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Baroness Carnegy of Lour: I think that I picked up from the noble Lord, Lord Clement-Jones, that the Liberal Democrats are not going to support the amendment and that they fancy their own ideas, which they will put forward later. I do not know what the rest of the Committee thinks about that, but it seems to me that my noble friend is giving the Government a chance to achieve what they want to achieve—obviously they have thought deeply about what they want to achieve—by reforming the existing community health councils, not by disruption. I am sorry that the Liberal Democrats do not support the amendment, which seems a sensible first shot. If the Government cannot be persuaded or forced to agree to it, we shall have to resort to some later measure, but this is the best possible objective.
I do not want to repeat all the arguments, but I should like the Minister to tell me one thing. When talking about patients forums, the Government always talk about patients, not the public. Do the Government consider that every member of the population of a given area is a patient—presumably because we all go to see a GP—or do they mean only those who have been or are patients in a hospital?
Lord Hunt of Kings Heath: Perhaps I can respond to that point now. For a trust that covers an acute hospital, for example, we mean only those who are or have been patients, but for primary care trusts, all patients who are registered with a GP within that area will be covered. Primary care trusts will have a broad public role in that sense.
Baroness Carnegy of Lour: In that case, the Bill would be clearer if there were a reference to patients and the public. My noble friend Lord Howe asked the important question of who will campaign against a hospital being closed. Can a patients forum do that? That and many other issues would be of concern to the whole community, not just to people who see themselves as patients at a given moment. With the destruction of community health councils, that role will be left to local authorities. As we all know, local authorities will act in a party political way—that is their nature. We do not want that. We want the job to be done by the community as a community on grounds of health. Any member of a local authority knows that it is difficult to separate such issues from the political scene. In that respect alone, the Bill is inadequate. I hope that references to patients can always include the public when that is what is intended. I also hope
that somewhere—presumably in the patients forum, if the current proposals are adopted—the ability to campaign will be included, because it is essential.
Lord Morris of Aberavon: I find it difficult to be enthusiastic about community health councils. The Government's proposals for England have positive attractions. In 1974, I was responsible, as Secretary of State, for the appointment of all members of community health councils. I had high hopes for them and thought that they would be the means of dealing with the matters set out by the noble Baroness, Lady Finlay. There is a great need to provide the patient, who is at the heart of our health service, with the machinery to ensure that his or her views are made known and to monitor our health system.
Regrettably, the record has been patchy. I started off with high hopes and was responsible for community health councils for five years. I have not heard reports that they have improved since that time. CHCs' records depended on the quality of their membership and perhaps even more so on their staff. Generally, however, they were a disappointment.
I should like to give the Government's proposals, certainly as they apply to England, a fair wind. The machinery is badly needed, and it needs to be improved. I have found the record of the CHCs to be extremely patchy, and I had hoped for very much better.
Baroness Thomas of Walliswood: I apologise that, earlier in the proceedings, I interrupted the noble Baroness, Lady Carnegy of Lour, but I had forgotten the point we had reached in the exchange between her and the Minister. I simply wanted to raise an issue which has not yet been discussed—the potential for conflict between patients forums, which in a way represent the two contractual parties to the local health service. I was wondering what the Minister can tell us to reassure us about that.
Based on my experience of the health service—I have been a member of a hospital trust board and of a CHC—I realise that the patients forum for a given primary care trust and the forum for a given acute hospital trust will not always agree on who is at fault, what has gone wrong, whether something has gone wrong, or any of the other issues that the patients forums may wish to examine. Unless I have misunderstood the proposals, that situation will be exacerbated by the fact that the officials of the two bodies will be employees of those bodies.
Lord Hunt of Kings Heath: I must make it clear that the staff who support patients forums will be employed by the national commission. They will be wholly independent of the individual NHS trusts.
Baroness Thomas of Walliswood: I thank the Minister for that intervention; it clarifies a point I had not fully taken on board. Nevertheless, there remains the potential for a conflict of interest which could go against what I assume to be the Government's
objective—to improve things for patients and, as the noble Baroness, Lady Carnegy of Lour, said, for members of the public.
Baroness Masham of Ilton: No one could have explained the situation of the fragmentation of the Government's new National Health Service as far as patient support bodies are concerned more clearly than the noble Earl, Lord Howe. I shall speak to the group of amendments on patients councils—Amendments Nos. 111 to 136—because I feel so strongly that there must be an independent body to which patients know they can go. It is interesting, however, that Wales and Scotland are retaining their CHCs. I believe that that will just cause more confusion.
4.45 p.m.
Lord Hunt of Kings Heath: This has, once again, been an extremely interesting debate. This is one of the very important parts of the Bill, on public and patient involvement in the NHS. As some noble Lords will know, I have a particular interest in community health councils because, like my noble friend Lady Pitkeathley, in 1974, I was one of the first CHC secretaries to be appointed. As my noble friend Lord Morris has suggested, those were heady days. At the time, we all thought that CHCs would be tremendous organisations that would have a real impact on how patients were dealt with within the NHS. Experience, however, has not been as positive as one would have wished.
Of course some CHCs have done very valuable work, and I pay tribute to CHC members and staff who have served in the years in which CHCs have operated. The fact, however, is that CHCs' performance over the years has been patchy. Can any noble Lord, hand on heart, say that the NHS is in such good condition that it can identify that the patient comes first, or that, since CHCs began operating, the NHS has become completely sensitive to the needs of patients? I do not think that any noble Lord can honestly say that. The fact is that the NHS still has a considerable way to go before it treats patients as we all want them to be treated.
I fully accept that the key test will be whether the Government's combined proposals have led to much more powerful patient and public involvement in the NHS than was achieved by the CHCs. However, I am absolutely confident that our proposed arrangements will be very much more powerful and effective than the current arrangements under CHCs.
Life has indeed moved on since 1974. We have very clear views on the need for consent and public involvement and on ensuring that NHS staff can be very positive about talking to patients, involving patients and seeking patients' consent. I believe that our proposals will enable that to happen. As the noble Earl, Lord Howe, suggested, we have debated the proposals at length, and the Government have been able to develop our thinking in the light of the many debates we had during passage of the Health and Social Care Act 2001.
Our new system does place different functions in the hands of different bodies, but I make no apologies for that. The intention is that a specifically identified function can be performed in the optimum manner. Rather than expecting a simple single organisation with limited powers to perform a complex range of functions, we are putting in place specific and appropriate mechanisms to deal with various functions that we believe are encompassed within public and patient involvement.
On complaints, for example, rather than having one complaints officer per CHC—totalling about 200 nationally—we shall have many more people within the patient advocacy and liaison services who will be based within each NHS trust and be available whenever a patient or his relative has a complaint, and who will in many instances be able to deal with the problem on the spot. I recently visited the Luton and Dunstable NHS Trust, which has already appointed a patient advocacy and liaison service. That service has a booth in the outpatient A and E department and is already very successful in dealing with complaints and problems as they arise. I recommend that noble Lords make contact with local NHS trusts to see at first hand the effectiveness of a service that is instantly available to the public. It is obviously much better to deal with a problem immediately than to allow people to leave dissatisfied with the health service and to make a complaint subsequently. It is much more effective to try to nip problems in the bud as they arise.
One accepts, however, that PALS will not be able to deal with every problem and that the public will seek to pursue some problems. That is where independent advocacy services will come into play. We shall have very professional people available across the country, where patients or their relatives want the service, to help people to make their complaints. I also certainly accept the comments of the noble Baroness, Lady Finlay, on the complications of the current complaints system. She will know that we are reviewing that. Nevertheless, availability across the country of effective, professional, well-trained and independent advocates—not patchy availability, as with CHCs—is one of the guarantees of the type of independence described by the noble Earl, Lord Howe.
Patients forums will have extensive powers, including a statutory right to inspect health authority and local health board premises and local authority premises where healthcare is provided on behalf of a trust, as well as the power to make reports and recommendations for the improvement of services to the trust board. Reports will be made available to key decision makers in the community, including the local overview and scrutiny committees, and local strategic partnerships about the views and concerns of patients. If a patient forum wishes to provide and pull together the views of patients on the issues raised by the noble Earl, Lord Howe, of course it will be fully able to do so.
The noble Baroness, Lady Thomas, asked me about the position if perhaps a primary care trust and a neighbouring patient forum disagreed with each other. Surely it is more healthy for opinions that the public are putting forward to be expressed rather than that a
group of 30 people, whom very few in the community know, should purport to represent the views of the entire community. It is not tenable to believe that that would be effective. If there are disagreements between patients, as there often are about how the NHS should proceed, it is much more effective for those views to be in the public domain.I believe that patient forums will be effective, but we are making other changes as well, such as the establishment of overview and scrutiny committees of local government, for example. The noble Earl, Lord Howe, is disappointed that we are essentially giving them a power rather than a duty. On the first day of our debate, he chided me about over-centralisation and suggested that the Government were determined to dictate what local bodies should do. I should have thought that the noble Earl would support the general principle that it is for local government to be given the ability but for individual local authorities to make their own decisions. My experience is that local government generally takes a very close interest in health service issues. I should be very surprised if every principal local authority did not establish effective overview and scrutiny committees.
We are addressing one of the principal criticisms that has always been levied at the health service—the so-called democratic deficit. When we come to crucial discussions and debates about changes in services to which the noble Earl referred, surely it is a much more powerful measure to give local authorities the right to refer such issues to the independent reconfiguration panel at national level, which will then advise the Secretary of State. Surely that is a very powerful indication of democratic local government having a very great influence in the future development of the National Health Service. A democratically elected local authority will be in a much more effective position to give its views on major changes of services than we currently see with community health councils.
The only test for the Committee is to decide whether our proposals will be more powerful and effective than the position under the current community health councils. I have long been interested and passionately concerned about improving patient and public involvement in the NHS. I am absolutely convinced that we are introducing an extremely powerful package of measures, which includes patient forums, independent patient advocacy, patient advisory liaison services, local authority overview and scrutiny committees and, at national level, the Commission for Patient and Public Involvement in Health, which will also have an important role locally, enabling the work of patient forums to be co-ordinated in the way suggested by the noble Earl, Lord Howe. I look to the Committee to support those measures.
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