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(a) renaming Community Health Councils as Patients' Councils (referred to in this section as "Councils");
(b) the information which local National Health Service bodies must provide to Councils;
(c) the funding of Councils and the provision of premises and other facilities by the Secretary of State;
(d) the membership of Councils.
(3) The functions of a Council are--
(a) to establish sub-committees for each National Health Service trust and Primary Care Trust in the district of the Council, to be known as Patients' Forums (referred to in this section as "Forums");
(b) to facilitate the co-ordination by Forums of their activities;
(c) to make reports and submit recommendations to Health Authorities, local authorities and their committees, National Health Service trusts, Primary Care Trusts, the national patients' body for England and to the Secretary of State in accordance with the regulations;
(d) to carry out such arrangements as may be made with the Council under section 19A of the 1977 Act (independent advocacy services);
(e) to appoint, for each Forum within its district, one member as a non-executive director to the board of the trust to which the Forum relates;
(f) to appoint a representative, having such functions as may be prescribed, to attend meetings of each relevant Health Authority;
(g) to arrange for functions of Forums to be performed under joint arrangements between Councils, where such arrangements are appropriate to meet the needs of their communities;
(h) to receive and respond to disclosures under the Public Interest Disclosure Act 1998 (c. 23) where such disclosures reveal matters of concern for patients in the health service or for the wider community;
(i) to refer issues of concern to patients to Health Authorities, local authorities and such national quality assurance bodies as the regulations may prescribe and to the Secretary of State;
(j) such other functions as the regulations may prescribe.
(4) The functions of a Forum are to--
(a) monitor and review the operation of services provided by, or under arrangements made by, the trust to which it relates;
(b) obtain the views of patients, carers and the wider community about those services and report on those views to the Council and to the trust;
(c) having regard to the views obtained in accordance with paragraph (b), provide advice and make reports and recommendations about matters relating to those services to the Council, the relevant Health Authority, and the trust;
(d) make available to patients and their carers advice and information about those services;
(e) carry out such functions in relation to primary care services as may be prescribed by regulations made by the Secretary of State;

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(f) in prescribed circumstances, to perform any prescribed function of the trust with respect to the provision of a service affording assistance to patients and their families and carers;
(g) carry out such other functions as may be prescribed.
(5) Regulations shall provide for the membership of a Forum, which shall comprise--
(a) as to at least a quarter of its membership, members or representatives of voluntary organisations whose members or client groups have an interest in the health service;
(b) as to at least a quarter of its membership, patients;
(c) as to at least a quarter of its membership, carers;
(d) such other persons as may be prescribed.
(6) References in subsection (4) to "services" are references to--
(a) services provided as part of the health service (within the meaning of the 1977 Act) in England,
(b) services provided in England in pursuance of section 31 arrangements in relation to the exercise of health-related functions of a local authority, and
(c) services provided elsewhere (and not part of the health service in England) in pursuance of section 31 arrangements with a local authority in England.
(7) In this section--
(a) "relevant Health Authority" in subsection (4)(c) in relation to a Forum for a Primary Care Trust, means the Health Authority whose area is, or includes, the area for which the trust is established;
(b) "prescribed" means prescribed by regulations made by the Secretary of State;
(c) "section 31 arrangements" means arrangements under regulations under section 31 of the Health Act 1999 (c. 8) (arrangements between NHS bodies and local authorities);
(d) "carer", in relation to a patient, means a person who provides care for the patient, but who is not employed to do so by any body in the exercise of its functions under any enactment;
(e) "the health service" has the same meaning as in the 1977 Act;
(f) "patient" includes (as well as a patient within the meaning of that Act) a person who receives services provided in pursuance of section 31 arrangements in relation to the exercise of health-related functions of a local authority."

12.44 pm

The Minister of State, Department of Health (Mr. John Denham): I beg to move, That the House disagrees with the Lords in the said amendment.

Mr. Speaker: With this it will be convenient to consider the following: Lords amendments Nos. 7 and 8 and consequential amendments Nos. 1 to 7 thereto; Lords amendments Nos. 9 to 15 and Government motions to disagree thereto; Lords amendments Nos. 16, 17 and 68; Lords amendments Nos. 82 and 83 and Government motions to disagree thereto.

Mr. Denham: In setting the scene for the amendments, it is important to stress that this is a major Bill. It puts in place many of the measures and powers that are needed to modernise the NHS and to implement the NHS plan, which was launched last July with widespread support from the NHS, its staff, professional organisations and patients groups. The plan underpins the unprecedented investment in the NHS that this Government are making, but which the Conservative party would put under threat.

Miss Anne McIntosh (Vale of York): I am grateful to the Minister for allowing me to speak. I gather that the Bill is the flagship Bill of the Government in their dying

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days. Is there any particular reason why the Secretary of State is not here to present the Bill and speak to the amendments?

Mr. Denham: The hon. Lady knows that I have handled the great bulk of the stages of the Bill, and I am doing so today. My right hon. Friend the Secretary of State is taking part in a visit which in principle has been planned for many months.

For the first time in the history of the NHS, nursing care for the elderly will become free in nursing homes from October this year. Just in the past few days, the Conservative party has again made clear its preference for private insurance as the answer to long-term care. The Bill will protect patients and be fairer to GPs by improving the regulation of GPs and other primary care professionals. It will extend prescribing rights. It will strengthen joint working between the NHS and social services by allowing care trusts to be established. It will protect the essential work of cancer registries and other vital parts of the NHS by protecting the information flows that it needs. [Interruption.] As we approach the closing stages of the Bill none of those must be put in jeopardy. [Interruption.]

Mr. Speaker: Order. The Minister knows that we are talking not about the general terms of the Bill, but about Lords amendments to it. He should speak to them.

Mr. Denham: I am grateful to you, Mr. Speaker. I was about to point out that because the Bill is so important we must not put its provisions in jeopardy at this stage in its progress through Parliament. The Lords amendments deal with two substantive issues: the reform of patient representation and patient information. This group of amendments deals with patient representation.

In all the challenges we face in modernising the NHS, the need to make the NHS patient-centred is one of the most fundamental. In the past 25 years too little progress has been made in that area. No matter how good each individual episode of clinical care is, too often patients feel that they have to make their way round the system instead of the system being built around their needs. They have to wait for an appointment that is inconvenient instead of being able to book one. They return time and again for different tests instead of having all the tests done on one day. Their passage from one part of the system to another, perhaps from the health service to social care, is not smooth and seamless as it should be. Too often simple problems, complaints and misunderstandings are not dealt with quickly, some then becoming major problems.

We are already taking action to tackle those issues, but we know and patients know that change will be faster, more effective and more lasting if patients and carers have a voice at the heart of every part of the NHS.

In the NHS plan we set out proposals for a radical change to the system of patient representation. In each trust and primary care trust a patient advocacy and liaison service will be able to tackle emerging problems there and then. A practical answer--

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