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Earl Howe: My Lords, I thank the Minister for his reply which I have to say I found far from reassuring in many, if not most, respects. A good proportion of the early part of his speech was devoted to rehearsing past debates about CHCs. I do not think that there was any need for him to do that. I accept that CHCs are about to come to an end. My concerns are purely for the future. I remarked earlier that the credibility of Ministers on these issues is on the line. As far as I am concerned, it still is.

The Minister essentially implied at the end of his speech that it is for the commission to get on with the job of setting up the new arrangements and that Ministers can effectively stand back from that process. I simply raise again the issue of the raft of ministerial undertakings. We were told that there would be consultation. What seems to be in store for us is a model for patient and public involvement on which no one whatever has been consulted. How is it credible to set up a system to service the interests of patients and the public if neither patients nor the public have been asked what they want? It seems to me an absurdity.

I turn to the issue of the commission's independence. What we have in these regulations is not what I would view as a reserve power; it is a licence to micro-manage. I think that I know a reserve power when I see one. A reserve power, which I quite understand is needed in certain circumstances, takes the form of a power of direction. That power of direction was indeed in the Bill. If the Minister wishes us to believe that a power for the Secretary of State to approve, alter and veto the commission's work programme is necessary to enable him to fulfil his accountability to Parliament, then I say that that is palpable nonsense. What other non-departmental public body is subject to the same restrictions? I cannot think of one and I challenge the Minister to name one. I do not accept his explanation. I do not accept that a power is needed to dot every "i" in the work programme.

Lord Hunt of Kings Heath: My Lords, I give the example of NICE. No one suggests that NICE is

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anything but independent in the technology appraisals or the clinical guidelines that it undertakes. But Ministers approve its work programme.

Earl Howe: My Lords, is not NICE a special health authority? I think that that falls into a different bracket altogether.

Lord Hunt of Kings Heath: My Lords, let me give another example—the Commission for Health Improvement, which I think is a non-departmental public body. There is no suggestion that Ministers have ever sought to intervene in the way it carries out its reviews. But I as the responsible Minister have regular meetings with the commission and have agreed issues to do with a number of reviews that it undertakes. That is a perfectly satisfactory arrangement.

Earl Howe: My Lords, but is there a power for Ministers to approve or vary the work programme of the Commission for Health Improvement? I do not believe that there is. I think that the commission can act perfectly freely as it sees fit. What we are talking about here is something of a different order altogether. I simply do not accept that Ministers need a power to dot every "i" in the work programme. The Minister's words of 21st January last year were:

    "The independence of the system for PPI"—

patient and public involvement—

    "is critical to its success".

How strongly I agree. I do not think that to talk about acting vigorously and being in a strong position to promote a programme is any comfort.

I see the flexibility and responsiveness of the commission as very important in the way in which it operates, but I am not sure that anything that the Minister said on that gave me any comfort either. For example, will the commission be able to undertake legal action against the NHS and to fund patients forums to do so? Will the commission and patients forums be able to campaign to change government policy? From what the Minister said, I doubt very much that that will be the case.

The Minister referred to the transfer of staff from CHCs and said that there would be room for the best staff. I quite agree that there was never any guarantee or indeed a suggestion of a guarantee of a passport to further employment after CHCs came to an end. However, how many of the staff can now look forward to a continuing role in representing patients and the public? It is clear that the answer is very few. That is a grave disappointment, and I am sure will be met with dismay by the hard-working staff of CHCs.

We come to the concept of consortiums and networks. It may well be an imaginative approach that the commission has adopted, but I am still just as negative as I was and, indeed, not a little confused. How exactly is it suggested that consortiums will be

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involved in the running of patients forums? What does that concept actually mean? Has the Minister thought about the practicality?

Lord Hunt of Kings Heath: My Lords, it means that the consortium of voluntary organisations will employ staff who will provide the infrastructure support to patients forums to undertake their work.

Earl Howe: My Lords, let us see how that works. I think that it will be enormously bureaucratic and complicated. For a start, we are in for a huge tendering exercise. There will be a vast array of bids, all needing evaluation. All the contracts will need to be monitored. Arrangements will have to be put in place for that, and all that is before anyone has even set foot in a hospital. It is a guaranteed recipe for bureaucracy.

We understand that the local consortiums are to be in place by 1st September, or at least that that is the aim. What one gathers from that—the Minister admitted it—is that patients forums will not be. That is deeply regrettable and contrary to the understanding that we had during the passage of the Bill.

I thank the Minister for his comments on a one-stop shop, although I am not sure that I fully understood them. He spoke about patients forums providing access to all and providing a physical presence. I do not know whether that is or is not a one-stop shop. It seems to me a roundabout way of saying that it might not be, which I again find deeply regrettable.

Lord Hunt of Kings Heath: My Lords, I think that what I said was consistent with what I said in debate. There must be discretion to decide the arrangements at local level. What I cannot say is that every patients forum PCT will set up a high-street shop. They will have to ensure ready access through various means. One of those forms of access will be physical access.

Earl Howe: My Lords, I do not think that a telephone line, for example, is what most of us have been led to think of as a one-stop shop.

Lord Hunt of Kings Heath: My Lords, that is what I meant by physical access. Clearly, it will be important, if a member of the public needs the services of a patients forum, that they can meet representatives of the patients forum and that there is not simply a telephone line.

Earl Howe: My Lords, I thank the Minister for that reply. The issue hinges on practicalities and accessibility for patients and the public. The Minister gave the overall budget figure for the commission, for which I am grateful. I am frankly amazed that the commission believes that a comprehensive patient and public involvement service can be provided for 34 million, bearing in mind that there will be 571 patients forums, if I have the figure right. We must have a strong, rigorous system for patient and public involvement in which all elements are properly resourced. I know that the Minister believes that too as

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I have quotes from him saying exactly that. However, I do not share his confidence that it will be forthcoming. That is no criticism whatever of the chairman of the commission.

The Minister addressed the accountability vacuum. I do not see CHI as a substitute of any kind for the involvement of patients in the monitoring and scrutinising of the day-to-day work of the NHS. It cannot possibly be a substitute. I am surprised that the Minister should suggest that. As to the date for establishing patients forums, that is still a matter of hope and vague guesses. The Minister has done his best, but I am not reassured.

Turning to overview and scrutiny committees and the establishment and dissolution of trusts, the Minister suggested that structural issues did not constitute a major change to the health service. The closure of a facility, even temporarily, is well established by case law as amounting to a substantial variation of services. I hope that the health service will bear in mind that point and that it will be included in the relevant guidance.

I am most grateful to the noble Lord, Lord Clement-Jones, for his sterling and cogently argued speech which dovetailed neatly with my own without any prior consultation between us. I do not intend to divide the House on these Motions. There would be no point in doing so. The reason for the debate has already been stated. I thank the Minister for his reply, which I shall study carefully in Hansard. I give him notice that we shall return to these matters. In the mean time, I beg leave to withdraw the Motion.

Motion, by leave, withdrawn.

Commission for Patient and Public Involvement in Health (Membership and Procedure) Regulations 2002

8.52 p.m.

Earl Howe had given notice of his intention to move to resolve, That this House calls on Her Majesty's Government to revoke the regulations laid before the House on 10th December 2002 (S.I. 2002/3038).

Motion not moved.

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