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I have listened with interest to the two previous contributions, and the hon. Member for Woodspring (Dr. Fox) appears to think that I have performed a U-turn. He must have been absent when I spoke on Second Reading. I said that I had been a member of a CHC for 10 years and served as its vice-chair, but added:
On Second Reading, I said--and I repeat it tonight--that the provisions in the Bill, as it stands, do not offer a better alternative to the CHC system, and I tabled my new clauses in the hope that we could improve the Bill in a constructive fashion.
Mr. Fabricant: The hon. Gentleman has suggested that there is nothing in the Bill that would make CHCs better. Does he agree with me and other Opposition Members, including those in the Liberal Democrat party, that the Bill will make the position worse?
Mr. Hinchliffe: There are positive aspects in the Bill that I wish to mention, but I think that we can improve it. I hope that by the end of the debate we shall have a new structure that will represent patients' interests in a more effective way.
As I argued a moment ago--and as I argued on Second Reading--the effectiveness of CHCs varies considerably. Every hon. Member knows that. Some are excellent, but some are anonymous and some are invisible. I picked up that point when the Select Committee on Health conducted a major inquiry into adverse incidents and considered some serious problems. I asked several patients who had been affected--in some instances they had lost relatives--and some of them had never even heard of the local CHC. We must address that point.
In other areas--the Alder Hey case is a positive example--CHCs have played an important role and there is a different picture. We need to get consistency, and I hope that my new clauses will introduce a degree of consistency.
Dr. Fox: The hon. Gentleman has said, as the Minister has said before, that some CHCs are excellent--so is not the logic to bring the standards of the poorest up to the standards of the best, if necessary by plugging the gaps that the hon. Gentleman mentioned by introducing services such as patients advocacy and liaison services? Would that not be better than going down the route of abolition, and introducing other bodies to ameliorate the damage, as is suggested in his new clauses 9 and 10?
On Second Reading, I made the point that, arising from the work that the Health Committee did on the scrutiny of complaints in our adverse incidents inquiry, we picked up directly from patients the clear principle that they wanted to be included in any changed system. I mentioned the details on Second Reading, and I shall not repeat them now. However, the two key areas that patients were concerned about were independence and having a comprehensive system.
My concern about the Bill echoes one or two of the points that have been made in the two previous speeches. The PALS--patient advocacy and liaison services--system is, indeed, trust based. It focuses on the work of a single trust, be that a hospital or a primary care trust. Therefore it is neither independent nor comprehensive. However, I have no problem with a system that offers an effective customer services department in my local hospital or my local primary care trust where I, as a patient, can go to resolve issues face to face with the trust. As I understand it, that is the purpose of PALS, so I am happy for that system, as proposed in the Bill, to remain.
The concern that I raised on Second Reading about patient advocates was that the Bill was not explicit about the location of the advocacy function. We were initially advised that that function might be commissioned by health authorities. I was worried about that because I have dealt with complaints that relate to health authorities. It struck me as wrong that any system that purports to be independent could be funded by a party to a complaint, that is involved in the problem. It was suggested that we might locate advocates within the remit of the local authority scrutiny panels, but those panels will be scrutinising the work of the new care trusts.
Dr. Brand: The hon. Gentleman knows that I have much respect for his views. Is he not surprised that we are being asked to decide on the Bill tonight, before we know of the outcome of the Government's review of the complaints system? Perhaps he has greater knowledge of what is in the minds of Ministers, but is he not alarmed that we are being invited to adopt a framework without knowing what it has to deliver?
Mr. Hinchliffe: If the hon. Gentleman reads my speech on Second Reading, he will see that I referred to that matter. However, the principles that we can establish tonight will relate to the review's conclusions.
The Bill also provides for the patients forums. I am concerned that the new arrangements will focus primarily on one aspect of the system and will not enable a complaint or problem to be considered comprehensively. We all know that the patient's pathway through health care often starts in primary care, and moves on to secondary and tertiary care before going back into the community. The system needs to reflect the need to look across the board at the comprehensive issues that affect patients when they have a complaint.
I want to thank a number of people who have been involved in many discussions with me and others in the past few days and during the Committee's proceedings. The Clerk was extremely helpful, because he attempted to
Dr. Stoate: My hon. Friend knows that I support what he is trying to do. I met my CHC earlier today and its members, too, were happy with the new clauses and amendments. They believe that they will strengthen the position of CHCs rather than make it worse. I urge the Minister to accept my hon. Friend's new clauses and amendments.
Mr. Hinchliffe: I am grateful for my hon. Friend's support. The new clauses and amendments have drawn a wide range of support from Labour Members, and have also received positive comments from the Opposition. I am proud to have got both my hon. Friend the Member for Houghton and Washington, East (Mr. Kemp) and my right hon. Friend the Member for Chesterfield (Mr. Benn) to support the same new clause. That is quite an achievement--I think I have discovered the third way.
I pay tribute to my right hon. Friends the Minister of State and the Secretary of State for the work that they have done on this issue in the past few weeks and today. They have taken the concerns that we have expressed seriously, and listened to them.
Let me explain my proposals, because Conservative Members obviously do not understand them. I am suggesting that the PALS system should remain. The customer services role is valid and reasonable. It will be genuinely helpful in resolving many--possibly most--of the issues that affect patients in local hospitals and local primary care trusts. I have also included patients forums in new clause 9, because it is logical for them to be closely involved in considering the detail of individual trusts at a local level.
The hon. Member for Sutton and Cheam (Mr. Burstow) said that I would introduce an extra tier. I am probably more intimate with the detail of his new clause than he is--he knows the background to that, and I do not wish to embarrass him. There would be no extra tier. Instead, my proposed arrangements would occupy the same tier as the CHC would represent in his new clause on the retention of CHCs. I want patients councils to be established as umbrella bodies that will collectively draw together the individual patients forums to address the issue that worries me--the lack of a comprehensive overview of the work of the trusts. That function will create a better system.
I am proposing to establish a common secretariat to service the individual forums and the patients councils. The councils functions would not be dissimilar to those discharged by CHCs. However, the significant change, which reflects the Select Committee's views on advocacy, is that they would, in most instances, host the independent advocacy services set out in new clause 10. The hon. Member for Sutton and Cheam is wrong to say that CHCs already have that advocacy function, because many
In my dialogue with the Government, I have recognised that basing advocacy services within every patients council may not be the most appropriate arrangement. There are geographic differences in the areas to be covered. I believe that patients councils should be consulted by the Secretary of State, in accordance with new clause 10, about where the advocacy function should be placed.