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Baroness Masham of Ilton: In the last few months there has been a mushrooming of health organisations, both voluntary and statutory. The Minister has launched many of them, and nobody could do it better than he could. I recently attended a reception for the National Patient Safety Agency, a much-needed National Health Service body. Last night, the Minister also spoke at the Parkinson's Disease Awareness Week reception. Nobody could be more aware of the importance of these valuable bodies, which do excellent work.

Many voluntary organisations give much-needed information to people who are devastated when they have been diagnosed with a long-term medical condition. Those people need information and support. With the complexity of the National Health Service and the need to pass on information about patient groups, there needs to be a powerful, independent voice for local people. I have spoken to many people who have stressed that independence is the most important aspect of a people-led, not staff-led, body. There must be a central point, with easy, friendly access, to co-ordinate and direct the public to the many different bodies. That is why I support the need for patients' councils. If these councils are not independent, many members of the public will not come forward for help and advice, as they will feel that they might be victimised or branded as troublemakers.

During the Easter Recess, I attended a dinner in Harrogate. I talked socially there to a doctor who sang the praises of the Harrogate Community Health Council, and said what a pity it would be if it were disbanded. He also told me that a rumour was circulating the North of England that the Secretary of State for Health had fallen out with a local CHC, and that that was the reason they were being disbanded. I would like to ask the Minister if that is fact or fiction. The Secretary of State should surely be wise enough not to go against the wishes of the public on a matter such as this.

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This is an opportunity to make patients' councils more effective and to allow them to do more than CHCs. People have become frightened of having an operation in case they develop an infection such as MRSA in hospital. If the councils are not independent, and if people do not feel free to speak out, there will continue to be endless cover-ups by some trusts.

I would like to see the patients' councils help to bring health and social services into a better and closer relationship. Patients are left in hospitals, blocking beds, because of the slowness of social services in providing aids and adaptations to make their houses suitable. Patients' councils could help to stimulate the co-ordination of public health matters. I must declare an interest here, because my husband has to have his INR checked periodically—that is a blood coagulation test—and I use a mattress to prevent pressure sores. I have in my bag a letter from the Northallerton Health Services NHS Trust, which tells me that the district nurses service will continue to be provided by the community nurses based at Bedale, but from 1st April 2002, the mattress—which is currently rented by the Northallerton trust—will be rented by Harrogate, because Masham, where I live, will fall under the Harrogate primary care trust.

I give the Committee this example to illustrate how the new system is already causing fragmentation. The public will need patients' councils to be flexible, to cross trusts, to be able to network across strategic health authorities on issues of wider geographical concern, and to sort out many of the small issues of confusion before they become expensive big problems of discontent.

I hope the Minister will be helpful today. So many people support their local healthcare facilities in so many different ways. Patients' councils could encourage them to do more. The National Health Service needs all the help it can get from everybody.

7 p.m.

Earl Howe: I am pleased to support the amendments, which the noble Lord, Lord Clement-Jones, has so ably introduced. I do so mindful of the fact that politics is the art of the possible. I echo the remarks of the noble Lord, Lord Weatherill, that the best model for patient and public representation, for everybody's sake, would be a reform and strengthening of community health councils, as I proposed in my earlier amendment. To my regret, that is not going to happen. Putting our disappointments behind us, it is right that we should examine the proposals that are on the table and suggest ways of improving them.

I shall not repeat all my earlier criticisms of this part of the Bill, but it might be appropriate to focus on a few of its key features. There is a huge gulf between what the Government say they want and what we are being offered in the Bill. The Government say that they want a patient-centred service. How can that be achieved by setting up institution-based representation? As we have said on a number of occasions, a patients forum will monitor only the services of the trust on which it

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is based. Who will monitor the NHS more generally from the patients' perspective or look at the wider dimensions of health-related issues? The best of the CHCs have achieved that informed overview very well. We shall lose that if patients' councils are not established.

We are told that there will be mechanisms to ensure that patients forums work together on key issues. Such informal arrangements are no substitute for having an overarching, lay-led organisation that the public can clearly identify and hear speaking up for them across the NHS. A patients' council would be founded on the combined authority of patients forums, each of which would contribute inside knowledge of its local NHS.

The next main issue is independence and impartiality. I shall have more to say on that theme on a later amendment, but for now I shall underline one point. If patients' forums are to do their job effectively, the public have to have confidence in them. How will that be possible when the only information fed to the forum will come from the trust? How will the forum be able to check up on what the trust is telling it? How will it know whether it is being given the whole picture on clinical priorities in waiting lists, on real trolley time waits in A&E or on the financial state of the trust? Such reassurance and verification would be achieved through patients' councils, which would also be guarantors of independence, giving the public confidence that their interests were being put forward impartially by its constituent patients forums.

The noble Lord, Lord Clement-Jones, has listed many more advantages that could come with patients' councils. The one-stop shop could be restored. As the noble Lord, Lord Rea, said, that may be a cliché, but it is still very much to the point. Many services that the patient could relate to could be centred in one place—complaints handling, information, advice, access to local consultation and so on. We could bring together the array of groups and bodies that the Government are currently proposing for lay reference panels, for local providers of ICAS services, for local networks of the Commission for Patient and Public Involvement in Health. A patients' council would embrace the whole lot and in so doing would vastly improve local lines of accountability, which are singularly deficient in the arrangements as now planned. Patients' councils would also act as community-led health watchdogs, which is perhaps the single most significant net loss arising from the abolition of CHCs.

Those are the main reasons why I support the amendments. The letter from the chairwoman of the Long-Term Medical Conditions Alliance opposing the amendments has been referred to. I have no doubt that she is an admirable and public spirited person, but, if I may say so, she puts herself at risk of being classified as a stooge of the Government. The envelope in which her letter reached me today was identical—with an identical label—to an envelope containing a helpful letter from the Minister. I should be delighted to be told that I am wrong in concluding that both letters were dispatched centrally by the Department of Health.

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I hope that the Minister will not give us a dusty answer to the amendment. If he attempts to do so, he ought to bear in mind that the concept of patients' councils, as embodied here, is supported not just by Members of this House but by numerous patient and voluntary organisations, as the noble Lord, Lord Clement-Jones, mentioned. I hope that we can collectively convince the Government that these are sensible ideas which, if implemented properly, could be a major plank in the delivery of a patient-centred health service.

Baroness Chalker of Wallasey: I hesitate to intervene in the debate, as I am more associated with medical services overseas than those in the UK. I do so as a result of my experience long ago, as Member of Parliament for Wallasey, when we formed the patients participation association to buttress one element of the then CHCs that did not work terribly well. That concerned the links between general practitioners and the local hospital and social services.

That organisation did some excellent work in the late 1980s and through the 1990s. It has now dwindled, but it did so only when the CHCs took up the challenge set by the association. The issue is very important, particularly for older people, who have less confidence in what is going on than some of us who are lucky enough to be told by the Minister and to hear of all the changes in a different way.

The proposal by the noble Lord, Lord Clement-Jones, and others is fundamental for encouraging confidence in the health service. Being sick—even a little sick, as I was some time ago—is not something that one views with any confidence, however good the doctor may be. Being part of the great wheel of the health service terrifies the over 60s and probably people much younger as well.

Establishing a council for the care and consideration of the needs of the patient would be a very valuable service. I hope that the Minister will give serious consideration to accepting the amendment—or a parallel one if there is something not quite right in some aspect of it or if it is not quite correctly drafted, as I well know that Ministers so often say. I believe that the amendment is very well drafted, but should the Minister believe that it is not perfectly drafted I beg him to come back with something that will give greater confidence in the National Health Service, which sometimes has a few problems at the moment.

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