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Lord Harris of Haringey: I am grateful to my noble friend for indicating that he supports the direction of the amendment. I am also grateful for his clear commitment that staff of patients forums will be employed by the commission at national level and be subject to all the employment circumstances that follow from that. That is an important principle in terms of demonstrating the independence of the staff supporting patients forums from local health service bodies and agencies.
However, I am not entirely satisfied that the responses given will in practice address the point. It seems to me that there could well be circumstances in which a local patients forum which, although to many independent bystanders, might appear to be doing an effective job, will be regarded by the commission as being a considerable "pain". Therefore a member of the staff of the commission, who will be performance managed on the basis of how well he or she supported the patients forum, will have the wonderful excuse that, because these people are complete maniacs to deal with, it is an impossible job and he cannot achieve anything. And the performance management regime may well recognise that.
Despite the fact that some patients forums will be difficult, will not fit a national pattern and will not be doing the sorts of things that the commission may wish them to be doing but will be doing other things relevant to their local communities or the interests of the patients they are representing, we would like to see a circumstance in which they will still be able to influence the work programme that the staff are supporting. It is clear that the staff will be doing other things as well. But it would be helpful if some way could be found of reflecting on the face of the Bill or perhaps in the many sets of regulations promised at a later stage, the partnership described by my noble friend.
Lord Hunt of Kings Heath: I have already intimated that we shall be bringing in regulations to govern the relationship between forums and the commission. I shall be happy to give further consideration to the specific point my noble friend raised to see whether or not we should put more detail into the regulations to cover it. In general one has to rely on common sense. In most cases, the relationship between patients forums and the commission would be able to deal with the issues raised by my noble friend. I do not see any reason why we should not cope with that satisfactorily.
Lord Harris of Haringey: I am grateful for that further assurance from my noble friend. I hope that when considering the shape of regulations explicit reference to the nature of the partnership and the handling of staffing arrangements will be made. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
The Deputy Chairman of Committees (Lord Ampthill) : The Minister replied to Amendments Nos. 142 to 145 without my hearing the noble Lords who tabled them speak to them.
[Amendments Nos. 142 to 145 not moved.]
Clause 20 [Abolition of Community Health Councils in England]:
Earl Howe moved Amendment No. 146:
- Page 26, line 14, leave out subsections (1) to (3) and insert—
The noble Earl said: The amendment has a simple purpose: to ensure that the abolition of CHCs and ACHCEW is not effected before the new bodies are fully operational. It is in the interests of patients and the public that there should be so far as possible a seamless transition between CHCs and their successor bodies. CHCs should continue to perform their statutory functions until the new arrangements are fully up and running. In some areas of the country it is more than possible that that will not happen by the target date of 1st April next year. In that event, patients must not be left without a watchdog. The timing of abolition for CHCs should depend on consultation.
Similar considerations apply to ACHCEW. As we all know, it plays a key role in consultation with government and with leading health professional and regulatory bodies such as the GMC, the RCN and the BMA. It runs high-profile monitoring campaigns such as Nationwide Casualty Watch, which highlights long
Lord Clement-Jones: I support Amendment No. 146, for the cogent reasons given by the noble Earl, Lord Howe. The timing of the abolition of CHCs allied to the timing of the setting up of the new bodies is clearly crucial. On our calculation it could be anything up to nine months or a year before the new bodies come into effect. What will fill that gap? It should be the continuance of the old system until the new system is up and running. I should be interested to hear what scheme the Minister has in mind and how he intends to fill that gap.
Lord Hunt of Kings Heath: I agree that we need to ensure a smooth transfer from current arrangements to the new arrangements. It is our intention that CHCs will not be abolished until the commission and patients forums are in place and overview and scrutiny committees are carrying out their health service scrutiny functions. For that reason we have set up and are working closely with a transitional advisory committee, which is giving us great help.
Once the commission is established we shall be taking its view about the readiness of the new system, and particularly that of patients forums to take over from CHCs. Between now and the abolition of CHCs we shall work closely with all those organisations to ensure no gaps are left in the system. CHCs will not be abolished until we are confident all their functions have been picked up in the new system: independent advocacy by independent complaints advocacy providers; scrutiny by OSCs; and monitoring of local services by patients forums. There will be a managed transition to all parts of the system. Until the end of the year the transitional board will work closely with officials in my department, acting as a resource for them and providing insight into the issues that will be important to stakeholders as the system changes.
As regards consultation, I am very reluctant to prescribe with whom we should consult on the face of the Bill. However, I can say that arrangements to involve and consult stakeholders are in place. The department has a great deal of experience in consulting with a wide range of organisations. We shall certainly not let the system down in relation to patient/public involvement.
Earl Howe: Although the Minister has not been able to go quite as far as my amendments would require, I find his reply largely reassuring. I shall, of course, read his response carefully in Hansard. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 147 not moved.]
Earl Howe moved Amendment No. 148:
The noble Earl said: This amendment takes us into an area that is of prime importance if the voice of patients is truly to be heard, and if that voice is to be a constructive instrument for change in the health service. The regulations governing community health councils grant a right to CHCs to be consulted on any proposals that would lead to a major change in the provision of healthcare in an area. They also enable CHCs to notify the Secretary of State when they are not satisfied that sufficient time has been allowed for consultation on proposals of that kind, or where they believe that a consultation has been inadequate.
There are many examples of that sort of consultation. At present, if a health authority or PCT wishes to make a change in the way that services are provided to patients, the CHC is consulted. If, as
Once CHCs have been abolished, I am very worried that there will be no equivalent mechanisms to ensure the same kind of consultation with, and by, the successor bodies on changes to local health services. There are several gaps in the Bill in this respect. We understand that overview and scrutiny committees (OSCs) will be able to make referrals to the Secretary of State on controversial decisions, or if they think that consultation has not been adequate. Well, that is positive; but there are no provisions to that effect in the Bill. We do not even have draft legislation to go on. Can the Minister say what will happen if an OSC chooses not to refer a matter of intense local concern and simply does nothing? In those circumstances, and as a longstop, I believe that there ought to be a way for patients forums to refer directly to the Secretary of State, or to their local strategic health authority.
Again, at present, if there is a consultation exercise that falls short of what is correct—let us say, if insufficient information is given out, if facts and figures are misrepresented, or if key people have been left out of the loop altogether—CHCs have a duty to refer the matter to the Secretary of State. When CHCs disappear, the Health and Social Care Act 2001 does not provide any channel for the referral of failures to consult or of inadequate consultations. This means that those health bodies which decide not to consult, or which contrive to fix the result of consultations, will get off scot-free unless challenged in the courts. Again, OSCs have no rights of referral in this Bill. Patients forums will have neither the resources nor the legal power to engage in legal proceedings. So what remedy will there be? Apparently none.
There is another kind of consultation absent from the Bill. At the moment, the Secretary of State must consult CHCs on reorganisations of health authorities, NHS trusts, and PCTs, as well as on changes to GP and pharmacy services. These are matters that can make a real difference to local communities. It is absolutely right that those communities should have a chance to say what they think. In Clause 1 of the Bill we have a provision that permits consultation on the establishment or variation of a strategic health authority. It seems to me that that does not go far enough. We should have a specific provision on the face of the Bill that requires consultation on all re-organisations, including the establishment of care trusts. But the same applies equally to proposed changes in specialist commission—intensive care, HIV, paediatric care and coronary care. If there are flaws in the plans put forward to re-organise this or that aspect of healthcare provision, and local people realise that, they should have a guaranteed route up the line to the Secretary of State.
Consultation of this nature is not and should not be an optional extra. The whole point of any reform to the National Health Service is to improve services to patients. The best way to ensure that we have that right is to ask patients what they want. I suggest that that dialogue between government and the public is fundamental to good policy-making. It is also one way of balancing out the tendency of a state-run monopoly provider of healthcare to impose solutions from above on a one-size-fits-all basis.
My amendment attempts to carry through to the Bill the current statutory obligations to consult at government and local level on major decisions affecting patients. I believe they are vital for the well-being of patients and the NHS. I beg to move.
"(1) The Secretary of State may by order provide for the abolition of Community Health Councils established for districts in England under section 20 of the 1977 Act and for the abolition of the Association of Community Health Councils for England and Wales ("ACHCEW") established under paragraph 5 of Schedule 7 to the 1977 Act.
(2) Before making such an order, the Secretary of State shall consult with those bodies in subsection (3), and must be satisfied that there are in place replacement bodies able to meet the needs of patients and communities nationally and in all localities in England.
(3) The bodies referred to in subsection (2) are—
(a) overview and scrutiny committees or joint overview and scrutiny committees provided for in sections 7 (functions of overview and scrutiny committees), 8 (joint overview and scrutiny committees etc) and 10 (application to the City of London) of the Health and Social Care Act 2001 (c. 15),
(b) Strategic Health Authorities,
(c) Patients' Councils,
(d) Patients' Forums,
(e) Community Health Councils,
(f) The Commission for Patient and Public Involvement in Health,
(g) The Association of Community Health Councils for England and Wales, and
(h) such other bodies as the Secretary of State shall deem appropriate."
9.45 p.m.
After Clause 20, insert the following new clause—
"REFERRAL OF CONSULTATION ARRANGEMENTS AND DISPUTED DECISIONS
(1) In section 11(2) of the Health and Social Care Act 2001 (c. 15) (public involvement and consultation) for paragraph (a) there is substituted—
"(a) the Secretary of State,
(aa) Care Trusts,".
(2) Before an establishment order for a Strategic Health Authority, an NHS trust, a Primary Care Trust or a Care Trust is made, varied or revoked, the Secretary of State shall consult those bodies in subsection (5) whose districts are wholly or partly within the area of operation of the relevant authority or trust.
(3) Any Strategic Health Authority considering whether to exercise its powers under section 17A of the 1977 Act shall first consult the bodies provided for in subsection (5) whose districts are wholly or partly within the area of operation of the relevant Primary Care Trust.
(4) The Secretary of State shall by regulations make provision—
(a) concerning the application of section 11 of the Health and Social Care Act 2001 such that if in the view of any of the bodies in subsection (5) consultation arrangements are inadequate, the body in question shall refer the matter to him;
(b) for the referral to Strategic Health Authorities of disputed decisions concerning the planning or operation of health services by bodies detailed in subsection (5);
(c) for circumstances in which bodies detailed in subsection (5) shall refer decisions concerning the planning or operation of the health service to him including the circumstances in which referrals shall be made directly to him by Patients' Forums and Patients' Councils on the failure of overview and scrutiny committees to respond to a referral made to them under section 18(2)(m) of this Act;
(d) placing a duty on the Secretary of State and those bodies receiving referrals to respond to them within a specified time limit and giving reasons for any decision taken in relation to the subject matter of the referral.
(5) Those bodies referred to in subsections (2) to (4) are—
(a) overview and scrutiny committees or joint overview and scrutiny committees provided for in sections 7 (functions of overview and scrutiny committees), 8 (joint overview and scrutiny committees etc) and 10 (application to the City of London) of the Health and Social Care Act 2001,
(b) Patients' Councils,
(c) Patients' Forums."
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