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The noble Earl said: We now come to the issue in the Bill which, more than any other, has provoked controversy and passionate disagreement across the party-political divide. I refer of course to the Government's proposal to abolish community health councils. The proposal is not new to us. It has been regurgitated by the Government from the legislative
Following that, there was, very noticeably, no pledge in the Labour Party's election manifesto that they would do away with CHCs if re-elected. That is hardly surprising in view of the outright hostility with which the healthcare professions and patients had greeted the original proposals. Yet, instead of abandoning the idea gracefully, the Government have returned to it with renewed vigour.
It would be one thing if Ministers had begun this exercise with the express aim of wanting to enhance and improve patient and public involvement in healthcare. I have no objection to that idea. Indeed, I am thoroughly in favour of it. Community health councils, as we have said previously in this Chamber, are not perfect creatures. They require modernisation. Although many work very well indeed, many do not.
However, rather than taking as their starting-point the imperative to find a working formula that is best for patients, the Government began with a decision that, whatever happened, CHCs must be swept away. The consultation document sent out by the Government stated at the beginning:
My attachment, and the Opposition's attachment, to CHCs is not borne of sentiment, awkwardness or cussedness. Unlike the Government, we are open-minded about how best to ensure that patients have an independent voice and an independent watchdog within the NHS. We believe strongly that there should be reform. The reason we want to see CHCs retained and strengthened, and not abolished, is simply that no other model for patient representation that we have seen has the potential to do as effective a job. The arrangements that the Government wish to substitute for CHCs are slightly different from those that they presented to us before the general election. It therefore behoves us all not to dismiss them out of hand, but to examine them in a constructive spirit.
There are several key tests for any replacement arrangements for CHCs. Will they be truly independent of government and of the health service? Will they be effective in acting as a watchdog on behalf of patients and the general public? Will they be convenient to users? Will they command public confidence? It is my contention that the Government's proposals fail every single one of those tests.
What do the proposals amount to? They amount to inventing a number of new types of body and parcelling out the functions of CHCs among them. In acute hospital trusts there will be in-house patient advice and liaison services whose job it will be to provide information to patients. For each trust and PCT there will be a patients forum, whose members will inspect and monitor health services for patients
If you want to make a complaint, to whom do you go? Do you go to a patients forum or to an overview and scrutiny committee? No. You go to the independent complaints advocacy service. That service will not be a unified service, but rather it will be provided by a range of separate NHS organisations. So who will draw everything together? Overseeing patient involvement nationally and reporting to the Secretary of State will be the new commission for patient and public involvement. It will be the job of the commission to support and co-ordinate patients forums.
Assuming that you have that structure clearly in your head, what is its most striking feature? Clearly, it is highly fragmented. It is far from being immediately understandable to the ordinary patient. The transparency of the current system has been lost. It is not, like a community health council, a one-stop shop for the patient, a place where he or she can be guided, informed, supported and represented on an independent and impartial basis. The separation of the scrutiny work, the monitoring work and the complaints work of CHCs will automatically reduce the extent to which these areas of activity mutually inform one another.
It is therefore less likely, not more likely, that the new system will sort out problems for patients in a speedy and effective way. That is because many patients have quite complex problems involving a number of different services. Where a patient's journey spans a number of different trusts, it will no longer be possible for one body to monitor or track the whole of a patient's experience. Individual patients forums will have a remit only for considering their own trusts' functions, with no formal way of coming together to provide an informed local overview.
The matter can be summed up very simply. Instead of being centred on the needs of the patient, the new structures are simply being bolted on to the existing machine. I suggest that that fact should make us suspicious. The obvious question is: what is being lost in the wash? The answer is: a great deal. The remit of patients' forums and of the commission for patient and public involvement will be considerably restricted compared with that of CHCs and ACHCEW at present. They will not, for example, be able to campaign against the closure of a hospital. They cannot query major capital projects or call for public consultation. They cannot take legal proceedings to enforce their rights or those of patients. They cannot undertake "casualty watch"-type exercises. They will have no overarching remit to represent the interests of the public or engage in work for the general public benefit in the field of healthcare. Unlike CHCs, the forums will have no power to refer contentious or disputed decisions to the Secretary of State. The
What is also being lost is independence. How can we call the Commission for Patient and Public Involvement in Health independent, when its chairman and first chief executive will be appointed by the Secretary of State? How can we call PALS independent when they will be staffed by trust employees? How will patients forums present themselves as truly independent when they are trust-based organisations with an inbuilt trust-based perspective? How, indeed, can the public have 100 per cent confidence in a forum that is not separate from the National Health Service but based within it?
Every key test that I set out earlier for the Government's proposals has been failed. We need to ask the Government to think again, to take the tried and tested model of community health councils—for which there is widespread support—and work up proposals to strengthen and build on that model, consult on those plans and come back to Parliament again. I beg to move.
Lord Peyton of Yeovil: I warmly support what my noble friend has said, and the amendment that he has proposed. My complaint about the Government setting up these organisations is that they always behave like gardeners who, having planted a nice rose, or some vegetables or trees, cannot restrain themselves digging them up to see how the roots are doing. Nothing grows in those circumstances, yet all governments persist in doing this. The present Government are worse than most in relation to this thoroughly bad habit.
The Government suffer, au fond, from a certain confusion. They are very keen to be seen to be concerned with the welfare of the patient—the ill, the sick—and they are right to be so. They are also concerned, however, to do things in a way that is convenient to them, and that tends to edge forward and be given a priority that is denied to patients. I do not suppose for a moment that the Minister will get up and say that he entirely agrees with me, but I am bold enough to hope that, before he retires to bed tonight, he might just wonder whether there is not a grain of common sense and truth in what I am trying to say.
"COMMUNITY HEALTH COUNCILS: SCHEME FOR REFORM
(1) The Secretary of State shall lay before Parliament within twelve months of the date of coming into force of this section regulations setting out a scheme for the reform of the Community Health Councils in England.
(2) Before laying regulations under subsection (1), the Secretary of State shall consult the Association of Community Health Councils for England and Wales and such other bodies representing the interests of patients as he considers appropriate.
(3) The scheme set out by the Secretary of State in regulations under subsection (1) shall extend to all parts of the health service (including the provision of Part 2 services under the 1977 Act).
(4) The Secretary of State may make regulations providing for access by members of a Community Health Council to premises from which services under Part 2 of the 1977 Act are provided.
(5) The scheme set out by the Secretary of State in regulations under subsection (1) shall provide for the proper representation of the population in the area served by a Community Health Council on that council.
(6) Regulations under subsection (1) may not be made unless a draft of the statutory instrument containing the regulations has been laid before, and approved by a resolution of, each House of Parliament."
"The immediate focus of this document is the Government's intention to legislate at the earliest opportunity to replace CHCs".
In other words, whether anyone liked it or not, that would be the conclusion of the consultation exercise.
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