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Earl Howe: My Lords, the Minister is always very reasonable in his replies to me. I am grateful for the trouble that he has taken to respond to my points. He said essentially that a citizen should be able to rely on his local authority and allow the local authority the freedom to make its own decisions. I agree that in an ideal world that would be the preferred way forward.

However, I cannot help returning to the fact that overview and scrutiny committees are the keystone of the entire architecture of patient and public involvement. It is where the power lies. If they fail for any reason the edifice crumbles. The amendments that I have tabled do not really tell overview and scrutiny committees how to do their job but that that they must do it.

I return to the question that I asked in Committee. If for the past 20 years or so it has been appropriate to give local communities a guarantee that their health services will be scrutinised, why all of a sudden is it not appropriate? I do not think that I have had an answer to that.

Lord Filkin: My Lords, in the Local Government Act 2000 the Government have already placed that responsibility on local authorities. They said that the local authorities had the central constitutional leadership role to promote the economic, social and environmental well-being of their areas. It could not be clearer that they are responsible for promoting the health and well-being of their communities. From recollection, if the noble Lord went back to our debates, I am certain that he would find that we referred to that at the time. The promotion of the health and well-being of their areas was central to the local government argument. That is why we do not think that the amendment is necessary.

The second reason is that these are democratically elected bodies. We still have some separation of constitutional roles between central and local government. Noble Lords frequently criticise this side of the Chamber for putting too many duties on local government. In that respect we believe that these bodies have a clear role and power, which we have affirmed in the strongest possible way by saying that NHS staff have to give evidence to them. They will have access to people and to papers to fulfil their duties. One could hardly affirm the importance of their role more strongly.

I agree with the noble Earl that this will not happen immediately. People will not suddenly be perfect at this. But I do not think that changing a duty to a power will make the slightest bit of difference. The issue is the

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vigour with which we all promote the good practice which will be gained by experience over the coming years.

5.45 p.m.

Earl Howe: My Lords, I am very grateful to the Minister. My understanding of what he said is that there is in effect already a duty in the Local Government Act which obliges local authorities to perform those activities and functions which are conducive to the well-being of the local population. I hope that the noble Lord will correct me if I am wrong, as I realise that I am paraphrasing him.

If that is so, I take the point seriously because it is a new one to me. I must reflect on it. I think that there is a risk as regards resources. Knowing my own local authority and the financial constraints it is under, it is entirely possible that it will be faced with the unenviable task of focusing its resources on those activities that fall into the "must do" category and abandoning—or at least severely curtailing—those activities that are not mandatory. As I understood the Bill before the noble Lord made the helpful comments that he has just made, there would be nothing illegal in its abandoning the overview and scrutiny of health services. I think that the noble Lord has introduced an extremely important ingredient into the discussion. I was minded to press the amendment, but in the light of what he has said I shall not do so. Therefore, I beg leave to withdraw it.

Amendment, by leave, withdrawn.

[Amendment No. 47 not moved.]

Lord Clement-Jones moved Amendment No. 48:

    Page 23, line 38, after "by" insert "Patients' Councils,"

On Question, amendment agreed to.

[Amendment No. 49 not moved.]

Earl Howe moved Amendment No. 50:

    Page 23, line 41, leave out subsection (3) and insert—

"(3) Regulations shall provide for the membership of a Patients' Forum, which shall comprise—
(a) as to at least a quarter of its membership, members or representatives of voluntary organisations whose purpose, or one of whose purposes, is to represent the interests of—
(i) persons for whom services are being provided under the 1977 Act or in pursuance of arrangements under section 31 of the Health Act 1999 (c. 8) (arrangements between NHS bodies and local authorities) in relation to the exercise of health related functions of a local authority, or
(ii) persons who provide care for such person, but who are not employed to do so by any body in the exercise of its functions under any enactment;
(b) as to at least a quarter of its membership, persons for whom services are being provided under the 1977 Act or in pursuance of arrangements under section 31 of the Health Act 1999 in relation to the exercise of health related functions of a local authority;

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(c) as to at least a quarter of membership, persons who provide care for such persons, but who are not employed to do so by any body in the exercise of its functions under any enactment; and
(d) such other persons as may be prescribed."

The noble Earl said: My Lords, Amendment No. 50 seeks to probe the Government on their plans for the composition of patients forums. The key requirement for patients forums is that they should effectively represent the needs of the community that they are appointed to serve. To do that they must have credibility. That means that the public must have confidence in the members.

One feature of the Government's proposals that troubles me not a little is the selection process for who is to serve on patients forums. It has the look of a centrally directed fix. As I understand it, the Government's idea is that the selection should be entirely handled by the Commission for Patient and Public Involvement in Health with guidance from the NHS Appointments Commission.

The guidance from the NHS Appointments Commission, providing that it is simply guidance, is fair enough. But the procedure as a whole is neither clear nor transparent. It has all the makings of a system under which forum members can be parachuted in out of nowhere without anyone locally knowing who they are and what they stand for. That would not be good news.

There have also been suggestions that the commission may give preferential treatment to serving CHC members and officers. I am all in favour of retaining the services of those individuals whose experience and competence are of proven worth. However, it does not seem to me that CHC members, as such, should be guaranteed a fast-track route to membership of patients forums. We all acknowledge that while some CHCs have been extremely effective, others have been less so, which in the end must be a reflection on the calibre of their membership. If the public really is to have confidence that patients forums will provide something that is a cut above CHCs then the last thing that we should be doing, surely, is to encourage the perception that the appointments to patients forums are not being conducted fairly; that is to say, on the basis of a level playing field.

The Commission for Patient and Public Involvement in Health, like it or not, will be seen as a creature of the Secretary of State. Patients forums, like it or not, will be at risk of being seen—in one sense or another—as inside the NHS system because of their inevitable trust-based perspective. Patients forums must look independent and impartial. That means that the appointments procedure itself must look and be independent and impartial. The way they are going, the Government will not achieve that.

The proposals that we have debated for patients councils would address the concern in part, but we must be a bit more specific about the actual membership of patients forums. For example, no current employee of the trust or any other NHS organisation should be eligible for membership. No serving local or national politician should be eligible.

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There should be no overt political bias, a point that was made in the Bristol report, which said that all regulatory systems,

    "must be at one remove from party political debate. They must be seen to have a life and status of their own, free from changes in political fashion".

The people who should be eligible for membership are those who, from the receiving end, have a stake in the success of the trust—in other words, those who have used its services or have had direct experience of it. That includes carers or close relatives of the service users and representatives of local voluntary organisations that act in the interests of patients and carers. Provided that they are fairly appointed—on merit—those people will command the confidence of everybody in the locality. My amendment suggests that there should be a split of membership categories that is prescriptive, but not a strait-jacket. It would, therefore, allow for flexibility.

In your Lordships' House, we are always wary of shopping lists. If my proposal is a shopping list, it is such only in a loose sense. I tabled the amendment in the hope that the Minister would reassure the House about some of the concerns that I voiced and explain in more detail what the Government had in mind as regards the appointments process for patients forums and the kind of people who would be eligible to serve on them. I beg to move.

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