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Lord Astor of Hever: I rise to support Amendment No. 145, which was spoken to so eloquently by the noble Lord, Lord Clement-Jones, and to support the spirit of Amendment No. 134A. If I were dining a la carte, I would definitely go for Amendment No. 145.

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Although my noble friend Lord Howe has put his name to Amendment No. 134A, we on these Benches feel that it is not yet perfect. Further drafting is needed in order to ensure that the views of bodies representing a wider group than just patients and carers are taken into account and also to consider how the body should be linked to advocacy service providers.

At Second Reading in the other place, the Secretary of State announced that the department would be funding work to look at the feasibility of establishing a national patients' organisation to act as an umbrella body for NHS patients. However, as the noble Lord, Lord Clement-Jones, pointed out, that study has not been completed. Can the Minister tell the Committee what is the progress to date on that initiative?

We agree with the noble Lord, Lord Clement-Jones, that the national patients' council should be put on a statutory basis to ensure its independence and protection from changing opinion within the Department of Health, otherwise it will be liable to abolition or loss of funding without parliamentary debate. The political debate that has taken place over the past few months with regard to the abolition of CHCs shows how statutory status ensures that governments have to account to both Houses of Parliament when seeking to abolish bodies that represent the public interest.

The group overseeing the scoping study passed a statement on 7th March which stated:

    "The advisory panel agreed, after consideration of the interim findings, based on consultation with a wide range of patient bodies and detailed feedback from over 60 organisations, that a national statutory body is needed to fulfil the key functions identified".

We hope, therefore, that the Government will now make a commitment on the face of the Bill that they will introduce a national body. If they do not do so, we feel that they will be riding roughshod over the wishes of the scoping study that they themselves established.

Lord Harris of Haringey: I rise to speak briefly in support of Amendment No. 144. Since tabling the amendment, I realise that, given the propensity of the NHS to use acronyms, this body might find itself being called "NATPUC" which is not the most appropriate name for a health service body.

It is worth noting the wide degree of consensus expressed on all sides of the Committee on the principle that some form of statutory status is needed here. So wide is that consensus that I note that the noble Lord, Lord Clement-Jones, has put his name to four different versions of the body. No doubt this develops the style that is typical of the Liberal Democrats in the run-up to elections: they are all things to all people. However, perhaps that is a cheap jibe which I shall withdraw instantly.

The importance of statutory status should not be underestimated. I know that government thinking appears to have moved on this, in that the principle of any reference on the face of the Bill was one that was rejected in another place. However, I understand that this concept may now be acceptable.

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I shall draw on my experience of serving as the director of the Association of Community Health Councils for almost 12 years. During that period, I gathered together a fat file of denunciations of my actions and those of the association by successive Secretaries of State, some of whom are now Members of your Lordships' House, although thankfully they are not present tonight. It is the function of consumer bodies and bodies representing the public interest in many spheres to make waves and to cause difficulties. On occasion, that goes against what Ministers wish to hear. Indeed, my file of denunciations concludes with what is probably the most vitriolic attack of all; it came from my right honourable friend Frank Dobson, who was then Secretary of State for Health. It was clear that he believed that anyone associated with the Labour Party, like myself, should not have been making the kind of comments we were issuing when a Labour Secretary of State was in office.

However, the point here is that every organisation along the lines of a CHC will, on occasion, need to be critical of government Ministers. If it is made too easy for governments of either complexion to say, "Let us abolish this organisation by removing its funding stream", then that is an extremely unsatisfactory situation. Statutory status matters a great deal and would be appropriate on the face of the Bill.

I still believe that, with one exception, my amendment is the best of the bunch. I take the point made by the noble Lord, Lord Clement-Jones, that it would have been better had the proposed new clause stated,

    "The Secretary of State shall by regulations provide",

rather than,

    "may by regulations provide".

There are a number of elements in my amendment which I hope, even at this late stage, the Government will consider. The first element concerns the question of whether or not the new national body should have explicit responsibility for dividing and allocating funds and resources to patients' councils around the country. My noble friend the Minister suggested earlier that the proposal was that funding would come through the regional offices of the NHS. That is the arrangement that currently applies to CHCs.

However, it is not always a happy relationship. The regional office of the NHS is there to ensure that the NHS region functions as it thinks appropriate, and there are sometimes stresses and strains between the regional office and CHCs, particularly those CHCs which are the more effective and perhaps create more waves on the issues which need to be addressed by the local health service. A system whereby the funding stream came through a body which was clearly established for the purpose of representing the patients' and users' interests at a national level would be an appropriate way to handle that issue.

Similarly, issues arise about who employs the staff-- again a point referred to earlier. I think that the current arrangement--which is very complicated--whereby staff of CHCs are employed by health authorities, paid through a trust and managed by and accountable to

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the regional office is a very messy one. There have certainly been instances where perhaps inappropriate pressure has been applied to staff of CHCs by regional offices. There has also been ambiguity caused by the question of who is the employer and who pays the salaries. Again, arranging for staff to be managed and appointed through a national organisation would provide arm's length support for the principle of independence, which I believe is extremely important.

The final point that I consider critical is that the national body should have responsibility for quality control and performance management of patients' councils. That is something that has been lacking in the past. On occasion, regional offices have taken on that responsibility and, again, it has not always been a happy arrangement. Under such a system it would be clear that all patients' councils across the country were being performance managed by the national body.

That leads on to the question of what will be the governance arrangements for this national body. The current Association of CHCs is, of course, run by a standing committee which is elected from CHCs. That cannot be the appropriate way of doing things if the organisation is responsible for the performance management of individual CHCs and for some of the funding issues. It would be much better if the governance body contained representatives of patients' councils and various bodies around the country but also other people with an interest and belief in representing the interests of health service users and carers. By having that balance between people who are involved in patients' councils and those who are involved in representing the interests of health service users and carers through other mechanisms, you provide, if you like, a non-executive function which ensures that the performance management of local patients' councils is done in an effective and fair fashion and in a way which is not seen externally as self-serving.

The balance of membership is extremely important, and that is why I have reservations about Amendment No. 134A--which, rumour has it, is the favoured amendment today. The reason for this is that there is no reference at all within that amendment to the questions of staffing and funding. There are provisions in it which may allow staffing and funding to pass through the national patients' body, but it is not specifically prescribed.

There is nothing said in Amendment No. 134A about what are the Government's arrangements for the national patients' body. That could lead to all kinds of problems. You could end up with a national patients' body, the membership of which consisted entirely of hand-picked cronies--after an appropriate "Nolanesque" process--who would simply be there to ensure that what the Minister wanted to happen would happen in respect of patient representation. I am sure that that is not the intention of the Government. But it would be helpful if they made it clear that it is far removed from their intentions. It would be helpful to make clear on the face of the Bill the arrangements for the governance of the organisation, how it will be run and how it will relate to patients' councils.

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A further point which is omitted from the proposed new clause in Amendment No. 134A is any reference to the new body's relationship with independent advocacy services. That is not a problem if the view that I expressed earlier prevails; namely, that patients' councils are responsible for organising or making sure that arrangements are made for independent advocacy services in their area. If that is the case, it does not matter that no reference is made to independent advocacy services in respect of the national patients' body.

However, if the view expressed by my noble friend the Minister prevails--namely, that there will not necessarily be any prescribed form for the provision of independent advocacy services--it is important that there is a clear linkage between the independent advocacy services and the national patients' body, however that body is constructed.

I hope that we shall receive a clear signal from my noble friend the Minister that the principle of statutory provision for a national patients' body is accepted but that the specific reservations expressed in relation to Amendment No. 134A have also been taken on board by the Government.

9.45 p.m.

Lord Hunt of Kings Heath: This has been an extremely interesting debate. I was particularly interested in my noble friend's fat folder of anguish expressed by Ministers at his activities and those of his organisation. I am not sure that my file is quite so fat as his; however, I recall being called in by a deputy secretary some years ago to be told that if I did not stop criticising the Government they would instruct health authorities not to pay any further subscriptions to the NHS Confederation, its predecessor organisations--a point to which I may return in relation to devolution in future discussions in Committee.

This is an important issue. The Government are sympathetic to the concept of a national body. We are backing a study by patient organisations into the feasibility of a national body to represent patient interests at national level. We have seen an early draft of the recommendations and we feel that Amendment No. 134A goes a long way to meeting the broad thrust of those recommendations. It is our intention to accept the new clause proposed in Amendment No. 134A.

In accepting the amendment, we shall be creating a new independent statutory body to advise the Government on the effectiveness of the new arrangements for patient and public involvement. What is significant in relation to a number of the questions raised regarding how the new national body will operate--particularly those raised by my noble friend--is that the new clause will place a duty on the Secretary of State to consult on all the regulations made in regard to the new national body.

I want to make it clear that the Government are committed to wide consultation on how exactly the body should operate. This will include some of the issues raised by my noble friend, including the

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appointment of members--we shall want to see a rigorous, high-quality membership--the funding of the body and the provision of information to it. We shall have the final benefit of the recommendations resulting from the feasibility study soon. We shall examine them closely, together with any other suggestions put to us, before framing the regulations.

It is worth discussing briefly the kind of role that the new national body might occupy--first, importantly, in providing advice to government and NHS bodies on the arrangements for patient and public involvement in the health service. No doubt it will fulfil that role by gathering information from the NHS and the public about the development of these arrangements, by obtaining the views of staff involved in the patient advocacy liaison services and of members of patients' forums and patients' councils. Once these arrangements are fully in place, the body will then be able to advise the Government on the future development of processes for involving patients and the public. The body will have a duty to advise the Government through publishing an annual report, and to report to Ministers separately on its operations and its view on the effectiveness of the arrangements in the NHS.

The body will also be able to represent to the Secretary of State the views of patients, carers, and patients' forums and councils. In doing so, it will provide the opportunity for collaboration between the different patient organisations. It is to be hoped that that will allow for the co-ordination of patients' views from different organisations. I believe that it will also lead to somewhat more cohesive arrangements than are currently in place. Most importantly, the body will be able to support and advise patients' forums and councils. I am sure that that will be enormously effective in spreading good practice and in encouraging those bodies to be as effective as possible. I can give the Committee an example of how that might work. The body might draft a code of conduct for members of patients' forums, suggest service standards for the provision of advocacy services and provide advice on how the forums should relate to the board of the NHS trust, or the primary care trust, to which it relates.

I was interested in the comments made by the noble Lord, Lord Clement-Jones, and by my noble friend Lord Harris about some of the roles of a national organisation in relation to the funding and staffing of local patients' forums and councils. It is worth pointing out that, at present, CHCs are funded by the Secretary of State via a lead health authority in each region, whereas the Association of Community Health Councils is funded by CHC subscription, and also, I guess, by some income revenue raising activities.

I turn to the question of whether or not those arrangements should be replicated. I have great reservations about pulling the funding of the forums and councils up to the centre and using this proposed national body as a way of allocating those moneys. I do so for two reasons. First, if resources were allocated from this central body, and if staff were employed by it, I suspect the people working at local

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level would inevitably look to the national body as a fount of wisdom and accountability to the detriment of their work at local level.

Secondly, if this national body were concerned with the allocation of resources to patients' forums and councils, I suggest that it would be sucked into enormously difficult arguments about the formula to be adopted to ensure that it reached a fair-share position. The one issue that I always avoided at the NHS Confederation was any debate about RAWP, and any other allocated process that followed. I did so because I knew that we could never win. If the new patients' body were to employ all the staff and allocate all the money, I cannot help but wonder whether it would become sucked in by such difficult details to the detriment of its over-riding power.

I can assure my noble friend that we shall listen most carefully to what he and other noble Lords have to say about the proposed new patients' body. However, I believe that Amendment No. 134A most closely fits the Bill. That is why I urge Members of the Committee to accept it.

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