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Earl Howe moved Amendment No. 19:

Page 26, line 15, after "bodies" insert "or persons"

The noble Earl said: My Lords, at Report stage the noble Lord, Lord Clement-Jones, tabled an amendment the purpose of which was to broaden the functions of the Commission for Patient and Public Involvement in Health by giving it the unfettered role of representing the interests of patients and the wider community. It was an important amendment which went to a Division and was defeated. I have not sought to bring back those particular issues at Third Reading. I have instead tabled Amendments Nos. 19 and 20 which are narrower in scope. Specifically they are designed to extend the matters upon which the commission is permitted to make representations and to widen the audience, as it were, of those to whom it is allowed to speak.

We can see in subsection (2)(a) of Clause 20 that the commission has the function of,

"advising the Secretary of State, and such bodies as may be prescribed, about arrangements for public involvement in, and consultation on, matters relating to the health service in England".

In other words, the commission's functions are all about process. The rest of the clause continues in that vein. What the commission does not appear to be about is the experiences of real patients or the configuration of health services. That, for me, is a missed trick. At the moment CHCs and their national body, ACHCEW, can carry out a wide variety of activities. They can brief the press about hospital closures or policy changes affecting the health service. Another thing they can do is brief Members of both Houses of Parliament about issues relating to patient representation. It is no secret that ACHCEW has briefed me for this Bill and has done so very well. If the Government are serious about having a national body which is there to support the empowerment of patients—and that is what the commission is supposed to be about—surely to goodness it has to be allowed to do more than just comment to the Secretary of State about the arrangements in place to deliver that empowerment. This whole exercise should not just be about structures and processes; it should be about what matters to patients, and the commission should be allowed to speak out publicly on any matter if it wishes to.

The scope of these amendments is much more restricted than the one that was defeated at Report stage. I am not now proposing an unfettered power because the amendments would in fact allow the Secretary of State to decide exactly how the

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commission should operate. But when it comes to the matters where the commission has a legal standing, I do think that we need to progress beyond the scope of subsection (2) and the relatively narrow set of issues detailed in subsection (6)—the safety and welfare of patients. We need a body that can speak out on matters that bear upon the health service more generally. Again, I think of exercises such as Casualty Watch or speaking out on a particular PFI project. Why should it not be allowed to do such things? The danger, as the noble Lord, Lord Clement-Jones, said on Report, is that once the commission's permitted activities are set in stone in the Bill, any attempt to stray beyond them will technically be ultra vires. We should build in an element of flexibility.

I hope that the Minister will treat these amendments more kindly than the amendment that we debated on Report. They are intended to be helpful. I beg to move.

Lord Clement-Jones: My Lords, like the noble Earl, Lord Howe, I regret the fact that the amendment tabled on Report was not agreed to. I assure the Minister that these amendments are not the previous amendments in a different guise. They are much more limited in their extent and would, as the noble Earl explained, simply widen the subject matter on which the commission can make representations.

Without the amendment, as the noble Earl explained, the commission would be restricted to making representations about the arrangements for patient and public involvement, as opposed to the issues that really affect people's health and health services. In view of the information that the commission will be amassing, it would be a waste to have such a body if it was not able to make representations to the Secretary of State and others on the issues that really matter. That would leave patients and the public effectively without a voice on health services at national level.

As the noble Earl explained, ACHEW is currently able to draw on the information, experience and expertise of CHCs and its own research to inform what it says or asks for—indeed, campaigns for—at the national level. Recent examples include: changes in investment in accident and emergency services, which was a result of its regular "casualty watch" survey; debates on charging for NHS services, which were stimulated by its recent report, A tax on illness; and the representations that it is currently making on patient confidentiality.

The amendments would allow the commission to take up such issues at the national level; it would otherwise be prohibited from doing that. It should be noted, however, as the noble Earl pointed out, that the commission will still be restricted to making representations to bodies and persons who are prescribed by the Secretary of State. If the Minister would state which bodies and persons he envisages the Secretary of State prescribing, we should all find that

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extremely useful. We are keen to ensure that the commission can make representations to the media, politicians and so on if it feels that that is appropriate.

Baroness Masham of Ilton: My Lords, I want to ask one question, which I have asked on several occasions but to which I have not received an answer. Is there going to be a body that can put forward people's views on the closure of hospitals? CHCs have been able to do that.

5.45 p.m.

Lord Hunt of Kings Heath: My Lords, I must apologise to the noble Baroness, Lady Masham; I thought that I had answered that question on several occasions. The role of the CHC in relation to significant changes of services is being transferred from appointed bodies—the CHCs—to democratic local government. The overview and scrutiny committee of the principal local authority in an area, which is democratically elected, will deal with those issues. It will have the right to call in officers of NHS bodies to examine them. If there is disagreement on a proposal, that can be referred to a national body, the Independent Reconfiguration Panel, which will advise the Secretary of State. Far from dissipating the current mechanism, we have strengthened it by linking it to locally elected councils.

I accept that the amendments are worded differently from those that we debated on Report. However, they cover much the same ground. The noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, clearly hark for some national body to focus on representing what might be the views of patients. The noble Earl referred to their attempts to speak out. That misreads the whole purpose of the commission.

Subsection (2)(a) clearly states that it will advise the Secretary of State,

"and such bodies as may be prescribed, about arrangements for public involvement in, and consultation on, matters relating to the health service in England".

The principal aim in that regard is to ensure that we get patient and public involvement right. I do not believe that the public interest would best be served if such a commission allowed itself to go down the track of having a representative role, which we know cannot be carried out by such an appointed body. That is why I resisted the amendments on Report.

The noble Earl, Lord Howe, underestimated the commission's functions. He described that as involving a rather process-oriented set of roles. Paragraphs (a) to (h) in Clause 20(2) contain a very powerful set of responsibilities, which will ensure that we get public and patient involvement right. I draw his attention in particular to paragraph (d), which refers to,

"providing assistance to Patients' Forums and Patients' Councils, and facilitating the co-ordination of their activities".

The commission has the potential to help local patients' forums by pulling together their activities, which will enable patients' forums to work together.

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When a number of patients' forums wish to come together over various issues, the commission will help and enhance that process. That is a much better approach. It involves using experience at the local level—helping patients' forums to come together to express views on patients' experience and thinking rather than seeking at a national level to carry out a role that I do not believe such bodies can be expected to carry out effectively.

I point out to the noble Earl that Clause 20(3) gives the commission the function of promoting,

"the involvement of members of the public in England in consultations or processes".

The arrangement is not focused solely at prescribed bodies. The commission has a much wider role—to examine the way in which individuals' involvement in the National Health Service can be enhanced and developed. It is much better for the commission to focus on helping to ensure that we get effective public involvement rather than being side-tracked by attempting to have a representational role that I do not believe it could carry out effectively.

Earl Howe: My Lords, I am grateful to the Minister, although I am disappointed by what he said. I took great care to frame the amendments in such a way that they did not replicate the amendment that was defeated on Report. It would not have been proper to raise the same issues.

The whole point of these amendments is to give the Secretary of State the option of broadening the functions of the commission—the areas of activity in which it can engage. I do not belittle the functions listed in Clause 20(2). Broadly speaking, the commission is an enabler, which will assist patients' forums and communicate with the Secretary of State. I understand that that is a very important role. But for whom will it speak? I do not believe that it will speak for patients. That is the source of my disappointment. It will speak for the bodies, structures and processes that represent patients, which is at one remove from the coal face.

I understand the Minister's reluctance at this point to confer on the commission what he termed "a representative role". Again, I say that I took care not to be prescriptive in these amendments. If they were accepted, it would be entirely up to the Secretary of State to determine the extent to which the commission should widen the scope of its activities. The noble Lord, Lord Clement-Jones, listed a number of subject areas which I considered to be very relevant in that context.

I wanted to stand here with a clear conscience in speaking to the amendments and to convey to the House that I believed they were substantively different from the amendments that we debated and rejected on Report. I believe that I can do so. For that reason, I feel that I can take the opinion of the House.

5.51 p.m.

On Question, Whether the said amendment (No. 19) shall be agreed to?

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Their Lordships divided: Contents, 100; Not-Contents, 104.

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