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Baroness Hanham: I apologise for intervening rather late in the process of this Committee. As I do so, perhaps I may remind Members of the Committee that I am the chairman of a National Health Service trust. I rise to speak on the question of consultation, to which my noble friend has just referred. I note that all the way through the debate on the amendments reference has been made to this clause, which recommends that regulations should be consulted upon with the community health councils and patients' councils. I have absolutely no objection to that; it is perfectly proper.

However, the organisations that will be the subject of the proposals are not being mentioned. Therefore, I should like to put down a marker that presumably the National Health Service trusts, care trusts and primary care trusts will be involved in such consultation, as well as the wider community.

Earl Howe: I realise that I failed to speak fully to my Amendment No. 134. Perhaps I may do so quickly. It is an amendment which I drafted as a clause on its own and it concerns complaints. Its purpose is to unify the complaints procedures for health and social services. Increasingly, complaints are made about issues that involve both health and social care provision. That trend is likely to continue because health bodies and local authorities are working together more closely, as has been said throughout today's proceedings. Indeed, they are being encouraged to do so.

It would be easier for complainants if their complaints could be investigated by a single body. That would save them having to disaggregate what may often be complex components of a complaint in order to lodge them with the appropriate bodies.

10.15 p.m.

Lord Hunt of Kings Heath: Clearly these amendments concern the arrangements for independent advocacy under Clause 17 and the complaints process for the NHS. The Bill places a new duty on the Secretary of State to arrange for independent advocacy services to be made available specifically to support people who wish to pursue a complaint against the NHS under the NHS complaints procedure. It is the first time that such a duty has been placed on the Secretary of State and I believe that it is a

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very welcome development. It means that patients who wish to complain will receive the support that they need both to understand the complaints process and to resolve the complaint itself. I believe that it represents a significant improvement over the current arrangements.

Having said that, I have concerns about the amendments that have been spoken to in this debate. Perhaps I may turn to Amendment No 125, which seeks to leave out,

    "to such extent as he considers necessary".

Clearly, that would take away the Secretary of State's discretion over funding the new independent advocacy service. I cannot agree to that because, finally, it is a matter which I believe must fall to the Secretary of State.

However, what is not in doubt is that the new service must be resourced appropriately to enable it to respond to the demands placed upon it. It is certainly in everyone's interests to ensure that the independent advocacy service is as effective and efficient as possible.

Amendment No. 126 relates to the question of medical practitioners. I do not agree with the aim of the amendment. Medical practitioners have access to support through their professional bodies. I believe that those bodies are particularly effective in representing the views of medical practitioners. I do not believe that it would be appropriate to make independent advocacy available to them.

Amendments Nos. 127 and 128 aim to extend the Secretary of State's duty to arrange independent advocacy services to people who wish to complain about the services provided by a local authority. I understand the reasons for that proposal but there are genuine difficulties with it. The purpose of the new independent advocacy services is to assist complainants against the NHS. We have a different statutory arrangement and framework which applies to local authority services. It would be very difficult to extend the scope of an NHS independent advocacy service in that way.

However, I accept that similar issues arise as to how to help service users take up concerns about the services that they receive. We know that there are already many examples of advocacy in social services and particularly in relation to social services for children. We debated that matter in particular in our discussions on the Children (Leaving Care) Bill. I can tell the noble Earl that, following a recent consultation exercise on social services complaints procedures, we are looking at the possibility of a statutory right of access to advocacy as part of those procedures.

Amendment No. 129 seeks to extend the provision of independent advocacy services to those making complaints against independent providers, including independent hospitals, medical agencies and care homes.

Again, I see difficulties in that. The independent advocacy service is there to support those making complaints under the NHS complaints procedure. While that will apply to independent providers who

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are contracted by the NHS to provide health services to NHS patients, it will not extend to services provided by independent hospitals. Those organisations should make their own arrangements as they see appropriate to provide advocacy for patients who complain about their services.

The Government intend that independent advocacy should be just that, as set out in detail in subsection (5). That subsection already requires the Secretary of State to have regard to the principle that the provision of services should be independent from the person against whom the complaint is made, or who is investigating or adjudicating on the complaint.

Independence arises from a number of different factors. Clearly, funding is one such factor. If the service were resourced by the person making the complaint, that provision would not be independent and the principle set out in the clause would have been breached. We intend to respect the independence of funding already provided in the clause, and so separate provision is not required.

We have said also, in subsection (6), that we shall consult the relevant patients' council about the arrangements for providing the independent advocacy service. That will ensure the relevant local element of independence which the amendment seeks to enforce. For that reason, it is not necessary to legislate for a monitoring and accreditation scheme.

On Amendment No. 131, it is the Government's intention that independent advocacy services should be provided by a source entirely independent of any person or body that is the subject of or involved in the complaint. We shall seek to ensure that as far as possible.

Amendment No. 132 would have no effect because a reference in an Act to a person also includes a body. That is a reference to the Interpretation Act 1978.

Amendment No. 133 demonstrates the risk associated with lists. The amendment would limit whom the Secretary of State could consult about arrangements for independent advocacy. By listing the relevant patients' councils, community health councils and national bodies involved in advocacy, it confines the persons to be consulted to those organisations. It would have the effect of narrowing the scope of the clause. Of course, we wish to have the widest possible involvement by organisations from whom we shall seek and welcome views. I should say to the noble Baroness, Lady Hanham--and she would certainly expect me to say it--that the views of trusts and health authorities will be especially welcome, as will the views of the NHS Confederation.

On Amendments Nos. 96 and 134, I return to the issue of a unified complaints procedure covering both the NHS and social services. Last year we consulted on social service complaints procedures and we intend to propose changes to them in due course. Noble Lords will probably be aware that we also funded a two-year UK-wide evaluation study of the NHS complaints procedure. Now is not the time to discuss or to legislate for a unified NHS and social services complaints

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procedure ahead of those particular activities, but I certainly accept that to ensure--particularly in relation to services that are to be run together--that there is an easy way for the public to make complaints about those services is a challenge to the NHS and to social services.

Baroness Cumberlege: I support the Minister on the matter of lists. I believe that they are a snare and a delusion, except when my husband goes to the supermarket and then they are absolutely essential!

On the matter of the independent advocacy service, the Minister said that it is a significant improvement, which I would endorse. I believe that it is a great move forward. If it works really well, it will reduce litigation towards which we should all work. However, there is some timidity in terms of the unified advocacy service. Earlier today my noble friend Lord Howe described some of the approaches of the Government to this Bill in terms of looking at the functions and then looking at the structures to support those functions. This is another part of that. If we were to put patients first we would not worry about this. We would ensure that we worked out the structures to enable the patients to use a unified service. I am afraid that we have shades of Mrs Archibald back again because we know that many patients become trapped between the social services element, the care element and the National Health Service element. Of course, later we shall go into that in relation to nursing services and care services.

In relation to Amendments Nos. 127, 128 and 134, proposed by my noble friend Lord Howe, I urge the Minister to meet with his colleagues. I know some work has taken place, but the role of government is to ensure that such structures are set up so that patients are aided in what can be a stressful, difficult time when they are often fobbed off by one agency or another.

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