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Earl Howe: I thank all noble Lords who have taken part in the debate, not least the Minister for his clear and full reply. He knows that this is not an issue on which we shall see eye to eye. He has defended the Bill as best he can. For example, he referred to the merits of

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patient advocacy and liaison services. I do not disagree with his analysis, but PALS are not part of the Bill, nor of the amendment to which I have been speaking.

The Minister referred to the patchy performance of community health councils. I agree with him on that count, which is why we believe that CHCs should be reformed and strengthened, rather than abolished. He defended the separation of CHC functions on grounds broadly of modernisation and the need to distinguish different roles relating to patient involvement. I cannot accept that analysis. It seems to me that the Government's proposals for patient and public involvement follow the classic formula of divide and rule. That is what the fragmentation and filleting of CHC functions amount to. As my noble friend Lord Peyton pointed out so well, they are designed to suit the Government and not the patient. They will give Ministers an easier life.

I am particularly sorry that the Liberal Democrats do not feel able to resume the support for CHCs that they mounted so effectively and robustly last year. It is curious that in professing to want to listen to patients and the public, the Government are deaf to the cries of the public about the abolition of CHCs. The noble Baroness, Lady Finlay, reminded us that that has not been so in Wales, or indeed, in Scotland. If CHCs are abolished under this Bill, it will leave England as the only part of the UK without a robust—

Lord Hunt of Kings Heath: I am grateful to the noble Earl for giving way, but I must say that I have not heard the cries of the general population on this issue. I have certainly heard the cries of community health councils, which is perfectly legitimate, but surely the substantive point is made in the article in the Health Service Journal by de Montfort University, which my noble friend Lady Pitkeathley quoted. CHCs have extraordinarily low visibility in the public mind. My noble friend quoted the MORI survey showing that less then 3 per cent of those making complaints had heard of the CHC. That is the problem.

Lord Clement-Jones: I wish to ask the Minister a question, although I do not know whether it is in order to do so at Committee stage. What will be the budget of the new system compared to the old one? It is sad that the Minister is complaining about the lack of visibility of CHCs when he probably argued for years in particular posts within CHCs that they were highly underfunded and did not have the resources to have higher visibility. Yet, a great many more resources will be put behind the bodies that he and his colleagues are now proposing.

Lord Hunt of Kings Heath: The budgets have not yet been fully worked through, but there will be more people. More resources will be spent on patient and

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public involvement as a result of the changes that we are making than was spent under community health councils.

Lord Clement-Jones: That begs the question whether the self-same resources that were devoted to CHCs could not have done a rather better job.

Lord Hunt of Kings Heath: I doubt that very much. I come back to the point that I raised earlier. Rather than putting all the different functions together into one body, it is better to separate them out so that there is the right expertise to deal with the separate functions more effectively.

Lord Clement-Jones: Better? Perhaps. I doubt it, but it will certainly be more expensive.

Earl Howe: The Minister challenged me to cite organisations that have voiced support for the concept of CHCs. I have a list of them, including the Patients Association, the National Pensioners Convention, Mencap, and others that I shall not bother to read out. Those organisations have expressed concern in writing about the abolition of CHCs and the inadequacies of the replacement structures.

Lord Hunt of Kings Heath: With respect to the noble Earl, he talked about the general public, not organisations.

Earl Howe: With respect to the Minister, he is splitting hairs. Many of those organisations represent the general public and specific interests of patients. However, I understand his concern that, to many members of the public, CHCs are invisible. I fully concede that. But that does not in any way detract from my general position; that is, that CHCs are worth conserving and worth improving.

I do not wish to prolong this debate. It is perhaps worth reminding ourselves of something Professor Kennedy said in his report on the Bristol Royal Infirmary. He said,

    "Public consultation, whereby the public are presented with a fait accompli or their views are ignored leads to disengagement and cynicism. The net effect is frustration, loss of trust and an increasing lack of interest amongst the public in bodies and structures that are supposed to promote their interest".

Nowhere could there be a better example of what Professor Kennedy meant than the Government's dirigiste approach to these issues. He precisely identified the risk we run with these proposals. My amendments respond to what I know for certain is a wide degree of support not only for the concept of retaining the model of the CHC but also for improving it and bringing it up to date. On an issue of such prime importance for patients I have no hesitation in seeking the opinion of the Committee.

5.1 p.m.

On Question, Whether the said amendment (No. 105) shall be agreed to?

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Their Lordships divided: Contents, 90; Not-Contents, 117.

Division No. 1


Ackner, L.
Anelay of St Johns, B.
Astor of Hever, L.
Beaumont of Whitley, L.
Blatch, B.
Bowness, L.
Brightman, L.
Brougham and Vaux, L.
Buscombe, B.
Byford, B.
Campbell of Alloway, L.
Carlisle of Bucklow, L.
Carnegy of Lour, B.
Chadlington, L.
Colville of Culross, V.
Colwyn, L.
Cope of Berkeley, L. [Teller]
Cox, B.
Crickhowell, L.
Darcy de Knayth, B.
Denham, L.
Dixon-Smith, L.
Dundee, E.
Elton, L.
Fellowes, L.
Fraser of Carmyllie, L.
Freeman, L.
Gardner of Parkes, B.
Goschen, V.
Gray of Contin, L.
Griffiths of Fforestfach, L.
Hambro, L.
Hanham, B.
Hanningfield, L.
Hayhoe, L.
Hogg, B.
Holderness, L.
Hooper, B.
Howe, E.
Howe of Aberavon, L.
Howe of Idlicote, B.
Hunt of Wirral, L.
Jenkin of Roding, L.
Jopling, L.
Kimball, L.
King of Bridgwater, L.
Kingsland, L.
Listowel, E.
Luke, L.
Lyell, L.
Marlesford, L.
Masham of Ilton, B.
Mayhew of Twysden, L.
Miller of Hendon, B.
Monro of Langholm, L.
Monson, L.
Mowbray and Stourton, L.
Moynihan, L.
Murton of Lindisfarne, L.
Naseby, L.
Noakes, B.
Northbrook, L.
Northesk, E.
Norton of Louth, L.
O'Cathain, B.
Onslow, E.
Park of Monmouth, B.
Patten, L.
Peyton of Yeovil, L.
Platt of Writtle, B.
Rawlings, B.
Rees, L.
Renton, L.
Roberts of Conwy, L.
Roll of Ipsden, L.
Seccombe, B. [Teller]
Selborne, E.
Selsdon, L.
Shaw of Northstead, L.
Sheppard of Didgemere, L.
Skelmersdale, L.
Soulsby of Swaffham Prior, L.
Strange, B.
Swinfen, L.
Tebbit, L.
Thomas of Gwydir, L.
Vivian, L.
Weatherill, L.
Wilcox, B.
Williamson of Horton, L.


Acton, L.
Alli, L.
Andrews, B.
Archer of Sandwell, L.
Ashley of Stoke, L.
Ashton of Upholland, B.
Bassam of Brighton, L.
Berkeley, L.
Billingham, B.
Blackstone, B.
Blood, B.
Borrie, L.
Bragg, L.
Brett, L.
Brooke of Alverthorpe, L.
Brookman, L.
Campbell-Savours, L.
Carter, L. [Teller]
Chan, L.
Christopher, L.
Clarke of Hampstead, L.
Clinton-Davis, L.
Cohen of Pimlico, B.
Corbett of Castle Vale, L.
Crawley, B.
David, B.
Davies of Coity, L.
Davies of Oldham, L.
Desai, L.
Donoughue, L.
Dormand of Easington, L.
Elder, L.
Evans of Temple Guiting, L.
Evans of Watford, L.
Falconer of Thoroton, L.
Faulkner of Worcester, L.
Filkin, L. [Teller]
Fyfe of Fairfield, L.
Gale, B.
Gavron, L.
Gibson of Market Rasen, B.
Gladwin of Clee, L.
Golding, B.
Gordon of Strathblane, L.
Goudie, B.
Gould of Potternewton, B.
Graham of Edmonton, L.
Greengross, B.
Grenfell, L.
Grocott, L.
Hardy of Wath, L.
Harris of Haringey, L.
Harrison, L.
Haskel, L.
Haskins, L.
Hayman, B.
Hilton of Eggardon, B.
Hollis of Heigham, B.
Howells of St. Davids, B.
Howie of Troon, L.
Hunt of Kings Heath, L.
Hylton, L.
Irvine of Lairg, L. (Lord Chancellor)
Jay of Paddington, B.
Jones, L.
Jordan, L.
Judd, L.
King of West Bromwich, L.
Kirkhill, L.
Laird, L.
Lea of Crondall, L.
Lipsey, L.
Macdonald of Tradeston, L.
McFarlane of Llandaff, B.
McIntosh of Haringey, L.
MacKenzie of Culkein, L.
Mackenzie of Framwellgate, L.
Milner of Leeds, L.
Mitchell, L.
Morgan, L.
Morris of Aberavon, L.
Murray of Epping Forest, L.
Nicol, B.
Ouseley, L.
Parekh, L.
Paul, L.
Pitkeathley, B.
Plant of Highfield, L.
Ponsonby of Shulbrede, L.
Prys-Davies, L.
Puttnam, L.
Radice, L.
Ramsay of Cartvale, B.
Rea, L.
Rendell of Babergh, B.
Richard, L.
Rogan, L.
Sainsbury of Turville, L.
Sawyer, L.
Serota, B.
Sewel, L.
Sheldon, L.
Simon, V.
Smith of Gilmorehill, B.
Stone of Blackheath, L.
Symons of Vernham Dean, B.
Temple-Morris, L.
Thornton, B.
Turner of Camden, B.
Uddin, B.
Walker of Doncaster, L.
Whitaker, B.
Whitty, L.
Wilkins, B.
Williams of Elvel, L.
Williams of Mostyn, L. (Lord Privy Seal)
Woolmer of Leeds, L.

Resolved in the negative, and amendment disagreed to accordingly.

11 Apr 2002 : Column 554

5.11 p.m.

[Amendment No. 106 not moved.]

Clause 15 [Establishment of Patients' Forums]:

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