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Lord Clement-Jones: My Lords, I support the amendment moved by the noble Earl, Lord Howe. For patients forums to be properly effective and truly representative, they must include members from a wide variety of backgrounds.

In the past five years, we have debated many health Bills that specify proportions for the membership of many organisations, such as primary care groups and primary care trusts. In that respect, it is a modest amendment and will make sure that we get the balance right. It is extraordinary that a patients forum might have only one patient member.

These are modest and important proposals and could well be accepted by the Government. In general, it would be useful to hear from the Minister how he envisages that the patients forums will be made up.

Lord Hunt of Kings Heath: My Lords, I hope that I can reassure the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, about this matter. They are right to suggest that Clause 18(3) provides the minimum requirements. The detail is for regulations, and we wanted to retain flexibility in relation to membership and the ability to respond to changing circumstances. That is why we have not gone for the list system, as the noble Earl implied.

We will publish regulations, and our intention is that half the membership will be drawn from local patient carer groups and local voluntary organisations. The other half will be made up of a representative selection of patients who use or have used the services of the trust involved. To ensure independence, which is important, appointments will be made by the Commission for Patient and Public

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Involvement in Health, working with the NHS Appointments Commission. Thus, we will strike a balance between the voluntary sector, patients and carers and incorporate experience of the various strands of a patient journey.

I do not accept the specific point made by the noble Earl. The problem with CHCs has not been the calibre of member; in the main, their membership has been highly committed. The problem has been caused by what CHCs have been asked to do. That is why we have sought to split up some of those functions and put them into more focused organisations. I can assure the noble Earl that CHC members will have no prior claim as such in the appointment process, although their background of involvement in patient affairs will, no doubt, ensure that they will be duly considered.

Appointments will be through open competition. We expect advertisements to be placed in the local press, and the commission will be charged with ensuring that as many people as possible are aware that they are encouraged to put their names forward.

The noble Earl spoke about employees of the trust and politicians. I assume that he meant local councillors and Members of Parliament. I do not know whether he meant to go wider than that. I understand why he mentioned that matter, and we will address such issues in regulations. I hope that we do not reach a position in which the fact of being a politician would disqualify someone from membership of any body at all. We must get the balance right; the fact that people have put their name forward for political office is a mark of their public service. I would be wary of extending the principle. We could find that the declaration of any political affiliation whatsoever could somehow disqualify someone from public service.

Ultimately, however much we politicians may disagree on the Floor of the House, we must agree that involvement in politics is an essential part of public service that we should encourage. We will, of course, take account of the points raised by the noble Earl and the noble Lord, Lord Clement-Jones, when we consider the regulations.

Earl Howe: My Lords, I thank the Minister for that helpful reply, but I must respond to his final point about political affiliation. Certainly, I agree that political affiliation of any kind should not bar anyone from voluntary service in whatever form. However, we must be careful about serving politicians or local councillors who have the ability to create an overt political bias in an organisation. Patients forums should not be politicised in that way. That is the point that I was making.

The Government would do well to consider how to involve not just the patients of a particular trust but hard-to-reach groups that may not be registered with a GP. Such people have a legitimate interest in the local community and in the way in which local NHS facilities operate. We must not focus too much on the

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patient category. I agree that patients are an important component of the patients forums, but they should not be the only component.

The Minister's reply was helpful, and I shall read what he said carefully. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Clement-Jones moved Amendment No. 51:


    Page 24, line 11, after "Forum" insert ", a Patients' Council"

On Question, amendment agreed to.

Lord Clement-Jones moved Amendment No. 52:


    Page 24, line 15, after "15" insert "and a Patients' Council established under section (Establishment of Patients' Councils)"

On Question, amendment agreed to.

[Amendment No. 52A not moved.]

6 p.m.

Clause 19 [The Commission for Patient and Public Involvement in Health]:

Lord Clement-Jones moved Amendment No. 53:


    Page 24, line 21, after "Commission" insert "shall represent the interests in the health service of patients and the wider community and"

The noble Lord said: My Lords, I rise to move Amendment No. 53 and to speak to Amendments Nos. 85 to 90 in the group. The purpose of the amendments is to ensure that the new national commission is not limited in its functions and to enhance the independence of the commission.

Statutory bodies are only able to carry out activities and functions which are conferred on them by statute. They are powerless to extend their own remit. Any act they perform which is outside the limits placed on them in legislation will be ultra vires.

At present, community health councils and the Association of Community Health Councils are able to carry out a wide variety of activities because the enabling statute provides that each CHC is,


    "to represent the interests in the health service of the public in its district; and ... to perform such other functions as may be conferred on it by virtue of paragraph 2 below".

That provision is contained in Schedule 7 to the 1977 Act. By the same token, statute also provides that ACHCEW, the Association of Community Health Councils for England and Wales, will,


    "advise Councils [CHCs] with respect to the performance of their functions; and . . . to assist councils in the performance of their functions and to perform such other functions as may be prescribed".

That is also contained in Schedule 7 to the 1977 Act.

Through being charged with advising and assisting CHCs, ACHCEW is thus able to benefit from the wide remit afforded to CHCs. If the clause remains unamended, the commission, for example, would be unable to carry out many of ACHCEW's current functions. Those include research and policy work, conducting casualty-type exercises; running or engaging in national campaigns or making donations to those campaigns; campaigning about national

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policy changes affecting the health service; commenting on guidance issued by bodies such as the GMC beyond those concerns which may fall within the remit of Clause 19(6); and taking legal proceedings. We on these Benches understand that such activities would be ultra vires.

If the Government are genuine in their desire to empower patients and the public, they will expand on the commission's remit. Although pressed several times in Committee, the Minister did not say whether the commission would be able to represent the interests of patients and the public in an independent way, as CHCs and ACHCEW do.

I am afraid that in Committee we pressed on a raw nerve of the Minister's by referring to the example of South Birmingham. A recent report by University College London, PFI vs Democracy—the case of Birmingham's hospitals, describes how the Department of Health tried to silence the South Birmingham CHC and suggests the independent challenging role as a possible reason for the decision to abolish CHCs. It is clear that without the amendment the Commission for Patient and Public Involvement could effectively be fettered. The essence of the amendment is to convert the commission to a powerful voice for patients, which also provides quality assurance for the patient and public involvement structures at local level.

The Government's intentions for the commission were revealed in response to the Bristol inquiry. They described its objectives only as to set standards and provide training and guidance and build capacity within local communities for greater community involvement—in other words, no patient voice role. The purpose of the amendment is to make explicit and put to the forefront the commission's function in a role of representing the interests of patients and the wider community.

Amendment No. 85 is designed to allow the commission to carry out its functions without interference from the Secretary of State; without directions being given by him. The purpose of Amendment No. 89 is to ensure that the Secretary of State will make payments to the commission and that those are adequate to allow the commission to carry out its many functions. The purpose of Amendment No. 88 is to allow the commission to appoint its first chief executive rather than the appointment being made by the Secretary of State for Health. Finally, the purpose of Amendment No. 90 is to prevent the Secretary of State for Health from being in a position to dictate to the commission how it may spend money given to it by the Secretary of State. I beg to move.


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