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Lord Clement-Jones moved Amendment No. 107:
- Page 20, line 38, at end insert ", and
The noble Lord said: I rise to move Amendment No. 107 and to speak at the same time to Amendment No. 112. We had some debate after the Health and Social Care Act in respect of the status of care trusts. The purpose of Amendment No. 107 is to obtain what I suspect will be similar ministerial reassurances as regards the status of care trusts.
The purpose of Amendment No. 107 is to ensure that care trusts to be established under the Health and Social Care Act will also include patients forums. Legislative provision for the establishment of care trusts is contained in the Health and Social Care Act and it would be anomalous if patients forums were to be established for NHS acute trusts and primary care trusts, but not for care trusts themselves. The establishment of patients forums for care trusts, if regarded as separate bodies from PCTs or acute trusts, would require primary legislation, which is why they are included in the Bill.
I turn to Amendment No. 112. Clause 16(1) allows the Secretary of State to make regulations to permit inspection of other premises from which services are provided. The purpose of subsection (1) is to provide a commitment that regulations will include care trusts and other private providers, including nursing homes. Inspection of premises controlled by care trusts need to be brought within the ambit of the clause. At present it is not clear whether the clause includes private providers such as residential homes.
The Department of Health's document Involving Patients and the Public in Healthcare: Response to the Listening Exercise specifies new powers to inspect NHS care provided by the independent sector. Contracts between health service bodies and private providers cannot guarantee rights of inspection and give patients forums no power to enforce their rights. That is why the amendment is needed. I beg to move.
Lord Filkin: On speaking to Amendment No. 107, I can give the noble Lord the assurance he seeks. A care trust does not have a distinct legal identity. It is either an NHS trust or a PCT and therefore in either case would have a patients forum established.
I understand what the noble Lord, Lord Clement-Jones, is seeking to achieve with Amendment No. 112, but I hope I can explain why it is unnecessary. In discussing Amendment No. 107, I explained that the legal status of care trusts as NHS trusts or primary care trusts is already provided for in Clause 16. The patients forum of an NHS trust or PCT which has become designated as a care trust will already be able to visit the relevant premises.
I turn to the question of whether,
The commission will authorise inspectors to inspect establishments and agencies and it will interview service users and seek their views on the care they receive. It will have an important role in supporting consumers by investigating complaints about regulated services and giving the public information about services. Being a national body, it will also be able to inform government of the general availability and quality of care services.
The commission will cover the need for inspection of nursing homes and other care facilities. To extend inspection arrangements to patients forums would be an unnecessary duplication of that valuable work. Having said that, where, for example, a doctor provided general medical services at a nursing home, that would fall within Clause 16(2) and may be provided for in regulations, giving patients forums a right of entry.
I agree that patients forums should be able to inspect private sector premises where NHS patients are treated. In general, the relationship between the NHS and the independent sector is a contractual one, and so it is anticipated that usually forums will inspect by virtue of the contracting process. In other words, where the private sector provides NHS services in contracts with the NHS, patients forums will have a right of inspection. That will apply to all future contracts.
There will be significant human rights implications in a general right of access to private premises. While patients forums will represent a major element of the inspection regime, they need to liase with other agencies to ensure inspections are maintained at an appropriate level.
I share the concerns to ensure adequate representation and safeguard standards of care. But, as I hope I have demonstrated, the amendments are unnecessary and the Government resist them.
Lord Clement-Jones: I thank the Minister, particularly for his positive reply on the status of care trusts. I accept that; it is entirely consonant with replies that the noble Lord, Lord Hunt, has given in the past. However, the Minister's reply on Amendment No. 112 gives two legs to the three-legged stool and is not satisfactory. I welcome patients forums rights of inspection for healthcare in both the public and private sectors where there are contracts. But it seems anomalous that the care trusts' patients forums will have the right of inspection only in the healthcare sector and not the social care sector when they have responsibility for patient representation and consultation in both areas. The whole purpose of a care trust is the integration of health and social care; and yet, the patients forum that is applicable to that care trust will not have those powers of inspection.
I ask the Minister, his colleagues, and, indeed, the department to reconsider the matter. It seems that there is a gap in the process, and that there are just two legs of the stool. I believe that those serving on care trust patients forums will find it fairly anomalous not to have that power of inspection in such circumstances. I do not know whether the Minister wishes to add anything further to his response and, perhaps, give us an assurance that he will further consider the matter. I see from his facial expression at present that he does intend to budge one inch on the issue. I shall, therefore, withdraw the amendment at this stage, but I may well return to the matter on Report. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Earl Howe moved Amendment No. 108:
The noble Earl said: In moving this amendment, I shall speak also to Amendments Nos. 109 and 130. One of the principal features of community health councils has been their overarching remit to represent the interest of patients and of the public in the health service. It is that element of their remit that I believe has enabled them to adapt to changing circumstances over the years, such as the need to develop services for those who wish to make a complaint against some aspect of the health service. If patients forums lack such a remit, it seems to me that they could find themselves acting ultra vires if ever they were to engage in activities other than those prescribed in the Bill.
If patients forums are to be seen by the public as representing their interests, they should have a proper public profile; for example, they ought to be able—on occasions—to engage in public campaigns, whether locally or nationally, perhaps in opposing the closure of a hospital. They ought to be able to put resources behind such campaigns; they should have the ability to call for public consultations; they should be able to inspect premises, other than those specifically provided for in the Bill; and they ought to be able to initiate legal proceedings to enforce their rights, or to protect patient rights.
Unfortunately, there have been occasions in the past when CHCs have been warned by officials in the Department of Health that they are not permitted to engage in campaigns or to criticise government policy. CHCs have always been able to see off such attempts to stifle their public voice on behalf of patients. They have done so by virtue of their wide statutory remit, which Amendment No. 108 seeks to reproduce for patients forums. One of the most well-known "public profile" activities of CHCs is casualty watch, which has a tremendous value for both patients and the health service. However, as far as I can see, neither that nor any of the other activities that I have mentioned will be permissible for patients forums or for the Commission for Patient and Public Involvement in Health. Nor are they functions that overview and scrutiny committees of local authorities will be given to undertake. Under this Bill they simply fall away.
It is perfectly obvious to me that this is a deliberate omission. Concerted public criticism of the health service by patients will, effectively, be muffled. That is a matter of very great concern. If we look at the remit of the Commission for Patient and Public Involvement in Health, we can see that it will have very similar problems. It will not be able to engage in research, or in policy work on issues that are not in the domain of patients forums—in other words, almost any national issue. It will not be able to run or take part in campaigns; it will not be able to voice its view about national changes of policy affecting the health service; and it will not be able to take legal proceedings, as, indeed, ACHCEW did recently in a case that concerned a patient's right to confidentiality.
I turn to Amendment No. 109. I am very troubled by the provision in Clause 15(2)(e), which permits patients forums to perform,
(c) for each Care Trust"
5.15 p.m.
"nursing homes and other privately owned facilities"
should be required to allow patients forums access to inspect. As Members of the Committee will be aware, we have established a National Care Standards Commission to inspect nursing homes and other such places. It has its own chief executive and so on. From April 2002 it took over the regulation of social care services and private and voluntary healthcare from local authorities and health authorities. The commission will register and inspect all care homes, children's homes, domiciliary care services, residential family centres, independent fostering agencies, voluntary adoption agencies and nurses agencies as well as private and voluntary healthcare establishments.
Page 20, line 39, at end insert "represent the interests in the health service of patients and in particular must"
"any prescribed function of the trust",
to which it relates. That seems to me to be a recipe for generating a conflict of interest. Patients forums must be independent of the trusts to which they relate and be seen to be so. In the new paragraphs that I propose for Clause 15(2), I am suggesting that the role of representing local concerns about matters affecting health should be carried out by patients forums and not by the commission. This would mean that information about local concerns, including matters that may form the subject of referrals, are provided as necessary by patients forums to the local authority overview and scrutiny committees. Responsibility for these activities would be removed from the commission, which will instead have responsibility for the provision of support to patients forums in fulfilling these functions. Amendment No. 130 would achieve that aim, but would leave the commission with a responsibility to make representations at national level, if that were ever necessary. I beg to move.
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