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Lord Hunt of Kings Heath: I apologise to the noble Baroness for not responding to the specific point that she raised. The role of community health councils in relation to major changes in services will be transferred to the overview and scrutiny committee of the local authority. If a proposal for a major change is made with which the overview and scrutiny committee disagrees, it will be referred to a panel, or an advisory committee, that we are establishing at national level called the national reconfiguration committee, which will then make recommendations to the Secretary of State. Therefore, in essence, the new local authority overview and scrutiny committee will have that responsibility in the future.
Lord Harris of Haringey: Perhaps I may intervene before my noble friend sits down. He started his response by giving us a fairly lengthy account of the strength of PALS. I am well aware that my noble friend has been a long-term advocate of such arrangements. However, does he accept that the PALS arrangements, which, I am sure will be a very valuable part of "customer relations" for a local trust, are not the same as independent advocacy?
I believe that my noble friend said that it would not always be appropriate for the body dealing with patients' complaints to be the PALS. I am quite worried by those remarks. I should be grateful if my noble friend could further clarify them. We must be quite clear that the handling of complaints, and advising and supporting complainants, must be independent of the trust concerned.
My noble friend also said that the Government did not wish to be prescriptive about who should provide advocacy. Would my noble friend think it appropriate to place some residual duty on the patients' councils to satisfy themselves that appropriate advocacy arrangements are in place and are strong enough so that, if they are not satisfactory, the patients' council can provide the service?
My further point relates to the relationship between patients' councils and patients' forums. My noble friend said that patients' councils should not be pre-eminent in terms of patient representation at local level. I believe him to be wrong in that respect. Given the fact that my noble friend has acknowledged that there is a danger that patients' forums might be subject to isolation--indeed, almost subject to "agency capture", which I think is the jargon for it--can he tell us what form the arrangements will take? Who will be responsible for the performance management of patients' forums, who will set the budgets for them, and who will appoint and manage their staff?
I do not believe that I explained myself adequately when I spoke a short while ago. I am concerned with the ever-lasting business of inspection and scrutiny. Patients are mainly concerned with the ability of doctors and nurses to get them better. They are not so concerned with the cogs of administration. I hope that those at the sharp end of the NHS will not find themselves too much tortured by a machinery of complaints that requires them to spend an inordinate
Lord Hunt of Kings Heath: I understand the noble Lord's concern; and, indeed, I have some sympathy with it. At the end of day, we need to have a proper complaints system, as well as a health service that is sensitive to the needs of the public and patients. That is the purpose of many of the Bill's mechanisms. Equally, if by prompt action--this is where the PALS come in--we can deal with problems as they arise, it may well mean that patients do not always wish to go through a formal complaints process because the problem has been resolved.
However, if patients wish to go through a proper complaints process, I can reassure my noble friend that the options will be open to them in the future, as they have been in the past: they can go directly through a formal complaints system, or, if they wish to have help to do so, they can go directly to the independent patients' advocacy service. There is no question about that. I believe that the PALS service will provide a very straightforward and easy route in many cases, thereby allowing problems to be put right as soon as possible.
My noble friend also asked about the secretariat for the patients' forum and the patients' council. Some of these issues will need to be developed because neither the forum nor the council will be able to employ staff directly. We shall need to find a mechanism through which such staff can be employed. That is not unusual because CHCs have found themselves in the same position. The intention is that the funding will come from the Secretary of State through regional offices. I do not believe that I can reassure my noble friend that I have a robust system of performance management at my finger tips. However, we shall be debating a number of these issues later. I can tell him that we shall wish to support the patient council and the forum and that we shall enable them to be as effective as possible in their work. Some of the work carried out by my noble friend in that area would be apposite to that aim.
Baroness Cumberlege: I do not want this Committee stage to be haunted by my fictitious patient, but the Minister said he felt that she would not be served well in the current situation. I should like the noble Lord to explore that comment. We need to know exactly what we are jettisoning, and what we are gaining in its place.
Lord Hunt of Kings Heath: The litany of failure outlined by the noble Baroness was a breakdown both in terms of services provided by different parts of the NHS and in terms of co-ordination between them. I should point out to the noble Baroness that there are examples of that happening at present. The existence of CHCs per se does not seem to me to have had an impact on the situation. Under the new arrangements, it is important to note that when, for example, the relatives of Mrs Archibald confront a problem they would have an avenue through which to raise it
In the first instance, PALS comes into play in dealing with problems as they arise. However, if that does not work out and if, say, Mrs Archibald's relatives decide to go through a formal complaints process, that would undoubtedly be co-ordinated by seeking the help of the independent advocacy service.
Lord Harris of Haringey: I shall not make the mistake again of saying that I wish to comment before my noble friend sits down. Perhaps I may clarify a few points about independent advocacy. Clause 13(3)(c) refers to patients' councils carrying out,
Lord Hunt of Kings Heath: It is very difficult at this stage to say what will happen in practice. It is clear that the independent advocacy services could be provided in the way suggested; alternatively, they could be provided by another public organisation. Indeed, they could even be provided by a voluntary organisation. It is important to ensure that we have a robust, independent and effective service for the public. Of course, that responsibility rests with the Secretary of State. But before making any arrangements he will need to consult any relevant patients' council and such other persons as he considers appropriate. Whatever the arrangements are for the provision of those services, there will be an opportunity for patients' councils to express their views.
Lord Harris of Haringey: Would it not surely be better for the patients' council with local knowledge to have the residual responsibility for deciding where the contract should be placed locally to provide the most effective service for local people?
Lord Hunt of Kings Heath: Given the importance of ensuring that there is an effective service of consistent high quality throughout the country, that responsibility must rest with the Secretary of State.
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