NHS Reform & Health Care Professions Bill

Public Bill Committee, 6 December 2001.

Standing Committee A

Clause16 - entry and inspection of premises

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I beg to move amendment No. 209, in page 21, line 5, leave out 'may' and insert 'shall'.

Ann Widdecombe (Conservative, Maidstone and The Weald)

With this we may discuss the following amendments: No. 210, in page 21, line 14, at end insert—

'(f) prison service premises where such joint working as is specified in section 21 is taking place.'.

No. 211, in page 21, line 25, at end add—

'(4) In this section ''premises'' shall have the same meaning as in section 23(6) of the 1999 Act.'.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

The amendments relate to the powers that the Bill will give to patients forums. Amendment No. 209 seeks to replace the word ''may'' with ''shall'' because entry and inspection is a critical function of any regime through which patients and community representatives carry out their tasks. However well-meaning the Secretary of State's intentions, it seems reasonable to require him to issue regulations on the entry and inspection of premises by patients forums, rather than leaving the matter to his discretion. Heaven forfend, as the Under-Secretary might say, but the current Secretary of State may not hold that post for ever; some might question whether he holds that post now in respect of certain health service functions. Regulations must also be made to clarify the way in which the clause's provisions will be implemented, and the amendment seeks to establish whether the Department will consult all relevant stakeholders when drafting regulations.

Amendment No. 210 concerns the powers of patients forums to inspect delivery of NHS care in prison premises where there are joint working arrangements, as identified in clause 21. In a previous sitting, the Under-Secretary said that we might discuss some of these matters when we considered clause 21, and I am happy to leave that to her discretion. However, it would be useful if she explained now whether the clause as drafted would enable such inspections.

By definition, it is difficult to discover what is going on in prisons. Such isolation has given rise to current concerns about the level of prison health care, although it should be said that those concerns are not necessarily a reflection on prison medical officers. The isolated nature of the delivery of prison health care is a critical factor in terms of quality. Opening up the environment in which NHS care is delivered in prisons would not only improve accountability and openness, but raise quality.

Amendment No. 211, which makes reference to section 23(6) of the Health Act 1999, is a probing amendment that is intended to establish whether privately owned establishments such as nursing homes and others in which NHS care is provided will be open to inspection. Does the Under-Secretary think that the Bill's current definition of the word ''premises'' will enable the widest possible coverage?

Oliver Heald (Conservative, North East Hertfordshire)

Patients are now being sent abroad and to other parts of the country for their treatment; we shall hear more about that later. Would the amendment allow a patients forum to inspect the treatment that patients from south-east England receive in France or Germany?

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

That question applies not only to inspections by patients forums, but, importantly, to quality control inspections such as those carried out by the Commission for Health Improvement. We touched on that issue earlier. The Bill was never intended to cover quality assurance and community participation because it was drafted long before the latest panic measure of exporting patients—shortly followed by staff—to Europe. There is no definition to which I can refer that would be wide enough to cover all the options that the Government are currently dreaming up.

None of us wants patients to wait longer than they need to, but the Government must think carefully about the areas in which they want NHS patients treated so that those patients will be adequately covered by quality assurance measures, the reach of civil litigation for negligence and the duty and right of patients forums to inspect those systems and input to them. The Minister described extensively—perhaps even eloquently—her vision of public participation in every area of NHS care. However, the hon. Member for North-East Hertfordshire (Mr. Heald) raised an interesting point about what sort of patient and public involvement there can be in those settings.

I do not want to be distracted from the point, which concerns the definition of premises. Having found the correct part of the Health Act 1999, I recognise that the definition suggested in this amendment—which I stress is a probing amendment—is more limited than the one it seeks to replace. I am unsure how that happened, but it was almost certainly a function of drafting the amendment late at night while examining many different definitions of premises. Will the areas listed in the clause include private health care providers whose premises are covered by the regulations that apply to the Commission for Health Improvement where it has been given the right to inspect premises?

I should have prefaced my comments by saying that during the last sitting, we had a heated debate about the Government's intentions. Liberal Democrat Members argued that there was no need to abolish community health councils and that the Government's proposals for patients forums were flawed.

Simon Burns (Conservative, West Chelmsford)

So did we.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Indeed, so did the Conservatives who spoke in that debate. However, the amendments that we shall discuss this morning are efforts to be constructive within the framework of the Government's proposals. In that spirit, I hope that we get a reasoned debate, a constructive response—that is likely with this Minister—and perhaps some give from the Government.

Simon Burns (Conservative, West Chelmsford)

Clause 16 deals with the entry and inspection of premises, which—whether it relates to the national health service or any other area of service provision or commerce—is a critical power given to the authorities to enforce the provisions of legislation. In the past, various sectors and service providers have complained that powers of entry and inspection have been carried out in an over-bureaucratic and almost officious way.

Without wanting to get into arguments about Europe, a consistent source of complaint has been the fact that inspection powers that are brought on to the statute book via European provisions are often fine-tuned by British Governments, of whatever party, to make them much more onerous. That has been a particular problem in respect of food hygiene and standards. It is important to ensure that the provisions on inspection and rights of entry fulfil the intentions of the Bill without making it unnecessarily burdensome and officious, which is in no one's interests.

The clause gives the Secretary of State powers to issue regulations governing the nuts and bolts of powers of entry and inspection. In the first sitting of the Committee, my hon. Friends and I, and the hon. Member for Oxford, West and Abingdon (Dr. Harris), pointed out to the Minister that the Bill contains numerous regulation-making powers, yet we have not seen any draft regulations. It would have been extremely helpful to the work of the Committee, especially on this clause, had we been given a greater insight into what the Secretary of State may intend if he is minded to issue regulations.

Oliver Heald (Conservative, North East Hertfordshire)

My hon. Friend is making an important point. Does he agree that it is astonishing that we have not yet seen one draft regulation, given that we have now reached clause 16 and that the Minister promised at the very beginning of our proceedings, in response to my first point of order, that he would let us see them all?

Simon Burns (Conservative, West Chelmsford)

My hon. Friend makes a powerful point, and he did indeed raise that point of order at the beginning of the first sitting. We are now approaching the end of the second week of our proceedings, yet we have seen no draft regulations in any shape or form.

The Government did not dream up the Bill in the last few weeks; it has been thought about for a long time. To return to the debate at the end of the previous sitting, this part of the Bill is frankly just a vindictive repetition of the provisions of the Health and Social Care Act 2001. I presume that, during the passage of that Act, the Department of Health must have been giving thought to powers of entry and inspection. That was in January, February and March of this year. We are now at the back end of the year and we still do not know how the Government intend to flesh out any regulations that the Secretary of State may wish to issue.

I should have thought that the Under-Secretary, having noted the Minister of State's response to the point of order made by my hon. Friend the Member for North-East Hertfordshire, would anticipate the debate and that the Department of Health would work overtime to prepare a skeleton of the draft regulations to enable us to get a better idea of the Secretary of State's intentions.

As the hon. Member for Oxford, West and Abingdon said, amendment No. 209 seeks to change the provisions in the beginning of clause 16 so that it would no longer be that the Secretary of State ''may'' make regulations, but that he ''shall''. That would place a duty on him—he would have to make regulations—and his choice would be removed; that would either strengthen the Secretary of State's hand or box him in, depending on one's point of view.

There is logic to the amendment. It is not desperately satisfactory to leave the decision up in the air and up to what the Secretary of State may want to do. If one concedes that patients forums should have the power of entry and inspection of premises, it would probably be in their best interests to have regulations that spell out those powers and how far they can act in fulfilling the duties in the Bill. I regret that we do not have such draft regulations.

The hon. Member for Oxford, West and Abingdon also tabled amendment No. 210, which deals with Prison Service health providers and allowing patients forums to have powers to investigate problems and the provision of health care in the Prison Service. As he pointed out, there is no statutory remit for community health councils to look into the provision of health services in our Prison Service—there is outside prisons—but a number of community health councils, on a voluntary and ad hoc basis, have liaised and forged informal ties with prison health services. On balance, that is a good thing.

I do not want to pre-empt the debate on clause 21, but it would be fair and right to say that during many years, under Governments of both political persuasions, the provision of health care in the Prison Service has been a scandal. Improvements have been made in recent years, but, to be brutally frank, the provision of such health care has been at a level that would not be tolerated by constituents outside of prison.

That is not a criticism of the medical profession working in the Prison Service, but of a culture that has grown over years, and of the reluctance—until recent times—of the Department of Health to take over the running of the prison health service because the cost of doing so would come out of its budget and not that of the Home Office. At a time when our health service has been under constant and increasing strains because of rising expectations, increasing demand and targets set politically—by this Government in particular—the Department of Health would have found it difficult to incorporate the funding of the prison health service within its budget without a knock-on effect.

In many ways, the prison health service is out of sight and out of mind, by definition of its location, and the issue has not been high on many people's political agendas. Because of that and associated problems, this measure would provide a positive step forward for patients forums, if they ever see the light of day. The Bill has a long and winding journey before it reaches the statute book; who knows what may happen to it during its long passage through Parliament? Its predecessor was derailed earlier this year.

On the assumption that the Government will get their way--the only assumption that we can make--patients forums could provide a welcome and useful service not only in the provision of health care in general, but to the enhancement and improvement of health care in the prison system. I see no reason why they should not be extended to the Prison Service health care system. We have accepted the principle that the health service outside prisons should be monitored and that our constituents should have an organisation to monitor health care and investigate individual problems. Why should not the Prison Service? Why disfranchise that part of health care simply because it deals with individuals who have been disfranchised?

I hope that the Minister will have an open mind and will think seriously about an amendment that is designed simply to enhance and improve the Bill. If she is prepared to accept the principle in relation to patients forums, a belt and braces operation would be an insurance policy for her. She might want to concede the point in relation to community health councils if they were to be saved from this vindictive Government.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I am grateful for the opportunity to clarify the problem. I drafted the amendment to apply the definition of prescribed premises in section 23 of the 1999 Act, as amended by the Bill. That is jumping the gun, because the Bill is not yet an Act and—who knows?—may never reach the statute book. I hope that that is in order, Miss Widdecombe--if it is not, we shall have to return to the matter on clause stand part--to ask hon. Members to ensure that in lines 40-45 on page 18 the definition of prescribed premises in the new world of private sector delivery of NHS care is more appropriate.

Simon Burns (Conservative, West Chelmsford)

I am extremely grateful for the hon. Gentleman's intervention and relieved that I allowed him to intervene. It has reduced my work and clarified what was becoming a somewhat confusing situation. So as not to add to the confusion, I will leave the hon. Gentleman's explanation of the amendment for the Under-Secretary to answer.

The clause contains some provisions outlining regulations that can be made. In the context of our discussion on the amendments and the fact that we do not have any draft regulations to examine, can the Under-Secretary explain one or two points? That will help us to make up our mind about whether our concerns, especially in amendments Nos. 209 and 210, will be met. Clause 16(3) says:

''The regulations may in particular make provision as to—

(a) cases and circumstances in which access is to be permitted''.

It would help if the Under-Secretary could flesh out in more detail how the Government envisage the regulations reflecting clause 16(3)(a).

Clause 16(3)(b) refers to regulations making provisions about the

''limitations or conditions to which access is to be subject.''

My hon. Friends will be interested to know what limitations and conditions the Under-Secretary has in mind. That brings us to the nub of my original point about the balance that is necessary in the regulations—which, we hope, the Secretary of State ''shall'', rather than ''may'' make—to limit the opportunity for them to become too nanny-statish and interfering. That would be to miss the important point and function of the regulations.

We are also interested to know whether the patient forums, under the regulations that we hope ''shall'' be issued in line with amendment No. 209, will be allowed to go everywhere that the Commission for Health Improvement can go. The intention is unclear in the Bill and its provisions for what regulations the Secretary of State may or shall make, and we have not seen any draft regulations to make that clear.

My hon. Friend the Member for North-East Hertfordshire raised an important new point that he probably could not have made had we discussed the amendments on Tuesday. Today's media show an unfolding drama and a change of circumstances in the provision of health care that is happening under our very eyes. Unfortunately, we have only the ''Today'' programme reports and, presumably, leaks in the national media to tell us what the Government have in mind. As the House will be sitting in an hour and a half's time, we may be notified soon as to whether the Secretary of State will make a statement on the Floor of the House about the treatment abroad of patients on long waiting lists in this country.

I see that you are looking perplexed, Miss Widdecombe; you may be wondering whether this has anything to do with clause 16. I would hate, for various reasons, to test your patience, so let me reassure you. The amendments, and the regulations that would emanate from them, deal with inspections by patients forums. They will have the power to inspect and monitor the provision of health care for all patients in this country.

When using the phrase ''in this country'', we have always assumed it to mean what it says. Until August of this year, we understood that, legally, the health service had to treat patients in England, Scotland, Wales or Northern Island. However, a whole new approach has opened up for the Government, whereby patients, by law, can be treated in European countries. There have been pilot schemes in parts of the south-east of this country over the last two months. If the leaks are to be believed, there will be an extension of the whole policy, so that any patient who has to wait more than six months on a waiting list for treatment will have the opportunity to go overseas to be treated.

That raises the question of what inspection will there be of the service and treatment provided for our constituents who may be treated overseas. Unless I misunderstand our amendments and clause 16, it seems that once our constituents are travelling on a train, plane or bus to Europe to be treated, the powers of entry and inspection of premises to ensure the provision of health care, will be taken away. The powers for bodies to act on behalf of our constituents will be denied in those areas overseas where they are being treated. This is an area where the Minister needs to reassure us.

Will clause 16, with its powers of entry and inspection of premises, apply to premises in Europe? Will the regulations made by the Secretary of State, for the patients forums to carry out their duties in this country, equally apply to those premises in Europe? Will clause 16 help our constituents who are being treated under the Government's latest policy to try and undo their abject failure to bring down the waiting list times? If the answer to that question is no, the patients forums will not have that power and that our amendment No. 209, will not apply to regulations that are made by the Secretary of State for premises in Europe, then our constituents are being deprived. What mechanism will there be to ensure that the premises overseas are of a sufficiently high standard, and that the provision and quality of health care is of a standard that patients would expect in this country? Would the provisions of clause 16 and the application of amendment No. 209 apply to premises in Europe, as they do in this country?

If the answer is yes, patients forums would have the power of entry and inspection of premises overseas —because the Government have some deal with providers of health care in Europe that are going to be treating British subjects —then that raises more issues. One would want to know how the system would work overseas and what legality this clause would have to the entry and inspection of premises overseas. It opens up a Pandora's box of potential problems, and, I imagine, a legal minefield. I hope that the Minister will be able to give us an explanation and seek to reassure us on this very important issue.

In conclusion, with regards to amendments No. 209 and No. 210, for the reasons that I have outlined, I hope that the Minister will be minded to accept our two very reasonable amendments, which are solely to put down to seek to improve and enhance the quality of this part of the legislation.

Andrew Murrison (Conservative, Westbury)

In drafting the clause, the Government have taken into account only those matters that can be examined. They are going for the easy option, rather like the man who searches for his keys under a street light. Instead, the clause should deal with those areas of health care in which there is a crying and pressing need for inspection. In my experience, there is such a need in the prison medical service, but it seems that it has been specifically excluded. I should be grateful if the Under-Secretary would explain why.

It is taken as read in this country that the prison medical service is under-resourced, but it is also the subject of close scrutiny. As I have said, there is an extensive network of regulation, audit and inspection throughout the national health service—for the most part, that is welcome—but that simply is not true of the prison medical service. If one were to pick a group of people in this country whose health care was inadequate, it would be the prison population. It is the function of Government to focus on those areas in which they can do the most good first of all, but for some unfathomable reason they have ignored the prison medical service. I hope that the Under-Secretary will explain why.

The treatment of NHS patients abroad appears to be catching the Government somewhat on the back foot. When the Bill was drafted, the Government's plans for such treatment were not quite as well advanced as perhaps they now are, so the Bill needs to be updated to reflect the evolving picture. In terms of both the prison medical service and the treatment of NHS patients abroad—the two areas about which I am most concerned—the Government, patients forums and CHCs have a limited overview.

We have heard a lot about shipping people to the continent for operations, but little about quality control. If we are to accept the definition of health care that the Bill provides—we do not know whether the Bill's omission of these matters was deliberate or an oversight—we must ensure that patients treated abroad are covered by these forums in the same way as those treated in this country. Even though patients are being contracted out to a foreign provider, they deserve equally good health care. We have not heard much about quality control in and scrutiny of the provision of health care abroad on NHS trusts' behalf, and I hope that the Under-Secretary will clarify that issue.

Peter Atkinson (Conservative, Hexham)

I would go much further on this matter than my hon. Friend the Member for West Chelmsford (Mr. Burns). We are being asked to accept a clause that will give a potentially draconian power to patients forums, without first seeing the regulations that will govern the provision. That is an insult to the Committee; if my right hon. and learned Friend the Member for Sleaford and North Hykeham (Mr. Hogg) were in attendance, he would certainly spend an hour or two expressing his outrage at what is happening today.

Parliament is probably shell-shocked by the current volume of legislation curtailing the liberty of individual citizens. Many years ago, a proposal to give patients forums the right to access to what could be private premises would have prompted a huge debate, but we are being asked to nod it through without knowing what powers the Secretary of State will grant. I hope that the Under-Secretary will give us some idea of what those powers will consist of.

The Minister of State has added to the list of bodies that can grant such powers to patients forums. The list now includes health authorities, local health boards, local authorities and all who provide a service under the National Health Service Act 1977. I do not have a copy of the Act to hand, but I believe that it is widely drawn and might include those who provide drugs, and sole practitioners who practise from home. As members of patients forums, they would have a right of entry. Would they have the right, for example, to stage a dawn raid on a doctor's house, break down the door, examine patient records and fillet them for whatever information they wanted? According to the Health Act 1999, in effect, they do have such a right. A doctor or a pharmacist may well not want their premises to be turned over by unqualified people who are members of a forum simply because they were patients or belonged to a local voluntary organisation. Such people will have the right to enter the private premises of a pharmacist who lives above the shop, and loot his records for any reason that they like.

Andrew Murrison (Conservative, Westbury)

One chief concern that might arise, but which is not covered in the Bill's summary treatment of the responsibilities and powers of patients forums, is confidentiality. My hon. Friend rightly alluded to the probable make-up of patients forums, and although I am sure that they will consist almost exclusively of people of great probity and integrity, those people will nevertheless have the right to rifle through sensitive and confidential material if their responsibilities are not adequately defined. That is true not just of general practitioners' surgeries but, potentially, of sensitive areas in hospitals. The general public have a right to expect that that confidentiality be guaranteed, yet the Bill as drafted makes no mention of that.

Peter Atkinson (Conservative, Hexham)

My hon. Friend has expanded on the concerns that I have raised, and they do seem alarming. During consideration of clause 15, the Under-Secretary discussed membership of patients forums, but we were given no real clue as to their composition, even though we are granting such people considerable powers.

Oliver Heald (Conservative, North East Hertfordshire)

My hon. Friend may recall that, in the previous sitting, the Under-Secretary said that the people who will make up patients forums will differ in kind from those who make up CHCs, so it sounds as if the forums will not consist of the great and the good. The Under-Secretary should say whether she is contemplating that forums will consist of those who do not necessarily have an established reputation for, say, local community service. What exactly does she have in mind?

Peter Atkinson (Conservative, Hexham)

It is essential that the Under-Secretary answers that question. It is not just doctors' surgeries or the offices of primary care trusts and local councils that could be affected; the records of private hospitals, for example, could be turned over. My hon. Friend the Member for West Chelmsford raised the somewhat fanciful but nevertheless important point that the provision could apply to a hospital in France that provides patient services to the UK. I doubt whether it could in practice, given that our courts have no jurisdiction there. However, private hospitals and perhaps drug companies could be invaded—if that is not too strong a word—by members of patients forums. I find that incredible.

The regulations that the Secretary of State conferred on the Commission for Health Improvement through the 1999 Act presumably give some clue as to the regulations that will be granted to patients forums. They are draconian. They confer the right, in this case on the commission, to inspect premises at will. They do not consider the question of an appeal, or the need to obtain a warrant from a magistrate to prove the necessity of entering a premises. Section 23(4) of the 1999 Act states:

''Any person who without reasonable excuse obstructs a person authorised by the Commission . . . is guilty of an offence and liable on summary conviction to a fine not exceeding level 3 on the standard scale.''

I forget what level 3 is, but members of the Committee who are lawyers will no doubt be able to advise us on that.

That right comes with the power of prosecuting, convicting and fining, for example, a doctor who resists when a patients forum representative wants to enter and search his premises and take away letters and patients' files. As far as I can see, there would be no requirement for such a representative to explain why they wanted to make such a search and to obtain permission.

Why do they want to turn over this pharmacy? Why do they want to enter this drug company? Even people who provide services such as meals for patients could have their factories raided. There is great potential for infringement of personal and civil liberty.

Oliver Heald (Conservative, North East Hertfordshire)

I have now found the reference: the Under-Secretary discussed having a varied group of individuals on the patients forum including representatives of the ''travelling community''.

Peter Atkinson (Conservative, Hexham)

I do not want to be attacked for being racist, but is the Under-Secretary seriously suggesting that gypsies should be given the power to raid doctors' surgeries? It is fantastic, and although I am sure that she will try to reassure us, she has not had the courtesy to bring the regulations before the Committee to allow us to see how the power will be exercised. She should do so, because this is a serious piece of legislation. It is the Committee's duty to examine the diminution of citizens' liberties, and she is not giving us an opportunity to do that.

Richard Taylor (Independent, Wyre Forest)

I am incredibly confused. I thought that the amendments sought to widen forums' access to include prisons, which I heartily support. However, we are discussing restricting access because of the risk to confidentiality, which is something that must be taken in account. I expect that the Under-Secretary can reassure us on that, but as things stand I need to vote for both the amendment and the clause.

Oliver Heald (Conservative, North East Hertfordshire)

I echo the point about the regulations and the requirement that they be made. It is unhelpful that we have not seen the draft regulations, particularly as it is suggested in later Government amendments that a wider group of bodies than that which appears on the face of the Bill should be covered.

We must also know whether patients forums will have the ability to carry out the work that the regulations might contain. Another concern is whether patients forums will have an adequate budget to enable such inspections to take place. I recently asked a parliamentary question about the budget for patients forums, and I received the answer that that was still under discussion with the Treasury. We know that community health councils spend about £23 million a year, and this year an extra £10 million has been provided to set up patient advocacy and liaison services, but that was a one-off payment.

The estimate of public sector financial and manpower effects in explanatory note 191 states that

''the creation of Patients' Forums in each Strategic Health Authority will require some increase in public expenditure. This will be partly offset, however, by the funding allocated to CHCs and Patient Advocacy and Liaison Services (PALS) which totals £33 million.''

We must bear it in mind that £23 million of that is the on-going revenue budget of the community health councils, whereas the £10 million allowed for patient advocacy and liaison services was a one-off payment to set them up. Primary care trusts are concerned that there is no funding for PALS, and they are worried that they will have to find the money for the patient advocacy and liaison officers out of their budgets.

The Secretary of the State is not committed to make regulations, we have not seen any draft regulations although we were promised them and there is no budget for the entry and inspection of premises. Is this just window dressing as part of the Government's overriding aim to silence the independent watchdogs which have been showing the true state of the national health service in England today through documents such as ''Casualty Watch'', which shows how many people are waiting on trolleys, and the evidence that my local CHC produced on hospitals in my area? The excellent study on cleanliness at the Queen Elizabeth II hospital in Welwyn Garden City sparked a controversy, and my Labour opponents accused me of scaremongering when I referred to the CHC report in the run up to the most recent general election. The same CHC pointed out that the local health authority grossly overspent; when I mentioned that, I was again accused of scaremongering. Now we find out from the reply to my parliamentary question that my local NHS trust has hugely overspent. The Commission for Health Improvement toured my local hospitals and gave them no stars. The CHCs raised the alarm to show the true position, but they will be silenced.

Andy Burnham (Labour/Co-operative, Leigh)

A moment ago we heard a revealing contribution from the hon. Member for Hexham (Mr. Atkinson) when he used the phrase, ''I am not racist, but''. Before the hon. Member for North-East Hertfordshire concludes his remarks, will he let us know whether he agrees with his hon. Friend, and can we take that contribution as reflecting the Conservative approach to patient involvement in the NHS?

Oliver Heald (Conservative, North East Hertfordshire)

The hon. Gentleman may have misunderstood the important point that my hon. Friend was making.

Andy Burnham (Labour/Co-operative, Leigh)

Does the hon. Gentleman agree with it?

Oliver Heald (Conservative, North East Hertfordshire)

Let me answer the point—I am never reluctant to answer questions. ''Who will be appointed to the patients forums?'' is a legitimate question. I have the consultation document, ''Involving Patients and the Public in Healthcare Discussion'', paragraph 5.3 of which talks about

''independent bodies made up of patients and others from the local community, with extensive powers to inspect all aspects of the work of trusts.''

That does not tell one much about who is to be appointed. Given my support for CHCs and their work, I was alarmed when, in the previous sitting, I heard the Under-Secretary discuss not having the sort of people who have traditionally been on CHCs on the patients forums. She said:

''We must also go out and find people, so that we do not depend on the normal people who can come forward.''—[Official Report, Standing Committee A, 4 December 2001; c. 250.]

She made the legitimate point that we need to recruit more people from the black community—I agree with that—but went on to talk about the travelling communities. There may be some valuable members of the travelling communities who could do useful work on patients forums.

Andy Burnham (Labour/Co-operative, Leigh)

Probably not, though.

Oliver Heald (Conservative, North East Hertfordshire)

I did not say that. The sorts of people who served on community health councils wanted to give public service and had time to do so. Many of them knew about hospitals and health care. For example, the CHC in East Hertfordshire includes people who have inspected the Queen Elizabeth II hospital year after year, and there are people in North Hertfordshire who have inspected the Lister hospital year after year. They have a collective memory going back for many years about what those hospitals are like. They know where to look when they inspect hospitals, and it will be a pity if they cannot continue to play that role.

The Under-Secretary may just be trying to sound inclusive. However, I am afraid that she means that people who know all about health in a local area are to be turfed out, so that we end up with people who know nothing much about what goes on in hospitals.

John Baron (Conservative, Billericay)

The other point about consistency and continuity in patients forums is that if different people turn up to inspect hospitals every year or every six months, it does not make for consistency of application in terms of such inspections.

Oliver Heald (Conservative, North East Hertfordshire)

I agree, and I fear that the system that is being set up will include lots of new people, often for reasons of ''inclusion''. If they were going to do a good job, no one would support them more strongly than I. However, it is worrying if an organisation that acts as a watchdog is to lose its collective memory.

Peter Atkinson (Conservative, Hexham)

My hon. Friend is making a good point about continuity. The point that I was trying to make, which seemed greatly to upset the hon. Member for Leigh (Andy Burnham), was that we are giving these people a powerful weapon—the right of entry into premises—and I doubt very much whether someone of no fixed address who travels around the country is qualified to have that power.

Oliver Heald (Conservative, North East Hertfordshire)

I was about to come to that point. Let us by all means have as balanced a body as possible. However, I have seen no evidence to suggest that CHCs are not balanced, although they may have fallen down on inclusion. In many areas, certainly in mine, CHCs have done a marvellous job. I am in favour of spreading best practice, and I would be happy for my local CHC to have these powers. Indeed, I would strongly support their being able to look at all areas of hospitals. Patients forums may be set up all over the country only for us to discover that neither the way in which they operate nor the quality of people involved is uniform. That is worrying in terms of consistency.

Andy Burnham (Labour/Co-operative, Leigh)

The hon. Member for Hexham is explicitly opposed to the great unwashed having access rights to NHS premises, although they may have paid for them through their taxes. However, the hon. Member for North-East Hertfordshire just said that he is in favour of that. What is the Conservative position?

Oliver Heald (Conservative, North East Hertfordshire)

I am afraid that the bad news for the hon. Gentleman is that I had not yet come to that point. I was finishing my first point about not losing the collective memory of CHCs. I am worried that the Under-Secretary is falling into a trap, unless she is a willing accomplice to the crime. If one takes away a watchdog's collective memory by appointing a whole lot of new people with no experience, it may turn into a toothless tiger.

Simon Burns (Conservative, West Chelmsford)

Before my hon. Friend moves on from the powerful point that he is making, does he agree that the Under-Secretary's comments during the debate on Tuesday are gratuitously offensive to many hard-working and dedicated members of CHCs, whose continuity is, as he says, so important?

Oliver Heald (Conservative, North East Hertfordshire)

Yes. The passage to which my hon. Friend refers is insulting. The Under-Secretary said:

''CHCs, no matter how good they are, would acknowledge that they are not fully representative of their communities. My constituency CHC is not because it is a static membership organisation that meets on the second Tuesday of the month. It tends to be self-selecting in the sort of people who can, or want to, take part. It is mainly politicians who enjoy going to meetings on the first Monday, the second Tuesday, the third Wednesday and the fourth Thursday of the month. Asking people in a voluntary sector setting to give that type of commitment is sometimes extremely difficult. We need to be more creative and more imaginative about the way that we seek to involve patients and the public in a range of public services, but particularly in the health service.''—[Official Report, Standing Committee A, 4 December 2001; c. 248.]

Personally, I think that the people in my local CHCs have done a great job in inspecting local hospitals. Year after year, in a spirit of public service, they have undertaken hard, some might say boring, work. The fact that they did it consistently did not mean that they always found things that were wrong—indeed, they tended to be quite constructive—but when that was the case it was they alone who gave the warning. The Under-Secretary may set up all her new committees: patient safety, CHI—

Simon Burns (Conservative, West Chelmsford)

My hon. Friend is absolutely right about the quality of the inspection work done by those public-spirited people. However, that is what the Under-Secretary would have been saying between 1992 and 1997. It is not the people or their performance of their duties that have changed, but the fact that the Government will not brook any opposition.

Oliver Heald (Conservative, North East Hertfordshire)

Yes, it is sad that a Government with such a large majority have so little confidence in terms of allowing opposition to flourish, listening to debate and changing policies that are obviously wrong.

It is extremely foolish to set up all these other bodies and abolish CHCs, which are the bodies that overall—I accept that some did less well than others—gave the early warnings about quality and safety.

My hon. Friend the Member for Hexham referred to the approach that should be taken to entering the premises of a private individual such as a community pharmacist or a GP. When an inspection is carried out, it is important to be certain that the patients forum has good grounds for proceeding, that it is not based on the grudge of a dissatisfied person, that it forms part of a proper, sensibly organised investigation of a quasi-judicial character, and that the inspectors are the sort of people who will make a properly objective assessment of the information that they find. I wonder whether the Under-Secretary has borne that in mind at all. We have no draft regulations for the framework of entry and inspection, so there is no flavour of whether reasonable grounds will have to be given for them to be carried out. We have no hint of whether there will be even the mildest vetting of those who are to serve on patients forums. If the Under-Secretary is to go out and find members of the travelling community without assessing, in any detail, who they are, concerns will be raised.

If there are good members of the travelling community who can do a good job, we would like to know about it, but plucking people from the streets and byways of Britain would cause concern. The Under-Secretary could produce regulations that would give us an idea of how the appointments process will work, and that might tell us what she means when she talks about going out and searching for people. We would welcome that.

Peter Atkinson (Conservative, Hexham)

In the course of my hon. Friend's remarks, will he consider what someone who wanted to resist such a visitation could do? The 1999 Act refers to:

''Any person who without reasonable excuse . . . obstructs a person''.

Presumably, the only recourse would be for them to refuse entry to the patients forum, and if they did so they might then appear in front of a court and put their case as to why they had not admitted the forum to the premises. I do not know how it would work but I am sure that my hon. Friend, as a lawyer, can advise the Committee.

Oliver Heald (Conservative, North East Hertfordshire)

Of course, one way is to allow oneself to be the subject of prosecution, but that raises the concern that the citizen's position would not necessarily be protected. It will be useful to know how the Under-Secretary intends to deal with abuses of the system. If there was an unjustifiable use of the power, what would be the recourse of action for the community pharmacist or the general practitioner?

I shall now discuss whether regulations should be made on a mandatory basis. The wording of clause 16 refers to the premises being entered—amendment No. 211 addresses that. Which parts of premises could not be inspected? There may be parts of a hospital that the Government would like people to look at—the entry hall or, perhaps, a new shop—but one might be concerned that an inspection would not penetrate serious clinical areas. What does the Under-Secretary have in mind? We want to know whether we are to have a pick-and-mix, a la carte approach before forming our view of the clause.

On the subject of places abroad and those in far-flung parts of this country, a primary care trust might discover that the patients in its area are typically taken to Germany or France for treatment and that the quality of treatment there is far better than it is here. On our tour, members of the Opposition Front Bench team have been pleasantly surprised by the sheer quality on offer on the continent. Let us suppose that patients forums were concerned about the quality of treatment, or about what redress was available to patients who went to a hospital in France or Germany and received poor treatment. Would they be able to inspect premises in those countries? Does the Secretary of State envisage reaching agreements with the authorities in France and Germany to allow inspection of their premises?

Andy Burnham (Labour/Co-operative, Leigh)

Am I following the hon. Gentleman correctly? Are the Conservatives against people having access in this country, but in favour of their being able to root around in premises abroad?

Oliver Heald (Conservative, North East Hertfordshire)

I think that the hon. Gentleman has got over-excited and has not listened. Our position is very clear. The Conservative party's view is that we should retain CHCs but improve them and give them the powers that they need to do their job properly. I have made that point, and my hon. Friend the Member for West Chelmsford made it at great length the other day.

Simon Burns (Conservative, West Chelmsford)

Powerfully.

Oliver Heald (Conservative, North East Hertfordshire)

And extremely powerfully. The hon. Member for Leigh must also accept that the Opposition's job is to scrutinise Bills line by line.

The European decision in July was to the effect that patients in need in this country have a right to go abroad for treatment. For a short period, the Secretary of State spun that as being rather a good thing. If a lot of patients are to be shipped from the south-east of England, where the current pilot is, to France and Germany, and the watchdog bodies will be the patients forums, I think that it is legitimate to ask the Under-Secretary—I am sure that the hon. Member for Leigh will agree—whether patients forums will be able to go into premises where patients are being treated. If, for example, a hospital in France had a lot of spare capacity and the NHS made an agreement with it—which could easily happen in the current climate—that that hospital would do 500 or 5,000 operations a year, would a patients forum be able to examine it and ensure that patients from its area were getting satisfactory treatment there?

The facilities for medical care for the armed forces are now within the NHS. Will patients forums be able to visit the hospital in the midlands that deals with the armed forces?

Notoriously, Prison Service health facilities are less good than those of the NHS. That subject will be debated more fully later, but what watchdog role will patients forums have over mental health services in prisons? As the Under-Secretary knows, that is a matter of great concern. I recently spoke at the MIND conference in Scarborough. I was surprised by the number of people who asked about prison medical services, in particular, the mental health services available there, a cause of dissatisfaction. They think that that regime is far less sympathetic than the NHS, that treatment is more old-fashioned and that prisoners do not get the quality of care that they would get even in one of our hard-pressed acute mental health wards.

Will the Under-Secretary explain the role of patients forums in prisons, and how the entry and inspection requirements will work? Clearly, there are difficulties with allowing individuals to enter prisons as a right.

Hazel Blears (Labour, Salford)

And come out again!

Oliver Heald (Conservative, North East Hertfordshire)

There are security reasons why one might worry about that, especially as appointment details for patients forums are not well known. The Home Office might have concerns about some individuals being allowed, as a right, to enter prisons.

On costs, which I mentioned earlier, it is clear from paragraph 191 of the statement on financial effects that there is currently no budget. Can the hon. Lady give us some good news on that and, as a baseline at least, assure us that patients forums will have the £23 million that CHCs have?

[Interruption.]

Ann Widdecombe (Conservative, Maidstone and The Weald)

Order.

Oliver Heald (Conservative, North East Hertfordshire)

I was offering the Under-Secretary an opportunity to intervene and say yes. I hope that she will cover that point when she replies.

I had three further points to make, but I will reduce them to one. I have been speaking for some time, and it is always good to curtail one's remarks.

Simon Burns (Conservative, West Chelmsford)

No, my hon. Friend is doing very well.

Oliver Heald (Conservative, North East Hertfordshire)

My hon. Friend says that I am doing very well, but I will curtail the points that I was going to make.

It will be the role of the Commission for Health Improvement to enter and inspect premises. I understand that guidelines suggest that it should get round to each hospital once every four years or so; the Under-Secretary may confirm that. Will patients forums be allowed to go into premises whenever they wish, or will regulations introduce some regime to limit the number of occasions or provide for the adoption of a bureaucratic system to give early warnings about their visits?

That has been a vexed subject with bodies such as Ofsted. Questions have always been asked about whether the notice period that it gives is a good idea. Some people say that it should undertake on-the-spot inspection: just turn up, go in and see what is going on. Others say that it is a good idea to give some notice so that all the staff are present and everyone in the enterprise is visible. What is the Minister's view about the patients forums' visits? Will they have a straight power of entry and inspection, as the police have in certain circumstances, or will that power be circumscribed by early warning systems and a bureaucratic system?

Dr. Harris rose—

Ann Widdecombe (Conservative, Maidstone and The Weald)

Order. Before I call the hon. Gentleman, may I tell the Committee that I have listened to the debate with interest and considerable restraint? It has gone far wide of the subject of the amendments. Indeed, it has gone round the equator and back on the subject of clause stand part, also touching on matters that should properly be debated under clause 18. I therefore give the Committee notice now that I will not allow a clause stand part debate on this clause. Hon. Members may wish to bear that in mind during the remainder of the debate on the amendments. I shall also take into account the wide-ranging nature of this discussion when we come to discuss clause 18.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I am grateful to you, Miss Widdecombe, for giving me a second bite at the amendments. I entirely agree with your diagnosis of the debate that we have had and am more than happy to forgo a clause stand part debate.

I want to comment on some points that have been made on the amendments before the Under-Secretary replies, if she will indulge me. I am delighted that my three amendments have stimulated the Conservatives to make such lengthy contributions, but I am conscious that we are running out of time and I want to deal with the issue that the hon. Members for North-East Hertfordshire and for Hexham raised about the appropriateness of including certain people in inspection teams.

I first have some questions that relate to the definition of premises in clause 13(2)(c)(ii), which I ask as formally as I can. A discussion on the amendments—I refer especially to amendment No. 211—is not the best place for this, but as there will be no clause stand part debate will the Under-Secretary say whether that definition covers premises abroad and whether the Commission for Health Improvement go into premises abroad under contract to the NHS? By extension, is that the correct definition for the inspection rights of patients forums under the clause, and would patients forums have the right, if their budgets allowed, to examine provision abroad?

Secondly, may I ask why special health authorities are not included in the list in paragraphs (a) to (e) in clause 16? If I am right, high security mental health trusts, for example, function as special health authorities, but are not covered, even with the Government amendments in the next group.

Thirdly, confidentiality is important and was raised by the hon. Member for Westbury (Dr. Murrison) and mentioned by the hon. Member for Wyre Forest (Dr. Taylor). There is nothing new concerning confidentiality that does not already exist for community health councils. We want ''Casualty Watch'' and we realise that when watching ''casualty'' we are watching casualties, who have a right not only to confidentiality, but to privacy and that is not available in corridors, regardless of whether the beds have wheels. There are issues concerning privacy and confidentiality and I am sure that the Under-Secretary accepts that she must reflect on whether new issues arise and whether she is satisfied with the current arrangements for community health councils.

Finally, I want to respond to the point about alleged unsuitability of some people to take part in patients forums. The hon. Member for Hexham made a controversial statement, which may have been inadvertent. It does not help to shout down such comments or to use words such as ''racism''. Nevertheless, some of the assumptions made must be challenged and I shall do so. The hon. Member for North-East Hertfordshire said something along the lines of, ''if there are good people in the travelling community'', the implication being that there are no good people in the travelling community. When he said ''good'', I think he meant that we should add value to the process.

Oliver Heald (Conservative, North East Hertfordshire)

Will the hon. Gentleman give way?

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

In a moment, because I want to ensure that the hon. Gentleman understands what I am saying. His assumption is dangerous and is the same as the assumption that there is an automatic risk to owners of premises from people in the travelling communities, whether defined as gypsies or otherwise.

Oliver Heald (Conservative, North East Hertfordshire)

Will the hon. Gentleman give way?

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I will give way because it is important to do so and I am inviting the hon. Gentleman to clarify his comments. Making his point in the way that he did—it may be valid and I do not challenge his right to do so, nor am I accusing him of racism--emphasises the fact that there will be providers in the health service who share or make judgments about the travelling community and gypsies that are inappropriate, prejudiced and unreasonable. For that reason, the inspection regime must ensure that it covers any concerns that people may have that they are being excluded and subjected to prejudice. There may be racism in the health service--I am not saying that that is the hon. Gentleman's view--which is why it is important to go out and find people in those communities who can say whether the health service is responsive to their needs. Another example is that of asylum seekers, who are also a vulnerable group of patients.

I do not believe that community health councils need to be abolished to provide inclusiveness. Oxfordshire community health council has done a darn sight more to protect the health care of asylum seekers than any Government legislation, which is repressive in this area--

Peter Atkinson (Conservative, Hexham)

Will the hon. Gentleman give way?

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

In a moment.

Government legislation denies detained asylum seekers access to decent health care. It is not necessary to abolish CHCs, but the Government are right to identify what needs to be done.

Oliver Heald (Conservative, North East Hertfordshire)

I could have said, ''If we could find a good member of the accountancy profession'' or any other body. What I meant by good was someone who could make a valuable contribution to a patients forum. I hope that the hon. Gentleman agrees that there is concern--I am angry about the abolition of CHCs--that good members of CHCs who have given years of service may be turfed off and unable to continue doing their useful work. That was the context of my comment.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I note that and I may like a chance to respond, but I want to give way to the hon. Member for Hexham.

Peter Atkinson (Conservative, Hexham)

The hon. Gentleman is mixing up two issues. I have no problem with members of patients forums talking to gypsies, the travelling community or asylum seekers to find out about their health needs and I hope they would do that. However, it manifestly defies common sense that members of a group that is itinerant by nature should serve on a forum. That is not an attack on them because they are travelling people; it is simply that they would not have the knowledge of the community, area or, indeed, the medical institutions necessary to be members of a forum.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

But members of that group have knowledge of their own experience and that of people in their community. We are discussing not premises and geography, but the delivery of health care to individuals. The hon. Gentleman misunderstands the reason for inclusiveness, which is to ensure that when inspections and overviews take place, decisions are made for all sections of the community, and not just for those that are established. It is a difficult area. The idea that people who are established in the community might be ''turfed off'' a forum by ''itinerants'' is dubious. That line could be used by other people whose views are inappropriate and who might not want travelling people to take their place. I am sure that that is far from the hon. Gentleman's view, but his position worries me, because it could be seen to share some interpretations with people who feel that the health service is for the white middle class.

Oliver Heald (Conservative, North East Hertfordshire)

On a point of order, Miss Widdecombe. I apologise that I have been called away from the Committee on an urgent matter. I apologise particularly to the Under-Secretary because I wanted to hear her winding-up speech, but I shall read it carefully in Hansard.

Ann Widdecombe (Conservative, Maidstone and The Weald)

Thank you, Mr. Heald.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I shall give the Under-Secretary the opportunity to wind up, but I want to put on record my concern about the approach taken by Conservative Members.

Hazel Blears (Labour, Salford)

I shall do my utmost to cover all the points that have been raised by hon. Members. We have had a wide-ranging debate on the amendments, which raised a significant number of important issues.

Amendment No. 209 would make it mandatory for the Secretary of State to make regulations. It is not usual to oblige the Secretary of State to make regulations in any legislation. That would create uncertainty about the extent of the duty being imposed and might oblige him to make regulations in respect of every paragraph; he would not have the power to decide which were appropriate for regulations. I shall resist the amendment because it is not appropriate to have such a provision in the Bill. Nevertheless, it is important that the regulations cover many of the issues raised by hon. Members.

The hon. Member for Oxford, West and Abingdon asked whether all stakeholders would be consulted about the content of the regulations, how they would operate, which premises would be included, how visits would take place, who would have access and whether prior notice would be given. He also mentioned details about confidentiality. These are all extremely important matters. I can confirm that in drawing up the regulations, there will be widespread consultation with all the stakeholders in the system to ensure that we get the regulations absolutely right. These are matters of practicality, and the regulations need to balance the rights of patients forums and those of other people in the system. We want to ensure that we get that balance absolutely correct, and the content of the regulations will be much better if they are formed after consultation and debate. We intend to allow that.

That is the very reason why the draft regulations are not before the Committee; they have not been drafted and they are not ready. It is not a matter of the Government's withholding regulations from the Committee. My right hon. Friend the Minister of State actually said that he would share the regulations if they were prepared, but he confirmed that they were not prepared. The reason is that we want to conduct extensive consultation on the contents of those regulations.

At this point, it may help if I draw Members' attention to a document that I have placed on the Table today. It is a proposed implementation programme for all the patient and public involvement provisions. I am keen to share that with hon. Members, because it sets out a project plan that takes us all the way up to April 2003 and beyond.

I should like to give Members a sense of how the proposals will be implemented, when consultation will take place and when regulations will be drawn up. I appreciate that the document is complex, so I want Members to have a chance to look at it, perhaps before we debate some of the later clauses dealing with patient and public involvement. The heading of the document refers to a ''proposed implementation programme''. Obviously these matters will be subject to consultation with people in the field who are already involved in community health councils, patients forums, local authorities and a wide range of bodies, who I hope will play a real and substantive part in drawing up a coherent framework for patient and public involvement. I hope that the document will help hon. Members to see that this is not a hastily conceived plan, but a structured and managed programme for implementing patient and public involvement.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I am grateful for the information provided and I have no questions about it at this point. I want to take the Under-Secretary back to her original rejection of amendment No. 209, in which she said that accepting the amendment would make it mandatory for the Secretary of State to make regulations relating to the list of premises. It is appropriate that that is mandatory because, presumably, these are the premises where there should be some rights of inspection. I am not suggesting in this amendment that those would be full rights, because clearly the nature of the rights would have to be negotiated, for reasons that have been given by Conservative Members.

The implication that the Secretary of State might not then make regulations providing for the inspection of one of those areas implies that the Under-Secretary envisages circumstances in which there would be no inspection and entry rights for patients forums. That would be a diminution of the powers currently held by community health councils. The Under-Secretary should clarify whether that is the implication of her remarks.

Hazel Blears (Labour, Salford)

No, I do not envisage the circumstances that the hon. Gentleman has suggested. The provision is right to allow the Secretary of State to make regulations in relation to these matters. I do not think that that detracts from the power or strength of the provision, and the amendment is resisted on that basis.

I shall now discuss the ''prison clauses''. Obviously, we shall have a debate under clause 21 about the substantive nature of the partnership arrangements between the Prison Service and the national health service. It might help if I now deal with the powers of entry and the powers of patients forums in relation to the Prison Service.

The primary responsibility for the environment of care for prisoners rests with the Prison Service. There are already established mechanisms for independent inspection and scrutiny of prisons. These cover health care services for prisoners and are provided by Her Majesty's chief inspector of prisons, who conducts a regular programme of announced and unannounced inspections, covering the full range of prison activity, including health care provision. As part of their inspection, the chief inspector's teams carry out survey work to assess patient satisfaction with health services, and they have direct access to prisoners to assess their views. Other inspections in prisons are carried out by boards of visitors, comprising independent laypeople. They are in place at all prisons, and they provide an element of day-to-day independent oversight of all aspects of prison activity, including health care. Boards can raise concerns with the prison's governor and through their annual report to the Home Secretary.

Several hon. Members rose—

Hazel Blears (Labour, Salford)

I am spoilt for choice.

Simon Burns (Conservative, West Chelmsford)

On the question of boards of visitors, does the Minister think that a board's composition of members might suffer in the way that memberships of community health councils have?

Hazel Blears (Labour, Salford)

The Government are keen to involve people from the widest section of the community. That approach applies across Government: we want their involvement in boards of visitors, education services and regeneration projects, for example. When we talk of public involvement, we are committed to ensuring that we are not simply using words or offering an empty shell, but that individuals who offer a wide range of experience participate in such bodies.

Simon Burns (Conservative, West Chelmsford)

Will the hon. Lady give way again?

Hazel Blears (Labour, Salford)

I want to make progress because I have many points to answer. I believe that I have dealt with the hon. Gentleman's point.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Will the hon. Lady give way to the mover of the amendment?

Hazel Blears (Labour, Salford)

Yes.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I am sure that boards of visitors do excellent work in their own way, as does Her Majesty's chief inspector of prisons in respect of detention centres for asylum seekers with medical problems and in the prison health care system—excellent work, which is often ignored by the Home Secretary. However, it is certain that the boards of visitors do not have expertise in health care areas or reflect patient and public community involvement. If NHS provision is to be given to prisons, it is eminently reasonable to provide the same rights of access, entry and inspection for patients forums or, were they to remain, CHCs. That would all come under NHS care. The idea that one can have details of a patient's condition and of any complaint about a prison's governor wholly disregards the key separation, which the Prison Service recognises must exist, between the clinical confidentiality of a prisoner and other areas over which the governor has charge.

Hazel Blears (Labour, Salford)

I believe that I have outlined that the primary responsibility for the care environment in prisons lies with the Prison Service, and that independent inspection regimes exist in prisons. During the debate on clause 21 and partnership arrangements, hon. Members will appreciate the step-by-step incremental approach being taken to improve health care services in prisons. Many hon. Members acknowledged that those services had suffered from considerable deficiencies in the past. At present, independent inspection lies with Her Majesty's chief inspector of prisons and the boards of visitors.

Andrew Murrison (Conservative, Westbury)

Will the hon. Lady give way?

Hazel Blears (Labour, Salford)

I have spent sufficient time on the clause and we shall have an opportunity to discuss more general matters of prison health care under clause 21.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

On a point of order, Miss Widdecombe. Can you clarify something for the Committee? If there is not enough time under the guillotine to discuss clause 21, is not the ministerial assurance that we may discuss matters during the debate on that clause meaningless? It will all be dictated by the timetable.

Ann Widdecombe (Conservative, Maidstone and The Weald)

Indeed, Dr. Harris, I can confirm that if the Committee has not reached clause 21 and debated it by 5 o'clock tonight there will be no debate.

Hazel Blears (Labour, Salford)

I am keen to make progress so that we can discuss the substantive issues of clause 21, which covers more than access to premises and is important to improving health care. I shall make my comments as swiftly as I can.

Several hon. Members raised points about how to achieve the right balance between allowing access to premises and recognising that visits from patients forums to those in private properties should not be intrusive or comprise of dawn raids that turn over people's premises. I acknowledge the worries about that but, as the regulations develop and are consulted on, we shall try to ensure that when services are provided from private premises, access will generally be limited to the areas to which patients are permitted access, and will be accessed only at reasonable times that are agreed to by the occupier. We must be conscious that premises, such as those of community pharmacists, are often used as living accommodation.

Confidentiality, which is extremely important, has also been raised. It is not envisaged that patients forums will be given the right to access confidential information, such as patient records. Records are protected under the Data Protection Act 1998 and under common law. It is very important that patients have confidence that their personal matters will not be exposed to unnecessary and inappropriate scrutiny.

Patients forums are not an inspectorate body, as the CHI is, in terms of quality. Patients forums are designed to involve patients in the services that are provided by their trust, and to listen to patients' views. They need to have access to premises to look at things such as cleanliness, food and patients' environment, and to ensure that the facilities are appropriate. The forums are not an inspecting and monitoring body; that is not their prime purpose. They are there to get patients' views on services in the trust. It will be absolutely crucial to achieve a balance between the rights of patients forums and the rights of other individuals.

I turn now to the issue of the members of patients forums, although this discussion may stray into other areas. I want to give the assurance that, in many cases, the members of patients forums will be existing members of community health councils. I have no doubt about that. We are specifically trying to provide a transition path, as hon. Members will see from the implementation plan. We want to work with community health council members to see whether they can find a place within the new system that enables them to bring in their skills, experience, expertise, and depth of knowledge. We would be foolish in the extreme to discard the depth of knowledge that members of community health councils have acquired over many years.

I am absolutely determined that we find a pathway for staff of community health councils who want to take a part in the new system, members of community health councils and members from all the other communities that I identified on Tuesday. I genuinely believe that it is important to hear from all of them if the NHS is to respond properly to the whole of our community.

Simon Burns (Conservative, West Chelmsford)

The Under-Secretary is being rather contradictory now. On Tuesday, she rather foolishly dismissed the current membership of community health councils as basically being local politicians who like to attend meetings on Monday, Tuesday, Wednesday and Thursday evenings. She suggested that a whole new wave of people would be brought in to be more representative of the local community. The Minister now seems to be backtracking and saying that, actually, most of the new members of the forum will be existing members of community health councils. What is it to be?

Hazel Blears (Labour, Salford)

With respect to the hon. Gentleman, he seems incapable of grasping a complex situation that combines the merits of both. He seems to feel that we need an exclusively either-or position, and this matter is too important to embark on that path. I remind him of Tuesday afternoon's debate, in which I explicitly said that we would set up a transition advisory board to ensure that members in the system see a key role for themselves in future and can take on new responsibilities. I said:

''I made an explicit point that the proposals build on the best of work done by community health councils and, especially, their members.''—[Official Report, Standing Committee A, 4 December 2001; c. 254.]

I am on the record as saying that, and I believe it. I can confirm that that will be the case. That does not mean that we do not need to be much more creative and imaginative about how we involve a wider range of people in future. I am sure that we will do that.

I should like to deal with the issues of finance and resources. Rightly, people in a range of organisations are anxious that the new system be properly resourced. I am not in a position to give specific details today, but I can reassure Members that the new system of public and patient involvement is more complex and will need resources. We need to ensure that those resources are adequate so that patients and the public can influence their health care.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

The specific question asked by the hon. Member for North-East Hertfordshire, who sadly is not present, was whether the patients forums would be getting the £23 million that CHCs currently have, or whether some of the money would be absorbed along with the £10 million that has been allocated to the purposes of PALS and the National Care Standards Commission.

Hazel Blears (Labour, Salford)

We must view the system as a whole. I have previously argued that all the different components of the system add up to a coherent entity, and we need to fund the whole system, rather than its constituent parts, to ensure that it operates properly.

The issue of treatment abroad has been raised. I understand hon. Members' concerns about patients forums being involved. Treatment abroad is not entirely a novel idea; many patients in the past have been treated in European countries under forms E111 and E112. We are all aware of the system and the reciprocal arrangements that have been in place for many years for treatment here and in other European Union countries. In terms of that issue and of private health care, we envisage that rights for inspection will be included in the contracting process. It is clearly not possible for the Bill to affect law in other countries, but we do intend to ensure rights to quality monitoring and inspection. They are important to the interests and safety of patients in the private sector and, indeed, wherever care is commissioned on behalf of the national health service.

Andrew Murrison (Conservative, Westbury)

The Under-Secretary is right to say that people have been treated abroad under various agreements for many years. However, the point is that the Bill introduces a raft of new regulations and inspections, both through CHI and through patients forums. Many members of the Committee will be worrying about how we can inspect or regulate services provided abroad, so that those treated there may expect the same standards and regulatory functions as those treated in the United Kingdom.

Hazel Blears (Labour, Salford)

I believe that we would all share the concerns of patients. It is right that we think about quality, standards, aftercare and the way in which patients are treated, wherever they might be, provided that treatment is under, and funded from, the national health service. We therefore need to look at the contracting provisions to ensure that such proposals are in place and are effective.

I believe that I have dealt with most of the issues raised by hon. Members—

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Perhaps I may assist. Will the definition of premises in clause 13 allow the Commission for Health Improvement to inspect the quality of care given abroad? Will, by implication, patients forums be allowed to undertake monitoring visits—I recognise that they will not be as rigorous as CHI visits—and should a better definition of ''premises'' replace that given in clause 16?

Hazel Blears (Labour, Salford)

I should begin by pointing out that the definition of ''premises'' in clause 16 seeks to reflect the functions as set out in clause 15(5). Patients forums are a different creature from CHI, and the premises in question are those connected with the functions and services that patients forums are intended to inspect. That is why there is a different definition.

I do not have information to hand on the definition in clause 13 and the question whether CHI will be able to inspect abroad, but I undertake to write to the hon. Gentleman on those matters.

The other issue that I did not deal with, which was raised by the hon. Member for North-East Hertfordshire, is the armed forces. As I understand it, if members of the armed forces are treated on NHS premises—they are longer treated in separate armed forces facilities but in NHS hospitals—or if they receive services provided by, or arranged by, a trust, such services will be subject to patients forums' rights of inspection and monitoring under clause 16. The provision would cover hospital premises in which members of the armed forces were being treated.

Andrew Murrison (Conservative, Westbury)

On that specific point, will patients forums have access to military facilities where NHS patients are being treated? I am thinking in particular of service families.

Hazel Blears (Labour, Salford)

The intention is that patients forums will have access to premises in which NHS patients are being treated, and that they will follow those patients, whether they are in primary care or secondary care. It is very important that, in representing to trusts the views of patients and the public, patients forums can base those views on evidence that they have been able to collect.

Peter Atkinson (Conservative, Hexham)

I thank the Under-Secretary for offering some further explanation of the regulations. It is clear that she has a good idea of what they will contain, given that she was able to read from a draft. It is a pity that we could not have had those regulations for today's debate.

I am glad that the private parts of doctors' and community pharmacists' properties could not be raided, but the Minister has said nothing to convince me that the patients forums need such powers at all. If they go into doctors' surgeries or community pharmacies to inspect cleanliness and talk to patients, only a tiny number of the doctors or others in charge of premises will refuse to admit them. If a forum is refused admission, surely it can go to the Commission for Health Improvement and ask it to undertake an investigation, because regulations will give CHI the necessary powers. Those powers would be needed on only an extremely small number of occasions. We are giving excessive powers to the patients forums.

The Minister has not said anything about how the Committee, or the House, will consider the regulations. Will they be made by affirmative or negative procedure? Will we see and debate them? Will there be proper parliamentary scrutiny? Can she reassure us further on that?

Hazel Blears (Labour, Salford)

I believe that the powers that we are giving to patients forums are necessary. It is important that they do not simply form a view without that being informed by patients and service users. It is the whole essence of the system of patient and public involvement that patients forums do not speak simply for themselves, but make an effort to go and find out what service users have to say.

A key part, although not the only part, of that process is for the patients forums to look at the physical facilities available to see whether they are effective, appropriate and suitable for their use. The hon. Gentleman said that a tiny proportion of people might refuse to let the forums in. I think that it is right and proper that when people are willing to get involved in such voluntary organisations, we give them the necessary powers and facilities to carry out their work properly.

I am sensitive to the need to strike a balance between the activities of patients forums and the privacy and dignity of patients, which addresses the point that the hon. Member for Oxford, West and Abingdon made. We must ensure that patients' privacy and dignity is not compromised by visits from patients forums, which would defeat the object of having them. That balance is crucial, as is ensuring that they do not duplicate their visits so that people receive one visit after another. Where there are several patients forums, they must be properly co-ordinated so that they do joint visits to look at a range of issues. Such matters are not beyond our wit or ken. We are competent enough to organise a system that creates neither duplication nor the problems about which the hon. Gentleman expressed concern.

We want to have extensive consultation on regulations with all those involved in the field. Their ideas might help us to get an even better system, in terms of its practical working. People who have been involved in such activities often know what works best, what is not a good idea and what is impractical. I want us to be very well informed before we promote regulations to the House.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I do not disagree with the hon. Lady's points about the membership of patients forums. That is not where she and I have disagreements.

On the definition of premises referred to in amendment No. 211, I am not entirely satisfied because she has not been able to answer one of my questions and has said that she will write to me. However, for the reasons that I have given, amendment No. 211 is not in a fit state to be pressed.

On amendment No. 210, I disagree strongly with what the hon. Lady said in her attempted reassurances. If we are allowed, I note that we could have that debate under clause 21. I fear, however, that we will not have time then to cover either that or CHI's remit in prisons, which the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton) promised could be examined under clause 21 when we discussed it earlier. Those points might have to be dealt with at a later stage or in the House of Lords.

On amendment No. 209, I disagree with the Minister's comment that the wording should not be ''shall'', but I do not believe that it is appropriate to press the amendment. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Hazel Blears (Labour, Salford)

I beg to move amendment No. 156, in page 21, line 7, at end insert—

''( ) Health Authorities,

( ) Local Health Boards,

( ) local authorities,''.

Ann Widdecombe (Conservative, Maidstone and The Weald)

With this it will be convenient to discuss Government amendment No. 157.

Hazel Blears (Labour, Salford)

Amendment No. 156 does not represent any policy change. We have always intended patients forums to have a right to inspect any premises where NHS patients in England go to receive health care. That sometimes includes premises owned or controlled by Welsh NHS bodies, and local authority premises where services are provided under a section 31 agreement with the local authority.

Until proposed structural changes to the NHS in Wales were introduced into the Bill, Welsh NHS bodies were covered by the original wording of the clause. After those changes, trusts in Wales will still be covered—

It being twenty-five minutes past Eleven o'clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order.

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

Standing Committee A

Clause 16 - Entry and Inspection of Premises

Alan Hurst (Labour, Braintree)

I remind the Committee that with this we are taking Government amendment No. 157. I also remind hon. Members of my co-Chairman's ruling that there will not be a stand part debate on clause 16.

Hazel Blears (Labour, Salford)

I hope that the amendments will be straightforward. As I said this morning, amendment No. 156 does not represent a change in policy. We have always intended that patients forums should have a right to inspect any premises in England where patients go to receive health care. That includes premises owned or controlled by Welsh national health service bodies and local authority premises where services are provided under a section 31 agreement with the local authority.

Until the proposed structural changes to the NHS in Wales in the Bill were introduced, Welsh NHS bodies were covered by the original wording of the clause. After the changes, trusts will still be covered in Wales, but not the new health boards and health authorities that will be created. In the case of local authorities, provision is made under the duties of patients forums outlined in clause 15 to extend the forums' functions to services provided pursuant to a section 31 arrangement. Those services may be provided on local authority premises. The amendment puts right an omission by allowing the forums entry rights to such premises. The amendment as it relates to local authority premises has the agreement of the Local Government Association, which will be consulted on the finer detail of the regulations.

I turn to amendment No. 157. Under clause 15 the forums' functions extend to health-related services provided under section 31 arrangements with a local authority. Therefore, entry rights must properly be extended to cover such premises, to ensure consistency. ''Local authority'' must be given the same meaning there as in section 31 of the Health Act 1999. The amendments are designed to tidy up; they ensure that patients forums can have entry wherever NHS patients from England are being treated.

Oliver Heald (Conservative, North East Hertfordshire)

For the sake of completeness, will the Under-Secretary explain what the reciprocal arrangements are? Will Welsh community health councils be able to come into English NHS trusts to do the same job of scrutiny in reverse, so that there are no gaps in the system?

Richard Taylor (Independent, Wyre Forest)

Does the amendment include those special authorities that will still exist after the next reorganisation?

Hazel Blears (Labour, Salford)

The Welsh are still reviewing the roles of community health councils. They have decided to keep CHCs but are looking at extensive reform of their powers and duties so that they reflect the new make-up of the national health service. As far as I am aware, they have not yet resolved many of those issues, but it will be important to ensure that the system has no gaps where rights of entry are not provided. I understand that the functions of the CHCs, and the way in which they perform in Wales, will be included in the forthcoming NHS (Wales) Bill. I take the point that the hon. Member for North-East Hertfordshire (Mr. Heald) made about Wales.

Oliver Heald (Conservative, North East Hertfordshire)

Can the Under-Secretary give a commitment that community health councils in Wales, for as long as they exist, will have exactly the same rights as are set out in the clause?

Hazel Blears (Labour, Salford)

No, I am not in a position to make that commitment. Patients forums are being set up because they are being given new powers to follow the patient wherever the patient goes: into primary care premises, where CHCs currently do not go, and into the private sector by virtue of contracting provisions. It would not, therefore, be right for me to give a commitment that existing bodies could exercise what are, in effect, new powers to give patients forums rights of entry. However, the hon. Gentleman made a good point about proposals on how the scrutiny and inspection system will operate in relation to the Welsh organisations. The people of Wales must consider and decide for themselves how they want their system to operate. That is the effect of devolution.

Oliver Heald (Conservative, North East Hertfordshire)

There should be no weakening of the position in Wales simply because its people have decided, as they are entitled to, that they want community health councils to remain in place. It does not make much sense to say that a CHC in Wales will not be able to do what a patients forum can do in England as regards entering and inspecting premises. The Under-Secretary agreed that there should not be gaps in provision, especially given the cross-boundary issues. If a CHC in Wales is unhappy about the way in which a Welsh patient has been treated in an English hospital, it may feel that it should investigate that. Many such cases might arise along the border region. Why should not CHCs have the same powers as patients forums? Will the Under-Secretary give a commitment to take up the matter with her counterpart in the National Assembly for Wales to ensure that the Welsh are not disadvantaged in such circumstances?

Hazel Blears (Labour, Salford)

As the hon. Gentleman will understand, it would be entirely inappropriate for me to decide here what will happen to the organisation of patient and public involvement in Wales, because that is a matter to be decided in Wales. He made a good point about not wanting gaps to appear, and I can draw that to the attention of the people in Wales who will consider the matter, but it is not for me to say any more about it. The Bill is designed to cover the establishment of patients forums in respect of patients being treated by the NHS in England.

Oliver Heald (Conservative, North East Hertfordshire)

Can the Under-Secretary confirm that the Government's intention in moving the amendment is not to allow Westminster in any way to disadvantage Wales relative to England, which is arguably its effect, but to give Wales the opportunity to decide the issue?

I assume that it is necessary for the House to give the powers to the CHCs if they are to acquire them. If that is wrong and the matter can be dealt with and tidied up in Wales, I should be grateful to hear the Under-Secretary say that. I do not want the message to go out that Westminster is acting to the advantage of the English and the disadvantage of the Welsh. That is always a danger where devolution is concerned.

Hazel Blears (Labour, Salford)

With respect, the hon. Gentleman is making heavy weather of the matter. I have already said that it will be dealt with in the forthcoming NHS (Wales) Bill. The Government want to enhance and deepen patient and public involvement in the whole national health service, not reduce it, and we have no wish to create inequity. There will be local consultation in Wales with all the relevant stakeholders about the type of organisation and the functions that they want for CHCs operating in their country. They will consider the reforms in order to decide exactly how they might be incorporated, and the detail will be dealt with in the NHS (Wales) Bill.

Amendment agreed to.

Amendment made: No. 157, in page 21, line 25, at end add—

''( )In subsection (1), ''local authorities'' has the same meaning as in section 31 of the 1999 Act (arrangements between NHS bodies and local authorities).''.—[Ms Blears.]

Clause 16, as amended, ordered to stand part of the Bill.

Clause 17 - Annual Reports

Richard Taylor (Independent, Wyre Forest)

I beg to move amendment No. 212, in page 21, line 44, at end insert—

''(e) the Members of the House of Commons representing constituencies in the relevant locality.''

It gives me great pleasure to move the amendment. I have not been here long, but I have achieved one or two ambitions. One of them was to see an amendment that had not necessarily been tabled by the Government achieve something. This amendment is a tremendous opportunity for that. It is supported not merely by the Opposition, but by me—I would prefer to sit in the middle if there were a seat.

From the response to the listening exercise, ''Involving Patients and the Public in Healthcare'', one can see that the Government have accepted that the amendment is necessary. In paragraphs 3.21 and 3.28 on pages 10 and 11, they agree that local MPs should be the people to receive forum reports and the amendment seeks to enshrine that requirement in the Bill. It would show that the Government and the Under-Secretary are listening—as she promised that she would—and taking action. I want to see those in my amendment added to the list of people who receive reports from forums.

Oliver Heald (Conservative, North East Hertfordshire)

I support the amendment. One strength of the community health council system has been the generous way in which CHCs have kept Members of Parliament informed by sending them agendas, reports and information on other proceedings. Earlier, I said that I had become aware of the problems of one of my local hospitals because the CHC had brought them to my attention through reports and minutes of meetings.

However, there are other ways in which the aim of the amendment—that reports come into the possession of hon. Members—could be achieved. Provision could be made for a report to be laid before Parliament. Another way would be to give the Secretary of State permission, or require him, to publish a report that he receives. I therefore want to check with the Under-Secretary that there is not already something in the Bill that would cause such reports to come into the possession of Members of Parliament.

Hazel Blears (Labour, Salford)

I understand the wish of the hon. Member for Wyre Forest (Dr. Taylor) to see the amendment enshrined in law. I am pleased that he acknowledged that the listening document was genuine. As he pointed out, paragraph 3.21 of our response to the document states that local MPs have a role to play in shaping their health services, as they have an important role in raising issues in Parliament. We shall ensure that they receive copies of patients forum reports from their constituency so that they are kept aware of important local issues. We must ensure that the information in those annual reports is widely available.

It is inappropriate to put a provision into primary legislation because it is a matter of good practice rather than statutory responsibility and requirement. It would set a strange precedent for legislation if we were to require copies of a document to be sent to individual Members of Parliament. We could, however, require copies of all reports in which Members of Parliament might have a legitimate interest to be sent to them individually.

As we said in the listening document, we shall ensure that Members of Parliament get copies of documents and that they are kept in the loop regarding events in their constituency. I certainly appreciate being kept informed by the patient groups, including the community health council, in my constituency. Members of Parliament should receive that information, but it is inappropriate for a requirement to be placed in the Bill in this way. The spirit of the suggestion made by the hon. Member for Wyre Forest is sensible and we will ensure that what he has suggested happens, but for those reasons we must resist his amendment.

Oliver Heald (Conservative, North East Hertfordshire)

It is true that other Acts contain a provision that the person who receives the annual report is the Secretary of State, and there is also a duty to publish. Does the Under-Secretary envisage that such a provision would apply here, or would it be unnecessary because the forum would be publishing the report itself? The Bill stipulates what the report must include, but it does not require it to be in the public domain; many people would think that it should be.

Hazel Blears (Labour, Salford)

Perhaps I can reassure the hon. Gentleman. We envisage that patients forums' reports will be widely available in the community, and that they will publish them themselves in addition to sending them to the Secretary of State. The regulations under clause 18(2) will provide for the publication of patients forums' reports:

''the preparation and publication of reports by Patients' Forums (including the publication of reports under''

clause 17. There is a provision to ensure that that information is in the public domain. It would otherwise be of limited use because it is obviously the type of information that people would want to consider and act upon. There is currently no provision in the community health council regulations for reports to go specifically to Members of Parliament, but we know that they do because we receive them regularly. The amendment is therefore superfluous, but its spirit will be acknowledged and acted upon.

Richard Taylor (Independent, Wyre Forest)

On the Under-Secretary's assurance that we will automatically receive those papers, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Richard Taylor (Independent, Wyre Forest)

I beg to move amendment No. 213, in page 22, line 1, after 'include', insert '—

(a)'

Alan Hurst (Labour, Braintree)

With this we may discuss the following amendments: No. 214, in page 22, line 2, after 'Forum', insert—

'(b) details of the arrangements of the Trust to which the Forum relates under section 11(1) of the Health and Social Care Act 2001.'.

No. 215, in clause 18, page 22, line 29, after 'in', insert 'the'.

No. 216 in page 22, line 29, leave out from 'the' to end of line 30 and insert 'Commission for Patient and Public Involvement in Health'.

Richard Taylor (Independent, Wyre Forest)

May I first make an inquiry? Amendments Nos. 215 and 216 refer to clause 18—do you still want to take them together, Mr. Hurst?

The Chairman indicated assent.

Richard Taylor (Independent, Wyre Forest)

Amendments Nos. 213 and 214 allow us to ask a question. Clause 18 implies that the forum will be the only mechanism by which a trust can take citizens' views, but I wonder whether that is intentional. The trust should have that duty, not only its forum.

Amendments Nos. 215 and 216 concern clause 18(2)(j):

''the preparation by a Patients' Forum of annual accounts, and their inclusion in accounts of the NHS trust or Primary Care Trust''.

Will the Minster clarify whether it would be more appropriate to include the accounts in those of the Commission for Patient and Public Involvement in Health?

John Baron (Conservative, Billericay)

We must clarify how the different bodies will relate both to each other and to those working in primary and secondary care. To avoid confusion, the Department of Health should publish a clear guide for the public on where they can access information and advice; the British Medical Association would endorse that view. It would also help if health professionals were to be provided with information on arrangements for providing advice and gaining patients' views. To follow an earlier point, it seems inappropriate that the only way in which we shall be able to access patients' views is through the forum. There should be guidelines on how to obtain the public's view of how the health service is operating at the coal face, and professionals also need guidelines on where they stand.

Oliver Heald (Conservative, North East Hertfordshire)

To follow the points made by my hon. Friend the Member for Billericay (Mr. Baron) and the hon. Member for Wyre Forest, the report should include information that patients forums come across on how trusts perform their duties to involve and consult patients and the public on issues such as the planning and provision of services, the development and consideration of proposals for changes in the way in which those services are provided and decisions that affect the operation of services. In Hertfordshire, consideration is being given to changing the way in which services are delivered across the county. The current arrangements for explaining the issues to people such as Members of Parliament, the public and councillors are good, although we have not yet reached the conclusions, which may be more controversial.

Whether a particular hospital continues to provide services such as accident and emergency is the type of issue about which patients and the public care most. They want to feel that they know how to complain and are aware of anything that might affect their services. The way in which trusts perform their duties to involve and consult patients and the public about the planning and provision of services is crucial. It is, however, not the sort of thing on which the Commission for Health Improvement would necessarily concentrate. Community health councils were ideal but, given that the Government are determined to abolish them, the annual report should include such details. That is the purpose of amendment No. 214.

The two amendments to clause 18 concern what should happen as regards the annual accounts for patients forums because the present proposals do not involve an independent set of accounts for patients forums. I may be wrong about that—the Minister will tell us in a moment if that is the case—but it looks as if patients forums will be seen as part of the trust accounts, and will not have a separate place. That raises questions about funding that we can come on to, if briefly, when we discuss clause 18.

Surely there is a case for having accounts concerning patients forums in with the accounts of the Commission for Patient and Public Involvement in Health. That would ensure that the accounts of the NHS trusts and primary care trusts, for which the forums are established, have accounts that are separately managed and presented from those of the forums themselves. The functions would then be separated out in every way. There is clearly a need for a rigorous watchdog, and if patients forums are to be that watchdog and to be independent, they should have an independent arrangement for their accounts.

Hazel Blears (Labour, Salford)

The hon. Member for Wyre Forest asked whether patients forums will be the only way for the NHS to consult. I can assure him that that is certainly not the case. The forums will be but one way in which we can find out the views of patients and the public about what our health services are doing, and whether they are providing the right quality of service. The new Commission for Patient and Public Involvement in Health will be given a specific remit to involve the public, and to ensure that public participation is a key part of developing health services and looking at reconfigurations. That will ensure that there is a wider input into those matters than simply from patients themselves, although they are important to the system.

John Baron (Conservative, Billericay)

Will the Under-Secretary clarify how the patients forums and other consultative bodies will relate to each other? It is not clear to me what communication there will be between them and how, at the end of the day, we will gather information from the general public on how the NHS is functioning at ground level. It appears that different bodies will be doing different things.

Hazel Blears (Labour, Salford)

The hon. Gentleman is right that different bodies will be doing different things. We have decided that the various functions have to be carried out at the different levels in the NHS at which they are carried out. There is a clear need to draw the system together to ensure that we get a coherent overview. Clause 19 outlines the role of the Commission for Patient and Public Involvement in Health, which will operate at the national, regional and local levels as the mechanism to draw all the different functions together. That will ensure that we get all the necessary data and intelligence about what is happening in our health economy.

The hon. Gentleman made a sensible point about providing a comprehensive guide to how the service will work. We are working on comprehensive guidance for everyone involved in the system, including health care professionals, patients, members of the public and local authorities who, for the first time, will have an active role and legal powers to take part in the system. I do not underestimate the importance of having clear, precise information available for everyone about how they can get involved in the system, which issues concern them and which part of the system they should go to for assistance. That will be the key to taking us forward to success.

On the NHS's general duty to consult, we are working on various guidance frameworks to ensure that the NHS knows what a good piece of consultation ought to involve. In many areas, consultation has improved dramatically in recent years, but we must ensure that good practice is spread right across the system so that there is a template for good consultation involving the public and patients. They will not be the same in every area, because communities are different and there must be flexibility, but some core competencies will be contained in any good piece of public involvement. I hope that all parts of the NHS and other bodies taking decisions on health—the broad definition in the Commission's powers—will learn from the framework documents to ensure that their consultation is of the highest possible quality.

Oliver Heald (Conservative, North East Hertfordshire)

We have heard a good deal about pieces of guidance and regulations being prepared. The Minister of State promised us on the first morning that we could have copies of things as they were ready. Are any of those documents ready? If not, have Ministers decided on their contents? We would like to know what they are.

Hazel Blears (Labour, Salford)

This morning, I gave hon. Members the proposed implementation plans, which set out the time scale for developing guidance and consulting on regulations. I can assure the hon. Gentleman that had the documents to which he referred been ready, they would have been shared with the Committee. We envisage that guidance for the NHS will be published early next year, and that there will be discussion and consultation on that. My right hon. Friend the Minister of State did not promise to produce regulations that do not exist.

Oliver Heald (Conservative, North East Hertfordshire)

Will the Under-Secretary give way?

Hazel Blears (Labour, Salford)

This is tiresome.

Oliver Heald (Conservative, North East Hertfordshire)

It may be tiresome for the Under-Secretary, but it is our job to scrutinise. It is always tiresome for a Government to endure the scrutiny of an Opposition; in the past I felt much the same as she does.

In respect of the patient advocacy and liaison services, it is stated that guidance will be developed and issued in January 2002. Is the Under-Secretary seriously suggesting that no substantial, worked-on document exists on that subject? It is clear that work is on-going in respect of these matters. Why cannot a progress report be published, setting out what has been decided so far?

Hazel Blears (Labour, Salford)

I have tried to do as much as I can to share information on the proposed implementation plan, and I hope that I have answered many of the questions on how we envisage the system developing. I can promise the hon. Gentleman that there is no question whatever of our keeping up our sleeve drafting regulations and guidance in a deliberate attempt to avoid scrutiny. We are more than happy to be open and transparent, and to share as much information as we possibly can. I want not only patients and the public but hon. Members to be involved in this process, so that they feel they have a role in shaping how legislation develops.

John Baron (Conservative, Billericay)

Following on from the suggestion of my hon. Friend the Member for North-East Hertfordshire (Mr. Heald), it would have helped had we been given this information a few days earlier. I thank the Under-Secretary for producing the programme, and there is no doubt that it is useful, but it has given rise to questions—for example, on patients forums—that we might otherwise have considered. I, for one, would have wanted to know more about the progress of the agreed pilot projects, given the body that they are seeking to replace. Instead of providing such information on the day of discussion, it would be useful, if possible, to have at least a couple of days' notice. Given that the pilot projects have been agreed, the information could have been produced sooner, which would have helped the Committee in its deliberations.

Hazel Blears (Labour, Salford)

I am pleased that the hon. Gentleman is finding the document useful. It constitutes a gathering together of the progress on all the pieces of the jigsaw, so it has not been possible to share such information earlier. I wanted to gather together all parts of the system for the Committee's benefit, because I recognise that this is a complex issue. The greater the understanding, the more robust our proposals will be. I can assure members of the Committee that we have provided the information as soon as was possible.

On monitoring the duty on the NHS under section 11, the Commission for Patient and Public Involvement in Health will be responsible for reporting to the Secretary of State on how well all the public involvement mechanisms are working. There is provision in the Bill to check how well the NHS is performing the duty to consult. I am very keen to make certain that we have an audit process. In the past, no body has been able to monitor how well the system is working in different parts of the country, and there has been variation in standards. One hopes that the commission will provide that consistency across the board, so that people will have access to the same high standards that they have every right to expect, regardless of which part of the country they live in.

I turn to amendments Nos. 215 and 216, on the funding stream for patients forums, and the suggestion that that would be more logically contained within the remit of the Commission for Patient and Public Involvement in Health, rather than the trust. I take the point made by the hon. Member for Wyre Forest, and we have been considering the matter for some time. It may be more appropriate for the funding stream to be delivered in a different way and I undertake to consider the matter further with a view to introducing an amendment at a later stage. We are aware of the issue, we intend to address it and I assure the hon. Gentleman that we shall do so.

For all those reasons, I ask the Committee to resist the amendments, which are not appropriate in terms of the annual reports. We shall introduce the requirements by good practice rather than in the Bill and I undertake to look again at the funding stream for patients forums.

Amendment negatived.

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

Oliver Heald (Conservative, North East Hertfordshire)

It may be that the hon. Member for Wyre Forest did not want to withdraw the amendment, as one might have expected, but I hope that the Minister's assurance that she will look again at the matter, particularly the issues under clause 18, still stands; I am sure that it does. It may be possible for another way to be found to return to the matter on Report. I was going to raise one or two points but, after further thought, I shall leave them.

Clause 17 ordered to stand part of the Bill.

Clause 18 - Supplementary

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I beg to move amendment No. 217, in page 22, line 40, at end insert—

'(mm) the referral of matters of a prescribed description to—

(i) any overview and scrutiny committee in relation to which the Primary Care Trust or NHS trust for which the Forum is established is a local NHS body by virtue of regulations made under section 1(4) of the Health and Social Care Act 2001 (including that provision as read with section 8(5)) and as applied by section 10(2) of that Act; and

(ii) the relevant Strategic Health Authority.'.

Alan Hurst (Labour, Braintree)

With this it will be convenient to take the following amendments: No. 218, in page 22, line 42, leave out 'and'.

No. 219, in page 22, line 43, after 'Authorities', insert

'and overview and scrutiny committees'.

No. 220, in page 23, line 7, at end insert—

'(3A) Where an NHS trust provides significant services for patients resident in areas covered by more than one overview and scrutiny committee, the membership of the Forum for that Trust should be drawn proportionately from each of those areas.'.

New clause 3—Duty of overview and scrutiny committee to review and scrutinise—

'In section 21 of the Local Government Act 2000 (c. 22) (overview and scrutiny committees), leave out paragraph (2)(f) and insert—

''(2A)Executive arrangements by a local authority must ensure that the overview and scrutiny committee or committees of an authority to which section 7 of the Health and Social Care Act 2001 applies, has a duty to review and scrutinise, in accordance with regulations under that section, matters relating to the health service (within the meaning of that section) in the authority's area, and to make reports and recommendations on such matters in accordance with the regulations.''.'.

New clause 4—Functions of overview and scrutiny committees: supplementary provisions—

'(1) In line 1 of section 7(3) of the Health and Social Care Act 2001, leave out ''may'' and insert ''shall''.

(2) In section 7(3) of the Health and Social Care Act 2001, there is inserted—

''(aa) as to matters relating to the health service in the authority's area which it must refer to the Secretary of State''.'.

New clause 5—Patient Forum representation on overview and scrutiny committees—

'In section 21 of the Local Government Act 2000 (c. 22) (overview and scrutiny committees), there is inserted—

''(10A) When fulfilling its duty under subsection (2A) above, the overview and scrutiny committee of a local authority, or any sub-committee of such a committee, shall include at least one member of each Patients' Forum established for each NHS Trust and Primary Care Trust which provides services to the area of the local authority concerned.''.'.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

This is an important group of amendments, designed to probe and to raise concerns that the current arrangements, particularly for oversight and scrutiny, are not as they might be. The Health and Social Care Act 2001 and the Local Government Act 2000 were predicated on a wider change. However, with the onset of the general election—on which we all look back with relief and pleasure—some aspects of legislation had to be dropped for the time being, so there may be omissions. I know that the Under-Secretary will have studied the matters carefully and I hope that she will be able to reassure hon. Members who share my views about them.

Amendment No. 217 would insert into the supplementary provisions in clause 18 an additional paragraph, and some of the words in the amendment are lifted from another part of the Bill. One of the important functions of community health councils is the ability to ensure that there is scrutiny of local decision-making. I will speak later with regard to whether overview and scrutiny committees have the relevant powers and duties to make the appropriate referrals. However, the first point I want to make explicit is that regulations should be provided for the referral of these matters to overview and scrutiny committees.

By misfortune rather than by design, I do not think that there is any problem in recognising which overview and scrutiny committee is relevant for each area. Indeed, there are arrangements for joint committees where required, and clearly some primary care trust patients forums will overlap more than one overview and scrutiny committee. That will not be a significant difficulty as regards the amendment.

The people already involved in the matter recognise that this amendment would allow patients forums to refer matters to relevant overview and scrutiny committees, and to strategic health authorities. As the Government would have it, patients forums would have first-hand knowledge of services, and should be able to put issues of concern on the agenda of overview and scrutiny committees. The second amendment in this group is amendment No. 219, which is consequential. Amendment No. 219 would insert into line 43 the need to have relevant regulations regarding membership. There may well be other members of the Committee who have strong views on those issues.

Amendment No. 220 again talks about membership. I am sure that the hon. Member for Wyre Forest will speak in his customary style, which is brief and to the point, on these matters.

Mike Hall (Labour, Weaver Vale)

The hon. Gentleman could learn from him.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Indeed. The hon. Member for Wyre Forest speaks with great clarity, normally.

There is a question about whether the geographical membership of patients forums will reflect the geographical areas covered logically. There is also a question of whether the overview and scrutiny committees, which are geographical in their nature—by definition, and by their establishment—will have members on the patients forums to which they can relate clearly. I hope that those amendments are self-explanatory.

I now move to the three new clauses that are to be considered in this group of amendments, which are important. New clause 3 is complex and I suspect that, in terms of drafting, it needs to be read in relation to the Local Government Act 2000. I have looked at this carefully and, while there may be drafting errors, I hope that it was sufficiently clear for the Minister to understand its intention. That intention is to place a duty on overview and scrutiny committees to carry out the scrutiny of local health services. Under the Health and Social Care Act 2001, overview and scrutiny committees have the power to scrutinise, but not the duty. Therefore, some local authorities could choose advertently, or inadvertently—I seem to say that so often in relation to this Bill—not to exercise this power, leaving the local community with no powers of scrutiny for the NHS.

Paragraph 1 of schedule 7 to the NHS Act 1977 places community health councils under a duty to

''(a) represent the interests in the health service of the public in its district; and

(b) to perform such other functions as may be conferred on it . . .''

The CHC Regulations 1996 expanded upon this duty. Regulation 17 places a duty—not just a power, but a duty—upon each CHC to:

''keep under review the operation of the health service in its district, to make recommendations for the improvement of that service and to advise any health authority upon such matters relating to the operation of the health service within its district as the Council thinks fit.''

The amendment, effectively, puts a similar duty on the overview and scrutiny committees. If the Minister cannot accept this new clause, I would be grateful if she reassured me that she has plans to provide this duty, because I have been told that it does not exist. Otherwise, I ask her to in some way seek to reassure me that the worries that prompted the amendment are unfounded.

Ms Blears indicated assent.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I am pleased to see her nodding, which I accept in good faith. It gives me hope that I will be satisfied on the matter.

New clause 4 would amend the Health and Social Care Act 2001 to add an extra section, placing a duty on overview and scrutiny committees to refer matters of concern to the Secretary of State. Community health councils have the duty to refer to the Secretary of State a decision that has involved inadequate consultation or given rise to significant local unhappiness, thereby placing responsibility and accountability with him. In a previous debate, we heard how careful Ministers were to ensure that, where necessary, accountability lay with the Secretary of State, even if they were not keen that the performance of those duties should be expertly scrutinised.

The new clause, in conjunction with new clause 3, would ensure that the powers of overview and scrutiny committees were coupled with a duty to refer matters to the Secretary of State in circumstances prescribed by the regulations. I do not need to go into any more detail about the current powers of CHCs, but the new clause is intended to replicate those powers within the new structures.

New clause 5 would amend the Local Government Act 2000. Many long minutes, if not hours, were spent hunting down the sections that I wanted to amend, but I am pretty sure that the new clause is in the right ballpark in terms of accuracy. It would provide for overview and scrutiny committees or sub-committees to include at least one member of the relevant patients forum. That would be a way of feeding information from the work of forums into the work of the committees, providing a more integrated approach and greater co-operation between the two. OSCs will need first-hand knowledge of patients forum members to exercise their functions. At the moment, CHC members have the powers of referral, inspection and scrutiny and they must know what is going on. In the context of the new structure, it is important to link the two bodies more closely together; an effective way of doing so would be to ensure that OSCs have shared membership with the relevant patients forums.

There may be an argument for having a wider body within the new framework to represent patients forum views cited at overview and scrutiny committee level; it could be called a patients council. I suspect that, at a later stage, we might consider such arrangements. For the time being, we should ensure that OSCs have the powers and duties to scrutinise and refer, and that they have the expertise to call upon in terms of personnel to ensure that scrutiny is adequate and decisions to refer are appropriate.

I look forward to hearing the Under-Secretary's response to these important amendments and new clauses. We should take this opportunity to ensure that overview and scrutiny committees are workable.

Oliver Heald (Conservative, North East Hertfordshire)

The community health councils—which act as the local watchdog and independent voice—and the overview and scrutiny committees are interlinked. The role of the one, the CHC, is vital to the work of the other, the committee. I draw the Minister's attention to the emergency motion that was passed by Croydon council in December 2000. It said that

''this council is proud of the way Croydon CHC provides a strong independent voice for the people of Croydon on NHS matters . . . The involvement of an independent watchdog role is essential''.

There were numerous other articles in Croydon newspapers at that time, with headlines along the lines of , ''Health watchdogs play a crucial role''. The story ran again when the Government lost the previous provisions.

The amendments relate to one of the important interfaces if we are to have the changes; that between patients forums and overview and scrutiny committees. My party and I rather agree with the sentiments of the motion to which I referred. We are proud of community health councils and do not really see the need for the changes, but if they are to be made, patients forums will be the bodies with the first-hand knowledge of services. They must be in a position to refer matters to relevant overview and scrutiny committees. Amendment No. 217 is, therefore, right up our street.

The purpose of amendments Nos. 218 and 219 is to include overview and scrutiny committees in the list of bodies that will be obliged to make and publish comments on reports or recommendations made by patients forums. It is important that the overview and scrutiny committees use the powers that they are given. The hon. Member for Oxford, West and Abingdon (Dr. Harris) has raised concerns that giving a body a power is not the same thing as making it do the work.

Amendment No. 220 would ensure that the membership of patients forums contained representation from residents of the catchment areas and related to the relevant overview and scrutiny committees. That seems sensible to us. The new clauses would place a duty on overview and scrutiny committees to do their work. That might seem draconian, but I think that it is important that the work is done. This is a way of highlighting the importance that Parliament places on the duty that has been given to those committees.

Turning to new clause 4, regulation 18(5) of the community health council regulations places CHCs under a duty to refer inadequate consultations and contested decisions to the Secretary of State. In the course of carrying out the functions of representing the views of patients and their local communities in health services, CHCs sometimes disagree with plans being considered for those services. CHCs are relied on to provide the community perspective on plans, although they are always willing to look at other views. New clause 4 would provide a safeguard in the system, and we are tempted by it.

I am not entirely sure, from what the hon. Gentleman said, what the effect of new clause 5 would be, but I will be interested to hear the Minister's response.

Richard Taylor (Independent, Wyre Forest)

Amendment No. 219 is absolutely crucial. As we have heard, it would add the overview and scrutiny committees to the list of bodies that comment on the forums' reports. Given that they are the only democratically elected bodies concerned, they have every right to be asked to comment on the reports.

Amendment No. 220 would ensure that all overview and scrutiny committees relevant to a trust were represented. That is only a small part of my concern about membership. We strayed widely, as your co-chairman Miss Widdecombe said at the time, Mr. Hurst, on to clause 18 this morning. There are various other points that I would like to make. Can we return briefly to the topic under clause stand part?

Alan Hurst (Labour, Braintree)

I can confirm that the hon. Gentleman will have the opportunity to say more on that matter during the clause stand part debate.

John Baron (Conservative, Billericay)

I have two brief comments. I congratulate the Government on including, under clause 18(3), in the membership of a patients forum,

''at least one person who is a member or representative of a voluntary organisation''.

I believe, as perhaps do other hon. Members, that that is vital. The Government should do much more to empower the voluntary and community sector in their efforts in the community in general. Here is an example of how they can be involved in local decision making; in this case, for health care provision. That is a good move.

Will the Minister clarify a concern that I have, relating to clause 18? Under the new proposal—

Alan Hurst (Labour, Braintree)

Order. The hon. Gentleman is spreading the discussion widely. He may have opportunities to say more during the stand part debate. At this time, he should keep himself strictly to the amendments and new clauses before the Committee.

John Baron (Conservative, Billericay)

I apologise.

Hazel Blears (Labour, Salford)

It is clear that the amendments relate to operational aspects, which I believe are best dealt with through regulations. However, I will deal first with those amendments that relate to patients forums.

Amendments Nos. 217, 218 and 219 would provide patients forums with the right of referral to the overview and scrutiny committees. They would require overview and scrutiny committees and strategic health authorities to comment on the reports and the recommendations made by patients forums. Clause 18(2)(m) already provides for regulations to be made about the provision and publication of patients forums' reports. Section 7(3) of the Health and Social Care Act 2001 provides for the overview and scrutiny committees to have the same rights of referral that are currently held by community health councils.

We do not accept that we need further legislation in that respect, but I have heard the strength of argument with which the hon. Members for Wyre Forest and for Oxford, West and Abingdon made their points. They believe that there ought to be a right of referral for patients forums, or that the overview and scrutiny committees ought to respond to what patients forums raise. When we talk about the operation of the local Commission for Patient and Public Involvement in Health under clause 19, it will be seen that we intend the information arising from the deliberations of patients forums to be drawn together by the commission. The commission will have the power to refer those matters to an overview and scrutiny committee for its consideration. That will ensure that scrutiny is informed by what local people say, which is important.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I accept that I did not clarify amendments Nos. 218 and 219 very carefully, and I would like briefly to do so now. I think that the Minister understands them, so I will deal with her response.

The Minister maintains that clause 18(2)(m) will deal with my concern. My concern, however, is that there needs to be a duty—and regulations need to be available—for such bodies to respond to reports by patients forums. Clause 18(2)(m) refers only to regulations on the preparation and publication of reports by patients forums, not responses to them.

Hazel Blears (Labour, Salford)

I take the hon. Gentleman's point, and I have said that the regulations provide for the preparation of reports. However, getting the overview and scrutiny committee to respond to the specifics of the report is important. I would like to think further about how we could strengthen that process and when we debate clause 19 and the operation of the commission at local level, hon. Members will become aware of our intention to ensure that all parts of the system are joined together and respond to the issues raised. The question of the overview and scrutiny committee being required to respond to issues raised by patients forums is important. I will think further about it and come back to hon. Members.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I accept that answer and will take the matter no further at this stage. The Under-Secretary cited section 7(3) of the Health and Social Care Act 2001, which refers to the functions of overview and scrutiny committees and the regulations that make provisions for them. Which particular paragraph of subsection (3) gives to overview and scrutiny committees the duties and powers to make the referrals that are stated in my amendment?

Hazel Blears (Labour, Salford)

I shall endeavour to answer that when we debate the relevant amendments and new clauses.

Amendment No. 220, which is supported by the hon. Member for Wyre Forest, aims to ensure that the membership of a forum is drawn proportionately in areas covered by more than one overview and scrutiny committee. I understand the hon. Gentleman's desire to ensure that forums are representative and agree that those sitting on them should represent the whole community, as far as that is possible. However, it is appropriate for the regulations in clause 18(2) to deal with that. That clause refers to the appointment of members, the terms of appointment and how we ensure the widest possible representation. At this stage, it is inappropriate to include such fine points as the hon. Gentleman proposes in primary legislation.

The thrust of the Government's changes is to ensure that the representative bodies in the patient and public involvement system cover as wide a range of groups and individuals as possible, and that all voices, some of which perhaps have not been heard traditionally, have a say in the new system.

In response to the amendments on overview and scrutiny, it is important to return to the principle behind the placing of the scrutiny of the NHS in the hands of local government. We want scrutiny to be in the hands of an independent, democratically elected body. That proposal had widespread support when it was included in the 2001 Act. We also want the body to be in touch with the communities that it represents.

The local government overview and scrutiny committees should develop a degree of expertise in scrutiny. During the past 12 months, many local authorities have begun to undertake the scrutiny of their services in different areas. Many useful and worthwhile recommendations for changes to services that would make improvements to the local community have resulted. We want the expertise that local government has built up for scrutinising its own services to be extended, transferred, developed and deepened for the scrutiny of the NHS.

We want the exercise to be democratic, with locally elected representatives, but we must recognise that, because the bodies will be independent, they will be entitled to organise the way in which other bodies are scrutinised in accordance with their priorities and methods of work. We do not want to compel an independent body to behave in a manner that would conflict with the principle of independence. I cannot think of a circumstance in which a local authority will not want to represent the views of its community on the functions of the NHS. If it refused unreasonably to carry out scrutiny, or if such a decision were frivolous or based on irrelevant considerations, the matter would be open to judicial review. There is provision, therefore, to ensure that local authorities scrutinise properly.

With regard to the provisions from which the hon. Member for Oxford, West and Abingdon has quoted, under section 7(3) of the Health and Social Care Act 2001 regulations can require NHS bodies to consult overview and scrutiny committees. We can use the powers in those regulations to replicate the current position for community health councils. We have said on several occasions that the new powers for overview and scrutiny committees to refer matters to Ministers will be no less rigorous and powerful than those currently enjoyed by community health councils.

I should point out to the hon. Gentleman that, in statutory terms, the powers that community health councils currently hold relate to the process of consultation. They can refer in cases where the processes were inadequate, where the right people were not consulted, where there was insufficient time for consultation or where such decisions were arrived at in a defective manner. It is very much an administrative law provision, but there is no statutory right to refer matters on the basis of the merits of proposals. A tradition has built up over the years whereby provisions that are contested on their merits are referred to Ministers; for example, where there is a dispute in the community and people are at odds about the merits of a proposal.

It is clearly important that decisions on process and on substance be subject to proper scrutiny and review. I certainly want to ensure that the power of overview and scrutiny committees to make references is no less than that enjoyed by community health councils, and that issues of process and of substance are looked at in a sensible way.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I have been listening carefully, and I am not sure whether the Under-Secretary said that the right of referral has emerged but should no longer exist, or that it has emerged and should continue to exist. I think that she meant the latter. Referral involves taking away from the NHS the right to decide locally and giving that right to the Secretary of State, as can currently happen with controversial re-providing decisions; or hospital closures, as ordinary people call them. As it stands, section 7(3)(b) of the Health and Social Care Act 2001 grants the power to make reports, not referrals, so I am still not clear where in existing legislation the right of referral is granted.

Hazel Blears (Labour, Salford)

I will come to that point. The Government certainly intend that the right of referral on contested reconfigurations, or on matters that were previously the subject of referrals, should continue. A better system of public and patient involvement will enable people to get involved at the outset when options are being developed. Given that there will be greater opportunity to shape proposals when they are first considered, I hope that we might see fewer contested matters. In my experience, giving people the opportunity to get involved at the beginning of a process sometimes minimises the matters that remain subject to dispute.

None the less, I should make it absolutely clear that the right of referral must exist in the system. If matters are contested and there is a great dispute in the community, a democratically elected body—the overview and scrutiny committee—must have the power to decide that it is right and proper that they be referred.

Oliver Heald (Conservative, North East Hertfordshire)

I have been reading an update on the costing exercise for the replacement of community health councils in England, which was prepared by Mr. Roy and given to me by the Association of Community Health Councils for England and Wales. Mr. Roy said that the assumption is that only three quarters of the NHS in England will be covered by local authority overview, and that specialised services and so on will not be covered. Is that why the Under-Secretary is not keen to accept new clause 3?

Hazel Blears (Labour, Salford)

No, Mr. Hurst. The Health and Social Care Act 2001 refers to regulations relating to the requirement for local NHS bodies to consult the overview and scrutiny committees and provides, in section 7(3)(c), that the regulations can determine the matters on which local NHS bodies must consult the overview and scrutiny committees. That is wide enough to cover matters such as specialist commissioning in addition to the physical provision of services on the ground. The regulations can specify the matters on which the NHS must consult the overview and scrutiny committees to enable them to take a view.

Clearly, within the NHS there will be specialist provisions covering more than one area. A service could be pan-London, for example, or cover a conurbation, so the flexibility in the 2001 Act, which provides for overview and scrutiny committees to work together, to co-opt other members, and to have joint committees working together on scrutiny, is important. It is crucial that they have the flexibility to deal with issues that cross boundaries and cover more than one area. There is flexibility within those regulations for overview and scrutiny committees to operate in different ways depending on the circumstances of the issue that they are scrutinising. That flexibility is built into the system.

Oliver Heald (Conservative, North East Hertfordshire)

If that is right, why does the Under-Secretary oppose new clause 3?

Hazel Blears (Labour, Salford)

We are resisting new clause 3 because the powers to make reference to Ministers can be included in the regulations under section 7(3) of the 2001 Act. The overview and scrutiny committees have a power to scrutinise and they will have the power under those regulations to refer contested reconfigurations to Ministers in a way that is no less powerful than that pertaining to community health councils.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

This is the nub of new clause 4, which covers referral. I have looked carefully at section 7(3) of the 2001 Act, which states:

''Regulations may, in relation to an overview and scrutiny committee of an authority to which this section applies, make provision''.

Paragraphs (a), (b), (c), (d), (e) and (f) then list the matters to which the subsection applies, but none mentions the words ''refer'' or ''Secretary of State''. It is difficult to see how the Under-Secretary can rely on section 7(3) and regulations therein to provide the power, let alone the duty, to refer to the Secretary of State decisions with which overview and scrutiny committees are unhappy. I am reassured by the Under-Secretary's view that it should be there, but I am not satisfied that she is correct in saying that it is there.

Hazel Blears (Labour, Salford)

I understand the hon. Gentleman's concern. It is important to ensure that the law provides the power of referral. Section 7(3)(c) of the 2001Act provides a power to specify the matters on which the NHS must consult the overview and scrutiny committees and section 64(8) provides that the power in regulations can include a requirement to make incidental supplementary provisions on the authority making the order as we consider expedient. We could make provision here to decide what happens when the overview and scrutiny committees have been consulted. They would then have the power to decide, having been consulted, that they are happy with the proposals and therefore intend to make the referral.

However, I am reviewing the arrangements for community health councils and their power of referral. We shall be consulting on the policy framework on the regulations and the guidance for health scrutiny early in 2002, when we intend to invite the views of all stakeholders, which clearly includes local government. We are conscious that local government bodies are independent. We want a partnership with which they are comfortable. They will represent the views of their local communities and refer some very important matters to Ministers on the future of health services in their area, so we must ensure that the powers we put in place are powers that they also feel that they can operate properly to ensure that those referrals take place.

I appreciate that the Bill is a little tortuous at the moment. There are the regulations under section 7 of the 2001 Act, which then provide a further incidental power under section 64 of the 2001 Act, to ensure that referrals can be made when there is a contested reconfiguration. It may be tortuous, but it can certainly happen. I will be consulting on the regulations and guidance that we issue to ensure that the power for referral of contested reconfigurations is certainly no less than the power that the community health councils currently have. Hopefully it will be more coherent, because there is a slight difference between the statutory powers that they have now and the powers that they perhaps should have in future.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I would have been very grateful but for the last few words of the Under-Secretary's speech. I understood that such a review might have been done by now. If it had been done, we might have known where we stood when we were in a position to amend the Bill in Committee, instead of being obliged to wait for the review results.

Nevertheless, I accept what the Under-Secretary said in good faith. She has placed it on the record that she recognises that to describe the burying of a ''maybe'' power in a supplementary provision of a miscellaneous and supplementary part of another Act when it would be best put, for everyone's ease of understanding, with section 7 of the 2001 Act is rather tortuous might be an understatement.

I am grateful to the Under-Secretary and I should like to put those remarks on record. If the hon. Lady has not finished, I should also like to say a few words about new clause 3.

Hazel Blears (Labour, Salford)

Perhaps I may help the hon. Gentleman in terms of the regulation powers. I understand that the primary legislation that relates to community health councils had no power to refer either, and actually used the same framework of powers used when the community health council regulations were made. There seems to be a history of tortuous legislation in this field, which we might be able to address.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Perhaps the Under-Secretary would write to me setting that out, because it is easier for me to see it at any time of the day or week when it is written down.

I want to take the opportunity to press the hon. Lady a little further on new clause 3. We have covered new clause 4, but new clause 3 does make a significant change. The current arrangements are set out in the Local Government Act 2000 in section 21—which is amended by section 7(1) of the Health and Social Care Act 2001—which adds, in order to deal with the overview and scrutiny committee in the context of the health service, an extra paragraph (f) to section 21(2). Section 21(2) is predicated on the basis of executive arrangements by local authorities, which must ensure that the overview and scrutiny committee has the power to do various things. While new clause 3 takes this health issue out of that section, it adds a new section that states:

''(2A) Executive arrangements by a local authority must ensure that the overview and scrutiny committee . . . has a duty to review and scrutinise''.

I should like reassurance from the hon. Lady because, if she is continuing to resist that new clause, the Government would be foolish not to do something. As the hon. Member for Wyre Forest has said, there are wheels within wheels between some trusts and some people in local authorities, particularly when local authorities have huge political majorities on less than an overall majority. Therefore, we do need an assurance that there will be a duty to scrutinise, and not just the power to do so if they feel like it.

Hazel Blears (Labour, Salford)

I can confirm that we are resisting this new clause. I explained previously that with regard to scrutiny—even councils scrutinising the decisions of their own executives—local government does have a power, not a duty. Local government is an independent organisation and we do not seek to compel councils to operate in any particular manner. I have said that where they unreasonably refuse to scrutinise, they would be open to judicial review, as any public body would be in relation to an unreasonable refusal to exercise its powers.

Therefore, we do not wish to depart from the general provisions that relate to scrutiny of local government functions, as they relate to the NHS. We want the scrutiny of the NHS to be part of a framework of scrutiny, and therefore to be dealt with in a consistent manner by local government, as it would deal with the scrutiny of its own executive functions. It is also important to confirm that those in local government will not be the only scrutineers in the new system. Our debates on patients forums have confirmed that they will scrutinise trusts at a local level by inspecting, monitoring and assessing standards. Several bodies will be scrutinising the system, and that will provide a series of checks and balances.

Oliver Heald (Conservative, North East Hertfordshire)

The Under-Secretary will remember that in schedule 7(1) to the National Health Service Act 1977, community health councils were placed under a duty

''to represent the interests in the health service of the public in its district''.

The overview and scrutiny committees will address that issue, but they are not under a duty to do so. This is taking something away from the watchdog when that is not what we want to happen.

Hazel Blears (Labour, Salford)

It would be difficult to describe transferring the functions of community health councils to democratically elected local government as reducing and diluting existing powers. The decision to transfer powers to local government was broadly welcomed because local government has a standing within the community, its members are elected at local level and it represents constituents on a range of issues. To include the way in which the national health service functions in terms of local government's powers is therefore correct. I referred to community health councils having no statutory duty of referral on primary legislation with regard to contested reconfigurations, which is why this situation remains as it is.

Transferring community health councils' powers to local government will enable some issues to be looked at in a broader framework, with the effect that health service decisions will be examined in the context of the wider decisions that local authorities must make, making the process more robust. I have said twice that it is inappropriate to compel local government to operate in a certain manner, and I am sure that it will exercise the powers of scrutiny in what I hope will be flexible, imaginative, innovative and creative ways that are in the community's best interests.

New clause 5 relates to the requirement for patients forums to be members of the overview and scrutiny committees. I agree that when they are scrutinising, local authority committees should be able to draw on an informed patient perspective when considering specific health care provision. Patients forums are an obvious place for insight into and expertise on these issues, but we should not oblige local government to operate in a specific way in these circumstances. We are clear that it is good practice for forum members to be co-opted on to overview and scrutiny committees, and we shall be promoting that as part of the consultation on how overview and scrutiny committees should operate. I am keen for overview and scrutiny committees to co-opt as members, taskforces or sub-committees—whatever arrangements they want to set in place—as many local people as they can to inform the agenda.

Especially in the early days—when perhaps local government members will not have as much expertise as some people already in the system have—it will be crucial for local patients and members of former community health councils to be able to inform the overview and scrutiny committees on the top community issues that must be looked at as priorities. The evidence base from the patients forums will feed into the overview and scrutiny committees so that the scrutiny consists not only of a formal appearance by the chief executive of the trust every six months when they tick the boxes, but an in-depth analysis of the quality and standards of service that are provided to the community. Drawing in the expertise of the patients forums will be key, and it is a matter of good practice. However, it is inappropriate to compel local government to organise itself in a particular way. That would involve a diktat from the centre, but we want overview and scrutiny committees to grow organically and develop best practice for their local communities. For that reason, we shall resist new clause 5.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

New clause 5 contains the word ''shall''; if it contained the word ''may'', it would be more acceptable. Is the Under-Secretary also saying—she may be right—that that power already exists in section 21(10) of the Local Government Act 2000, which states:

''An overview and scrutiny committee of a local authority, or any sub-committee of such a committee, may include persons who are not members of the authority . . . and any such persons are not entitled to vote''?

Is the Under-Secretary satisfied that that covers good practice satisfactorily even though it does not specify patient forums and health care?

Hazel Blears (Labour, Salford)

However the hon. Gentleman ''may'' choose to put his case, in these circumstance it is inappropriate to place that power in the Bill. It is a matter of good practice, and I have no doubt that good practice will be established across the country. Section 21(10) of the Local Government Act 2000 provides that people such as members of patients forums and others who have a degree of expertise that can help to inform the overview and scrutiny committees' deliberations should be part and parcel of the process by bringing their skills to those committees' proceedings. For those reasons, we must resist new clause 5.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

For the moment, I am prepared to accept the Under Secretary's undertaking that there will be clear guidance that it would be good practice to involve members of patients forums or other bodies related to patients forums at overview and scrutiny committee level.

On new clause 4, the Under-Secretary is giving some hope that she will be able to explain to me that the power to refer—and the possibility of regulations creating the power to refer—will be made clearer. If that happens, I look forward to receiving a letter from her that clarifies the situation.

The hon. Member for North-East Hertfordshire put his finger on problem with new clause 3. The perception is that there is a duty for CHCs to make that referral, but the Under-Secretary is not replacing that duty with another duty. That is the problem that she will have in reassuring people that the regime is robust. The best thing would be if we go away and reflect on that matter, and perhaps it can be considered further in another place.

I must assume that the hon. Member for Wyre Forest, who is a friend but nevertheless in parliamentary language not a hon. Friend, heard what the Under-Secretary said about membership because I know that that is something about which he feels strongly.

It may well be that I have had adequate reassurance regarding amendments Nos. 217 to 219 because I still do not take the view that the existing arrangements require reports back to patients forums by bodies such as the ''overview and scrutiny committees'' mentioned in amendment No. 219. I will reflect on the Under-Secretary's remarks, and I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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

Oliver Heald (Conservative, North East Hertfordshire)

Some people have expressed concern that appointments of members of patients forums will be made from members of the local commission

because they are the people with the right to appoint members of the forum. It is all starting to look a bit cosy. Will the Minister explain how she expects to find the other kinds of people whom she mentioned to widen the membership of patients forums? Alternatively, does she take the view that because the local commission will have a wide base it does not matter if it becomes the local forum?

I want to ask the Under-Secretary about funding. In the context of subsection (2)(h), the new system will need adequate resourcing if it is to work. Supporting patients forums will necessitate employing and paying numbers of staff. We started a discussion that we did not complete about how forums would be funded. I have received a note from Mr. Roy of the Association of Community Health Councils for England and Wales in which he estimates that costs for patients forums will be about £32.5 million in 2003-04. In making that calculation, he assumed a total of between 400 and 500 forums, which is far less than some had thought; took account of the narrower range of responsibilities of CHCs; assumed that the independent complaints advocacy service element would be taken out; and put in an adjustment to reflect the extended remit into primary care and parts of the private sector.

The other aspect is patient advocacy and liaison services. I may have unwittingly misled the Committee this morning when I said that the cost of PALS was £10 million and that it was a one-off payment. A better way of putting it is that a small number of pathfinder, or pilot, PALS were given £10 million this year and will be given £10 million next year. But when the system is rolled out nationally, none of the other PALS will get anything. The money will therefore have to come from PCT budgets or some other source.

We know from the financial assessment in the notes to the Bill that the Government are effectively saying, ''We shall take account of the £33 million that is spent on PALS and CHCs in funding the new structure.'' This morning I asked the Under-Secretary for an assurance that at least as much money would be available for patients forums as for CHCs; that is, at least £23 million. That would be a lot less than ACHCEW considers is needed, and she will recall that the Audit Commission estimated £60 million. I have assumed a figure of half that, but even so at £23 million the cost of CHCs is much lower. Can the Under-Secretary promise us that at least £23 million will be available for patients forums?

Concern has been expressed to me by Mr. Tester of the Society of Community Health Council Staff about the way in which CHC staff will be treated over the transition. Apparently, health authority staff are being assured that they will have a job for 12 months after health authorities cease to exist in April 2002, but no assurance has been given on what will happen to CHC staff. Can the Minister give us any information about that? Appointment of staff, of course, is an issue to be dealt with in the regulations that we have not yet seen.

Richard Taylor (Independent, Wyre Forest)

I have three quick points and questions about membership of the forums. I was very pleased to hear the Under-Secretary say this morning that there will be arrangements for CHC members to be considered for membership of the forums. Under the proposed implementation programme—if all goes through—CHCs will not actually be abolished until April 2003. There will be some members of CHCs whose appointments come to an end between now and then, and it will scarcely be sensible to appoint new people. Can there be some mechanism whereby, if they wish, people can extent their appointments until April 2003?

The Under-Secretary said yesterday that she thought that about half of the people on forums will be representatives of voluntary bodies and that half will represent patients and carers. That was much more encouraging than the phrase ''at least one'' in the Bill. Can she add some detail about the size that she envisages for patients forums?

Finally, one reason why I object to the changes is the plethora of new bodies with which we will be faced. There are at least three commissions; I am not sure whether I am confused, or whether the people who have written the response to the listening exercise are confused. On page 5 of that response, the seventh bullet point of paragraph 2.6 says that

''the NHS Appointments Commission...will be charged with making the appointments to Patients' Forums.''

However, page 11, paragraph 3.26 states:

''The Commission for Patient and Public Involvement in Health will conduct the appointments process.''

Which commission will actually make the appointments?

John Baron (Conservative, Billericay)

I welcome the involvement of the voluntary and community sector in membership of the patients forums. It is very important that the Government do their best to empower that section of society and recognise all that it can do. I would, however, like some clear guidelines on how the forums are to function and be regulated. That follows on in part from the comments of the hon. Member for Wyre Forest. For example, can we have clarification on the forums' access to information and advice? What information will they be able to access? Will the public be welcomed into them? How public will they be? Will they have an advisory role? Those questions relate to who is appointed to the forums, as the make-up of the forum will obviously reflect its nature and function. I would be grateful for more details about that.

Can the Under-Secretary clarify the selection process? For example, are opportunities going to be advertised locally? Will an effort be made to advertise in deprived areas, to ensure that there is good representation from a cross-section of society? Will the Minister reassure us that the appointments will not be controlled by the health authority, or by the trust? The independence of the forums will be crucially important, because they will play an important part in ensuring that health care meets patients' requirements. Forums must be independent and willing to question as they see fit.

I apologise to the Committee if I have missed something, but I do not understand where the money will come from for the forums. Will it come from primary care trusts or from central Government? Whoever controls the funding will have a relatively important say in how the forums function. I assume that the funding comes from central Government and will bypass primary care trusts, which I welcome as a way of ensuring the forums' independence.

There seems no collective voice for patients above the level of the forum. Currently, local lay representatives elect representatives who oversee the regional national bodies. Under the new proposals, the voices of people who act at strategic health authority level will be staff-led and have no element of lay decision-making. Will the Under-Secretary give her views on that?

Andrew Murrison (Conservative, Westbury)

I have two chief concerns. First, the make-up of forums is opaque. Secondly, public access to them is similarly opaque and the subject matter of regulations that we have yet to see.

The Local Government Association made a good point in its response to the consultation. It said:

''Membership . . . should reflect a representative sample of the local population to ensure that hard to reach groups are included''.

I agree with that, but we must also have people with the adequate skills so that the interests of users are adequately represented. How does the Minister propose that we tap in to the right skill mix so that those views are adequately represented and members are effective advocates? We can make the analogy with school governing bodies, to which it is difficult to recruit volunteers with the right skills mix to take responsibility for such things as health and safety and finance; matters for which many are not well equipped. I seek the assurance that the forums will be made up of people who are representative and have the right level of experience and skills mix.

Oliver Heald (Conservative, North East Hertfordshire)

Does my hon. Friend agree that the Under-Secretary might have proposed that those who are severely handicapped or who have the problems as set out in the briefing of the Royal National Institute for the Blind should serve on patients forums? It is a surprise that she has not proposed that. We have heard a great deal about having a wide variety of members, but someone with those problems might be a useful person on a forum when considering access to hospitals and how services could be provided for people who are visually impaired, or deaf and blind.

Andrew Murrison (Conservative, Westbury)

My hon. Friend makes a good point. It is easy for us to say that we need to ensure that the forums are representative, but putting that into practice is extremely difficult. Of course, we must try, and to that extent I welcome the Under-Secretary's comments. However, I would emphasise that people must be adequately skilled to do the job that we are asking of them. Public access is important. As some of us will know from attending the public meetings of community health councils, the meetings are valuable and well attended. We should ensure that the patients forums act in a similar way.

Hazel Blears (Labour, Salford)

I am delighted that we are discussing important issues for patients and the public at large in terms of how the new system will work.

First, in relation to appointments to patients forums, the hon. Member for Wyre Forest referred to pages 5 and 11 of the response to the original document. I am pleased that he has the response document, because things have moved on apace in consultation. The hon. Member for Billericay may be reading from the original document rather than the response. I will deal with his points in a moment.

The criteria for appointments to patients forums will be set by the independent appointments commission, which will take on board the concerns expressed by the hon. Member for Westbury (Dr. Murrison) about people having the right skills and ability to do an important and complex job. When we consulted, people said clearly that they did not want a formal process that would exclude many people from a range of different communities. If an advertisement is not placed in The Times, or a traditional recruitment process is not employed, some may feel that they do not have the necessary skills to make an application. If the process were national, it might seem bureaucratic and remote from communities.

People said that they wanted the rigour of the independent appointments commission criteria, but thought that recruitment should be done at a local level by people in touch with local voluntary organisations—such as citizens advice bureaux—and with the whole network that makes up the fabric of many communities, many of whose activists are involved in a range of organisations.

The criteria will be set by the independent appointments commission but the recruitment will be carried out by the staff of local networks of the Commission for Public and Patient Involvement in Health. The independent statutory corporate body will do the recruiting and appointment at local level in local communities, which answers the point made by the hon. Member for Billericay about independence. That body will also be charged specifically with building local capacity in the community, in recognition of the fact that volunteers do not appear out of thin air.

We must bring volunteers through the system and gradually get them more involved, while giving them more skills to take on responsibilities. The local workers of the commission will be specifically charged with going out to the community and finding people who are interested in taking part. Those people may not be ready to take part from day one; they may need more support, education and training on specific issues, so their contribution is a real one. The local commission will be charged with doing that.

The way in which we propose to recruit patients forum members has the best of both worlds; the rigour of the independent appointments commission, and the local connection at a community level of the local networks of the Commission for Patient and Public Involvement in Health. In that way, many volunteers will apply.

Although there is sometimes difficulty in finding volunteers for a range of public organisations, the Wirral community health council, which is obviously keeping in close contact with our debates, sent me an encouraging e-mail yesterday. It stated that when it set up its private health forum a couple of months ago, it received 64 requests for information and 32 applications for 12 places. It shortlisted and interviewed 18 people, and said that the response was much more than had been the case via the traditional processes. It said that it might be able to export a few spare people to help other areas. I am delighted that people are coming forward and want to take part in the new structures.

I can confirm to the hon. Member for Wyre Forest that we will set up a transitional advisory board to help us manage the transition. As a result of the listening exercise, I am conscious that people did not want a big bang. They did not want CHCs abolished before the new structures were up and running, so we will have a board that comprises representatives of CHC staff, CHC members, Unison, the Society of Community Health Council Staff and others. We are delighted that ACHCEW is involved, as are other patients' groups, such as the Long Term Medical Conditions Alliance. Patients have a real input to make, as do representatives from local government, because they are involved in scrutiny. A wide-ranging board will help us independently to manage the transition.

One of the problems that the board is specifically charged with considering is how to work out a way in which members of the current structures can find their way into and populate the new system. The board will consider whether it is practical to extend their terms of office. By amending the CHC regulations, we would be able to ensure that people whose terms of office were due to expire could stay on and be managed through the process. As hon. Members have seen from the post-implementation plan, it is proposed that CHCs disappear in April 2003 as part of the managed transition into the new structures.

Public access to information and advice on the proceedings of patients forums is vital. Clause 18(4) states that the regulations will apply or correspond to the provisions of the Local Government Act 1972, which covers access to meetings and documents. That is to try to ensure that patients forums are at least as open as CHCs have been. I hope that that reassures hon. Members on the issue.

John Baron (Conservative, Billericay)

I do not have the 1972 Act in front of me, which is a terrible admission. Access to public meetings is fine, but my experience suggests that if they are not advertised and widely known about, there is no point in having access as no one knows that they are taking place. May I have clarification on that point?

Hazel Blears (Labour, Salford)

The hon. Gentleman makes a good point, which is that the proceedings of all the bodies will need to be properly advertised. There is no intention that any of them operate in secret. I am not sure whether the provisions for local government on access to information provide for pre-advertisement, although I recollect that they do so, based on my time as a councillor. I remember having to put forward documents that would have been available for inspection before a meeting, which leads me to think that members of the public would need to be notified so that they could inspect them. I shall check, but I think that a statutory provision requires notice of meetings and of the documents to be considered. The provisions provide that the tiny proportion of private meetings need a good reason for not being open to the public. We want to ensure that that is followed as rigorously as possible.

It is of course essential that we advertise for members of patients forums, and not only in traditional ways. We could advertise in supermarkets, post offices and newsagents to try to bring the positions to the attention of a range of people who traditionally might not have been notified of them. We want to recruit our members actively.

The hon. Member for Billericay raised an issue about the voices represented and a lack of lay members above patient forum level. I directed him to the response to the listening document, which moves the debate on significantly. As regards clause 19 and the commission, there were concerns that the voices were not local and independent lay members. Everyone loved the functions, but was concerned about the structures. The response moves us on. It says that the local networks of the commission will have reference panels of local lay people to guide the work programme. There will be lay people involved at the level of patients forums. I do not like the word ''above'' because I do not see this as a hierarchy. . There will, however, be people at every level of the system. There will also be lay members on the national commission, which will be made up of people from patients' forums and local strategic partnerships to ensure that there is a lay voice at every level of the proceedings. That is important, and we must make sure that it happens.

Under clause 18(4), we can even modify the provisions of local government legislation. I think that that legislation provides for prior notice, but even if it does not, we certainly can. We would provide prior notice to enable the greatest number of people to know when and where meetings are and how they can get involved.

As I said, I hope that there will be more ways of consulting than just meetings. I recently talked to people in a rural area who told me that it was sometimes difficult to get to meetings. It was a farming community, and most of those to whom I talked were farmers. They really wanted to have a say in their health service. They said that they were all on e-mail and that we could use technology to have a consultation. That would mean that they did not have to travel 20 or 30 miles to take part in meetings. Using new technology to improve our consultations will be important.

I am not sure whether the hon. Member for North-East Hertfordshire was here when I spoke about funding this morning. I said that I did not want to isolate each individual part of the system and allocate a particular pocket of funding to it. We must see the whole system as coherent package of measures to strengthen patient and public involvement in the NHS. As I said, the system will be backed up by adequate resources. I recognise that good involvement requires the staff to service it. People must be helped to have a say, and I recognise that that will take resources. However, I do not want to pick off individual parts. We must fund the system as a whole, just as the system needs to operate as a whole. That is my intention.

John Baron (Conservative, Billericay)

I thank the Under-Secretary for her modest clarification of funding. I apologise if I missed the answer, but my question was about where the funding will come from. If patients forums are to be truly independent, funding should not come from the budgets of primary care trusts. We rely on patients forums to ensure that the service meets the public's requirements. If forums are funded by local primary care trusts, there could be a conflict of interest.

Hazel Blears (Labour, Salford)

I dealt partially with that when we discussed earlier amendments on the requirement to ensure that the funding stream came through the commission and not the trusts, so that there would be an element of independence. I told the hon. Member for Oxford, West and Abingdon that I had identified the issue as important and that we would table an amendment to strengthen independence in that regard.

The hon. Member for North-East Hertfordshire raised two other issues, the first relating to the position of CHC staff. I said on Tuesday that I went to the staff conference a couple of weeks ago. We launched a human resources framework document that was directed specifically at CHC staff. We have already given a commitment that they will be treated like all the other health service staff who are going through structural and organisational change as the balance of power is shifted. They must go to clearing houses and look at vacancies to see where their new role will be in the system. We want to ensure that CHC staff, including the staff of ACHCEW, have the same opportunities to find their way through the new system.

I understand Mr. Tester's point that the commitment is to ensure that staff in the NHS as a whole have a job for at least 12 months from 2002, which is when the main functions in ''Shifting the Balance of Power within the NHS'' come in. CHC staff are looking for a similar guarantee beyond 2003, which is the timetable proposed in the implementation plan. I understand that that matter is still being discussed among officials and representatives of the staff's trade union. I understand their point. We will endeavour to give them as much protection as we can, but we do not want one group of staff in the health service to be treated differently from the other staff. We want to provide equity, but we are conscious of the need to ensure that people find, where they want it, a new role in the new system.

Finally, I shall deal with the point raised by the hon. Member for Westbury about ensuring that people bring a range of skills to patients forums, including people with disabilities. I commend to him the campaign currently being conducted by Scope, an excellent organisation. I learned about what it calls its ''missing persons'' campaign recently at a conference. The organisation is identifying people with a range of disabilities and the campaign's theme is, ''Have you seen this missing person—as a magistrate? Have you seen them as a school governor, or in your health service?'' It is a marvellous campaign and it brought home to me that we hardly ever see people with disabilities shaping our civil society. That is a key issue for us. Such material helps to put it on the agenda, and we intend to operate a lot of missing persons campaigns. It is time that missing people had a say in our health service.

4.30 pm

Oliver Heald (Conservative, North East Hertfordshire)

I echo the Under-Secretary's remarks. Disabled people should be given more prominence in all spheres. Scope does a great job. However, I should like to take the Committee back to the money, if I may. It is obvious that more needs to be spent on the new bodies than was spent on the community health councils. The estimates are £35.6 million for the commission, £32.5 million for patients forums and about £12 million for the advocacy service.

The Under-Secretary says that she wants to look at the matter in the round. Does she agree, first, that more money needs to be spent than was originally spent on the community health councils? Does she also agree with Mr. Tester, who, as she said, thinks that the proposals are better than the original ones but who also says that although the proposed system has the potential to be dynamic, it will also depend on being adequately resourced?

If the Under-Secretary cannot even say that the same amount of money—£23 million—that was spent on community health councils will be available for patients forums, which is about £10 million less than the estimate of what is actually required, does that not suggest that the Government are thinking of not adequately resourcing the measures? Considering the figure of £32.5 million, which is a low estimate anyway—as I said, the Audit Commission has estimated £60 million—will the Minister at least say that the Government are committed to providing the £23 million, and might even do better?

Hazel Blears (Labour, Salford)

I have said everything that I want to say about finance. I have said that the system will be adequately resourced, and that remains my position.

Question put, That the clause stand part of the Bill:—

The Committee divided: Ayes 7, Noes 3.

Clause 19 - The commission for patient and public involvement in health

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I beg to move amendment No. 221, in page 24, line 8, at end insert—

''(3A) It is also the function of the Commission to monitor the performance by NHS bodies of their duty of public involvement and consultation as specified in section 11 of the Health and Social Care Act 2001 (public involvement and consultation).''.

Alan Hurst (Labour, Braintree)

With this it will be convenient to discuss the following amendments: No. 222, in page 24, line 27, at end insert—

''(c) the Secretary of State''.

No. 223, in page 24, line 35, after ''Forum'', insert

''those persons specified in section 16(1)(d) and (e) and in section 16(2)''.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I shall be brief because some of us harbour hopes of discussing later clauses.

The purpose of the 2001 Act was to place on NHS bodies a duty to ensure adequate public involvement. It seems appropriate that that duty should be monitored, as other things in the health service are. It is also reasonable to say that the commission, which is set up with that duty in mind, is best placed to carry out the monitoring of the requirement to involve and consult patients and public on

''(a) the planning of the provision of those services,

(b) the development and consideration of proposals for changes in the way those services are provided, and

(c) decisions to be made by that body affecting the operation of those services.''

As happened with CHCs, there is a danger that people in the health service will think that that covers the public involvement element and that the issue need no longer concern them. The Under-Secretary will probably state with as much passion as she has so far demonstrated that that is not the intention. The amendment would serve her purpose well and I hope that she considers it satisfactory.

Amendment No. 222 inserts the Secretary of State into the list of bodies to whom the Commission for Patient and Public Involvement might report concerns about the safety and welfare of patients, if they are not satisfied about the way in which matters are being dealt with. It is reasonable that a line of report to the Secretary of State should exist. I understand the need for the commission to maintain independence, but we must be concerned about the safety and welfare of patients.

Amendment No. 223 would broaden the groups of bodies, or persons, who should provide the commission with information so as to include primary care practitioners and participants in local pharmaceutical services, pilot schemes and so on. Those people are referred to in clause 16(1)(d) and (e), and subsection (2). The amendment would also include people who own or control premises where services are provided. If the commission seeks information under its NHS duties, it is reasonable that everyone who will provide NHS services should be covered by provisions under the Bill.

Those are reasonable amendments and we ask the Under-Secretary to accept the lead amendment or give a reassurance that NHS bodies will be adequately monitored.

Richard Taylor (Independent, Wyre Forest)

I shall be even briefer. The Under-Secretary has already assured us that promotion of public involvement will take place. We want to substitute the word ''monitoring'' to ensure that that happens. She has partly reassured me on amendment No. 222, which would ensure that there was a mechanism for a statutory body to refer to the Secretary of State. She has referred to that, but I am not clear in my mind which body it will end up being, so I would like a further reassurance that there will be such a body.

Hazel Blears (Labour, Salford)

Three amendments refer to the functions of the commission and reporting arrangements. I do not think that they are necessary because sufficient powers exist, but that is not to say that the amendments are not important. Amendment No. 221 would give performance-management responsibility for the duty on the NHS to consult and involve the public. The commission's responsibility is to work with the local community and trusts to help them to deliver their responsibilities under section 11 of the 2001 Act. To ask them to help to deliver and to performance-manage would put the commission in an invidious position. The way in which the NHS carries out its duties in accordance with the rest of its organisational provisions needs to be performance-managed. We envisage that strategic health authorities will be the performance management bodies, and that they will ascertain how well the NHS is fulfilling a variety of its duties. However, it would be wrong for the Commission for Patient and Public Involvement in Health—

John Baron (Conservative, Billericay)

Will the Under-Secretary give way?

Hazel Blears (Labour, Salford)

In a moment. Under clause 19(2)(a), the commission will advise the Secretary of State

''about arrangements for public involvement in, and consultation on, matters relating to the health service in England''.

The commission is therefore empowered to explain to the Secretary of State matters such as relevant issues and concerns, and good consultation and good practice, but it would be wrong for it to carry out hands-on performance management of a function of the national health service.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I can reassure the Under-Secretary that at no point in amendment No. 221 does the word ''management'' appear—it is concerned simply with monitoring performance. It is important to recognise that one can monitor performance without having to call it performance management. That is management-speak gone crazy.

Hazel Blears (Labour, Salford)

I believe that the powers in clause 19(2)(a) will be sufficient to cover advising the Secretary of State on how well the situation is working. I should correct what I said earlier: in fact, regional offices of health and social care will performance-manage strategic health authorities, which will performance-manage trusts and PCTs. However, the powers under clause 19(2)(a) will be sufficient to cover that.

Under amendment No. 222, the Secretary of State would be one of the persons or bodies to whom the commission might report a matter of concern relating to the welfare of patients, but under subsection (6) the commission already has the power to report to the Secretary of State. If it becomes aware of such a matter, it can report it

''to whichever person . . . it considers most appropriate''.

Under subsection (7), bodies to which the commission might report a matter ''include'' the regulatory body and the Commission for Health Improvement. Given the use of the word ''include'' the commission will, if necessary, be able to report a matter elsewhere, depending on what it is. The commission should have the discretion to decide what it wants to do with information that it obtains.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Many times have I sought to create lists of things to put in Bills. The Under-Secretary has always said that we should not create lists because they might not be sufficiently inclusive. I am not arguing with her view, but why on earth, therefore, does subsection (7) exist, given that it could include anything? She seems to be defending her position with the very same argument that she employed to oppose the use of lists in legislation. I am happy for her to regard that point as rhetorical; none the less, I could not avoid making it.

Hazel Blears (Labour, Salford)

I shall do as the hon. Gentleman suggests.

Amendment No. 223 would insert providers of local pharmaceutical services and primary care services into the list of bodies that must provide information to the commission. However, the commission does not need to obtain information from individual GPs and other providers of primary care, because its functions do not relate to such individuals. Instead, they concern the involvement of patients and the public in the NHS, and the mechanisms through which that is achieved, such as patient advocacy and liaison services, and patients forums. It is therefore not appropriate to extend the power in the way proposed in the amendment. As I have said, we need to get the balance right to ensure that the functions reflect the powers that the bodies must exercise.

In addition, we consider it wholly inappropriate for a body that rents its property to the NHS, but which is otherwise unconnected to it—for example, a leisure centre—to be compelled to provide information to the commission. We want to ensure that we get the balance right between getting as much information as we can, and avoiding unnecessary intrusion in inappropriate areas.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

May I give the Under-Secretary another example? Let us say that a large contract for delivery of NHS care is given to a BUPA hospital somewhere in Salford. [Interruption.] Lucky her, if she is saying that her constituency does not have one. However, I think that it might have one soon, given the way that things are going. Will there be a duty on such a provider of NHS services to co-operate with the commission over public involvement, or is the privatisation of the delivery of the services an excuse to skimp on co-operation with the commission and with public involvement in important issues of provision? Or will the Under-Secretary say that it is a function of the commissioner of those services to ensure that there is adequate public involvement and co-operation with the Commission for Patient and Public Involvement in Health?

Hazel Blears (Labour, Salford)

A similar issue was raised this morning, and I said that we would ensure, through contracting provisions, that the views of patients and the public were properly taken into account.

I am delighted that the Committee seeks to make the commission an even stronger body than under the proposals. That is perhaps a recognition of the immense contribution that the commission will make at national, regional and local level towards ensuring that the system of patient and public involvement is more rigorous, independent, accountable, accessible and integrated than the previous one. I must resist the amendments. I do not think that they are necessary, or add to the powers and descriptions in the Bill. I ask the Committee to resist them.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I have listened carefully to the Under-Secretary. In response to her last remark, the fact that various amendments have been tabled suggests that hon. Members do not think that the Bill will achieve what she says it will. I will go away and reflect on her response. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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

Oliver Heald (Conservative, North East Hertfordshire)

I have five points to make. First, ACHCEW asked why the commission staff could not be allowed to undertake the advocacy referred to in clause 19(2)(e). Mr. Tester of the Society of CHC Staff says:

''Unless staff can keep their NHS terms and conditions and remain NHS employees when working for ICAS they are unlikely to be willing to transfer.''

What is the Minister's reaction to that?

Secondly, the RNIB has asked what will be done to ensure close partnership between local societies for blind and partially sighted people, national bodies representing them and the commission. Thirdly, what outreach work will be done by the commission's local office staff, and how will the risk of isolation be averted?

As we are short of time, I will reduce my questions to four. If the local office of the commission is to bring together issues and concerns from across the strategic health authority area, it needs the power to place items on the agenda of an overview and scrutiny committee, if they are to be addressed. What powers to do that will the local office of the commission have?

John Baron (Conservative, Billericay)

I have one question for the Under-Secretary, regarding a point that I have already touched on. How will the different bodies relate to each other and to those working in primary and secondary care? I am intrigued by how the patients forums and the Commission for Patient and Public Involvement in Health will relate to each other to ensure that there are no traffic accidents, and to ensure the true independence of the patients forums. To avoid confusion—this is a thought from the British Medical Association—the Department of Health might perhaps publish a clear guide for the public on where they can access information and advice.

Health professionals must be provided with clear guidance and information on arrangements for providing advice and for gaining patients' views. Clarification of that would be welcomed by all parties concerned to ensure that traffic accidents are kept to a minimum and that everyone remains focused on the task in hand.

Hazel Blears (Labour, Salford)

I shall deal with the many points as swiftly as I can. The Commission for Patient and Public Involvement in Health will commission independent complaint and patient advocacy services, set standards, and ensure that advocacy services are consistently good and of high quality and that local people have the same access to advocacy services wherever they live, which is important. It is therefore not appropriate for the commission's staff to provide those advocacy services, because of the danger of conflict of interest—the body commissioning services and setting standards and frameworks would then also be the body seeking to provide those services. It is more appropriate for the commission to focus on places where good advocacy services exist already and seek to commission those while, in places where there are gaps, seeking to establish new organisations that can fill those gaps for advocacy services in the community.

Clearly, on transfer of staff, the transfer provisions that apply to members of staff in any organisation who transfer to new organisations will apply under TUPE. In addition, I have already said to the trade unions that, wherever possible, we will seek to ensure that people are not placed in a less advantageous position than they were in previously. Such staffing issues are properly the subject of current negotiations between employers and employee representatives. However, we are certainly anxious to meet the legitimate concerns of staff about their future security and terms and conditions as far as we can.

To facilitate the input not just of the RNIB but of a range of organisations representing people with various disabilities, voluntary organisations and patients groups, we have set up the transition advisory board, as I said. We want to ensure that part of its work concerns who should be on the commission, how it should operate, and how to ensure that we have the widest range of views on the commission at national level, which will be translated to local organisations. That will ensure that we pick up all the concerns of all stakeholders in the health service and beyond—a process that includes reaching out into local government. Clearly, many of the issues dealt with by local government have a huge impact on people's health and well-being. The transition advisory board is a key to the success of all those systems, as its recommendations will underpin the proposals that are eventually implemented.

I shall now discuss outreach work for the local network of staff. I am conscious of the risk of isolation. I want to ensure that local staff from the commission work with colleagues who are already doing a range of community development work in many areas, whether staff from the councils for voluntary service or people working on urban regeneration or in local strategic partnerships—the whole fabric and network that makes up civil society. I want to ensure that those staff are keyed in so that they are not duplicating work, but finding where the gaps are, and where they can help to fill them and make the system stronger and more vibrant.

Clause 19(2)(g) provides a specific power for the commission to place items on the agenda of the overview and scrutiny committee. It is important that, once it has drawn together the patients forums and the independent complaints and advocacy service, it should see what trends are emerging at local level. It can then make the overview and scrutiny committee aware of those trends, as it has the legal powers to deal with them. At local level, the commission is the glue that brings the system together. I want to make it flexible enough to meet local circumstances, and not one-size-fits-all. I want to ensure that it regularly brings together all the different parts of the system, so that we may learn the lessons, and learn from the information, data and intelligence available. That will provide a much wider view of what is going on in the health service at a local PCT level, which can be fed in to enable not just the overview and scrutiny committee but the strategic health authority to be informed about what is going on.

As I told the hon. Member for Billericay, it makes sense to produce clear guidance on how the system will work and where people can access it. The PALS system will be on the spot in the trust, and NHS Direct will direct people, but it is also important to have the overview.

I want to correct the position with regard to staff, as negotiations are on-going. As I understand it, they will be applying for new posts within the system rather than transferring under the TUPE regulations, but I am keen that a proper route should be available to them. They should have every assistance to ensure that they have a place within the new system.

I believe that I have dealt with all the issues raised by hon. Members. The commission will be a tremendous way of strengthening the whole system of patient and public involvement. When we carried out the listening exercise, the main thing that people told me was that they wanted a body that was independent of the health service and of local government, that could be a challenging feature of the whole system and that could exercise real power and influence with the health service and with local authorities to try to ensure that services were developed in the best interests of patients.

The commission is not about speaking for itself, but about enabling local people to get their voices heard and facilitating their involvement in the system. That is not easy, but the commission will provide an excellent way forward.

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

The Committee divided: Ayes 8, Noes 3.

Schedule 6 - The Commission for Patient and Public Involvement in Health

Laura Moffatt (Labour, Crawley)

I beg to move amendment No. 158, in page 70, line 10, leave out from 'Commission' to end of line 11.

Alan Hurst (Labour, Braintree)

With this it will be convenient to discuss amendment No. 159, in page 70, line 17, leave out sub-paragraphs (5) and (6).

Laura Moffatt (Labour, Crawley)

In a debate earlier this week, the hon. Member for North-East Hertfordshire said:

''As with so much of the Bill, the Secretary of State does not give away any powers.''—[Official Report, Standing Committee A, 4 December 2001; c. 201.]

However, I hope that the amendments will enable the Under-Secretary to demonstrate that that is possible.

Amendment No. 158 relates to the consent of the Secretary of State to the appointment of the chief executive of the commission. It would take that power away from him and remove that requirement. Amendment No. 159 would do the same in respect of terms and conditions of employees of the commission. That would be a sensible thing to do.

Many of us have heard lots of interest expressed by local politicians and local people who have been involved in health campaigning for many years. We would be mad to assume that those people are going to walk away because there are new procedures in place and new ways of working. They will want to be engaged with what is going on. The amendments would help them to understand that the commission will be independent and able to do its job much better than ever the community health councils were able to do. I hope very much that my hon. Friend the Under-Secretary will accept the amendments.

The rest of the debate is in Hansard.