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Mr. Denham: Can the hon. Gentleman identify a single way in which the patients forums or the patients councils, as we proposed them, would be less statutorily independent than CHCs?

Mr. Heald: One of the greatest achievements of the community health councils has been casualty watch. It is to have a national body--

Mr. Denham rose--

Mr. Heald: Let me finish the point. It is to have a national body, which will be able to co-ordinate these matters, and which will be independent and able to communicate fearlessly the picture for the country as a whole. Governments do not like that, but the public at large and Members of Parliament certainly appreciate it.

Mr. Denham: Why would the national body as set out in the Bill have been in any way less able to do casualty watch than the CHCs are at the moment? We have made it clear that it could do so equally well.

Mr. Heald: We want something that is genuinely independent, and we want it--[Laughter.] The Minister

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laughs, but independence is important. We are used to a Government who constantly spin figures and change the basis of figures--a Government who are all about spin rather than reality. If it is independent--

Mr. Hammond: Does my hon. Friend agree that the problem is that the patients councils and patients forums as proposed in the Bill would be established by secondary legislation--regulations introduced by the Secretary of State--and would not be enshrined in primary legislation, as CHCs are?

Mr. Heald: My hon. Friend is right about that. All too often, we are asked to accept assurances. We know what the community health councils and the national body do at the moment. We are expected to give the Government carte blanche because they are nice people giving us assurances, but that is unacceptable. We want it in the law.

I am grateful to have had the opportunity to make this short contribution to the debate.

Mr. Patrick Hall (Bedford): I am very disappointed with the situation that we now face. People have put a great deal of work into trying to find answers to a multitude of questions, but those questions remain on the table and all the work will have to start again.

A lot of work has been put in over the past 10 months to make sense of a set of proposals that, to start with, were fragmented and posed more questions than they answered. When the Bill left the House on Third Reading, it contained a much better set of proposals. The new structure for patient representation was not nearly as fragmented as it was when it was first suggested, thanks to the Government's acceptance of the amendment tabled by my hon. Friend the Member for Wakefield (Mr. Hinchliffe), and thanks to a great deal of work that had been done outside this place, by civil servants and others, to which the Government paid attention. With patients councils forming the overview and the administrative cohesion that was missing from the initial set of proposals, we had a structure that would have worked and would have made sense locally.

The statutory, independent patients forums would be very important for every part of the local health service. They would not perpetuate the traditional emphasis on hospitals--the acute sector--but would give equal importance to the primary care sector, and to community health services. Patients councils would have been well able to play the important role of fitting that structure together. They would also provide a means of disseminating and receiving information, locally, regionally and nationally, and a means of informing local authority scrutiny committees.

We have not returned to where we started, but the situation is unsatisfactory and unresolved, and people will still have in mind questions that they will pose in the weeks and months ahead, to which the Government will need to return in future.

Will the Minister give one assurance? Will he acknowledge that no system that deals with patient representation and patient empowerment will work unless it has the good will of all the people who are already involved in those areas? Most of them serve on CHCs and most are volunteers, but many work for other voluntary

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organisations, as my right hon. Friend will know. Their good will and work needs to be acknowledged. The Government could have begun the process in a better way with regard to those people. The process began 10 months ago and there has been constructive consultation since, but there will certainly have to be a great deal more of it to deal with these matters when the Government return to power.

I should like an assurance from my right hon. Friend that the views of those in the voluntary sector--voluntary members of CHCs as well as staff--will be taken on board, so that such people will be fully involved in returning to the drawing board to consider the new structure. We need the involvement of those people to make any new structure work.

1.30 pm

Mr. Hammond: We really should not be having this debate. If the Government had listened to what people had to say and genuinely consulted at the outset, as they pretended they had, they would have realised that the Bill's proposals were unacceptable. They are unacceptable to the Conservative Opposition, to all other parties in the House and, indeed, to the great majority of Labour Back Benchers. They are unacceptable to outside bodies representing patients and to most commentators on the subject. It is only the Government's arrogance that has resulted in their having to make such a humiliating climbdown at the 11th hour.

The Minister is wrong to suggest--indeed, the Labour party was wrong to suggest in last night's press release--that the climbdown is somehow in order to save the principle of free nursing care. I believe that all parties in the House have expressed their support for the introduction of free nursing care.

Clause 56 removes from local authorities the statutory duty to provide or procure free nursing care, and the power to do so. There is no reason why, if clause 56 had fallen and the Bill had not become law, the Government could not have introduced free nursing care by directing health authorities to pay for it--unless the Minister is suggesting that the country is littered with local authorities that would insist on paying for such care even when their health authorities were offering to do so and to provide it.

I do not want to take up too much of the House's time, but I should like to ask the Minister one or two specific questions; he has come to the House supported by the usual invisible army, and I know that he would be disappointed if I did not do so. How has he reconciled the retention of community health councils with the creation of overview and scrutiny committees? There will be significant overlap of their functions and a potential for conflict between them.

Will the Minister explain Government amendment No. 4, which proposes to leave out subsections (6) and (7) of proposed new section 19A, under clause 17, which deals with the introduction of independent advocacy services? Proposed new subsection (6) provides that, before making arrangements for independent advocacy services, the Secretary of State should consult the relevant patients council and any other persons "as he considers appropriate". Obviously, there will be no patients councils

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to consult, so it is entirely appropriate to remove that reference. However, why should the Secretary of State not consult

By removing the subsection, the Minister will be allowing the Secretary of State to introduce regulations for the provision of independent advocacy services without a requirement to consult anybody on doing so.

Government amendment No. 7 addresses schedule 5. It is not clear why the House should be minded to agree to the removal of a definition of a patient advocacy and liaison service, and to giving the Secretary of State free rein to define such a service through any regulations and in any way he chooses. I would be grateful if the Minister could elaborate on those two points, because they are not merely consequential amendments, but significant changes to the process that the Secretary of State will have to undertake.

Throughout, the Government's case for abolishing the CHCs is that they want to introduce something that is much stronger and much more effective. Their problem has been that no one believes them. It is true that CHCs are a thorn in the side of Health Ministers. The Minister knows that and my right hon. and hon. Friends have told me the same thing. The function of CHCs is to be a thorn in the side of Health Ministers.

One of the most common outputs of CHCs that Members receive is the excellent publication "Casualty Watch". Let us consider the Government's version of their motivation. The Secretary of State was sitting one morning in his office reading a copy of the Daily Mail with the headline, "The abandoned patients--Catalogue of shame as hospitals leave elderly waiting on trolleys". The article beneath it added:

and so on. We are asked to believe that the Secretary of State said to his advisers, "I have a great idea. Why don't we strengthen these bodies? Why don't we make them more independent and more effective so that they can produce more of this type of documentation and circulate it to the press and Opposition Members of Parliament?" That is a totally implausible scenario.

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