NHS Reform & Health Care Professions Bill

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Mr. John Baron (Billericay): The other point about consistency and continuity in patients forums is that if different people turn up to inspect hospitals every year or every six months, it does not make for consistency of application in terms of such inspections.

Mr. Heald: I agree, and I fear that the system that is being set up will include lots of new people, often for reasons of ''inclusion''. If they were going to do a good job, no one would support them more strongly than I. However, it is worrying if an organisation that acts as a watchdog is to lose its collective memory.

Mr. Atkinson: My hon. Friend is making a good point about continuity. The point that I was trying to make, which seemed greatly to upset the hon. Member for Leigh (Andy Burnham), was that we are giving these people a powerful weapon—the right of entry into premises—and I doubt very much whether someone of no fixed address who travels around the country is qualified to have that power.

Mr. Heald: I was about to come to that point. Let us by all means have as balanced a body as possible. However, I have seen no evidence to suggest that CHCs are not balanced, although they may have fallen down on inclusion. In many areas, certainly in mine, CHCs have done a marvellous job. I am in favour of spreading best practice, and I would be happy for my local CHC to have these powers. Indeed, I would strongly support their being able to look at all areas of hospitals. Patients forums may be set up all over the country only for us to discover that neither the way in which they operate nor the quality of people involved is uniform. That is worrying in terms of consistency.

Andy Burnham: The hon. Member for Hexham is explicitly opposed to the great unwashed having access rights to NHS premises, although they may have paid for them through their taxes. However, the hon. Member for North-East Hertfordshire just said that he is in favour of that. What is the Conservative position?

Mr. Heald: I am afraid that the bad news for the hon. Gentleman is that I had not yet come to that point. I was finishing my first point about not losing the collective memory of CHCs. I am worried that the Under-Secretary is falling into a trap, unless she is a willing accomplice to the crime. If one takes away a watchdog's collective memory by appointing a whole lot of new people with no experience, it may turn into a toothless tiger.

10.30 am

Mr. Burns: Before my hon. Friend moves on from the powerful point that he is making, does he agree that the Under-Secretary's comments during the debate on Tuesday are gratuitously offensive to many hard-working and dedicated members of CHCs, whose continuity is, as he says, so important?

Mr. Heald: Yes. The passage to which my hon. Friend refers is insulting. The Under-Secretary said:

    ''CHCs, no matter how good they are, would acknowledge that they are not fully representative of their communities. My constituency CHC is not because it is a static membership organisation that meets on the second Tuesday of the month. It tends to be self-selecting in the sort of people who can, or want to, take part. It is mainly politicians who enjoy going to meetings on the first Monday, the second Tuesday, the third Wednesday and the fourth Thursday of the month. Asking people in a voluntary sector setting to give that type of commitment is sometimes extremely difficult. We need to be more creative and more imaginative about the way that we seek to involve patients and the public in a range of public services, but particularly in the health service.''—[Official Report, Standing Committee A, 4 December 2001; c. 248.]

Personally, I think that the people in my local CHCs have done a great job in inspecting local hospitals. Year after year, in a spirit of public service, they have undertaken hard, some might say boring, work. The fact that they did it consistently did not mean that they always found things that were wrong—indeed, they tended to be quite constructive—but when that was the case it was they alone who gave the warning. The Under-Secretary may set up all her new committees: patient safety, CHI—

Mr. Burns: My hon. Friend is absolutely right about the quality of the inspection work done by those public-spirited people. However, that is what the Under-Secretary would have been saying between 1992 and 1997. It is not the people or their performance of their duties that have changed, but the fact that the Government will not brook any opposition.

Mr. Heald: Yes, it is sad that a Government with such a large majority have so little confidence in terms of allowing opposition to flourish, listening to debate and changing policies that are obviously wrong.

It is extremely foolish to set up all these other bodies and abolish CHCs, which are the bodies that overall—I accept that some did less well than others—gave the early warnings about quality and safety.

My hon. Friend the Member for Hexham referred to the approach that should be taken to entering the premises of a private individual such as a community pharmacist or a GP. When an inspection is carried out, it is important to be certain that the patients forum has good grounds for proceeding, that it is not based on the grudge of a dissatisfied person, that it forms part of a proper, sensibly organised investigation of a quasi-judicial character, and that the inspectors are the sort of people who will make a properly objective assessment of the information that they find. I wonder whether the Under-Secretary has borne that in mind at all. We have no draft regulations for the framework of entry and inspection, so there is no flavour of whether reasonable grounds will have to be given for them to be carried out. We have no hint of whether there will be even the mildest vetting of those who are to serve on patients forums. If the Under-Secretary is to go out and find members of the travelling community without assessing, in any detail, who they are, concerns will be raised.

If there are good members of the travelling community who can do a good job, we would like to know about it, but plucking people from the streets and byways of Britain would cause concern. The Under-Secretary could produce regulations that would give us an idea of how the appointments process will work, and that might tell us what she means when she talks about going out and searching for people. We would welcome that.

Mr. Atkinson: In the course of my hon. Friend's remarks, will he consider what someone who wanted to resist such a visitation could do? The 1999 Act refers to:

    ''Any person who without reasonable excuse . . . obstructs a person''.

Presumably, the only recourse would be for them to refuse entry to the patients forum, and if they did so they might then appear in front of a court and put their case as to why they had not admitted the forum to the premises. I do not know how it would work but I am sure that my hon. Friend, as a lawyer, can advise the Committee.

Mr. Heald: Of course, one way is to allow oneself to be the subject of prosecution, but that raises the concern that the citizen's position would not necessarily be protected. It will be useful to know how the Under-Secretary intends to deal with abuses of the system. If there was an unjustifiable use of the power, what would be the recourse of action for the community pharmacist or the general practitioner?

I shall now discuss whether regulations should be made on a mandatory basis. The wording of clause 16 refers to the premises being entered—amendment No. 211 addresses that. Which parts of premises could not be inspected? There may be parts of a hospital that the Government would like people to look at—the entry hall or, perhaps, a new shop—but one might be concerned that an inspection would not penetrate serious clinical areas. What does the Under-Secretary have in mind? We want to know whether we are to have a pick-and-mix, a la carte approach before forming our view of the clause.

On the subject of places abroad and those in far-flung parts of this country, a primary care trust might discover that the patients in its area are typically taken to Germany or France for treatment and that the quality of treatment there is far better than it is here. On our tour, members of the Opposition Front Bench team have been pleasantly surprised by the sheer quality on offer on the continent. Let us suppose that patients forums were concerned about the quality of treatment, or about what redress was available to patients who went to a hospital in France or Germany and received poor treatment. Would they be able to inspect premises in those countries? Does the Secretary of State envisage reaching agreements with the authorities in France and Germany to allow inspection of their premises?

Andy Burnham: Am I following the hon. Gentleman correctly? Are the Conservatives against people having access in this country, but in favour of their being able to root around in premises abroad?

Mr. Heald: I think that the hon. Gentleman has got over-excited and has not listened. Our position is very clear. The Conservative party's view is that we should retain CHCs but improve them and give them the powers that they need to do their job properly. I have made that point, and my hon. Friend the Member for West Chelmsford made it at great length the other day.

Mr. Burns: Powerfully.

Mr. Heald: And extremely powerfully. The hon. Member for Leigh must also accept that the Opposition's job is to scrutinise Bills line by line.

The European decision in July was to the effect that patients in need in this country have a right to go abroad for treatment. For a short period, the Secretary of State spun that as being rather a good thing. If a lot of patients are to be shipped from the south-east of England, where the current pilot is, to France and Germany, and the watchdog bodies will be the patients forums, I think that it is legitimate to ask the Under-Secretary—I am sure that the hon. Member for Leigh will agree—whether patients forums will be able to go into premises where patients are being treated. If, for example, a hospital in France had a lot of spare capacity and the NHS made an agreement with it—which could easily happen in the current climate—that that hospital would do 500 or 5,000 operations a year, would a patients forum be able to examine it and ensure that patients from its area were getting satisfactory treatment there?

The facilities for medical care for the armed forces are now within the NHS. Will patients forums be able to visit the hospital in the midlands that deals with the armed forces?

Notoriously, Prison Service health facilities are less good than those of the NHS. That subject will be debated more fully later, but what watchdog role will patients forums have over mental health services in prisons? As the Under-Secretary knows, that is a matter of great concern. I recently spoke at the MIND conference in Scarborough. I was surprised by the number of people who asked about prison medical services, in particular, the mental health services available there, a cause of dissatisfaction. They think that that regime is far less sympathetic than the NHS, that treatment is more old-fashioned and that prisoners do not get the quality of care that they would get even in one of our hard-pressed acute mental health wards.

Will the Under-Secretary explain the role of patients forums in prisons, and how the entry and inspection requirements will work? Clearly, there are difficulties with allowing individuals to enter prisons as a right.

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