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Lord Clement-Jones: The Minister seemed to miss out most of the red meat of public debate. Is he saying that it will not be possible for the commission to engage in a national campaign or one about policy changes affecting the health service? Will it not be able to comment on guidance issued by professional bodies
that are not acute trusts or PCTs? Is the Minister saying that the campaigning element will be completely absent?
Lord Hunt of Kings Heath: The commission will have a crucial role in bringing to the Government's attention issues relating to the way in which the health service is involving the public in local decision making. Clause 19(2)(b) gives a clear function in advising the Secretary of State in relation to advocacy services. Subsection (2)(c) gives the commission a clear function in representing to the Secretary of State and to other prescribed bodies arrangements in relation to patients forums. It allows the commission to provide assistance to patients forums, to advise and assist providers of independent advocacy services, and to set quality standards. Those seem to me to be wide-ranging functions which will enable the whole public involvement in the NHS to be much more effective than it is at present.
Lord Clement-Jones: I am sure that the Minister is quite genuine in his response. However, the worry in relation to Clause 19 is that we are merely creating a tame poodle—that the commission will not have teeth. I know that this Government are not particularly fond of public debate, but those who want to see the commission prosper want it to be able to engage in public debate, to represent the interests of local patients and the public and to be able to debate and campaign in a robust way. That is a perfectly legitimate thing to do in a democracy in regard to what is probably the most important area of public service that we have.
There is the huge suspicion—which I share—that Clause 19 represents an emasculation of what we already have. I recognise the Minister's sincerity. I am sure that lawyers will pore over his words as they will be used to interpret Clause 19 in due course, and to that extent they may find his words helpful. However, there is the suspicion that the provision does not go nearly far enough. That is a matter of great regret.
I hope that the Minister will consider the matter further. I share the view that at national level the commission is an important body. Where we clearly differ—as in the debate on patients' councils—is on what role the commission should play at local level and whether people should rely on what is effectively a government body to do the campaigning for them at local level.
Lord Hunt of Kings Heath: In my reference to Clause 19 I missed out subsection (2)(g), which states that the commission has the function of,
- "representing to persons and bodies which exercise functions in relation to any area . . . the views of members of the public in that area about matters affecting their health".
Lord Clement-Jones: Those are slightly weasel words. I did not respond to the noble Lord, Lord Harris, for which I apologise. The positioning of the
amendment at the beginning of the clause was designed to elicit a response from the Minister at large, rather than in regard to the individual subsections.I still do not believe that that gives a great deal of comfort. It is highly targeted forms of representation—not, for instance, a media campaign—which would be legitimised by paragraph (g). I believe that the Minister would have to accept that in terms of the interpretation of the clause.
Everything is carefully parcelled up. I am sure that these clauses have been drafted for a purpose. The thinking has been: "Yes, but we must not give them too much". That is the key worry. I do not intend to press the amendment at this stage. However, we may wish to return to it. I believe, in common with many others, that the powers of the commission will be crucial. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 129 to 131 not moved.]
[Amendment No. 132 had been withdrawn from the Marshalled List.]
[Amendments Nos. 133 to 136 not moved.]
Schedule 6 [The Commission for Patient and Public Involvement in Health]:
Lord Clement-Jones moved Amendment No. 137:
- Page 85, line 2, leave out from beginning to second "the"
The noble Lord said: Perhaps I may pick up a further strand relating to the commission. I believe that the noble Earl, Lord Howe, will speak to the remainder of the amendments in this group. I shall not elaborate on the issue at great length.
The point has arisen that the commission should be free of the trammels of the Secretary of State. This is a running theme throughout the Bill. Most of us on the Opposition Benches are agreed that the Bill—despite having the intention of decentralisation—in actuality takes considerable extra power for the Secretary of State. This is just another example. The Commission for Patient and Public Involvement in Health will be subject to directions given by the Secretary of State. Effectively, therefore, it will be the creature of the Secretary of State.
If the Secretary of State and his ministerial colleagues really wanted to give the assurance that this body would be a robust public representative that could challenge and scrutinise and do all the things that it needs to do, they would agree to the removal of these words. It should be wholly independent of the Secretary of State and of any possible political interference and, if it were, it would enjoy much greater all-party support and, no doubt, that of patients' organisations as well. I beg to move.
9.15 p.m.
Earl Howe: I rise to speak to Amendments Nos. 138, 139 and 141. I am sorry to say that, due to an error, Amendment No. 140 was withdrawn without reference to me, but I trust that I may speak to it briefly.
The Commission for Patient and Public Involvement in Health, which is to be established under Clause 19, will, as the Minister said, have a major role to play in ensuring that the new arrangements that will replace CHCs really work. At national level, it will have the task of issuing guidance and providing training, as well as advising the Secretary of State. At local level, its function will be to support the work of patients forums and to provide wider community involvement in local health decisions. Just as patients forums need to be independent of the trusts to which they relate, so too does the commission need to be independent. What is more, it needs to be seen to be so.
It is, therefore, anomalous that Schedule 6 to the Bill should provide for the chairman of the commission to be appointed by the Secretary of State. There should be a bottom-up, rather than a top-down, approach to appointments in the commission. The first chairman of the commission is, perhaps, a separate case, but even he or she should be appointed by the NHS Appointments Commission rather than by the Secretary of State. Subsequent chairmen should, in my view, be appointed by members of the commission. That formula would ensure that the commission was independent, and it would remove any possibility of political interference. Unless the commission is independent in that sense, it cannot gain the full confidence of patients' organisations. We would do well to bear in mind that the Secretary of State does not even appoint the chairmen of NHS trusts nowadays. So one has to ask why he should have the power of appointment over the chairmanship of a body such as this, which has a much greater need than any NHS trust to prove an absence of political bias.
Then we come to the membership itself. If the majority of members of the commission are nominated and elected by patients forums, that will ensure its democratic accountability to the main patients' representation bodies. That is what Amendment No. 139 proposes. Similarly, I ask why it should be the Secretary of State who appoints the first chief executive. The chairman and members of the commission should do that themselves; they should also determine the terms and conditions of his or her employment. The chief executive must have credibility as an independently appointed champion of patient representation. That will hardly be the case if people regard him or her as a political appointee.
Lord Hunt of Kings Heath: These amendments concern the level of control and accountability that the Secretary of State has with regard to the commission in two areas: appointments and funding. Schedule 6 is based on standard guidance from the Cabinet Office on the setting up of executive non-departmental public bodies, and replicates what has already been applied in the case of the Commission for Health Improvement.
The commission will be an independent organisation, but, because it is to be publicly funded, there has to be some form of formal accountability to Parliament, in addition to its making annual reports to the Secretary of State. The clauses and the schedule in
the Bill before your Lordships tonight are based on that principle. Because the functions of the commission will be set out in statute, the Secretary of State has a responsibility to Parliament and to the public to ensure that it is able to carry them out. One of the ways of making that possible is through the key appointments to the commission.The chair and the chief executive will need to be able to account for the commission's actions to the Secretary of State, who, in turn, is accountable to Parliament. This process provides Parliament with a tool for holding Ministers to account over the performance of non-departmental public bodies. I do not believe that the commission is different from any of the other important non-departmental bodies that have been established in relation to the National Health Service.
Amendment No. 138 would remove the Secretary of State's ability to appoint the chair. If the Secretary of State did not appoint the first chair, who would? Although the Secretary of State could delegate the appointment to the NHS Appointments Commission—as he does in the case of local organisations—in the end, it is a Secretary of State appointment.
As I said earlier on Amendment No. 104A, it is a necessary part of the constitutional arrangements to ensure public accountability that the Secretary of State appoints the chair of the commission. I do not see why this commission should be seen as any different from any of the other seven executive non-departmental public bodies that the department is concerned with.
Amendment No. 141, which is consequential on Amendment No. 140, would remove the Secretary of State's ability to appoint the first chief executive of the commission. It is our intention that subsequent chief executives would be appointed by the commission, but it is not unusual when establishing new organisations for the Secretary of State to make the first appointment, as happened in the case of the Commission for Health Improvement. This is not to do with issues of independence; it is simply to do with the fact that unless the Secretary of State is able to make such an appointment, there can be a long delay before the chief executive is in place. We all agree that, because of its importance, the commission should be up and running as quickly as possible.
Amendment No. 139 makes the valid and interesting suggestion that appointments to the board should be elected and nominated by patients forums. However, it would turn the commission into a patients forum representative body. The commission has a vital role to play in relation to the work of patients forums, but it is not there simply to act as a mouthpiece for them. It is a national resource for everyone who wants to speak up on matters that affect their health.
We want the board members of the commission to be of the highest possible calibre. Recruitment of the chair, chief executive and board members will be through open competition. We want the net to be cast far and wide. It should certainly not be confined to patients forum nominees or representatives.
As I said on Amendment No. 104A with regard to CHI, the commission will be funded from public money. There has to be a mechanism for ensuring that the money allocated to it is spent on enabling it to discharge its functions. The suggestion in Amendments Nos. 137, 142, 143, 144 and 145 seems to be that the Secretary of State should have no power of direction over how the commission should spend the money it is allocated. Instead, that accountability would be provided only through conditions attached to funding. That approach is more limiting. It would restrict what the commission could spend its money on to what was set out in the conditions. Directions could be added throughout the year, thus giving more flexibility.
As I said on Amendment No. 104A, if a serious problem arose in relation to the commission's activity or governance that, for whatever reason, the commission was failing to address, it would surely be right that the Secretary of State, who is accountable to Parliament for how that body acts, should be able to take whatever action is necessary at the time. If a non-departmental public body receives funds from the Secretary of State, as in the case of the commission, it is appropriate and necessary for there to be some control to guard against financial impropriety and to ensure that the funds are applied for proper purposes, as set out in the Bill.
The Government want the commission to be as effective as possible. We want it to have as strong a membership and staff as can be. We shall do everything we can to support that. However, as with any non-departmental public body, there must also be safeguards for the public purse and public accountability. That is why the Bill is drafted as it is.
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