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Lord Rea: The noble Lord, Lord Clement-Jones, has described very clearly the functions of the patients' councils proposed in the amendment. I put my name to it because I feel that the matter merits particular consideration by my noble friend. It is not that I feel that he does not give full consideration to every amendment; but, as he knows well, the amendment had considerable support in another place from government Members as well as opposition Members. My purpose is to give it support from this side of the Chamber.

Throughout our deliberations today, I have had a strong sense of déjà vu. However, matters have moved on since this time last year. The Bill as it stands is certainly an improvement on last year's version in terms of representing patients' interests. Nevertheless, the underlying disquiet about the abolition of the CHCs remains. That is not because CHCs are averse to reform or to change—quite the contrary. But by proposing simply to scrap them and start afresh, the Government have lost a wide tranche of support right across the political spectrum. I am afraid that that includes some of their most loyal supporters.

The uncertainty about the future of CHCs has already led to a haemorrhage of some of their most able staff and members. However, many of those who remain want to see an effective system of representation and independent scrutiny of the NHS up and running, whatever the name of the organisation, as soon as possible. They accept that many of the Government's proposals are attractive, but the system proposed in the Bill is complex. Patients and the public in general will need the equivalent of an A-Z guide to find their way through it.

The CHCs provide an entry point which people have learnt to use. Even if 97 per cent of people apparently did not know about their CHCs—and I find that difficult to believe—their social worker, if they had one, their local citizens advice bureau, and certainly their legal advisers or general practitioners, did know how to get in touch with the local CHC. The CHCs have provided a single entry point which people have learnt to use—the term "one-stop shop" should now perhaps be put on one side; it has become a cliché. It is useful for people to be able to go to one place—not only patients but, importantly, other people who are concerned about the working of the National Health Service in their area. These points were raised by my noble friend Lord Harris. The concerns of the population, as well as those of patients, must be looked into properly.

The proposal for patients' councils brings back such a single-entry facility. But more than that, as the noble Lord, Lord Clement-Jones, pointed out, the councils would act as independent, locally based co-ordinating bodies which would oil the wheels of the system of patients' forums, independent advocacy services and scrutiny which will come into being with the passage of the Bill.

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The amendment received a great deal of support when David Hinchliffe's Bill was debated in another place. Its principles have wide support from national organisations. I have counted at least 24 which have voiced concern about the abolition of the CHCs and the inadequacies and complexity of the replacement structures. The noble Lord has mentioned a few. I mention the BMA, the GMC, the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, the National Association of Citizens Advice Bureaux and the Consumers' Association.

I have also been reliably informed that, only yesterday, a meeting of the Transition Advisory Board (TAB), set up by the Department of Health to smooth the changeover from CHCs to the new system, reached the conclusion that a co-ordinating body very similar to the patients' councils proposed in the amendment should come into being in each local area. CHC representation in TAB is only one-third of its membership; and I am told that it did not advocate patients' councils as such. The other two-thirds include government representatives, local government representatives and the voluntary sector.

For all the reasons put forward by the noble Lord and those that I have mentioned, I hope that my noble friend will give serious consideration to the amendment and, if necessary, come back on Report with another one which embodies its principles but which may differ in detail to suit the Government's legislative rules.

6.45 p.m.

Lord Weatherill: My interest in the amendment, to which I have added my name, stems from my experience as Member of Parliament for Croydon North East for many years and the high esteem in which the Croydon CHC was held, not only by volunteer groups in my borough but also by individuals and by Croydon council. Indeed, when the abolition of the CHCs was first mooted, the council passed a resolution which was supported by all the political parties—which rarely happens in Croydon.

Perhaps I may place on record what the resolution said:

"This Council is proud of the way that Croydon CHC provides a strong and independent voice for the people of Croydon on NHS matters and of the way it carries out its functions as the local watchdog . . . This Council judges that the involvement of an independent watchdog role is essential in helping the Council undertake its proposed new responsibility for scrutiny of the NHS and in adding cohesion to, and commanding public confidence in, other initiatives in the NHS Plan".

Against that background, I am sure that many in Croydon and many others elsewhere—judging from my post-bag—will share my disappointment that the CHCs are to be abolished. That is why I have added my name to the amendment. It is a compromise. As a Whip for many years in the other place, as Chairman of Ways and Means, and as Speaker, I have had considerable experience of the art of compromise. Patients' councils would provide a means of progressing the most important role of the CHCs and

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would work perfectly well within the context of the Government's own framework for patient and public involvement.

Unless we seize this opportunity to achieve consensus on this issue, it is hard to see how or why the public should have confidence in the Government's proposals. I therefore hope that the Government will accept this compromise solution to a matter that is causing concern to so many in the health service in my former constituency and elsewhere, and among many other organisations across the nation. I repeat that this proposal has strong support in the other place, and I hope that this amendment will find favour with Her Majesty's Government and with the Minister at the Dispatch Box this evening.

Baroness Pitkeathley: Many of us who have worked for a long time with patients and user organisations are aware of the frustration expressed in the letter from the Long Term Medical Conditions Alliance quoted by the noble Lord, Lord Clement-Jones, and of the anxieties that the alliance expressed about the promotion of bureaucracy at the expense of the voice of individual users of the National Health Service. We are also aware of the excitement and anticipation felt by many groups about the possibilities offered by the new structures, and of their wish to get on with making them work for the benefit of patients, carers and the general public. It is certainly true that we do not yet know how these structures will work, but I believe that there are adequate safeguards as to accountability and review built into the process.

Prolonging the debate and making new proposals is not helpful at this stage. The Government have shown great commitment to public and patient involvement, and the Minister has also shown his personal commitment to that, time and again. It is now time to get on with it, and to take advantage of the great good will that exists in the field towards the proposals. I oppose the amendment.

Baroness Carnegy of Lour: It seems to me that we are at last having a realistic discussion on the subject of patient involvement, because patients are being treated as what they are, which is customers of the National Health Service. When the noble Baroness, Lady Pitkeathley, contributed before—and my noble friend on the Front Bench commented on this—she let the cat out of the bag by saying that the Government see members of the public as, in a sense, members of the National Health Service. She implied that the National Health Service was a big tent that included the patients. It is not like that. The National Health Service is a service provided for the public. The public are the customers, and they must be able—at some point in this huge, byzantine structure that is being set up—to have an independent view.

When my noble friend Lady Hanham was describing, from the point of view of the board, the problem of having the chairman of a forum as a member of the board, I wondered what would happen if a patient happened to disagree in a way that could not be reconciled with the view of the board. What

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would happen to the wretched chairman? By creating this big tent, the Government have created big problems for themselves. The noble Lord, Lord Clement-Jones, has suggested a mechanism by which there could be straightforward representation of public and patient interests from outside the National Health Service, which is, after all, their service, provided for them and paid for by them. That proposal does, indeed, clarify the issue.

As I listen to this discussion, I see the Government getting themselves into the most amazing muddle, and, in the long run, their proposals will not work. They cannot work because there is a conflict of interest in the system. The public must be able to say, "We think you are wrong, and we want something different". They must be able to do that through a body that is independent of the service. To that extent, the noble Lord, Lord Clement-Jones, is making a very important suggestion.

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