NHS Reform & Health Care Professions Bill

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Dr. Harris: New clause 5 contains the word ''shall''; if it contained the word ''may'', it would be more acceptable. Is the Under-Secretary also saying—she may be right—that that power already exists in section 21(10) of the Local Government Act 2000, which states:

    ''An overview and scrutiny committee of a local authority, or any sub-committee of such a committee, may include persons who are not members of the authority . . . and any such persons are not entitled to vote''?

Is the Under-Secretary satisfied that that covers good practice satisfactorily even though it does not specify patient forums and health care?

Ms Blears: However the hon. Gentleman ''may'' choose to put his case, in these circumstance it is inappropriate to place that power in the Bill. It is a matter of good practice, and I have no doubt that good practice will be established across the country. Section 21(10) of the Local Government Act 2000 provides that people such as members of patients forums and others who have a degree of expertise that can help to inform the overview and scrutiny committees' deliberations should be part and parcel of the process by bringing their skills to those committees' proceedings. For those reasons, we must resist new clause 5.

Dr. Harris: For the moment, I am prepared to accept the Under Secretary's undertaking that there will be clear guidance that it would be good practice to involve members of patients forums or other bodies related to patients forums at overview and scrutiny committee level.

On new clause 4, the Under-Secretary is giving some hope that she will be able to explain to me that the power to refer—and the possibility of regulations creating the power to refer—will be made clearer. If that happens, I look forward to receiving a letter from her that clarifies the situation.

The hon. Member for North-East Hertfordshire put his finger on problem with new clause 3. The perception is that there is a duty for CHCs to make that referral, but the Under-Secretary is not replacing that duty with another duty. That is the problem that she will have in reassuring people that the regime is robust. The best thing would be if we go away and reflect on that matter, and perhaps it can be considered further in another place.

I must assume that the hon. Member for Wyre Forest, who is a friend but nevertheless in parliamentary language not a hon. Friend, heard what the Under-Secretary said about membership because I know that that is something about which he feels strongly.

It may well be that I have had adequate reassurance regarding amendments Nos. 217 to 219 because I still do not take the view that the existing arrangements require reports back to patients forums by bodies such as the ''overview and scrutiny committees'' mentioned in amendment No. 219. I will reflect on the Under-Secretary's remarks, and I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Mr. Heald: Some people have expressed concern that appointments of members of patients forums will be made from members of the local commission

because they are the people with the right to appoint members of the forum. It is all starting to look a bit cosy. Will the Minister explain how she expects to find the other kinds of people whom she mentioned to widen the membership of patients forums? Alternatively, does she take the view that because the local commission will have a wide base it does not matter if it becomes the local forum?

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I want to ask the Under-Secretary about funding. In the context of subsection (2)(h), the new system will need adequate resourcing if it is to work. Supporting patients forums will necessitate employing and paying numbers of staff. We started a discussion that we did not complete about how forums would be funded. I have received a note from Mr. Roy of the Association of Community Health Councils for England and Wales in which he estimates that costs for patients forums will be about £32.5 million in 2003-04. In making that calculation, he assumed a total of between 400 and 500 forums, which is far less than some had thought; took account of the narrower range of responsibilities of CHCs; assumed that the independent complaints advocacy service element would be taken out; and put in an adjustment to reflect the extended remit into primary care and parts of the private sector.

The other aspect is patient advocacy and liaison services. I may have unwittingly misled the Committee this morning when I said that the cost of PALS was £10 million and that it was a one-off payment. A better way of putting it is that a small number of pathfinder, or pilot, PALS were given £10 million this year and will be given £10 million next year. But when the system is rolled out nationally, none of the other PALS will get anything. The money will therefore have to come from PCT budgets or some other source.

We know from the financial assessment in the notes to the Bill that the Government are effectively saying, ''We shall take account of the £33 million that is spent on PALS and CHCs in funding the new structure.'' This morning I asked the Under-Secretary for an assurance that at least as much money would be available for patients forums as for CHCs; that is, at least £23 million. That would be a lot less than ACHCEW considers is needed, and she will recall that the Audit Commission estimated £60 million. I have assumed a figure of half that, but even so at £23 million the cost of CHCs is much lower. Can the Under-Secretary promise us that at least £23 million will be available for patients forums?

Concern has been expressed to me by Mr. Tester of the Society of Community Health Council Staff about the way in which CHC staff will be treated over the transition. Apparently, health authority staff are being assured that they will have a job for 12 months after health authorities cease to exist in April 2002, but no assurance has been given on what will happen to CHC staff. Can the Minister give us any information about that? Appointment of staff, of course, is an issue to be dealt with in the regulations that we have not yet seen.

Dr. Taylor: I have three quick points and questions about membership of the forums. I was very pleased to hear the Under-Secretary say this morning that there will be arrangements for CHC members to be considered for membership of the forums. Under the proposed implementation programme—if all goes through—CHCs will not actually be abolished until April 2003. There will be some members of CHCs whose appointments come to an end between now and then, and it will scarcely be sensible to appoint new people. Can there be some mechanism whereby, if they wish, people can extent their appointments until April 2003?

The Under-Secretary said yesterday that she thought that about half of the people on forums will be representatives of voluntary bodies and that half will represent patients and carers. That was much more encouraging than the phrase ''at least one'' in the Bill. Can she add some detail about the size that she envisages for patients forums?

Finally, one reason why I object to the changes is the plethora of new bodies with which we will be faced. There are at least three commissions; I am not sure whether I am confused, or whether the people who have written the response to the listening exercise are confused. On page 5 of that response, the seventh bullet point of paragraph 2.6 says that

    ''the NHS Appointments Commission...will be charged with making the appointments to Patients' Forums.''

However, page 11, paragraph 3.26 states:

    ''The Commission for Patient and Public Involvement in Health will conduct the appointments process.''

Which commission will actually make the appointments?

Mr. Baron: I welcome the involvement of the voluntary and community sector in membership of the patients forums. It is very important that the Government do their best to empower that section of society and recognise all that it can do. I would, however, like some clear guidelines on how the forums are to function and be regulated. That follows on in part from the comments of the hon. Member for Wyre Forest. For example, can we have clarification on the forums' access to information and advice? What information will they be able to access? Will the public be welcomed into them? How public will they be? Will they have an advisory role? Those questions relate to who is appointed to the forums, as the make-up of the forum will obviously reflect its nature and function. I would be grateful for more details about that.

Can the Under-Secretary clarify the selection process? For example, are opportunities going to be advertised locally? Will an effort be made to advertise in deprived areas, to ensure that there is good representation from a cross-section of society? Will the Minister reassure us that the appointments will not be controlled by the health authority, or by the trust? The independence of the forums will be crucially important, because they will play an important part in ensuring that health care meets patients' requirements. Forums must be independent and willing to question as they see fit.

I apologise to the Committee if I have missed something, but I do not understand where the money will come from for the forums. Will it come from primary care trusts or from central Government? Whoever controls the funding will have a relatively important say in how the forums function. I assume that the funding comes from central Government and will bypass primary care trusts, which I welcome as a way of ensuring the forums' independence.

There seems no collective voice for patients above the level of the forum. Currently, local lay representatives elect representatives who oversee the regional national bodies. Under the new proposals, the voices of people who act at strategic health authority level will be staff-led and have no element of lay decision-making. Will the Under-Secretary give her views on that?

 
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