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Earl Howe: My Lords, I give my emphatic support to the amendments, which again expose serious weaknesses in the powers of the commission. The empowerment of patients and the public—by which I mean genuine empowerment—entails making the national body as independent as possible of government and as free as possible to act in ways that will benefit those whom it is established to serve.

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In Committee, the Minister said that he did not think it was appropriate for the commission to be given the wider power of representing the interests of patients and the public; that is to say, speaking up for them. He felt that that was more properly the job of Parliament. I find that a thin argument. Indeed, it is not a real argument at all. Parliament can indeed speak up for people but from where is it supposed to obtain its information? Surely, it must be from organisations which can speak out without fear or favour. Those organisations need the power to obtain the information and disseminate it appropriately and freely. I suggest that that is not usurping Parliament; it is supporting it.

I recall a comment made by the noble Lord, Lord Clement-Jones, in Committee that if the Government are not prepared to see the commission engaging in public debate, all we shall have is a "tame poodle". It will be a creature of the Government in all meaningful senses.

I turn briefly to Amendments Nos. 85 to 90, which are grouped with Amendment No. 53. We move to an equally important set of issues. The Commission for Patient and Public Involvement is supposed to be an independent body operating at arm's length from the Department of Health with the explicit job of assisting patients and others in a locality in having a say in decisions. That is how the Minister described it in Committee, but looking at Schedule 6 I cannot help observing that if the commission is at arm's length from anyone it is surely the patient and not the Department of Health.

The Secretary of State is being given direction-making powers. Why? He surely has enough powers over the commission when he is funding it and approving the business plan. For what purpose are directions needed? There is no equivalent power over the council for the regulation of healthcare professionals? Why does the Secretary of State have to be involved in the appointments process? Why have an independent appointments commission if the Secretary of State is going to make them?

In Committee, the Minister stressed the importance of preserving proper accountability to Parliament and cited that as a reason for the Secretary of State's powers of appointment to the commission and his powers to ensure that funds are applied for proper purposes. That is something of a smoke-screen. The Secretary of State has given himself more power over appointing the supposed national patient representative organisation than he has over the NHS itself. Why? Who is the commission supposed to be serving? Is it the patients or the Government? Why not give patients a sense of ownership of the body by allowing patients forums to nominate those who serve on them?

The claws of the Secretary of State have been sunk deep into the commission. It is a creature of government and will be perceived as such. Everything

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in Schedule 6 speaks of command and control and even at this late stage I hope that the Government will feel able to think again.

Lord Hunt of Kings Heath: My Lords, I am sorry that noble Lords believe that the commission will be a poodle and a creature of the Government. That is certainly not the intention of the Government. We see it as having a vitally important role in enabling people in the community generally to have a say and a view about matters that affect their health and to ensure that their views are taken into account when decisions are made that affect their health.

My noble friend Lord Harris is not in his place at present, but I recall that when we debated these issues during the passage of the previous Bill we discussed the need for there to be a national body which could help improve the quality of patient involvement at local level. I believe that the commission has a vital role to play in that as well as ensuring that the Secretary of State receives advice, as is indicated in Clause 19, on these important issues.

However, to state, as Amendment No. 53 does, that the commission has a much broader representative role is a great step away from what we want to see happen. I do not believe that the commission can be put in place to represent the interests of the entire community of this country on health issues. That is why I made the point in Committee that that is the role of Parliament. If noble Lords are saying that the commission should take on the huge role of representing the whole public interest in healthcare, then we would be giving it a task which it would be ill fitted to perform.

We want to see a commission that will actively seek out the varying views of people with an interest in health—I take the point raised by the noble Earl, Lord Howe, in the last group of amendments—in particular from those people in marginalised groups. We want it to take on a very important role in helping to train and support people to become involved so that they can take part in all the activities that will flow from the enactment of the Bill. Furthermore, we want it to have a major role in ensuring that patients forums themselves are effective. Clause 19(2)(f), which sets out the commission's role in setting quality standards in relation to patients forums and patient advocacy services, will be one of the most important of its functions.

Comments have been made that the commission is not sufficiently independent. The noble Earl, Lord Howe, referred in particular to the level of accountability and control held by the Secretary of State with regard to appointments to the commission. In Committee in the other place we went some way towards reinforcing the independence of the commission. The requirement in the Bill for the Secretary of State to give his consent to the appointment of the chief executive of the commission was removed, as was the ability of the Secretary of

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State to make directions about the appointment, terms and conditions of employment of the employees to the body.

Schedule 6 is based on standard guidance from the Cabinet Office and the Commissioner for Public Appointments on the setting up of executive non-departmental public bodies. Since the functions of the commission will be set out in statute, the Secretary of State has a responsibility to Parliament and, indeed, to the public to ensure that the commission is able to carry out those functions through its key appointments. The chair will need to account for the commission's actions to the Secretary of State, who in turn is accountable to Parliament for those actions. That provides Parliament with the tool for holding Ministers to account over the performance of non-departmental public bodies.

Amendment No. 86 would remove the ability of the Secretary of State to appoint the chair of the commission. I agree that it is important to ensure that the independence of the commission, as an independent body charged with ensuring the effective operation of public/patient involvement in health matters, is not only upheld but is seen to be upheld.

We have said already that the commission board members will be appointed by the NHS Appointments Commission. We have now reflected on the question of the appointment of the chair of the commission. I can tell noble Lords that the Government have decided that the chair, too, will now be appointed by the NHS Appointments Commission. That will go a long way towards meeting the issue of independence, while satisfying the Secretary of State that the probity and quality of the individual who takes the position as chair will be assured.

I turn now to the issue addressed in Amendment No. 88. The amendment would remove the power of the Secretary of State to determine the terms and conditions of the appointment of the first chief executive. The reason why the Bill has been drafted in this way is to enable the commission to get itself up and running as quickly as possible. We have followed the same principles in other new NHS non-departmental public bodies which have been established. After the first appointment, the responsibility for further appointments will become the responsibility of the commission. Indeed, we anticipate that, should the initial recruitment exercise for the chair be successful, then the chair designate would serve on the interview panels for the position of the first chief executive.

I urge noble Lords to consider the following. If the commission is to be successful and if we want it to be up and running in order to be able to carry out its functions, then the early appointment of a chief executive would be extremely helpful. That is the only reason why the provision here has been so drafted.

The amendment also suggests that appointments to the board should be elected and nominated by patients forums. Indeed, the effect of Amendment No. 87 would be to turn the commission into a patients forum representative body and limit competition to candidates known to patients forums. I should like to

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re-emphasise the point I made in Committee: the commission is not a representative organisation for patients forums. It goes much wider than that and it has much wider duties. It is for that reason that we need to be able to draw from a far wider pool of people in order to make the appointments.

Amendments Nos. 85, 89 and 90 concern the Secretary of State's direction-making powers over the commission. I understand why noble Lords may believe that a direction-making power might diminish the independence of the commission, but in a sense we must return to our debates yesterday. It is not envisaged that this direction-making power will be one that will come into play on a frequent basis. It is there as a backstop power, one which will enable the Secretary of State to ensure that the commission does not overstep its power to do things ancillary to its main functions.

As I have already pointed out in relation to the other measures concerning patient and public involvement that we are seeking to establish, it is in no one's interest for such organisations to—

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