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Dr. Evan Harris: I have not followed the full detail of exactly which amendment the hon. Gentleman is talking about, but he will remember that, despite the guillotine, we had time to have a lengthy debate in Committee on whether CHCs could be reformed, not abolished, and that we voted on that amendment. We both agreed that we got little out of the Under-Secretary in terms of a considered response because she is passionate about her model, but most people prefer the model proposed in the new clause.

Mr. Burns: The hon. Gentleman is absolutely right. The only disadvantage or sadness about the debates that we managed to have in Committee was that they were related to earlier clauses on the back of the Government's proposals; we were unable to have specific debates on clause 20, solely under which CHCs will be abolished. The debate that we had was better than nothing, but we would have welcomed proper and full debate at the time on the specific clause that deals with the abolition of the CHCs.

The procedure that the Government have adopted to rid themselves of this network of councils throughout the country has been typified by a brazen lack of regard for

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the views of others. No doubt, those who support the Government on this issue will say that a consultation process took place. If they believe that, they will believe in a number of things that it is not wise to believe in.

When the Government sent out their consultation document, the basic assumption in point 1.5, which deals with this issue, was that CHCs would be abolished. The document did not ask whether they should be abolished, or whether they should be reformed and improved. It simply stated that


That is really wonderful if one wants open, frank, straightforward and meaningful consultation.

Before discussion even began, the Government set down what they would do at the end of the process. If the views expressed in the submissions that they received from members of the public, people who have dedicated their lives to working for CHCs, hon. Members on both sides of the House, other organisations inside and outside the NHS and local authorities did not coincide with the criteria in point 1.5 of the consultation document, they were disregarded. That is what the Government have sought to do ever since they introduced their original legislation on the matter.

My preferred option is for retention, reform and improvement, which is what new clause 2 seeks to provide. It would give the Government a breathing space in which they could make proposals to improve and reform the existing structure. In no way do I support the Government's proposals, because they would not lead to the independent integrity of the complaints procedure and of the organisation for patients remaining intact.

Unfortunately, I am not confident that the Government are prepared to reconsider at this late stage and to abandon what they have been seeking to use their large majority to ram through Parliament. However, I know that some Labour Members will not be bamboozled into supporting such a Government poodle. When we discuss the other new clauses in the group, it will be interesting to hear the comments of other Members to hear precisely what their proposals intend to do.

The Government are making a great mistake and they do themselves no credit by sticking rigidly to their plan to ram clause 20 through the House tonight. I only hope that the other place gives careful consideration to the issue and to the comments of Members on both sides of the House. With its expertise and role as a revising Chamber, I hope that the other place will try to bring some common sense to the Government on this issue.

Mr. David Hinchliffe (Wakefield): I wish to speak to new clause 5 and to its consequential amendments. It is worth making the point that all three main parties, as well as the Independent Member, have signed up to the new clause and that a number of outside organisations believe that it is the appropriate way forward. We have backing from the Patients Association, the Consumers Association, Age Concern, the Association of Community Health Councils for England and Wales, the Royal College of Nursing and several other important national bodies.

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I shall briefly sum up the purpose of the new clause. I do not wish to speak at length, because the issue has been rehearsed several times in this Parliament, including on Second Reading, and in the last Parliament before the general election.

I have always been concerned that, since the inception of the national health service in 1948, there has been a lack of sense of ownership of the service by its users. It has been a challenge for successive Governments to address that question, and I am not sure that we have yet come up with a coherent solution. I have always been concerned that there has been a consistent lack of democracy in the NHS, particularly at a local level.

I have favoured a role for local government and I have been very conscious that the democratic deficit has been maintained by the concern of certain professionals—particularly in the medical profession—to obstruct what they regard as the political control resulting from politicians and elected people asking questions about the direction of the service at a local level.

Community health councils were advanced in 1974 as the patients' voice. I had the privilege of serving on a CHC from 1974, and was vice-chairman of one for many years before I became a member of the local health authority. It is fair to say that CHCs have had variable success. In some areas, they have done a first-class job in representing the interests of patients but, in others, they have been less effective.

6.45 pm

I do not accept the statement of the hon. Member for West Chelmsford (Mr. Burns) that the Government do not like opposition and that their motivation for removing CHCs is the result of that. I believe that there are sound reasons for re-examining a system that since 1974 has, in some respects, served us quite well but, in others, not as well as it should have done. The time has come for reforms and I support aspects of the direction in which the Government are moving.

The previous Parliament considered the Health and Social Care Act 2001 and I recognise that it contained a number of positive elements. I certainly commended them at the time. I have always believed in an important role for local government, so I was very happy that the Government came up with the idea of having overview and scrutiny committees based in local authorities. They were given the power to object to key changes in policy, such as closures, and have the statutory function that CHCs have traditionally had.

I was always concerned that CHCs, as constituted, did not have a democratic mandate. Local authorities have such a mandate and are accountable to the electorate. Therefore, on issues such as closure and change of use, the local democratic system should play a major part and people should be able to express their views.

I also supported the idea of patient advocacy liaison services—PALS. The revised idea for PALS to be based in trusts to deal with complaints is a good one. I was in my local primary care trust only yesterday and saw the PALS organisation very well signposted. People can go there to seek advice and support, and I welcome that.

I also supported the proposal for patients forums. My concern was that there would be a need to examine the level above those forums in the local health economy,

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which is why we had an important debate on patients councils when we considered the Health and Social Care Act 2001. In a sense, we return to that debate tonight.

I believe that I had an agreement with the Under-Secretary's predecessors in the Department of Health before the election to include some positive elements of CHCs in the new framework. My slight concern, however, was that, when my amendments were discussed in another place, the Minister in the House of Lords gave a somewhat different version of patients councils than I had proposed in the Commons. Hon. Members who had followed the debate recognised that the emphasis was different in the two Houses, which is why it was difficult to get the proposals through the Lords.

I warmly praise the Under-Secretary's role, because she has gone out of her way to listen to those of us inside the House and elsewhere who have serious concerns. She has worked long and hard to come up with a solution that will come as near as possible to meeting my concerns and those of other hon. Members. It has been a pleasure to work with her, because she has genuinely tried very hard to find a solution. We are inches apart, but those inches are extremely important. Therefore, I wish to expand on the issues on which there is a slight difference between us.

The positive changes in the Bill include the creation of the Commission for Patient and Public Involvement in Health. I spoke at length to my hon. Friend about this issue last summer and I recognise that she has a passionate concern to engage in the health service disadvantaged groups and those who never had a say about their local health care. As she knows, I occasionally visit her constituency to watch rugby league and I am aware of the problems that it faces. I know that she wishes to engage in the health service people who were not previously involved in any way.

I welcome the fact that the commission will have an enabling role, will be involved in developing a public voice and will be concerned with those who have no voice. In the last Parliament, I made the point that the main users of the NHS in my area were young women with children, and they have no voice. The main users are not engaged with the health service in any way. I recognise the need to encourage that involvement and to listen to people with first-hand experience of the problems that they face.

I welcome my hon. Friend's proposal for a common badging system—I hope that it is taken a stage further. If we have a symbol that is known nationally and locally, people will know where to go to have their voice heard in the NHS. That idea could extend to advocacy.

I shall briefly list my key concerns about the Government's proposals. I am worried that the system is too complex and that many people will not understand it. I mentioned on Second Reading that I did not fully understand it. Although I now have a better idea of what the Minister is trying to achieve, I still believe that the system is over-complex and that it needs to be simplified.

The fragmentation of the separate patients forums also concerns me. They will focus on the individual work of their trusts and, as I said in a debate in the last Parliament, we need to look beyond that because it is too narrow. I am also worried about the lack of independent back-up and support for patients forums. They may well have to rely on the trusts that they are deemed responsible for monitoring.

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In the last Parliament, the Health Committee examined adverse incidents in the NHS and the complaints system. In respect of serious complaints, it thought that independent advocacy, which is a stage beyond the PALS role, should be based within the CHCs. The patients councils that I propose should also have a role in the structure, and the monitoring and scrutiny of forums should be linked to the advocacy function.

New clause 5 and consequential amendments would ensure that patients councils were included in the Bill and that they were made up of forum members so that they offered an overview of local health issues, because that is lacking. I accept that the Minister made it clear that she expects the commission's local networks to do that job, but members of patients councils of individual forums need to be able to get together to look across the local health economy. The Government do not propose that, although I think that my hon. Friend said that it will be encouraged.

I want patients councils to be serviced by the commission's local network. The secretariats would comprise the commission's local networkers so that national standards are linked to the local priorities set by patients councils, which are close to the grass roots and patients' concerns.

Finally, the Health Committee envisaged basing the advocacy function within patients councils, which would give a consistent and easily identifiable base for that work. I hope that the badging system can be applied to that so that people are clear about where they need to go when they have serious problems.

I do not want to say much more because we have rehearsed these arguments several times and most hon. Members are well aware of the issues. I hope that my proposal would provide a unifying structure of lay people at the level of the local health economy, offering an overview of that economy that is lacking in the Bill. My hon. Friend the Minister implied that she will try to bring that about by regulation. I am afraid that I have been in this place long enough to have heard similar offers by numerous Ministers in different Governments. This is not meant as any disrespect to her, but I want that provision written into the Bill. I hope that even at this late stage the Government will accept my proposal.


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