NHS Reform & Health Care Professions Bill

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Dr. Murrison: One chief concern that might arise, but which is not covered in the Bill's summary treatment of the responsibilities and powers of patients forums, is confidentiality. My hon. Friend rightly alluded to the probable make-up of patients forums, and although I am sure that they will consist almost exclusively of people of great probity and integrity, those people will nevertheless have the right to rifle through sensitive and confidential material if their responsibilities are not adequately defined. That is true not just of general practitioners' surgeries but, potentially, of sensitive areas in hospitals. The general public have a right to expect that that confidentiality be guaranteed, yet the Bill as drafted makes no mention of that.

Mr. Atkinson: My hon. Friend has expanded on the concerns that I have raised, and they do seem alarming. During consideration of clause 15, the Under-Secretary discussed membership of patients forums, but we were given no real clue as to their composition, even though we are granting such people considerable powers.

Mr. Heald: My hon. Friend may recall that, in the previous sitting, the Under-Secretary said that the people who will make up patients forums will differ in kind from those who make up CHCs, so it sounds as if the forums will not consist of the great and the good. The Under-Secretary should say whether she is contemplating that forums will consist of those who do not necessarily have an established reputation for, say, local community service. What exactly does she have in mind?

Mr. Atkinson: It is essential that the Under-Secretary answers that question. It is not just doctors' surgeries or the offices of primary care trusts and local councils that could be affected; the records of private hospitals, for example, could be turned over. My hon. Friend the Member for West Chelmsford raised the somewhat fanciful but nevertheless important point that the provision could apply to a hospital in France that provides patient services to the UK. I doubt whether it could in practice, given that our courts have no jurisdiction there. However, private hospitals and perhaps drug companies could be invaded—if that is not too strong a word—by members of patients forums. I find that incredible.

The regulations that the Secretary of State conferred on the Commission for Health Improvement through the 1999 Act presumably give some clue as to the regulations that will be granted to patients forums. They are draconian. They confer the right, in this case on the commission, to inspect premises at will. They do not consider the question of an appeal, or the need to obtain a warrant from a magistrate to prove the necessity of entering a premises. Section 23(4) of the 1999 Act states:

    ''Any person who without reasonable excuse obstructs a person authorised by the Commission . . . is guilty of an offence and liable on summary conviction to a fine not exceeding level 3 on the standard scale.''

I forget what level 3 is, but members of the Committee who are lawyers will no doubt be able to advise us on that.

That right comes with the power of prosecuting, convicting and fining, for example, a doctor who resists when a patients forum representative wants to enter and search his premises and take away letters and patients' files. As far as I can see, there would be no requirement for such a representative to explain why they wanted to make such a search and to obtain permission.

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Why do they want to turn over this pharmacy? Why do they want to enter this drug company? Even people who provide services such as meals for patients could have their factories raided. There is great potential for infringement of personal and civil liberty.

Mr. Heald: I have now found the reference: the Under-Secretary discussed having a varied group of individuals on the patients forum including representatives of the ''travelling community''.

Mr. Atkinson: I do not want to be attacked for being racist, but is the Under-Secretary seriously suggesting that gypsies should be given the power to raid doctors' surgeries? It is fantastic, and although I am sure that she will try to reassure us, she has not had the courtesy to bring the regulations before the Committee to allow us to see how the power will be exercised. She should do so, because this is a serious piece of legislation. It is the Committee's duty to examine the diminution of citizens' liberties, and she is not giving us an opportunity to do that.

Dr. Richard Taylor (Wyre Forest): I am incredibly confused. I thought that the amendments sought to widen forums' access to include prisons, which I heartily support. However, we are discussing restricting access because of the risk to confidentiality, which is something that must be taken in account. I expect that the Under-Secretary can reassure us on that, but as things stand I need to vote for both the amendment and the clause.

Mr. Heald: I echo the point about the regulations and the requirement that they be made. It is unhelpful that we have not seen the draft regulations, particularly as it is suggested in later Government amendments that a wider group of bodies than that which appears on the face of the Bill should be covered.

We must also know whether patients forums will have the ability to carry out the work that the regulations might contain. Another concern is whether patients forums will have an adequate budget to enable such inspections to take place. I recently asked a parliamentary question about the budget for patients forums, and I received the answer that that was still under discussion with the Treasury. We know that community health councils spend about £23 million a year, and this year an extra £10 million has been provided to set up patient advocacy and liaison services, but that was a one-off payment.

The estimate of public sector financial and manpower effects in explanatory note 191 states that

    ''the creation of Patients' Forums in each Strategic Health Authority will require some increase in public expenditure. This will be partly offset, however, by the funding allocated to CHCs and Patient Advocacy and Liaison Services (PALS) which totals £33 million.''

We must bear it in mind that £23 million of that is the on-going revenue budget of the community health councils, whereas the £10 million allowed for patient advocacy and liaison services was a one-off payment to set them up. Primary care trusts are concerned that there is no funding for PALS, and they are worried that they will have to find the money for the patient advocacy and liaison officers out of their budgets.

The Secretary of the State is not committed to make regulations, we have not seen any draft regulations although we were promised them and there is no budget for the entry and inspection of premises. Is this just window dressing as part of the Government's overriding aim to silence the independent watchdogs which have been showing the true state of the national health service in England today through documents such as ''Casualty Watch'', which shows how many people are waiting on trolleys, and the evidence that my local CHC produced on hospitals in my area? The excellent study on cleanliness at the Queen Elizabeth II hospital in Welwyn Garden City sparked a controversy, and my Labour opponents accused me of scaremongering when I referred to the CHC report in the run up to the most recent general election. The same CHC pointed out that the local health authority grossly overspent; when I mentioned that, I was again accused of scaremongering. Now we find out from the reply to my parliamentary question that my local NHS trust has hugely overspent. The Commission for Health Improvement toured my local hospitals and gave them no stars. The CHCs raised the alarm to show the true position, but they will be silenced.

Andy Burnham (Leigh): A moment ago we heard a revealing contribution from the hon. Member for Hexham (Mr. Atkinson) when he used the phrase, ''I am not racist, but''. Before the hon. Member for North-East Hertfordshire concludes his remarks, will he let us know whether he agrees with his hon. Friend, and can we take that contribution as reflecting the Conservative approach to patient involvement in the NHS?

Mr. Heald: The hon. Gentleman may have misunderstood the important point that my hon. Friend was making.

Andy Burnham: Does the hon. Gentleman agree with it?

Mr. Heald: Let me answer the point—I am never reluctant to answer questions. ''Who will be appointed to the patients forums?'' is a legitimate question. I have the consultation document, ''Involving Patients and the Public in Healthcare Discussion'', paragraph 5.3 of which talks about

    ''independent bodies made up of patients and others from the local community, with extensive powers to inspect all aspects of the work of trusts.''

That does not tell one much about who is to be appointed. Given my support for CHCs and their work, I was alarmed when, in the previous sitting, I heard the Under-Secretary discuss not having the sort of people who have traditionally been on CHCs on the patients forums. She said:

    ''We must also go out and find people, so that we do not depend on the normal people who can come forward.''—[Official Report, Standing Committee A, 4 December 2001; c. 250.]

She made the legitimate point that we need to recruit more people from the black community—I agree with that—but went on to talk about the travelling communities. There may be some valuable members of the travelling communities who could do useful work on patients forums.

Andy Burnham: Probably not, though.

Mr. Heald: I did not say that. The sorts of people who served on community health councils wanted to give public service and had time to do so. Many of them knew about hospitals and health care. For example, the CHC in East Hertfordshire includes people who have inspected the Queen Elizabeth II hospital year after year, and there are people in North Hertfordshire who have inspected the Lister hospital year after year. They have a collective memory going back for many years about what those hospitals are like. They know where to look when they inspect hospitals, and it will be a pity if they cannot continue to play that role.

The Under-Secretary may just be trying to sound inclusive. However, I am afraid that she means that people who know all about health in a local area are to be turfed out, so that we end up with people who know nothing much about what goes on in hospitals.

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Prepared 6 December 2001