| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Lord Clement-Jones: The noble Earl, Lord Howe, put the case admirably for these amendments. We come now to one of the major problems for critics of the new arrangements in the Bill. When one looks at the way in which the powers of the new bodies are defined, or can be defined, in terms of regulation, one sees that they do not have the same breadth as the powers that the CHCs currently enjoy under the legislation governing such councils. It is extremely important that these new bodies should have the ability to mount campaigns, and that they should have the ability to commission surveys. I have in mind the accident and emergency survey and the casualty watch mentioned by the noble Earl, Lord Howe. They must have the ability to take a very broad view about the way in which patients and the public interest are represented; they must not be over prescribed by the Secretary of State as regards their remit. Such amendments are most important. Noble Lords on these Benches certainly support them.
Baroness Pitkeathley: I am a little puzzled by the purpose of these amendments. I hope that my noble friend the Minister will clarify the position in his reply. I thought that the Government's aim under the Bill is to move away from the idea of a body representing patients and the public and to enable patients and the public to be very much more involved in the fabric, as it were, of the NHS. Therefore, from that point of view, it seems to me that the proposed amendments are unnecessary.
Although it may be true that each part of the new system has less power than that currently enjoyed by the CHCs, on the whole it seems to me that they will have more power, much more accountability and, therefore, much more ability to allow the voice of the public and that of patients to come through.
Lord Clement-Jones: Perhaps I may briefly intervene. The noble Baroness has put forward a most
interesting concept, if we wish to return to Athenian democracy whereby everyone gets together in the basilica. I am sure that that would be absolutely perfect in an ideal world, and that there would be no need for any representation. Indeed, patients would be directly involved in such processes. However, until that time, I regret to say that I believe that some form of representation will be necessary.
Lord Hunt of Kings Heath: It is very tempting for us to travel down the route of a debate on Athenian democracy. However, I shall resist that temptation. I believe that my noble friend is absolutely right. She has taken us back to what Kennedy said; namely, that the public should be on the inside rather than being represented by someone on the outside. That is why we believe that the essential building block to everything that we propose in relation to public and patient involvement must be the patients forums. The great advantage that they have, as opposed to the current arrangement, is that they are related to each individual trust and primary care trust. Therefore, they will be able to get very much closer to being able to put forward the varied experience and views of patients.
On reading Clause 15(2), which relates to the establishment of patients forums, it will be seen that we are talking about very wide-ranging powers. For example, a patients forum must,
- "monitor and review the operation of services provided by, or under arrangements made by, the trust for which it is established . . . obtain the views of patients and their carers about those services and report on those views to the trust . . . provide advice, and make reports and recommendations, about matters relating to those services to the trust . . . make available to patients and their carers advice and information about those services",
5.30 p.m.
Lord Clement-Jones: I apologise to the Minister for the fact that I keep popping up and down. I am interested in the example given in a recent booklet produced by University College London researchers about PFI and the hospitals in Birmingham. I am sure that the Minister has read the booklet, as it is close to home. Does he really envisage patients forums for the Birmingham acute hospitals performing the same excellent function as did the CHCs in Birmingham in campaigning to find out the real cost of those PFI hospitals in circumstances after the passage of the Bill?
Lord Hunt of Kings Heath: The noble Lord tempts me down an interesting route. He knows that I chaired an independent review into the future of the city's health services. He knows, I suspect, that the City of Birmingham suffered from malaise over 20 to 30 years because of a failure of parties in the NHS to agree on the future of a new university teaching hospital.
I do not agree, and never have done, with the views of the South Birmingham Community Health Council on those matters. Nor do I think that the great majority of Birmingham people so agree. If the city had followed the strictures of the South Birmingham Community Health Council we would not now have, as we do, the start of a process leading to a magnificent teaching hospital in the City of Birmingham.
Lord Clement-Jones: The Minister is saying, essentially, that that is not a legitimate role for the new patients forums, and that is why the Bill is drafted as it is. I can well understand the Minister's view. He is reacting against his own experience. That is why the powers of the patients forums are restricted. If the Minister admitted that, we would all be much clearer.
Lord Hunt of Kings Heath: The noble Lord misses the point I seek to make. I have no problem with the South Birmingham Community Health Council—a number of members of which I know rather well—putting forward its views. I said that I do not believe that those views represent the opinion of the great majority of people living in Birmingham.
Lord Clement-Jones: But the issue is whether the patients forums in Birmingham would be able to campaign in the same way as did the South Birmingham CHC?
Lord Hunt of Kings Heath: There are two points there. We come on to the substantive nature of the amendment. The noble Earl, Lord Howe, seeks to give a much broader power to patients forums to represent the interests of patients in the health service. My view, which perhaps experience in Birmingham shows, is that there is and has been a big problem with some CHCs where a small group of members purports to represent the interests of an entire population. I do not believe that that is possible. As a result, many CHCs which tried to do that lost credibility and influence. How can CHCs purport to represent the entire population of a large community when less than 3 per cent of those making complaints had even heard of community health councils?
I envisage patients forums working effectively by enabling the many voices of the public—the patients—to be heard and considered, but they should not purport to represent the entire population and give a collective view on behalf of it. Alongside that we have to take account of the new role of local authorities through their overview and scrutiny committees. The noble Lord, Lord Clement-Jones, is a fierce democrat, as I am. I welcome the fact that Birmingham City Council will now have a measurably more important role in decisions on the health service in the future. Frankly, I prefer that to be done through the local ballot box than by a group of people who, with the best will in the world, cannot say, "We represent the people of the City of Birmingham".
I turn to Amendment No. 109. I am somewhat concerned with one aspect of it. First, the noble Earl, Lord Howe, expressed concern about the clause,
which removes the forums' function of taking over a patient advocacy and liaison service in prescribed circumstances set out in Clause 15(2)(e). While I would anticipate that being a rare occurrence, we regard PALS as being an important service, critical to patients and their families. We believe that where a forum considers that the trust is failing to provide an adequate service, it should be able to do something about it. That is an example of how effective we believe patients forums will be in future.Perhaps I may explain to the noble Earl, Lord Howe, how we think that would work. If, for instance, a forum were concerned about the quality of the PALS service, it would report that to the board of the trust or the primary care trust. Incidentally, PALS will be provided within primary care trusts as well as within other NHS trusts. If there is no improvement, it will report again, copying its report to the strategic health authority. If again there is no improvement, the forum will report the matter to the Secretary of State. The Secretary of State would then need to make a decision about what action he takes. He may choose to direct the trust to take action. He may also decide that the forum should take over responsibility for the PALS. If the latter, the forum will make arrangements for the provision of the PALS, perhaps arranging for another trust PALS to take over the service, but with the host forum retaining responsibility for it, or a voluntary sector organisation taking over PALS but reporting to the forum.
It is not intended that forums will provide the PALS services, as clearly they would not be equipped or resourced to do so. However, it is making abundantly clear to individual NHS trusts and primary care trusts that if they are not providing a satisfactory PALS service, their local patients forums, far from being a poodle, are in a very good position to see that something is done about it.
As regards Amendment No. 130, we do not accept that what is contained in Clause 19(2) should be replaced in the way the noble Earl suggests. I agree that the issue of patients forums collaborating and working together is important. However, we feel that the commission, working at local level, will be best placed to take an overview of the health service across the whole health economy area because individual forums, as the noble Earl suggests, are trust and primary care trust specific. The advantage of going down the route we suggest is that the commission working at local level will have the ability, staff resources and clear duty to ensure that indeed the various patients forums work together on specific issues, as the noble Earl suggested needs to happen.
Amendment No. 130 is consequent to Amendment No. 109. As I said, we remain convinced that the engagement of the wider public and representation of their views should be to the local commission. As regards the arguments raised by the noble Earl about the role of the national commission, the arguments I have deployed concerning the wider public interest are as relevant to the national commission as they are to local forums. At the end of the day, the more focused we are—as we are in the various arrangements we are
setting out—the less opportunity there is for confusion or for a situation in which neither the commission nor the patients forums will be effective or credible because they seek to do something which they will not be able to do effectively.
| Next Section | Back to Table of Contents | Lords Hansard Home Page |