NHS Reform & Health Care Professions Bill

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Ms Blears: I am keen to make progress so that we can discuss the substantive issues of clause 21, which covers more than access to premises and is important to improving health care. I shall make my comments as swiftly as I can.

Several hon. Members raised points about how to achieve the right balance between allowing access to premises and recognising that visits from patients forums to those in private properties should not be intrusive or comprise of dawn raids that turn over people's premises. I acknowledge the worries about that but, as the regulations develop and are consulted on, we shall try to ensure that when services are provided from private premises, access will generally be limited to the areas to which patients are permitted access, and will be accessed only at reasonable times that are agreed to by the occupier. We must be conscious that premises, such as those of community pharmacists, are often used as living accommodation.

Confidentiality, which is extremely important, has also been raised. It is not envisaged that patients forums will be given the right to access confidential information, such as patient records. Records are protected under the Data Protection Act 1998 and under common law. It is very important that patients have confidence that their personal matters will not be exposed to unnecessary and inappropriate scrutiny.

Patients forums are not an inspectorate body, as the CHI is, in terms of quality. Patients forums are designed to involve patients in the services that are provided by their trust, and to listen to patients' views. They need to have access to premises to look at things such as cleanliness, food and patients' environment, and to ensure that the facilities are appropriate. The forums are not an inspecting and monitoring body; that is not their prime purpose. They are there to get patients' views on services in the trust. It will be absolutely crucial to achieve a balance between the rights of patients forums and the rights of other individuals.

I turn now to the issue of the members of patients forums, although this discussion may stray into other areas. I want to give the assurance that, in many cases, the members of patients forums will be existing members of community health councils. I have no doubt about that. We are specifically trying to provide a transition path, as hon. Members will see from the implementation plan. We want to work with community health council members to see whether they can find a place within the new system that enables them to bring in their skills, experience, expertise, and depth of knowledge. We would be foolish in the extreme to discard the depth of knowledge that members of community health councils have acquired over many years.

I am absolutely determined that we find a pathway for staff of community health councils who want to take a part in the new system, members of community health councils and members from all the other communities that I identified on Tuesday. I genuinely believe that it is important to hear from all of them if the NHS is to respond properly to the whole of our community.

Mr. Burns: The Under-Secretary is being rather contradictory now. On Tuesday, she rather foolishly dismissed the current membership of community health councils as basically being local politicians who like to attend meetings on Monday, Tuesday, Wednesday and Thursday evenings. She suggested that a whole new wave of people would be brought in to be more representative of the local community. The Minister now seems to be backtracking and saying that, actually, most of the new members of the forum will be existing members of community health councils. What is it to be?

Ms Blears: With respect to the hon. Gentleman, he seems incapable of grasping a complex situation that combines the merits of both. He seems to feel that we need an exclusively either-or position, and this matter is too important to embark on that path. I remind him of Tuesday afternoon's debate, in which I explicitly said that we would set up a transition advisory board to ensure that members in the system see a key role for themselves in future and can take on new responsibilities. I said:

    ''I made an explicit point that the proposals build on the best of work done by community health councils and, especially, their members.''—[Official Report, Standing Committee A, 4 December 2001; c. 254.]

I am on the record as saying that, and I believe it. I can confirm that that will be the case. That does not mean that we do not need to be much more creative and imaginative about how we involve a wider range of people in future. I am sure that we will do that.

I should like to deal with the issues of finance and resources. Rightly, people in a range of organisations are anxious that the new system be properly resourced. I am not in a position to give specific details today, but I can reassure Members that the new system of public and patient involvement is more complex and will need resources. We need to ensure that those resources are adequate so that patients and the public can influence their health care.

Dr. Harris: The specific question asked by the hon. Member for North-East Hertfordshire, who sadly is not present, was whether the patients forums would be getting the £23 million that CHCs currently have, or whether some of the money would be absorbed along with the £10 million that has been allocated to the purposes of PALS and the National Care Standards Commission.

Ms Blears: We must view the system as a whole. I have previously argued that all the different components of the system add up to a coherent entity, and we need to fund the whole system, rather than its constituent parts, to ensure that it operates properly.

The issue of treatment abroad has been raised. I understand hon. Members' concerns about patients forums being involved. Treatment abroad is not entirely a novel idea; many patients in the past have been treated in European countries under forms E111 and E112. We are all aware of the system and the reciprocal arrangements that have been in place for many years for treatment here and in other European Union countries. In terms of that issue and of private health care, we envisage that rights for inspection will be included in the contracting process. It is clearly not possible for the Bill to affect law in other countries, but we do intend to ensure rights to quality monitoring and inspection. They are important to the interests and safety of patients in the private sector and, indeed, wherever care is commissioned on behalf of the national health service.

11.15 am

Dr. Murrison: The Under-Secretary is right to say that people have been treated abroad under various agreements for many years. However, the point is that the Bill introduces a raft of new regulations and inspections, both through CHI and through patients forums. Many members of the Committee will be worrying about how we can inspect or regulate services provided abroad, so that those treated there may expect the same standards and regulatory functions as those treated in the United Kingdom.

Ms Blears: I believe that we would all share the concerns of patients. It is right that we think about quality, standards, aftercare and the way in which patients are treated, wherever they might be, provided that treatment is under, and funded from, the national health service. We therefore need to look at the contracting provisions to ensure that such proposals are in place and are effective.

I believe that I have dealt with most of the issues raised by hon. Members—

Dr. Harris: Perhaps I may assist. Will the definition of premises in clause 13 allow the Commission for Health Improvement to inspect the quality of care given abroad? Will, by implication, patients forums be allowed to undertake monitoring visits—I recognise that they will not be as rigorous as CHI visits—and should a better definition of ''premises'' replace that given in clause 16?

Ms Blears: I should begin by pointing out that the definition of ''premises'' in clause 16 seeks to reflect the functions as set out in clause 15(5). Patients forums are a different creature from CHI, and the premises in question are those connected with the functions and services that patients forums are intended to inspect. That is why there is a different definition.

I do not have information to hand on the definition in clause 13 and the question whether CHI will be able to inspect abroad, but I undertake to write to the hon. Gentleman on those matters.

The other issue that I did not deal with, which was raised by the hon. Member for North-East Hertfordshire, is the armed forces. As I understand it, if members of the armed forces are treated on NHS premises—they are longer treated in separate armed forces facilities but in NHS hospitals—or if they receive services provided by, or arranged by, a trust, such services will be subject to patients forums' rights of inspection and monitoring under clause 16. The provision would cover hospital premises in which members of the armed forces were being treated.

Dr. Murrison: On that specific point, will patients forums have access to military facilities where NHS patients are being treated? I am thinking in particular of service families.

Ms Blears: The intention is that patients forums will have access to premises in which NHS patients are being treated, and that they will follow those patients, whether they are in primary care or secondary care. It is very important that, in representing to trusts the views of patients and the public, patients forums can base those views on evidence that they have been able to collect.

Mr. Atkinson: I thank the Under-Secretary for offering some further explanation of the regulations. It is clear that she has a good idea of what they will contain, given that she was able to read from a draft. It is a pity that we could not have had those regulations for today's debate.

I am glad that the private parts of doctors' and community pharmacists' properties could not be raided, but the Minister has said nothing to convince me that the patients forums need such powers at all. If they go into doctors' surgeries or community pharmacies to inspect cleanliness and talk to patients, only a tiny number of the doctors or others in charge of premises will refuse to admit them. If a forum is refused admission, surely it can go to the Commission for Health Improvement and ask it to undertake an investigation, because regulations will give CHI the necessary powers. Those powers would be needed on only an extremely small number of occasions. We are giving excessive powers to the patients forums.

The Minister has not said anything about how the Committee, or the House, will consider the regulations. Will they be made by affirmative or negative procedure? Will we see and debate them? Will there be proper parliamentary scrutiny? Can she reassure us further on that?

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Prepared 6 December 2001