NHS Reform & Health Care Professions

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Dr. Harris: I am finding this Committee stage rather a metaphysical experience because we go from broad generalisation about the need to involve people and the forces of reaction to the citing of the fact that there is something in the existing legislation surrounding CHCs—or something in the water that they drink—

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that restricts them to second Mondays and third Tuesdays. I find this whole debate surreal. I want the Minister to address the argument, which I tried to make constructively in my opening remarks, that there is no reason why all the powers and new models, systems and, presumably, meetings in the ether rather than at a specific time cannot be used by reforming, not reacting to the existing system.

Ms Blears: I have tried to explain to the hon. Gentleman that his proposals to—as he says it—reform simply tinker with the system at the margins. They do not reflect the new shape of the NHS or that, as I have said we shall have PALS on the spot in the trust. We shall have patients forums inside the trust, levering up standards and quality. We have already transferred the legal duty to refer contested reconfigurations to the local authority over the scrutiny committee; that is one function that has already gone. We shall have the Commission for Patient and Public Involvement in Health, specifically charged with being the grit in the system to bring some rigour and ensure that we involve a wide range of people—whose voices have traditionally not been heard—in shaping the way that our health service develops. It will be a statutory body, whose job it will be to go out and create community capacity, to find the people, to populate all of these mechanisms and to ensure that those people can have a real say and make a real difference to the way that the health service works.

It is not right simply to reform the status quo. What is needed is a completely fresh look at the system. The best CHCs were doing some of that good work. We want to set up a new system that reflects the way in which we are devolving power to the PCTs—a system that ensures that patients and the public have a say at every single level within the system, that they are properly empowered to make a difference. There is nothing worse than asking local volunteers—I readily acknowledge that many members of CHCs have given 10, 15 or 20 years of fantastic voluntary work—to go on to bodies without the necessary back-up, training, education, support and guidance to enable them to feel that they can make a real difference in the decisions in which they are asked to participate. That is the type of system that we want to set up. We want to create a band of really active citizens who are able to shape the health service that they pay for as taxpayers—and long may it remain so—and therefore deserve to have a real say in shaping.

Dr. Murrison: We have heard about these armies of volunteers who will spring up and populate patients forums, PALs and everything else. Those of us who have experience of the voluntary sector and specifically of CHCs know that it is extremely difficult to get people to volunteer for them. I would be fascinated to know where the hon. Lady will get this army of volunteers to populate her new bodies.

Dr. Harris: The Wirral.

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Ms Blears: No, they will not, they will come from their own communities and they will come because they will feel that they can make a difference. The one thing that motivates people to become involved in public sector activity or service is the feeling that the two or three hours a week that they have to spare is being put to good use. They want to feel that they are not sitting in meetings dealing with correspondence, apologies and matters arising, but are making a difference to the health service.

I shall give the Committee an example. Recently I visited Somerset and saw independent health panels at work. People are asked to serve on them completely at random, so it is a varied group of individuals, and they sit on the panel for three years. They learn the ropes in the first year, engage in the issues in the second and are mentors for the new first-year people in the third. It is independently facilitated and all the decisions in the health community are referred to the health panel for consideration. At the end of the sitting, the panel has a matrix to show which proposals were changed as a result of its consideration.

During the period that I was told about, the panels had made a difference in 72 per cent. of issues. The members of those panels told me that that was why they wanted to be involved. They did not expect all the suggestions that they made to be adopted, but they realised that their two hours a week could make a difference to shaping the health service. That is not about sitting in static meetings, but about being engaged because members consider that the national health service is important, care enough about it and have the experience.

Half the people on patients forums will be recent or past patients and the other half will be voluntary sector organisation representatives. If they can examine a particular task or service—maternity, urology or coronary heart disease services, for example—that will engage people. We must also tell people that we value them and ensure that they are compensated for time off work. We must ensure that they can find the next step in their voluntary activity, and that we give them training, education and support to bring them through the system. We must tell them that their voluntary work is valuable and that we want to draw on their expertise, knowledge, talents and potential. We must also go out and find people, so that we do not depend on the normal people who can come forward. We must ask whether we have anyone to represent the black or travelling communities. Is anyone speaking for the homeless or young people?

In my constituency, we recently consulted people with Alzheimer's. People would say that we could not consult those with Alzheimer's, but we did. It is hard work, but if we are determined we can go out and do it. That is how we get volunteers to take part: value them, bring them forward and make extra efforts to bring them in. That is why we must be creative. Simply moving amendments that ask for the status quo is not the way forward for our health service. It does not value people's contribution and put them on the inside of the system in the patients forum, where they can make a difference, and tell the trust board that

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something is wrong and that they want something done about it. They can call people to account and drive up the quality and performance in the health service. That is why patients forums are crucial to the measures that the Government want to put in place, and that is why I ask all hon. Members to resist the amendment.

Dr. Harris: As a Committee member asking the Government not to do something, I feel like the sole patient or public voice on one of the new boards. Will the Government suddenly be so cowed by such a volunteer that they say, ''Of course, we are wrong. The fact that you are here as a representative of a patients forum and not a community health council means that our historic approach to ignoring, if we have been ignoring, patient involvement has been entirely wrong''? I suspect that the majority of board members who are supposed to jump to the voice of the lone volunteer will behave like the Government in Committee today. They will not really address the concerns that have been raised—any more than the Under-Secretary has today—but merely restate mantra-like the fact that things must change.

I invited the hon. Lady to explain why community health council-type organisations had to be abolished rather than reformed. That was my challenge. I put it to her that the fact that they were variable did not mean that, with all the powers of legislative change, the Government could not impose minimum standards and issue guidance to ensure that that variability did not exist. The Secretary of State is rather good at making regulations and, if practice makes perfect, he should be getting better, although I am not too sure about that. The Under-Secretary has not addressed my challenge.

7.15 pm

I cited the hon. Member for Wakefield because he asked, as I did, why the focus of community health councils cannot not be created around the new communities if the Government believe that those councils do not have the relevant powers or shape, or why they cannot change their names, if the Minister thinks it appropriate. Why can those councils not have the necessary functions once other organisations have been set up? Why can there not be reform and evolution, which the Government use as a defence, in the Bill?

The Government do not say that they will abolish all hospitals when some hospitals under-perform. They do not abolish a position when some people are not doing a job especially well or do not have the relevant powers. They defended their action on that basis when they did not abolish general practitioners, but gave them the powers to commission. That has also not been addressed. When hon. Members of either House come to consider the issue, it is important to stress that the Under-Secretary has not dealt with it.

The Under-Secretary says that the system is coherent, and cites in her defence what appear to be her own deeply held views, which one CHC seems to endorse. That is little more than the power to aver that something is so. She claims that when PALS are set up,

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when scrutiny committees exist, when there are patients forums in every hospital or members of those forums on the trust board, all that would be left would be an empty shell once the other functions had been given to the reformed CHCs. I believe that those CHCs could be the bodies with a member on each trust board.

I invited the Under-Secretary to consider the list of powers that the amendments would still leave with those reformed CHCs, which she describes as empty shells with nothing valuable to do. I also invited her to consider the inclusion in councils' annual reports of details of the arrangements maintained in that year that pertained to the views of patients, carers and the wider community. [Interruption.] The hon. Lady is arguing from a sedentary position—a point that she made, in fairness—that patients forums will have that role. She has not addressed my question about the Government's need to create a new structure when the existing structure could use the experience and enthusiasm of the people already involved—[Interruption.]—because they have been through a lot recently—

 
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