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Dr. Fox: Will the Minister answer a question that has often been asked during this debate? Was there any consultation with the CHCs about their potential abolition before the national plan was introduced?

Mr. Denham: Prior to the national plan, there was consultation with everybody who had an interest in the NHS. That included CHCs and patients. We introduced the plan in response to what patients said about what had happened to them, and about what they thought was available to them when things went wrong.

In the debate over the past few months, there have been three distinct voices. First, we heard the complacent and conservative voice of those who will not recognise the scale of the changes that need to be made if we are really going to put the patient's voice at the heart of the NHS. Those are the ones who advised us to tinker with this or that problem.

Secondly, we heard the voice of those who have suddenly discovered an interest in patients' rights that was never evident before. They are happy to jump on a bandwagon to make the Government look temporarily uncomfortable, without making a real commitment.

Thirdly, and more importantly, we have heard the constructive voice of those who have considered the Government's proposals, and asked whether the proposals are right and how they could be improved. This debate has involved many people inside and outside the House, and I welcome the contributions that my hon. Friends have made tonight. We should listen to that third voice.

Mr. John Austin (Erith and Thamesmead): I do not know whether my right hon. Friend received any Valentine cards today. I received one from some residents in Bexley, asking me to support their request for independent monitoring and independent advocacy in the national health service. Does my right hon. Friend agree that the amendments tabled by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) would give a guarantee of such provisions?

Mr. Denham: I shall come to those amendments in just a moment. The issues that my hon. Friend mentions are very important.

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I shall set out briefly what we shall put in place. There will be a patient advocacy and liaison service in every trust and primary care trust. Patients want someone to sort out their problems when things first go wrong, before they need to make a formal complaint. PALS are not a replacement for CHCs because that is a role that CHCs have never played. PALS will be a powerful part of each trust, but patients forums will have the power to ensure that PALS remain influential and effective.

There will be a patients forum for each trust, monitoring its work, inspecting premises, electing a non-executive director and reporting on the quality of patient services of each trust. The patients forums will also have the power to take action if PALS fail to provide an effective service. They will have independently appointed members, representative of individual patients, patients groups and carers organisations. Establishing a patients forum for every trust and PCT is key, because that will bring the voice of the patients to bear on the individual building blocks of the NHS--that is, on each chief executive, each medical director, each nursing director, each clinical governance lead.

We have also recognised the importance of co-operation by patients forums in each local area. One of our findings from consultation and debate was the need to institutionalise such co-operation. As a result of amendments, the Bill already supports the idea of joint committees between patients forums to enable that to happen. We have already made it clear that forums in each area should share administrative and professional support, so that expertise can be located in one place.

The amendments tabled by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) take those issues a step further. I shall say more about that shortly, but first I want to say something about another issue, which was in the NHS plan and has been stressed throughout the consultation. We need an independent advocacy service for patients in every part of the country, because however good the system is in each trust things will go wrong and will not be sorted out, and someone will not then be able to rely on a part of the NHS to take them through the complaints procedure and ensure that they are looked after.

We are talking about a service that has never existed uniformly in the NHS. Some community health councils have provided it, but others have not. As we have made clear, we will ensure that independent advocacy services exist in every part of the country. That represents a major step forward in patient rights in the NHS, but my hon. Friend the Member for Wakefield seeks to go further by enshrining it in the Bill.

The NHS has long lacked any democratic scrutiny at local level. The Bill provides for overview committees to scrutinise the service locally, and to scrutinise joint work between the NHS and local authorities, in exactly the same way as the work of local authorities is scrutinised.

I want to leave time for the hon. Member for Woodspring (Dr. Fox), so I shall be brief. During consultation, organisations stressed the need for a national body representing patients' interests--a body that could represent patients, while also supporting those whom we want to volunteer to serve on patients forums. We are already working on a study, instigated by patients organisations, on the best way to set up such a body.

From the outset, we have stressed our wish to ensure that the experience and expertise of CHC members and staff can be retained in the NHS. We expect local health

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communities to help CHC staff to find new employment. As I think my speech should make clear, in future there will be more rather than fewer opportunities to work in patient empowerment and scrutiny in and around the NHS than there are at present, backed up by our commitment of an additional £10 million of investment--a sum that builds on the funds already available for CHCs.

What we have already done has greatly strengthened the voice of patients in the NHS. The Opposition amendments tie us to a system that, however hard people have worked, is not right for the modern NHS. My hon. Friend the Member for Wakefield has raised an important point. We have already said--indeed, we have said it in the Bill--that patients forums should work together; my hon. Friend says we should go further and legislate for a patients council capable of facilitating the co-ordination of the work of patients forums as well as other functions.

I think that the case has been made very clearly that there are people whose problems begin in primary care, continue in the ambulance trust and end up in the hospital trust, perhaps then returning to primary care in a long stay context. We need co-ordination across the system. My hon. Friend is, I think, right to want the Bill to include provision for a patients forum.

I have said that we will provide a common secretariat to support patients in each area. Amendment No. 26 would enshrine that responsibility in the Bill and extend it to providing support for the patients councils. That would ensure that the new organisations had a coherent structure at local level.

Although we have made this commitment from the outset, a case has been made that it would be a big step forward to include--for the first time in the 50 or more years since the NHS was founded--the provision of independent advocacy in NHS legislation. New clause 10 will do just that. It also places a responsibility on the Secretary of State to consult with interested bodies, but particularly with patients councils, on the best location of those services.

Nevertheless, although we accept the amendments in this group tabled by my hon. Friend the Member for Wakefield (Mr. Hinchliffe), which will enable us to create a better structure, much of the necessary action is not purely legislative. We must have clear signposting to the new advocacy services. Additionally, the telephone number, like that for NHS Direct, should be the same in every part of the country so that people are routed to the service.

I have again set out our proposals and stated very clearly how we have already responded to the issues raised in consultation. I have also dealt with and accepted the new clauses and amendments tabled by my hon. Friend the Member for Wakefield. I know that the hon. Member for Woodspring would now like to reply to the debate.

Dr. Fox: I am so grateful for the crumbs that the Minister has seen fit to leave the Opposition to reply to the debate.

Very many questions remain completely unanswered. Despite repeatedly asking the Minister, we still do not know how much the new system will cost. We still do not really know what will happen to CHC staff and to CHC

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medical records. CHCs keep a huge amount of confidential information. Will that be returned to patients doctors or go to hospital trusts? What about cases in which patients have complained about those very hospitals or trusts? Who owns the information and where will it go?

The Government's approach of abolition is illogical. As the Minister and some Labour Members said, some CHCs are excellent. An argument made repeatedly today by Opposition Members is that we have to bring the standards of the poorest up to those of the best. If it is possible for CHCs in some parts of the country to be excellent and to provide the standards and services that many hon. Members and very many members of the public claim they offer, that should be an argument for reform.

On Second Reading, the hon. Member for Wakefield (Mr. Hinchliffe) said--he quoted it himself today--that the abolition of CHCs and scrutiny were an "afterthought" in the Government's plan. I am sure that most hon. Members agree that if his new clauses are accepted, that would diminish the damage that would be done by the Government's original proposals. However, I am sorry that he did not throw his considerable weight in the House behind new clause 2 and fight for proper reform of CHCs.

The hon. Member for Sutton and Cheam (Mr. Burstow) said that the provision is just an extra tier on top of the Government's proposals, and I have much sympathy with that comment. It certainly means more complexity and a more labyrinthine structure. I wonder about the whole concept of a single point of access. As was mentioned in the debate, what about a patient who, in a single episode of illness, has several complaints about different bodies? Where is his or her single point of entry to the system? I am not sure that the new clauses tabled by the hon. Member for Wakefield identify that point.

My hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson) described local examples of CHCs working well and the need for reform. My hon. Friend the Member for Eddisbury (Mr. O'Brien) started the ball rolling with his expose of the Prime Minister's cynical use of the term "consultation". He gave the House a very good example of how the culture of this Government operates.

It is sad that the Labour Back Benchers who spoke at length on Second Reading about their opposition to the principle of abolishing CHCs have been absent from this debate. Notably missing have been those Labour Members who have been going around Westminster telling us privately how much they hate the Government's proposals. We did not hear much from them in the debate.

It has been a genuinely sorry tale. There has been a refusal to apologise for claiming consultation when there was none, and a refusal to be properly accountable to those who are most involved--the CHCs. Despite knowing that he was going to change the system at the end of this debate, the Prime Minister refused to give a straight answer to straight questions at Prime Minister's questions today. The Minister could not even give us a straight answer to the straightest question of all--was there consultation with the CHCs before their abolition was announced in the national plan? If they were thirsty, they could not ask for water.

New clause 2 does not tie us to a failed system; the only thing it ties anyone to is reform. The new clause would bring the standard of the poorest up to that of the

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best. We did not want CHCs to be abolished. We will continue to fight to thwart the Government's plans beyond this House in the other place, so that these proposals go into the general election--

It being Nine o'clock, Mr. Deputy Speaker proceeded to put the Question already proposed from the Chair, pursuant to Order [this day].

The House divided: Ayes 163, Noes 301.

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