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Baroness Pitkeathley: My Lords, I have spent a large part of my life campaigning for a stronger voice for patients and the public in public services. If I felt that patients' councils would help that along, I would support the amendment. However, I do not feel that it would give patients greater recognition or power. It would introduce a new bureaucratic structure with no guarantee of greater patient power.

The Government's commitment to increasing patient and public involvement in the health service, which I believe is at the heart of the NHS reforms, has not received sufficient recognition or praise. The new system, with the patient advocacy and liaison services, the patients forums and the local and national elements of the commission, is the biggest boost ever given to patients in the history of the NHS. We should rejoice in that. It is not about organisations representing patients or speaking on their behalf; it is about bringing patients into the system and enabling them to help with planning according to community needs, to make decisions and to control resources.

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That is a huge cultural change in the NHS and many people will resist it. It will take time and it will take even more commitment. That is why we need the many different strands of enabling patient power to develop.

However, I am in sympathy with the idea of enabling patients forums to share their experience and learn from good practice. I do not feel that patients' councils are the way to help that along. The one-stop shop is always a seductive idea. We hear about it in many contexts—one-stop shops for carers, one-stop shops for the lottery and so on. The idea of the high street presence is very attractive and seductive, but it is hard for it to give real access to patients. We need a single point of access, but that can be done by telephone or, increasingly, by the Internet. Patients need as many points of entry as possible in order that their voice can be as strong as we can make it.

Lord Weatherill: My Lords, I regret that I disagree with the noble Baroness, Lady Pitkeathley. One of the differences between this House and the other place is that in my former incarnation as Speaker I had to listen to endless speeches over and over again, whereas here I am able to say that the points that I wanted to make have been rather better made by the noble Lord, Lord Clement-Jones.

I strongly support the amendment for all the reasons that I gave in Committee on 11th April at cols. 581 and 582. In contrast to what the noble Lord, Lord Peyton, said about the previous amendment—which was very difficult to understand and had all the impact associated with the old Army phrase, "If you can't tell 'em, confuse 'em"—this one is clearly set out in ways that we can all understand. I hope that it will commend itself to your Lordships. As the noble Lord, Lord Clement-Jones, has said, it has wide support in the other place and I trust that the Government will accept it.

4.15 p.m.

Baroness Carnegy of Lour: My Lords, the noble Baroness, Lady Pitkeathley, understands the Bill very well. She has explained that patients' interests will be dealt with in a new way within the system. As somebody who has not worked in the National Health Service, I can understand the thinking behind that. The trouble is that the means allowed for patients' representation are locked into the system. We have heard from my noble friend Lady Hanham the problems presented by the chairman of a patients forum being on the board of the trust. I understand why that provision has been included, but it is bound to alter the way in which the forum can operate. That is clear from the structures. Anyone who has been involved in administrative systems can see that it gives a particular characteristic to the patients forum.

The most important aspect of Amendment No. 40 comes in subsection (4), which says:

    "The functions of a Council are to represent the interests in the health service of the public in its district".

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Every member of the public is potentially a patient. At any given moment many members of the public have relatives or friends who are patients. The public, not just patients, have a continuing interest in the health service. The public must surely be able to feed their thoughts into the system from outside, not from within the system.

My general worry about the Bill is that there is too much of the big tent about it. It embraces everybody who is concerned as if they were all members of the health service, whereas the public are not members of the health service; they are the customers. The amendment identifies the public as the customers and would enable them to get at the health service from outside. That is its main advantage. The community health councils did that and the proposed patients' councils would do the same. It is an important addition to the system that would not conflict with the rest of the Bill. We should accept it.

Lord Peyton of Yeovil: My Lords, I agree with what my noble friend has just said. The Government have set up an elaborate new organisation that is quite powerful. There is a real danger that people on the ground—or on the operating tables and in the wards—will tend to be forgotten and reduced to statistics for waiting lists and the rest of it.

I fear that the Government are attempting to defend their new organisation against the possible irritations caused by complaints from patients' councils. That could well happen. I remain extremely doubtful about the remoteness of strategic health authorities. I also have grave doubts—I am afraid that I was not able to stay yesterday—about the organisation known as the Commission for Health Improvement. As I have said before, I always suspected that health improvement was the task of the department, but now we have a special commission for it. Unlike the department, which occupies modest offices, the commission occupies some very smart premises in Finsbury. Despite what it says, it leaves in its wake a trail of people who have been vexed and irritated by yet one more inquiry.

The more organisations there are that are capable of subjecting everybody to inquiries, the more we need some defence with the eloquence that a patients' council could generate. I hope that the noble Lord will forgive me if I repeat the quotation that I gave at an earlier stage of the Bill from the chairman of a large hospital group, who told me clearly, "We are suffering from death by a thousand visits". I fear that these thousands of visits by invigilators, inquisitors, monitors and the rest are becoming a real pest. I am left with the hope that patients' councils—which the Minister seems to think will be a source of discomfort—may prove to be what is wanted, as at least one line of defence against the inquisition of potential tyrants.

Baroness Masham of Ilton: My Lords, the previous amendments have illustrated the complexity and confusion surrounding the Bill's proposals on the new bodies to represent patients. The Government are

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setting up an independent audit committee to ensure that the new money coming into the National Health Service is spent correctly, and that seems wise. They have made it clear that there is a need for independence. Why are they so adamant that patients should not have an independent body representing them? I cannot understand that, especially as the Minister understands the National Health Service so well. If patients' councils are set up, it will be vital that they are both independent and are seen to be independent. Unless patients or their representatives have an independent body to go to for help and advice, they will feel gagged and vulnerable when using the service.

One sometimes wonders whether the National Health Service is run for the patients or the staff who work within it. For years, there has been a health centre in North Yorkshire where the staff car park was smoothly tarmacked while the patients' car park was full of potholes and rough stones. It is important that one has as good facilities as possible for patients. If patients do not have an independent body with a wide variety of people representing them who have the interests of the National Health Service at heart, it will seem that the Government are not allowing freedom of speech and freedom to try to strive for good, acceptable standards for all who work and use the National Health Service.

Staff have their unions and professional bodies. Patients also need an independent voice, not a fragmented muddle. I therefore support the amendment.

Lord Stoddart of Swindon: My Lords, I do not think that I would have entered this debate—this is my first say on the Bill—unless I had had an unfortunate experience with the Department of Health. That experience concerns mixed-sex wards, a matter which I have been pursuing for the past eight years and has not yet been revolved. As it is quite clear that mixed-sex wards are still with us, in December, I wrote a letter to the Department of Health. Although I waited for three months, I received no reply. Indeed, I would not have had a reply by now if I had not tabled a question for Written Answer asking for one. If that is the way in which I am treated as a Member of your Lordships' House, what chance is there for the ordinary patient? He has no chance at all.

The fact, unfortunately, is that the patient is not treated as a customer or as a patient to be respected. All too often, he is treated as a supplicant. We must understand that patients are not supplicants. Currently, on average, each family in this country pays between £2,000 and £2,500 annually for the health service. So he is not a supplicant, he is a paying customer. He deserves to be treated in that manner. In normal circumstances, one would expect that a business with captive, paying customers would treat those customers very well indeed. At the moment—make no mistake about it, I am a supporter of the National Health Service—they are not being treated in

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that way. Patients therefore need a voice, and a strong one. What is proposed in the Bill is not a strong voice but a diffuse voice.

I shall support the amendment because it will give focus to that voice. I hope that it will give power to patients. I hope that, if this amendment is sustained and the Government accept it, patients' councils will believe in themselves and in those whom they represent and not cosy up to the National Health Service or the entrenched bureaucracy, but work on behalf of patients and not be afraid to voice their own and patients' concerns about the organisation of the National Health Service, which needs a very great shake-up indeed.

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