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Lord Clement-Jones: We shall have to differ on that. The Minister's view is that no action is good unless the Secretary of State takes it himself. That seems an extraordinary view. Aneurin Bevan warned against the rattle of bedpans in the Department of Health. We are now faced with that situation. It seems extraordinarily centralist.
I warn the Minister that during its next stages these Benches will judge the Bill on whether it is clear where independent advocacy lies, or whether patients' councils and patients' forums have sufficient independence. The Minister asserted the independence but I have not seen chapter and verse of it.
The Minister made a virtue of proliferation of the various forums. However, he then said that they might become isolated. Why do we not cure that problem before it arises rather than building in mechanisms in case those bodies become isolated.
Lord Hunt of Kings Heath: A moment ago the noble Lord accused me of being over-centralist. With the patients' forum we are placing the key responsibility for patient involvement at NHS trust level. The noble Lord seeks to move that to a patient council which is one level removed from the patient.
Lord Clement-Jones: The Minister knows his constitution. Having considered centralisation or federalism, he knows that the great trick about devolution is to ensure that decisions are taken at the appropriate level with the right mechanism. We believe that the most coherent point at which that can be done is at the patients' council level. It can then be the co-ordinating factor. If we are not careful, patients' forums will lead to forum shopping. The experience of Mrs Archibald, cited by the noble Baroness, Lady Cumberlege, was telling.
I do not disagree with the Minister's aim regarding more effective patient and user representation. Indeed, we shall probably quote those words back at him when judging whether or not the Bill meets that criterion. We shall consider the total package. If it does not meet what we believe are necessary criteria, we shall act accordingly in later stages of the Bill. In the meantime, I beg leave to withdraw the amendment.
The noble Lord said: The posture of suspended disbelief probably applies as much to this part of the Bill, which precedes the provisions on the patients' council, as to the previous amendments. We wish to test whether the Minister is flexible about the way in which scrutiny will operate.
My local government colleagues in the party believe that these scrutiny provisions may work. As the Minister pointed out, the overview and scrutiny committee has become a central plank of the way in which local government now operates. With the institution of cabinet government at local government level, it is a different animal from a few years ago. Nevertheless, some issues need to be resolved. I suggest that conflict of interest may well need to be resolved as these scrutiny powers take hold.
However, I wish to note a few key gaps in the powers of the overview and scrutiny committees. Amendments Nos. 37 and 53 deal with overview of strategy for health improvement. That is an important area. The issue of making information available to patients' councils arises from scrutiny. CHCs were able to take a view about a pattern of behaviour or circumstances which informed the way in which they did their job. It is important to have that link between scrutiny and patient representation, and patients' complaints and patient advocacy.
The committees should be able to refer to other NHS bodies such as CHI and NICE, and to set up local inquiries. There should be the ability to co-opt observers from patients' forums on to scrutiny committees. Above all, there should be procedural standards for the scrutiny committees. That seems to be one of the weakest areas. It is important to have transparency about the operations of the committees. We need to know, for instance, whether the party whip will operate in these circumstances. I understand that planning committees have clear guidelines about the use of the party whip. I believe that it would be wrong for the party whip to operate where scrutiny of the local health service takes place. These are important additional issues which need to be dealt with. In moving the amendment, I speak also to Amendments Nos. 38, 41, 45, 46, 49, 50, 51 and 53. I beg to move.
Earl Howe: Clause 7 is the first in a series of clauses that give effect to the arrangements outlined in the NHS Plan to introduce better local accountability for health services and to enhance the voice of patients and the general public. The Minister will not be surprised to hear that I still hold the view that I expressed on Second Reading that the arrangements are a mish-mash, despite everything that he has said on the previous group of amendments. I cannot make complete sense of the Bill as it stands. The Minister may be able to illuminate some of the dark corners of the Bill as we proceed, but I doubt that he can dispel my concerns entirely. Like the noble Lord, Lord Clement-Jones, I shall wish to return to these matters with vigour.
I hold that view because Ministers have approached the issue from the wrong direction. They have asked what structures might be invented to perform certain functions, whereas they should have asked what they were trying to achieve. The end result is a pile of structures. It was seven at the last count, although
Let me restate our objective. It is to examine the structures that the Bill proposes, look at what they are intended to do and then suggest ways of rationalising them so that they are more user-friendly and less bewildering than they are at the moment.
Clause 7 relates to the role of local authorities in enhancing local accountability. My problem with the idea of greater local authority involvement is not so much with the theory as with the practice. Local councillors are already stretched. They have limited time to do what they are required to do. That means that the real work on Clauses 7 and 8 will have to be done by the officers, who are already dealing with a host of other social services and health-related issues--not only the co-called Section 31 arrangements under the Health Act 1999, which permit local authorities and health bodies to collaborate, but also the arrangements adumbrated under the Bill for the formation of care trusts.
Many councils already find it difficult to fulfil their statutory child protection and adoption services in anything like a satisfactory way. In that context, the issue of resources rears its head almost immediately. Amendment No. 47 addresses that. Local authorities cannot do what the Bill asks of them unless they are given the financial wherewithal to do it. If they are not properly resourced, the whole exercise will fall down in a heap because it will not command confidence. If it does not command confidence, it will be useless. The first thing that the Minister needs to tell us is how he will ensure that this particular bird will fly. Not only do there need to be officers in place dedicated to servicing OSCs, there also need to be resources made available directly to those councillors who sit as scrutiny councillors.
Those new duties come hard on the heels of other scrutiny functions laid down in the Local Government Act 2000. Even before Part 2 of that Act has bedded down, scrutiny councillors will be required to extend their purview into non-local authority functions. That is a tall order.
The Explanatory Notes attempt to put a small amount of flesh on the bones of the clause, which is pretty skeletal by any standards. However, there are a number of important lacunae. What are OSCs there to do? If they are to count for anything, they must talk to the outside world a bit. They must talk to patient groups and, if they wish, to national bodies such as the Commission for Health Improvement and the Audit Commission. They must be able to set up local inquiries with the power to call for evidence. Those are functions that CHCs have at the moment.
The danger as the Bill is drafted is that OSCs will be cut off from everybody except the NHS. Unlike CHCs, they will not have the benefit of inspections to inform their scrutiny work, because inspections will be carried out by patients' forums. Unless patients' councils and forums have a duty to pass on relevant information, the OSCs will operate in a vacuum, or will at any rate
What happens once the OSC has reached a conclusion on a matter? Presumably, although the Bill does not say so, it will be able to make its views known to the local NHS body in question. When that happens, what is the NHS body obliged to do? Does it have to do anything? In Amendment No. 48, I suggest that it should.
All those matters should be the subject of advance consultation by the Secretary of State. Despite the smokescreens and bluster of various kinds, there has been no consultation on the detailed proposals for local authority functions, but there has to be consultation if the regulations are to prove workable and effective.
Amendment No. 43 relates to the effective use of time and skills. Subsection (3)(f) would require any officer of a local NHS body to attend before the committee to answer questions. My noble friend Lord Peyton referred to that provision earlier. I am worried about that on several counts. Obviously the OSC will need to be able to question the chief executive of a health authority or trust on occasions. It may also need to question other officers, but those officers cannot be made subject to the beck and call of the OSC every week of the year. The OSC is a lay panel. The officers of the health authority, trust or PCT are busy professional people. In most ordinary circumstances they must be allowed to get on with doing their job. The OSC should not consider that it has the right to summon officers of the trust willy-nilly without there being a good reason for doing so and without first being satisfied that the officer concerned can represent the trust or health authority at the most appropriate level. Even worse than summoning an officer for a trivial reason would be--I hesitate to say this--to have a scrutiny committee agenda for party political reasons rather than for the purpose of improving local NHS provision.