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Lord Clement-Jones: My Lords, I do not want to delay the proceedings and was not given notice of what the noble Earl, Lord Howe, wanted to say. However, I agree with him in many respects. My personal estimate, which was not rocket science, was that four days in Committee were required to deal with the number of amendments tabled. I communicated that to the Government Front Bench. That is proving to be the case.

It is not helpful to be proved right, but we are being short changed on the Bill. We shall try to co-operate as much as possible during the time available to us, but a lack of planning has been demonstrated. If a little more time had been made available, we could have sorted things out more effectively.

Lord Carter: My Lords, I am responsible for the procedure and the programme and must take full responsibility. If I were the health spokesman in Opposition, and if I had been sitting where the noble Earl is sitting now, I would have made exactly the same point.

However, he will remember that he agreed the Bill could be completed in Committee in three days. We are hoping to achieve that. Today's programme has included the Third Reading of the International Criminal Court Bill. A succession of amendments, which were major items of policy, were tabled by the Opposition at that stage and therefore the debate took much longer than expected. We then had what I can only call a remarkable debate on the order dealing with metrication measures. Again, that took much longer than expected.

Last night I suggested to the usual channels that I hoped to begin the Bill at about six o'clock--a little later if, as we thought there might be, there was a statement on the foot and mouth epidemic. However, the House regulates itself and self regulation requires all Members of the House to regulate themselves.

I am in the hands of the House. I believe that we should now make some progress. I understand the position that noble Lords take and believe that we all want the Bill to receive proper consideration. We have

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Thursday to deal with it and I know how our Lordships feel about sitting late on Thursday. When I make arrangements I do so in entirely good faith--I am sure that the noble Earl accepts that--but today is the kind of day when self regulation does not quite work.

On Question, Motion agreed to.

House in Committee accordingly.

[The DEPUTY CHAIRMAN OF COMMITTEES (Lord Lyell) in the Chair.]

Clause 15 [Annual reports]:

Lord Astor of Hever moved Amendment No. 108:

    Page 12, line 2, after "established," insert "the overview and scrutiny committee, the Patients' Council, the Independent Local Advisory Forum, the Health Authority,"

The noble Lord said: In moving this amendment, I shall speak also to Amendment No. 109A. Clause 15 requires patients' forums to prepare and publish a report of their activities on an annual basis.

Lord Hunt of Kings Heath: I am sorry to interrupt the noble Lord, but does he mean Amendments Nos. 109 and 110?

Lord Astor of Hever: I am speaking to Amendments Nos. 108 and 109A. Clause 15 requires patients' forums to prepare and publish a report of their activities on an annual basis. These reports shall include details of how the forums have sought to obtain the views of patients. That is an important requirement of patients' councils if forums are to fulfil their duty as intermediaries and advisers in the health service in their areas.

For that reason, we believe that the reports should be circulated more widely than is proposed in Clause 15(1)(b). Amendment No. 108 ensures that the annual report is sent to each overview and scrutiny committee established within its area, to the patients' forum, the independent local advisory forum and the health authority. As the Bill is currently drafted, a copy of the report will be sent only to the relevant trust and to the Secretary of State. The bodies which our amendment seeks to include will be important partners in overseeing and maintaining a high standard of health and social care for residents and patients. If they are to play a key role in taking a strategic view of patient services and provision, they will need to be aware of all the relevant data which enable them to carry out their tasks more effectively.

I turn to Amendment No. 109A, which is slightly different. The patients' forums as proposed under the Bill will take over one of the most vital parts of the role now carried out by CHCs. CHCs have statutory powers of inspection in relation to hospitals, NHS premises and premises where NHS care takes place. Under present arrangements CHCs report their findings to health authorities and trusts, and that is a vital two-way process. This amendment places a duty on patients' forums to prepare a report of any matters that arise from the inspection of premises within 60 days of the visit. It is proposed that that report will be sent to the relevant trust's overview and scrutiny

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committee, independent local advisory forums and the relevant health authorities. Those bodies will again have a duty to respond.

Where the patients' forum is not satisfied with the response from any of the listed bodies, it has the power to refer the matter to the Secretary of State. That is an important safeguard for patients which we believe will lead to a quicker response to patients' concerns. Without sanctions and a public airing of concerns, health service providers may be slow to remedy unsatisfactory situations, or be unable to remedy situations without national input.

Although we do not support the abolition of CHCs, we believe that, if there are to be new bodies to take over their functions, they should have all the tools at their disposal to ensure that patients' views are aired and remedied and maintain a link with all partners in the provision of healthcare. I beg to move.

9.15 p.m.

Lord Clement-Jones: I rise to speak to Amendment No. 110. I hope that the Minister understands from the wording that this is a probing amendment which is designed to elicit assurances from the Government about the independence of patients' forums from trusts. Clearly, this is one of the issues that run throughout the provisions relating to the forum and the council. This amendment seeks to make sure that the annual report of the patients' forum makes transparent whether such influence has taken place.

Lord Hunt of Kings Heath: I apologise to the noble Lord, Lord Astor, for confusing Amendments Nos. 109 and 109A. The noble Lord was absolutely right.

I turn first to Amendment No. 108. Clause 16(2)(l) already states that regulations may be made in respect of the preparation and publication of reports by patients' forums. For that reason, we do not believe that it is necessary to include this provision within the body of Clause 15; nor do we believe it is necessary to specify the organisations to which the forum should send its report. This is very much a matter for the forum itself. The forum will send its report automatically to the Secretary of State and the trust. It need not be limited to that, and I am sure that it would not be so limited in practice.

Amendments Nos. 109 and 109A both refer to patients' councils, but those bodies will not be responsible for making visits or inspections of premises. That is the function of patients' forums which will work at trust level. Patients' councils will be made up of members of patients' forums in that area and will make reports to health authorities, local authorities and the Secretary of State for a response, if necessary. I understand that there may be an intention here that patients' councils should act as co-ordinating bodies which might prepare reports on their member forums' inspections. But we must avoid duplication of effort in relation to the particular focus of patients' forums in undertaking visits. Patients' councils will wish to keep an overview of the activity carried out by

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forums in their areas. There is nothing in the Bill to prevent a council referring matters to the Secretary of State.

Forums already have the duty to make reports and recommendations to the trust on the operation of its services and patients' views of those services. To ensure that their views are effective they will appoint a non-executive director to the trust board or a member of the primary care trust. They must also produce annual reports which detail their activities as specified in Clause 15. These arrangements make forums independent of the trust and ensure the transparency of their relationship, while ensuring that the bodies maintain a constructive working relationship. In a sense, that is my answer to the noble Lord, Lord Clement-Jones, in relation to Amendment No. 110. The link between forum and the trust is central to our proposals.

These proposals are not intended to engender adversarial relationships. Patients are the most important part of the health service, and it is intended that patients' forums work in concert with their trust to improve services. I repeat the points I made yesterday in Committee. The forums have the status and the tools to ensure that they have a real influence in the running of the NHS. They will be bodies secure in their independence from the trust to which they relate. It is not necessary to replace a requirement in the Bill for them to record any attempts on behalf of the trust to influence the discharge of their functions.

Again as I said yesterday in Committee, if there are specific problems in the way a trust behaves towards its forums, that would be a matter for referral to the regional office of the Department of Health which would take the appropriate action.

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