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Baroness Masham of Ilton: Before the noble Baroness responds, will it be made clear to the member

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representing patients what his or her role is and will there be a substitute should that member be absent for a long period as there is only one of them?

Lord Hunt of Kings Heath: I do not think that it would be possible to appoint a substitute. If a non-executive member were absent for a long period his or her membership of the board would undoubtedly be called into question. As regards the standards expected of all board members, I refer to the code of conduct and appraisal arrangements in the health service and the corporate governance arrangements which would be applicable to all trust board members.

The Earl of Listowel: Can the Minister explain how long such a patient representative is expected to stay on the board? Is there a finite length of membership?

Lord Hunt of Kings Heath: The maximum period for each term is four years, although non-executives are sometimes appointed for less than that. One can be appointed certainly for two four-year terms and then I believe there are circumstances in which one can be appointed for another one or two years. I would expect that the kind of limits on appointments that apply to other non-executives would also apply to the non-executive from the patients' forum. However, that will be specified in guidance and regulations.

Baroness Hanham: I am grateful to the Minister for his careful reply. I was not expecting anything more. However, I cannot say that he has reassured me. I am very concerned. The terms for the patients' forum representative are unusual. I can think of no other situation where one has an individual with the right of inspection. That is an unusual right. There is the right of inspection of a trust--the premises and everything that goes with it--and then the turning from poacher to gamekeeper by sitting on the board. The patients' forum representative is a very strange animal.

A secondary issue is the confidentiality aspect. Not much these days is debated in private; it is mostly open and above board but there are issues about patients' complaints and sensitive matters relating to patients.

I shall read what the Minister said. It is one of those rare occasions with this Minister when I do not agree. I believe that he makes a mistake. I shall consider the matter carefully. We shall probably return to the issue if there is a later stage of the Bill. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 115 to 120 not moved.]

Lord Hunt of Kings Heath moved Amendment No. 121:

    Page 13, line 10, leave out from "members" to end of line 12 and insert "under paragraph 4(c) above of a Primary Care Trust for which there is a Patients' Forum shall be a person appointed by the Forum."

On Question, amendment agreed to.

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[Amendment No. 121A not moved.]

Lord Hunt of Kings Heath moved Amendments Nos. 122 and 123:

    Page 13, line 15, leave out from "trust" to "and" in line 16 and insert "for which there is a Patients' Forum shall be a person appointed by the Forum.","

    Page 13, line 17, leave out "before "any"" and insert "at the beginning"

On Question, amendments agreed to.

[Amendment No. 124 not moved.]

Clause 16, as amended, agreed to.

Clause 17 [Independent advocacy services]:

[Amendments Nos. 125 to 133 not moved.]

On Question, Whether Clause 17 shall stand part of the Bill?

Lord Clement-Jones: Although we on these Benches wholly support the concept of independent advocacy, I wish to speak to the Question in order to debate the overall shape of provisions regarding patient advocacy, patient consultation and patient representation.

The noble Lord, Lord Harris, made some valuable points yesterday in Committee. He asked the Minister:

    "Would my noble friend think it appropriate to place some residual duty on the patients' councils to satisfy themselves that appropriate advocacy arrangements are in place and are strong enough so that, if they are not satisfactory, the patients' council can provide the service?".--[Official Report, 19/3/01; col. 1197.]

We had a considerable debate about how independent advocacy services would be provided. I took no great satisfaction from the Minister's reply. He said:

    "It is clear that the independent advocacy services could be provided in the way suggested; alternatively, they could be provided by another public organisation. Indeed, they could even be provided by a voluntary organisation".--[Official Report, 19/3/01; col. 1199.]

It is widely accepted across the Committee that the provisions relating to consultation, representation and advocacy are flawed and highly fragmented. There has been very little give in what the Minister has said about the scheme yesterday and, to some extent, today, despite the fact that it was hurriedly put into the plan at the last minute; and outside the Government there is a universal belief that the provisions taken as a whole are fragmented and unsatisfactory. The Government have given very little extra in Committee apart from the new national patients' council. We welcome that, but the new scheme is flawed and we are not satisfied with it.

The Minister could have given much more of a fair wind to the idea of bolting together independent advocacy with the patients' councils. That would be logical and, in the view of many outside observers and many in this House, it would considerably improve the scheme. Giving patients' councils the right to commission and provide independent advocacy services would be a significant improvement to a fragmented scheme.

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I shall not go on at great length, because we have a great deal of business to get through today. I have given an example of the inadequacy of the provisions. As we progress through the Bill, the Minister's approach and his attitude to suggestions for improvement will colour our view on these Benches as to whether the proposals as a whole can be approved. I am in considerable doubt about whether to give any kind of a fair wind to these very fragmented proposals. I look forward to the Minister's reply.

10 p.m.

Lord Hunt of Kings Heath: I do not want to go over all the ground that we covered in our eight-hour debate yesterday on these matters. The Government's case is that the arrangements will result in a stronger, more effective mechanism for user involvement, for dealing with and sorting out problems out and for helping people through the complaints system. At the local level, there will be democratic involvement in the decision-making process. I firmly believe that. I have no doubt that at the end of the day, we shall have much stronger patient and public involvement in and impact on the National Health Service. I am tempted to go back to Mrs Archibald, but I shall resist at this stage. I am convinced that she and her relatives would receive a better service as a result of the arrangements that we are putting in place than they receive at the moment.

I listened with great interest to the noble Lord's comments on independent advocacy. We want some flexibility on how the advocacy arrangements can be made. Patients' councils could be one of the organisations that provide that advocacy, but we believe that we need greater flexibility. I am also convinced that the responsibility should be laid firmly on the Secretary of State, although he will have a duty to consult the relevant patients' councils on the arrangements to be put in place for independent advocacy providers. I also assure the noble Lord that we shall specify criteria that will define best practice for independent advocacy. Those criteria will include the need to make use of existing high-quality local provision; the need for the services to be accessible, including in relation to language--I take to heart the comments made yesterday by the noble Earl in that respect; physical access will need to be open; there must be proof of quality of output; and, whichever service is commissioned, it must be equipped demonstrably to offer advocacy expertise.

I believe that the presence of independent advocacy, established in a way that many people over many years have requested, will prove to be an absolute boon to members of the public who have found failures in the service and who wish their complaints to be addressed. They will find that they receive an enormous amount of support from those services. I believe that the provision will prove to be a very important plank in the new arrangements.

The Earl of Listowel: I welcome the Minister's statement that measures will be put in place to ensure that the independent advocacy services are acceptable to people who do not speak English. That is an

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important concern. I believe that in Tower Hamlets more than 60 different languages are spoken. At the CHC at which I called this afternoon, a Kurd visited with a friend who was a translator. Therefore, I welcome that news.

I should like to know more about the independent advocacy service and to know whether it will be run on a walk-in, non-referral basis. In addition, can the Minister indicate whether the current community health council premises, of which I believe there are more than 100, many of which have recently been refurbished, might be used to house the independent advocacy service? My key concern is whether alternative access will be made available other than through NHS Direct. We spoke about that matter during yesterday's debate. I can see that there is a great advantage in picking up a telephone and being able to reach the service easily. Equally, sometimes delicate matters can be dealt with better in person.

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