NHS Reform & Health Care Professions

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Dr. Harris: There are many reasons why Wales has a different system. First, the Assembly has a system of proportional representation that allows partnership government. Secondly, there is partnership government, which means that matters are not decided in the politburo negotiations of a single party. Thirdly, at least one party in Wales—possibly two—is concerned about the exercise of local democracy, democracy in the health service and adequate patient and public oversight, and seeks to retain the CHCs on that basis.

Mr. Burns: The hon. Gentleman's figures are wrong. There are not only two parties in Wales with those concerns, because the Conservative party in Wales also supports the continuation of community health councils. I cannot believe that Rhodri Morgan would retain community health councils in Wales if he did not believe that they should be retained. Unusually, I would give the Labour party in Wales the credit for that sensible policy. As I said earlier, I only wish that the Under-Secretary for Wales were here tonight, because he would be able not only to elaborate on the mechanics of the matter but to explain to the Committee why it is important for Wales to retain these invaluable bodies and for the English not to do so.

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Wales has got it right and the Government have got it totally wrong in England, because they cannot realistically explain why they are hell-bent on taking this action. They are making a grave error. If the proposals are approved in another place, the Government will deprive all our constituents of a service that is proven, tried and tested. It works, is independent and has the interests of local communities and their health care at heart and conducts advocacy on patients' behalf in a highly effective way.

I would say to the Under-Secretary, particularly as she is a new Minister, that she should think again, because there are ways, as the amendments suggest, in which community health councils could be reformed to meet any criticisms that the Government may have. The failings apparent to the Government, but not to many other people in the country, can be remedied. The Under-Secretary is making a grave blunder at the beginning of her ministerial career if she puts behind her her first-hand experiences as the chair of a community health council and, for narrow, party political dogma and to silence opposition and criticism, decides to go ahead with a pernicious and petty proposal.

Dr. Richard Taylor: I shall be brief, because time is short, but I must make two points in support of amendment No. 163. As an illustration, I would like the Under-Secretary to put herself in the shoes of somebody in my county. We have three major conurbations with three community health councils, so patients have to go only to one CHC for any of the services that are currently and, I hope, will continue to be, within its remit. Under the new arrangements, there will be five patients forums, and a given patient in one of the conurbations might have to consult three separate organisations. That is my first point—what a tremendous inconvenience. CHCs have all services under one roof.

The second point is about the constitution of CHCs, which include representatives from the voluntary sector who in my experience not only represent their own voluntary sphere but act as very good spokespersons for the whole community. They also include a number of elected councillors, and that introduces a democratic element. There is also a relatively small number of appointees. It does not appear that forums will be constituted in the same way.

6.45 pm

Dr. Murrison: I must say that the Bill is not exciting a great deal of enthusiasm among my constituents, but if I were to pick out an item from it that has raised a collective eyebrow it would be the proposal to abolish community health councils. CHCs have been going for about 27 years. It takes a long time for people to get used to institutions, but they have finally got used to CHCs. Broadly speaking, people know what they are and the geographic area that they cover, and they are comfortable with them. CHCs are like a pair of old carpet slippers; people have become used to them. Now, for no good reason, the Government propose abolishing them; they want to throw out the comfortable carpet slippers and replace them with

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something unknown. In all likelihood, it will be another generation before people are fully used to the change and comfortable with the replacement. Doing that with good reason is fine, but we have yet to be provided with a good reason for disposing of CHCs.

The Association of Community Health Councils of England and Wales was upset. It does not understand why the Government want to abolish it, particularly as its feedback suggests that it is doing a good job on behalf of patients, carers and the general public. It said:

    ''The proposed alternatives to CHCs, as set out in the Bill, fall far short of meeting the widespread concerns about the independence of the new bodies and their lack of integration. If the Secretary of State pushes ahead with the Bill in its current form patients will lose a respected, effective, independent health Watchdog and in its place they will get a system that is more fragmented, more confusing to the public and less independent.''

That is quite polite. A good analogy would be of poodles and watchdogs. We are losing a watchdog, and it will be replaced by poodles—lots of them. There will be fragmented poodles, poodles for primary care and poodles for secondary care.

Where is the joined-up Government in that? Surely we should have a seamless join between primary and secondary care. People do not necessarily distinguish between the two. They know when they are unwell that they need access to health care. It would be far more helpful to have fewer such watchdogs—watchdogs that will take people through the whole multi-tiered layers of the NHS, from primary to secondary and tertiary care, but hopefully not beyond that—but it should be seamless. People do not want to be bothered with multiple tiers and multiple layers. They want a one-stop shop. That is what they have now; and that is what they are about to lose.

Except for patient forums, patients lack a collective voice. The community health councils are recognised by the public as somewhere to go if they have concerns about the health service. They will be abolished. As a general observation, it seems that the Government have started from the standpoint of wanting to abolish CHCs—it seems to be a constant theme—but they have not told us why. They do not explain adequately how the functions of CHCs will be carried out under the new system. They merely present us with alternative institutions.

The notion that the Government started with the idea of abolishing CHCs without knowing exactly why and without knowing how the replacements for CHCs would carry out the functions currently undertaken by CHCs is my principal concern about the Bill.

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I am delighted to have the opportunity, under your chairmanship, Miss Widdecombe, to deal with the amendments. I hope that I can enlighten members of the Committee about the reason for the Government's proposal and that I can even convince one or two of them that the new system will be more independent, integrated, accessible and accountable and much stronger than the previous system. It will give patients a much better and more vigorous voice within the national health service—and beyond it.

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I shall now mention the amendments tabled by the hon. Member for Oxford, West and Abingdon. I shall be generous and not go through the detail of them because they would create a jumble of functions between patients forums and the commission. Many names would be changed. I did not think that the hon. Gentleman favoured style over substance, but his amendments skim the surface of the proposals rather than deal with the in-depth nature of the changes that the Government want to make.

Mr. Burns: If the Under-Secretary considers that our amendments and those tabled by the hon. Member for Oxford, West and Abingdon are poorly drafted but concedes the case that they make, surely she can allow her own fine parliamentary draftsmen to knock them into shape.

Ms Blears: The amendments are beyond being able to be knocked into shape. They fail to appreciate the nature and depth of the Government's proposal. I shall deal with their substantive nature, however, rather than the way in which they are drafted.

Dr. Harris: The hon. Lady said that the amendments would merely change names. I hope that she will accept that they would, in fact, reform the existing system, including the change of name. We should not just change names when we say that we are making reforms, but carry out the reform. I am upset that the hon. Lady has accused me of doing what the Government have tended to do.

Ms Blears: I shall not lengthen what is a fairly superficial debate, but the amendments would change names.

Mr. Burns: Superficial?

Ms Blears: The hon. Members for Oxford, West and Abingdon and for West Chelmsford—[Interruption.]

The Chairman: Order on the Opposition Benches, please.

Ms Blears: Both hon. Gentlemen have asked us to explain why we want to replace community health councils with patients forums working inside each trust. That is the key to the matter. We want bodies that are within the structures of the national health service that can really act as levers for change. We want them to drive up quality and have sufficient influence and clout within the system to make a difference for patients, and we want them to be balanced by equally strong bodies on the outside, which can effectively overview and scrutinise the system.

It is a difficult balance to strike but, in the past, the community health councils had virtually all of their powers on the outside. They often reacted after events had occurred. They were often not able to influence the shaping, the configuration and the options that were being developed about the health service. They felt that, no matter what their powers were, those powers were exercised in response to events. They were reactive organisations. I say that with some feeling, having been a chair of a community health council for several years and having often been faced with a set of

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events in which I had no alternative but to threaten legal action because I and my association had no right to be on the inside and to be party to such decision-making processes. A fundamental part of the Government's proposal is to ensure that not only patients, but members of the public have a voice in shaping the health service from the inside. Clause 15 is the key to achieving that, because it recommends patients forums in each trust. The forums will be able to work from the inside. They will have a member on the trust board. They will know what is important to patients and will be able to do something about it.

 
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