| Health and SocialCommunity Health and Standards) Bill
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Andy Burnham (Leigh): That is precisely the point. The new structures proposed by the Bill would help to represent the interests of outlying hospitals more than they are in existing NHS structures. Larger institutions have sometimes disregarded the interests of smaller hospitals. The Chairman: Order. Before the right hon. Gentleman continues, I should say that we are probably moving away from the amendment to having a stand part debate. I am happy to have a ''stand part debate'' now, providing that other hon. Members do not seek a stand part debate at the end of this debate. Sir George Young: That is a most helpful suggestion, Mr. Atkinson. This is not the right point at which to debate the relationship between social services and foundation trusts. If your ruling is that we can have a stand part debate, I shall not say another word. The Chairman: Order. The right hon. Gentleman may continue. However, I hope that other Committee members will not rise to speak when I put the question that the clause stand part of the Bill. We would then Column Number: 312 have a stand part debate all over again. If the Committee wants to consider this a stand part debate, we shall have one now.Sir George Young: The signal has turned from amber to green. I am much obliged. If, for the sake of argument, a foundation trust generates a surplus, which is one of its objectives, the needs of community-based care should not be set to one side and certainly should not be focused on the narrow needs of the district general hospital. As social services would not be part of foundation trusts as of right, the only way in which they could be made part of them would be through the intermediation of the regulator. I am not sure that that is the best way in which to proceed. Perhaps the Minister will explain how the new concept in the NHS will not undo the good work done in breaking down the Berlin wall between health services and social services. The NHS has promoted closer relationships between primary care trusts and social services and has introduced joint budgeting and bed-blocking initiatives. I hope that the initiative will not undo that good work. I am the custodian of the Select Committee on Health, although I am not a member of it. I will therefore conclude by reading from its report:
That is the assurance that I seek from the Minister. Dr. Harris: I support the points made by the right hon. Member for North-West Hampshire (Sir George Young) and thank him for his support for the theme that was raised earlier in the consideration of the Bill. This is indeed the first time that the words ''overview and scrutiny committees'' appear in the Bill. Of course, questions have been asked before about the danger of over-concentrating on the acute sector, on secondary care rather than on primary care and on the health side of health and social care rather than on social care itself. We would support the amendment if it were to make the clause stronger, because the bodies listed—specifically the overview and scrutiny committees and the Commission for Patient and Public Involvement in Health, which are, presumably, informed by the views of patient forums, and particularly PCT patient forums, through their reports to the commission—must be taken into account. In that respect, the debate is similar to that on clause 6, during which I asked whether, in considering an authorisation rather than simply a variation of authorisation, the regulator must have regard to the views of local people. The amendment lists a series of local bodies. The Minister said that the list was too long and would provide an individual veto to too many groups. It would be worrying if the Government could not reassure the Committee that authorisation could not be prevented in some circumstances, either by opposition to the proposed variation of authorisation Column Number: 313 from an overview and scrutiny committee or through a properly formulated report to the regulator from the Commission for Patient and Public Involvement in Health.If the Minister says that ''is to'' is sufficiently strong to ensure that there will not be a variation of authorisation if it is strongly opposed by those bodies, I ask again why that applies only to a variation of authorisation and not to the authorisation itself. The Minister argued previously that paragraphs 7.10 and 7.11 of ''A Guide to NHS Foundation Trusts'' ensure that local bodies are consulted and that their opinions on authorisation must be taken into account. However, I should have thought that a variation to the authorisation is equivalent to the authorisation. As the Government have seen fit to ensure that there is a specific mention in primary legislation of the overview and scrutiny committee's opinion and the Commission for Patient and Public Involvement in Health in clause 9, I should be grateful if the Minister would explain why, at the very least, that was not required in clause 6. I hope that the Minister will consider accepting the amendment. It will reassure those of us who understand the reasons given by the right hon. Member for North-West Hampshire why there is a danger of the entire health care system being led by the secondary care system. In planning a holistic health and social care system, hospitals' services especially should follow what is required by primary care and, indeed, the social care sector. Dr. Andrew Murrison (Westbury): I support amendment No. 139. I am not sure that my hon. Friend the Member for West Chelmsford quite appreciated the hornets' nest that he would be stirring up in moving the amendment, but that has happened, and we are having a fruitful debate on it. I, too, am concerned with the apparent preoccupation with acute care, which appears to be the main thrust of the Bill. I am also rather surprised by it, as I have said to Ministers before. Hitherto, they have shown a commendable interest in primary care. They were, in fact, steering our health service in the correct direction in so far as they were emphasising less the acute side of the service, which has certainly received most emphasis since 1948, and focusing more on social care and primary care. I am somewhat surprised, frankly, that we have the Bill, and I am also surprised by its tone. The amendment proposed by my hon. Friend the Member for West Chelmsford would be a very small and incremental step in the right direction. There is little doubt that we focus heavily on the glamorous side of health care, especially hospitals. We tend to be less interested in community hospitals than the acute sector, despite the fact that the former probably add more to the sum total of human happiness, in many respects, than the latter. I was very interested in the Community Care (Delayed Discharges etc.) Act 2003, which appeared to fracture the relationship between social services and the acute sector. I have a particular interest because, Column Number: 314 some months before that, my ten-minute Bill appeared to suggest, in a probing manner, that fining might be a good idea in order to establish a more workable relationship between social services and the acute sector. The Government appeared to take that forward with a vengeance, and there is little doubt that there has been a strained relationship, or that a somewhat strained relationship is developing, between local government and the acute sector partly as a result of that. The amendment proposed by my hon. Friend the Member for West Chelmsford will go some small way to re-establishing the proper relationship that should exist between those two sectors. In truth, social services and the acute sector are one and the same thing as regards health care for our constituents. I commend my hon. Friend for suggesting this small, but significant, adjustment to the Bill. I am sure that it will be extremely fruitful, and I hope that the Committee will be minded to accept it.Mr. Streeter: I also commend my hon. Friend the Member for West Chelmsford for having spotted that important point. I support the amendment because I am increasingly concerned about the lack of co-operation and integration in different parts of the country—including the west country—between social services and acute hospitals. This is an opportunity for us to make it clear in the Bill that we want the new foundation trusts to work closely with social services committees and to listen carefully to reports made to them, the regulator or the general public by any overview and scrutiny committees pursuant to the Local Government Act 2000. That is particularly relevant and important to elderly people, where there is often a gap between the care offered and the kind of co-operation and integration that should take place, largely because funding comes from different budgets—from different jam jars.
9.45 amThat situation may even get worse if foundation trusts are set up that are answerable to a new electorate, rather than to the electorate that puts in place a social services committee or an overview and scrutiny committee on a local authority. I support the hon. Member for Oxford, West and Abingdon. This amendment would strengthen the provisions set out in clause 9 and ensure that the regulator must have regard to any report made by an overview and scrutiny committee. The best place for that injunction is not in clause 9, which deals with the variation of authorisation—I imagine that that would be a relatively infrequent activity—but in clause 6, because the initial authorisation is surely the most important document that will be published, certainly in the first few years of any new foundation trust. The regulator should have regard, at that stage, to any reports by an overview and scrutiny committee. I hope that the Government will think again. It surprised me that subsection (2)(a) should appear so expressly in clause 9 but is not referred to at all in the previous clauses on the granting of initial authorisation. That is probably an oversight; these things can happen when drafting detailed, long and Column Number: 315 complicated measures, and I hope that the Government will reconsider it.It is important that, where possible, the Bill should send a signal from the centre to acute hospitals, foundation trusts, social services committees and local government that they should work together in a more integrated and co-ordinated way. This is an opportunity to make that very clear, and I hope that the Government will listen.
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| ©Parliamentary copyright 2003 | Prepared 22 May 2003 |
