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Lord Hunt of Kings Heath: My Lords, I am overwhelmed by the warmth with which the regulations have been received in this debate. I hesitate to reopen the debate that we have had over the past few years on the issue. But both the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, seem to have misunderstood completely why the Government wish to make changes to improve patient and public involvement in the National Health Service. If we had really wanted the kind of weak, patchy patient representation that they both accused the Government of seeking, we would not have proposed the new arrangements. Instead we would have retained community health councils—the very bodies that have produced such patchy performance in their 25 years' operation and that have had such little influence in improving the outcome of care for patients. We made the changes because we wanted enhanced patient and public involvement.

When we first debated the issues, I said that I would not have brought legislation before your Lordships' House if I did not believe that the new arrangements would be profoundly more powerful for patients and the public than the current ones. Arrangements including the architecture of patient advisory and liaison services within each trust; the establishment of patients forums; the powerful new role being given to local authorities through overview and scrutiny committees; the independent arbitration service; and the role of the national commission—which will have an enormously influential role in ensuring that patient forums, in particular, perform strongly and effectively—will be far more powerful than those provided by community health councils at present.

Listening to some noble Lords, one would imagine that CHCs provided a golden age of public involvement in the health service. The evidence is very different. Surveys have found that only 3 per cent of the population have ever heard of community health councils. I am convinced that the new arrangements will touch many more people in this country than CHCs ever did. I do not detract from the hard work of many staff and members of CHCs. But the cumulative impact of CHCs over 25 years has been disappointing and patchy. Noble Lords will know that I was one of the first CHC secretaries to be appointed in the early days of the system. But I do not believe that they ever achieved the role that they were given.

As regards the date of abolition of the CHCs, which was announced a few days ago, the intention is that they will cease on lst September. I say to my noble friend Lord Rea that that is a firm government decision. As I said during the debate on the Private Notice Question from the noble Earl, Lord Howe, it was the firm intention that there would be no gap

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between the abolition of CHCs and the appointment of patients forums. But we have had to make changes in the light of experience. I am satisfied that the problems currently faced by many CHCs, with staff and members leaving, are genuine. Because of uncertainty it was best to give people a clear date when CHCs would be abolished.

I would have wished to assure noble Lords tonight that there would be a patients forum in place in all parts of the country on lst September. I regret that I cannot do that, but I do know that the commission will be working very hard indeed to establish patients forums as soon as possible. I say to the noble Earl, Lord Howe, that there will be continued inspections by other bodies such as the Commission for Health Improvement and the patient, environment and access teams. I hope that patients forums will be established very quickly so that inspections by them can be maintained and continued, but I cannot at the moment give a firm date by which all patients forums will be established. I know that the commission hopes that it will take place certainly by the end of the year and as soon after lst September as possible. I have no doubt that the commission will have more to say about that in the weeks ahead.

As regards ICAS, it is for the Secretary of State to establish it through commencement of Section 12 of the Health and Social Care Act 2001. ICAS will be covered by the commission's work programme. It will be funded by the commission. I give an assurance that there will be an ICAS service up and running on lst September and that it will be provided to all who wish to use its services from all over the country. The commission will be providing a national helpline so that it will be very straightforward for patients, relatives and carers to access that helpline and the ICAS service.

I recognise that as regards complaints and case work, it is essential that there should be no hiatus at all between CHCs being abolished and the new arrangements being put into place. I give an assurance that case work will be carried over.

I also refer to the comments made about patients' advocacy and liaison services. I have always been a keen advocate of the PALS service. The indications that we are receiving from the field are that they are having an enormously beneficial impact both in terms of being able to deal with problems as they arise when patients, relatives or carers raise them, but also on the way NHS services are run. I am absolutely determined to ensure that the NHS recognises the value of those services.

As to the issue of the independence of the commission and its work programme, we discussed this when the legislation was passing through the House. This kind of situation is not out of the ordinary in similar bodies where the Secretary of State has to approve the work programme. I wish to make it clear that if the work programme did not need to be agreed by the Secretary of State, or if changes could be made without his consent, that would detract from the commission's overall accountability to Parliament and the public for its actions and use of public funds.

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We have got the balance right between the necessary accountability and the freedom of manoeuvre that the commission wishes to have, and which I am sure it will operate.

Lord Clement-Jones: My Lords, I apologise for interrupting the Minister but he seems to have substituted "freedom of manoeuvre" for "independence". Is the Minister redefining the remit of the commission?

Lord Hunt of Kings Heath: My Lords, not at all. I am trying to describe the appropriate balance for public bodies that are ultimately accountable to Parliament. Far from the commission being inhibited and under the control of the Government, I am confident that it will be in a strong position to operate in the way it wishes and to develop its work in the light of experience.

Lord Clement-Jones: My Lords, can the Minister confirm that the commission will be independent, as pledged by Ministers during the passage of the Bill through Parliament?

Lord Hunt of Kings Heath: My Lords, of course the commission will act independently. There is no suggestion that it will not. Frankly, when I look at the members of the board, who are led by Sharon Grant, the chair of the commission, the idea that the commission will act as a kind of government poodle is ridiculous. Indeed, there have already been extremely vigorous discussions between the chair of the commission and Ministers and officials in my department. I have no doubt whatever that the commission will act vigorously. That is what we want it to do.

The noble Lord and the noble Earl raised the issue of casualty watch. We have debated this time after time. I have made it consistently clear that the commission has the power to ask forums to undertake work on specific themes, based on reports it receives from patients forums. It will be able to instigate reviews on what is important to patients over a wide range of subjects. This could include surveys of accident and emergency departments and the implementation of national service frameworks.

The one-stop shop is important. It will be built around primary care trusts because they are population based. I am absolutely assured that the patients forum in each primary care trust will be able to provide access to all who require its use. In addition to helplines and the other ways in which it can be accessed, as I suggested in our debates, there will be a physical presence, either in the form of members of the patients forum going out to meet people in their own homes or the public coming to meet them to discuss their concerns.

We do not want to tie the whole situation down by saying that there must be, say, a high street shop for every patients forum. Clearly that must be decided at local level. The point about ready access is crucial here. It will be provided.

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I said that I would tell your Lordships as soon as I knew the position on funding. Details on that have been sent out to the health service today. The figure will be 34 million, compared with the 23 million currently received by community health councils. The commission assures me that it can deliver a meaningful and effective system of patient forums and ICAS for that figure.

Lord Clement-Jones: My Lords, will the Minister clarify that? Is that 34 million purely for the commission or does it also include the money available for ICAS?

Lord Hunt of Kings Heath: My Lords, it will be for the commission, for patient forums and for ICAS. However, I am sure that the noble Lord agrees that it is significantly more than the sum currently being spent on community health councils.

Lord Clement-Jones: Yes, my Lords, although the estimate made for a meaningful figure for the structure set out in the original Bill was 100 million.

8.30 p.m.

Lord Hunt of Kings Heath: My Lords, I am confident that the figure we have given will certainly be sufficient to ensure that a very effective service is put in place.

The commission will have a small staff at national level. It also intends to have nine regional offices located in government office regional areas. I understand that they are likely to have around 18 staff per office, on average. Those will be directly employed. It will also contract out support for PCT patients forums to 150 consortiums of voluntary organisations—one operating in each locality. The 150 areas will be broadly modelled on local authority areas, with some boundary tweaking to ensure coterminosity with NHS boundaries.

I listened with care to the comments of the noble Earl and the noble Lord about the direct employment of staff. The question is whether they are good and will provide an effective service rather than whether they are directly employed by the commission or by the consortium. We have debated the role of the voluntary sector many times in this House. The commission has come up with an imaginative solution to the issue of where people should be employed. It is fantastic that they are to be placed within the voluntary sector. I know that many people in the voluntary sector welcome the fact that they will be able to forge just the right kind of partnerships at local level, but based on a contractual arrangement so that the commission can assure the quality of the service to be provided. I hope that noble Lords accept that it is an imaginative approach that deserves to succeed.

As for the conflict of interest question, let me make it clear that voluntary organisations are simply providing staff to support patients forum members. It is the members who will monitor NHS services and make recommendations, not the staff. It is important

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to recognise that this is not a staff-led but a member-led approach, and the members will make the judgments and recommendations and be the engine room of patient and public involvement at local level. The staff are there to support that function.

I listened carefully to the question of the staff position. I always said that I hoped that there would be room for many of the good people working in community health councils in the new structure. There is a great deal of room and enormous opportunity in local government, with the overview and scrutiny committees, in the NHS, with the PALS, with the independent advocacy services and in patient forums. However, we have never envisaged that we could guarantee employment. I never at any stage suggested that we could do that; we never believed that we could deal with CHC staff differently from the way in which we deal with other staff in the NHS when they are affected by restructuring.

I have seen some work from overview and scrutiny committees, not least in Birmingham City Council where the committee produced an excellent report on breast-feeding which had strong recommendations from the NHS and local government. I should declare an interest, as my mother-in-law chaired that committee. That impressed me because it showed how influential those committees will be in future.

The noble Earl, Lord Howe, asked about the power to scrutinise, as opposed to the duty. We argued about that when the Bill was debated, and, as I said at the time, the Government want local authorities to have discretion. They should have discretion because they are democratically elected at local level. Therefore, I do not accept that we should have put a duty on them. That said, I find it almost inconceivable that a local authority would not establish an OSC when making a major change in service. That is when representations may certainly be made to the Secretary of State. If it were ever the case that a local authority did not establish an OSC, it would be up to the local community to make representations direct to the Secretary of State. However, that is a very remote suggestion.

The noble Earl, Lord Howe, asked why OSCs were not given a role in relation to the establishment and dissolution of trusts. That is not a major change in service but a structural issue. With the greatest respect, we should not accord structural issues the importance of a service issue, in which case the change could have a big impact on the country. Indeed, having lived through any number of structural reorganisations, I can say that most of them pass the public by. I still meet doctors and members of the public who refer to area health authorities, which were established in 1974 and abolished six or seven years later.

I say in conclusion that I do not doubt the sincerity of all noble Lords in wanting to ensure that the new arrangements work. Nor am I complacent about the need for patients forums to be established as soon as possible so that there is as small a gap as possible between the abolition of CHCs and the establishment of patients forums throughout the country. I am optimistic. I believe

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that in the chair of the new commission we have someone who has already shown great leadership skills. The commission will clearly be determined and will not be backward in making its views known. I imagine that within a very short space of time the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, will gladly use the ammunition and evidence that they put forward to have a go at the Government, and that is absolutely right. I am absolutely convinced that as the new arrangements bed down they will be seen by the public, patients and the NHS to be much more powerful than what we have at the moment. On that basis, I commend the regulations to the House.


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