NHS Reform & Health Care Professions Bill

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Mr. Heald: It is true that other Acts contain a provision that the person who receives the annual report is the Secretary of State, and there is also a duty to publish. Does the Under-Secretary envisage that such a provision would apply here, or would it be unnecessary because the forum would be publishing the report itself? The Bill stipulates what the report must include, but it does not require it to be in the public domain; many people would think that it should be.

Ms Blears: Perhaps I can reassure the hon. Gentleman. We envisage that patients forums' reports will be widely available in the community, and that they will publish them themselves in addition to sending them to the Secretary of State. The regulations under clause 18(2) will provide for the publication of patients forums' reports:

    ''the preparation and publication of reports by Patients' Forums (including the publication of reports under''

clause 17. There is a provision to ensure that that information is in the public domain. It would otherwise be of limited use because it is obviously the type of information that people would want to consider and act upon. There is currently no provision in the community health council regulations for reports to go specifically to Members of Parliament, but we know that they do because we receive them regularly. The amendment is therefore superfluous, but its spirit will be acknowledged and acted upon.

Dr. Taylor: On the Under-Secretary's assurance that we will automatically receive those papers, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Dr. Taylor: I beg to move amendment No. 213, in page 22, line 1, after 'include', insert '—


The Chairman: With this we may discuss the following amendments: No. 214, in page 22, line 2, after 'Forum', insert—

    '(b) details of the arrangements of the Trust to which the Forum relates under section 11(1) of the Health and Social Care Act 2001.'.

No. 215, in clause 18, page 22, line 29, after 'in', insert 'the'.

No. 216 in page 22, line 29, leave out from 'the' to end of line 30 and insert 'Commission for Patient and Public Involvement in Health'.

Dr. Taylor: May I first make an inquiry? Amendments Nos. 215 and 216 refer to clause 18—do you still want to take them together, Mr. Hurst?

The Chairman indicated assent.

Dr. Taylor: Amendments Nos. 213 and 214 allow us to ask a question. Clause 18 implies that the forum will be the only mechanism by which a trust can take citizens' views, but I wonder whether that is intentional. The trust should have that duty, not only its forum.

Amendments Nos. 215 and 216 concern clause 18(2)(j):

    ''the preparation by a Patients' Forum of annual accounts, and their inclusion in accounts of the NHS trust or Primary Care Trust''.

Will the Minster clarify whether it would be more appropriate to include the accounts in those of the Commission for Patient and Public Involvement in Health?

Mr. John Baron (Billericay): We must clarify how the different bodies will relate both to each other and to those working in primary and secondary care. To avoid confusion, the Department of Health should publish a clear guide for the public on where they can access information and advice; the British Medical Association would endorse that view. It would also help if health professionals were to be provided with information on arrangements for providing advice and gaining patients' views. To follow an earlier point, it seems inappropriate that the only way in which we shall be able to access patients' views is through the forum. There should be guidelines on how to obtain the public's view of how the health service is operating at the coal face, and professionals also need guidelines on where they stand.

Mr. Heald: To follow the points made by my hon. Friend the Member for Billericay (Mr. Baron) and the hon. Member for Wyre Forest, the report should include information that patients forums come across on how trusts perform their duties to involve and consult patients and the public on issues such as the planning and provision of services, the development and consideration of proposals for changes in the way in which those services are provided and decisions that affect the operation of services. In Hertfordshire, consideration is being given to changing the way in which services are delivered across the county. The current arrangements for explaining the issues to people such as Members of Parliament, the public and councillors are good, although we have not yet reached the conclusions, which may be more controversial.

Whether a particular hospital continues to provide services such as accident and emergency is the type of issue about which patients and the public care most. They want to feel that they know how to complain and are aware of anything that might affect their services. The way in which trusts perform their duties to involve and consult patients and the public about the planning and provision of services is crucial. It is, however, not the sort of thing on which the Commission for Health Improvement would necessarily concentrate. Community health councils were ideal but, given that the Government are determined to abolish them, the annual report should include such details. That is the purpose of amendment No. 214.

The two amendments to clause 18 concern what should happen as regards the annual accounts for patients forums because the present proposals do not involve an independent set of accounts for patients forums. I may be wrong about that—the Minister will tell us in a moment if that is the case—but it looks as if patients forums will be seen as part of the trust accounts, and will not have a separate place. That raises questions about funding that we can come on to, if briefly, when we discuss clause 18.

Surely there is a case for having accounts concerning patients forums in with the accounts of the Commission for Patient and Public Involvement in Health. That would ensure that the accounts of the NHS trusts and primary care trusts, for which the forums are established, have accounts that are separately managed and presented from those of the forums themselves. The functions would then be separated out in every way. There is clearly a need for a rigorous watchdog, and if patients forums are to be that watchdog and to be independent, they should have an independent arrangement for their accounts.

Ms Blears: The hon. Member for Wyre Forest asked whether patients forums will be the only way for the NHS to consult. I can assure him that that is certainly not the case. The forums will be but one way in which we can find out the views of patients and the public about what our health services are doing, and whether they are providing the right quality of service. The new Commission for Patient and Public Involvement in Health will be given a specific remit to involve the public, and to ensure that public participation is a key part of developing health services and looking at reconfigurations. That will ensure that there is a wider input into those matters than simply from patients themselves, although they are important to the system.

Mr. Baron: Will the Under-Secretary clarify how the patients forums and other consultative bodies will relate to each other? It is not clear to me what communication there will be between them and how, at the end of the day, we will gather information from the general public on how the NHS is functioning at ground level. It appears that different bodies will be doing different things.

Ms Blears: The hon. Gentleman is right that different bodies will be doing different things. We have decided that the various functions have to be carried out at the different levels in the NHS at which they are carried out. There is a clear need to draw the system together to ensure that we get a coherent overview. Clause 19 outlines the role of the Commission for Patient and Public Involvement in Health, which will operate at the national, regional and local levels as the mechanism to draw all the different functions together. That will ensure that we get all the necessary data and intelligence about what is happening in our health economy.

The hon. Gentleman made a sensible point about providing a comprehensive guide to how the service will work. We are working on comprehensive guidance for everyone involved in the system, including health care professionals, patients, members of the public and local authorities who, for the first time, will have an active role and legal powers to take part in the system. I do not underestimate the importance of having clear, precise information available for everyone about how they can get involved in the system, which issues concern them and which part of the system they should go to for assistance. That will be the key to taking us forward to success.

On the NHS's general duty to consult, we are working on various guidance frameworks to ensure that the NHS knows what a good piece of consultation ought to involve. In many areas, consultation has improved dramatically in recent years, but we must ensure that good practice is spread right across the system so that there is a template for good consultation involving the public and patients. They will not be the same in every area, because communities are different and there must be flexibility, but some core competencies will be contained in any good piece of public involvement. I hope that all parts of the NHS and other bodies taking decisions on health—the broad definition in the Commission's powers—will learn from the framework documents to ensure that their consultation is of the highest possible quality.

Mr. Heald: We have heard a good deal about pieces of guidance and regulations being prepared. The Minister of State promised us on the first morning that we could have copies of things as they were ready. Are any of those documents ready? If not, have Ministers decided on their contents? We would like to know what they are.

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