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The Earl of Listowel: I see great value in the Minister's emphasis on focusing on the patient and his or her experience, but something is being lost. Here one has an institution with a shop front in the community that processes complaints but also can take a broader view of strategy and thinking and the needs of the community. I do not believe that that asset is being replaced by the oversight and scrutiny committee. I do not have experience of local government, but I have worked with socially excluded people. It is easy to lose touch with that experience. When one deals with people who do not speak English, or perhaps are illiterate, or have difficulty connecting with the system, they are more likely to fall between those patients who are recruited to the new forum and council and the local authority group. I should be very grateful if the Minister could reassure me on that matter.

Earl Howe: I am grateful to all noble Lords who have taken part in this short debate. The difference of view between us underscores what I see as one of the shortcomings of the network of structures created by the Bill; namely, its fragmentation. Overview and scrutiny committees are designed to fill a democratic deficit, which I thoroughly applaud, but their remit is not the same as that of patients' forums. I believe that the latter have their own roles to play in reflecting the views of the locality and trying to represent them on a day-to-day basis in the health service. Not to have a broader compass, as my amendments suggest they should, would be a shame. It may be that, in practice, their role will broaden out because people inevitably come to talk to you if your door is open. I am sorry not to see something more formally reflected in the wording of the Bill. But I am, as ever, grateful to the Minister for the trouble that he has taken to answer my points, and I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 79 to 81 not moved.]

The Deputy Chairman of Committees (Viscount Simon): Before calling Amendment No. 82, I must advise Members of the Committee that, if it is agreed to, I cannot call Amendment No. 83 due to pre-emption.

Lord Rea moved Amendment No. 82:

The noble Lord said: This amendment is conveniently tabled at this point because we are considering in this clause the general functions of patients' forums.

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One of the main worries about the new arrangements is that the independent status of the CHCs will be lost. The patients' fora will be set up in association with one NHS or primary care trust. Therefore, it already appears that they will not have the independence of the CHCs. My noble friend may differ. He may say that they will operate under a different structure and will be able to take a completely independent position. I am not so sure about that; nor are many people who are rather critical of the whole thrust of the Government's reforms. Perhaps my noble friend will clarify how far the patients' fora will be removed from their parallel trusts, and the mechanisms by which they will be seen to be independent. I beg to move.

Lord Hunt of Kings Heath: In response to my noble friend, I say that there will be no point in having patients' forums unless they are to be effective; and, to be effective, they need to be independent. I restate to the Committee that the intention is that patients' forums will be provided with the independence required to fulfil their functions. They will be independent from the trusts for which they have responsibility--just as independent as community health councils are from the health authorities with which they have a relationship.

Forums will be established by the Secretary of State, not by trusts. The trusts will have no power to control how a forum carries out its functions. Members of the forums will be appointed independently through the auspices of the NHS appointments commission, which comes into operation on 1st April this year. Regulations will determine the criteria under which those appointments are made. Forums will be not be based in the trust, as in the case of the patient advocacy liaison service (PALS), but will be supported by a common secretariat shared with other local forums and the patients' council to whom they appoint representatives. Funding will be determined in regulations but will be received independently of the forum's trust.

I wish to state to my noble friend that the link between forums and their trust is central to making these new arrangements work effectively. To ensure that their views are effective, forums will appoint a non-executive director to the trust board. The forum will have the opportunity to build in the patient view at an early stage of the trust decision-making process. To make sure that all are aware of the forum's activities and the trust response, a patient prospectus will be published each year, detailing what patients think of services and how the trust is addressing those issues.

The patients' forum will sign off the patient prospectus as well as publishing its own annual report. I believe that these arrangements ensure that the forum will be independent of the trust and will prove to be a robust ally of the patients and the public concerned with that trust.

Lord Rea: I thank my noble friend for those reassuring words. I have a certain sympathy with him

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in that these words will now be in Hansard; they will be read countrywide and studied in considerable depth. The Government will be held to them. With those remarks, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 83 not moved.]

Clause 12 agreed to.

9.30 p.m.

Lord Clement-Jones moved Amendment No. 84:

    After Clause 12, insert the following new clause--

(1) The Secretary of State shall establish an independent national body, known as the Association of Patients' Forums, with a duty to provide a national overview of the patient experience to the Secretary of State and National Health Service bodies, on a regional and national level.
(2) The Secretary of State shall make regulations for the purposes of subsection (1) above.
(3) Before making regulations for the purposes of subsection (1) above, the Secretary of State shall consult such bodies as represent the interests of persons likely to be affected by the regulations."

The noble Lord said: In moving Amendment No. 84 I shall speak also to Amendments Nos. 134A and 145. It is common ground on all sides in the Committee that ACHCEW has played an extremely valuable role over the years, not only in co-ordinating the activities of CHCs nationally and in spreading best practice, but in giving information to members of this House and the other place; for example, its snapshot surveys of accident and emergency departments. They have played a valuable role in keeping us abreast of what is happening in our hospitals.

The major gap in the Bill is the failure either to retain ACHCEW or to put another body in its place. A letter from the National Consumer Council is typical of many representations made to me and my colleagues on these Benches and no doubt to many other noble Lords. The NCC stated:

    "Despite the various local structures, the Bill still leaves a gaping hole, in that it omits a national body for patient and public representation".

One hopeful development was that the Government in another place recognised the case for a national body to bring together the various patient representation bodies, the forums and councils. The Department of Health proceeded to fund a short feasibility study to explore how such a body could work in practice. I understand that the results of the study will be produced by 31st March.

There is general consensus about the likely functions of such a body. First, it would bring together the evidence from the patient forums and councils about the general issues arising for patients at the local level and ensure that it is used to influence future policy developments at a national level; secondly, it would provide support training and development for the patient and public representatives; thirdly, it would ensure quality by monitoring that all the patients' councils and forums' services are delivered to agreed standards; and, fourthly, it would shape best practice on a national basis. That is an extremely important

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agenda for such a body. However, by the time the conclusions of that feasibility study might be published, the Bill could have finished its parliamentary journey through this House or a general election might have been declared. Therefore, it is important that we put down a marker and, if possible, come to an agreement on an amendment while the Bill is in Committee.

It is important that the national body should be statutory and not simply one set up through co-operation between the councils. We believe that it should be a body corporate with powers defined in the Bill. It may be that one should not be over-prescriptive, but certainly the broad outline of the powers and duties of the body should be included.

There are various different ways of achieving what we seek. The noble Lord, Lord Harris, will notice that we are back to an a la carte process with a series of amendments that have different impacts and may have different fan clubs in the ways they operate. Amendment No. 84 contains a fairly broad power to enable regulations to be made, but it sketches out only the broad outline of the kinds of duties that such a national body would have. Amendment No. 134A sets out considerably more of the powers and duties of such a body. It does not go into as much detail as many would like. For instance, it does not state that the new body will be responsible, in the same way as ACHCEW is, for funding patients' councils or patients' forums or that it should be a conduit for such funding. However, it allows regulations to be made that may or may not provide for that in the future.

Amendment No. 145 is perhaps the most comprehensive of all the amendments. It provides not only for a national body but also for regional patients' councils. That is certainly a preference of many in the CHC movement who would like to see the creation of those forms of regional councils. It would also have a resonance with regional government to be set up in the future.

I hope that one of the amendments will commend itself to the Government. I suspect that Amendment No. 134A is probably most to their taste. All the amendments would allow for developments to take place in the future. We need to have a provision that gives reassurance that this body will be set up. Therefore, the word "shall" in the first line of Amendment No. 134A is extremely important; otherwise, there might be a feeling that this would be nice to have--an optional extra--but might not happen once the Bill is enacted.

I trust that the Minister will be able to give a fairly good indication as to exactly what is acceptable in this collection of amendments and certainly give hope that we can start planning for the future and that a national body will indeed be set up. I beg to move.

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