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Mr. Hammond: The hon. Gentleman has referred to two clearly identifiable individuals, and may have put the

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suggestion into some minds that those people were guilty of some impropriety. Would he confirm, for the record, that that was not his intention?

Mr. Austin: I did not intend that implication as far as those two individuals were concerned, but I stand by my assertion that the financial scams in which the health authority became involved were unlawful. They certainly led to financial losses.

I am aware that the proposal to abolish CHCs followed consultation on the national plan. I welcome both the consultation and the plan, but it was general consultation--there has been no specific consultation on the proposal to abolish CHCs or on their replacement. CHCs had some weaknesses, and some of the Bill's proposals address that. The Welsh Assembly has decided to consult widely on patient advocacy and support, including the future remit of CHCs. It is likely that local health councils will continue in Scotland. The Welsh Assembly may, of course, reach conclusions different from those arrived at in England--that is what devolution is all about. However, England should be entitled to the same consultation as Wales, and I urge the Secretary of State to adopt a similar procedure in England.

Time does not permit me to go into detail on the roles of patient advocacy and liaison services and patients forums, but I welcome additional resources for advocacy and dealing with complaints.

The CHCs were not resourced for or charged with the responsibilities of dealing with complaints, but that is what they have done, effectively, in most cases. CHCs have proved themselves capable of organising, servicing and supporting patient forums. As they have been so successful, I would apply the adage, "If it ain't broke, don't fix it."

There are faults in CHCs, and remedies are needed, but where they have failed--or, perhaps, not been as successful as they might have been--it has generally been because they have lacked resources or statutory powers. They are tried and tested and, above all, they are trusted by patients as champions of the users of the NHS. Will my hon. Friend the Minister consider keeping CHCs, placing PALS within them, and giving them the responsibility for servicing, supporting and co-ordinating the work of patients forums?

I served for 24 years as a local councillor, so I welcome the scrutiny role being given to local government. Local authorities have a duty to care for the general well-being of their areas. Although Greenwich borough council was neither a health nor an education authority, when I was leader it set up health and education advisory committees. We thought it right that the local authority and its elected representatives should scrutinise providers. I welcome the new scrutiny role, but do not see it as a substitute for the scrutiny of the CHCs.

Under the Bill, the power to veto, or refer to the Secretary of State or an independent body, closures or major changes in services will transfer from CHCs to the scrutiny committee of the local authority. The Minister may say that that addresses the democratic deficit. Increasingly, however, patterns of service and service delivery are determined jointly by health authorities and local authorities. A local authority is much less likely to comment adversely on service provision that it has been responsible for planning or delivering. The joint working

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of NHS and local authorities and the creation of care trusts, which I welcome, strengthen--not weaken--the case for monitoring by an independent body such as the CHC.

I echo the points made by my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) about areas that have two tiers of local authorities. District councils have a vital role to play--

Madam Deputy Speaker: Order. Time is up.

5.55 pm

Mrs. Virginia Bottomley (South-West Surrey): I appreciate the opportunity to speak on Second Reading. Aspects of the Bill are undoubtedly constructive and positive and will help to build better health care and greater confidence. Other aspects are more doubtful and will need careful scrutiny in Committee. Further elements are, frankly, wrong-headed, and I hope that the Government--although they are not given to listening--will think again.

I shall comment on the Government's style of stewardship of the national health service and the gap between their perceptions from the political bunker, advised by political appointments made by the Department of Health and No. 10 Downing street, and the reality experienced by people who use or work in the health service. One of the advantages of being a Back Bencher, and one associated with health care in many manifestations over many years, is that one has the time to listen and to learn what really concerns people.

I shall start with the positive points, and I am grateful to the hon. Member for Erith and Thamesmead (Mr. Austin) for paying credit to Baroness Cumberlege. If ever there were a champion of the cause of nursing and nurse prescribing, it is my noble Friend. I am pleased to see such an extension of nurse prescribing in the Bill.

Like my hon. Friend the Member for Woodspring (Dr. Fox), I am pleased by the Bill's more constructive attitude towards the relationship with the independent sector. At last, that provides recognition that pragmatism rather than political dogma is taking a higher priority. The Government have spoken in a paltry manner about and to the independent sector. They have had an obsession with the ownership of the means of production in health care, which is quite unlike their attitude in other parts of the public sector. Even now, they harbour some reactionary prejudices in that regard.

The fact is that the independent sector delivers much excellent care. I have not used it, I hasten to say, but if we are to meet people's rising expectations of health and social care, we shall have to use the independent sector. There must be more scope to allow people to put their hands into their own pockets to purchase services and treatments that the NHS is not, despite its justice and integrity, able to provide. For the Government to say anything else is unhelpful and irresponsible.

Let me turn now to matters that I hope will receive further scrutiny in Committee. There are real questions about confidentiality of patient information. I am concerned about comments made by the British Medical Association. In the running of cancer registers, issues arise about patient information being made available and the degree to which that might be extended to other areas.

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The confidentiality of patient information in the NHS is a fundamental principle. With that in mind, I mean to draw to the House's attention a matter that I regard as being extremely serious. In my constituency, there is a patient who is a chronic schizophrenic. I have had contact with him for 12 years, and he suffers great distress and, frankly, poor service. He is being treated with anti-psychotic drugs, but he believes that his condition is influenced by satellites. Whatever the House's view on that, I felt that, as his Member of Parliament and after repeated and urgent entreaties, it was right that I drew the matter to the attention of the Prime Minister.

I leave it to the House to imagine my horror when, on 28 December, I was contacted by Mr. Guy Adams of The Daily Telegraph who told me that he had received a tip-off from No. 10 that I was wasting time, raising questions about UFOs. I regard that as the most shocking breach of patient and constituent confidentiality. It is all the more extraordinary that, having raised with the Prime Minister questions about the growing inequity in health services in this country since his stewardship began, and having written to the right hon. Gentleman after a Prime Minister's Question Time last summer, I should receive, five months later, an inadequate reply from a parliamentary secretary.

The correspondence I received from No. 10 consists of a photocopied letter from a correspondence secretary. That paints an extraordinary picture of the priorities of the Prime Minister and his office and their view of the courtesy due to Members of Parliament, and it insults one of my constituents who suffers a long-term and chronic condition. I should not have dreamed of raising his case in the House--even now I hope that it will not come to his attention--had not someone in No. 10 brought it to the attention of The Daily Telegraph. I have spoken to the parliamentary commissioner and written to Sir Richard Wilson, but I thought that as the Minister takes an interest in mental health policy, he might like to investigate the matter further himself.

The Standing Committee will have to give further consideration to other aspects the Bill, such as the clauses relating to the royal commission on long-term care. I have no Front-Bench responsibilities and can offer my views as one who has been a Minister and considered the issue. Bedlam is already breaking out about the different proposals for England and Scotland for the funding of long-term care. In my view, Christine Hancock is right to say that the proposals are unworkable. The greatest injustice we could do to elderly people would be to imply or pretend that their long-term care was to be funded; that would be to mislead them when, in fact, the service available to them was to be inaccessible or entirely lacking.

The Government should try to disregard the political timetable that always occupies first place in their thoughts--which is not surprising, given that from the word go the Prime Minister has made it clear that his only thought as Prime Minister is re-election, not public service. On this issue, the right step for the Government may be not to please the interest groups, but to take the braver decision that it is not affordable to please the interest groups. It might be more responsible fully to achieve the priorities that they have set than to open up a new wish list of policies, initiatives and constructs.

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I say that because the gap between the Government's rhetoric and the reality on the ground appears to be growing all the time. People working in the health service in my area say that they feel beleaguered, oppressed, undermined and tyrannised. I live in a red-light district--an area in which the care available to my constituents has been deteriorating. I have raised the issue repeatedly with Ministers.

Although in the localities of the Secretary of State for Health and the Prime Minister only one person in 66 waits more than a year for treatment, my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) will confirm that in West Surrey one person in eight waits more than a year for in-patient treatment. That is not an adequate service in this day and age. Ministers dismiss the issue and talk about long-standing financial difficulties. I acknowledge that such difficulties exist, but I have constituents living on social security in West Surrey who have to wait more than a year for treatment at eight times the rate of the constituents of the Prime Minister and the Secretary of State. If Ministers care about the lottery of funding and the health care lottery, they cannot continue to be so indifferent to the problems in West Surrey.

Ministers have taken steps to make themselves even less accessible to Members of Parliament and those who represent localities. The new body, the national reconfiguration panel, is presumably another attempt by Ministers to wash their hands of the problems with which they do not want to become involved. I have described how impossible it is to gain the attention of the Prime Minister: even though he does not hesitate to launch the NHS plan, he has no interest in hearing about reality from Members of Parliament--even those who have been in the House as long as he has.

In their centralising, authoritarian manner, the Government are removing regional chairmen. In my judgment, regional chairmen have performed a valuable role. They are not part of the management line on which the Government repeatedly turn the screw, and they do not belong to the tribes of nurses, doctors and professions allied to medicine. They have a degree of independence and Ministers are well advised to listen to them, but their post is to be abolished.

That abolition takes place alongside another about which the House is almost unanimously concerned--that of community health councils. For the past year, my local health authority has survived in crisis. Despite a deteriorating service, ministerial pressure has forced the health authority to say that it will close most of the community hospitals. It is community health councils which, with distinction, responsibility and rigour, have argued the case and developed a rational consensus on a more sensible way forward.

Will Hutton, not known as a great Conservative thinker, has said:

That issue causes me great concern. Devolution to NHS trusts--much misportrayed by the Labour party, which we in our business have to accept--allowed genuine delegation to those people who were most involved and closest to patients. Now, trust chief executives and regional directors up through the line have less room for manoeuvre and less freedom to speak. That greatly

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worries those who work in the service. I say that because, having been forced to develop the extremely unappetising proposals I have described, the chief executive of my local health authority, who is an honourable and sincere person, is now leaving the health service, and the chief executive of the community trust most involved has left the service on sabbatical. If the Government's bullying of people in the service results in the loss of talented individuals, it will be a great shame for the NHS.

Another aspect of the culture over which the Secretary of State presides, and of which there has been no mention, is Nigel Crisp, the new chief executive. Conservatives believe that politicians do not own the NHS but act as stewards. The Government should show more respect and concern for those working in the service. I am worried about reports from the medical profession that the Government are fuelling doctor hostility and suspicion. Doctors live under great pressure and face very high expectations from patients and the public. The degree to which they are subjected to unfair pressure and intimidation from the current team of Health Ministers should cause us all alarm and concern. I am sure that Government Members are aware that the reports are widespread.

There are growing expectations of health care, and the Bill includes sensible measures. However, I hope that in Committee the Government will think again and temper their rhetoric with the reality and delivery of care as it affects all our constituents from day to day.

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