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Ms Linda Perham (Ilford, North): I welcome the Bill, which implements a number of the proposals in the NHS plan, on which I spoke at the end of June and again in the Queen's Speech debate in December. I support the Government's continuing commitment to reforming and modernising our cherished NHS. However, along with many other right hon. and hon. Members of all parties, I have concerns about the Government's proposals to change the system of patient representation in the NHS, including the proposed abolition of community health councils.
I was a member of Redbridge CHC during the 1980s. My hon. Friend the Member for Romford (Mrs. Gordon) represented the neighbouring CHC of Barking, Havering and Brentwood, as it then was. Together, we took on the might of the obstetricians and gynaecologists at the local hospitals in fighting for improvements in health treatment for women and children in our areas. I believe that my CHC performed an effective scrutiny role for NHS services, challenging the health authority, flagging up important issues and dealing with patients' complaints.
CHCs undoubtedly need reinvigoration: they need their powers enhancing and extending to cover primary health care, in respect of which there is a considerable deficit. I regret that the Government, in their commendable efforts to improve patient representation in relation to complaints and the scrutiny of services, have decided to abolish rather than reform CHCs. I have had strong representations about the issue, not only from Redbridge CHC but from a number of local and national organisations and from individuals.
The patients forums are the only new bodies in the Bill, and there are anxieties that the patient advocacy and liaison services, while being immediately accessible to patients, may lack the independence from the trusts that the CHCs enjoy. Will they provide a true advocacy service, as it appears that they may need to steer people towards independent advocacy services? They may be useful when complaints can be quickly resolved, but what about the more serious issues that will take longer to tackle?
I was pleased to hear the Secretary of State say that the independent advocacy services may include local authorities. However, there needs to be a way of monitoring the standards of service provided by such bodies. I look forward to hearing how the services will work in practice on behalf of patients and how they will be integrated and monitored to provide the highest standards for all NHS patients--in particular, those who are seeking a resolution of their complaints. I am confident that, whatever we come up with, the Government will provide a proper service for patients, particularly to deal with their complaints.
As secretary of the all-party group on ageing and older people, I welcome a number of the measures included in the Bill, perhaps with the exception of the ominously numbered clause 28. I wonder why it is deemed necessary to state that the president of the Family Health Services Appeal Authority
Parts III and IV of the Bill contain provisions that should be widely supported, including--in spite of what the right hon. Member for North-West Hampshire (Sir G. Young) said--the care trusts. I hope that they will provide a workable partnership between local authorities and health authorities to integrate services, in particular for older people, who use 40 per cent. of NHS resources and who often suffer from the consequences of a lack of co-ordination between the services.
As my right hon. Friend the Secretary of State said, clause 48 will free 35,000 people in nursing homes from having to pay for nursing care. However, the all-party group and others are concerned that 125,000 people will still have to pay for personal care. As hon. Members know, the Sutherland report recommended that nursing and personal care should be free. Often, it is difficult to separate and define those two activities, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, both in an intervention on my right hon. Friend and in his speech.
I welcome the £1.4 billion extra that is to be spent on health and social services for older people. I also welcome the provisions of clauses 52 and 54. Clause 52 will enable the Secretary of State to specify in regulations that local authorities, when determining whether care and attention are otherwise available, should ignore certain capital. At present, authorities may refuse to support someone who has capital of more than £16,000.
Clause 26 contains new arrangements for the suspension and removal of practitioners from relevant lists on grounds of inefficiency, fraud or unsuitability, which my right hon. Friend the Secretary of State covered in some detail in his opening statement. I am pleased about that provision because it is another step towards protecting patients.
I well remember the Government's swift action last year when they amended the Medical Act 1983 to increase from 10 months to five years the length of time before doctors who had been removed from the medical register could apply for reinstatement; that followed on from my ten-minute Bill, which arose out of a case involving a doctor in my constituency. I thank my hon. Friend the Minister of State, the hon. Member for Southampton, Itchen (Mr. Denham), who is to reply to the debate, for his help in progressing that matter.
I hope that the Bill will result in the enactment of radical changes in the ways in which health and local authorities co-operate and work together, in particular in providing for older people. I also hope that the Government will listen to our concerns and respond positively as the Bill progresses through Parliament.
Mr. Simon Burns (West Chelmsford): The Bill is like a curate's egg--good in parts and infinitely bad in others. It would be fair to say that I, like many other hon. Members in the Chamber, warmly welcome the provisions on free nursing care, which are long overdue, but I am concerned--as are hon. Members on both sides of the House--about the proposals to abolish community health councils. That is not simply a question of the total lack of proper consultation or working with CHCs on which the Government have embarked. I am fearful that the patients forums and patient advocacy and liaison services with which the Government wish to replace the councils simply will not work and, more important, will not be seen to be working. Regardless of whether the trust or the health authority is to finance the replacements, local people will not have the confidence to believe that they are independent bodies working on behalf of local individuals, as, by and large, the CHCs, in spite of some failings, have been perceived to do. The CHCs have been the independent representative body for the local community over the whole range of health care provision.
No one is going to say that the present CHC structure is 100 per cent. ideal. However, on balance, I believe it to be the best system. There are problems with the system--for example, with the Mid Essex CHC in my area. Owing to severe financial problems 15 months ago, the Mid Essex Hospital Services NHS trust proposed to close three wards in my area with a loss of 84 beds. Not unnaturally, the local community was in uproar. The CHC was consulted. Local people violently opposed the closure and did not believe that it would achieve the savings for which the trust was aiming, although it would adversely affect patient care. Trade unionists, professionals working in the health service in mid-Essex, Conservative and Labour Members of Parliament and even the local authorities opposed the proposal.
As the decision was so wrong and unjust, we were desperate for the CHC to use its powers to oppose the proposals. It could have asked the Secretary of State and the Department of Health--an independent body in so far as one can have one, as the Department and Ministers are totally detached from the running of the health service in mid-Essex--to consider the issues and arguments against the closure so that what we believed to be the right decision could be reached, which was to prevent closure of the wards.
What happened? At the preliminary meeting, the CHC was as appalled as everyone else. However, when it came to the crunch meeting and the decision had to be taken to appeal to the Secretary of State, the CHC ducked the issue and formally refused to oppose the closure of the three wards. That was in November 1998. The CHC thought that it had a deal with the trust to stagger the closures. Within three months, it was clear that closing the three wards would not save the money envisaged and that waiting and out-patient lists were escalating to such a level that closure was not feasible. The trust had a new chairman and chief executive. Fortunately, because of the pressures put on the CHC by the local community, it reconsidered its decision three months later and appealed formally to the Secretary of State. Immediately, the trust changed its mind and announced that it would reopen the wards.
For three months, that CHC failed to represent the views of the people of mid-Essex. That is an illustration of the fact that CHCs do not always get it right. However, for many years the Mid Essex CHC has done tremendous work representing individuals with complaints about the health service, and has fought for improvements in health care. There are arguments on both sides, but that is not a reason to get rid of CHCs which, by and large, have done a good job.
I question whether as many locally elected councillors should be members of CHCs, regardless of their political party. If we were to keep CHCs, I would structure their composition to include more independent individuals of no known political persuasion, rather than appointing so many local authority representatives, be they from the Conservative, Labour or Liberal Democrat parties, Plaid Cymru or whatever. That would give less of a partisan, political flavour to those bodies.
The CHC system contains some flaws, but it is preferable to what is proposed in the Bill. Certainly, CHCs are more respected by the people whom they serve. Like my hon. Friend the Member for Woodspring (Dr. Fox), I hope that the Government will think again about the proposals when the Bill is scrutinised in detail in Committee, on the Floor of the House and in another place. It is clear that the Bill faces much opposition from Back-Bench Labour Members. I hope that they will stand up and be counted, and fight for CHCs.
The question of long-term care was discussed as part of the Queen's Speech debate a few weeks ago. I said then that the Government's proposals fudged the issue, and that not all the recommendations of the royal commission had been adopted. The result was a short-term fix that did not go to the heart of the problem.
Serious difficulties remain with regard to free nursing care. As I said earlier, I warmly welcome the proposals in that regard but, as other hon. Members have noted, there will be a problem when it comes to distinguishing nursing care from personal care and services.
I put that to the Minister of State, the hon. Member for Barrow and Furness (Mr. Hutton), in the debate on the Queen's Speech. He said that he agreed that anecdotal evidence suggested that, in times of tight health service budgets, people were assessed as needing residential rather than nursing care. The reason for that is that residential care is cheaper, and places less of a strain on social service or NHS budgets. Although I am sure that the Government's intentions are good, I fear that problems could arise when it comes to defining nursing care and personal care and services when money is tight. That problem will not be easy to resolve.
The hon. Member for Bedford (Mr. Hall) mentioned that much of the Bill is a skeleton structure and that Ministers will have great regulatory powers to flesh it out. The proposals on long-term care are no exception. Clause 52 provides that the disregard limit--presently determined on a sliding scale between £10,000 and £16,000--will be increased, but we do not know by how much. Any increase in that limit will benefit many people.
Similarly, people will not be required to sell their houses during their first three months residence in a home. That will also help, but I wonder whether the period is too short. When people first go into a nursing or residential home, they are often confused and distressed. Will three months be long enough for them to settle and stabilise in their new surroundings before they are required to consider something as serious, and with such long-term consequences, as selling a house or making other arrangements, such as those outlined elsewhere in the Bill?
If they had won the 1997 general election, the Conservatives were committed to introducing a voluntary insurance scheme. That scheme would have allowed people to bypass the means test by as large an amount as they wished, so protecting their homes or assets. It would have offered a sensible way forward, and would have been preferable to tinkering with the disregard amounts.
Regardless of what happens to the Bill in Committee, the rules on the disregards for homes need to be reconsidered. I offer the example of a husband and wife who live in their own home. Under the present rules, if one of them has to go into residential care, the other may remain in the family home, which does not have to be sold. That is eminently reasonable, but society and the structures of caring have changed since the rules were drawn up.
Briefings from citizens advice bureaux show that, increasingly, children live in the family home to act as carers for an aged parent. Under the present rules, those children are not allowed to stay in the home if the person whom they are looking after has to go into care. The same applies to other relatives or long-term permanent carers who are not related to the person being cared for. Arrangements whereby people could lose their homes because they are not married to the individual who is going into a home seem to belong to a bygone, antiquated age. I urge the Government to consider that matter further in Committee, as I believe it badly needs to be tackled.
Problems have arisen or grown more acute over the past 20 years because people are living longer and because, with the state's encouragement, they want to stay in their own homes. They highlight the financial difficulties of long-term care with which our parents' generation was not burdened, as the National Assistance Act 1948 covered that.
The Government have gone some way to addressing the problem with regard to nursing care, although I have highlighted the difficulties that remain. However, they should have been bolder and done more to help the even larger proportion of the population who will end their lives in residential rather than nursing care. The Bill will not make that problem go away. The House will have to return to it, and I suspect that it will have to do so in the not-so-distant future.