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Baroness Masham of Ilton: My Lords, before the Minister leaves that point, will he assure the House that there will be confidentiality? Some people do not want to go locally for that type of service.

Lord Hunt of Kings Heath: Yes, my Lords. I very much accept that point. Of course, the devolvement of commissioning resources for sexual health services to primary care trusts does not in any way detract from the issue of confidentiality. I believe it is worth remarking that some very good people have entered that field over the years. We are seeing an improvement in both the quality and quantity of services. However, there is a tremendous demand on those services and, through the commissioning process, we shall have to ensure that sufficient services are commissioned in the future.

I turn to the issue of CHI. I am glad that, in general, the comments about CHI have been positive. The noble Baroness, Lady Noakes, in particular referred to the potential of CHI. I agree. I believe that it has made a good start. The reviews of clinical governance have been helpful. They are certainly starting to bite in the health service, and I am confident that CHI can take on the wider responsibility that we now envisage.

I say to my noble friend Lord Turnberg, who is chair of HQS—I was previously a chair of that organisation—that I very much value the work that it does. Through the Bill, we are enabling the functions of CHI to be discharged to another person. Therefore, it is possible that other organisations can be used once the Bill is enacted. I would certainly always encourage CHI to work with other relevant organisations. I also accept the comments of the noble Baroness, Lady Hanham, who found that the CHI review was both helpful and constructive.

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The noble Lord, Lord Clement-Jones, sought to highlight what I can only describe as the rather extraordinary suggestion that I have been inconsistent with my comments in debates on the Care Standards Bill. I carefully re-read my comments and I can assure the noble Lord that they contain a coherent thread of consistency. When we debated that Bill, we were starting with two new bodies. At that time we considered it right that regulation of private healthcare should be different from arrangements for the management of the health service. I am sure that some noble Lords will remember that argument.

I also stressed the need for close collaboration between CHI and NICE on the regulation of independent healthcare. They are already permitted to subcontract work to each other. As the NHS has developed, it has become absolutely clear that the inter-relationship between the NHS and the private sector is an ever more important factor in dealing with the capacity issues that we face in the health service. We have also had the Kennedy report.

Building on that, my right honourable friend the Secretary of State has talked about the need for closer working between the various inspectorate bodies— not only CHI and the National Care Standards Commission but also the Social Services Inspectorate and the Audit Commission—so that health and social care services are subject to a common set of standards, whether they are provided by public, private or voluntary sector organisations. It seems to me that we are seeking to develop what we started. It also seems that we are seeking to ensure consistency and not an over-bureaucratic approach to regulation and inspection, as the noble Baroness, Lady Hanham, suggested.

Lord Clement-Jones: My Lords, I thank the Minister. However, the Secretary of State specifically used the word "integration". Precisely what plans are there for that?

Lord Hunt of Kings Heath: My Lords, as he suggested, we are currently developing our ideas on work in that area in the light of what Kennedy said. Obviously, when that work has been resolved, we shall bring it to the attention of noble Lords.

I was delighted that the noble Baroness, Lady Howarth, spoke about the work of the National Care Standards Commission. I hope that she can be persuaded to stay on for our subsequent debates on regulations concerning the commission. I believe that hearing about the way in which the commission goes about its work produces a great deal of confidence. As part of the review, I look forward to constructive discussions between the National Care Standards Commission, the Commission for Health Improvement and the other regulatory bodies.

I turn to the question of community health councils on which many comments have been made in our debate. Noble Lords will know that my noble friend Lady Pitkeathley and I were two of the first CHC secretaries to be appointed in the 1970s. Therefore, I do not come to this debate with a lack of knowledge

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about the experience, potential and performance of CHCs. But one has to say that their performance has been very patchy over the past 25 years. The ultimate test is the extent to which the public and patients feel involved in the National Health Service and the extent to which services provided in the National Health Service are informed by user experience. For all the tremendous work carried out by CHC staff and members over the past 27 years, I do not believe that at the end of the day one can say that they have succeeded to the extent hoped for in the early 1970s.

The test of our proposals is: will they produce more effective, more efficient and vigorous patient and public involvement in the health service? I have no hesitation whatever in saying that they will. Patients forums will be independent. The national commission will, as my noble friend Lord Harris suggested, provide the quality control that has been missing. The work of PALS at the local trust level will ensure that problems are dealt with as they arise. There will also be independent advocacy and the overview and scrutiny committee of local government. Combined, I have no doubt that they will pack a very powerful punch.

As my noble friend Lord Harris of Haringey suggested, over the past 18 months we have listened to the debate and have made changes. Even as the Bill was being discussed in the other place, we removed the Secretary of State's power to veto the appointments of the chief executive and staff of the commission. We introduced an explicit power for patients forums to refer matters of concern to local authority overview and scrutiny committees. We made a change to the accounting arrangements for patients forums so that they will now receive their funding via the commission rather than via their local trusts. We have ensured that the local independent complaints advocacy service will be commissioned by the national commission, which will also monitor the effectiveness of that independent service. We have ensured that PALS will be based in trusts but have also ensured that each independent patients forum will monitor the local PALS and will have the power to remove a failing PAL from the trust.

The board of the commission will be appointed by the NHS Appointments Commission, with the Secretary of State appointing the chair. However, I can say to my noble friend Lord Harris that that appointment will be subject to the Nolan procedures.

So far as concerns membership of the patients forums, I was surprised that doubts were expressed about people in the community coming forward to serve on those bodies. I believe that being a patients forum member will be a very exciting and invigorating job. It will be closely linked to the NHS trusts and will be close to where services are provided for the public. I believe that there will be every possibility of attracting very high calibre people.

The noble Baroness, Lady Hanham, mentioned an issue that she raised on the previous occasion we debated this matter. She asked how the non-executive director from the patients forum would be appointed to the board. That matter is clearly still under discussion. I know that the noble Baroness is

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concerned about how such appointees would take part in corporate discussions. I say to the noble Baroness that the health service is very used to people coming from a whole range of different backgrounds—universities, staff members and local authorities. I do not believe it is beyond the wit of the calibre of people who chair such organisations to ensure that such appointments can take corporate responsibility for the decisions they make.

Baroness Hanham: My Lords, I thank the Minister for giving way. Perhaps I may re-emphasise that I accept that all those people have a role, but it is the fact that the patients forums have inspectorate powers on the trusts which makes them so different and which makes this non-executive member so different.

Baroness Masham of Ilton: My Lords, can the Minister tell us whether the members of the patients forums will be paid?

Lord Hunt of Kings Heath: No, my Lords, they will not be paid. They will be appointed by the national commission in the light of criteria set by the NHS Appointments Commission. Perhaps I may say to the noble Baroness that I would be happy to discuss that matter with her between now and Committee. Many of these details have still to be developed. Her experience will be relevant here. All I was seeking to say is that I do not believe that it is beyond the wit of the NHS or local boards to work out ways in which these very important people can play a full part in the deliberation of the board.

My noble friend Lady Gibson raised a number of questions about the staff of CHCs. We shall have a clearing house process. Those staff will have to apply for their jobs but, like health authority staff under the Shifting the Balance of Power proposal, the aim is to continue employment for them until the new arrangements are in place. I believe that there are many opportunities. There will be many more people involved in patient representation and patient advocacy in the new situation than there were in the old. CHC staff have enormous expertise to bring to the table. I am sure that good staff will have no difficulty in ensuring that they find a place in the new arrangements.

Time presses on and I must turn to Clause 25. A number of noble Lords have raised concerns about how we intend the regulation of professions to proceed. It is worth making the point here, particularly to the noble Lord, Lord Walton, and my noble friend Lord Turnberg, that if the council which we propose is to be effective, it will need powers. We believe that the council needs to be able to make progress in the task of modernising regulation. It needs powers, therefore, to ensure that any obstacles which it encounters can be overcome. The Kennedy report came to the same conclusion. It said:


    "We believe that the Council should have statutory powers to require the various bodies to act in the interest of patients and conform to principles of good regulation".

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There is no doubt, from many of the responses we have received, that a lot of people agree with that, even some of the regulatory bodies so affected. For instance, the UKCC, the current regulatory body for nurses, midwives and health visitors, said that there is little point in establishing the new over-arching council unless it has statutory powers and real teeth. The General Optical Council said that the council should have the powers necessary to take prompt action against a regulatory body which is not discharging its role adequately.

The Government accepted the recommendation of the Kennedy report that the council should be the guardian of the public interest and one which operates independently of government. I want to assure the House that in giving the new council reserved powers, it will be expected to respect the independence of the regulatory bodies and allow them the maximum opportunity to act voluntarily.

I understand the concerns of noble Lords that this power is a means by which the Secretary of State may gain undue influence over the running of the regulatory bodies. That could not be further from the truth. The Bill was carefully drafted to ensure that the only power of the Secretary of State to direct the council is with regard to value-for-money issues. In all other respects the council will act independently of the Department of Health. The Bill makes it clear that the council will be accountable to Parliament and it will be open to be scrutinised to ensure that it functions as intended.

The council will not be subject to political control. The council will select its own chair from among its membership, except for the first chair who, in order to smooth the process of setting up the new body, will be selected by the Secretary of State. But that is no departure from the way that we have been dealing with the new regulatory council, the nursing and midwives council and the health professions council. But even that first appointment must be selected from among the members of the council, none of whom will have been appointed by the Secretary of State. The task of appointing the lay members will be carried out by the NHS Appointments Commission.

In Committee in another place we tabled an amendment to meet the regulatory body's other principal concern, which was that the power in Clause 25 should not be used lightly. If the council should ever use its powers to direct a regulatory body to make a rule when it considers that to be desirable for the protection of the public, there must now be a period of consultation between the council and the body before that happens. That will ensure, as we would expect to be the case, that the power is used as a last resort when all other means of resolving the difficulty have been exhausted. Any rule that the regulatory body was directed to make would still be subject to approval by the Privy Council.

I refer to the comments of my noble friend Lord Prys-Davies, which I listened to with great interest, and the report of the Select Committee on Delegated

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Powers and Regulatory Reform. We shall look at that carefully and consider the implications. I would also say to noble Lords, and in particular to the noble Lord, Lord Walton, that we stand ready to have further discussions with the regulatory body to see if we can assuage concerns. Clearly, I accept that we want to have a constructive dialogue and reach a satisfactory conclusion—


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