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Mr. Paul Truswell (Pudsey): I wish to concentrate on the patient representation elements of the Bill. I hate to say it but, unlike my very good and hon. Friend the Member for Wakefield (Mr. Hinchliffe), I more or less understand them.
I have both a dream and a nightmare about the Bill's proposals. In the dream, everything falls into place and it represents a radical extension of patients' voices in the NHS. In the nightmare there is fragmentation and confusion. I sincerely hope that the reality much more closely resembles the dream than the nightmare.
In various guises, I have worked with and in CHCs for almost 24 years; I think that they were established in 1974, so I have been involved with them for most of their lifetime. I personally have a positive view of the role that their members and officers have played over the years. I am not, however, a fully paid up member of the CHC preservation society, although I am keen to conserve the very good things that the CHCs have achieved and the lessons that they have taught us. I believe that a model based on the CHC would have been valid for the Bill, but the Government have taken a different tack, which I hope is ultimately vindicated.
On Second Reading of the Health and Social Care Bill, I expressed concerns about the overall lack of co-ordination between PALSthe patient advice and liaison servicethe independent advocacy service, patients forums and the overview and scrutiny committees. The need for that role has been recognised in
As my hon. Friend the Member for Wakefield said, whether glue and bureaucracy really go together only time will tell, but what we really need at this juncture is a clearer exposition of how the commission's local networks will be resourced and how they will operate. They should, ideally, provide a servicing role to patients forums not unlike that currently performed by CHC staff in support of CHC members. They should provide independent policy, legal, research and administrative support. It is worrying that the explanatory notes relating to subsection (2)(d) refer only to the local commission providing "administrative support". I hope that that is a shorthand way of describing all the support that I have listed above, but if it is not, that will be a real deficiency in the system. That support will have to come at a cost, and I believe that that cost will be much greater than the current cost of CHCs. If that cost is not met, however, the system will be much the worse off.
In Leeds, the local commission will have to service seven patient forums. Additionally, it will have to discharge its outreach function of increasing public participation and its co-ordination and monitoring role between the various pillars of the new system. If we add to local costs the cost of setting up PALS and the independent advocacy service, we are talking about a significant sum. It would be helpful if Ministers could at some stage quantify and cost the proposals and provide a commitment that the Government will provide the resources to make them work effectively. I believe that, to discharge its function effectively, the commission should be much more localised than it is intended the strategic health authorities will be. I should think that it must have a base within a city the size of Leeds.
I also wonder whether the commission's local network will provide support to patient forum members who are elected to a trust board. Those individuals will have to carry a substantial burden. It is therefore crucial that nominees to trust boards have effective independent support and advice. If they do not, I fear that they will simply be co-opted into the collective corral of the NHS board on which they serve. It is also unclear whether the nominees will perform the function of delegates from the patient forum with all that that might imply. I certainly seek clarification from the Minister on that point.
As has been said, some welcome action is being taken to increase the forums' powers beyond those of the CHC. However, I re-iterate the comment that those powers could quite easily have been added to those of CHCs. The CHCs have, for example, asked for many years for their remit to be extended to primary care, a request on which the Bill obviously delivers. We should also extend visiting rights to private sector facilities, and there should be provisionwhich has been called for for many yearsfor unannounced visits so that forum members, on behalf of patients, can see facilities, warts and all.
The hon. Member for Broxbourne (Mrs. Roe) mentioned the power currently vested in CHCs to refer unacceptable proposals to the Secretary of State. I hope that that power will continue regardless of the body in which it is vested; otherwise health bodies will continue to treat consultation as a cynical exercise and the patient's voice with some contempt.
In order to promote wider membership, we should introduce measures for patient forum members that are similar to those enjoyed by local authority members, including a statutory right to time off. An alternative to that would be some form of remuneration, particularly as some forum members will be paid non-executive directors of trusts. We should also consider proposals such as a loss of earnings provision.
Forum members must be appointed for a sufficient period to allow them to learn the ropes and make an effective contribution. Currently, CHC members are appointed for four years and, as I understand it, can serve two terms. Such an arrangement has much to recommend it to ensure continuity.
I certainly welcome the commission's overarching local and national remit, which seems to be an effective way of killing two birds with one stone. I am less enamoured, however, with suggestions that the Secretary of State should appoint the commission chairman and chief executive. Surely, for the sake of independence being seen to be done, other arrangements can be found.
I welcome the recognition in the NHS plan and in the Bill of the importance of advocacy services, which will complement existing services in places such as Leeds where they are provided very effectively by the voluntary sector. It would be interesting to have the Minister's views on how the services envisaged in the Bill will fit in with the advocacy services that are already being provided in places such as Leeds. I am also pleased that the distinction between advocacy and advice has been recognised in the renaming of PALS by use of the word "advice" rather than "advocacy".
A focus on advocacy is long overdue. In the mid-1980s, Leeds city council established an advocacy service. The health service viewed it with great suspicion and found the term advocacy to be adversarial, threatening and intrusive. I believe, however, that if such services had been more widely available, some of the scandals that have occupied the time of this place over the years might have been averted and that the necessary corrective action might have been taken much earlier.
I have grave reservations about the transitional arrangements between abolition of CHCs and the new structure coming into place. As has been said, the transition needs to be achieved in a manner that does not entail patient representation and the patient voice being left in limbo. It is also essential that the many good and effective CHC staffmost of whom we know and respect in this placeare not lost to the system. They have the experience and expertise to make the new structure work.
I genuinely believe that the Bill could represent one of the most ambitious, exciting and radical steps taken by the NHS in its history. Conversely, it could fulfil the fears of ACHCEW. I hope that my right hon. and hon. Friends will succeed in making it the first possibility. However, they will do that only if they combine a genuine commitment to extending patient involvement with the funding that is necessary to make the structure work properly.
Mr. Roger Gale (North Thanet): I shall concentrate on part 2 of the Bill, which has received almost no attention at all in this debate and I believe is a time-bomb that is ticking away and could explode and blow the health professions to pieces.
On 13 November, the Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton), wrote a letter to hon. Members headed, "Modernising Regulation in the National Health Service". He started by saying:
This morning, one health visitor told me that she believes that the proposals will sound the death-knell of a part of the health care professions that is already finding it desperately difficult to recruit. I know from my own experience in my own constituency just how short-staffed they are. I should have thought that the Minister of State would want at the very least to promote their cause and help them to recruit to that vital part of the health service, rather than effectively to snub them, remove them from the title of that council which the Government are determined to create, and leave them wondering whether they have a future at all.
We have had the debate on osteopaths and another Minister of State has held an inquiryit was a whitewashinto the workings of the GOC, but we are about to make all the same mistakes again, having learned nothing from that experience. I find that desperately sad. Ministers should consider the two orders properly, recognise the value of those true professionals to the health service and change their minds.
It was said earlier that the Government have succeeded in making the elderly wait to get into hospital beds and wait to get out of those beds. In Kent, that is absolutely true. The right hon. Member for Holborn and St. Pancras (Mr. Dobson), when he was Secretary of State for Health, took a wildly unpopular but courageous decision on the reorganisation of health care in east Kent. I was, and still am, not very popular for backing it either. The right hon. Gentleman recognised that it is necessary, in a modern health service, to determine when and how services will be delivered, and that may mean some unpopular changes. However, that plan is being completely undermined by the Government's attitude to the health service.
When my hon. Friend the Member for Woodspring (Dr. Fox) opened the debate for the Opposition, he said that we had lost tens of thousands of residential and nursing home beds. That is true, and it is especially true in Kent. Thousands of those beds have gone and, as a result, hundreds of patients are blocking the beds in our acute hospitals. The Bill will do nothing to enhance cottage hospital care, to create minor injuries units, to get patients out of the beds that they are blocking or to solve the problems that many of our constituents face in desperation day after day. It has been said that the Bill is