Health and Social Care Bill

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Mr. Burstow: My hon. Friend is right. I hope that Ministers will have considered that, and will exercise their powers under the 1977 Act, which enable them to make changes to the composition and functions of CHCs. Reform is available through existing legislation. However, it may have been appropriate to add specific references to the new NHS bodies.

There is evidence of poor performance and a question about under-resourcing. In a way, the Government appear to acknowledge under-resourcing by accepting, at least in the briefing, that an additional £10 million will have to be invested in the first year of the new arrangements. Whether that figure is a gross underestimate of what will be needed in the long run is another question. Certainly, my CHC is struggling to do a decent job with the resources available. If we want decent patient empowerment, we must consider the resources available. I hope that the Minister will clearly explain what resources will be available to make the system work effectively.

I believe that the concerns about and criticisms of CHCs amount to a case for reform rather than abolition. There should be reforms to strengthen CHCs' capacity to support patients, and to broaden their scope to include primary care and the new care trusts. The hon. Members for Colne Valley and for Rochdale made points about powers to augment, but not to replace or supplant, the role of CHCs.

The amendments fall into two categories. Some use our preferred approach of reform rather than abolition, but the amendment moved by the hon. Member for Woodspring would put a delay mechanism in place that would require the Secretary of State to certify that the new arrangements functioned effectively before he abolished CHCs. We might have a long wait before the Secretary of State could provide such a certificate. As things stand, the Government's proposals are not fit for the purpose. The sum of the parts adds up to less than the whole. The result is not synergy, but the anti-synergy that I was talking about earlier. I hope that in considering the amendments, the Minister will step back and reflect on the comments, not necessarily of members of the Committee, but of all those who are concerned with patients' interests. Those views are what matter and the Government should listen to them more than to anything else.

Sir George Young (North-West Hampshire): Of the large number of amendments before us, the one that most attracts me is amendment No. 241, which would provide for the clause to come into force—that is, for CHCs to be abolished—only when the Secretary of State was satisfied that the new bodies were functioning well. That is the right approach.

I hope that the Minister will concede that this proposal has not been a presentational triumph for the Government. For an Administration who pride themselves on the way in which they present initiatives and manage news, the episode has been a disaster. A group of people who were, I think, quite well disposed towards the Administration—those who work for and serve on CHCs—feel deeply bruised, if not betrayed, by the events of the past few months. It might be helpful if the Minister were to concede, in winding up the debate, that the matter has not been handled well, and that those who serve on CHCs have every reason to feel aggrieved at the way it has been presented. That might begin to heal some of the wounds.

I have no difficulty with the principle of examining the interface between the consumer, or patient, and the NHS. The existing system was introduced 25 years ago and it is reasonable for an Administration to examine it and decide whether it constitutes the best way of discharging the function in question. When we took office in 1979, we gave some attention to CHCs. In those days they were slightly different. They were more political—certainly in London. Some had been captured by the trade unions and some were very radical and campaigning. They have now matured a great deal and are more professional. However, in 1979 they caused the incoming Conservative Administration quite a lot of inconvenience and grief. None the less, we decided to leave them as they were, for several reasons.

We were making many changes to the NHS and there is a limit to the number of changes that can be made at one time. Some elements must be left stable while others are moved around. Attempting to move too much at once results in an unstable structure. In addition, one of the themes of our reforms and the name of the relevant White Paper was ``Patients First''. We wanted the patients' views as we proceeded with the reforms. If we had abolished or reformed the CHCs, we would have been denied the clear voice of the consumer. Among my regrets about the present process is that I should have liked the CHCs' views about the rest of the Bill—the care trusts, pharmaceutical changes and so on. However, because they have understandably been preoccupied with their own survival, they have had to take their eye off the ball. We have not received much briefing from CHCs on those aspects of the Bill, which I regret.

If we had decided in 1979 to abolish the CHCs, I hope that we would not have done so in the way chosen by the present Administration—slipping the idea out under cover of the NHS plan, having given some signals that CHCs would survive and were appreciated. I understand the argument for reform. There are tensions within the existing functions of CHCs. They have several different jobs to do, and it is difficult for one body to accomplish all of them. Indeed, Winchester CHC is not opposed to reform or to its replacement by other bodies, although it has reservations. However, if the argument against the present structure is that too much is being done by one body, the argument against the new structure is that it involves too many bodies. It is, as it were, the obverse of the problem. At present there is a one-stop-shop. People know where to go: to the CHC. Under the new structure I expect some patients or consumers to be confused about which of the variety of bodies that are to be established they should approach.

I was impressed by the argument put to me by Winchester CHC that if the Government proceed with the new structure, co-ordination will be needed to link the various elements. The new structure is over-prescriptive and centralised. The hon. Member for Sutton and Cheam and my hon. Friend the Member for Woodspring have described problems that could arise under the new system.

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A patient in my constituency who had an accident at home and dialed 999 would be taken by ambulance to Andover hospital. That hospital has a small accident and emergency department looked after by local GPs. If the patient's condition turned out to be more serious than Andover hospital could cope with, he would be taken by ambulance to Winchester and, if it turned out to be even more serious, from Winchester to Southampton. At the moment, if something went wrong, the local CHC could track the episodes. One CHC would provide assistance in establishing what went wrong, and where. Under the new structure, as my hon. Friend said, it would be necessary to knock on several doors. It is not clear to me how the different elements of the process will be co-ordinated and linked for the benefit of the individual patient.

As the hon. Member for Sutton and Cheam said, the proposed model for the four types of replacement body is organisation-based: it is based on the trusts and other bodies. The present structure is patient-based: there is one body for patients to approach. I see some danger of fragmentation. The new bodies will perhaps be less effective, and may become isolated, without a co-ordinating body at local or regional level to bring them together. That was what struck me when I met my local CHC. I was interested to find that the British Medical Association is quite forthright on the matter. It states:

    ``CHCs should not be abolished until all the new systems replacing them are in place.''

That is what amendment No. 241 would provide. Even the research department of the House of Commons Library, which is usually very neutral, refers to clauses 7 to 15 as

    ``a panoply of measures designed to provide a new system of patient and public consultation''.

Other members of the Committee may have read in Public Finance a perceptive piece by Liz Kendall, entitled ``Community Test'', which I came across yesterday. She writes:

    ```Do you support abolishing your constituents' independent voice in the NHS?' could soon become the question Parliamentary candidates fear most during the election campaign.''

On the proposed patients forum she writes:

    ``The big surprise in the Health and Social Care Bill is that these forums will now have a statutory basis and a substantial degree of independence. This looks more like a political move designed to appease the CHC movement than a properly considered policy. While CHCs were right to feel angry and betrayed at the way their abolition was announced (a throwaway line at the end of Chapter 10 of the NHS Plan), replacing them with strong, independently minded Patients Forums will only be effective if they work constructively and are genuinely representative of the communities they serve.''

She continues:

    ``The Government's analysis of the problem is broadly accurate''—

which is a generous comment—

    ``but . . . good ideas have been marred by a lack of overall strategy and little or no thought to implementation. These issues are the real challenge for Labour's second term.''

Some Conservative Members will have views about that.

Dr. Fox: I should not allow that generous interpretation to go unchallenged. Even if we accepted such an analysis, Labour Members have argued that one of the reasons for abolition is that patients do not complain to CHCs because they do not know where to go, or because they feel that the process is too complex, so would it not be logical to ascertain whether the number of complaints under the new system has risen or fallen before deciding whether it is a better or worse system?

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