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Dr. Evan Harris: I am listening closely to the hon. Gentleman's thoughtful contribution. I know that he is asking questions about what the area should be, but whether it is patient councils or local networks coming from on high in the commission, does he accept that there is a strong argument for ensuring that the area is generally the area covered by the relevant overview and scrutiny committee, to enable co-ordination with the scrutiny function?

Mr. Hall: That should be the largest geographical area covered by the replacement co-ordinating body. I have some questions about that, but I shall not take up the time of the House. That proposal would be logical, but in some instances the area covered might be too big. Communities do not necessarily fall entirely into one county council area, for example. It may be necessary to split that into smaller areas. I would certainly argue for that in the case of Bedfordshire, but I did not intend to bring that into the debate, as I do not want to complicate it. The matter has been far too complicated, and for far too long. We need to come to some clear conclusions, preferably today, and not wait for the other place to deal with it.

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I understood that the local networks would be established to carry out the local overview, co-ordination, support and integration work that many of us said was missing a few months ago. The Government acknowledged that and brought those functions back in. However, I am now not sure about that. I understand that the Government intend to create a locally based collective voice of patients forums, which could well be another body, in addition to the network—another body that will need to be resourced in order to function. That is the impression that I got from the briefing that was made available. It states that in black and white.

I understand that it is intended that the additional body that will be the collective voice of the patients forums will be underpinned by legislation, forcing patients forums to work together and forcing the networks and the wider commission to listen to the outcome of the deliberations of the patients forums. My questions are intended to be helpful and constructive, and to tease out these matters so that we can be clear and move on. I am not clear about the matter, and I have tried to follow it over recent months. The Government have had plenty of opportunity to remove all doubts, but I still have serious doubts.

New clause 5 has the advantage, at least, of being robust and clear. It provides a simple mechanism, which, last autumn, I thought that the local networks would fulfil. If that is the case, let me be persuaded. If my hon. Friend the Under-Secretary is to respond to this part of the debate, and if she does not want the House to accept new clause 5, she will have to explain clearly why. She will need to describe how the system will work and give an example of how it will work on the ground somewhere; otherwise these matters will continue to confuse. If we are confused at this stage in the legislative process, that could make matters far worse months and years down the line. We need the plan to work on the ground, with real people. It is time for us to move on to a better system. I urge my hon. Friend to help us to do that.

Mr. Peter Atkinson: I am grateful for the opportunity to follow the hon. Member for Bedford (Mr. Hall) in our short debate. He has made well a number of important points that have been worrying people, including members of the community health council in my constituency. We are moving into unknown territory, and at this late stage of the Bill, we still do not have answers to those questions. The hon. Member for Wyre Forest (Dr. Taylor) asked the most cogent question—why the Government are proposing such a system. We have had no proper explanation of why we need such a complicated change. I hope that at this late hour we will get an explanation from the Minister.

Rather more years ago than I care to remember, I used to be a member of something called an area health authority. Those were abolished, but seem to be coming back in a slightly different guise, called a strategic health authority. I remember only too well how our hearts sank when members of the community health council rose to speak. They were a thorn in our side. They discharged their job extremely effectively, and after a time we began to respect them for the way that they worked and their dedication to their job.

It is true that not all CHCs are perfect. Some were undoubtedly poor. My hon. Friend the Member for West Chelmsford (Mr. Burns) made our position clear. We are not against change. The hon. Member for Wirral, West

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(Stephen Hesford) seemed to think that we were going backwards and arguing for the status quo. We are not doing that. We argue that we should build on a good foundation, which the community health councils provide. Let us make changes, rather than throwing them all out.

The patients will be left with a confusing plethora of patients forums. In Northumberland we are to have one primary care trust, but in County Durham, for example, there are to be six PCTs, and each one will presumably have a patients forum. We will have an ambulance trust and a mental health trust, and I understand that the county council and the NHS are getting together to provide a community care trust, which will take over the functions of the social services department and merge them into one trust.

Even now it is hard enough to involve patients in the affairs of the NHS. The attitude still prevails that treatment from the health service is some sort of privilege, and that one should be grateful to be seen by a doctor. Increasingly, patients know that if they have a complaint, they can turn to the community health council. Citizens advice bureaux and others will point them in that direction, but patients will have great difficulty in finding their way through the maze to the appropriate patients forum.

Stephen Hesford: Is not one of the strengths of the new system its location in the places that patients use? One of the downsides of the old system—perhaps the hon. Gentleman and other hon. Members share my experience in this respect—is that if we were to go into the street now and ask a British citizen whether they had heard of a community health council, they would say no. [Interruption.] That is my overwhelming experience. People have not heard of CHCs after almost 30 years.

7.30 pm

Mr. Atkinson: I take the hon. Gentleman's point, but I must disagree. There is more chance of people finding community health councils than patients forums. If he thinks that the system would be improved by placing representatives in the major hospitals, ambulance stations or wherever else, the community health councils can consider that proposal. As we are proposing to reform CHCs, the suggestion is certainly worth discussing. I do not rule it out, but I must restate my view that we will lose a great deal by abolishing CHCs, which are independent and can build up a considerable body of expertise over the years. They know the health service in the areas that they serve, but we will lose that expertise, which is a great pity.

Northumberland community health council, which serves my area, has written asking me to support new clause 5 if the Opposition's proposal fails. It points out that it has dealt in the past 12 months with complaints about the health service from 178 patients in the county. That shows how much good work it does. The health service is going through another revolution as a result of the Bill and other legislation, so it is completely daft to abolish the patients organisation when it will probably be most needed and to introduce a new system that is untried and unclear at a vital time for the health service.

I want briefly to speak to amendment No. 73, which stands in my name and relates to patients forums and their power. We had a small debate in Committee about the

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matter with which it deals. My concern is that the patients forums are being given extreme power. In particular, they are given the right of entry into premises. All of us need to be guardians of our freedom. In that context, I cannot see any reason why members of a patients forum should have a compulsory right of access to health service premises, including the surgeries of doctors and pharmacists. My constituency has doctors and pharmacists who work as sole practitioners and operate from their homes. The pharmacists live above the shop, so to speak. The powers in the Bill give patients forums a right of entry into such premises. My amendment seeks to specify that the power should not extend to the living quarters of doctors and pharmacists and I hope that the Minister will be reasonably helpful in that regard.

I cannot see any reason why patients forums should have such powers and I would be grateful for some explanation. Can the Minister imagine a doctor saying "In no circumstances can you come into my surgery" to members of patients forums who are seeking an appointment to make a visit? In the rare event of that happening, the Commission for Health Improvement could use its powers of entry. Surely that is sufficient.

Lynne Jones: Surely, patients forums should have access to areas to which patients themselves have access.

Mr. Atkinson: Yes, but they should not have compulsory powers. I am sure that the hon. Lady cannot imagine why they would need the powers. Why do they need a right of entry? It is inconceivable that a hospital or any other health body would say "You can't come in" to a patients forum. Why must we give patients forums draconian powers, giving lay people a right to rummage through the private possessions of a doctor or pharmacist? The hon. Lady shakes her head, but it is true. The powers in clause 16, which deals with entry and inspection of premises, allow the Secretary of State to make regulations giving the right and power of entry. We need to be aware of people's civil liberties. As I said, if entry is refused, the Commission for Health Improvement, which has the appropriate powers, can enter the premises if it is believed that something serious is happening.

I hope that the Minister will consider amendment No. 73, as I think that Parliament has a right to protect the rights of individuals. They have been sorely hammered in recent months, and this is one occasion when we could avoid hammering them even more.


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