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Lord Clement-Jones: I thank the Minister for that response. It was admirable in the way that it dealt with all the issues raised. There is considerable food for thought in what the Minister said. I believe that he has answered the point raised in relation to care trusts.

One always has those philosophical debates about lists, prescription and so on. I should not wish to set a precedent by having the Minister accept any amendment in that respect. I shall consider what the Minister said and meanwhile, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 68 to 74A not moved.]

Clause 11 agreed to.

Baroness Northover moved Amendment No. 75:

(1) The Secretary of State shall, by regulation, set up a local mediation scheme to be operated by Patients' Councils.
(2) Regulations under subsection (1) shall provide for--
(a) petitioning of Patients' Councils by local stakeholder groups;
(b) the broad criteria by which requests for mediation are to be decided;
(c) the bodies and office holders that Patients' Councils will have the power to call to a mediation meeting;
(d) the time period within which mediation meetings must be arranged;
(e) reports to be provided by the Patients' Council to the Commission for Health Improvement, the Commission for Mental Health, the Audit Commission and the Secretary of State.
(3) Before making regulations under this section, the Secretary of State shall consult Community Health Councils, Patients' Councils, Patients' Forums and such bodies currently providing mediation schemes and the wider community, as the Secretary of State shall consider appropriate. The noble Baroness said: In moving this amendment, I shall speak also to Amendment No. 98 and Amendment No. 98A which stands in the name of the noble Earl, Lord Howe. These amendments are designed to introduce a local mediation service operated by patients' councils. The purpose of that arrangement is to make provision for the local resolution of problems concerning the planning and delivery of local services.

The resolution of problems at an early stage locally would reduce the need for problems to be directed through the courts or referred to the Secretary of State. The amendment ensures that the results of such

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mediation are to be reported to the Commission for Health Improvement, the Commission for Mental Health and the Secretary of State so that any lessons that can be learned from that particular conflict can be picked up by those bodies and good practice disseminated elsewhere in the service.

This provision ensures also that there is an accountable and transparent system in place and seen to be in place. That seems to us a very sensible provision with which I hope the Minister will sympathise. I beg to move.

Lord Hunt of Kings Heath: I was interested in the speech of the noble Baroness. I have severe doubts about the amendment because, in a sense, she is proposing that patients' councils act as a mediator between different NHS organisations within a particular locality.

There is a fundamental problem of principle in that regard in that we see patients' councils as having a specific focus based on patients. Their role, alongside the patients' forums, is surely to represent the interests and views of patients as regards local services.

In view of that, one wonders to what extent they could then act as a neutral observer in being able to mediate between the different interests of the health service or, indeed, between the health service, local government and voluntary bodies.

It seems to me that if there is a dispute, there are two ways in which it can be dealt with. First, if it is a concern about major service changes, it must be the role of the overview and scrutiny committee of the relevant local authority to scrutinise the proposals and, if it disagrees with them, it can refer the matter to the independent reconfiguration panel which we shall establish to advise the Secretary of State. If it is not so much a question of a major service change but is in a sense a spat between different NHS bodies and organisations, it is for the NHS regional office to sort that out.

I understand what the noble Baroness seeks to achieve but I have reservations about giving patients' councils a role which in some ways may detract from their focus on patients and their interests.

Baroness Northover: I listened with interest to what the Minister said. It rather illustrates the problems which we are having, in the sense that on this side of the Committee we are looking for a unified approach to those matters, whereas it seems from the list which the Minister has just given that the Government are looking for a diverse and varied approach to all the different parts. That is reflected in the amendment. In looking for a unified, independent and informed overview of what is happening, we are seeking to tie together the different parts, and that does not seem to be the Government's approach.

However, I shall wait with interest to see what follows on from these debates and where we can move to. Therefore, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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Clause 12 [Patients' Forums]:

Earl Howe moved Amendment No. 76:

    Page 9, line 40, at beginning insert "Before the commencement of section 18,"

The noble Earl said: In moving this amendment, I shall speak also to Amendments Nos. 11 and 138. I need not tell the Minister that there is a fundamental difference of view between the Government and ourselves on the future of community health councils. I want to raise an issue which relates to the implementation of the Government's proposal to abolish CHCs.

If the Government have their way, Royal Assent for the Bill will be granted some time in advance of 1st April 2002 when the new bodies proposed in the Bill become fully operational. During Standing Committee in another place, the Minister, Mr Denham, indicated that the Government would continue to fund CHCs and ACHCEW until 2002. That assurance, although welcome, leaves open the question of exactly when CHCs will be abolished. To my mind, we need to make absolutely certain that, as far as possible, there is a smooth transition between the existing regime and the new one. That can happen only if the new systems are fully operational and bedded down before CHCs cease to exist. That in turn means that the statutory powers and responsibilities of CHCs should continue in being alongside the new structures for a period of time.

There is uncertainty about the Government's intentions as a result of a letter circulated recently to CHCs by the Chief Nursing Officer, Sarah Mullally, in which she said:

    "CHCs will remain in each area until the new system is in place".

Taking those words literally, that could mean that different abolition dates will be set for different CHCs according to how well advanced the implementation of the new systems is in each area. On the other hand, it could mean that there will be one cut-off date for all CHCs, regardless of how firmly established or not the new arrangements may be.

The fact is that that uncertainty exists and it reflects quite badly on the Government. As I said before, there was a total absence of consultation on those proposals when they were announced originally. Even if I accepted, which I do not, the view expressed by Ministers that ACHCEW had no legitimate expectation of being consulted, it seems to me a matter of courtesy to keep ACHCEW informed of the timetable for the demise of the CHCs and to give some indication of how plans should be made for that.

The way in which ACHCEW has been treated by Ministers is highly regrettable. I hasten to add that I have received no whinging from ACHCEW in relation to this at all. That is purely my own view and, therefore, I would be grateful for reassurance from the Minister. How do the Government see the transition process working? Will they undertake to keep all parties properly informed of the timetable? Above all, will they ensure that as far as possible the transition to the new regime will be a seamless one?

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It would also be helpful to have clarification on what will happen to the employees of CHCs. Will they be offered the opportunity of applying for positions in, say, patients' councils and, if so, will their terms and conditions of employment be protected? Can the Minister tell the Committee what will happen to the records maintained by CHCs? The records represent a valuable resource, but issues of confidentiality will need to be considered. It would be helpful if the Minister could provide clarification on those concerns. I beg to move.

9 p.m.

Lord Rea: Amendment No. 138, in this group, stands in my name. I can do no worse than remind my noble friend of a paragraph in my Second Reading speech to which he did not have time to reply. I expressed more or less the same sentiments as those produced by the noble Earl, Lord Howe, although perhaps not in as elegant a fashion. I said:

    "Can we be assured that the new organisations will be up and running before the community health councils are abolished? If, as I hope, many of the community health councils' paid and voluntary staff are transferred to one or other of the new bodies, can they continue to function under the aegis of the CHCs while the new arrangements are being brought into being? How are the phasing out and phasing in to be managed so that the experience of the CHCs' staff and volunteers is not lost?".--[Official Report, 26/2/01, col. 1022].)

There is already much disquiet among CHC and ACHCEW staff about the future and I believe that some of them have already taken other jobs. Perhaps my noble friend can tell the Committee what the Government's thinking is on this matter.

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