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Baroness Finlay of Llandaff: I support the amendments. I have listened to the comments that have been made so far and feel that, as a healthcare professional, it is important that I voice my support. The independence of the view of patients is crucial. I cannot over-emphasise how vulnerable patients feel when they are ill. If they feel that they are complaining into an organisation on which they are dependent for their care, they are terrified that there may be some backlash against them.
Only this week I sat with a patient who asked whether he had grounds for complaint. He was frightened of raising the issue with me. I went through
the issues and felt that he might possibly have grounds for complaint, but not for litigation, and explained the situation to him. As he looked at me with tears in his eyes, he said that I had put his mind at rest, for which he was grateful. However, he also said that he had been frightened even to raise the issue.I believe that such independence is crucial, and that the House ignores the issue at its own peril and at the peril of the public. Healthcare professionals ignore the need for an independent patient voice at their peril, because that is the safeguard in ensuring that we improve the standards of practice.
7.15 p.m.
Lord Hunt of Kings Heath: Like the noble Lord, Lord Clement-Jones, I regret that it was not possible in the dying stages of the previous Parliament to reach a final settlement on the successor arrangements to community health councils. If we had been able to do so, much of the current uncertainty would not exist. That was unfortunately not to be, but life moves on.
I have absolutely no quarrel with the motivation behind the amendment or with the noble Lords who have spoken in favour of it. The need for co-ordination at local level between patients forums is inescapable and very important indeed. However, I disagree with the noble Lords on the way in which that co-ordination should operate. The noble Lord, Lord Clement-Jones, described our proposals as "top down", but I very much disagree with that description. We are simply saying that patients forums—which are at the local level where the patient receives services—will be the truly important agency for involving the public.
My worry about patients' councils as proposed by the noble Lord, Lord Clement-Jones, is that rather than helping a decentralised model to work more effectively, they will create a further statutory tier of patient involvement which will get in the way of a fluid approach to co-operation between patients forums at a local level. I stress that all of the functions described in the amendments are already provided for in the Bill. Moreover, we have reached the current position after being informed by a great many views from a wide range of stakeholders and informed observers. That makes me very confident about the integrity of our proposals. Our system has been recognised by many people as stronger, more independent and better placed to deliver the necessary empowering structure.
The concept of patients' councils is not new; indeed, it has been a critical developmental stage for our proposed arrangements. In many respects, our debate on patients' councils in the previous Session was the catalyst for moving us on to think through the key issue of how to ensure both an informed and continuing process of review at the organisational level, through patients forums, and how to meet the need to build up a picture of patients' experience across a wider health economy. We are proposing that the latter need be met through the auspices of the commission at the local level.
When we discussed patients' councils in the previous Parliament, the proposal was that they should be matched to about 100 health authorities. As noble Lords know, however, it is now envisaged that there will be 28 strategic health authorities in England. That is another very big change from the circumstances which applied when we last debated patients' councils.
As I understand it, the noble Lord, Lord Clement-Jones, is also proposing that patients' councils should match the local authorities which are responsible for establishing overview and scrutiny committees. Surely he will accept, however, that the flow of patients does not necessarily match local authority boundaries. Therefore, even if we established patients councils at the local authority level, we would still have to make other arrangements to ensure that we can capture the patient experience of people outside those local authority boundaries. I believe that our proposals much better meet the need for flexibility and recognise that patient flows go very much wider than current local authority boundaries.
I think that we can all agree that the overview of the patient experience must result from the combined activity of the elements of the new system which we are proposing. We believe that patient forums and the independent complaints advocacy service providers have to be empowered to perform their functions effectively and in a manner which develops their capacity to grow. We all believe, I think, that forums must work together to share outcomes, to plan joint work and to identify key themes and trends from across their respective boundaries. We believe that the system must be informed by the real life experience of patients and not just of a few patients by proxy. I think that we also agree that the public must know how to access support if they want to complain, how to get their views heard, how they can make a difference, and who is responsible for decisions to put things right. I think that we all agree that we must have consistent standards across the country.
All of those issues are addressed in the Bill. The fundamental change to our proposals since we debated the previous legislation is our proposal to establish a Commission for Patient and Public Involvement in Health. The commission will have not only core functions at a national level, which we shall debate shortly, but—and this is so important—a range of local functions. Therefore, as we have discussed, the key issue is the relationship between patients forums and the commission at the local level. It is clear that the forums will require effective and skilled staff support, and it is the commission that will provide it. Forums will also require briefing support and assistance with administration and secretariat roles and the management of finances.
The noble Earl, Lord Howe, dealt with forums' need to have information so that they can make judgments on the effectiveness of the trusts which they will review. The commission will have a very important role to play in that. Moreover, the CHI reports will be a very valuable addition to the resources available to each patients forum. We are also proposing in the Bill the creation of a new Office for Information on Health
Care Performance which will also provide much needed valuable information to individual patients forums. Commission staff working at local level will clearly have a very important role to play in supporting the work of patients forums and enabling those forums to make the most of the responsibility being given to them.We intend to make regulations requiring patients forums to come together on a regular basis to share their findings. As is argued for the patients' councils amendments, this sharing of information is critical to ensuring that the "patient's journey" is truly understood and captured. We shall also use the regulation-making powers in the patients forums clause—Clause 15(5)—to require forums to work together. Clause 19(2)(d) allows for the commission to provide assistance to patients forums and to facilitate the co-ordination of activities. Clause 19(5) states:
- "The Commission is, so far as practicable, to exercise its functions by reference to the areas of Primary Care Trusts".
I would argue that the crucial importance of the work of the national commission at local level, with a staff resource that will be available at local level, will give a much more flexible approach to achieving the kind of co-ordination between patients forums that noble Lords desire and it captures the entire patient journey, as so eloquently suggested by the noble Earl, Lord Howe, without setting up another statutory patient organisation at the patients' council level.
I would be very cautious about detracting from the primacy of the role of the patients forum at that level. Statutory patient councils would do that. Our approach in using the auspices of the national commission at local level will achieve all that noble Lords desire.
Lord Clement-Jones: I thank the Minister for his very interesting reply. He tried to pull out all the stops in his arguments, but it is clear from the speeches of other noble Lords that the arguments are against him. He can be in no doubt about the feeling of the Committee, with the exception of the noble Baroness, Lady Pitkeathley. I wish that I could be excited about the proposals and the new structures. It is far more preferable to reduce our enthusiasm slightly and wait a little longer until we have a set of proposals that we can support.
I very much appreciate and agree with the arguments of the noble Lord, Lord Rea, as to the importance of the single point of access. I have not used the phrase "one-stop shop"; we must clearly desist from overworking that phrase. That is one of the key arguments, and the noble Lord, Lord Weatherill, made some important points about the trust and confidence that people have in their local CHCs. We must ensure that any scheme of reform has the same degree of public trust.
The noble Baroness, Lady Carnegy, is not known for supporting my propositions, but she really put her finger on the point. Ministers talk obsessively about the system being one of patient and public involvement, which comes from inside rather than outside the NHS, and so on. The argument advanced
by the noble Baroness about there being a conflict of interest tucked in there somewhere is extremely important.The vital issue of independence was raised not only by the noble Baroness, Lady Carnegy, but by the noble Earl, Lord Howe and the noble Baronesses, Lady Finlay and Lady Masham. The Minister did not give the lie to that argument. I thought when considering the wider element of confidence in the NHS that the remarks of the noble Baroness, Lady Chalker, were extremely important. It is a matter of fundamental confidence and one that will have great significance for the public, whether they are patients, family, carers, or whatever incarnation they may have. It is important to have that broad view of both primary and acute care. The patients' councils would do that.
It is gratifying that the Minister accepts the need for co-ordination, but the way in which that takes place is crucial. He talked about a fluid approach, but others might describe it as an incoherent approach. He talked about not being top down. The commission is the creature of the Secretary of State for Health. How more top down than that can one get? I cannot agree with the Minister on that either.
The Minister is extremely confident about the integrity of his proposals. I am afraid that outside this House, vast numbers of people do not have great confidence in those proposals. It is interesting that the Minister talks about these proposals—patients' councils—being part of the genesis of the new exciting era, as outlined in the Bill as it stands. It is certainly not a building block; it is rather like a stage of a rocket that is dropped off half-way through its ascent to the stars. That is all that it is and it bears no relationship to the Government's current proposals. It is all very well for the Minister to say that patients' councils no longer fit as we now have strategic health authorities, but that is just because the goal posts have been moved. I do not agree with that scheme of devolution, but that is clearly a separate matter.
The proposal for patients' councils does not assume coterminosity with local authorities. It is a matter of discretion. They could be coterminous where appropriate, but they may not be, and they may need to be wider than the boundaries of local authorities.
We have had a good debate. I hope that the Minister is considerably more flexible and sympathetic than he appears because we shall be a ferocious dog with this bone throughout the passage of the Bill. I assure him that it is the single most important matter to which we shall return on Report and Third Reading, if necessary. I trust that the Minister will ponder further between now and the next stage. In the meantime, I thank Members of the Committee for their support and contributions. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 16 [Entry and inspection of premises]:
[Amendments Nos. 112 to 114 not moved.]
[Amendment No. 114A not moved.]
Clause 17 agreed to.
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