| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Baroness Hanham: I believe and hope that the Minister will acknowledge that I have never at any stage said that I did not think there should be a patients forum representative. I have been seeking all the way through to ensure that there is not only a proper process but a complete understanding of the accountability of this person.
I believe that we are beginning to dig ourselves out of a hole. Certainly what the Minister is saying is getting better as we progress. When we first started there was no question of the appointments commission having any role in this, so I am glad that that has now been accepted.
I was equally interested to hear about the seven voting members on a board because that has the potential—even with a trust that has a university representative—of easing-in a patients forum representative non-executive director without causing too many subsequent ripples. Indeed, at some stage it may be decided that there can be an additional member if seven are allowed. The Minister may wish to continue this discussion in the light of experience as we see how matters progress.
I am glad that the appointments commission will be able to reject a candidate. However, I am conscious that the appointments commission will also be responsible for the appointment of the patients forum candidates. Can the Minister reassure me that once the decision is made as to who the patients forum wants to be elected, there will then be a separate consideration
by the National Health Service Appointments Commission of that person? There may or may not be quite a difference between being a member of a patients forum and a member of a board, but we need two processes in this regard.
Lord Hunt of Kings Heath: There will be different processes. The appointment of patients forum members will be the responsibility of the national commission and the bulk of the work will be carried out by its local staff. But it will be done under the auspices of the appointments commission, which will set the standards under which such appointments take place.
I accept that the noble Baroness was not seeking to criticise the appointment of patients forum non-executives. I fully accept that from her experience as a trust board chair she wants to make sure that the process works as effectively as possible. I will be happy to continue the dialogue over the next few weeks as we debate the Bill to ensure that we make as clear as we can how we expect the system to work.
Perhaps it would help if I gave some examples of where a patients forum representative might be rejected by the appointments commission. This might happen where a candidate lives outside a PCT area; where the candidate has been convicted of a criminal offence; where the candidate is not legally entitled to work in the UK; where the candidate would not be able to be available for approximately five days every month. That is a very important backstop.
Baroness Hanham: I am grateful to the Minister for that explanation. I shall read what he said—and I may take up his offer to come back on this issue yet again—but certainly, for me, his reply was helpful.
This is a completely different appointment to a board than any there has ever been. Like the Minister, I was an elected member on an area health authority, but I did not have inspectorial rights. This patients forum director will come from an organisation which has the right of inspection and criticism, and now a right to report to the overview and scrutiny committee. Such an appointment is potentially more contentious—it need not be—both for the board and the individual. That is my last word on the subject. It is a role that we may need to finesse a little—and, sadly, we may have to do so in the light of experience—but I hope not to have to come back to this issue. If I do, I hope that the Minister will allow me the latitude to do so at a later stage.
Baroness Noakes: I thank noble Lords who have taken part in the debate—particularly the noble Lord, Lord Clement-Jones, and my noble friend Lady Hanham—and the noble Baroness, Lady Masham, for her interesting question. I thank the Minister for his response, in particular for his affirmation of the involvement of the NHS Appointments Commission.
I was almost convinced until the Minister gave examples of the grounds on which a candidate would be rejected. Having told us firmly that candidates could be rejected— which sounded excellent—the
grounds for rejection seem technical—for example, not living in the area rather than not meeting the criteria for being a good contributor to an NHS trust. I should like to press the Minister to say whether or not a patients forum representative could be rejected if that person did not bring anything to the corporate team in terms of directing an NHS trust. However, that point apart, the Minister's response in that area was very helpful.It was also helpful that he reaffirmed that each director of a trust or member of a PCT would have full corporate responsibility. However, there must remain concerns about this because these people will be representatives of organisations with inspectorial rights. Going back to the position of the council-nominated members of health authorities, one of the reasons that they disappeared from the scene was because it was not felt that they contributed in a corporate way. On a universal basis there are honourable exceptions—including noble Lords here present.
I wish to consider the Minister's reply and possibly return to the point. Meanwhile, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
6.30 p.m.
Lord Clement-Jones moved Amendment No. 111:
- Before Clause 16, insert the following new clause—
The noble Lord said: The noble Lord, Lord Harris, was polite enough to talk about gaps in respect of the provisions relating to patient and public involvement. The situation is rather more serious. The word "chasm" would perhaps be more appropriate.
The amendment would establish patients' councils to integrate the work of the patients forums operating in their areas—which in the view of my noble friends and many of your Lordships is a major matter to be put right in the Bill. Amendment No. 111 is similar to that tabled by David Hinchliffe, chairman of the Select Committee on Health in another place, during the passage of the Health and Social Care Bill prior to the last general election—which enjoyed cross-party support in both Houses.
The Department of Health response to the listening exercise stated that patients' councils provided a sensible option for facilitating the co-ordination of patients and public involvement mechanisms—but the proposals do not build on that concept, which is surprising in view of those words.
The amendment provides for the creation of patients' councils as a statutory means of integrating the work of patients forums in a local area. I listened with some incredulity to the Minister talking about how the various forums would, by regulation, track the patient's journey and make sure that it was covered. The Minister seemed to be making a good case for patients' councils but I shall scrutinise Hansard to see whether I can pray his words in aid even further at the next stages.
The local areas covered by patients' councils could be coterminous with a local authority overview and scrutiny committee and provide support to its scrutiny function, although, following discussion, some other area may be preferred. For example, there may be more than one patients' council in a large county. Regulations would provide for membership of relevant forums in other community groups, which may include local strategic partnerships. As membership bodies, patients' councils would be accountable to patients forums. With lay membership and statutory duties, they would also be more accountable to local patients and communities than the Government's proposed commission local networks. As independent statutory bodies, they would help to reinforce the independence of patients forums at local level.
The Government's model is extremely top down, particularly in the workings of the commission. In theory, there is no reason for national or local emanations of the commission to take any notice of the views of the local community on any issue. It is not the commission's job to represent local communities. It is unlikely that local communities would be able to develop the same positive relationship with their local commission as they have in many cases with community health councils. Communities will not own the commission or direct its work—and certainly will not be represented on it.
Patients' councils would operate as a local base for staff provided by the commission for patient and public involvement. Support would be provided for patients forums as needed. Patients' councils would also be able to provide commission advocacy for people wishing to make a complaint about the NHS, in line with the provisions for the independent
As well as providing an identifiable locus where the public could raise concerns about the local health service, patients' councils could act as one-stop shops where the public could get independent information and advice. Community health councils currently provide easily accessible one-stop shops. If they are abolished, the public will face a confusing array of fragmented bodies from which to seek help.
The role of representing local concerns about matters affecting health would be taken by patients' councils rather than the commission. Information about local concerns, including matters that may form the subject of referrals, would be provided as necessary to the local authority overview and scrutiny committee. A local independent statutory body would take responsibility for ensuring that the local community's concerns are raised. Oversight and scrutiny committees and health service bodies could be required to comment on reports.
The national Commission for Patient and Public Involvement in Health would no longer have responsibility, as proposed in the Bill, for making such representations. It would support patients' councils that function and make representations nationally.
Patients' councils would share with the commission the task of ensuring that consultations were undertaken by health service bodies and assist where appropriate. That would ensure that a local independent body took on the vital role of ensuring that patients and the public were consulted locally. That would be more likely to result in local action than relying on outposts of a national, staff-only body.
The national commission would of course be included in the list of bodies to which patients' councils should send their reports. Local authorities have also been included as bodies that must provide patients' councils with information because their work will impact on the health of the local population.
Amendment No. 111 also permits the making of regulations to allow patients' councils to refer matters to oversight and scrutiny committees and, in specified circumstances, for patients' councils to make referrals to the relevant strategic health authority—the Commission for Patient and Public Involvement in Health or the Secretary of State. That is not intended to usurp the referral power of oversight and scrutiny committees but to allow patients' councils to make referrals where OSCs do not carry out their scrutiny functions or where referrals would be more appropriately directed at strategic health authorities.
Currently, OSCs have the power to scrutinise but they do not have the duty, unlike CHCs—which have both the duty and the power. Patients' councils would appoint members to sit on overview and scrutiny committees and strategic health authorities. That would ensure coherent representation of patient forum
The role envisaged for the commission of pioneering new ways of working with local communities and hard-to-reach groups is welcome and would not be compromised by the amendment.
There remains a strong case for a local, lay-led organisation that could pull together all the various fragmented functions of the system; provide and arrange complaint support; represent the local community; and provide a visible, accessible and approachable point of contact to the local community.
In summary, patients' councils would offer integration and simplification; a one-stop shop, less bureaucracy; local credibility and accountability; a powerful independent voice for local people; an overview of health issues and services; flexibility; support and back-up for local authorities; and a genuine local watchdog. All that would be compatible with the Government's overall plans—as they accepted in the 2001 Act. It would be a new way of working, not the recreation of community health councils. Patients' councils would embrace the Government's stated vision of a new approach to patient and public involvement while building on the most valued aspects of CHCs.
I shall not catalogue all the bodies that support patients' councils but they are legion. They include the Patients Association, Age Concern, Action for Victims of Medical Accidents, Help the Aged, Mencap, doctor-patient partnerships, the Royal College of Nursing, the Local Government Association and the Democratic Health Network.
I want to deal with one set of criticisms that appeared in the Guardian today because I know that the Minister, in his entirely dispassionate way, will wish to refer to it. It was interesting that the letter in the Guardian was received directly by noble Lords today. The chairman of the Long-term Medical Conditions Alliance states in her letter:
Of course, there are a number of national charities which are frustrated by this situation. I am a trustee of two of them. But that does not mean that opting for some second-rate, inadequate system of public and patient involvement is the way forward. What we need is a proper scheme that will fill the chasm that I mentioned earlier and make sure that we have the proper involvement and that the new bodies do fulfil a
"ESTABLISHMENT OF PATIENTS' COUNCILS
(1) The Secretary of State shall, subject to subsection (3), establish a body to be known as a Patients' Council ("Council") in England in each area for which an overview and scrutiny committee has been established under section 7 of the Health and Social Care Act 2001 (c. 15) (functions of overview and scrutiny committees).
(2) Each Council shall be appointed from among members of the relevant Primary Care Trust Patients' Forums and NHS Trust Patients' Forums operating in that area and representatives from the relevant community interest groups.
(3) Where it appears to the Secretary of State that there is a need to establish a Council for an area other than that represented by a local authority with overview and scrutiny functions, he shall, after local consultation, establish a Council for such other area as appears to him will meet the needs of the local community.
(4) The functions of a Council are to represent the interests in the health service of the public in its district and in particular to—
(a) facilitate the co-ordination of the activities of member Patients' Forums including by the provision of staff and services to Patients' Forums,
(b) provide or make arrangements for the provision of services under section 19A of the National Health Service Act 1977 (c. 49) (independent advocacy services) at the direction of the Commission for Patient and Public Involvement in Health,
(c) represent to persons and bodies which exercise functions in its area (including in particular the overview and scrutiny committees and the joint overview and scrutiny committees referred to in sections 7, 8 and 10 of the Health and Social Care Act 2001) the views of members of the public in its area about matters affecting their health, and
(d) advise the bodies listed in subsection (5) on involvement of the public in its area in consultations or processes leading (or potentially leading) to decisions by those
bodies or the formulation of policies by them, which would or might affect (whether directly or not) the health of those members of the public, monitor the effectiveness of this involvement and co-operate with the Commission for Patient and Public Involvement in Health in carrying out this function.
(5) The bodies referred to in subsection (4)(d) are—
(a) health service bodies,
(b) other public bodies, and
(c) others providing services to the public or a section of the public.
(6) The Secretary of State shall, following consultation with the Association of Community Health Councils for England and Wales, Community Health Councils, patients' and carers' organisations and the wider community, by regulation make provision in relation to Councils as to—
(a) the Patients' Forums and other community interest groups from which members of the Council are to be appointed,
(b) any qualification or disqualification from membership,
(c) terms of appointment,
(d) the proceedings of a Council,
(e) the discharge of any functions of a Council by a committee of the Council or by a joint committee appointed with another Council,
(f) the circumstances in which Councils will co-operate with each other in the exercise of their functions and exercise functions jointly with one or more other Councils,
(g) funding of Councils and the provision of staff, premises and other facilities,
(h) the preparation and publication by a Council of annual accounts,
(i) the provision of information (including descriptions of information which are or are not to be provided) to a Council by an NHS trust, a Primary Care Trust, a Strategic Health Authority, the Commission for Patient and Public Involvement in Health, the relevant local authorities or a person providing independent advocacy services (within the meaning given by section 19A of the National Health Service Act 1977),
(j) the provision of information by a Council to another person,
(k) the preparation and publication of reports by Councils,
(l) the furnishing and publication by NHS trusts, Primary Care Trusts, Strategic Health Authorities and overview and scrutiny committees of comments on reports or recommendations of Councils, and
(m) the referral of matters of a prescribed description to any overview and scrutiny committee, the relevant Strategic Health Authority, the Commission for Patient and Public Involvement in Health or the Secretary of State for Health.
(7) The regulations shall also include provision applying or corresponding to any provision of Part 5A of the Local Government Act 1970 (c. 70) (access to meetings and documents).
(8) In section 21(10) of the Local Government Act 2000 (c. 22) (overview and scrutiny committees) after "members of the authority" there shall be inserted "and shall include a person appointed by the relevant Patients' Council".
(9) In paragraph 1 Schedule 5 to the National Health Service Act 1977 (c. 49), as amended by the Health Authorities Act 1995 (c. 17) after sub-paragraph (c) there is inserted—
"(d) persons appointed by the relevant Patients' Councils."."
"It is time for the arguing to stop so that action can begin".
If anyone is guilty of having made sure that the arguing continues and that action cannot begin, it is the Government. The Government are the ones who unscrambled the proposals that were just about there before the last general election. They have wholly failed to come up with a scheme which the majority of people at local level can get behind.
Next Section
Back to Table of Contents
Lords Hansard Home Page