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Baroness Noakes: My Lords, I rise to support Amendment No. 39 and to pay tribute to my noble friend Lady Hanham for her tenacity in raising the issues posed by the appointment of patients forum members as representative members of PCTs and of NHS trusts.

There are two aspects to this matter. First, we seek to ensure that people appointed to PCTs and NHS trusts have the right competencies. There can be no place on these bodies for mere representatives. The people appointed to such boards must meet certain quality thresholds and there should be no question of devising special categories for members from patients forums or, indeed, from anywhere else. To do otherwise would be to jeopardise the integrity of those boards.

Secondly, the patients forum representative must be for corporate members of the PCT or the NHS trust. They cannot serve on the boards and say that they are in place solely, or even mainly, to represent the concerns of the patients forum. Their responsibilities go far wider than that.

I hope that the Minister will be able to give the assurances asked for by my noble friend. If no clear answers can be given, then the only way forward would be to place the issues beyond doubt by way of this amendment.

Lord Hunt of Kings Heath: My Lords, I am most grateful to the noble Baroness, Lady Hanham, for her interest in this matter. Of course she speaks with a great deal of authority as the chair of a large NHS trust in London. As the noble Baroness mentioned in her remarks, I have been pleased to meet her on a couple of occasions to try to go through some of the detail of how this will work in practice.

I wish first to make it clear that the NHS Appointments Commission will appoint all non-executives to trusts and it will appoint the patients forum non-executives. Those non-executives will be appointed subject to exactly the same checks and balances. The way that it is to work in practice has been agreed with the commission. One of the members of a forum will then be interviewed by a panel which will include the chair of the trust. If the candidate fits the criteria set by the Secretary of State, the panel will recommend to the commission that the candidate should be appointed.

I have listed the specific criteria under which a person might not be appointed. The noble Baroness thought that that was somewhat mechanical. However, she was right to draw attention to the more

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general qualities that are required for all non-executives. Some of those essential requirements are that they need to live in the area served by the trust; they must have a strong personal commitment to the NHS; they should be able to demonstrate a commitment to the needs of the local community; they must be good communicators with plenty of common sense; they must be committed to the public service values of accountability, probity, openness and equality of opportunity; they must be able to demonstrate an ability to contribute to the work of the board; they must be available for up to five days per month; and they must be able to demonstrate an interest in healthcare issues. Those criteria are regarded as essential.

We then move on to the desirable criteria. They should have experience as a carer or a user of the NHS; they should have experience of serving in the voluntary sector, in particular within an organisation working with health issues; they should have already served the local community in local government or in some other capacity; they should have an understanding of or experience in management either in the public, private or voluntary sectors; and they should be able to offer specialist skills or knowledge in the work of the trust. Those are exactly the kind of qualities on which a judgment will be reached about any non-executive.

It is also worth making the point that the members of patients forums will have to go through an appointment process. I should have thought that many of the qualities required for membership to an NHS trust would apply equally to membership of a patients forum. I also believe that the role of the chair of the trust in the appointment process will be very important indeed. They will be able to give their assessment of whether the candidate would work well with the rest of the board. They would also be able to tell whether the candidate has the required skills for that particular trust and they would be able to make clear to the candidate the kinds of duties and responsibilities that the candidate would be called upon to contribute to the work of the board.

I turn now to the issue of corporate responsibility. It goes without saying that the patients forum non-executive will have exactly the same corporate responsibilities as a member of the board. I do not run away from the fact that sometimes it will be difficult for the patients forum non-executive to balance those corporate responsibilities against the spread of views that may be expressed by the patients forum. However, as I have often pointed out in this debate, the health service is well used to appointing people to serve on boards who have to strike a balance between different responsibilities. I can cite my own experience in the 1970s when I was appointed by Oxford City Council as a member of the Oxfordshire Health Authority. I remember clearly that it was a challenge to balance those responsibilities. However, it is our experience that most people are able to face up to that challenge. Ultimately, it is far better to have people inside the board rather than on the outside.

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When a patients forum non-executive ceases to be a member of the forum, he or she will have to step down from the trust board. The forum would then elect another candidate to be considered by the appointments commission.

The noble Baroness raised the important issue of whether the non-executive from the patients forum will be appointed in addition to the existing non-executives or in the fullness of time replace a non-executive who has come to the end of his or her term in office. There is a degree of flexibility. NHS trusts are enabled to request an increase in the number of non-executives. Apart from trusts providing high security psychiatric services, which have seven non-executives, most trusts have five non-executives. Those trusts can move up from five to seven subject to their requesting the agreement of the Secretary of State, that agreement being given and the necessary regulation being laid. So within the current system there is scope for increasing the number of non-executives.

I hope that the noble Baroness feels that I have answered most of her points. We have benefited from her input. As we move to developing regulations to give effect to this policy, we would be pleased if she were able to give us the benefit of further advice during that stage.

4 p.m.

Baroness Hanham: My Lords, I have a feeling that I should quit while I am winning. I am extremely grateful to the Minister for his reply to what has become a detailed questionnaire. He has now resolved all the points. If he is offering me a chance to help with the regulations, I shall be absolutely delighted to do so. I am grateful to the Minister. On that basis, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Clement-Jones moved Amendment No. 40:

    Before Clause 16, insert the following new clause—

(1) The Secretary of State shall, subject to subsection (2), establish a body to be known as a Patients' Council ("Council") in England in each area for which an overview and scrutiny committee has been established under section 7 of the Health and Social Care Act 2001 (c. 15) (functions of overview and scrutiny committees).
(2) Each Council shall comprise from among members of the relevant Primary Care Trust Patients' Forums and NHS trust Patients' Forums operating in that area and representatives from the relevant community interest groups.
(3) Where it appears to the Secretary of State that there is a need to establish a Council for an area other than that represented by a local authority with overview and scrutiny functions, he shall, after local consultation, establish a Council for such other area as appears to him will meet the needs of the local community.
(4) The functions of a Council are to represent the interests in the health service of the public in its district and in particular to—
(a) facilitate the co-ordination of the activities of member Patients' Forums including by the provision of staff and services to Patients' Forums,

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(b) provide or make arrangements for the provision of services under section 19A of the National Health Service Act 1977 (c. 49) (independent advocacy services) at the direction of the Commission for Patient and Public Involvement in Health,
(c) represent to persons and bodies which exercise functions in its area (including in particular the overview and scrutiny committees and the joint overview and scrutiny committees referred to 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)) the views of members of the public in its area about matters affecting their health, and
(d) advise the bodies mentioned in subsection (5) on involvement of the public in its area in consultations or processes leading (or potentially leading) to decisions by those bodies or the formulation of policies by them, which would or might affect (whether directly or not) the health of those members of the public, monitor the effectiveness of this involvement and co-operate with the Commission for Patient and Public Involvement in Health in carrying out this function.
(5) The decisions in question at subsection (4)(d) are those made by—
(a) health service bodies,
(b) other public bodies, and
(c) others providing services to the public or a section of the public.
(6) The Secretary of State shall, following consultation with the Association of Community Health Councils for England and Wales, Community Health Councils, patients' and carers' organisations and the wider community, by regulation make provision in relation to Councils and in particular provide as to—
(a) the Patients' Forums and other community interest groups from which members of the Council are to be appointed,
(b) any qualification or disqualification from membership,
(c) terms of appointment,
(d) the proceedings of a Council,
(e) the discharge of any functions of a Council by a committee of the Council or by a joint committee appointed with another Council,
(f) the circumstances in which Councils will co-operate with each other in the exercise of their functions and exercise functions jointly with one or more other Councils,
(g) funding of Councils and the provision of staff, premises and other facilities,
(h) the preparation and publication by a Council of annual accounts,
(i) the provision of information (including descriptions of information which are or are not to be provided) to a Council by an NHS trust, a Primary Care Trust, a Strategic Health Authority, the Commission for Patient and Public Involvement in Health, the relevant local authorities or a person providing independent advocacy services (within the meaning given by section 19A of the National Health Service Act 1977),
(j) the provision of information by a Council to another person,
(k) the preparation and publication of reports by Councils,
(l) the furnishing and publication by NHS trusts, Primary Care Trusts, Strategic Health Authorities and overview and scrutiny committees of comments on reports or recommendations of Councils, and
(m) the referral of matters of a prescribed description to any overview and scrutiny committee, the relevant Strategic Health Authority, the Commission for Patient and Public Involvement in Health or the Secretary of State for Health.

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(7) The regulations shall include provision applying or corresponding to any provision of Part 5A of the Local Government Act 1970 (c. 70) (access to meetings and documents).
(8) In section 21(10) of the Local Government Act 2000 (c. 22) (overview and scrutiny committees) after "members of the authority" there shall be inserted "and shall include a person appointed by the relevant Patients' Council".
(9) In paragraph 1 of Schedule 5 to the National Health Service Act 1977 (c. 49), as amended by the Health Authorities Act 1995 (c. 17) after sub-paragraph (c) there is inserted—
"(d) persons appointed by the relevant Patients' Councils."."

The noble Lord said: My Lords, in moving Amendment No. 40, I shall speak also to the consequential amendments in this group.

These amendments seek to establish patients' councils to integrate the work of the patients forums operating in their area. As I explained in Committee, Amendment No. 40 is similar to the one put forward by David Hinchliffe, MP, the chairman of the Select Committee on Health, during the passage of the Health and Social Care Bill before the last general election, which enjoyed cross-party support in both the House of Commons and the House of Lords.

The amendment provides for the creation of patients' councils as a statutory means of integrating the work of patients forums in a local area. This local area would in general be co-terminus with local authority overview and scrutiny committees and provide support to their scrutiny function. Regulations would provide for membership from relevant forums and other community groups.

As membership bodies, patients' councils would be accountable to patients forums. With lay membership and statutory duties, they would also be more accountable to local patients and communities than the Government's proposed local networks of the commission, which are set out in response to the listening exercise. As independent statutory bodies, they would help to reinforce the independence of patients forums at local level.

Patients' councils would operate as the local base for staff provided by the Commission for Patient and Public Involvement in Health. They would also be able to provide or commission advocacy for people wishing to make a complaint about the NHS in line with provisions for the independent complaints advocacy service now contained in the Health and Social Care Act 2001. As well as providing an identifiable point where the public can raise concerns about the local health service, patients' councils could also act as one-stop shops where members of the public could get independent information and advice.

Under the amendment, the role of representing local concerns about matters affecting health will be carried out by patients' councils rather than by the commission. Patients' councils would share with the commission the task of ensuring that consultations are carried out by health service bodies and assist where this is appropriate. The national commission will be included in the list of bodies to whom patients' councils should send their reports.

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Patients' councils will appoint members to sit on overview and scrutiny committees and strategic health authorities. This will ensure a coherent representation of patients forums members' interest at a strategic level.

Overall, there is an extremely strong case for a local, lay-led organisation which would pull together all the various fragmented functions of the system; provide and arrange complaints support; represent the local community; and be a visible, accessible and approachable point of contact for the local community.

In contrast, the Government's model, relying on a national commission, is built from the top down. In the Government's model there is no in-built reason why the national commission or its local manifestations should take any notice at all of the views of the local community on any issue. Community health councils currently provide easily accessible one-stop shops. In contrast, the Government's scheme involves a confusing array of fragmented bodies from which to seek help.

It seems extraordinary, after all this debate, that the Government are not accepting what seems to most of us to be sound common sense. In Committee, the Minister offered three main reasons for the Government's reluctance to accept patients' councils—that is, the possible usurping of patients forums' role as the main source of influence within the system; the perception that introducing patients' councils would add an additional tier of bureaucracy; and, finally, the need for flexibility to work across administrative boundaries.

This misrepresents what is proposed for patients' councils in the amendment. For example, patients' councils would not affect in any way the role of individual patients forums as the key bodies working with and within NHS trusts, monitoring services and bringing about change. Local patients forums would simply come together to form patients' councils. This would allow their respective expertise to be shared to provide a joined-up view of a local health economy, the patient journey experience across different trusts, and wider health and health inequality issues. They would provide a focal point for local communities and have powers to take up issues of concern with oversight and scrutiny committees and others. These roles are otherwise lacking in the Government's proposals.

Introducing patients' councils would significantly reduce bureaucracy and simplify the system. Patients' councils would take away the need for several strands of bureaucracy contained in the Government's proposals—for example, local networks of the Commission for Patient and Public Involvement in Health; lay reference panels or other artificial means of forcing the different patients forums to work together and the commission to take account of them through as yet unspecified regulations; and the bureaucratic

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exercise of the commission's staff tendering, contracting, monitoring and evaluating independent complaints advocacy services from a variety of separate organisations. Staff based with patients' councils could provide this service more efficiently and consistently from an identifiable one-stop shop.

Under the Government's proposals, individual patients forums would need to compete for staff support from an entirely separate, staff only, local network of the commission. This would be unwieldy and bureaucratic. Patients' councils would combine the local staff of the commission with lay members drawn from patients forums and the wider community to work as a tight, efficient team.

It has also been implied that the local authorities' overview and scrutiny role in some way negates the need for patients' councils. However, many local authorities have expressed enthusiasm for the concept of patients' councils because they provide a natural link with the patient and public involvement system and would make it easier for them to engage with patients and the community on health issues. For instance, the Democratic Health Network, part of the Local Government Information Unit, supports patients' councils in these words:

    "The Democratic Health Network very much welcomes the idea of Patients' Councils to bring together the work of Patients' Forums. One of our main concerns has been the lack of a voice for patients that goes across the whole care pathway, from social services to tertiary care, because the transition from one level of care to another has often been problematic for service users and patients and is where 'seamless' care can often break down".

The Government know that the amendment has enormous support right across the voluntary sector; it has support from local government and it has wide support within this House and in the other place. They should listen to that overwhelming body of opinion on this matter. I beg to move.

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