Health and Social Care Bill

Public Bill Committee, 30 January 2001.

Standing Committee E

Health and Social Care Bill

Paul Burstow (Liberal Democrat, Sutton and Cheam)

On a point of order, Mr. Maxton. The Secretary of State is taking part in a conference organised by the Department that will deal with the matters covered by the clauses that the Committee will be considering today. Is it in order for the Secretary of State to hold such a conference while the Committee is scrutinising those very provisions, especially as I imagine he will be setting out in much more detail than we have before us how the new arrangements will work?

John Maxton (Labour, Glasgow Cathcart)

That is not a point of order for me. The Committee is here to debate what is listed on the amendment paper. Clause 14 Abolition of community health councils in england

Clause 14 - Abolition of community health councils in england

Liam Fox (Conservative, Woodspring)

I beg to move amendment No. 241, in page 11, line 19, at end add—

`(8) This section may not be brought into force until the Secretary of State has issued a certificate stating that it is his opinion that the bodies established under sections 7 and 10 are fully functional and performing their duties effectively throughout England.'.

John Maxton (Labour, Glasgow Cathcart)

With this it will be convenient to debate the following: Clause stand part.

Amendment No. 97, in clause 15, page 11, line 21, after `abolish', insert `or reform'.

Clause 15 stand part.

Amendment No. 248, in clause 10, page 8, line 9, after `(1)', insert

`Before the commencement of section 14 of this Act,'.

Amendment No. 254, in clause 13, page 9, line 26, after `(1)', insert

`Before the commencement of section 14 of this Act,'.

New clause 1—Reform of community health councils—

`.—(1) The Secretary of State shall lay before Parliament within 12 months of the date of coming into force of this section regulations providing for reform of community health councils in England which will ensure that all parts of the health service are effectively covered by a community health council.

(2) Regulations under subsection (1) above shall be subject to affirmative resolution of both Houses of Parliament.'.

New clause 7—Community health councils—

`Following the provisions in this Act, Community Health Councils shall be reformed following consultation.'.

Liam Fox (Conservative, Woodspring)

I shall speak briefly to the amendment, but I intend to speak mainly on clause 14 stand part.

The hon. Member for Sutton and Cheam (Mr. Burstow) has a touching naivety if he does not believe that Parliament is the last place where we are likely to find out the details of any part of Government policy; and the abolition of the community health councils could not be a better example. It is one of the most controversial parts of the Bill—if not the most controversial—and it will cause the most difficulty in the other place. If the Government do not change their view on this part of the Bill, they will have a great deal of trouble getting it through the other place, as a substantial number of Cross-Benchers oppose the measure.

We accept that the Government's proposals are likely to remain in place, and we are in no doubt that amendment No. 241 would simply buy time to ensure that any new mechanisms are up and running and properly in place before CHCs are abolished and before those whom they help are abandoned to the new system. Nothing could be worse than to abolish something that works before putting safeguards in place to ensure that people will not suffer as a result of the changes.

In this debate, we shall examine exactly what CHCs do, how they work, what they have done, what functions they fulfil and whether those functions will be fulfilled by the new bodies that the Government propose. CHCs have 700 permanent staff and 5,000 volunteer members. They were created by a Conservative Government under the National Health Act 1973. It must not be forgotten that they effectively offer free labour to the national health service worth about £8 million a year. Each year, CHCs assist about 30,000 people with complaints.

In his briefing notes, the Minister accepts how well CHCs work. They say:

``While some CHCs have done a very good job, their effectiveness and breadth of service across the country is patchy and too highly dependent on individual officers and members. Only in some parts of the country do patients receive a high level of support from their CHC when making a complaint about NHS services.''

That surely is the best possible argument for reform and standardisation. We should raise the standard of all CHCs to that of the best, which the Minister accepts are already doing a good job in representing community interests and patients. If that is possible under the current model, it requires us only to ensure that the best practices apply equally across the whole system, not to pull the entire system apart. Such vandalism, undertaken for reasons that we can only guess at, is completely unacceptable.

We move from an easy and coherent system to one where the functions will be divided up between the patient advocacy and liaison services, patients forums and local authority scrutiny committees. The ensuing fragmentation will mean that no individual body will oversee the whole of the patient's experience. That may well result in increased litigation costs due to patients failing to receive appropriate advice. Elderly patients, for example, have complex problems, which can span acute and community care services. With the separation of scrutiny and complaints work the broader patterns of local health service problems are less likely to emerge and the exchange of information will be enabled only through the creation of yet another new quango. Under the current system, patients know exactly where to go for advice and their complaints are dealt with in a single, transparent manner. Under the new system, they will—for the first time—have to shop around for their rights, and that can only lead to increased patient confusion.

I am sure that the point of order raised earlier by the hon. Member for Sutton and Cheam about the information supplied to the Committee reminded the CHCs of the manner in which they were treated as they were kept in the dark until the Prime Minister announced the plan to abolish them. To add insult to injury, there is the Government's—and the Prime Minister's—concept of consultation. Given that the Government refer to such Orwellian concepts as ``earned autonomy''—whereby bodies are free to do things, but only with the Government's approval—I suppose that consultation might mean something different to them than it does to the rest of us.

The Prime Minister said in the House that the CHCs had been consulted about their abolition, but clearly nothing could have been further from the truth. The CHCs were not consulted. We are all aware of the subsequent exchange of letters between the Prime Minister and my hon. Friend the Member for Eddisbury (Mr. O'Brien). The Prime Minister said:

``I am aware that there is bitter opposition—

that is to the abolition of the CHCs—

which is why the proposals are being consulted on.''—[Official Report, 15 November 2000; Vol. 356, c. 937.]

Even after the Prime Minister said that there was consultation, there was still no consultation on whether or not the CHCs should be abolished. During the debate on Second Reading, many Government Back Benchers were clear that there had been no consultation.

Philip Hammond (Conservative, Runnymede and Weybridge)

Where are they now?

Liam Fox (Conservative, Woodspring)

It is interesting that none of those who sought to raise such complaints were selected to serve on the Committee. That is another triumph for the Whip system, but one in the face for the proper scrutiny of legislation.

In reply to my hon. Friend the Member for Eddisbury, the Prime Minister said of the CHCs:

We consulted widely on the run up to the NHS plan.

I look forward to hearing from the Minister details of his meetings with the CHCs on their proposed abolition, when they were told that they might be consulted and when it was made clear that the decision had been taken to abolish them. At least, my hon. Friend received a reply from the Prime Minister, unlike the Association of Community Health Councils for England and Wales. It is unacceptable for the body being abolished to have written to the Prime Minister and to have received no reply.

The association disputes the Prime Minister's assertion that consultation took place. It states that the Under-Secretary of State had written to them to say that CHCs would be essential to ensure the representation of patients during the implementation of the national plan and in the new NHS. When the Under-Secretary wrote that letter on 26 June, either she knew that they were about to be abolished or Ministers were kept as much in the dark as the CHCs. Perhaps the Minister could give us the detail of who knew what and when.

When Richard Gordon QC told the CHCs that,

``in my opinion, the consultation process over the new NHS plan was . . . legally flawed.''

Ministers responded by stating:

``We do not accept that ACHCEW or CHCs had any legitimate expectation to be consulted in relation to the proposal that CHCs should be abolished in primary legislation to be introduced in Parliament in due course.''

According to the Government, the body that is being abolished has

``no legitimate expectation to be consulted.''

What sort of consultation process is that? It is an absolute disgrace and an affront to any concept of natural justice for Ministers to adopt such an attitude towards employees whose jobs they are about to remove. Had something similar occurred in any other sector of our business or industry, Ministers would have been up in arms about it. However, they think that it is all right to abolish an organisation that employs 700 people, and to say that those people have no legitimate right to expect to be consulted by the Government. That says everything about the arrogance with which the proposal was carried through.

We must consider the funding of the new system. The association claims that by 2004-05 the new bodies that will replace CHCs will cost about £114 million, compared with the current CHC budget of £23 million. In 2002-03, patient advocacy and liaison services will absorb £23 million, with an additional £10 million from the Department of Health. The patients forums are estimated to cost £45 million, which is 0.05 per cent. of hospital budgets. The association also estimates that adding health to local authority scrutiny will cost about £70,000 per authority, or £14 million in total. It has been calculated that health authorities will need to budget £4.2 million for the independent local advisory forums, and a further £4.2 million for specialist advocacy services. The Minister shakes his head. I hope then that he will give detailed financial estimates when he replies to the debate, as we need to know what the cost of the changes will be to the public purse. The £100.4 million for 2002-03 would rise to £114 million by 2004-05, as more primary care trusts are formed.

We are told that the role of patient advocacy liaison services will combine the meeting and greeting in hospital reception areas with steering patients towards the complaints system. The body will be set up under NHS auspices, with staff employed by NHS trusts, and will be a creature of the system. That may create a conflict of interest, as the complaints system will appear independent but its real independence will have diminished. Many patients would prefer to raise complaints and concerns away from trusts. In the current culture of the NHS there is increasing control from the centre, and there will be less and less confidence in the ability of trusts to deal independently and objectively with such complaints.

That said, there is no reason why an improved advocacy and liaison service, as proposed in this part of the Bill, could not co-exist with the current CHC set-up. If a patient advocacy and liaison service were added to the CHCs that work to the best possible level—those that the Minister says now operate well and effectively on their patients' behalf—that would seem to cover the reservations felt by the Government and other bodies. Therefore, why must there be such complexity of provisions?

The objectivity and independence of local authority scrutiny also concerns us. As care trusts become more common, conflicts of interest will inevitably arise when councillors are increasingly called on to scrutinise services for which their local authority has joint responsibility for funding and provision. Such councillors will not be independent of the services that they scrutinise. Many will be of the same political persuasion as the non-executive directors, and even the chairman, of the local trust. Either there will be a temptation for a lack of effective scrutiny for party political reasons—we all understand that it happens—or the system could be used as a political football in way in which it is not used at present.

Although local authorities may accept the extension of local scrutiny powers, that does not necessarily mean that they also welcome the abolition of CHCs. Croydon borough council and the Greater London Assembly, for example, have passed motions criticising the abolition of CHCs, and judging from the tone of the debate on Second Reading, they were in tune with Government Back Benchers.

Patients forums will monitor services provided by trusts, with a substantial part of their membership coming from voluntary groups. We are told that their work in examining how services are currently functioning will be supported by the independent local advisory forums, which will monitor the development of services.

So far, the Government have been unable to confirm that the lone member of a patients forum to be appointed to a hospital trust board will be selected by the relevant patients forums. Perhaps they will now confirm that. They have also sought to reassure Labour Back Benchers by portraying the patients forums as mini-CHCs in some of their internal party briefing. That is a ludicrous argument. If patients forums are mini-CHCs, why are CHCs being abolished?

We know that there is considerable disquiet on the Government Back Benches. We have all seen the letter from the Prime Minister's agent, congratulating the CHCs and stating that the Prime Minister

``agrees with every word''

of a congratulatory early-day motion, and that he

``would certainly like to add his congratulations to the work the CHCs have done over the last 25 years and wishes them every success in the future.''

The sheer cynicism of that was best summed up in a letter from the South Durham and Weardale CHC, which states:

``The truth of the matter is, there has been no consultation either before, or since the NHS plan was drafted or published. We are concerned that the Government have announced the intention to abolish the CHCs as a cynical attempt to silence any negative publicity during the winter and in the lead up to the General Election, as they know they are most vulnerable in regard to the NHS. What better way to deflect attention away from any shortcomings than by silencing the only independent monitor that the public has for the NHS?''

That quote did not come from me, but from one of the CHCs. Labour Members should remember that many CHC members and staff are Labour activists. They have no party-political reason to criticise the Government, and they are genuinely worried that the measure is a mechanism for silencing dissent. If the Government are willing to silence and axe even their most prominent colleagues in order to keep the show on the road, the CHCs should not be surprised if they are treated in the same way.

Philip Hammond (Conservative, Runnymede and Weybridge)

Does my hon. Friend agree that one of the greatest concerns of those who oppose the abolition of CHCs is that, under the Government's proposed scheme, it is not clear which institution will perform the important independent whistle-blowing role currently performed by CHCs? Is there not a suspicion that the Government are seeking to abolish that role altogether?

Liam Fox (Conservative, Woodspring)

Yes. The current Secretary of State has an amazing ability to say one thing and mean something entirely different. That is what I meant when I referred to the Orwellian nature of the Government's proposals and language. Only the current Secretary of State could describe the Bill as a decentralising measure, when it gives him unparalleled powers of hiring and firing within the NHS. In the extreme cases that we will deal with later, the legislation gives the Government the power to tell patients that information about them is not theirs but belongs to the state, should the state wish to use it in any way that the Secretary of State deems fit.

The measure is not decentralising, but the Secretary of State describes it as such. It does not surprise me, given the mindset that that implies, that the Government want to abolish the concept of whistle-blowing or independent scrutiny. I share the suspicions of my hon. Friend that the measure will make access to the complaints and scrutiny procedure more complex and difficult for patients. It will ensure that there is less chance of any further body bringing embarrassing information to light in the way that CHCs have so successfully done in recent years.

Ministers' attempts to avoid questioning have been an unfortunate feature of the whole sorry episode. When a seminar was held by the Association of Community Health Councils of England and Wales on 4 December, the junior Minister wrote in advance that she would be attending the seminar, but that she would be unable to answer questions about the Government's proposals to abolish CHCs. Never have I known such a naked abdication of responsibility by a Minister in charge of a Government proposal—telling those involved that she would be unable to discuss the proposal at a conference that they were attending. What hope do we have of holding the Government to account, when Ministers refuse to answer questions on matters for which they have prime responsibility? It is an outrage.

As the hon. Member for Sutton and Cheam mentioned in his point of order, the Department has arranged a meeting in Fulham that is taking place as we speak. Those who might most want to listen to our deliberations, and who have most to lose from the Government's proposals, have been taken off to another part of the city. No doubt they will be briefed by the Secretary of State, as this Committee has not so far been briefed, and will already know the details of the proposal. However, they will not be able to listen to what is being said in Parliament. That is typical of the way in which the Government do business.

The Secretary of State recently promised national guidelines on the proposed new structures, but as yet we have seen no sign of them. There is a strong suspicion that the Government are making up the entire process as they go along, never having thought in advance about what would happen if they abolished CHCs, and with little idea even now of how to implement the plan. We all accept that there is a strong case for reform of CHCs, to make them more effective. Their work could be more standardised, the appointment system could be reformed and resourcing could be improved. However those are not arguments for abolition and the Government have yet to make a case for that.

The question of patient information and confidentiality has still not been considered either on Second Reading or, so far, in Committee. The CHCs have expressed concern because of the volume of confidential information about patients that they hold. There are large numbers of such records, which may be handed over to hospital trusts whose staff may be the subjects of many of the files. We must hear from the Minister today exactly how such conflicts will be prevented. What mechanism will ensure that information that patients gave in confidence, often about trusts or staff, will not be relayed to the very people about whom they complained? We must know in detail what will happen to the records and a failsafe mechanism must be introduced.

Under the Bill, the Secretary of State will, as I mentioned just now, take powers over the control of patient information and will be able to make any information public if he deems that to be in the public interest. There will be potential for patient records from the CHCs to be put in the public domain at the whim of the Secretary of State. The system was not set up to do that. It would be contrary to every assurance that patients were given when they provided the information. They would have been told that it would be treated sensitively and in confidence. The Government need to sort this matter out, because it is one of the most appalling flaws in the procedure.

In the past, community health councils, or at least those at the top of the scale, have done a wonderful job. They have represented the entire public, not just patients, in the NHS. We have all seen the Casualty Watch documents that they produce, which are extremely useful in pointing out flaws in policy and identifying where service is poorest. That effectiveness has proved to be one of the nails in their coffin. The Secretary of State in particular detests Casualty Watch because it points out what is happening in the real NHS, as opposed to the one that he likes to describe in the House of Commons.

The CHC supported the victims of Harold Shipman in Hyde. The Northallerton CHC played a key role in suggesting that the counselling help line for victims of Richard Neale should be funded by the Northallerton NHS trust and health authority. The Sheffield CHC has demanded that the Commissioner for Public Appointments investigate the appointment of the new chairman of Sheffield Teaching Hospitals NHS trust, which was not publicly advertised, and for which only two candidates were interviewed. The junior Minister has not replied to the CHC's letters of concern.

Members of Barking, Dagenham and Havering CHC made an unannounced visit to the Corbet ward of St. George's hospital in Hornchurch, where they found staff shortages so severe that elderly patients were being put to bed at 4 pm. They found that seven of the 16 qualified nursing staff were off work owing to sickness. All those revelations are at risk of going by the board because of the new mechanisms being established by the Government. Indeed, there is a strong suspicion that they are being put in place in order to make sure that such matters are not brought to light in the way that they have been to the embarrassment of this and previous Governments.

A number of distinguished people have served on CHCs. It will be interesting to hear the views of the noble Lord Hunt—one of the first secretaries appointed to the CHCs in 1975—as he turns executioner for the organisations that he once championed. It will be interesting to listen to his reasoning.

We have a different approach to the subject in Scotland and Wales, which we will come to subsequently. Neither the Scottish Executive nor the Welsh Assembly has introduced plans to abolish CHCs. They seem to be at odds with the Government, viewing CHCs as something useful and their independence as something to be encouraged. Now that we are to get a two-tier service in terms of nursing care in the United Kingdom—courtesy of the Government's devolution proposals—it is not surprising that we are to get a second-rate advocacy service in respect of independence and autonomy in England.

A number of Labour Members have made vocal their criticisms of the Bill. One example is as follows:

``Does my right hon. Friend accept that community health councils do good work in our national health service? Does he also accept that those councils genuinely represent the patients and their families—the consumer? As he is engaged in some necessary, far-reaching reforms . . . could he delay deciding his approach to CHCs until he has advanced his other reforms?''

That is exactly what we propose in amendment No. 241. Another Government Back Bencher said:

``There is grave concern that such services will be fragmented among a range of providers and that the patient's voice element will be dissipated rather than co-ordinated.''

The hon. Member for Wakefield (Mr. Hinchliffe), who chairs the Health Committee, stated:

``My concern is that the proposal places patient advocates within trusts and they will not be seen to be independent in a way that patients need them to be.''—[Official Report, 21 November 2000; Vol. 357, c. 158.]

All those statements are from supporters of the Government, who have grave concerns about the proposals.

The Secretary of State has gone to great lengths to cite support from patients' bodies for the new structure. He stated that the College of Health

``welcomed the new statutory duty for public involvement and consultation by health authorities, primary care trusts and NHS trusts. We also welcome the creation of patient forums as statutory bodies.''—[Official Report, 10 January 2001; Vol. 360, c. 1081.]

Philip Hammond (Conservative, Runnymede and Weybridge)

Is my hon. Friend aware that on Second Reading a number of Labour Members who spoke against the abolition of CHCs made it clear that they had personal and direct relevant experience of them? Is it not extraordinary, therefore, that the Government have chosen to pack the Committee with Members who did not speak on Second Reading to the extent that, with the exception of the Minister, not a single Labour Member spoke on Second Reading?

Liam Fox (Conservative, Woodspring)

I see that my Whip is not present and I am treading on dangerous ground. I was in the Whip's Office and that I know how the membership of Standing Committees is decided. The more controversial the legislation, and the less sure the Government are of their ground, the less likely it is that independent opinion from their Back Benches will be represented. When a Committee is made up of those who did not speak in the Second Reading—missing those who discussed their reservations about Government policy—I would bet my bottom dollar that the Government know they are on weak ground intellectually.

Doug Naysmith (Labour/Co-operative, Bristol North West)

Is the hon. Gentleman aware that there are Labour Members present with experience of serving on CHCs? I have served on two, including one in his constituency. Perhaps he could explain why the Organisation of South-West Community Health Councils, including the one that serves his area, has chosen not to oppose the proposals and instead agreed to work with the Government to introduce more effective measures?

Liam Fox (Conservative, Woodspring)

Individual CHCs are answerable for their views. I hope that the hon. Gentleman is not trying to take a specific example and extrapolate it to the general, because it is clear that the vast majority of CHCs are against abolition. Is the hon. Gentleman suggesting that that example is typical of the attitude of CHCs?

Doug Naysmith (Labour/Co-operative, Bristol North West)

The 14 CHCs in the south-west do not oppose the Bill.

Liam Fox (Conservative, Woodspring)

That does not alter the point; the hon. Gentleman is well aware that that is not the view of the vast majority of CHCs or of the association, all of whom are against—

Adrian Bailey (Labour/Co-operative, West Bromwich West)

Will the hon. Gentleman give way?

Liam Fox (Conservative, Woodspring)

Before I give way to the hon. Member for West Bromwich, West (Mr. Bailey), I shall finish what I was saying about the misrepresentation of support for CHCs. The Secretary of State went to great lengths to say that the College of Health supported his proposals. However, the college also stated:

``The College of Health regrets the lack of discussion with public and patient groups prior to the decision to abolish Community Health Councils announced in the NHS Plan. CHCs have important statutory rights and duties to represent the views and needs of their local populations and to be consulted on proposed changes in the provision of care by health authorities and trusts. We are concerned that under the new arrangements proposed, these important statutory rights should be strengthened and not weakened to the detriment of patient and public empowerment.

While welcoming the introduction of Patient Advocacy and Liaison Services (PALS) to trusts and acknowledging the important role they should have in helping patients sort out problems before they become complaints, we have strong reservations about the extent to which they will be seen as truly independent by patients who have a complaint about the trust, if the trusts employ and direct the work of the advocates. We are also concerned that PALS based in hospitals may be badly placed to help the majority of patients whose problems are to do with community or primary health care or with failure to access the services they need or relate to lack of co-ordination between primary and secondary and with social services.''

The other main concern expressed by the College of Health was that abolishing CHCs would risk fragmentation at local level.

Adrian Bailey (Labour/Co-operative, West Bromwich West)

Will the hon. Gentleman give way?

Liam Fox (Conservative, Woodspring)

I have said that I would give way; the hon. Gentleman must contain himself.

The college's other main concern was:

``we risk fragmentation at local level and, importantly, the loss of a good mechanism for monitoring and identifying national trends and patterns in both good and bad practice through the sharing of local knowledge and experience.''

I quote those comments at length because the Secretary of State used the college's words in defence of his proposals.

Adrian Bailey (Labour/Co-operative, West Bromwich West)

Will the hon. Gentleman give way?

Liam Fox (Conservative, Woodspring)

I have made it clear that I will give way in a moment.

The Secretary of State prayed that organisation in support of his policy. That shows that there is no end to the Government's twisting of words to pretend that organisations that clearly have major doubts about the proposals are in favour. I look forward to the next fantasy.

Adrian Bailey (Labour/Co-operative, West Bromwich West)

I am grateful to the hon. Gentleman for ultimately giving way. I wish to be associated with the comments made by my hon. Friend the Member for Bristol, North-West (Dr. Naysmith); I would have got in first, but his timing was better than mine. First, I declare a non-pecuniary interest in that my wife is a member of a community health council. I, too, served for seven years on a CHC. I ask the hon. Member for Woodspring (Dr. Fox) to withdraw the accusations that he made about the membership of the Committee.

Liam Fox (Conservative, Woodspring)

I am confused by that intervention. I am not sure what the hon. Gentleman wants me to withdraw. Does he want me to withdraw the comment that CHCs provide different qualities of support, or does he disagree with the fact that CHCs are against the Government's proposals? Is he trying to pretend to the Committee that CHCs welcome their abolition? Will the hon. Gentleman clarify what offends him?

Adrian Bailey (Labour/Co-operative, West Bromwich West)

The hon. Gentleman went on for such a long time that he has probably forgotten what he was saying when I first asked him to give way. He was making accusations about the management and staffing of the Committee.

Liam Fox (Conservative, Woodspring)

When the hon. Gentleman has been here a while, he will understand that the staffing of the Committee is not the same as the membership of the Committee.

Doug Naysmith (Labour/Co-operative, Bristol North West)

Will the hon. Gentleman give way?

Liam Fox (Conservative, Woodspring)

There is no doubt that the hon. Member for West Bromwich, West will be rewarded, as naked ambition and toadying are now qualities much to be recommended in the Labour party. The function of scrutiny of legislation has been entirely abandoned by Labour. The concept that Members are here to hold the Executive to account and to question what is going on has been completely forgotten.

Doug Naysmith (Labour/Co-operative, Bristol North West)

I sat through the whole debate on Second Reading.

Philip Hammond (Conservative, Runnymede and Weybridge)

Why did the hon. Gentleman not speak, then?

Doug Naysmith (Labour/Co-operative, Bristol North West)

I was not called to speak. Two or three other Labour Members sat through the whole debate and were not called.

Liam Fox (Conservative, Woodspring)

I am sure that the hon. Gentleman is right, but that does not change my view that the majority of Labour Members who spoke in that debate, no doubt randomly chosen by the Speaker, were hugely against the Government's proposals.

John Maxton (Labour, Glasgow Cathcart)

Order. The membership of the Committee has nothing to do with the debate, so I would be grateful if hon. Members returned to the amendment.

Liam Fox (Conservative, Woodspring)

I am grateful to get back to the debate on the amendment, as I look forward to the Minister's reply to my specific points. I raised the issue of membership only so that those who read the report of our proceedings understand that the Committee does not represent the views of many Labour Members.

Ian Stewart (Labour, Eccles)

On a point of order, Mr. Maxton. Clearly, the hon. Member for Woodspring does not read the reports of our proceedings. The matter was dealt with at our first sitting. I raised a point of order about whether it was appropriate for the Opposition to second-guess what was in the minds of Ministers, or for them to suggest that qualification for serving on a Committee was related to attendance at a previous debate. The hon. Gentleman does not know why people could not be at a certain debate.

John Maxton (Labour, Glasgow Cathcart)

I have already ruled that the debate on membership of the Committee should now cease, so we should get on with debating the amendment.

Simon Burns (Conservative, West Chelmsford)

On a point of order, Mr. Maxton. Are we allowed to drink anything other than water?

John Maxton (Labour, Glasgow Cathcart)

Members of the Committee are not allowed to, I am afraid.

Simon Burns (Conservative, West Chelmsford)

Further to that point of order, Mr. Maxton. What would you do if an hon. Member were drinking coffee?

Ian Stewart (Labour, Eccles)

I was not.

John Maxton (Labour, Glasgow Cathcart)

I was not aware that someone was drinking coffee. If someone is, he should remove it.

Liam Fox (Conservative, Woodspring)

If I may, I will return to the abolition of CHCs. I recognise that a raw nerve has been touched.

We have six tests to apply. There has been no consultation, and costing has not been carried out properly. The abolition will lead to fragmentation of services, loss of staff and increased costing, so is it workable? We do not sufficiently understand the accountability and independence of future mechanisms. The new proposals fail all such measures.

The group to be abolished has given sterling service to the NHS. Many people may become unemployed who have been extremely loyal to the task, for remuneration that has not been fantastic. The Government have failed to make the case for the changes, and have failed to consult about them in advance. We suspect that the changes are being made up as they go along, and that information is being given to those outside before it is given to the Committee.

The Minister has a great task, as he has to reassure the Committee, and through it those who pay attention to our deliberations, that the Government are not simply trying to gag the NHS and to ensure that patients are less able to get headlines that the Government hate into newspapers. We are losing a valuable resource, which even the Minister tells us works well in many parts of the country.

Our argument should be about raising standards to the best. Sadly, it has become about an entirely different Government agenda: one of putting the political process first and putting politics before patients.

Kali Mountford (Labour, Colne Valley)

I did not intend to take too much of the Committee's time today, given that under the new programming rules time is of the essence and that the last speech was rather long, but I want to touch on a couple of the points raised. I do not recognise the picture of CHCs that has just been painted. I have had a quite different experience, and most Members will bring their own experiences. My experience of CHCs dates from when I was a councillor in Sheffield and the area health authority proposed to abolish one of the accident and emergency departments in the local hospitals. The proposal caused an outcry in the community and my own local authority opposed the proposal. I am sad to say that we felt that the CHC at that time did not serve the interests of the hospital patients—which most concerns me. Of course the CHCs have a role in consultation, but surely patients too have a role, as do their feelings about the service that they receive.

Unfortunately, I have had two recent experiences of a CHC in my area. One arose from my own medical disaster, as a result of which I met other patients; the second concerns the proposed reconfiguration of hospital services. On the latter point, one would have expected the CHC to take a major role. The local community decided to develop something called ``Save our services'' because it felt that the CHC was not taking the expected lead role. The ``Save our services'' organisation was very successful and, as a result of its lobbying, quite a lot of changes were made to the original plans for the reconfiguration of the local hospital services. I am saying not that the CHC did nothing, but that it did not seem to be sufficiently well-equipped to deal with the problem that it faced. Many people were disappointed. Members of the ``Save our services'' organisation who were approached by the CHC, which said that it felt that its role was not being supported, telephoned me to say that they were very disappointed.

Peter Brand (Liberal Democrat, Isle of Wight)

Is the hon. Lady suggesting that whatever replaces the CHC should be absolutely populist and always support popular campaigns to save a national health service provision, however suitable, modern and relevant it is to today's world? If she is saying that, she is treading an extremely dangerous line.

Kali Mountford (Labour, Colne Valley)

I do not think that I came anywhere near saying such a thing. However, consultation with patients and the community is essential. If we change anything, the people for whom we are changing it—mainly the patients—must have confidence in what is happening. That brings me to my other point, which concerns my own experience. When an accident in surgery happened to me, I was alarmed to find that the process for dealing with my complaint about it was extremely difficult. I have been in hospital several times recently—it is unusual to have the experience of being a Member of Parliament on a ward—and people were approaching me all the time. I was alarmed to find that no one knew how to access the service of the CHCs, and that hardly anyone had heard of them. That is a major flaw in the present process.

Regarding confidentiality, of course I would like to know what would happen to my own records. However, the CHC—inadvertently, I hope—gave information about me to another organisation, and even to another patient about whom information was then given to me. I have, therefore, experienced some terrible flaws in the CHCs and must deal with the problems that I have experienced personally and look at how the damage that is being done, to other patients and to myself, can be repaired. I have not felt well served, as a patient or as a representative of the community, by what has happened so far, and I have been lobbying since 1997 to change the structure of CHCs.

Liam Fox (Conservative, Woodspring)

Will the hon. Lady give way?

Kali Mountford (Labour, Colne Valley)

I will do so when I have finished this point. Opposition Members are entitled to argue that reform could be an option, but experience tells me that whatever reform takes place, CHCs are too distant from patients and not closely enough tied to the places in which patients experience problems: that is, GPs' surgeries and hospitals.

Liam Fox (Conservative, Woodspring)

The hon. Lady has mentioned the important subject of patient access and knowledge of where in the system to go for redress. Under the Bill, to whom should a patient complain after encountering a problem with a GP, the ambulance service and the acute trust during a single episode of illness?

Kali Mountford (Labour, Colne Valley)

The hon. Gentleman will be surprised to learn that patients in hospital expect some service there. I have now represented several patients who have had unhappy experiences, and in all cases their first port of call was the place about which they were complaining. That may surprise some Opposition Members, but most people with a complaint about a service will go back to where they received it.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The hon. Lady is developing an important point about the operation of CHCs, and about how we could deal with some of the problems. However, the Government are reviewing NHS complaints procedures. Does she agree that it would be better to design the architecture for the new system once the new complaints procedures have been revealed?

Kali Mountford (Labour, Colne Valley)

I completely understand the hon. Gentleman's point, but it does not detract from the main thrust of my argument, which is that people feel that CHCs have not always represented them well. Whatever new procedures are set up, my experience gives me no confidence that CHCs would be any better. Whatever the structure in which complaints are dealt with, access to the structure is important. I strongly believe that access needs to be where patients most expect it, which is where the service is provided.

Dr. Brand rose—

Dr. Fox rose—

Kali Mountford (Labour, Colne Valley)

I have a choice; I shall take the hon. Member for Isle of Wight (Dr. Brand) first.

Peter Brand (Liberal Democrat, Isle of Wight)

The hon. Lady is developing an important line of argument. It is important for people to receive support while they are in hospital or during an episode of primary care. Of course, most hospital trusts and all primary care practices have internal complaints procedures and internal liaison procedures. However, although in an ideal world those would be enough, does the hon. Lady recognise that in the real world something outside that arrangement is needed to support the patient when, for example, a multiplicity of organisations is involved? She has described something that is essential, and I am sad that she has had such poor experience in her area. Perhaps the Sheffield councillors on CHCs who advise hospital trusts should have done a better job.

John Maxton (Labour, Glasgow Cathcart)

Order. That was a long intervention.

Kali Mountford (Labour, Colne Valley)

I take the hon. Gentleman's point, although patient advocacy can be dealt with separately within an organisation. I do not think that it is impossible, as the hon. Gentleman seemed to suggest, to make distinctions within an organisation between the people and services about whom complaints have been made and the person who deals with the complaint.

Liam Fox (Conservative, Woodspring)

I entirely sympathise with the point that the hon. Lady is trying to make about single-point access to a system. Nevertheless, does she accept that whereas a patient encountering a problem with primary care, the ambulance service and the acute trust can, in the current system, make a complaint at a single access point, namely the CHC, under the proposed system patients will have to make three separate complaints at different points of access? That will not empower the patient; it will fragment the process of complaint and redress.

Kali Mountford (Labour, Colne Valley)

The hon. Gentleman seems to have missed my point completely. I find that patients are not doing anything at present. Once they have made an approach to one of the organisations—for example, a hospital's patient advocacy unit—I would expect them to be advised as to whether they need to make further approaches. At least they would have made the first approach. I find that patients are making no approach to get advice at all. Often, they just suffer in silence from the bad service that they have received.

We should be able to use the information that is gathered. When I asked whether there was any information that would help me in my own case, whether there were other patients who had experienced something similar, and whether there was a case for a certain doctor to go back and be retrained in the technique that was used in my surgery, I was told that no such information was held. We need that sort of information. In my experience as a representative, a councillor, a Member of Parliament and member of the community and, above all, as a patient, the organisation is far too cumbersome, remote and distant from patients. It needs vital reform. If that means creating something completely new, I am all for it.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I shall start by picking up on some of the points raised by the hon. Member for Colne Valley (Kali Mountford). We should be debating the reform of CHCs, not their abolition. Some of the amendments provide hon. Members with an opportunity to allow that debate to proceed as an alternative to throwing the baby out with the bath water.

I suspect that some of the hon. Lady's criticisms, drawn from her experience, will find an echo in all parts of the House. The performance of the complaints procedure could accurately be described as patchy. Equally, it has been acknowledged by the Government that the CHCs have done a very good job. I want to return to that point, and develop our view in asking some questions about how the matter will proceed.

The hon. Lady made a case for reform—she used the word herself in her conclusion—not abolition. The clause contains a proposal to remove the structure and substitute a new set of structures. I want to analyse some of those new structures to see whether they will allow effective scrutiny of our health service.

Will the Minister tell the Committee who, in the new set-up that the Bill will establish, will be responsible for undertaking such work as Casualty Watch? At the moment, CHCs, locally and perhaps regionally, take periodic snapshots of the performance of accident and emergency departments, recording the length of waits on trolleys, the age profile of the patients and the nature of the condition that they are waiting to have treated. That is invaluable, independently gathered information, which gives an insight into how that sector is performing. I hope that the Minister will tell us how such surveys will be conducted in future. Can he tell us why, at the end of last year, there were delays in finalising the funding settlement for CHCs at a national level? That appears to have delayed, if not put off altogether, the nationwide Casualty Watch, which usually takes place in January or February.

John Denham (Labour, Southampton, Itchen)

I am worried that my response may be rather lengthy. Patients forums will be able to, and will, carry out activities such as Casualty Watch. I do not know why the nationwide Casualty Watch did not take place, but I have no reason to believe that it had anything to do with the funding of CHCs.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Perhaps we can return to that, but it is certainly my understanding that there were delays in finalising the funding settlement for the Association of Community Health Councils for England and Wales, which made it much more difficult for it to plan sensibly for a Casualty Watch exercise in the coming period.

Liam Fox (Conservative, Woodspring)

Does the hon. Gentleman share my suspicion that this measure is not about increased scrutiny, but about decreased scrutiny, as a body under the auspices of a trust is less likely to be willing to criticise that trust? Under the new arrangements, local government will provide the care, so will be less willing to criticise its own provision of care. Does not that undermine objective criticism of services?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

What struck me as I read the NHS plan, the explanatory notes and the briefing paper is that the Government have managed to create a feeling of anti-synergy--the sum of the parts of this new structure will be worth less than the whole, and will reduce and diminish because they do not connect one with another. They do not enable the picture and patterns of individual complaints to be discerned. As a result, we will not benefit from synergy: we will lose synergy in this new system. CHCs may well have their flaws, but at least they integrate the various aspects of individual complaints and have an overview of the system as a whole. At their best, that is what they should and can do, and that is why we need reform.

Lorna Fitzsimons (Labour, Rochdale)

The hon. Gentleman is worried about trusts ``getting away with it.'' Surely the easiest way for them to get away with it is under the current system, because patients have nowhere to go and do not go anywhere, so complaints do not get heard.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The hon. Lady will have to excuse me, but we are debating the Government's proposal to abolish CHCs. We are discussing what the Government propose to put in their place and whether that will be better than the current system and better than instigating reform. Twenty years have been invested in CHCs: they have 20 years of experience. One of the arguments advanced for abolishing CHCs is that the variability of their performance depends on their individual members and officers. The Government's argument that a CHC's effectiveness is down to the performance of the individuals in it surely begs the question whether any new organisation would be any better. All the organisations will need to use human beings to carry out their tasks, and their performance will vary. Human beings are fallible, and that is particularly relevant, given the report that we shall hear about later.

Lorna Fitzsimons (Labour, Rochdale)

Will the hon. Gentleman give way?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am happy to take an intervention, but I have barely started and do not want to delay the Committee unnecessarily.

Lorna Fitzsimons (Labour, Rochdale)

Does the hon. Gentleman accept the main point made by my hon. Friend the Member for Colne Valley? CHCs, as currently constituted, do not deal with the problem caused when there is no one in situ--as with the patient advocacy and liaison services--and someone needs help there and then, especially if there is a problem with the consultant and a patient feels that he has not been properly understood and represented.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The key words are ``as currently constituted''. I shall address that point later as I deal with the amendments. The theme of this debate about abolition is ``if it ain't broke don't fix it''. We believe that the Government have failed to carry the argument for abolition of the community health councils. They have failed to persuade patients and professional organisations of their case--certainly according to the evidence we have had from representations. On Second Reading, some Labour Members also expressed concerns and are yet to be persuaded. This area of concern is one of the reasons why the Liberal Democrats voted against the Bill.

The proposals for patient empowerment and the abolition of CHCs were important for us. Our central opposition to the clause is based on the fact that it will result in the fragmentation of the work currently undertaken by CHCs, which will be divided among a number of bodies that have no clear linkage and no co-ordination. Patients come into the NHS at different stages and follow different care pathways. It is crucial to test any new system of patient representation and advocacy to ensure that it is able to cut across the boundaries of the different agencies and providers of care that come into contact with patients. It has to be patient-centred, which is a key part of what we understand to be the Government's aim for the NHS as a whole. The fundamental weakness of the Government's plans is that they are provider-centred.

The structures are based around providers rather than around patients.

We learned from the briefing material provided by the Minister last week that the Government accept that some CHCs are doing ``a very good job.'' However, Ministers go on to say that CHCs are very dependent on the individual officers and members. Where is the evidence that the replacement system will be free of the failings that the Government have identified in the CHCs? Performance and overview committees, patients forums, the patient advocacy and liaison services and the independent local advisory forums will all depend on members and officers who are perhaps equally as fallible as those currently involved in CHCs. It is striking how easy it is to construe from the explanatory notes, the briefing paper and ministerial statements that these proposals have been developed on the hoof, and are being re-written time and again. Indeed, the role of PALS is being re-written almost daily.

We learn from the explanatory notes that the overview and scrutiny committees and the patients forums, which will constitute the successors to CHCs, are the core of these new arrangements. They will have the statutory backing that the Bill provides. At best, however, those two bodies will have no more power—possibly less—than the CHCs that they are intended to replace. I accept entirely that some of those powers may not have been exercised as hon. Members would have wished, but the powers in the National Health Service Act 1977 are there to be used. At worst, the two bodies will represent a dilution of those powers by splitting up the inspection and scrutiny functions.

The scrutiny role will be left without the insight and intelligence that inspection brings. Furthermore, separating handling of complaints from scrutiny denies the overview function the ability to identify common problems and trends thrown up by complaints. Under the Bill, there is no obligation on patients forums to work with local authorities in exercising their overview function, and some aspects are not covered by any legislation. We are told in the explanatory notes:

``The new arrangements are to be supplemented by two new non-statutory arrangements, Patient Advocacy and Liaison Services (PALS) and Independent Local Advisory Forums''.

However, the briefing notes that the Minister rightly circulated to the Committee state that the Government see the advisory forums as providing an arena for patients to have their say about the whole local health economy. That is an important role, but the advisory forums will gather the views and experiences of all patients in their areas. If that important role is as the Secretary of State and Ministers have said in their briefing paper, why is it not dealt with as a specific measure in the Bill? Why is there shortly to be a dramatic expansion in the areas that health authorities cover? Health authorities in London are being reconfigured, so these new advisory bodies will be very remote when it comes to dealing with and drawing together the everyday experiences of patients.

All the matters that these area advisory groups and the patient advocacy and liaison services cover are discretionary and at the behest of the Secretary of State. They are not covered in the Bill. As with the advisory forums, the powers are not covered in the statutory provisions that are before us. Their role, as mentioned by the hon. Member for Rochdale (Mrs. Lorna Fitzsimons), appears to be more akin to that of a customer care manager, or even a concierge. The explanatory notes talk specifically about them being

``Situated in or near main reception areas of hospitals and act as a welcoming point for patients and carers.''

I am sure that that is a valuable role, and that the descriptions given in the briefing notes show an important augmentation of the existing system to address concerns. However, what about accident and emergency departments, where people have experiences of poor service? What about on the wards themselves? I think the most revealing phrase of all in the briefing notes is the heading on page 5:

``Guiding the patient through the system''.

In my view, CHCs provide a readily identifiable independent one-stop service for patients. That is clearly not the opinion of everyone in the Committee, but it is the experience of many people, to judge by the evidence that I have seen. More could be done to ensure that people are aware of CHCs. We will have a confused and confusing set of arrangements in their place, so a guide will certainly be necessary.

I asked the hon. Member for Colne Valley about my concern that the Government are putting the cart before the horse, as they are reviewing the NHS complaints procedures, and the results have yet to be published. Before we have had the benefit of seeing the complaints procedures, we are designing an infrastructure around which they will operate. It would seem more sensible to design the complaints system and then to decide on the independent elements designed to work with it.

The issues of costs has been explored at some length. I hope that the Minister will be able to tell the Committee how much extra will be pumped into the system. More specifically, I hope that he will confirm that about one twentieth of patient care budgets will be diverted to pay for patients forums. That may not seem a large proportion of those budgets, but every penny for patient care should go to patient care, not be siphoned off to fund new bodies. If the Government are committed to making the changes work, new resources should be committed to make them work effectively.

As I said, for the theme for our deliberations, we should take the adage, ``If it ain't broke, don't fix it.'' I do not have a misty-eyed view about the perfection of CHCs, and other hon. Members have made similar points.

Peter Brand (Liberal Democrat, Isle of Wight)

Does my hon. Friend agree that it is rather sad that awful CHCs have not been tackled using existing powers? The Secretary of State has enormous input into decisions about who serves on CHCs, as do local councils. I have been concerned about the poor performance of CHCs from Labour areas.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

My hon. Friend is right. I hope that Ministers will have considered that, and will exercise their powers under the 1977 Act, which enable them to make changes to the composition and functions of CHCs. Reform is available through existing legislation. However, it may have been appropriate to add specific references to the new NHS bodies.

There is evidence of poor performance and a question about under-resourcing. In a way, the Government appear to acknowledge under-resourcing by accepting, at least in the briefing, that an additional £10 million will have to be invested in the first year of the new arrangements. Whether that figure is a gross underestimate of what will be needed in the long run is another question. Certainly, my CHC is struggling to do a decent job with the resources available. If we want decent patient empowerment, we must consider the resources available. I hope that the Minister will clearly explain what resources will be available to make the system work effectively.

I believe that the concerns about and criticisms of CHCs amount to a case for reform rather than abolition. There should be reforms to strengthen CHCs' capacity to support patients, and to broaden their scope to include primary care and the new care trusts. The hon. Members for Colne Valley and for Rochdale made points about powers to augment, but not to replace or supplant, the role of CHCs.

The amendments fall into two categories. Some use our preferred approach of reform rather than abolition, but the amendment moved by the hon. Member for Woodspring would put a delay mechanism in place that would require the Secretary of State to certify that the new arrangements functioned effectively before he abolished CHCs. We might have a long wait before the Secretary of State could provide such a certificate. As things stand, the Government's proposals are not fit for the purpose. The sum of the parts adds up to less than the whole. The result is not synergy, but the anti-synergy that I was talking about earlier. I hope that in considering the amendments, the Minister will step back and reflect on the comments, not necessarily of members of the Committee, but of all those who are concerned with patients' interests. Those views are what matter and the Government should listen to them more than to anything else.

George Young (Conservative, North West Hampshire)

Of the large number of amendments before us, the one that most attracts me is amendment No. 241, which would provide for the clause to come into force—that is, for CHCs to be abolished—only when the Secretary of State was satisfied that the new bodies were functioning well. That is the right approach.

I hope that the Minister will concede that this proposal has not been a presentational triumph for the Government. For an Administration who pride themselves on the way in which they present initiatives and manage news, the episode has been a disaster. A group of people who were, I think, quite well disposed towards the Administration—those who work for and serve on CHCs—feel deeply bruised, if not betrayed, by the events of the past few months. It might be helpful if the Minister were to concede, in winding up the debate, that the matter has not been handled well, and that those who serve on CHCs have every reason to feel aggrieved at the way it has been presented. That might begin to heal some of the wounds.

I have no difficulty with the principle of examining the interface between the consumer, or patient, and the NHS. The existing system was introduced 25 years ago and it is reasonable for an Administration to examine it and decide whether it constitutes the best way of discharging the function in question. When we took office in 1979, we gave some attention to CHCs. In those days they were slightly different. They were more political—certainly in London. Some had been captured by the trade unions and some were very radical and campaigning. They have now matured a great deal and are more professional. However, in 1979 they caused the incoming Conservative Administration quite a lot of inconvenience and grief. None the less, we decided to leave them as they were, for several reasons.

We were making many changes to the NHS and there is a limit to the number of changes that can be made at one time. Some elements must be left stable while others are moved around. Attempting to move too much at once results in an unstable structure. In addition, one of the themes of our reforms and the name of the relevant White Paper was ``Patients First''. We wanted the patients' views as we proceeded with the reforms. If we had abolished or reformed the CHCs, we would have been denied the clear voice of the consumer. Among my regrets about the present process is that I should have liked the CHCs' views about the rest of the Bill—the care trusts, pharmaceutical changes and so on. However, because they have understandably been preoccupied with their own survival, they have had to take their eye off the ball. We have not received much briefing from CHCs on those aspects of the Bill, which I regret.

If we had decided in 1979 to abolish the CHCs, I hope that we would not have done so in the way chosen by the present Administration—slipping the idea out under cover of the NHS plan, having given some signals that CHCs would survive and were appreciated. I understand the argument for reform. There are tensions within the existing functions of CHCs. They have several different jobs to do, and it is difficult for one body to accomplish all of them. Indeed, Winchester CHC is not opposed to reform or to its replacement by other bodies, although it has reservations. However, if the argument against the present structure is that too much is being done by one body, the argument against the new structure is that it involves too many bodies. It is, as it were, the obverse of the problem. At present there is a one-stop-shop. People know where to go: to the CHC. Under the new structure I expect some patients or consumers to be confused about which of the variety of bodies that are to be established they should approach.

I was impressed by the argument put to me by Winchester CHC that if the Government proceed with the new structure, co-ordination will be needed to link the various elements. The new structure is over-prescriptive and centralised. The hon. Member for Sutton and Cheam and my hon. Friend the Member for Woodspring have described problems that could arise under the new system.

A patient in my constituency who had an accident at home and dialed 999 would be taken by ambulance to Andover hospital. That hospital has a small accident and emergency department looked after by local GPs. If the patient's condition turned out to be more serious than Andover hospital could cope with, he would be taken by ambulance to Winchester and, if it turned out to be even more serious, from Winchester to Southampton. At the moment, if something went wrong, the local CHC could track the episodes. One CHC would provide assistance in establishing what went wrong, and where. Under the new structure, as my hon. Friend said, it would be necessary to knock on several doors. It is not clear to me how the different elements of the process will be co-ordinated and linked for the benefit of the individual patient.

As the hon. Member for Sutton and Cheam said, the proposed model for the four types of replacement body is organisation-based: it is based on the trusts and other bodies. The present structure is patient-based: there is one body for patients to approach. I see some danger of fragmentation. The new bodies will perhaps be less effective, and may become isolated, without a co-ordinating body at local or regional level to bring them together. That was what struck me when I met my local CHC. I was interested to find that the British Medical Association is quite forthright on the matter. It states:

``CHCs should not be abolished until all the new systems replacing them are in place.''

That is what amendment No. 241 would provide. Even the research department of the House of Commons Library, which is usually very neutral, refers to clauses 7 to 15 as

``a panoply of measures designed to provide a new system of patient and public consultation''.

Other members of the Committee may have read in Public Finance a perceptive piece by Liz Kendall, entitled ``Community Test'', which I came across yesterday. She writes:

```Do you support abolishing your constituents' independent voice in the NHS?' could soon become the question Parliamentary candidates fear most during the election campaign.''

On the proposed patients forum she writes:

``The big surprise in the Health and Social Care Bill is that these forums will now have a statutory basis and a substantial degree of independence. This looks more like a political move designed to appease the CHC movement than a properly considered policy. While CHCs were right to feel angry and betrayed at the way their abolition was announced (a throwaway line at the end of Chapter 10 of the NHS Plan), replacing them with strong, independently minded Patients Forums will only be effective if they work constructively and are genuinely representative of the communities they serve.''

She continues:

``The Government's analysis of the problem is broadly accurate''—

which is a generous comment—

``but . . . good ideas have been marred by a lack of overall strategy and little or no thought to implementation. These issues are the real challenge for Labour's second term.''

Some Conservative Members will have views about that.

Liam Fox (Conservative, Woodspring)

I should not allow that generous interpretation to go unchallenged. Even if we accepted such an analysis, Labour Members have argued that one of the reasons for abolition is that patients do not complain to CHCs because they do not know where to go, or because they feel that the process is too complex, so would it not be logical to ascertain whether the number of complaints under the new system has risen or fallen before deciding whether it is a better or worse system?

George Young (Conservative, North West Hampshire)

I agree. The benefit of the amendment is that it would permit the retention of CHCs until it was possible to be satisfied that the replacements were working. If the Secretary of State were not satisfied, he would not issue the certificate, and CHCs would remain.

I wonder what is likely to happen next. As I said on Second Reading, the Bill is unlikely to hit the statute book if we have an election in April or May. The Bill will be on Report some time after 8 February, but even simple non-controversial Bills take seven or eight weeks to go through the other place. The clause may be opposed there, so the Minister may be confronted with the choice either to ditch clause 14 or to ditch the Bill. Will he abandon the other reforms, many of which cause us no difficulty, in order to keep clause 14? Or will he be persuaded by our arguments and by those that I hope will be made in the other place?

It would help if the Minister talked us through the timetable for the Bill's remaining stages--if not today, at some point in our proceedings. When will it be introduced in the other place? When will Report take place? I am sure that the Minister's propensity for producing amendments will be undiminished, and that we shall have to consider at least some Lords amendments. Will that happen in March or April? When will the Bill be enacted? If it comes to the crunch, will the Minister be prepared to abandon clause 14, and therefore keep CHCs, as the price for having the rest of the Bill?

Simon Burns (Conservative, West Chelmsford)

Like my right hon. and hon. Friends and the hon. Member for Sutton and Cheam, who is the spokesman for the Liberal Democrat party, I have grave misgivings about clauses 14 and 15. I am attracted by amendments Nos. 241 and 97, because I believe that it is foolish to abolish community health councils and replace them with something diffuse and confusing. The case against CHCs has not been made.

The hon. Member for Colne Valley and others have said that the CHC system is not 100 per cent. perfect. Of course it is not; no organisation can be perfect. The hon. Lady gave us a powerful example of such problems, and I suspect that, during their time as Members of Parliament, most hon. Members have come across problems with CHCs, as they will have done with many other organisations. We have had problems in mid-Essex, but during my 14 years as a Member I have not had to deal with problems or complaints from constituents about the way in which the Mid Essex CHC has handled cases. As I said on Second Reading, two years ago I had to deal with complaints about the proposed ward closures in my local hospital, but never with complaints from individual patients.

I suspect that the reason behind the abolition of CHCs has more to do with control freakery, and that the Government are trying to stamp out anything that could embarrass them by highlighting problems in the health service rather than trying genuinely to improve the system. It would be extraordinary if the Government had discovered problems with CHCs only in the past year or two. I suspect that, until 1997, they thought that CHCs were probably the best thing since sliced bread. We certainly never heard Labour Members complaining about CHCs when they were in opposition; they frequently praised them for doing their job, which was to highlight problems.

Kali Mountford (Labour, Colne Valley)

I was first critical of CHCs in Sheffield in 1994.

Simon Burns (Conservative, West Chelmsford)

I am grateful to the hon. Lady. My point is that during the period 1987 to 1997, when I was a Member of the House, Opposition Members were not heard to complain about the performance of their community health councils.

David Jamieson (Labour, Plymouth, Devonport)

She was not here.

Simon Burns (Conservative, West Chelmsford)

I am explaining that point to the hon. Lady. Neither she nor the hon. Member for Eccles (Mr. Stewart) was here. That is the point. I am talking about those hon. Members who were in the House during that period. When they were in opposition, they were keen on community health councils and full of praise for them and the effective, dedicated work that they did. That effective and dedicated work has not changed in the last three years. What has changed is the Government. They do not like criticism. They do not like any organisation, however independent, to contradict the rose-tinted view of the Secretary of State and the message that he wants to get across to the country about what is going on in the health service.

Lorna Fitzsimons (Labour, Rochdale)

Does the hon. Gentleman know that before I became a Member of Parliament, none of my family—and my sister is a solicitor and my brother a chemical engineer, so neither of them is lacking in intelligence—knew about the CHCs, although my father, sadly, passed away having spent a month in intensive care? Does the hon. Gentleman not see that it is outrageous that I had to become a Member of Parliament before my family had access to patient representation?

Liam Fox (Conservative, Woodspring)

It does not depend on that.

Simon Burns (Conservative, West Chelmsford)

As my hon. Friend says, it does not depend on that.

It is interesting that two Labour Members have said in interventions that they were members of community health councils. It is surprising, though, because presumably they were members of those councils before their election to the House. I am surprised that we have not heard from them how inadequate and flawed those community health councils were when they served on them. The answer is that, as my hon. Friend said, none of the Labour Back Benchers who are present today spoke in the Second Reading debate, and none of them has views that contradict what the Government want to ram through the House, because they were handpicked by the Whip, so we shall not hear from them.

The important thing is that we have a system of patient representation that is independent and seen to be independent. My fear is that the current system, which is perceived as independent, will be replaced by bodies that will not command the confidence of the general public that they represent their best interests and will move forward the enhancement and improvement of health care in their local regions.

My own community health council has written to me on the subject, and powerfully reinforces that point. Mrs Norma O'Hara, chief officer at the Mid Essex Community Health Council, said:

``I remain very concerned that individuals, in particular, will not receive the independent support they presently receive from the CHC.''

She is also concerned that

``matters highlighted through complaints, through regular visiting by specialised CHC members and by attending a myriad of health meetings will be lost if the new system is put in place.''

She is absolutely right.

The experience and expertise that community health councils have built up since their establishment in the 1970s is second to none. That will be wiped away by a highly petty move by the Government to get rid of an organisation that is doing its job. If the Minister feels that areas within the existing system are flawed or need to be tightened up and improved, why not take that course rather than take away the whole system and bring in the cockeyed system that the Government propose?

Paragraph 2 of the helpful briefing on patient representation in the NHS that the Minister has sent us in the last two weeks says:

``While some CHCs have done a very good job, their effectiveness and breadth of services across the country is patchy and too highly dependent on individual officers and members.''

I ask the Minister, because that is a very broad-brush and generalised condemnation, what is the evidence to support that statement? It would be helpful to discover the basis of the Government briefings that seek to undermine the CHC system. I hope that the Government will listen to the debate and, more important, to Labour Back Benchers who have not been selected to serve on the Committee. I hope that the Government will think again at this late stage. If they are not prepared to do so, I hope that, in the other place, the two clauses will be treated with the contempt that they deserve and be rejected.

Peter Brand (Liberal Democrat, Isle of Wight)

I should like to make some brief comments. Much has been said about the independence of CHCs, and the fear that whatever replaces them might not be so independent. It is right to worry about that, but I have another concern. CHCs are, on the whole, knowledgeable. They have a wealth of knowledge and experience of the NHS, and they understand it. That has been part of the maturing function that was described by the right hon. Member for North-West Hampshire (Sir G. Young).

I remember that, when CHCs were first set up, no doctor would talk to a CHC member. They were considered to be wild, outrageous people, interfering with the proper functioning of the profession. That has changed enormously. There is now co-operation, but not in the sense of collusion. There is an understanding on both sides that the public are represented through bodies such as CHCs, but those bodies have an obligation to understand the technical pressures and the constraints on medical provision.

The medical profession and the CHCs have evolved, in places where their relationship works, a responsible method of monitoring patient opinion and influencing the people who are charged professionally with delivering the service. In my CHC, we have reached the stage where local general practices have invited CHCs to set up an inspection regime for them. That is right. Inspection is one of the roles that the Minister could have given to CHCs.

I was sorry to hear the hon. Member for Colne Valley describe her experiences, but I was somewhat alarmed that one of her criticisms of CHCs was that they do not always represent popular campaigns. It is CHCs' role to find out what the public believe about a proposal to change the NHS, but it is also their role to evaluate that feedback and make reasonable comment. If the NHS were run purely by campaign—as politicians, we have too often been guilty of that—nothing would ever have changed. We would still be taking out tonsils on the kitchen table, and accident and emergency departments would be present in every village. That is what people would like, but it is not medically responsible.

Kali Mountford (Labour, Colne Valley)

I should like to clarify that at no point did I say that CHCs, or any other body, should simply take up populist campaigns. However, I felt that they were not responsive enough, and that they did not listen to the public. The service is, after all, aimed at the public.

Peter Brand (Liberal Democrat, Isle of Wight)

I am not sure whether that is much of a clarification. Clearly, CHCs should listen to the public. In fact, they should take the lead in public consultation, but that is not the same as—to use the hon. Lady's term—responding. One listens, evaluates and then takes a position. That is the same as our role in Parliament. We do not respond to every pressure group that wants to keep a particular hospital or accident and emergency department open. Hopefully, we receive briefings on the underlying reasons for changing the configuration. We can then decide whether the change is sensible.

The proposals are a mixed bag. The PALS system is fine, and I think that all well run trusts already have such systems. They may not be called by the same name, but they have liaison officers, and have good relations between complaints officers in trusts and staff on wards, in accident and emergency and on reception desks. Such a system will give patients the right advice, but is appropriate only when patients or their carers agree with the process produced by the trust.

In 90 per cent. of cases, that will be the right way to handle such complaints and give support. However, a simple way to receive such support is essential when complaints cannot be resolved in-house. My hon. Friend the Member for Sutton and Cheam said that the Government recognised the problem in their response to the Select Committee on Health about complaints procedure. It seems sad that we are abolishing a route whereby we could handle specialist complaint procedure, without being specific about what we are putting in its place, and that we are doing so before the Government formally respond to the problem, as they should in the next few weeks.

John Denham (Labour, Southampton, Itchen)

We have had a good introduction to the important debate on this part of the Bill. I welcome the hon. Member for Woodspring to the Committee to lead for the Opposition. He is not usually far from any bandwagon, and he has not disappointed us this morning.

Although the debate has been important and will continue to be, I feel disappointed by it so far. There has been a tendency to seize on the issue as one on which the Government have been criticised, so people have piled in to do that rather than to tackle the fundamental and serious question of what form of scrutiny and patient representation is needed to build a patient-centred national health service. Much of the debate has been complacent and lacking urgency about what needs to be done. It has proceeded on the premise that the situation is are pretty much okay from patients' point of view, and that tweaking with a few bad spots here or there will adequately deal with the problem. I do not believe that that is the situation, and it is not the vision set out in the NHS plan. That is why the Government propose a more fundamental change.

The clause is about the abolition of community health councils. It is essential that Committee members understand that the conclusion that CHCs are being abolished as a consequence of the decision to create a better and more powerful system of scrutiny and patient representation. It is not and never has been a primary objective of the Government. We did not start with the idea of getting rid of CHCs and then wonder what to put in their place, but by asking what was needed, from first principles, to build an effective system fit for the 21st century. We must change how the NHS operates, as well as protecting and enhancing the interests of individual patients. The change will be a comprehensive overhaul of the involvement of patients and the public in the running of the NHS. In key areas—for example, the oversight and scrutiny committees and patients forums—we are providing the necessary powers in the Bill, but in others we do not need new legislation to make the proposals work. As hon. Members have done, it is important to put the clause in the context of all the changes that we are making.

There is a need to strengthen support for patients, carers and their families. In the front line of that are the patient advocacy and liaison services. When we consulted on the NHS plan last summer, people said time and again that they needed someone to help sort out situations that had gone wrong. They wanted someone on the spot who could tackle an individual problem as it arose. We might like to think that the system already provided such assistance. The hon. Member for Isle of Wight said that that was often the case in trusts, but the overwhelming message from our public consultation was that patients did not feel that way. Through leaflets, radio phone-in programmes and meetings that Ministers attended, we were repeatedly told that something was going wrong, and that there was a need for someone to whom people could turn.

The advocacy and liaison services will be essential to sort out problems on the spot. We believe that they should be part of the trust, should have direct access to the chief executive, should be able to facilitate the swift resolution of problems and identify patterns of problems that emerge within trusts so that management can deal with them. There have been concerns about the independence and effectiveness of PALS, and we are building some safeguards into the process, but I will come to them later.

Ian Stewart (Labour, Eccles)

Will my hon. Friend the Minister comment on the accountability of PALS and advocates?

John Denham (Labour, Southampton, Itchen)

PALS will be part of the trust, reporting to the chief executive and sorting out problems as they occur. We expect the new independent patients forums to scrutinise the work of PALS and to assure themselves that they are working for patients as they were designed to do. As a safeguard, we will provide powers in amendments today so that, if necessary, a patients forum can recommend that the PALS be taken out of a trust and run independently. I honestly do not believe that that is likely to happen on many occasions, but it is built into the Bill as a safeguard against the danger that a trust management would browbeat or neuter the work of PALS and stop them from being effective on behalf of patients.

PALS will help patients going through hospitals and primary care, so on occasions serious and formal complaints will need to be addressed. We are reviewing the complaints system. There will be new proposals, and Ministers have not yet received the evaluation of the existing complaints procedure, but we think that we need a more independent system. Although we do not have the exact shape of the new system, we are confident that patients will require independent advocacy—someone to hold their hand. We are confident about going ahead with the proposals because it is difficult to conceive a complaint system in which there is no need for independent advocacy on behalf of the patients.

As part of the pattern for provision, an independent patient advocacy will be commissioned in each area of the country. We accept that there is a critical issue—it is managerial, not legislative—about ensuring that the signposting to the PALS in each hospital or primary care trust leads directly to the advocacy service. As we have heard, that is often lacking in the current system, so that some people do not find their way to CHCs.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The Minister said that the tasks of PALS would include discerning the patterns that complaints produce and reporting them to their chief executives. What powers and duties will be placed on PALS, should they come to the view that their chief executive and trust are not responding to their concerns? To whom to do they report, and will they be protected for doing so?

John Denham (Labour, Southampton, Itchen)

There is obviously extensive provision. The hon. Gentleman will know that the Government introduced legislation to protect individual members of staff, whatever their position—whether they are part of an advocacy and liaison service or in any part of the health service—who, having properly tried to raise their worries about how things were being managed, felt it necessary to become a whistleblower. That is a fundamental protection.

We shall certainly discuss it, but we shall need a good flow of information between the different parts of the system as they are being put together. I am not persuaded that we need to legislate for it, but it will be necessary for the patients forum and PALS to work closely together because the forum will be overseeing and scrutinising the work of PALS. A member of the trust board will have been elected from the patients forum. That person will be another friendly member of the trust board, although he or she will be there as a trust board member and not simply as a patients' representative.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The Minister referred to the appointment of a patients forum member to the trust board. However, neither the explanatory notes or the briefing paper discuss the problems that a patients' representative will have given his duty as a corporate member of the trust board. How will those difficulties be overcome so that the patients' representative can act for the patients?

John Denham (Labour, Southampton, Itchen)

A representative will be elected by the patients forum but, on balance, we believe that it will be better for him to be a full corporate board member. It guarantees patients a route through the system that does not exist now.

PALS and the independent advocacy service are the key organisations for the patient. Other elements in the system, such as the advisory forums for health authorities, are important in ensuring that patients and local communities have a voice. However, for individuals trying to find their way through the system, PALS and the independent advocacy service are the two critical elements. It is all about the experience of individuals.

We want to strengthen the patient's voice within the NHS. That is why we want to establish a patients forum for every trust and primary care trust. Subject to today's discussions, they will be statutory bodies independent of trusts. As I said, each forum will appoint one of its members to be a non-executive member of the local trust board. The patients forum will consider and comment on every aspect of trust care from the patients' perspective. They will also have the right to make inspections wherever NHS patients go—hospitals, doctors' surgeries, nursing homes and the private sector—and they will be able to make recommendations direct to the trust board, ensuring that patients' views are heard where it matters most.

Peter Brand (Liberal Democrat, Isle of Wight)

Will the Minister give way?

John Denham (Labour, Southampton, Itchen)

If I may, I shall finish the point; it may help because I am reflecting on points raised in the debate.

We are convinced that we need to focus on the main organisational unit of the health service. I see from the amendments that that is the difference between the Liberal Democrats and the Government. However, an organisation at a greater remove would not be able to bring the patients' perspective to bear sufficiently sharply or effectively. If the experience of the patient is to change, real changes must be made to the operation of the organisation; it has to be brought to bear directly on the board and its chief executive, executive directors and medical directors that change is required. Establishing a patients forum is the first building block to in our attempt to strengthen the patient's voice in the NHS.

Peter Brand (Liberal Democrat, Isle of Wight)

I wanted to ask a more detailed question. The Minister spoke about the Bill's provisions applying in those areas of trusts where patients have access. Will inspections be made of mortuaries, chapels of rest, kitchens, laboratories, laundries or—not far from him locally—sterilising departments?

John Denham (Labour, Southampton, Itchen)

The hon. Gentleman makes a fair point. The strict interpretation of the expression ``anywhere that patients go'' might be used to exclude—

John Maxton (Labour, Glasgow Cathcart)

Order. I hate to interrupt the Minister, but there are amendments on exactly that point later in the Bill, and it might be better to deal with it then.

John Denham (Labour, Southampton, Itchen)

I am grateful to you. We shall clarify the point later.

Desmond Swayne (Conservative, New Forest West)

Earlier, the Minister was asked about the future of Casualty Watch and similar publications. My understanding was that he thought that patients forums would be the proper place for them. Would he go further and make a stronger commitment? Will he make it his business to ensure that such publications find new publishers within the patients forums?

John Denham (Labour, Southampton, Itchen)

My difficulty is that the fear that Secretaries of State or Ministers would tell patients forums what to do persuaded us—as a reassurance—to make them independent statutory bodies, and that precludes me from instructing them to do anything of the sort. It is our expectation, however, that patients forums will undertake specific or general monitoring activity. That is important as an allegation has been made—and repeated this morning—that the aim of the exercise has been to remove from the system of scrutiny in the NHS any organisation or body that could play that role. That is not the case. Patients forums will be as able to carry out that role, as CHCs have in the past.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am grateful to the Minister for giving way so often on the details of the provision. In response to the hon. Member for New Forest, West (Mr. Swayne), he said that the Government's concern was to establish the bodies on a statutory basis so that there was no doubt that they could not be told what to do by the Government. Why have the Government chosen not to establish the area advisory committees on a statutory basis?

John Denham (Labour, Southampton, Itchen)

We believe that the powers of direction that require health authorities to set them up will be adequate. We shall debate that later, but in terms of safeguarding the independent patients'voice in the system, which has been the main focus of debate and concern, establishing the patients forum on a statutory basis was the right thing to do.

We have had a slightly odd debate. On one hand we had allegedly not consulted and on the other hand we were accused of making it up as we went along. The reality is that we have published a set of proposals and we have listened to what people have said about them. Some of the detailed legislative proposals that we are considering and some of the policy points that I am making reflect that discussion. Our approach remains intact, but we have sought to build in some of the safeguards that right hon. Members or people in CHCs felt were necessary and that is a perfectly proper way to proceed.

Liam Fox (Conservative, Woodspring)

The Minister has been talking about the accountability of the trust unit and the role of the patients forums, but much of what the trust does will be influenced by either the health authority's policy or the resources that it distributes to the trust. How will they be held to account?

John Denham (Labour, Southampton, Itchen)

I am not sure I have grasped the point that the hon. Member for Woodspring is trying to make. In a previous sitting we discussed the general system of performance management for trusts, but that is a slightly different issue. If the hon. Gentleman is inquiring whether patients forums or local authorities' scrutiny committees will be able to form a view about the level of resources or their deployment within the health service, the answer is that they will be able to do that. That is quite clear. Nothing in our proposals would constrain those bodies in that way.

Dr. Fox rose—

John Denham (Labour, Southampton, Itchen)

I should move on. Perhaps we could discuss the detail later.

Liam Fox (Conservative, Woodspring)

I was not trying to catch the Minister out. I was simply looking for clarification. In respect of the availability of a particular treatment or drug, for example, how would the patients forum guarantee representation of patients' rights given that the policy on such matters comes from the health authority and not the trust?

John Denham (Labour, Southampton, Itchen)

The patients forum would be able to take a view on any aspect of the care that was offered by a hospital trust or primary care trust. There are many health authorities that already discuss prescribing policies, in broad, strategic terms, with forums established at local level. We would expect that to happen. The proposal for advisory forums is built on the existing work of health authorities in conducting strategic, consultative forums at a local level. If one is seeking a group of patients that is able to take a view on the care that is offered to a patient in a particular provider part of the health service, the patients forum is just such a group. That is an issue that has been raised, and it is a matter for debate. We are focusing on the provider structure in the NHS, for the reasons that I have given. That is a matter of deliberate choice on the part of the Government.

I should like to cover a few relevant points. Although we have touched on it only briefly this morning, there is a case for ensuring that the individual patients forums are properly supported and that patients are properly represented at a level above the local. That issue was raised by the right hon. Member for North-West Hampshire (Sir G. Young). We are working with a group of patients' organisations, including the patients forum, the long-term medical conditions alliance, and the College of Health, with whom we have funded a study, which is under way. The report on the study will be available in March.

The study is concerned with establishing the best way of doing two things: providing a national focus for the new system of patient representation, and identifying the type of support that should be offered to patients who use the system. That is covered in the briefing that we circulated a few days ago. It is important because it may be necessary to take a broader view, and it will certainly be necessary to learn from current best practice in making the new system work as effectively as possible.

Doug Naysmith (Labour/Co-operative, Bristol North West)

It has been said that CHCs will be in existence until 2002. They are currently backed up by ACHCEW. Will the Minister confirm that funding for CHCs and for ACHCEW will continue until that date?

John Denham (Labour, Southampton, Itchen)

The NHS plan has set 2002 as the date on which the new system will replace CHCs. I see no reason to vary that timetable. We are committed to continuing funding, to ensure that there is no gap in between the two systems.

Amendment No. 241 suggests that we should run the new system before getting rid of the old system. That is an interesting idea. If the previous Administration had decided to keep the publicly managed railways going until we saw whether privately managed railways would work, we might not be where we are with the transport system. Clearly, it is important to ensure that there is a proper transition from one system to another. That is an issue not of legislation but of management. We must ensure that there is a proper transition. In practice, it would not be possible, financially or organisationally, to have a double running of the new system and the current system. I will ask the Committee to resist amendment No. 241.

There will be other elements. We touched briefly on the local advisory forums. We envisage those as relating to the strategic planning function of a health authority, both in response to the new duty of consultation, and to involve the public in priority assessing and planning. We want to take a flexible approach, building on what is good locally, but we envisage a core panel of patients and public, including representatives from patients forums and a wider pool of representatives.

I want to mention the overview and scrutiny committees. Local authorities are establishing those committees to scrutinise local government decisions, and the Bill extends their role explicitly to include scrutiny of the NHS. That will help to address the democratic deficit in the NHS. Health bodies will be required to provide information on local services to the overview and scrutiny committee, and it will make reports and recommendations to the NHS bodies that it reviews. If a trust does not act on the recommendations of the overview and scrutiny committee, it will have to justify that decision.

Over the past few months, we have been talking and listening to the views of stakeholder groups, including CHCs, on how to build on what is good and maximise the potential of a new system. Some of the measures before the Committee today are the direct result of that dialogue—specifically, the status and independence of patients forums, the commitment that I have made to commissioning of independent advocacy, and the feasibility study on the creation of a national patient body. Those developments help to show the work that we have done.

The clause follows, rather than leads, the decision to adopt a more effective and focused, and in some ways more broad ranging system of patient and public representation in the NHS. We should support it and resist the Opposition amendments so that we can make progress in establishing and, later today, discussing the detailed elements of, the new structure.

Liam Fox (Conservative, Woodspring)

It is fair to say, in summary of the arguments that have been advanced, that even the CHCs themselves would not claim to be universally excellent. They have more than willingly accepted that there are shortcomings in many areas. However, some of them are excellent, as the Minister mentioned in his remarks to the Committee. Logically, that is an argument for reform rather than abolition. Some CHCs work very well, which proves that they can work well and provides an argument for bringing them all up to that standard. The rationale adopted by the Government in clause 14 seems to be that any organisation is to be judged by its poorest exponent, and that that should trigger abolition. That would be a very harsh test to apply to any Government organisation, never mind Government personnel. It smacks of a conclusion reached before its justification has been properly considered.

The Government's handling of the matters that we have been discussing has been appalling. I am sorry that the Minister expressed no regret for that and did not apologise to the CHCs, which have been treated disgracefully, especially as they were not consulted about the contents of the plan and had to hear it, like everyone else, from the Prime Minister's lips. Staff who have given great service have been discarded in an unacceptable way. There is ample precedent for shadow authorities. It makes sense not to leave patients vulnerable until it is possible to be sure that a new system will work properly. There is a growing feeling, which has been reinforced today, that Ministers are making all the new systems up as they go along. For the reassurance of the public I want to press amendment No. 241 to a vote.

Question put, That the amendment be made:—

The Committee divided: Ayes 6, Noes 10.

Clause 15 - Power to abolish community health councils in wales

Clause 7 - Functions of overview and scrutiny committees

Desmond Swayne (Conservative, New Forest West)

I beg to move amendment No. 245, in page 6, leave out lines 14 to 18 and insert

`any county, county borough, district or London Borough Council having responsibility for social services within its area'.

John Maxton (Labour, Glasgow Cathcart)

With this it will be convenient to take amendment No. 226, in clause 7, page 6, line 18, at end insert—

`(e) any district council.'.

Desmond Swayne (Conservative, New Forest West)

After that passionate debate on the principles underpinning the clauses that we shall discuss for the rest of the day, I feel that it is down to me to lower the temperature of the Committee, and to bring us back to our ``meat and two veg'' agenda of detailed scrutiny of clauses and amendments. Notwithstanding the modest arrangements that we might make at lunch, and perhaps at 7 pm, the clock beckons us until 10 pm. I am sure that my hon. Friends would want us to give detailed and thorough, if not exhaustive, scrutiny to the amendments, so that those who have gone to Fulham today to learn of the rest of the Government's health agenda will wish that they had remained to share our scrutiny this afternoon.

Amendment No. 245 would make the principle of clause 7 clear. The practical consequence of the clause is that

``any county council, . . . any county borough council''

``the council of any district comprised in an area for which there is no county council''

will have oversight and scrutiny functions. The principle underlying that is that the local authorities detailed in the Bill are those that currently have responsibility for providing social services. However, we think that it is better to put into the Bill the principle rather than the practical consequence. Reform of local government may change the arrangements, so it is better to state the underlying principle that caused the Government to choose those structures to have responsibility for oversight.

We know that the function will not necessarily be easy to perform. It is somewhat analogous to the suggestions that have been made over recent years with respect to fluoride, whereby the Government has suggested that local authorities might consult their electorates and, as a consequence, bring about greater use of fluoride in the water. The problem is, of course, that local authority boundaries are not coterminous with water authority boundaries, so there is an immediate problem of how that exercise in seeking electoral consent will give practical effect to the policy.

There is a somewhat similar problem here, in that health authority boundaries, PCTs and trusts are not coterminous with the local authority scrutiny that will be provided. That problem is significant. I draw attention to the paper that the Government have provided within the last few days, entitled ``Patient Representation in the New NHS. Part One: A new voice for patients''. On page 6, the Government acknowledge:

``In many places, scrutiny committees from more than one authority will need to work together to ensure an efficient scrutiny process. Subject to Parliament, regulations will be made setting out how OSCs can pool or share powers or cooperate together to do this.''

I look forward to hearing the Minister spell out precisely how he envisages that that will take place.

``They will also set out how district councils may participate.''

That will be a very interesting discussion, to which we look forward, because I am sure that all members of the Committee will have received the correspondence from Epping Forest district council. It is obviously enthusiastic about taking up its responsibilities with regard to scrutiny—responsibilities that it believes that the Bill, as currently structured, denies it.

The council makes an interesting point. It says in its letter:

``It is not reasonable or realistic to expect the County Council to carry out a thorough scrutiny process when some 26 plus health service organisations are involved. This includes 2 Health Authorities, 16 Primary Care Groups/Trusts and at least 8 acute or specialist provider Trusts and ignores totally those Health Trusts which provide cross border services to a large part of our population.''

The council is speaking there of its own particular circumstances in Epping Forest, but I doubt very much that other district councils find themselves in a wholly different position.

I look forward with interest to the case that the Liberal Democrats will make for their amendment because, although I have some sympathy with it, I have reservations about expecting district councils to discharge the functions—[Interruption.]—The hon. Member for Sutton and Cheam murmurs from a sedentary position but, from my experience of my own district council, I wonder whether it is equipped to carry out that function. It is already struggling, given the resources that it has, to discharge its existing duties. How much additional resource will it be provided with if it is to discharge new oversight and scrutiny functions?

I would not go so far as to say that we are in danger of a surfeit of scrutiny, but there is a possibility that, by fragmenting the arrangements that were previously undertaken by community health councils and expecting the oversight to be taken up by any number of local authorities at different levels, we are creating the danger of fragmentation and we may weaken the authority with which local authorities can scrutinise the NHS by expecting scrutiny to occur at many levels.

We expect the Government to justify their stance but we are, by and large, comfortable with the notion of scrutiny at the level at which social services responsibility is exercised. Those councils are already under a statutory obligation to co-operate, under the Health Act 1999. We are confident that that is probably the right level, although we can foresee problems.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I shall start by trying to square the circle that the hon. Member for New Forest, West has attempted to draw with respect to amendment No. 226. Our aim in tabling the amendment was to add to subsection (2) the category of district councils. The rest of the clause deals with order-making and regulation-making powers that will dictate how each tier of government is to discharge its function. To enable the Minister to keep his promise to set out the way in which district councils may participate, it seemed sensible to us that the Bill should provide for them to participate in the first place. The Minister could then, in regulations, specify how they were to do so. In view of that, it might be argued that amendment No. 245 is more prescriptive and inflexible. Simply making the necessary addition to the list of bodies that can be involved in the scrutiny process allows for greater flexibility.

I pray in aid the parliamentary briefing from the Democratic Health Network, which has drawn attention to the fact that district councils have an important contribution to make. They have a role in environmental health and they have housing responsibility, not just as strategic planners but often as providers. Those issues are part of a health improvement agenda and a health inequalities reduction agenda. It is slightly puzzling—perhaps the Minister will provide clarification on this—that the remit of the oversight and scrutiny committees seems to be focused very much on the provision of services by trusts, whereas it might also have included the wider questions of health inequalities and health improvement. Will it be possible for those matters to be dealt with in the regulations?

We consider that there is a case for participation by districts in what is proposed. Perhaps it would be better for them to be organised jointly with their county authorities, but on some occasions specific reconfiguration issues might have more of an impact on one local authority and population than any other, so that locally based scrutiny of the proposals by the district council in question would be by far the most appropriate exercise of the powers under the clause.

John Denham (Labour, Southampton, Itchen)

If I have been listening properly, there is broad agreement about what the proper outcome should be. We shall touch on similar issues when we debate clause 9 and related amendments. The Government's view is that the lead responsibility for the scrutiny process should lie with social services authorities, which is the intention underlying the Conservative amendment. However, we recognise that there is a case for involving district councils in the process.

New clause 9 will enable us to make regulations for the joint working between social services authorities that will sometimes be necessary. That might be relevant, for instance, in my neck of the woods, where Southampton is the social services authority for my constituency, and Hampshire covers the constituency of the hon. Member for New Forest, West. The provision would also cover the involvement of district councils. There will obviously be situations involving primary care trusts, reconfigurations and things of that sort, where a district council input to the scrutiny process would be essential. There is no need for amendment No. 245. The existing wording of the Bill reflects a common intention.

Amendment No. 226 puts district councils on the same basis as social services authorities. That is not our intention, and new clause 9, when we come to it, will, I hope, be seen to deal adequately with the point made by the hon. Member for Sutton and Cheam.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

We deliberately put the amendment that we tabled in that part of the Bill, because the clause is about regulations. I interpret the clause to mean that the way in which scrutiny will be performed can vary. Will the Minister tell us in what way the clause precludes differential treatment between different tiers of local government?

John Denham (Labour, Southampton, Itchen)

I believe that new clause 9 deals with the matter more adequately. My understanding is that accepting such an amendment to subsection (2) might imply an equivalence of approach. I hope that new clause 9 will deal with the question.

Desmond Swayne (Conservative, New Forest West)

I accept entirely the hon. Gentleman's point that the practical effect of our amendment is to achieve precisely what the clause, as currently drafted, achieves. However, I do not understand why he has chosen to achieve that by specifying the types of council rather than what it is about those types of council that makes it appropriate for them to undertake the scrutiny. There is an agenda for reform in local government, and there is a regional government agenda. The types of council that the Government have specified might not always discharge the responsibilities that they currently do.

John Denham (Labour, Southampton, Itchen)

The answer is perfectly reasonable. We chose the best default option for inclusion in the Bill. Choosing to specify the type of authority as opposed to specifying authorities in terms of social services provision avoids any other selection of authorities that would have overlaps and duplications. Should responsibility for social services be transferred elsewhere—we have no intention of doing so—we will at least be left with a pattern of scrutiny that covers the country uniformly. If we had specified social services provision as a criterion, consequential changes would have been needed. We are getting into a hypothetical area of law-making. The effect of the measure is to provide a uniform pattern of scrutiny, and new clause 9 will allow district councils to be included in that pattern where appropriate.

Doug Naysmith (Labour/Co-operative, Bristol North West)

This is a minor point, which is not really related to the amendment. We are talking about social services provision as being the determining factor in deciding the direction of the Bill. I should like to place on the record, and I am sure that the Minister will agree with me, that district councils, through their environmental health function, have an important part to play in public health. I would not like to think that the direction of the Bill was being determined by questions of social services provision.

John Denham (Labour, Southampton, Itchen)

My hon. Friend is right, and that is why the amendments and new clause 9, which we shall consider later, are important. We must not exclude district councils from the process altogether. However, a decision must be taken about where the lead responsibility should lie, and that is the judgment that we have made.

Desmond Swayne (Conservative, New Forest West)

The Minister has adequately explained the matter, and said what I would have said in my intervention. In consequence, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Desmond Swayne (Conservative, New Forest West)

I beg to move amendment No. 242, in page 6, line 19, leave out `Regulations may' and insert—

`The Secretary of State shall, within 60 days of this section coming into effect'.

John Maxton (Labour, Glasgow Cathcart)

With this, it will be convenient to take the following amendments: No. 74, in page 6, line 19, leave out `may' and insert `shall'.

No. 26, in page 7, line 3, at end add—

`(7) Before making any regulations under subsection (3) above, the Secretary of State shall consult such bodies as represent the interests of those likely to be affected by the regulations.'.

Desmond Swayne (Conservative, New Forest West)

Given the hour, I am sure that the amendments will not detain us for too long. One thing has become abundantly clear from our debates this morning: there is a huge amount of uncertainty as to what, precisely, the arrangements are, and how they will work and interact. The amendments are concerned with what, precisely, is under scrutiny, what will be the subject of the reports of the scrutiny committee, what the NHS must consult the committees about, what information the NHS must or must not provide to them, and who has to appear before them. The regulations must, not ``may'', tell us all that.

There is already sufficient uncertainty. If the regulations will not give us that information, what use will they be? We crave certainty as to precisely what the regulations will spell out.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The amendment does nothing of what the hon. Gentleman mentioned, but limits the time in which the regulations can be published. The points that the hon. Gentleman talked about are tackled by amendments Nos. 74 and 26, which were tabled by my hon. Friend the Member for Isle of Wight and me.

I understand the concerns of the hon. Member for New Forest, West. We tabled the amendments for the same reason. We believe that the Secretary of State should have to take action, and that he should have to consult. Much of the Bill is being portrayed as having a spirit in which consultation is important, and a provision such as that in amendment No. 44 would enable the Government to give further assurances to those interested in the subject that, in relation to clause 7(3), they will meet the interests of patients and other groups.

Desmond Swayne (Conservative, New Forest West)

I do not want to get into a private row with the hon. Member for Sutton and Cheam, but I am sure that he will acknowledge that the effect of publishing regulations within 60 days will achieve the certainty for which we have asked. I accept that his amendments would achieve the same effect.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

We have common cause in wanting certainty, if in nothing else. I hope that the Minister will respond positively to the proposal that there should be consultation ahead of the publication of the regulations.

John Denham (Labour, Southampton, Itchen)

I may be wrong, but I shall assume that the amendments are probing amendments, designed to elicit assurances that there will be regulations and consultation on them with parties such as the Local Government Association and the NHS Confederation. Regulations will need to be in place before the overview and scrutiny committees can assume their functions. The regulations will be subject to scrutiny through the negative resolution procedure.

The process will be important. The scope of the powers of the scrutiny committee to consider, for example, major hospital reconfigurations, major service changes and so on will be set out in the regulations. Members of the Committee will be aware that some of the rights that CHCs enjoy derive not from primary legislation or regulation, but from a combination of guidance and judicial precedent. When moving to the new system, we clearly need to outline the appropriate powers for the scrutiny committee, so it will be necessary to raise issues on which we especially want to ensure that the committee plays an effective role.

The hon. Member for Sutton and Cheam mentioned health inequalities. We would want to consult on whether there would be an advantage in specifying the health improvement programme and its implementation as a key area for the scrutiny committee to examine. That is a way in which, through the regulations, it would be possible to institutionalise a focus for some of the issues with which he is concerned.

The matter is not for today. Regulations will be made, and we will consult.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Will the Minister tell us whether the current Association of Community Health Councils for England and Wales will still exist when the regulations are published? We must be able to check that the precedents set through the courts are firmly established and bedded down in the new regulations.

John Denham (Labour, Southampton, Itchen)

In view of my earlier assurances about the need for a proper transition from the existing system to the new system, that is likely.

Desmond Swayne (Conservative, New Forest West)

I thank the Minister for his response. We believe that the publication of the regulations is urgently required, because the process of deciding how the arrangements will work is already under way. The Minister will be aware that the discussion between the Local Government Association and the NHS Confederation was about precisely how the arrangement worked, and several questions were raised that need certainty. However, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

It being One o'clock, THE CHAIRMAN adjourned the Committee without Question put, pursuant to the Standing Order.

Adjourned till this day at half-past Four o'clock.

Standing Committee E

Clause 7 - Functions of Overview and Scrutiny Committees

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment No. 44, in page 6, line 20, at end insert—

`( ) as to the commissioning of independent advocacy services and requirements placed on any officer of a local NHS body or other specified body to assist the advocacy service in discharging its duties,'.

David Madel (Conservative, South West Bedfordshire)

With this it will be convenient to take the following: Amendment No. 237 in clause 9, page 8, line 8, at end add—

`(4) It is the duty of every body to which this section applies to commission independent advocacy services to support any formal complaints made against that body and to support patients' use and access to services provided by, or under arrangements made by, that body.'.

New clause 5—Patient Advocacy and Liaison Services—

`.—(1) The Secretary of State shall make regulations requiring all NHS trusts and Primary Care trusts to set up services to be known as Patient Advocacy and Liaison Services (PALS) and making provision for such services, including the establishment of links with Patients' Forums.

(2) It is the duty of each PALS to provide advocacy services to patients both in relation to everyday use of services provided by, or under arrangements made by, the relevant trust and in relation to complaints, including formal complaints, about the provision of such services.

(3) Before making regulations for the purposes of subsection (1) above, the Secretary of State shall consult such bodies as represent the interests of persons likely to be affected by the regulations.'.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Welcome to the Chair of this Standing Committee, Sir David. We are having very interesting deliberations. I want briefly to address this group of amendments, which deals with two related issues. The first is independent advocacy, which we spent some time discussing in the broader debate that we had this morning. We now come to the more specific details of how we are to secure that independent advocacy. The second is the further examination of the proposals for the patient advocacy and liaison services staff, which are not in the Bill but were referred to in the Government's explanatory notes.

Amendments Nos. 44 and 237 deal with the question of advocacy and would enshrine in the Bill the Government's commitment to providing the funds and the necessary regulations to ensure that independent advocacy services are established. They would also provide that whoever is responsible for funding those services--the pay and the rations--be it a local authority or a health authority or some other potential commissioner of these services, it is able to ensure that the advocacy service can operate effectively on behalf of patients. It should ensure that any NHS body it deals with understands that it should signpost patients to the advocacy service when that is appropriate, and should set out when that would be appropriate so that there is no doubt about that. It should also ensure that the various agencies within the trusts are willing and able to co-operate with the advocacy service.

New clause 5 also deals with the role of patient advocacy and liaison services. Even at this late stage, we should reconsider the name of these services, especially as the Government have not been persuaded of the merits of including in the Bill provisions governing the operation of this particular function within trusts. This morning we were told that many people in hospital who want to complain are not aware of the existence of community health councils. I fear that confusion will be sown by calling it an advocacy service, because, on any standard definition of that role, the post will not actually operate as an advocate. We are in danger of causing confusion. This is not merely a point of semantics. People will be confused when they consider the range of bodies that they are asked to deal with when they have problems with the NHS. We need to be careful about the language we use so that we minimise that confusion. I hope the Minister will comment on that, because we currently have two bodies that use the term advocacy in very different ways.

New clause 5 seeks clarity on the boundaries between PALS, the independent advocates and the patients forums. It would enable the Secretary of State to use regulation-making powers, and would at the very least allow further scrutiny, through secondary legislation, of the details of how PALS will be rolled out and operated on the ground. That is why we tabled these amendments. We do not want to diminish the value of such services within trusts—that has not been our argument—but this important role should have a statutory basis. That is what new clause 5 asks for, but if the Government cannot accept the amendments, I hope that they will be willing to table similar amendments.

How soon will the Government make proposals on advocacy services to guarantee that they are secured? How do they intend to secure the funding arrangements? Will there be new funds? Are funds already included in the comprehensive spending review, or will additional moneys be made available to fund the development of a comprehensive network of advocacy services? On the face of it, the comprehensive spending review does not contain the wherewithal to fund that significant expansion throughout the country.

I look forward to the Minister's response, and I hope that it will be positive.

John Denham (Labour, Southampton, Itchen)

I, too, welcome you to the Committee, Sir David. We have had some productive sittings, and I am sure that that will continue under your chairmanship.

It is an interesting group of amendments; they would be contradictory if we were to accept them all, but they allow us to explore the issues involved. The hon. Member for Sutton and Cheam (Mr. Burstow) asked whether PALS should be a statutory body. We envisage the service being one of the functions of trusts, and such functions—the specific services provided by trusts, such as running out-patients clinics or doing operations—are not provided for in primary legislation. It would therefore be rather odd to include PALS in the Bill. The hon. Gentleman will have noticed, however, that under later amendments we shall provide the means by which a failing PALS or one that had been neutered by management could be taken out of the trust. If those later amendments are accepted, we shall, in a roundabout way, have provided some protection of the advocacy and liaison service.

We disagree with the hon. Gentleman on independent advocacy to support patients through the formal complaints procedure. We have been persuaded by CHCs and others that that formal role needs to be separate from the advocacy and liaison service role. New clause 5 would seem to put PALS in charge, but we would not want that. Nor do I agree that the independent advocacy service should be provided by the local authority scrutiny committee, but where it should go is something for further discussion. There are two possible models of providing the independent advocacy service. It could either be commissioned by the health authority—the obvious choice—or by the local authority. In turn, the local authority could be either the commissioner of the service or a provider of the service, commissioning the service from itself.

At this stage, it is better to allow further discussion and even some local flexibility. Funds will clearly be needed. We may take a similar route to that taken for CHCs, which is to use the regional health authorities for that purpose. There are clear attractions in locating the advocacy service in a local authority, particularly if, as we suggest in the explanatory document, the authority were to provide the secretariat for the patients forum in the area. That would mean a concentration of staff; they would be working for the same service in the same location. It is better that the Bill is not too prescriptive. Discussions are continuing with the health service, the Local Government Association, CHCs and other patient groups. A clear line suggests itself, and we want to discuss it in more detail.

It has been a brief debate, but I hope that I have responded to the major points raised by the hon. Member for Sutton and Cheam.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am grateful to the Minister for having clarified one or two matters. In return, I shall clarify the thinking behind new clause 5. It is not intended to substitute powers for the provision of the independent advocacy service, and the Minister is right that it would be inconsistent for the other two amendments to be read alongside it.

The Bill should place a specific obligation on the Secretary of State to ensure that advocacy services are commissioned, even if we are not specific about the commissioner. Will the Minister suggest whether there would still be an opportunity for a legislative amendment if consultation on the matter were concluded before the conclusion of the passage of the Bill?

Although we may come back to these issues later, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment No. 45, in page 6, line 20, at end insert—

`( ) as to the composition of the committee so as to include representatives of the voluntary sector and the Patients' Forum'.

David Madel (Conservative, South West Bedfordshire)

With this it will be convenient to take the following amendments: No. 25, in page 6, line 33, at end insert—

`(g) as to information which the committee shall make available to Patients' Forums.'.

No. 75, in page 6, line 33, at end insert—

`(g) requiring the committee to liaise with the Patients' Forums on matters of concern raised by the Patients' Forums,

(h) as to matters allowing the committee to set up local enquiries with the power to call for evidence,

(i) as to matters allowing the committee to refer matters of concern to NICE, CHI, the Audit Commission and the Secretary of State.'.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

These amendments are about representation and how we ensure that the overview and scrutiny committees are not made up only of local councillors, important though their contribution to the scrutiny process will be. As with other local committees, the scrutiny committee will deliberate on the interests and expertise of others. In the context of the amendments, I am thinking of the role of the voluntary sector in our communities, and also the scrutiny role of those serving on patients forums—or, as we would prefer, a patients forum for each locality. We need to establish firm links between the role of the overview and scrutiny committees and the role of patients forums, so that we can avoid issues falling between stools. An overlap of membership would go some way towards addressing that concern.

The amendments deal with the type of information that will be available to patients forums. We want to establish clearly in the Bill obligations on the exchange of information between the overview and scrutiny committees and patients forums. I am sure that the Minister will tell us that that will happen anyway, but we have been told by Labour Members that the CHCs have not performed as well as they might, despite the fact that the regulations that establish them are detailed. All that I ask is for a reference point in the Bill, to make the fact that communication should take place between the two bodies clear and indisputable. The bodies are important to the establishment of the Government's framework for the new overview and complaint systems in the NHS.

Desmond Swayne (Conservative, New Forest West)

I add my congratulations to you, Sir David, on taking the Chair. It is always a tremendous pleasure to address the Chair, especially when you occupy it.

I understand the rationale behind the amendments tabled by the hon. Member for Sutton and Cheam. I share his anxiety about creating an interlinking network between the patient advocacy and liaison services and the scrutiny function. That is important, especially as those who participate in the PALS will have had experience of complaint handling, and will have powers of inspection. An avenue for the passage of information should be opened up.

My concern is about the nature of the membership of the overview and scrutiny committees. I have always regarded such committees as an opportunity to redress a perceived—and, I think, real—lack of democratic accountability in the health service. It is therefore proper that the members of those committees should be elected councillors. By introducing co-opted members as full members of such committees, would we weaken that principle? That is my only concern with the amendment.

John Denham (Labour, Southampton, Itchen)

The first two amendments seek to prescribe, through the Bill and through regulations, the relationship between the patient forums and the overview and scrutiny committees, in a way that goes beyond what is desirable or necessary. We understand the need for patients forums and scrutiny committees to work together. Although that is desirable, the bodies have different roles, and they must exist separately. The amendments would go too far in trying to merge their functions, at least at the edges. Patients forums are about bringing patients' views into the NHS, for every trust. The scrutiny committees are about scrutinising the way in which the NHS is developing and delivering its services locally.

There will, in practice, be plenty of scope for co-operation between the two bodies. Under the local government legislation enacted last year, scrutiny committees already have the power to co-opt and involve people who are not elected councillors as members of the committee. I agree with the hon. Member for New Forest, West (Mr. Swayne) that that should be under the control and in the gift of the democratically elected councillors. It should not be set out in regulation by central Government that scrutiny committees should co-opt a certain number of such people under certain circumstances. It is better for that to remain the prerogative of the committees.

Similarly, it will be useful for pertinent information to flow and be shared between patients forums and scrutiny committees, not least to enable them to understand each other's perspective on local issues. However, it is overly bureaucratic to set out in regulations exactly what information should be passed around. There is nothing in our proposals that prevents scrutiny committees and patients forums from sharing relevant information. I hope the hon. Member for Sutton and Cheam accepts that we are not trying to block the co-operation that he seeks, but that there is a difference between us over whether such co-operation should be prescribed by the legislation.

Amendment No. 75 raises different issues. The scrutiny committees would be able to refer matters to the Commission for Health Improvement, to the National Institute for Clinical Excellence, or to the Audit Commission. The Commission for Health Improvement will often be the most appropriate body to which to refer issues that are raised in the course of scrutiny, because of its powers to investigate the management, the provision and the quality of local health services. Under existing legislation, the CHI can accept referrals from any individual or body, so the provision is already there for scrutiny committees to make such referrals. A committee would not have to limit itself. It could make its concerns known to the Secretary of State, or to regional offices of the health service.

I have more difficulty with the idea of scrutiny committees establishing local inquiries. The hon. Member for Sutton and Cheam did not say a great deal about that in his opening remarks, and I may have misinterpreted him, but we could be in great danger if we were to have a plethora of bodies that were all able to set up independent inquiries into the same incident or series of events. Normally, inquiries in the health service are set up under health service legislation. They may be less formal, and be set up by the organisation itself—the health authority or the regional office on behalf of the Secretary of State. More formally, they may be set up under, for example, section 84 of the 1977 Act, which is the legislation under which the Bristol inquiry was established. Under exceptional circumstances, powers under the Tribunals of Inquiry (Evidence) Act 1921 may be used, as in the case of the inquiry into Harold Shipman. The CHI may also set up an independent inquiry.

We do not need to add another formal system for establishing inquiries into that field of provision. Clearly, in the broader sense of the word, scrutiny committees will inquire into various issues. They will be able to call in chief executives, ask about the accident and emergency departments or the provision of maternity services or whatever issue they choose to scrutinise. They will hold inquiries, rather like Select Committees. However, that is not the same as looking into a formal clinical incident, such as happened in Bristol.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am grateful to the Minister for commenting on that point. Certainly the intention behind the amendment is not to set up a second-guessing exercise around such important inquiries, but perhaps to consider issues of reconfiguration and performance. The Minister said that the Bill should not be too prescriptive about the provision of information. Does he accept that the Bill already contains considerable powers to stipulate what information can and cannot be provided by NHS bodies? Why cannot the Secretary of State stipulate what information should be exchanged between patients forums and overview and scrutiny committees?

John Denham (Labour, Southampton, Itchen)

The provisions on information are to ensure that the legislation reflects the safeguards that are provided in the wider operation of scrutiny committees in looking into local government services. They do not govern the flow of information from one body to another. I suspect that we are at one in wanting to see a useful flow of information between the two bodies. That would be eased considerably if we were to combine the secretariat and support for these functions within, say, a local authority.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

We welcome the proposition in the briefing notes that local authorities should provide the secretariat. Local authorities may well provide the glue in the new system that pulls it all together. If so, that will be very welcome. However, it would be strange if there were Chinese walls between the different institutions when it came to information exchange. We want to ensure that that does not happen.

The Minister usefully referred to the danger of a plethora of bodies undertaking inquiries. I share that concern, and may come back to that point. I welcome the fact that the Minister is seeking plenty of opportunities for co-operation between these bodies. Therefore, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Desmond Swayne (Conservative, New Forest West)

I beg to move amendment No. 243, in

page 6, line 20, at end insert—

`( ) as to matters relating to co-operation between the health service in the authority's area and providers of personal social services in that area'.

Amendment No. 243 need not detain us long because all it does is to add an item about which regulations may be made concerning the scrutiny committees. It strikes me as an obvious that co-operation between the health service and providers of personal social services should be included. I cannot imagine any circumstances in which a scrutiny committee would not consider that issue. There is a long history of institutional barriers between the NHS and the providers of personal social services, although much progress has been made in recent years in breaking down those barriers and moving forward to a better agenda. The creation of this new scrutiny function provides yet another institutional opportunity by which to pursue that agenda. As we are here to help, I thought we should place it in the Bill.

John Denham (Labour, Southampton, Itchen)

The hon. Member for New Forest, West is right about the need to be able to scrutinise both health and social services. I am advised that this is not a necessary provision, and that the combination of the measures that we are taking in this Bill and those that are already in the Local Government Act 2000 make it possible for scrutiny committees to undertake that function.

Desmond Swayne (Conservative, New Forest West)

In view of what the Minister says, I accept his assurances and beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

John Denham (Labour, Southampton, Itchen)

I beg to move amendment No. 187 in

page 6, line 32, leave out `or other specified body'.

This is a minor amendment concerning the arrangements that the scrutiny committee will make with the NHS for its scrutiny. The Secretary of State is permitted under the terms of this clause to make regulations concerning the requirement for NHS officers to appear before the scrutiny committee. It is envisaged, for example, that the scrutiny committee may call the chief executive of the trust to account twice a year. The scrutiny committee will assess, among other things, how well the trust has carried out its duties to consult and involve the public under clause 9. It is not necessary for the Secretary of State to be able to regulate for any ``other specified body'' to appear before the scrutiny committee. It should be just involve the health service, so the amendment removes the reference to ``other specified body''.

Desmond Swayne (Conservative, New Forest West)

I was intrigued about who else the Government thought might have been summoned when they drafted the clause, given that they have now changed their minds?

John Denham (Labour, Southampton, Itchen)

Ours is not to speculate on the workings of the minds of parliamentary counsel. Various suggestions are made to Ministers to be helpful, but after close scrutiny it is sometimes possible to identify helpful things that one should not take a power to do.

Amendment agreed to.

Desmond Swayne (Conservative, New Forest West)

I beg to move amendment No. 244, in

page 6, line 33, at end add--

`( ) requiring any member of an overview and scrutiny committee who is also a member of a Health Authority, NHS Trust or Primary Care Trust not to take part in the discharge by the Committee of the functions described in subsection (1) above.'.

It strikes me that there is an opportunity to discuss at some length Dame Fritchie's report on appointments in the NHS, but given the lateness of the hour, and knowing that we only have until 10 o'clock, I shall pass up that opportunity.

There has been a sharp increase in the number of local government representatives, to which Dame Fritchie's report bears testimony. I commend that report to all members of the Committee. NHS trusts, PCTs and health authority boards will inevitably have a not insignificant number of councillors of a political persuasion. It will make nonsense of the scrutiny function if members of local authority scrutiny committees scrutinise the responsibilities that they have discharged as board members. The amendment is entirely proper, as it would require them not to do so, and would exclude such conflicts of interest from the Bill.

John Denham (Labour, Southampton, Itchen)

I am happy to accept and to echo the sentiment behind the amendment.

Peter Brand (Liberal Democrat, Isle of Wight)

I am grateful to the Minister, and I think he is sensible to accept the spirit behind this amendment. Would he go a little further and say something about members of social services committees and those members of the executive of local authorities who are responsible for social services matters? They, too, should not be members of this scrutiny committee, as with joint commissioning the same conflict of interest may well arise.

John Denham (Labour, Southampton, Itchen)

The hon. Gentleman makes a helpful point. A conflict of interest may arise in a number of different circumstances with the operation of overview and scrutiny committees. The Department for the Environment, Transport and the Regions is working with the Local Government Association to produce a code of conduct for overview and scrutiny committees across a range of possible conflicts of interest, including financial conflicts of interest and conflicts of responsibility. We are working together on that code.

I understand that a draft code of conduct will be published within the next two weeks; it will certainly be available before the full parliamentary scrutiny of the Bill has been completed. It is worth saying that executive members on local authorities cannot be members of overview and scrutiny committees, but the hon. Member for New Forest, West makes a fair point about councillors who may also be board members.

Desmond Swayne (Conservative, New Forest West)

When the Minister said that he accepted it, I thought for a moment that he meant the amendment and not merely the sentiment behind it. In view of what he has said about the imminence of the code of conduct, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

John Denham (Labour, Southampton, Itchen)

I beg to move amendment No. 188, in page 6, line 34, leave out subsection (4).

David Madel (Conservative, South West Bedfordshire)

With this it will be convenient to discuss the following: Amendment No. 227, in page 6, line 37, at end insert—

`(4A) Regulations under this section may also provide for functions under section 21(2)(f) of the Local Government Act 2000 to be performed under joint arrangements, to be determined locally, between a county council and any or all districts within the county council area.'.

Government new clause 9— Joint overview and scrutiny committees etc.—

John Denham (Labour, Southampton, Itchen)

We flagged up this group of amendments and the Government new clause before lunch. We are trying to set up an improved joint scrutiny committee structure that allows flexibility for local authorities and for the NHS. Amendment No. 188 and Government new clause 9 allow for a range of options from which local authorities may choose the most appropriate format.

The new clause allows two or more authorities, which can include district councils, to form themselves into a single overview and scrutiny committee to scrutinise health organisations. If a district council joins with a county council, the scrutiny is the county council's responsibility; the county council therefore remains in the lead.

The new clause provides for two or more authorities whose scrutiny committees are responsible for scrutinising the NHS to give the lead to one authority so that it exercises the others' functions in relation to health scrutiny. Two or three local authorities could agree that one of them would exercise the scrutiny function. The clause also provides for a county council and a district council to arrange for the district to undertake the county council's responsibility of scrutinising health services in the district. That is likely to happen when a primary care trust is being reviewed. The clause provides for a county council to co-opt one or more district councils' OSC members on to its own OSC; and the county council may also co-opt district council OSC members if the county is part of a joint scheme with another OSC.

The aim is to allow flexibility and to enable the building of local scrutiny models that are fit for the purpose. The clause specifies that regulations relating to the joint arrangements will set out the circumstances and conditions under which joint schemes can be established. It should be noted that district council involvement in the joint scheme arrangements will be set out in regulations.

As I said earlier, the lead will always be with local social services authorities, and regulations and directions may also provide for those circumstances in which authorities will be required to put joint scheme arrangements in place. The regulations that relate to the normal arrangements for scrutiny and review of the NHS by OSCs will also apply to the scrutiny and review of the NHS when joint schemes are in operation.

New clause 9 provides real flexibility for local authorities when undertaking

their health scrutiny role. It will result in the most effective use of resources, and when appropriate district council involvement can be included. The Committee will know that that has been a particular concern to the Local Government Association and will have noted that the LGA has warmly welcomed new clause 9 in its briefing note.

Desmond Swayne (Conservative, New Forest West)

I shall not go back over ground that was covered this morning on amendment No. 245. However, I had hoped that the Minister would say rather more than that the regulations will cover the operation of the overview and scrutiny committees. I seek some understanding of how the Minister sees the system operating. Many people, including myself, are not clear about how it will operate and how the local authorities will divide up the patch between them.

We know of the correspondence from Epping Forest district council, but I shall quote the Democratic Health Network, as it is time that it had a second outing after its tour de force last week, which provoked a response of stony silence from Labour Members. It states:

``one health scrutiny area might include a Health Authority, several PCTs, a Care Trust and several acute Trusts as well as services provided under partnership arrangements''.

If, as a minimum, we expect the scrutiny committee to deal with the chief executive twice a year, its burden and work load may be significant. I would like to follow the Minister's concept of how the overlapping local authority responsibilities knit together. Rather than simply being told that regulations will provide that the process works, I want an understanding of how it will work.

Peter Brand (Liberal Democrat, Isle of Wight)

Clearly, our amendment No. 227 is in the spirit of Government new clause 9. I recognise that the new clause is essential in areas not blessed with coterminosity, such as the Isle of Wight.

Will the Minister explain how the joint committees will address the democratic deficit that he says is behind some of the changes? Committees will be composed of democratically elected individuals who may be democratically accountable as individuals. However, I cannot see that a joint body of perhaps four or five local authorities, and a local authority that perhaps has to service two or three joint authorities, creates a direct link between a democratic process and the scrutiny that is so important to the community. We will not end up with anything more directly accountable than a CHC, as it has elected members.

The nearest pattern that I could think of was the local land drainage committees, one of which I was a member of for some years. They travel around the country and see splendid things, but have no influence over anything. I am concerned that we will set up a mechanism to produce window dressing that is not accountable for the work that it does. I would like the Minister to explore what would happen on a joint committee, as opposed to a lead authority, if members of it or the sub-sets of the lead authority committee were of completely different political flavours, persuasions and backgrounds.

John Denham (Labour, Southampton, Itchen)

As a former member of a land drainage committee, I can bring relevant knowledge to bear on the subject. I recall that the committee often involved an extremely good lunch, and that a suspiciously large number of farmers who owned low-lying land seemed to be co-opted on to it.

I understand the points that both hon. Members raise. Guidance will clearly be needed about how local authorities come together, although we would want to leave some flexibility for people to work matters out locally. I shall take the example of the Southampton and South West Hampshire health authority, which I share with the hon. Member for New Forest, West. It is clear that there would be cases where there would be a desire to scrutinise the overall strategy—the health improvement plan and so on—of the health authority. At the very least that would require co-operation between Southampton city council, which is a unitary authority, and Hampshire county council. Other areas, such as that of the operation of primary care trusts in Southampton, might be solely a matter for the unitary authority in Southampton, because it happens in its area. Some flexibility in arrangements on topics is likely to be necessary, over time. It would not be possible or desirable for us to prescribe, from the centre, exactly what arrangements should be made in each case.

I do not agree with the hon. Member for Isle of Wight (Dr. Brand) that because two authorities come together the democratic element is lost. After all, both organisations are democratic, and would need, within the guidance, to agree on the way in which they brought their functions together. Such co-operation would provide a sensible and practical way for the scrutiny committees to operate at local level. One would expect reports to be made not just to the NHS body that is being scrutinised, but to the host local authority, to be considered by the wider body of council members.

Peter Brand (Liberal Democrat, Isle of Wight)

On a practical point, would it be possible for the joint authority to publish minority reports, or would that depend on the report going back to one of the host authorities, which would then evaluate it. I doubt whether there can be a mechanism for doing that, as it would be very difficult. In the Minister's own patch, where Eastleigh and Romsey share health services, there are two distinct views of how those services should be delivered by the local authorities.

John Denham (Labour, Southampton, Itchen)

First, minority reports are, and would be, possible under the scrutiny committee approach. During the scrutiny process, one would expect different local perspectives to come through from the councillors who were involved. The process is not a way of expressing the view of the local authority per se. It is a similar scrutiny process to those that apply to other local authority services. I do not see any major difficulty in local authorities sensibly co-operating with each other, and being able to explore, through the scrutiny process, all the relevant issues. Surely that is the most important point. The LGA was keen to make a similar provision for district councils for fear that a particular local perspective, or view of a topic, would otherwise be lost. With the new clause, we are ensuring that such perspectives are not lost.

Peter Brand (Liberal Democrat, Isle of Wight)

I fully agree with the latter part of the Minister's reply, but he also implied that we were talking about pure scrutiny. I thought that the new body would take over the strategic planning commentary, which was such an important part of the role of CHCs. Clearly, such a commentary is not just a matter of scrutinising what is currently happening, but of monitoring the direction in which local health provision is moving. That can be very different for different authorities—some may gain and some may lose.

John Denham (Labour, Southampton, Itchen)

The hon. Gentleman is right, and I had included, in my mind, the scrutinising of those major reconfigurations within ``scrutiny,'' so we agree on that. The hon. Gentleman seems to be concerned that the Government would somehow try to run the system so that geographically distinct or minority views were corralled into a wider body and thereby suppressed. I understand his concern. We must deal with that in the guidance on when scrutiny committees can come together to share their functions. I acknowledge his point, but that is something for which we can make proper provision.

Amendment agreed to.

Question proposed, That the clause, as amended, stand part of the Bill.

Desmond Swayne (Conservative, New Forest West)

Although our debates have covered most aspects of the clause, it is still not clear how local authorities will find the resources to discharge the responsibilities that we are placing on them. We have been given no inkling. Equally, our debates on the amendments have made it clear that those who will be discharging the scrutiny function will not have the benefit of having handled complaints or of having been inspected, which are two vital elements of scrutiny. In my view, those three counts place a large question mark over the fundamental nature of the clause.

John Denham (Labour, Southampton, Itchen)

There is some danger of going over old ground, but it is the Government's view that enabling local government to scrutinise the health service is a step forward because it will allow them start dealing with the democratic deficit in the NHS. It is inevitable that the pattern of health provision will not map directly on to local authority provision. We therefore need to make flexible arrangements to allow that to happen effectively. As scrutiny committees develop their role, they will gain great expertise, prove to be effective and, for the first time, bring a democratically elected local authority voice into shaping health services.

I acknowledge, as I have throughout, that it will be useful for the scrutiny committee to be informed by a range of information provided by the NHS, patients' organisations in general and patients forums, which undertake the inspections. We have set out in the explanatory notes a number of arrangements to ensure that it happens. I believe that it will be an informed process of scrutiny.

Question put and agreed to.

Clause 7, as amended, ordered to stand part of the Bill.

Clause 8 - Overview and Scrutiny Committees: Exempt Information

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I have a question on the Government's thinking about the difference in operation between NHS bodies, which are governed by the access arrangements made under 1960s legislation on access to public bodies, and local authorities, which are governed by the Local Government Act 1972. Can the Minister tell us a little more about how, through regulations, he can ensure that a trust cannot decide that it would be embarrassed to provide information that was not exempted under the Local Government Act that might nevertheless be exempt under the 1960s legislation? How can we ensure that local authorities, with their new powers of overview and scrutiny, can obtain all the necessary information, including information that trusts might not want published under the 1960s legislation but which they would have to publish if they were covered by the Local Government Act?

Desmond Swayne (Conservative, New Forest West)

I echo what the hon. Gentleman said, but I would go further. I believe that we have the chance to review the two sets of rules under which the two bodies will operate. If the scrutiny committees operate under one set of confidentiality rules and health authorities and the NHS enjoy a much wider discretion to withhold information, a measure of suspicion is bound to grow between two bodies that we want to work to a large extent in partnership.

It strikes me that the Bill may provide an opportunity for the Government to review the issue to see whether there is a means of introducing proposals for a common set of standards for confidentiality. I suspect that there will always be the temptation, and it might be a quite legitimate concern for NHS bodies, that information that they might regard as confidential, would not be regarded as confidential within the rather narrower terms under which local government bodies operate once they had been handed over to the scrutiny committee. That might result in a reinforcing of what might be an administrative inertia to hand over information in the first place.

Peter Brand (Liberal Democrat, Isle of Wight)

I am concerned about what information the scrutiny committee may have and what sort of paperwork there may be. A very relevant question was asked this morning by the hon. Member for Woodspring (Dr. Fox) in relation to clause 15 on who would become the custodian of files and information held by community health councils. The Minister did not answer at the time. Perhaps he could now let us know where that information will go? It will obviously include a mix of personal and clinical information as well as more strategic information.

John Denham (Labour, Southampton, Itchen)

The clause is essentially about the openness of the business of the scrutiny committee. Under clause 7, the Secretary of State can require the NHS to provide information to the scrutiny committee. So we will use that route to ensure that the necessary information is made available to the scrutiny committee.

The Local Government Act 2000 provided that meetings of the overview and scrutiny committee must be held in public. The Local Government Act 1972 provided for two exceptions to that general obligation: first, where certain confidential information may be disclosed and secondly where the scrutiny committee agrees by resolution of the committee or council that certain exempt information may be disclosed.

Section 12A of the Local Government Act 2000 sets out the categories of exempt information, such as information relating to a particular employee of the local authority or to a person receiving services from the authority. Where a scrutiny committee is discussing NHS matters, for example where it has asked the chief executive of the local health authority to attend, it is possible that the committee may discuss matters that would lead to the disclosure of information relating to the NHS that would not be appropriate to disclose to the public at large, such as information relating to personnel. The function of clause 8 in combination with schedule 1 to the Bill sets out the information that local authorities do not have to disclose at a public meeting of the scrutiny committee.

Where the restrictions on NHS bodies that are governed by the Public Bodies (Admission to Meetings) Act 1960 are more restrictive than the provisions that now apply to overview and scrutiny committees, we have modelled our approach on the approach in the Local Government Act 2000 rather than on the 1960 Act. The provision for public access to meetings and documents of NHS bodies is more restrictive than is the case for local government and overview and scrutiny committees. We think that the more open and legislative approach to overview and scrutiny committees when they are discussing health service bodies is justifiable. They are local authority committees and should be subject to the same regime of public access whatever the matter under scrutiny. That is the broad thrust of our approach.

The hon. Member for Isle of Wight was quite right to say that I failed this morning to address the specific point about material held by CHCs. It will be necessary to develop arrangements whereby, as a result of the winding-up of the CHCs, the Secretary of State will clearly be responsible for handling those files in the appropriate way. That may require returning information to individuals.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Will the Minister develop that point a stage further? If the Secretary of State has to decide how information is dealt with, will the Minister assure us that in all circumstances the consent of patients or relatives will be sought before the information is passed on to some new body?

John Denham (Labour, Southampton, Itchen)

We shall need to work through the exact arrangements in detail but, on first hearing, the hon. Gentleman's suggestion sounds eminently sensible. The Secretary of State will have to act properly with regard to the fact that the information is personal and confidential.

Question put and agreed to.

Clause 8 ordered to stand part of the Bill.

Schedule 1 - Exempt Information Relating to Health Services

John Denham (Labour, Southampton, Itchen)

I beg to move amendment No. 189, in page 58, line 37, leave out from `Authority' to end of line 38.

In the old days, before programme motions, one could happily dwell on one or two amendments for an entire afternoon. These days, the mind has to switch from topic to topic much more quickly.

This amendment amends paragraph 8 of schedule 1, which relates to GPs providing general medical services, or other practitioners providing services under part II of the National Health Service Act 1977, such as dentists. The amendment ensures that the description applies not only to those practitioners who provide services in the area of the scrutiny committee's local health authority, but to any part II practitioners.

Paragraphs 10 to 12 are intended to prevent the public disclosure of confidential or personal information about GPs and other primary care practitioners. The provisions also apply to their employees, such as practice nurses, placing them in the same position as employees of NHS bodies under paragraph 1 of the schedule. In practice, a scrutiny committee may deal with a wide range of different NHS bodies, and that may involve information going beyond that concerned solely with the committee's own area.

At present, paragraph 10 refers only to the part II practitioners on the list of the scrutiny committee's local health authority. However, there is no reason to protect only local GPs and not GPs in neighbouring health authority areas. Paragraph 11 already applies generally to providers of personal medical services or personal dental services, as does paragraph 1, which concerns the employees of NHS bodies. The amendment merely brings paragraph 10 in line with those provisions.

Amendment agreed to.

Schedule 1, as amended, agreed to.

Clause 9 - Public Involvement and Consultation

Desmond Swayne (Conservative, New Forest West)

I beg to move amendment No. 246, in page 7, line 39, after `Authorities', insert `(including Special Health Authorities)'.

David Madel (Conservative, South West Bedfordshire)

With this it will be convenient to take amendment No. 79, in page 7, line 39, at end insert—

`( ) Special Health Authorities'.

Desmond Swayne (Conservative, New Forest West)

Clause 9 places a duty to consult and involve persons for whom services are provided on health authorities, primary care trusts and NHS trusts. Our amendment would include special health authorities.

We have to put the case for the inclusion of special health authorities, but I rather hoped that the Minister would persuade me why they should not be included. They provide services to consumers, as set out in the clause. I notice that line 31 of page 7 states that people may be involved ``directly or through representatives'', which strikes me as entirely appropriate to our amendment, given the nature of special health authorities and the people that they serve. It strikes me that the clause was almost designed to accommodate them through representatives.

I look to the Minister to either accept the amendment or tell us why special health authorities should be excluded from the provisions.

John Denham (Labour, Southampton, Itchen)

Essentially, the reason for not including special health authorities is that by 2002, when the scrutiny committee procedure is in place, there will not be special health authorities providing services directly to patients, certainly in the way that we have been discussing. At present there are 17 special health authorities, but only the three special hospitals—Broadmoor, Ashworth and Rampton—provider health services directly to patients. The others provide a service to the NHS or carry out some other health service function on a national basis, for example the Prescription Pricing Authority, which administers prescriptions and payments to pharmacists.

Philip Hammond (Conservative, Runnymede and Weybridge)

Would the Minister rule out the possibility that a special health authority would be created in the future to provide other services directly to patients? It is a mechanism that the Government has already used a couple of times to implement provisions quickly.

John Denham (Labour, Southampton, Itchen)

We certainly have no intention to do so. We have moved away from the special health authority model. As the hon. Gentleman will know, the services provided by Broadmoor and Rampton will be provided by trusts and that is clearly the direction in which we wish to go in respect of Ashworth, too.

Our approach has been to build into the organisations that have been set up under the provisions of special health authorities their own arrangements for patient involvement. The National Institute for Clinical Excellence, for example, was established as a special health authority and NICE has its own arrangement. We ensured, for example, that the partners council of NICE would have representatives of the health professionals and patients and carer interests as well as other involvement. That is the approach that we prefer to take. The hon. Member for New Forest, West asked me why we had excluded special health authorities. It is because they are not direct providers of services to patients in the same way as the other bodies that we have mentioned.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

We, too, have sought to include in the Bill a requirement that special health authorities are part of the new empowering regime within the NHS. That is not least because of our concerns about the operation of NICE, particularly in regard to the discharge of its responsibilities in respect of appraisal of new health technologies and therapies. I was led to table the amendment by the experience of patients and patients' organisations in respect of the appraisal of beta interferon and copoxone. I do not want a long discussion about it because I think it is more appropriately debated elsewhere. However, that case signals why, although the legislation that established NICE may well contain regulations and obligations concerning the involvement of patients, the provisions have not translated into practice. As a result, many people outside the House have experienced a very unsatisfactory set of arrangements in respect of that appraisal and fear that that practice—which has also entailed the wholesale rewriting of the rules in regard to appraisals—has led to great concern about the way in which NICE is discharging its duties.

For that reason alone, let alone some of the arguments that have been put forward by Conservative Members, we feel that it would be of benefit to have special health authorities included in the Bill so that they too can be part of the new empowerment agenda that the Government are advancing.

Desmond Swayne (Conservative, New Forest West)

I am not entirely sure that I follow the Minister's logic. I cannot understand how special health authorities do not provide a service direct to patients any more than health authorities do. Once the primary care trusts have been set up, in what way would a health authority provide services more directly to patients than a special health authority? I do not understand the distinction that he is drawing between the two. If one falls within the provisions of the clause—the requirement to consult, particularly with respect to the planning of services—I do not understand why the other should not.

John Denham (Labour, Southampton, Itchen)

I would like to respond to the point raised by the hon. Member for Sutton and Cheam regarding the National Institute for Clinical Excellence. Like him, I do not wish to get into a debate about beta interferon. NICE would probably state that it had made considerable efforts, during its appraisals, to consult with patients' organisations and to seek the views of patients. We need to draw a distinction between that and any inevitable disappointment there may be at the conclusions that have been reached, or at the fact that no conclusion has been reached. It would be difficult to mount a case that NICE has not attempted to involve patients in its work, although there is, undoubtedly, always scope for improvement.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Just for the record, the Minister says that it would not be possible to advance a case to that effect. Does he accept that in respect of the appraisal of the disease-modifying treatments for multiple sclerosis, the appraisal committee specifically refused to take personal testimony from patients at its hearings?

John Denham (Labour, Southampton, Itchen)

For good reasons, the Government have not been drawn into detailed discussions about NICE and beta interferon. We have eschewed comment until the appraisal is over. However, I understand that NICE received evidence—

Philip Hammond (Conservative, Runnymede and Weybridge)

Will the Minister give way?

John Denham (Labour, Southampton, Itchen)

No, I will not, because I am still answering the previous intervention. I have hardly started.

I believe that NICE would state that it took evidence from appropriate patients' representatives, but I do not want to go further into a detailed discussion about beta interferon at this stage.

Philip Hammond (Conservative, Runnymede and Weybridge)

Before the Minister moves on, will he give way?

John Denham (Labour, Southampton, Itchen)

I was going to answer the point made by the hon. Member for New Forest, West. Health authorities are a key part of the local provision of services. They may not be, except in certain specialist areas, direct providers of services, but they undoubtedly have a key role in shaping the provision of services at local level. For that reason they should fall within the provisions of clause 9, alongside the other direct providers of patient services.

Philip Hammond (Conservative, Runnymede and Weybridge)

I should like to return to the Minister's explanation to the Committee of the Government's reticence on the issue of NICE and beta interferon. Will he tell the Committee whether it is expected that the Government will be in a position to talk about the issue before the general election, or does he expect that they will only be in such a position after the general election?

John Denham (Labour, Southampton, Itchen)

The general election could be in May 2002. NICE has said that it wishes to reach a conclusion by this summer, so we may well be in a position to discuss that conclusion before the general election.

Desmond Swayne (Conservative, New Forest West)

I think that I might reassure my hon. Friend that this Government certainly will not have an opportunity to discuss those issues after the general election—that is for sure. The Minister's logic for excluding special health authorities has not been persuasive, but that is not a matter that we wish to pursue now, and I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Desmond Swayne (Conservative, New Forest West)

I beg to move amendment No. 247, in page 7, line 41, at end insert—

`(2A) It is the duty of every body to which this section applies to publish annually (in such manner as it reasonably believes appropriate) a report on the arrangements it has made to discharge its duties under subsection (1) above'.

David Madel (Conservative, South West Bedfordshire)

With this it will be convenient to take amendment No. 80, in page 8, line 8, at end add—

`( ) Every body to which this section applies shall include in their annual report details of the arrangements maintained in that year for obtaining the views of patients, carers and the wider community.'.

Sitting suspended for a Division in the House.

[GW1]I think all this procedure is right - log's a bit confused and so am I.[TMB2]Unable to find a note on this.

On resuming—

Desmond Swayne (Conservative, New Forest West)

As I no doubt would have got round to saying, had you not interrupted me at such an opportune moment, Sir. David, amendment No. 247 places a duty on those bodies specified in clause 9 to produce an annual report to demonstrate how they have informed and consulted on the planning of the services that they make available, the development and consideration of proposals for any changes that they may have and any decisions that they have taken. It begs the question that if there is no annual report in which those bodies are required to demonstrate how they have met those provisions and consulted in that way, how else are they to be scrutinised, given the statutory responsibilities that are placed on them in the clause. I should be interested to hear how the Minister is planning to ensure that those functions are carried out. We believe that the best way would be to do it in an annual report and that that annual report should be available publicly for scrutiny. Not only will that be an effective tool for ensuring that the functions have been carried out, but we believe that it will be a powerful engine for generating best practice within the NHS by comparison between the different bodies concerned. We will be able to use those annual reports as an effective tool for measuring one against the other and generating a levelling-up across the board.

John Denham (Labour, Southampton, Itchen)

We will certainly see something akin to an annual report. Indeed, what we have proposed is that there should be a patient prospectus for all trusts, which should say how they have taken the views of patients into account. In fact, a prospectus will go further than that because, for the first time, people will be able to read not only what patients think of their local hospital but how the trust's management have taken patients' views on board to improve services. The prospectus will set out how trusts have gathered patients' views through the new trust level patient survey and show the results of the survey data. Patient surveys will contain core questions that will enable trusts to monitor progress in areas identified nationally for specific improvements in services such as primary care access, food and cleanliness. There will also be scope for additional questions to be included that reflect local circumstances. We will expect the patients forum, and the trust management, to identify the areas to be covered by the additional questions, and for the patients forum to then take the lead in developing those questions.

Philip Hammond (Conservative, Runnymede and Weybridge)

Is this not just another example of doublespeak? Does not a prospectus, in the normal course of language, imply that people have a choice? People review prospectuses and decide where they want to go. Can the Minister back up his choice of the word ``prospectus'' with any prospect of real choice being introduced for patients?

John Denham (Labour, Southampton, Itchen)

The prospectus normally sets out what is on offer, and that is precisely what a trust prospectus will do. Of course, under the failed internal markets, health authority bureaucrats had to second guess the choice made by clinicians. Now that Conservatives are commissioned at local level by front-line clinicians, they are much more involved in shaping services. So ``prospectus'' is a totally appropriate word.

For the record, I will say a little more about what the patient prospectus will do. The patients survey will be included. Trusts will have to show what action they are taking to deal with shortfalls identified through the patients survey. We expect the trust to share the survey data with the patients forum. We expect them both to agree local standards for all the service improvements. The prospectus will contain information on a range of local NHS services and non-NHS open information such as voluntary organisation addresses and telephone numbers. It will act as a single vehicle for publishing local targets and standards, how they were measured, progress made against them and new priorities for the next year.

However, the emphasis is on an evolving document that may change in shape over time. For those reasons, we do not regard the amendment as necessary, but I hope that the Government have made their intentions clear.

Desmond Swayne (Conservative, New Forest West)

The hon. Gentleman has told us about a prospectus, for which there may be some justification—there is certainly some justification for the provision of telephone numbers—but it is a very different document and it raises the question of whether, when there is only one item available, a prospectus is required. Patients by and large will not have the choice to consume those services or not. They are patients rather than consumers. It is not as though they can take the option often enough to go elsewhere.

``Prospectus'' is not the appropriate term. We are looking not for a glossy, promotional publication, but for a means of scrutinising whether the health authorities or the PCTs have met the requirements of the clause on public evolution. We are looking for an annual report that will scrutinise and be able to measure their performance. The Minister has told us about a prospectus in which they would seek to give an account of their performance in the most advantageous manner, as one would expect with any prospectus. It is not the same document, but the hour is late and we are not going to press the matter. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Peter Brand (Liberal Democrat, Isle of Wight)

On a point of order, Sir David. It would have been helpful if you had indicated at the beginning of the debate on the clause whether there was to be a stand part debate on the clause. I certainly would have wanted to make some points on that.

David Madel (Conservative, South West Bedfordshire)

If the hon. Gentleman wishes to address the matter, it is still open.

The rest of the debate is in Hansard.