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Baroness Masham of Ilton: May I ask the Minister a question? The noble Lord mentioned the fear of duplication. Why not have one body combining the patients' forums and the patients' councils? That would help to avoid the confusion, which I am sure will arise, in the public's mind.
Lord Hunt of Kings Heath: There are two points there. First, we have made it clear that there will be a common secretariat between the council and the forums which are covered in the area of that council. That will ensure co-ordination and a pooling of resources.
Secondly, we particularly want to put the emphasis of patients' forums as close as possible to the decision-making point where the patients are particularly affected. We believe that that is best done at the trust level where matters are decided in relation to operational services which affect the experience of patients. That is very much an improvement on the current arrangements. The common secretariat will ensure that there is no duplication of effort. It is
important to re-emphasise that it is very much at the patient care level where we want these measures to make an impact.
Baroness Masham of Ilton: What happens if there is conflict between the forums and the councils? Who sorts it out?
Lord Hunt of Kings Heath: A council is made up of representatives of the forums. The individual forums will be responsible to each trust for their own actions. If the forum representatives on a council come together, just like any other group or organisation, they will have to work out a way of working which embraces as common a view as possible. Clearly, there may be disagreements. I do not think that we should particularly worry about that matter.
Lord Astor of Hever: I am grateful to the Minister for that answer and clarification. Although we are slightly disappointed with his response to both amendments, I was happy that the noble Lord on two or three occasions said that patients are the most important part of the NHS. We shall consider his response to both amendments. In the mean time, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 109 to 110 not moved.]
[Amendments Nos. 111 and 112 not moved.]
Earl Howe moved Amendment No. 113:
- Page 12, line 10, leave out "may" and insert "shall"
The noble Earl said: In moving Amendment No. 113, I should like to speak also to Amendments Nos. 115, 116, 118 and 120. Clause 16 deals with the regulations pertaining to patients' forums and patients' councils. Currently, much of the work of CHCs is governed by regulations. It is important that regulations set out exactly what will be expected of patients' forums and patients' councils and how they will operate. The impact of the work of patients' forums will extend far beyond the boundaries of the trust for which they are established. It is therefore essential that the patients' forums and councils are properly informed, with information being supplied not just by the relevant local trust but also by health authorities and OSCs. Just as CHCs have a statutory right to receive information from health authorities, so the same should apply to the new bodies. That is the purpose of Amendment No. 115.
It was inevitable that we would encounter at least a handfull of amendments proposing the substitution of "shall" for "may". We have had one or two already. Amendment No. 113 does so because in this instance I simply do not understand why there should be any uncertainty about the issuing of regulations in Clause 16. Assuming that the Bill passes into law, we need be
in no doubt that the regulations will be essential. That seems to be borne out by the wording of subsection (4), which begins by stating:
- "The regulations must secure".
Amendment No. 120 tries to set out on a probing basis an outline of the membership of patients' forums. Its purpose is to ensure that the membership is balanced, inclusive and representative. There will doubtless be many interest groups that will claim to be representative of an area. But, to me, the key groups are patients, carers and relevant voluntary organisations. It is no use trying to lay down precise numbers for each category of representative, but it helps to set an upper limit to allow for flexibility and to ensure that no single category of member dominates the forum.
The purpose of Amendment No. 116 is to ensure that the comments made by OSCs, as well as by trusts and health authorities, on reports or recommendations by patients' forums and patients' councils are published. I see that as important in the interests of transparency and also to ensure that OSCs make the most of their role. I beg to move.
Lord Clement-Jones: I wish to speak to Amendments Nos. 119 and 120. Amendment No. 119 would add further provisions for which the Secretary of State may make regulations. In a sense, the amendment is designed to elicit from the Minister answers as to how he sees the patients' forums and patients' councils being funded, how the whole issue of travel and other allowances to members of the patients' forums and patients' councils will be met, and also the provision of information to patients' forums and patients' councils and how that will be organised. There seems to be a gap in the current clause.
The noble Earl, Lord Howe, touched on the issue of representation, which is covered by Amendment No. 120. In our view, the current provisions of the clause are rather sketchy. The noble Earl used the words "representative", "balanced" and "inclusive". I very much agree with that form of words. A scheme such as that included in Amendment No. 120 would meet that description. I do not believe that the concentration on individuals provided in subsection (4) of Clause 16 is adequate in that respect. I look forward to hearing what the Minister says in that regard.
Lord Rea: Perhaps I may add a few words at this point. Clause 16(4) states that regulations must secure that the members of a patients' forum include at least one member of a voluntary organisation and at least one patient. If that is interpreted precisely, it could lead to a very unrepresentative membership, including perhaps just one patient or one member of a voluntary group.
In the NHS Plan the intention is set down that there should be 50 per cent of each of the groups. But the regulations do not actually require that. Amendment
No. 20 seeks to rectify that. As well as rectifying that possible outcome, it also includes the requirement to have a sizeable group of carers, who might otherwise be unrepresented and who would provide valuable insights.
Baroness Masham of Ilton: I should like to support what has been said by the noble Lord, Lord Rea. I hope that the Minister will take serious account of his words.
9.30 p.m.
Lord Hunt of Kings Heath: Clause 16 provides for further regulation-making powers to define the detailed provisions relating to patients' forums and patients' councils. The amendments in this group seek to add requirements to the list of issues about which the Secretary of State can make regulations. However, I believe that some of the amendments deal with issues already covered by the Bill as drafted. The regulation-making powers in Clause 16(2) already apply to both patients' forums and patients' councils, making Amendment No. 119 unnecessary, as subsection (2) covers funding, expenses and the provision of information.
Similarly, the same remarks can be applied to Amendment No. 117. Clause 12(2)(f) allows additional functions to be given to patients' forums, while Clause 13(3)(d) serves the same purpose for patients' councils. Taken together with the general power to make supplementary regulations in Clause 16(2), the powers are already available to ensure that we can equip patients' forums and patients' councils to carry out their functions.
Lord Clement-Jones: Perhaps I may interrupt the Minister for a moment. He said that this was already covered in the clause. Can he elucidate that for me? As I read it, Amendment No. 119 covers both patients' forums and patients' councils, whereas the paragraphs under subsection (2) in Clause 16 cover only forums.
Lord Hunt of Kings Heath: I believe that it states that:
- "(1) The Secretary of State may by regulations make further provision in relation to Patients' Forums and Patients' Councils.
- (2) The regulations may in particular make provision as to".
- "Subsection (2) applies in relation to a Council as it applies in relation to its member Forums".
Perhaps I may turn to the issues raised in regard to overview and scrutiny committees. We are anxious not to prescribe a relationship between patients' forums and councils and the relevant overview and scrutiny committee. They have different, if complementary, roles and it is important that local co-operation should determine their relationship. That is why we have not sought to introduce a regulation-making power of the kind proposed in Amendments Nos. 115 and 116. However, we recognise the need to provide for the effective flow of information between patients'
forums, patients' councils and health authorities. The noble Earl will have noticed that we have tabled government Amendment No. 114 to that effect.Amendment No. 118 stems from the view that the local authority overview and scrutiny committee cannot be independent enough to scrutinise services provided by the local authority in partnership with the NHS. I have discussed this issue in earlier amendments and I do not accept that argument. The whole purpose of local authority overview and scrutiny committees is that they will be independent from the local authority executive. Their main role will be scrutiny of the local authority executive's decisions. I see no reason why they should not be able to provide effective scrutiny arrangements of services delivered under the Section 31 partnership arrangements.
In relation to membership issues, I do not accept the approach taken to membership in Amendment No. 120. We have made clear our policy that we want patients' forums and patients' councils to represent patients, carers and voluntary organisations representing patients. We envisage forum membership being 50 per cent patients and carers and 50 per cent voluntary organisations. But surely those are issues best left to regulations, which will allow flexibility to adapt as experience of the new system grows or enable local circumstances to be taken into account. It is very important that I should emphasise to the Committee that, whatever the proportions, we are committed to the NHS appointments commission overseeing all appointments.
Finally, I can reassure the Committee that we will lay regulations in each of the areas in Clause 16(2), so there is no need for Amendment No. 113, which would have no further effect over and above this commitment.
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