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Lord Clement-Jones: I have a great deal of sympathy with what the noble Earl, Lord Howe, has said, and particularly with his powerful critique of the Government's proposals. Under those proposals, at least four organisations—possibly five—will take over from CHCs: patient advocacy and liaison services; patients forums; the independent complaints advocacy service; and the local authorities' overview and scrutiny committees. There will be a patients forum for each trust locally. The functions of CHCs will be fragmented; no single body will have an informed local overview of health services. The benefits of the one-stop shop provided by CHCs will be lost. Many points
of uncertainty surround the scrutiny role of local authorities, particularly in relation to the lack of a duty to act.Forums will not be independent of trusts, and their membership will potentially be too much under the control of Ministers. They will have limited powers, even in comparison to CHCs, and will not even have staff of their own. The role and independence of the Commission for Patient and Public Involvement in Health, and its provision of staff, is extremely uncertain, ambiguous and unsatisfactory, particularly in terms of its activities at local level. There are many other objections to the proposals, and they will no doubt be the subject of debate today. Even the cost of the system has been estimated to be 10 times that of the current system.
If we were to put the clock back 18 months, we might well go further and support this amendment. Some people might still prefer CHCs to be reformed, rather than being abolished and having something new put in their place. I am tempted to say that we, on these Benches, would not have started from here. However, we have to deal with circumstances as they are. We have been debating these issues for more than 18 months, and matters have moved on. Many of your Lordships will remember the battle we had over the abolition of CHCs during the passage of the Health and Social Care Bill. A compromise over the powers of new patients councils, which was inserted in the Commons, might have been reached if the general election had not intervened. We believe that patients, the public, and the staff of the CHCs would be better served by agreement on definite proposals in this Bill, rather than by waiting for a scheme to be devised over the next 12 months.
It was interesting to read the letter in the Guardian today from a member of a modernisation agency, who also happened to be the chairman of the Long Term Medical Conditions Alliance. She admonished a number of us for political points-scoring in what I thought was a very political points-scoring way, praying in aid a discussion that she had had with 23 members of the alliance, which comprises some 117 organisations. The one area of agreement that I share with her, however, is that there has been enough uncertainty over the past 18 months, and we need some certainty in the Bill.
One-fifth of the membership of the CHCs has fallen away. Staff morale is getting lower by the day. We need to make decisions soon about the new patient and public consultation and representation structure, otherwise valuable expertise will be lost to us. In Committee, we wish to explore whether the Government can agree with opposition parties on a scheme whereby we can establish patients councils as a one-stop shop for patients and the public, and as a powerful voice in the National Health Service for the local community, but one that works from within the health service, as recommended by the Kennedy report. Failing such a willingness by the Government to agree, an insistence on the status quo for CHCs may be the only option open to us. We do not believe that
we have yet reached that point, but a great deal depends on the Minister's reply to this and other amendments.
Baroness Pitkeathley: I rise to oppose the amendment, and that is not because I have any lack of admiration for the work of many community health councils. Indeed, I was the chief officer of one myself for a short time in 1974, when they were set up. We have to recognise, however, that the world is very different now. Many of your Lordships will not be old enough to cast your minds back that far, but in 1974, the very idea that a body representing patients' views should be set up was revolutionary. Now, much more than that is demanded: patients must be at the centre of the running of the National Health Service. I have bored your Lordships before with my experience as a patient over long months last year, and with the fact that I feel that we have come a long way in enabling patients' views to be at the centre of the National Health Service, but there is still some way to go.
The Government's proposals in the Bill show their commitment to putting patients at the centre. We need organisations and structures that reflect that commitment, and it is a credit to consumer and patient organisations that we have reached the stage of being able to propose radical changes. On the simple issue of complaints, for example, the present system is cumbersome and takes a long time. Many patients' concerns are quite simple to deal with and could be resolved by the provision of information by the patient advocacy and liaison services, enabling them to be settled at an early stage. There will be many more PALS available than there have been CHCs. In addition, every primary care trust will have a forum that will monitor and review services, obtain the views of patients and carers—I am particularly pleased about that—provide advice and make information available. They will also provide annual reports to enable monitoring of how they are getting on.
The skills and experience of CHC staff and members will not be lost when the new system is set up. I would be very concerned about that, but I am convinced that they will be able to be integrated into the new system.
I am delighted with the Government's proposals to set up a national commission, which will have far greater powers at national level than ACHCEW ever had. The title of that national body—the Commission for Patient and Public Involvement in Health—shows that it will go even wider than involving patients.
We must be careful of overstating how well known and integrated CHCs have been. Many of your Lordships will be familiar with the MORI survey that showed that fewer than 3 per cent of those making a complaint had even heard of a community health council. The new structures will provide more accountability and will be much more focused, with a national voice. Make no mistake, these are radical proposals, but that is what we need. We want to make patients and the public an integral part of the running of the National Health Service. Everyone who is committed to that should welcome the proposals.
4.30 p.m.
Baroness Finlay of Llandaff: I find myself in a strange position when speaking to the amendment, because in Wales we shall be maintaining CHCs, but our experience of them and the way in which they are evolving may have been slightly different. Their collective memory has been extremely valuable. I have served as a non-executive member of a health authority in which the CHC members acted a little like sand in a shoe, but were also useful to inform what was going on. For patients and their carers they act as a single point to which they can go when they feel angry, confused, frightened or upset and are not sure which route to take. It is very important that patients and their carers have a single point of contact that can help them filter out the most appropriate route to take in the future.
I have also experienced the advocacy role of CHCs at the sharp end. A member from Cardiff CHC came along with a patient of mine to speak to me and help to resolve issues. The CHC member was extremely helpful in acting as the patient's advocate. We have some examples of good practice there which I hope will be picked up throughout whatever other systems evolve in the rest of the UK.
I would welcome any moves to simplify the complaints procedures. Any delays in complaints for patients and their relatives and carers increase stress and anger and make them feel that there is a conspiracy to withhold information from them. Any way in which that process can be simplified and speeded up must be welcomed.
Lord Skelmersdale: I am the first to admit that the current consumer representation in the health service has its faults, as we have heard over the past few minutes. However, that is no reason for the Government to throw everything up in the air and go nap on something entirely new. Reform is certainly needed, but wholesale destruction is not.
In an article in the Health Service Journal, much favoured by the Minister, CHCs are described as a channel for patients' concerns, with limited powers and very small budgets. Both those faults could and should be remedied in the Bill. However, the article does not point out that the Bill replaces a long-standing system of proven efficiency that is easily understood and—importantly—accessed by the public.
Above all, the article does not say that CHCs are independent of the NHS. That independence gives them authority in the eyes of the public. Nor does it say how, if at all, patients forums are to interact one with another. As my noble friend Lord Howe has said, the Government propose that individual patients forums will be able to consider only the work of trusts in which they are based. Even worse, they are to be situated in NHS buildings and staffed principally by NHS staff. What patient is going to complain in the same place and to the same organisation where the complaint originates?
The proposals are very complicated and, as I understand it, are still being worked out in the department, despite the amount of time that has been available for that. I can find nothing in them that could not be achieved through a reform of the existing system. Like the noble Lord, Lord Clement-Jones, I urge the noble Lord, Lord Hunt, who is well versed in the ways of the NHS, to stand back and for goodness sake think again.
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