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Lord Harris of Haringey: I understand what my noble friend said about the complications of resource allocation. It will no doubt be an interesting exercise for whoever has to undertake that task. In the future, the Secretary of State will undoubtedly have to explain the position that has been taken, rather than just saying that it was an historical accident arising from the original allocations to CHCs back in the 1970s.

However, I am not sure that I fully understand my noble friend's arguments about staff being employed by the national body and the concern that they would look to the national body rather than to the local body for guidance. The corollary of that argument is that if in effect staff are employed by the Secretary of State through a health authority or regional office, they will look to the Secretary of State for guidance and direction. Surely that is even less satisfactory in terms of independent effectiveness at local level than their looking to a national body which seeks to protect the interests of patients and health service users.

Lord Hunt of Kings Heath: I am not sure that I agree with that. I know that my noble friend can point to some areas where there have been problems with the current arrangements where he feels that some CHC staff have not been accorded the degree of independence by the employing authority which he considers they should be accorded. However, I believe that overall the system has worked well. It has comprised an employing organisation for staff which is reasonably removed from their work locality. I consider that if we were to have a national patients' body, as is suggested in the proposed new clause, and if it were to hold all the money and to employ all the staff, it would simply become a national service. I believe that that could detract from the essential element of all this work at the local level.

Baroness Noakes: Will the Minister consider funding and the employment of staff as separate

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issues? One could free staff from any residual concerns about who the paymaster is by having the direct contractual nexus with the new national body, but by having funding dealt with separately if issues of resource allocation are deemed to be too difficult, as my past experience indicates that they may well be. I believe that we can treat those two matters as quite separate issues. There is a serious issue as regards creating sufficient independence from the rest of the NHS for staff who are allocated to these functions.

Lord Hunt of Kings Heath: I accept that point. However, we intend that there should be an independent secretariat which supports both patients' forums and patients' councils. But because the forums and councils will not employ bodies in their own right we have to find another vehicle to do so. Inevitably there will be debate as to whether that is entirely satisfactory. As my noble friend has pointed out, there have been some problems in that area. I believe that on balance it is better that the secretariat, which will be independent, has an employer which is situated as close as possible to the relevant locality. A national organisation with a national employer would remove many decisions away from the locality where people work.

Lord Clement-Jones: We have had a significant debate in the past half hour. It is significant that the Minister has accepted an important principle tonight. It is welcome that he has accepted an amendment, although I realise that many Members of the Committee consider that it needs further development. I also welcome the fact that the Minister said that there will be consultation on how the body will operate.

Although one amendment has been accepted, in a sense we are still subject to work in progress. I say to the noble Lord, Lord Harris of Haringey, that he can make as many cheap jibes as he likes when he makes the good points that he does. I believe that he made four criticisms of Amendment No. 134A which I hope that the Minister will take on board as the Bill progresses. It is possible to correct by regulation the perceived holes in the amendment. For instance, a great deal was made, I think validly, of funding, employment of staff, responsibility for quality control and the nexus with the independent advocacy service. The noble Lord, Lord Harris, raised those points, rightly I believe. Despite the fact that the Minister is somewhat sceptical about how the funding may operate, in particular as regards membership and staffing, I hope that as the consultations progress, it may be possible for the various interested parties to come to an accommodation.

I believe that Amendment No. 134A has the flexibility for appropriate regulation to be made in due course. I shall move the amendment when we reach that point. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 85 to 95 not moved.]

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10 p.m.

Baroness Northover moved Amendment No. 96:

    Page 11, line 27, at end insert--

"( ) The Secretary of State shall by regulations make provision for a unified health and community care complaints procedure.
( ) Before making regulations under this section the Secretary of State shall consult Community Health Councils, Patients' Councils, Patients' Forums, patients' organisations and the wider community."

The noble Baroness said: In moving the amendment, I speak also to Amendments Nos. 126, 129 and 133. I may earlier have inadvertently encroached on an amendment of the noble Earl, Lord Howe; I shall try not to do so again.

Underlying these amendments is the determination on our part that there should be a unified, effective and independent complaints procedure. That theme came out strongly at Second Reading and earlier today. Patients and the public have always deserved the best from the NHS. Today, unlike in 1948, they also expect the best. They understand if resources are limited but they do not accept that access to high quality provision depends on where they live, to whom they are referred and what arrangements have been made locally to facilitate or otherwise a good service.

When things go wrong, most patients are savvy enough to know when they are being fobbed off, whether the body to whom they complain has an interest in simply muzzling them, or they have a suspicion that that is so, and some will simply never find their way through the Byzantine system that awaits their complaints. It is no doubt clear that we on these Benches are not optimistic that the Bill will achieve improvements in this area. The amendment seeks to do just that.

Amendment No. 96 states that the Secretary of State must provide for a unified health and community care complaints procedure, given that the two arms are being brought closer together. We would like the term "unified" to run throughout the complaints procedure. It is plainly ridiculous that one patient suffering from different problems at different stages of his treatment should need to find out about, and proceed to, complaints systems in bits and pieces. As we have heard, that is looking at complaints from the service's point of view, not the patient's.

Amendment No. 129 seeks to include independent hospitals, clinics, medical agencies, care homes and domiciliary care under the umbrella of what we are discussing here. Across all the amendments, we are discussing a unified, independent, transparent and easy to use approach. No part of the complaints procedures should be, or be seen to be, answerable to trusts. Those procedures have to be, and have to be seen to be, independent. They must not depend on the whim of the Secretary of State. They must be seen to be robust. As litigation in medicine increases, this is the time not to weaken and fragment, but to anticipate, strengthen, unify and make more independent the complaint and advocacy procedures so that when something seems to go wrong, the cause can be quickly

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and easily established with the full confidence of the patient in how they are being treated in the system. I beg to move.

Earl Howe: I shall speak to Amendments Nos. 125, 127, 128, 130, 131, 132 and 134. When speaking to my amendments to Clause 13 on patients' councils, I explained my view that advocacy services would sit most logically as an integral function of a patients' council. That view met with some agreement around the Committee. I shall not rehearse those arguments, but I should like to raise some issues surrounding the provisions of Clause 17.

Amendment No. 125 would remove the words,

    "to such extent as he considers necessary"

from new Section 19A(1). There is too great an overtone of subjectivity and discretion in Clause 17 on what the Secretary of State is enjoined to do. If he were so minded, the Secretary of State could set up a minimalist advocacy service, perhaps even as an adjunct to PALS based in NHS trusts. That would not do. The clause would be strengthened by the removal of those qualifying words.

Perhaps less provocatively, I have suggested in Amendment No. 127 that the remit of advocacy services should be extended to assisting individuals who wish to make a complaint under a procedure operated by a social services authority. At the moment some CHCs support such complaints. There is often an overlap between health service and social service complaints. If we are trying to break down the barriers between the NHS and social services, it makes sense to remove those barriers to help people find their way round the system.

In the same vein, I have suggested in Amendment No. 128 that apart from complaints made to the two health service commissioners, it should be possible for advocacy services to help someone whose complaint is directed towards the local government commissioner. Again, I am uneasy about the words, "so far as practicable" in subsection (5) on page 14. Perhaps the Minister would care to comment on them. Once one accepts that advocacy services need to be independent--I welcome that provision--it ought to follow that the arrangements are established as an independent service for all. I do not understand what is meant by practicability in that context. The subsection merely requires the Secretary of State to have regard to the principle of independence. It does not seem to fetter or compromise him in any way to insist that the arrangements have to be made everywhere or that they should be made in the form of an independent service.

Following on from that, the Bill should specify that, apart from being independent of the person complained of, the advocacy service should also be separate from any NHS or other body that may be involved in the complaint or that may have an interest in its outcome. That is the purport of Amendment No. 132. Amendment No. 130 continues that theme. If the advocacy service is to be truly independent, the way in which it is resourced should match that principle. There should also be some means of ensuring that the

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output of any given advocacy service is of an acceptable minimum standard and that the data gathered as a result of complaints work should be made available by way of anonymised reports to inform the work of other health bodies. Once again, we ought to ensure that there is information transfer if we wish the new bodies to perform a watchdog function.

Subsection (6) deals with the consultation process that would precede the setting up of an independent advocacy service. The noble Baroness, Lady Northover, has spoken to Amendment No. 133. I agree with her that consultation should take place with all bodies and groups which may be expected to make a contribution to the debate prior to the drafting of regulations.

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