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Mr. Hinchliffe: The hon. Gentleman is arguing that the existing structure of CHCs is independent. Does he understand the current make-up of CHCs, particularly the fact that one third of their members are members of local authorities? How would they monitor independently the work of future care trusts?

Mr. O'Brien: I hope that the hon. Gentleman would be surprised if I were not aware of the make-up of CHCs, as I have made a study of the subject. The members currently nominated by local authorities are in balance with the other interested parties on CHCs. One of the difficulties with the Government's proposals is that that balance would shift towards much more political involvement at local authority level. That is an important point to recognise, even if the Chairman of the Health Committee believes that the Government are proposing something different. Like him, I have had discussions with the Association of Community Health Councils for England and Wales. It was keen to support new clauses 9 and 10, but that support was expressed before the association had seen new clause 2. Today I had a meeting with CHC representatives who were specific about the fact that they regard new clause 2 as the better option and that they would prefer it to win through on Report.

The decision to abolish CHCs appeared shortly before the summer recess, tucked away in page 95 of the Government's NHS plan, in paragraph 10.35. It was a decision, not a proposal for consultation, and it had been made without any prior consultation. The staff of Chester and Ellesmere Port CHC and of Cheshire Central CHC came to see me almost immediately. They learned through the internet of the threat to their jobs and to what they realised were regarded as voluntary organisations. That is no way for any Government to handle the morale and expertise of people who have given dedicated service and who, above all, have demonstrated that they are in it not out of careerism, but to ensure that patients get the best out of the NHS. It was a ghastly shame on the workings of the Government that they informed CHC staff through the internet that their jobs were under threat.

Of course, the decision caused massive consternation. No prior consultation had taken place. I have had regular contact with my local CHCs, which are generally acknowledged to be excellent. However, I know that strong feelings have built up not only within them, as would have been expected--the decision has also been hugely controversial among patients and NHS staff who have found CHCs to be a worthwhile and important aspect of the broad delivery of health care services.

I raised the matter in Prime Minister's questions on 15 November last year. I asked the Prime Minister whether he was aware that his proposals to scrap community health councils were bitterly opposed. He answered:

He went on to say:

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in relation to the abolition of CHCs. He goes on to state:

The letter continues for a further two pages, without adding anything of substance, but the Prime Minister concludes:

It is important to put those matters on record.

The letter, which the Prime Minister's office placed in the Library, showed that despite all the claims about prior consultation, even the Prime Minister was caught out and had to correct the direct answer that he gave to me during Question Time.

I cannot tell the House how many calls, e-mails, faxes, letters and other representations I received from CHCs and others who were concerned about the issue in the days between the Prime Minister's answer on the Floor of the House and the day I received his letter. They were delighted to see that there was a chink of light after all and that CHCs might not be abolished. However, we found a few days later, when I received the letter, that that assurance had been cynically removed. I sought to question the Secretary of State for Health the following day--21 November--but he said that he would not give an answer. In my view, that was an outrage and a gross abuse of parliamentary accountability.

I was then fortunate enough to secure a debate on the matter in Westminster Hall. The debate had an unusually high attendance, but it was notable because it was well attended not only by Opposition Members, but by Labour Members. One displayed a touch of "careerismitis" during the debate, but none spoke in favour of the Government's decision--I wish that I could say "proposals", but I cannot. We were presented with a summary decision at the end of July last year.

Second Reading and a Committee stage have occurred to no avail, despite the strength of feeling that was expressed on the subject. It is fair to put it on record that, in terms of consultation and process, the proceedings constitute a travesty and a sham. The Government should be deeply ashamed of that. They owe an apology to the hard-working staff in CHCs across the country and to the volunteers and nominees from local authorities.

Mr. Hayes: Does my hon. Friend acknowledge that the sham continued this afternoon at Prime Minister's Question Time? Although the Prime Minister knew that we were considering the Bill later, he pretended at the Dispatch Box that consultation on the abolition of CHCs, not the new arrangements, was continuing. The sham went on. We heard weasel words from the Prime Minister, and weasel words from Dr. Stoate and other Labour Members.

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. The hon. Gentleman does not help the debate by using

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those terms, and he did not observe the forms of the House in the way in which he referred to another hon. Member.

Mr. O'Brien: I noted the Prime Minister's answer, to which my hon. Friend the Member for South Holland and The Deepings (Mr Hayes) referred quite properly. The Prime Minister attempted to paint a picture of genuine consultation. It was claimed that consultation, as it is defined in English, would take place and that people could make representations, which would be taken into account when a decision was made. We know that such consultation has not occurred. The Government have already made their decision on the abolition of CHCs. The process has been a sham. The fact that we have reached that point reflects shame on the House

My constituency of Eddisbury is in south-west Cheshire, and it is important to note that in Cheshire, where genuinely good CHCs exist, local Labour Members of Parliament have been challenged in the press to state whether they support abolishing them. Notwithstanding a hiccup from the hon. Member for City of Chester (Ms Russell), who pulled back from issuing a specific press release, nothing has been heard. No attempt has been made to justify the Government's actions.

Representatives of CHCs who came to see us today are rightly proud of their service to local patients. They are proud not only of their knowledge and independence but of their lack of careerism. The Association of Community Health Councils for England and Wales has rightly asked whether patients are better served by lapdogs or watchdogs. The association has earned a reputation for being a watchdog.

Trust and confidence are vital. The Government have the audacity to make a distinction in Wales. As it is a properly derogated matter, it has been decided to maintain CHCs in Wales. Why should England be different? We should all question CHCs' abolition in England.

The replacements could be more costly, more complicated and less trusted by vulnerable patients who need them. Ministers have said nothing to justify abolishing CHCs, to efface the shame of their lack of prior consultation or to show that they have listened. They have had the brass neck to resist all representations, logic and the need to retain trust and confidence. Let us hope against hope that, for once, this arrogant Government will stick their brass neck out far enough to accept that they have misjudged the matter, climb down with grace and support new clause 2.

8.45 pm

Mr. Denham: A patient-centred NHS is central to the vision that we set out in the NHS plan. Lip service has been paid for years to the idea of a patient-centred NHS, without bringing about any real change. As the NHS plan acknowledges, services are all too often not organised around the needs and lives of patients, and when things go wrong patients find inadequate safeguards and little help available to them.

During the consultation on the NHS plan, patients across the country complained that no one listened to them, that there was no one there when they needed help, and that there was no one to turn to for advice. Patients organisations stressed, throughout the consultation, that patients need to have real influence in every part of the

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NHS. That is why, during our consultations on the NHS plan, we decided that there was a case for real change. The NHS plan set out radical proposals to strengthen the voice of patients in the NHS. It also sought to address the lack of democratic scrutiny at local level by involving local government elected councillors. The Bill introduces the legislative change to deliver the plan.

I want to make it clear that the starting point for the proposals was not--and still is not--the abolition of community health councils. We have designed a new system based on the need to increase and improve patient representation in the NHS. The functions of CHCs will be taken forward by new more powerful or more appropriate organisations. It is for that reason, and no other, that the plan proposed the abolition of CHCs. Some CHCs have undoubtedly done good work, given their limited structure and remit. However, that has too often depended on the undoubted merits of the individuals involved, rather than on the structures in which they were working. The case for radical reform has been made, and it is a case that cannot be answered with piecemeal changes.

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