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Lord Rea: My Lords, I hope that my noble friend will clarify a point which might have been obvious if I had read every word spoken during the 90 weeks. I am a little uncertain about how the Commission for Patient and Public Involvement in Health will be chosen. Clause 19(1) states:
I am grateful for the contribution of all noble Lords. I listened with great interest to the interpretation that the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, put upon what has occurred between the introduction of the last Act and now. I do not share their view. I maintain that the principles before noble Lords today are wholly consistent with the principles enunciated in the Health and Social Care Act. Some of the practical effects of those principles have been tested and, I believe, improved upon by debates in this House and another place. I am grateful to all noble Lords for their constructive participation in those debates.
It was the suggestion of the noble Lord, Lord Harris of Haringey, in debate on Report on the role of primary care trust patient forums which unlocked the door to where we are today. I am grateful to him for that.
A number of questions were asked. I shall attempt to answer them as quickly as possible. The noble Earl, Lord Howe, asked how wide the remit was on making available advice and information on complaints about policies as well as services. In drafting the amendment we took on board comments from ACHCEW to ensure that those wider issues were encompassed. The critical element of the amendment is the making of complaints relating to services. It is drafted on the basis that that means advice and information on complaints in the wide sense that noble Lords indicated.
As I have said on a number of occasions, the direction-making powers are only in respect of functions that the commission carries out ancillary to its core functions. It is not a general direction-making power. It is a power to make the carrying out of ancillary actions subject to directions and is, therefore, of a limiting nature only. Concerns have been expressed about the independence of primary care trust patient forums. I have maintained that they will be wholly independent. They will not be under the thumb of the trust chief executives. Anyone who has discussed these matters with trust chief executives
I did not understand the description of the noble Lord, Lord Clement-Jones, of chief executives being under the thumb of Ministers. The noble Lord will know that that is wholly in conflict with shifting the balance of power on the basis of which this Bill was brought before your Lordships' House. In my right honourable friend's subsequent speech, he spoke of the need for the department to withdraw from micro-management of the health service.
My only caveat is this. We have debated this week a number of issues on health and social care. I can think of four or five instances when, far from asking me to withdraw the thumb of control, the noble Lord, Lord Clement-Jones, has asked me to intervene much more. I am disappointed
The noble Lord made a good remark with regard to accommodation for primary care trust forums. Of course we want them to be accessible. Primary care trusts might be placed in community hospitals or health centres. Using vacated CHC premises is also an excellent idea. I make the point that there are 184 CHCs. There will be many more primary care trust patient forums. That is one of the advantages of the changes we make.
The noble Earl, Lord Howe, asked about health inequalities. That is a focal point about the work of primary care trusts in their role of assessing health needs. The patient forums of those primary care trusts will be able to comment and to draw attention to issues of concern about that matter.
The noble Lord, Lord Clement-Jones, said that I was uncharacteristically coy about resources. I am always coy on the issue of resources. Although we have the headline figures for the health department on fundingthey are for the next five years for the NHS and three years for social serviceswe are still deciding how that should be "divvied" up. I cannot go further tonight on how we shall fund patient and public involvement. However, I can repeat our stated intention and commitment that we shall ensure that the new arrangements are resourced so that they work successfully in practice.
I was asked about the timetable. The headquarters of the Commission for Patient and Public Involvement in Health will be established in January 2003. It will then appoint staff to each primary care trust patient forum area. It will then co-ordinate the appointment of patient forum members. I understand what the noble Earl says in relation to numbers. There is a
The noble Baroness, Lady Hanham, is not in her place, but we debated a conflict of interest at great length. The point is that the patient forum member will be accountable to the whole board, as are other board members. We shall set out guidance that will help some of the issues that the noble Earl raised. At the end of the day, having been a local authority appointee to a health authority in the 1970s, I do not believe that they will be in a different position from those local authority members then, or university members now. I am sure that there will be tensions but we shall issue guidance to help to accommodate that.
On foundation trusts, it is too early to say how the patient public involvement issues will relate to them because we are still working on foundation trusts. The whole point about foundation trusts is to get greater public health involvement.
On the interesting suggestion that the noble Lord, Lord Clement-Jones, quoted from Dr Taylormy favourite GPof a citizens' health council, I have given it the seriousness that it warrants and I have to disappoint him. I believe that we have the correct title already. We have had a good debate and we have come to an acceptable conclusion. I hope that we can agree to the Commons amendments.
The noble Baroness said: My Lords, before speaking to Amendment No. 88, I declare an interest as patron of VERSA which has carried out a lot of work with post offices and particularly with small retail services. I receive no money. It is an educational charity that tries to help and to support small rural shops in rural areas.
In tabling this amendment I am trying to ensure that every claimant receives his or her money. My determination was further strengthened by today's Statement on Consignia. In Committee on 23rd May the Minister referred to the payment methods that the
In Committee the Minister stressed that the Prime Minister and the Paymaster General are agreed that the requirement to receive payment electronically will cut in only when those facilities are in place. That confirmation was welcome. Additionally, I seek assurance that not only will the facilities be in place, but also that anyone requiring to use them will be able to do so. Also in Committee the Minister assured the noble Earl, Lord Russell, that,
This Bill is concerned with introducing systems; I am concerned with enabling individuals, often at a time of great need, to gain access to their financial entitlement. So I take issue with the words "available" and "appropriate". The individual will need to access available facilities within a reasonable distance of his or her home. That applies particularly to the less well off in areas where public transport is often lacking or expensive. Will the Minister expand on how available the Government envisage those facilities will be? In considering the word "appropriate", I recall my English teacher banning the word from our essays on the ground that it is a catch-all word and effectively meaningless. Can the Minister explain the definition that she has in mind?
The purpose of Amendment No. 88 is to ensure that the board takes responsibility for ascertaining that the facilities necessary for each claimant to receive benefit are in place. It makes the point that every claimant shall be able to receive payment. The board has a duty of care and a responsibility to ensure that each claimant receives his or her money.
I turn to the availability and accessibility of post offices, the main way in which many receive their payments. My concerns grow. I begin to wonder whether anyone truly knows exactly how many post offices there are and where they are. Again on 23rd May the Minister said that,
When assessing how far people live from a post office or a sub-post office, is a circle drawn on a map with a compass to indicate a mile, so that the distance is taken as the crow flies and not as one would walk or cycle, which could be quite different? I decided to pursue the matter further and to find out more.
I then turned to Consignia's figures from Post Office Limited, which state that the average distance to a post office in rural areas is 0.7 miles, with 84 per cent of the rural population living within one mile of a post office. I turned again. The Performance and Innovation Unit in 2000 gave yet different figures: 85 per cent of rural populations live within one mile of a post office and 99 per cent of rural populations live within three miles. I turned again. Postcomm 2001 statistics say that 93.7 per cent of households live within two kilometres of a post office in England and that 0.23 per cent live more than four kilometres away.
I am sure that noble Lords will be as confused as I am. It did not give me confidence in the current position. Additionally, the Consignia figures for the closures of post offices in rural areas for 2000 and 2001 combined come to some 929. The Postwatch figure is 809 for the same period, of which 80 per cent were in rural areas. At the very least there appears to be major confusion. One organisation states that there were 929 closures and another says 809. In one year, 120 post offices are either unaccounted for or accounted for in differing ways.
That is truly extraordinary, but in addition I was told the following story this afternoon. The village of Trull, pronounced "Trowel", in Somerset, is three and a half miles from Taunton. The national Post Office management, in encouraging urban postmasters to retire, asked Trull's postmaster to retire on the basis that it was one "urban post office too many". Despite protestations that he did not run an urban post office, it was many weeks before the Post Office manager came to visit him. On arrival at Trull's post office, he realised that it was indeed a rural, not urban, sub-post office.
I know that the Minister has not been involved in all the Statements on the Post Office, although she sat in on today'sI was glad she was here for it. However, she must appreciate that there is strong feeling in both this House and another place that it was iniquitous for the Government to put on the Post Office the cost of withdrawing the Horizon project, referred to by the noble Lord, Lord Dearingwho is not in his placewhich meant that expenses of some £571 million were passed to it. The Government, in particular the Department of Social Securityas it was thenshould have taken that cost on board.
If I have laboured the point, it is only to make the real point that where people are able to collect their credit from is important to them. The Minister has often implied that the matter is not her department's direct responsibility. I have to disagree with her. It is
We live in an age where there have been many closures of post offices, banks and shops, which is as true of urban areas as it is of rural areas. The Government should understand and accept that many people are having to spend more of their benefits on the cost of travel to collect them. More often than not, those directly affected are the less well-off or the elderly.
I hope that the Minister will reflect on the feeling that I suspect will follow my introduction of Amendment No. 88. It is linked with Amendment No. 90 in the name of the noble Earl, Lord Russell, on which I hope to comment later when I have heard his contribution. Amendment No. 88 asks that,
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