as possible and learn from experience in relation to the issue of unannounced visits. I agree that that is something which must be allowed to happen under the new arrangements. In relation to GPs, we wish to have satisfactory agreed arrangements under which, as far as possible, such visits, unannounced as they may be, may take place. But that will have to be agreed with general practitioners.

We envisage that protocols will be produced for access arrangements which patients' forums may agree with health providers locally. Where access is denied, the forum would report that refusal to the relevant body. The regulations will set out the exact conditions and circumstances under which access will be permitted. They will include notice of a visit and a requirement to provide identification and the number of members who may participate. These matters were debated during the passage of the Care Standards Bill. The intention is not to create an adversarial system. Clearly, we want this to work in a constructive way. We must also ensure that the dignity and privacy of patients would not be overlooked in the arrangements. Hence the need for a protocol under which these visits would take place.

Amendments Nos. 105 and 106 would require the Secretary of State to make regulations requiring patients' forums to publish reports of inspections. I believe that these amendments are unnecessary. Provisions for regulations for the publication and distribution of reports by patients' forums are made in Clause 16 of the Bill. The forum has a duty to make reports and recommendations to its trusts and health authority and to make information on its activities available to the public and other organisations. In doing so, it clearly will be informed by the finding that it makes during inspections.

The response from the body inspected will be contained in the patient prospectus, which trusts will publish each year, detailing what patients think of their services and how the trusts are addressing those issues. The forum will be required to sign off the patient prospectus as well as publish its own report. Under Clause 16, the Secretary of State may already make regulations regarding patients' forums to prepare and publish reports.

I turn to Amendment No. 102, which I shall move in due course. This is a minor amendment to ensure that patients' forums have access to all family health

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services by extending their remit, as presently described in the Bill, to local pharmaceutical services as well. I suspect that we shall be debating local pharmaceutical services tomorrow. We want patients' forums to have the facility of scrutinising and inspecting any service used by patients. It is important that the forums should be able to scrutinise local pharmaceutical services as well as any other services. I hope that the Committee will agree to this amendment when I come to move it.

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