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Mr. Tom Harris: For the purposes of clarity, it would be wise to point out that, in Committee, the Lords voted for the abolition of community health councils, with a Government majority of 27. That was not made clear by the Conservative spokesman.

Dr. Harris: That is an intervention for the Conservative Front Bench. Some time ago, my party accepted that we should fight on for patients councils—the amendment tabled by the hon. Member for Wakefield has had our support throughout. We want to fight now for what patients councils provide; otherwise, we will just go round in circles. We cannot hold out time and again for the identical amendment in the House of Lords. I stress that unless we are satisfied on specific issues, there will continue to be opposition—it does not matter how strong; it will still be voting opposition—to the position that we have reached.

The hon. Member for Wakefield has been described as a grave-digger. Today, in his absence, he is more like the spectre at the feast. I accept, of course, the Government's assurances that the debate was not timed to coincide with the hon. Gentleman's absence. We had a helpful contribution from the hon. Member for Ilford, North, who I know has been working with the hon. Gentleman in negotiating with the Government. There is not much value in asking whether he went of his own accord; I am sure that he did.

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The hon. Member for Wakefield did not write to me to express his views before he left, although I know that it was a last-minute decision. The letter that he did write has not been published, and the hon. Member for Ilford, North hinted that the hon. Member for Wakefield did not agree completely with the Government's proposals. I probably share that lack of agreement.

Linda Perham: I said that my hon. Friend the Member for Wakefield was not entirely happy, as we would clearly have preferred the patients council model. However, the Minister has read out my hon. Friend's letter, and hon. Members can judge what he means from what the Minister said.

Dr. Harris: I accept that the Minister read from the letter. I do not suggest that she misread the hon. Gentleman's words, but I do not see why it should be a problem for the letter to be seen in its entirety and context. Although my party will make its own decision, it is useful to be informed by someone who has been involved in negotiation of the issues.

Let us consider some of the specific issues. Many of the functions proposed in the patients council model are delivered by the series of Government amendments. I put that on the record. When we are trying to persuade the Government to change their view, it is not helpful to hector them for doing so. We welcome the Government's proposals. That is how the two Houses work well, and how pressure from the Government's side works best. Even if it does exclude the Opposition parties, such negotiations bring progress to the public forum. There are, however, a number of objectives that have not yet been delivered by the amendments. I hope that in her response, the Minister will indicate that there may be some flexibility.

The Association of Community Health Councils for England and Wales, to which I pay tribute, has been up as late as all of us, dealing with the late amendments from the Minister. It is a remarkable feat of her office to have delivered vaguely competent amendments in such a short time, given that negotiations were still taking place on Tuesday. In a briefing sent to hon. Members on 17 May, the Association of Community Health Councils set out why it liked the patients council option. There are various criteria on which the association based its case for patients councils.

One criterion was integration and simplification. It is not clear that that criterion has been met fully, but the abolition of the local networks of the Commission for Patient and Public Involvement in Health helps to meet some of those concerns.

Another criterion was less bureaucracy than currently exists. I accept that there are arguments on both sides, but it is not clear that the proposed system is less bureaucratic because of the imbalances created by different types of patients forum of different sizes. The Association of Community Health Councils wanted a one-stop shop. The primary care trust patients forum provides almost all the aspects of the one-stop shop. Again, I put on record my gratitude for the progress made in the Government's amendments on that point.

A further factor was local credibility and accountability. To a certain extent, that relies on paid staff within the organisation. The theory of local networks and

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volunteer-run patients forums did not have that credibility, let alone the accountability. The fact that there will be staff for the PCTPFs—I agree with the hon. Member for Ilford, North that we need a better word, and as the Minister has had plenty of practice at coming up with new words I am sure that we will make progress in that respect—will provide more credibility.

The Association of Community Health Councils argued for a powerful, independent voice for local people. I am not convinced that the forum, as the Minister envisages it, delivers that, and I still fail to understand her distinction between the patients forum and the community health council or patients council model, in terms of allowing people to speak, rather than being spoken for. I have never understood what the hon. Lady meant by that.

What people want locally is for their view—their agreed view, if necessary—to be transmitted. The outcome is more likely to be a talking shop if people simply give their view, and no agreement is reached about the way forward by whatever body. I am sceptical about what the Minister said, particularly as she then said that there will be representatives—not people from, but representatives—of local health interest groups on the PCT patients forums. That is welcome, but it is inconsistent with her approach. I question whether it is a legitimate basis for her opposition to the patients council approach.

Another part of the case for patients councils is the need for an overview of health issues and services. That depends on whether the area governed by the primary care trust patients forum is large enough to provide an overview; otherwise it will merely provide a bottom view of a part of it. There is a major concern that when the Government think about PCTs, they are thinking about London, and not, as the hon. Member for Bedford (Mr. Hall) said, about shire counties and the size of PCTs there.

Bob Spink (Castle Point): Does the hon. Gentleman agree that under the current proposals, which lack overall integration, there would be no body to examine the impact of health issues on a local community?

Dr. Harris: There is the oversight and scrutiny committee of local authorities, which the Government introduced, but that does not represent the patient voice directly. That is why the patients council used as its base in terms of the local health economy, to quote the phrase coined by the hon. Member for Wakefield, the oversight and scrutiny committees of local authorities. That was a much better way of tackling the problem. In shire counties, there would be a county-sized overview and scrutiny committee, and a patients council or larger patients forum, which would benefit from the economies of scale, but would have the critical mass of expertise and be able to take a proper overview.

I shall be more specific. In Oxfordshire, there are a multitude of PCTs, so there will be four, five or six—who knows?—primary care trust patients forums with an interest in Oxfordshire, whereas at present there is one community health council that does a very good job, not just because of the people who serve on it, but because it is big enough to take an overview, with the one large acute trust in the county. It would be bizarre if there were five PCT patients forums with a wide remit and one acute

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trust patients forum that was subservient to them. That sounds like five chiefs and one Indian. It would be top-heavy and overly bureaucratic. It would be better to have a structure based at county level, which is where the overview and scrutiny committees work. That works well in London, for example, where PCTs are larger and often coterminous with local authorities.

The Minister should perhaps consider a scheme to allow the merging of PCT patients forums where that is supported locally. They could have a duty to consult on mergers, which would offer local people the structure that they want and would fit well with local authority scrutiny. The Minister knows that we supported the Government's proposals in the Local Government Act 2000, which provided for that function, but setting up multitudes of non-coterminous PCT patients forums is not joined-up government. If the Minister can make some concession on that important point, I might find more to commend in the amendments.

6 pm

There are currently about 180 CHCs and some 150 overview and scrutiny committees. The functions performed by CHCs include oversight and the reporting of concerns, and they have the resources, the secretariat and the research capability to perform the necessary investigations. Placing those functions with local authority overview and scrutiny committees would maintain the critical mass necessary for effective performance. Placing those functions with 300 or so PCT patients forums will multiply bureaucracy and increase costs. The Government claim that resources will be provided, but the House has an interest in ensuring that whatever resources are finally decided—we can argue about quantum—are spent as efficiently as possible. That could be achieved most efficiently through patients councils, or larger patients forums, operating at local authority level. The area covered should certainly be bigger than the chunks of shire counties that patients forums will cover in my area and others.

I have several detailed points to raise on the amendments, but I know that other hon. Members wish to speak. I hope that the Minister will accept interventions when she winds up the debate. I cannot at the moment support the Government's motion to disagree, but I recognise that we have made some progress. It would be wrong to fail to recognise that the provisions have improved in terms of function, but the structure is not yet right and some issues remain on resources. I hope that the Minister will express a willingness to negotiate both in the Chamber and outside on some of the specific points that I have made.

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