Health and Social Care Bill

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Sir George Young: I agree. The benefit of the amendment is that it would permit the retention of CHCs until it was possible to be satisfied that the replacements were working. If the Secretary of State were not satisfied, he would not issue the certificate, and CHCs would remain.

I wonder what is likely to happen next. As I said on Second Reading, the Bill is unlikely to hit the statute book if we have an election in April or May. The Bill will be on Report some time after 8 February, but even simple non-controversial Bills take seven or eight weeks to go through the other place. The clause may be opposed there, so the Minister may be confronted with the choice either to ditch clause 14 or to ditch the Bill. Will he abandon the other reforms, many of which cause us no difficulty, in order to keep clause 14? Or will he be persuaded by our arguments and by those that I hope will be made in the other place?

It would help if the Minister talked us through the timetable for the Bill's remaining stages--if not today, at some point in our proceedings. When will it be introduced in the other place? When will Report take place? I am sure that the Minister's propensity for producing amendments will be undiminished, and that we shall have to consider at least some Lords amendments. Will that happen in March or April? When will the Bill be enacted? If it comes to the crunch, will the Minister be prepared to abandon clause 14, and therefore keep CHCs, as the price for having the rest of the Bill?

Mr. Burns: Like my right hon. and hon. Friends and the hon. Member for Sutton and Cheam, who is the spokesman for the Liberal Democrat party, I have grave misgivings about clauses 14 and 15. I am attracted by amendments Nos. 241 and 97, because I believe that it is foolish to abolish community health councils and replace them with something diffuse and confusing. The case against CHCs has not been made.

The hon. Member for Colne Valley and others have said that the CHC system is not 100 per cent. perfect. Of course it is not; no organisation can be perfect. The hon. Lady gave us a powerful example of such problems, and I suspect that, during their time as Members of Parliament, most hon. Members have come across problems with CHCs, as they will have done with many other organisations. We have had problems in mid-Essex, but during my 14 years as a Member I have not had to deal with problems or complaints from constituents about the way in which the Mid Essex CHC has handled cases. As I said on Second Reading, two years ago I had to deal with complaints about the proposed ward closures in my local hospital, but never with complaints from individual patients.

I suspect that the reason behind the abolition of CHCs has more to do with control freakery, and that the Government are trying to stamp out anything that could embarrass them by highlighting problems in the health service rather than trying genuinely to improve the system. It would be extraordinary if the Government had discovered problems with CHCs only in the past year or two. I suspect that, until 1997, they thought that CHCs were probably the best thing since sliced bread. We certainly never heard Labour Members complaining about CHCs when they were in opposition; they frequently praised them for doing their job, which was to highlight problems.

Kali Mountford: I was first critical of CHCs in Sheffield in 1994.

Mr. Burns: I am grateful to the hon. Lady. My point is that during the period 1987 to 1997, when I was a Member of the House, Opposition Members were not heard to complain about the performance of their community health councils.

Mr. David Jamieson (Plymouth, Devonport): She was not here.

Mr. Burns: I am explaining that point to the hon. Lady. Neither she nor the hon. Member for Eccles (Mr. Stewart) was here. That is the point. I am talking about those hon. Members who were in the House during that period. When they were in opposition, they were keen on community health councils and full of praise for them and the effective, dedicated work that they did. That effective and dedicated work has not changed in the last three years. What has changed is the Government. They do not like criticism. They do not like any organisation, however independent, to contradict the rose-tinted view of the Secretary of State and the message that he wants to get across to the country about what is going on in the health service.

Lorna Fitzsimons: Does the hon. Gentleman know that before I became a Member of Parliament, none of my family—and my sister is a solicitor and my brother a chemical engineer, so neither of them is lacking in intelligence—knew about the CHCs, although my father, sadly, passed away having spent a month in intensive care? Does the hon. Gentleman not see that it is outrageous that I had to become a Member of Parliament before my family had access to patient representation?

Dr. Fox: It does not depend on that.

Mr. Burns: As my hon. Friend says, it does not depend on that.

It is interesting that two Labour Members have said in interventions that they were members of community health councils. It is surprising, though, because presumably they were members of those councils before their election to the House. I am surprised that we have not heard from them how inadequate and flawed those community health councils were when they served on them. The answer is that, as my hon. Friend said, none of the Labour Back Benchers who are present today spoke in the Second Reading debate, and none of them has views that contradict what the Government want to ram through the House, because they were handpicked by the Whip, so we shall not hear from them.

The important thing is that we have a system of patient representation that is independent and seen to be independent. My fear is that the current system, which is perceived as independent, will be replaced by bodies that will not command the confidence of the general public that they represent their best interests and will move forward the enhancement and improvement of health care in their local regions.

My own community health council has written to me on the subject, and powerfully reinforces that point. Mrs Norma O'Hara, chief officer at the Mid Essex Community Health Council, said:

    ``I remain very concerned that individuals, in particular, will not receive the independent support they presently receive from the CHC.''

She is also concerned that

    ``matters highlighted through complaints, through regular visiting by specialised CHC members and by attending a myriad of health meetings will be lost if the new system is put in place.''

She is absolutely right.

The experience and expertise that community health councils have built up since their establishment in the 1970s is second to none. That will be wiped away by a highly petty move by the Government to get rid of an organisation that is doing its job. If the Minister feels that areas within the existing system are flawed or need to be tightened up and improved, why not take that course rather than take away the whole system and bring in the cockeyed system that the Government propose?

Paragraph 2 of the helpful briefing on patient representation in the NHS that the Minister has sent us in the last two weeks says:

    ``While some CHCs have done a very good job, their effectiveness and breadth of services across the country is patchy and too highly dependent on individual officers and members.''

I ask the Minister, because that is a very broad-brush and generalised condemnation, what is the evidence to support that statement? It would be helpful to discover the basis of the Government briefings that seek to undermine the CHC system. I hope that the Government will listen to the debate and, more important, to Labour Back Benchers who have not been selected to serve on the Committee. I hope that the Government will think again at this late stage. If they are not prepared to do so, I hope that, in the other place, the two clauses will be treated with the contempt that they deserve and be rejected.

12 noon

Dr. Brand: I should like to make some brief comments. Much has been said about the independence of CHCs, and the fear that whatever replaces them might not be so independent. It is right to worry about that, but I have another concern. CHCs are, on the whole, knowledgeable. They have a wealth of knowledge and experience of the NHS, and they understand it. That has been part of the maturing function that was described by the right hon. Member for North-West Hampshire (Sir G. Young).

I remember that, when CHCs were first set up, no doctor would talk to a CHC member. They were considered to be wild, outrageous people, interfering with the proper functioning of the profession. That has changed enormously. There is now co-operation, but not in the sense of collusion. There is an understanding on both sides that the public are represented through bodies such as CHCs, but those bodies have an obligation to understand the technical pressures and the constraints on medical provision.

The medical profession and the CHCs have evolved, in places where their relationship works, a responsible method of monitoring patient opinion and influencing the people who are charged professionally with delivering the service. In my CHC, we have reached the stage where local general practices have invited CHCs to set up an inspection regime for them. That is right. Inspection is one of the roles that the Minister could have given to CHCs.

I was sorry to hear the hon. Member for Colne Valley describe her experiences, but I was somewhat alarmed that one of her criticisms of CHCs was that they do not always represent popular campaigns. It is CHCs' role to find out what the public believe about a proposal to change the NHS, but it is also their role to evaluate that feedback and make reasonable comment. If the NHS were run purely by campaign—as politicians, we have too often been guilty of that—nothing would ever have changed. We would still be taking out tonsils on the kitchen table, and accident and emergency departments would be present in every village. That is what people would like, but it is not medically responsible.

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