Health and Social Care Bill

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Mr. Hammond: Does my hon. Friend agree that one of the greatest concerns of those who oppose the abolition of CHCs is that, under the Government's proposed scheme, it is not clear which institution will perform the important independent whistle-blowing role currently performed by CHCs? Is there not a suspicion that the Government are seeking to abolish that role altogether?

Dr. Fox: Yes. The current Secretary of State has an amazing ability to say one thing and mean something entirely different. That is what I meant when I referred to the Orwellian nature of the Government's proposals and language. Only the current Secretary of State could describe the Bill as a decentralising measure, when it gives him unparalleled powers of hiring and firing within the NHS. In the extreme cases that we will deal with later, the legislation gives the Government the power to tell patients that information about them is not theirs but belongs to the state, should the state wish to use it in any way that the Secretary of State deems fit.

The measure is not decentralising, but the Secretary of State describes it as such. It does not surprise me, given the mindset that that implies, that the Government want to abolish the concept of whistle-blowing or independent scrutiny. I share the suspicions of my hon. Friend that the measure will make access to the complaints and scrutiny procedure more complex and difficult for patients. It will ensure that there is less chance of any further body bringing embarrassing information to light in the way that CHCs have so successfully done in recent years.

Ministers' attempts to avoid questioning have been an unfortunate feature of the whole sorry episode. When a seminar was held by the Association of Community Health Councils of England and Wales on 4 December, the junior Minister wrote in advance that she would be attending the seminar, but that she would be unable to answer questions about the Government's proposals to abolish CHCs. Never have I known such a naked abdication of responsibility by a Minister in charge of a Government proposal—telling those involved that she would be unable to discuss the proposal at a conference that they were attending. What hope do we have of holding the Government to account, when Ministers refuse to answer questions on matters for which they have prime responsibility? It is an outrage.

As the hon. Member for Sutton and Cheam mentioned in his point of order, the Department has arranged a meeting in Fulham that is taking place as we speak. Those who might most want to listen to our deliberations, and who have most to lose from the Government's proposals, have been taken off to another part of the city. No doubt they will be briefed by the Secretary of State, as this Committee has not so far been briefed, and will already know the details of the proposal. However, they will not be able to listen to what is being said in Parliament. That is typical of the way in which the Government do business.

The Secretary of State recently promised national guidelines on the proposed new structures, but as yet we have seen no sign of them. There is a strong suspicion that the Government are making up the entire process as they go along, never having thought in advance about what would happen if they abolished CHCs, and with little idea even now of how to implement the plan. We all accept that there is a strong case for reform of CHCs, to make them more effective. Their work could be more standardised, the appointment system could be reformed and resourcing could be improved. However those are not arguments for abolition and the Government have yet to make a case for that.

The question of patient information and confidentiality has still not been considered either on Second Reading or, so far, in Committee. The CHCs have expressed concern because of the volume of confidential information about patients that they hold. There are large numbers of such records, which may be handed over to hospital trusts whose staff may be the subjects of many of the files. We must hear from the Minister today exactly how such conflicts will be prevented. What mechanism will ensure that information that patients gave in confidence, often about trusts or staff, will not be relayed to the very people about whom they complained? We must know in detail what will happen to the records and a failsafe mechanism must be introduced.

Under the Bill, the Secretary of State will, as I mentioned just now, take powers over the control of patient information and will be able to make any information public if he deems that to be in the public interest. There will be potential for patient records from the CHCs to be put in the public domain at the whim of the Secretary of State. The system was not set up to do that. It would be contrary to every assurance that patients were given when they provided the information. They would have been told that it would be treated sensitively and in confidence. The Government need to sort this matter out, because it is one of the most appalling flaws in the procedure.

In the past, community health councils, or at least those at the top of the scale, have done a wonderful job. They have represented the entire public, not just patients, in the NHS. We have all seen the Casualty Watch documents that they produce, which are extremely useful in pointing out flaws in policy and identifying where service is poorest. That effectiveness has proved to be one of the nails in their coffin. The Secretary of State in particular detests Casualty Watch because it points out what is happening in the real NHS, as opposed to the one that he likes to describe in the House of Commons.

The CHC supported the victims of Harold Shipman in Hyde. The Northallerton CHC played a key role in suggesting that the counselling help line for victims of Richard Neale should be funded by the Northallerton NHS trust and health authority. The Sheffield CHC has demanded that the Commissioner for Public Appointments investigate the appointment of the new chairman of Sheffield Teaching Hospitals NHS trust, which was not publicly advertised, and for which only two candidates were interviewed. The junior Minister has not replied to the CHC's letters of concern.

Members of Barking, Dagenham and Havering CHC made an unannounced visit to the Corbet ward of St. George's hospital in Hornchurch, where they found staff shortages so severe that elderly patients were being put to bed at 4 pm. They found that seven of the 16 qualified nursing staff were off work owing to sickness. All those revelations are at risk of going by the board because of the new mechanisms being established by the Government. Indeed, there is a strong suspicion that they are being put in place in order to make sure that such matters are not brought to light in the way that they have been to the embarrassment of this and previous Governments.

A number of distinguished people have served on CHCs. It will be interesting to hear the views of the noble Lord Hunt—one of the first secretaries appointed to the CHCs in 1975—as he turns executioner for the organisations that he once championed. It will be interesting to listen to his reasoning.

We have a different approach to the subject in Scotland and Wales, which we will come to subsequently. Neither the Scottish Executive nor the Welsh Assembly has introduced plans to abolish CHCs. They seem to be at odds with the Government, viewing CHCs as something useful and their independence as something to be encouraged. Now that we are to get a two-tier service in terms of nursing care in the United Kingdom—courtesy of the Government's devolution proposals—it is not surprising that we are to get a second-rate advocacy service in respect of independence and autonomy in England.

A number of Labour Members have made vocal their criticisms of the Bill. One example is as follows:

    ``Does my right hon. Friend accept that community health councils do good work in our national health service? Does he also accept that those councils genuinely represent the patients and their families—the consumer? As he is engaged in some necessary, far-reaching reforms . . . could he delay deciding his approach to CHCs until he has advanced his other reforms?''

That is exactly what we propose in amendment No. 241. Another Government Back Bencher said:

    ``There is grave concern that such services will be fragmented among a range of providers and that the patient's voice element will be dissipated rather than co-ordinated.''

The hon. Member for Wakefield (Mr. Hinchliffe), who chairs the Health Committee, stated:

    ``My concern is that the proposal places patient advocates within trusts and they will not be seen to be independent in a way that patients need them to be.''—[Official Report, 21 November 2000; Vol. 357, c. 158.]

All those statements are from supporters of the Government, who have grave concerns about the proposals.

The Secretary of State has gone to great lengths to cite support from patients' bodies for the new structure. He stated that the College of Health

    ``welcomed the new statutory duty for public involvement and consultation by health authorities, primary care trusts and NHS trusts. We also welcome the creation of patient forums as statutory bodies.''—[Official Report, 10 January 2001; Vol. 360, c. 1081.]

Mr. Hammond: Is my hon. Friend aware that on Second Reading a number of Labour Members who spoke against the abolition of CHCs made it clear that they had personal and direct relevant experience of them? Is it not extraordinary, therefore, that the Government have chosen to pack the Committee with Members who did not speak on Second Reading to the extent that, with the exception of the Minister, not a single Labour Member spoke on Second Reading?

Dr. Fox: I see that my Whip is not present and I am treading on dangerous ground. I was in the Whip's Office and that I know how the membership of Standing Committees is decided. The more controversial the legislation, and the less sure the Government are of their ground, the less likely it is that independent opinion from their Back Benches will be represented. When a Committee is made up of those who did not speak in the Second Reading—missing those who discussed their reservations about Government policy—I would bet my bottom dollar that the Government know they are on weak ground intellectually.

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Prepared 30 January 2001