Health and Social Care Bill

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Dr. Brand: Will the Minister give way?

Mr. Denham: If I may, I shall finish the point; it may help because I am reflecting on points raised in the debate.

We are convinced that we need to focus on the main organisational unit of the health service. I see from the amendments that that is the difference between the Liberal Democrats and the Government. However, an organisation at a greater remove would not be able to bring the patients' perspective to bear sufficiently sharply or effectively. If the experience of the patient is to change, real changes must be made to the operation of the organisation; it has to be brought to bear directly on the board and its chief executive, executive directors and medical directors that change is required. Establishing a patients forum is the first building block to in our attempt to strengthen the patient's voice in the NHS.

Dr. Brand: I wanted to ask a more detailed question. The Minister spoke about the Bill's provisions applying in those areas of trusts where patients have access. Will inspections be made of mortuaries, chapels of rest, kitchens, laboratories, laundries or—not far from him locally—sterilising departments?

Mr. Denham: The hon. Gentleman makes a fair point. The strict interpretation of the expression ``anywhere that patients go'' might be used to exclude—

The Chairman: Order. I hate to interrupt the Minister, but there are amendments on exactly that point later in the Bill, and it might be better to deal with it then.

Mr. Denham: I am grateful to you. We shall clarify the point later.

Mr. Desmond Swayne (New Forest, West): Earlier, the Minister was asked about the future of Casualty Watch and similar publications. My understanding was that he thought that patients forums would be the proper place for them. Would he go further and make a stronger commitment? Will he make it his business to ensure that such publications find new publishers within the patients forums?

Mr. Denham: My difficulty is that the fear that Secretaries of State or Ministers would tell patients forums what to do persuaded us—as a reassurance—to make them independent statutory bodies, and that precludes me from instructing them to do anything of the sort. It is our expectation, however, that patients forums will undertake specific or general monitoring activity. That is important as an allegation has been made—and repeated this morning—that the aim of the exercise has been to remove from the system of scrutiny in the NHS any organisation or body that could play that role. That is not the case. Patients forums will be as able to carry out that role, as CHCs have in the past.

Mr. Burstow: I am grateful to the Minister for giving way so often on the details of the provision. In response to the hon. Member for New Forest, West (Mr. Swayne), he said that the Government's concern was to establish the bodies on a statutory basis so that there was no doubt that they could not be told what to do by the Government. Why have the Government chosen not to establish the area advisory committees on a statutory basis?

Mr. Denham: We believe that the powers of direction that require health authorities to set them up will be adequate. We shall debate that later, but in terms of safeguarding the independent patients'voice in the system, which has been the main focus of debate and concern, establishing the patients forum on a statutory basis was the right thing to do.

We have had a slightly odd debate. On one hand we had allegedly not consulted and on the other hand we were accused of making it up as we went along. The reality is that we have published a set of proposals and we have listened to what people have said about them. Some of the detailed legislative proposals that we are considering and some of the policy points that I am making reflect that discussion. Our approach remains intact, but we have sought to build in some of the safeguards that right hon. Members or people in CHCs felt were necessary and that is a perfectly proper way to proceed.

Dr. Fox: The Minister has been talking about the accountability of the trust unit and the role of the patients forums, but much of what the trust does will be influenced by either the health authority's policy or the resources that it distributes to the trust. How will they be held to account?

Mr. Denham: I am not sure I have grasped the point that the hon. Member for Woodspring is trying to make. In a previous sitting we discussed the general system of performance management for trusts, but that is a slightly different issue. If the hon. Gentleman is inquiring whether patients forums or local authorities' scrutiny committees will be able to form a view about the level of resources or their deployment within the health service, the answer is that they will be able to do that. That is quite clear. Nothing in our proposals would constrain those bodies in that way.

Dr. Fox rose—

Mr. Denham: I should move on. Perhaps we could discuss the detail later.

Dr. Fox: I was not trying to catch the Minister out. I was simply looking for clarification. In respect of the availability of a particular treatment or drug, for example, how would the patients forum guarantee representation of patients' rights given that the policy on such matters comes from the health authority and not the trust?

Mr. Denham: The patients forum would be able to take a view on any aspect of the care that was offered by a hospital trust or primary care trust. There are many health authorities that already discuss prescribing policies, in broad, strategic terms, with forums established at local level. We would expect that to happen. The proposal for advisory forums is built on the existing work of health authorities in conducting strategic, consultative forums at a local level. If one is seeking a group of patients that is able to take a view on the care that is offered to a patient in a particular provider part of the health service, the patients forum is just such a group. That is an issue that has been raised, and it is a matter for debate. We are focusing on the provider structure in the NHS, for the reasons that I have given. That is a matter of deliberate choice on the part of the Government.

I should like to cover a few relevant points. Although we have touched on it only briefly this morning, there is a case for ensuring that the individual patients forums are properly supported and that patients are properly represented at a level above the local. That issue was raised by the right hon. Member for North-West Hampshire (Sir G. Young). We are working with a group of patients' organisations, including the patients forum, the long-term medical conditions alliance, and the College of Health, with whom we have funded a study, which is under way. The report on the study will be available in March.

The study is concerned with establishing the best way of doing two things: providing a national focus for the new system of patient representation, and identifying the type of support that should be offered to patients who use the system. That is covered in the briefing that we circulated a few days ago. It is important because it may be necessary to take a broader view, and it will certainly be necessary to learn from current best practice in making the new system work as effectively as possible.

Dr. Naysmith: It has been said that CHCs will be in existence until 2002. They are currently backed up by ACHCEW. Will the Minister confirm that funding for CHCs and for ACHCEW will continue until that date?

Mr. Denham: The NHS plan has set 2002 as the date on which the new system will replace CHCs. I see no reason to vary that timetable. We are committed to continuing funding, to ensure that there is no gap in between the two systems.

Amendment No. 241 suggests that we should run the new system before getting rid of the old system. That is an interesting idea. If the previous Administration had decided to keep the publicly managed railways going until we saw whether privately managed railways would work, we might not be where we are with the transport system. Clearly, it is important to ensure that there is a proper transition from one system to another. That is an issue not of legislation but of management. We must ensure that there is a proper transition. In practice, it would not be possible, financially or organisationally, to have a double running of the new system and the current system. I will ask the Committee to resist amendment No. 241.

There will be other elements. We touched briefly on the local advisory forums. We envisage those as relating to the strategic planning function of a health authority, both in response to the new duty of consultation, and to involve the public in priority assessing and planning. We want to take a flexible approach, building on what is good locally, but we envisage a core panel of patients and public, including representatives from patients forums and a wider pool of representatives.

I want to mention the overview and scrutiny committees. Local authorities are establishing those committees to scrutinise local government decisions, and the Bill extends their role explicitly to include scrutiny of the NHS. That will help to address the democratic deficit in the NHS. Health bodies will be required to provide information on local services to the overview and scrutiny committee, and it will make reports and recommendations to the NHS bodies that it reviews. If a trust does not act on the recommendations of the overview and scrutiny committee, it will have to justify that decision.

Over the past few months, we have been talking and listening to the views of stakeholder groups, including CHCs, on how to build on what is good and maximise the potential of a new system. Some of the measures before the Committee today are the direct result of that dialogue—specifically, the status and independence of patients forums, the commitment that I have made to commissioning of independent advocacy, and the feasibility study on the creation of a national patient body. Those developments help to show the work that we have done.

The clause follows, rather than leads, the decision to adopt a more effective and focused, and in some ways more broad ranging system of patient and public representation in the NHS. We should support it and resist the Opposition amendments so that we can make progress in establishing and, later today, discussing the detailed elements of, the new structure.

12.30 pm

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