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Baroness Hanham: Perhaps I may intervene with a question that has been in the back of my mind during this whole discussion about patients forums. As chairman of a National Health Service acute trust I would put the other side of the point.
As the discussion continues I am conscious that there is a raft of organisations which will be able to encourage and enable patients to make complaints. I do not think that there is any problem with that. I am a little bothered about the other side of the equation, which is the ability and the resources to deal with the complaints. I say that because I am conscious of the pressure and the difficulties for staff dealing with many of the complaints which come to an NHS trust. Some of them are very difficult; some are very sad situations; and some involve an enormous amount of effort and work for those employed by the trust. This is not a job to which people rush. It is not one for which they may have received extensive training. Before we put in the raft of organisations which will beaver and burrow to ensure that everyone has the ability to make a complaint—however minor, but, perhaps more importantly, a major one requiring some investigation—can the Minister say what he proposes for the trusts which are already dealing with substantial numbers of complaints and which would find it helpful to have additional resources in order to deal with them?
Lord Hunt of Kings Heath: First, I welcome the intervention of the noble Baroness who brings a wealth of experience from running a busy NHS trust. It is always helpful to have that practical perspective.
I certainly agree with the noble Baroness that the current complaints system causes a great deal of work to be undertaken within individual trusts. I think that there is a variable quality about the way that trusts deal with them. I would also accept that there are views that the current complaints system is rather bureaucratic and cumbersome. She will know that we are undertaking a review of it.
I also accept that we need to do more to help trusts, not just in relation to the way they handle complaints, but more generally in responding to the inevitable increase in public and patient involvement in the health service and the inevitable increase in the scrutiny they will come under. That is life in the 21st century. It is life for all public organisations. The NHS will not be absolved from that.
I have been in discussion with the Modernisation Agency and the Leadership Centre on this matter to see what further support we can give to trusts in order to rise to the challenge of enhanced public and patient involvement. I should be happy to share some of my thoughts on the matter by writing to the noble Baroness.
However, I would also say that I am strongly of the view that the arrangements that we are putting in place will enable the NHS to deal with complaints in a more effective way. The development of the PAL service will ensure that many matters which, at the moment, end up in the complaints system will have been dealt with. I referred earlier to my experience of the PAL service in Luton. There is no doubt about the reduction in the number of formal complaints because it has been able to deal with issues as they arise. As we know, if one can deal with something there and then, many patients may feel that there is no need to go further. However, if the patient remains dissatisfied, we have established a very professional complaints service through independent advocacy. That will benefit the NHS trust because it will enable patients to articulate their complaints in the clearest way possible. It will enable the trust to deal with and focus on the issues being raised. The benefit of a patients forum is that it will be able to have face-to-face meetings with the trust board. If it has concerns about the operation of complaints within an individual trust, it will be able to bring to the trust board chapter and verse about the problems that are arising. I think that the trust board will find that extremely helpful.
I do not underestimate the challenges that trust boards will face. But I think that at the end of the day with the help and support that we can give them and with the undoubted helpful influence of patients forums and the PAL service, we will end up with a win-win situation where complaints are dealt with more promptly and more effectively and where the trust board will have the help of a patient forum in developing ideas about how one deals with these issues in the future.
5.45 p.m.
Baroness Hanham: I accept entirely what the Minister says about dealing with complaints at the outset and getting rid of them. I totally support that. I think that any reasonable trust does that now in the best way that it can. I am not really bothered about the trust board either. I am much more concerned about the people at the front line who deal with what are often extremely difficult issues. If they have a much more professional service coming at them from one side, they will be required to produce a much more professional service from the trust side. It is really a question of whether resources will be available to provide training and access to legal advice in order to be able to deal with the system or whether the trusts will be left on their own to deal with the financial aspects of what could potentially—at least in the initial stages—be resource intensive?
Lord Hunt of Kings Heath: As the noble Baroness will know, I am constantly being urged to let trusts get on with matters. We do expect trusts to be able to rise to challenges. But, as I have said, I am looking at the role of the Leadership Centre and the Modernisation Agency to see what support and advice we can give. I suspect that the work of the Commission for Patient
and Public Involvement in Health—although expressly it will be giving support to patients forums—will be an extremely important help to trusts themselves. They will be able to learn from the kind of casework and experience that the commission will identify through the work of patients forums and their commission staff at local levels. I shall be happy to meet with the noble Baroness to discuss this matter and to see what further practical support we might give to NHS trusts. That of course does not mean money. In terms of finances, it is right that that should come from their general allocations.
Baroness Hanham: Resources are not always money, as the Minister knows.
Earl Howe: This has been a useful debate. I thank all Members of the Committee who have taken part. I particularly thank the Minister for the illumination that he has shed on a number of aspects relating to the functions of patients forums. I think that he has exposed a fundamental difference of approach in the way that the Government look at these matters. The internalisation of patient involvement, as the noble Baroness, Lady Pitkeathley, made clear, is central to these proposals.
A danger in the Government's approach is that the public needs to have confidence in a patients forum. If a patients forum is based within a trust, that is one thing, but the patients forums must not be "of" the NHS. That may be a distinction which the public will lose sight of if we are not very careful.
To revert to the substance of Amendment No. 108, the questioning by the noble Lord, Lord Clement-Jones, exposed successfully my own conclusion that a great deal is missing in the Bill when compared to the powers enjoyed by community health councils. We shall feel the want of that when these measures are passed into law, as I believe they will be.
Lord Hunt of Kings Heath: I am grateful to the noble Earl for giving way. Does he accept that we cannot simply compare powers between CHCs, on the one hand, and patients forums, on the other; we must compare CHCs against the whole panoply of our proposed measures in order to draw a broad comparison?
Earl Howe: Yes, of course I accept that, but I still believe that if we take that comparison, a number of gaps remain. We may address those when we discuss a later group of amendments headed by Amendment No. 101, so I do not want to anticipate them now.
I agree with the Minister that patients forums will not purport to represent the entire local population. The overview and scrutiny committees are there to perform that function. The only problem is that there will be no guarantee under the Bill, as there is at present, that the committees will scrutinise what they are given to scrutinise. As far as I can make out, that power is entirely discretionary.
Some issues may not be of prime interest to local voters but be vital to users of services. I am thinking especially of mental health service users, for example, who may not even vote. They will have little scope to make their voice heard other than through their patients forums, and they may not get far with them.
I should like to comment briefly on the Minister's reply to Amendment No. 109. I am not sure why the Government are seeking to retain the power for patients forums to take over PALS. Patients forums will have a largely volunteer structure and I should have thought that the Commission for Patient and Public Involvement in Health would be a more natural home for PALS than the patients forums.
I am also unclear to what other functions the power may apply. Would the forum concerned have any say were such a decision in the offing? What guarantee is there that the clause will not be used to pass the buck, if I may put it that way, on the Section 11 duty—the NHS consultation duty—to patients forums, making them effectively the market research departments of the trust? I shall have to consider carefully what the Minister has said between now and Report.
Turning briefly to Amendment No. 130, I was prompted to table it by a comment made by a colleague of the Minister's, Hazel Blears. I am advised that her office classified casualty watch as a discretionary activity. If that is the Government's view, that is a great shame. As I pointed out earlier, casualty watch is a service that is valued not only within the NHS but much more widely.
We shall have to return to the matter later, but in the knowledge that we have much more to debate this evening, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 109 not moved.]
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