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7.41 pm

Mr. Patrick Hall (Bedford): Given my role as chair of the all-party group on community health councils, I will confine my remarks to those parts of the Bill dealing with patient and public involvement in the national health service and the abolition of community health councils in England.

Much has already been said about this process. It began in July 2000 with the publication of the national health service plan, which was followed by an Adjournment debate on the future of the CHCs one year ago and the incomplete progress, before the election, of the measure that became the Health and Social Care Act 2001. It is widely accepted that the process was burdened from the start by the lack of prior consultation on the future of the CHCs and the emerging picture of a replacement system that was complex and unclear. I believe that we have moved on from that painful experience.

The new proposals, especially as described in the recently published Government response to the listening exercise last September—which I have looked at—reveal that progress has been made. That welcome situation is due, at least in part, to the excellent work done, following the election, on re-engaging with community health councils. It is right to acknowledge the constructive role played by the Under-Secretary, my hon. Friend the Member for Salford (Ms Blears), who has understood that the new and better system we all want will not even begin to function without the involvement and good will of CHC members and staff.

There is evidence in the Government's response that they have been listening to people. For example, there is the sensible acceptance that patient advocacy and liaison services should be called patient advisory and liaison services. Also important is the Government's recognition of concerns about independence, accountability, integration and support, especially at local level. That said, the picture painted by the Bill does not enlighten us enough. The full picture will emerge as a result of some of the provisions of the Health and Social Care Act 2001, yet to be implemented, along with the provisions of this Bill and, in the main part, regulation and guidance that has not yet been prepared.

Legitimate concerns about the detail will not be addressed by the Bill. The Government's response is reassuring because it contains a lot of detail and paints a credible and coherent picture. However, the Bill does no more than provide a framework. I suggest that during the Bill's Committee stage, draft regulations be prepared so that the detail necessary to understand and support the Bill's framework can be considered. Such an approach was successfully adopted during the consideration of the Local Government Act 2000.

I have a few further points to make in the time remaining to me. The Commission for Patient and Public Involvement in Health is, as has been said, a bit of a

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mouthful. I note from the Government's response document that the title is described as shorter than the one originally proposed. However, I welcome the creation of the commission nationally to co-ordinate, monitor, promote best practice and support local networks. The Government describe it as a statutory and independent body, accountable to a national lay group.

I understand that the Secretary of State wishes to appoint the chair of the commission and approve the appointment of a chief executive. That does not, in my view, sit comfortably with the intention that the commission be fully independent. Therefore, I ask my right hon. Friend to think again about that.

On the commission's local operation, the Government propose local commission networks working in every primary care trust area through local outreach teams based in local premises. Having looked at the Government's response document, I believe that the essential functions of integration, co-ordination, informing and supporting patients forums, PALS and local authority overview and scrutiny committees—which my hon. Friend the Member for Wakefield (Mr. Hinchliffe) proposed the patients council should undertake—are retained. In addition, there is the interesting and radical suggestion that the networks will also promote and support local people in engaging in proposals affecting their health. That is radical, because such activity might not always be welcomed by the NHS management and boards. It is essential to have such a provision if we are to develop a national health service that is patient-centred.

I commend actions that are likely to generate informed and measured responses by the public and their elected representatives to health care proposals and changes in their area. However, to carry out those tasks, the local commission networks will need to be properly resourced. That will not come cheap.

The shop front—the one-stop shop—has not been mentioned in the debate so far. Community health councils in many parts of the country already provide them. Although I am ready to admit that not too many citizens have made use of them, the presence of a shop front is important, especially if we are looking ahead to an improved system. They should be retained. I am not convinced that that will necessarily be part of the future system. I think that the Government will argue that PALS should provide the point of contact, where and when needed, to patients and their families and that it will link to the independent advisory services for those who wish to pursue a formal complaint. However, the public are not supposed to be served by PALS except in so far as they become patients. The way in which PALS operates at primary care and community health level will clearly not be as obvious as a reception facility in an acute hospital.

The patients forum monitoring each trust will not be a shop front. The commission network could operate from a base that does not need to be visible. I wonder where and how the public are to be made aware of the new system so that they can become involved. That is important if it is to work. I acknowledge that the shop front is not a necessary condition for the whole thing to operate, but it seems a sensible ingredient.

One of the concerns that was much aired earlier this year related to the role of the patients forum member on the trust board—not as an observer, but as a full, remunerated non-executive director. The scope for

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conflicts of interest and loyalty is obvious, and at least that possibility is acknowledged by the Government. It seems that the election of such a person by a patients forum is not now compulsory—it can happen as and when a vacancy on the trust board naturally arises. That will, of course, lead to patchy coverage across the country. That situation needs to be thought through a little more.

More thought is also needed about the acknowledgement in the Government's response document that more work is required on how to support non-executive directors who find themselves in a conflict between their forum and the board. What does such support mean and who will provide it? That is a serious question about which we do not have any detail, because the regulations or guidance have not yet been produced.

Finally, the Government rightly emphasise the importance of the strategic partnerships, drawing together the experience of local networks, joint overview and scrutiny committees, the strategic health authority and joint bodies of patients forums attached to primary care trusts. However, where will the acute trust patients forums figure in that arrangement? Surely they have key information and an important role to perform. Exclusion from the strategic health authority level of integration seems potentially counter-productive. I look forward to those matters being addressed.

7.51 pm

Mr. Roger Williams (Brecon and Radnorshire): Liberal Democrat Members have no problems with distinctiveness and devolutions, so although we have grave reservations about some of the Bill's content, we have no difficulty in supporting the clauses that will give the Welsh Assembly powers to enhance, improve and modernise the NHS in Wales. Of course, the Assembly has not yet finalised those structures; much debate and discussion will take place before it does so.

The formation of local health boards will take the delivery of health out of the hands of distant bureaucrats and will let local doctors, medical professionals, lay people and democratically elected councillors take the lead in delivering appropriate services for the area in which they live and work. Accountability will be re-established.

The local health groups have delivered well and will form the basis for the local health boards. The hon. Member for Cardiff, Central (Mr. Jones) was uncertain about the number of health boards that should be established. We were grateful to him for his work on the last reorganisation of the NHS for the people of Powys. Coterminosity for local health boards and local authorities will help to ensure that the NHS and social services work together better in Wales and that delayed discharge from hospital will be eliminated as far as is possible. Elected councillors on health boards will also make a contribution to that process.

I especially welcome the proposals to set up a unique health board for Powys through the amalgamation of the primary health care trust and the local health group, given the particular requirements of the rural area. All in all, emphasis on primary health care will bode well for the health of the people of the nation of Wales, which has come out in a bad light in almost every survey.

Above all, I welcome the powers to abolish the five health authorities—they have been a dead hand on the NHS and have formed an unwanted layer of bureaucracy

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in Wales. They will be replaced by a much slimmer body that can take on a full national role in commissioning specialist tertiary care, and can guide and facilitate the commissioning of secondary care from the most appropriate provider. That is why I welcome the provisions granting the Assembly power to create a special health authority that will be able to commission tertiary care, as well as care for the mentally ill and for children.

I am pleased that community health councils will remain in Wales. I am sure that the Assembly will use its powers to ensure that they operate more effectively. It is sometimes said that they have only one tooth—to refer proposed changes back to the Secretary of State or to the Assembly for reconsideration. However, that is an important power and the CHCs exercise it with a degree of discretion.

I welcome the provisions in the Bill that will give the Assembly powers to make the NHS in Wales more effective and more accountable.

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