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Lord Harris of Haringey moved Amendment No. 109A,
- Page 21, line 11, at end insert—
The noble Lord said: During consideration of the Bill, I have already expressed my view that the Government have moved an enormous way to answer some of the criticisms of their earlier proposals for representing and involving the public and patients in the NHS. However, a number of gaps remain and the amendment is intended to fill some of them.
The first element of the amendment is to recognise that the patients forums that relate to primary care trusts will be different to those that relate to other trusts. The reason for that is that they will relate to a trust responsible not only for the delivery of certain primary care services but for arranging for other services to be provided—essentially, they will be local purchasers. Those trusts will also be the only ones that relate to a specific catchment area and population. So the nature of the work of their patients forums will be definably different from that of those that relate to other trusts.
That is a positive factor that should be recognised in the Bill. One of the remaining gaps in the Government's proposals is that there is no mechanism to enable the co-ordination at local level of patients' views, nothing to permit the different strands to be put together. Those strands should be brought together in the patients forum that relates to the primary care trust, which in turn relates to a specific population and area. The amendment would require a patients forum relating to a primary care trust, in considering any services arranged by that trust but for which another patients forum existed, to take into account the views of that other patients forum, so that such co-ordination could occur.
The other element of the amendment is that there should be a clearly laid out mechanism for such patients forums to obtain the views of the public living in the area. That is because they will relate to a trust with a defined catchment area and population. After obtaining those views, the patients forums will be obliged to report on them at least once a year—although I would expect that it would report far more frequently than that—to both the trust for which it is established and which arranges many of the services for the population of that area and the relevant overview and scrutiny committee.
I accept that my noble friend will no doubt tell us that there are all sorts of flaws in the drafting of the amendment, but we have plenty of opportunity to deal with that later. The amendment is intended to ensure that it is clear at local level which patients forum is co-ordinating which issues and that there is a patients forum clearly responsible for obtaining the views of the local population, articulating them and putting them forward. I listened with great interest to the exchange between the noble Lord, Lord Clement-Jones, and my noble friend about the adequacy or otherwise of the views expressed by the South Birmingham Community Health Council, of which I have fond memories. The amendment would require patients forums to put forward in a balanced and properly reflective way the views of the local population and community concerned. I commend the amendment to the Committee and I beg to move.
Lord Hunt of Kings Heath: I am grateful to my noble friend, especially for his acknowledgement that the Government have moved to meet some of the concerns that he expressed about patient and public involvement when we debated those matters during
My noble friend's intention is to make explicit in the Bill the circumstances in which PCT patients forums should work together with other forums, specifically where services are arranged by a PCT that is covered by one forum and provided for by another trust, which is covered by another forum. Secondly, my noble friend's amendment would require patients forums to obtain the views of the public not only on local healthcare services but on public healthcare services. That is an important issue. It would also require forums to make annual reports to local overview and scrutiny committees. All those matters are covered, one way or another, in the Bill.
I agree with my noble friend that it is vital that the forums work together, not least so that they do not duplicate activity. Perhaps more significantly, they should be able to organise themselves—if necessary with the help of the commission—to ensure that their activities reflect the way in which the NHS works and what a typical patient journey looks like.
We will provide in regulations the circumstances in which patients forums should work together. That is provided for in Clause 15(5). The local branches of the commission will assist forums to work together and will be ideally placed to identify areas where there may be a need for joint activity. The reservation that I have about my noble friend's approach is that it would create a hierarchy of patients forum status. The primary care trust patients forum might be seen to have primacy over other patients forums.
I accept, of course, that PCT forums will have an additional degree of insight and awareness of the patient's role, due to their dual role of provider and commissioner. As such, they will have a good deal to offer the collective discussions that the local branch of the commission will encourage. However, it goes without saying that PCT forums will have a different role from NHS trust forums simply because of the different roles of trusts and primary care trusts. We should be wary of creating what might become a hierarchy of different types of patient forum.
The issue of whether primary care trusts should have a specific role in relation to public health is already covered in Clause 15(2), which provides that patients forums,
The final point—an important one—relates to the issue of whether forums can make reports to trusts and overview and scrutiny committees. That is covered in
I shall be interested to hear my noble friend's further thoughts, but I hope that he will recognise that, in the current terms of the Bill, we seek to meet many of the points that he has raised in this important group of amendments.
Lord Harris of Haringey: I am grateful to my noble friend for his response. I accept that it is possible to interpret other parts of the Bill in the way in which he said and that it would be possible for regulations to deal with the issues. However, it would be helpful to have something in the Bill, simply because of the protection that it would afford to such important functions.
I shall not be too upset if the consequence of the amendment is to demonstrate that there are two classes of patients forum. I suspect that, had those who drafted the Bill not wanted to create two classes of patients forums, they would have drafted it in another way. The forums are set up in different ways under paragraphs (a) and (b) of Clause 15(1). In those circumstances, it should be recognised that a particular set of functions fall on the patients forum that relates to the primary care trust.
I shall read what my noble friend said with interest, and I hope that, before Report, it might be possible for us to have some indication of the content of the various sets of regulations to which he referred. That would give us a way of judging whether the points have been adequately addressed. It remains my preference for such matters to be addressed in the Bill. At this stage, however, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Noakes moved Amendment No. 110:
"( ) A Patients' Forum established under subsection (1)(b) must—
(a) in monitoring and reviewing the operation of services under arrangements made by the trust for which it is established, and provided by a trust for which another Patients' Forum is established, have regard to the views expressed by that Patients' Forum,
(b) obtain the views of the public living in the area for which services are provided or arranged by the trust for which it is established about the provision of health care services and the state of the public health in that area, and
(c) make a report on the views obtained under paragraph (b) above at least once a year to the trust for which it is established and to the relevant overview and scrutiny committee."
6 p.m.
"will monitor and review the operation of services provided by, or under arrangements made by, the trust for which it is established".
Given that primary care trusts will be the principal public health authorities in the NHS, the patient forum of a primary care trust is well able to discharge the responsibility relating to public health that my noble friend suggested.
After Clause 15, insert the following new clause—
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