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Lord Roberts of Conwy moved Amendment No. 5:



"MEMBERSHIP OF COMMUNITY HEALTH COUNCILS
After section 20 of the National Health Service Act 1977 (c. 49) (Community Health Councils) insert—
"20B MEMBERSHIP OF COMMUNITY HEALTH COUNCILS
The membership of Community Health Councils shall be constituted as follows—
(a) at least one member of the Council shall be appointed by each local authority of which the area or part of it is included in the Council's district, and at least half of the members of the Council shall consist of persons appointed by those local authorities;
(b) at least one third of the members shall be appointed in a prescribed manner by bodies (other than public or local authorities) whose activities are carried on otherwise than for profit;
(c) the other members of the Council shall be appointed by such bodies, and in such manner and after such consultations, as may be prescribed; and
(d) no member of the Council shall also be a member of a Health Authority, a Local Health Board, a Strategic Health Authority, a Primary Care Trust or an NHS trust.""

The noble Lord said: With all the changes proposed in the Bill to the 1977 Act, I am not at all sure where we stand with regard to the composition and membership of CHCs. Is a change proposed?

I suggest in the new clause that half the members be drawn from local authorities within the council's district, a third from voluntary organisations with an interest in health matters and the remainder as prescribed.

I listened carefully to what the noble and learned Lord, Lord Morris of Aberavon, had to say at Second Reading about his disappointment with local authority nominations for appointment to CHCs and

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I am bound to say that my experience as a Minister was similar to his. I think that was because the local authorities had not fully appreciated the importance of CHCs. They should certainly do so now.

As was said earlier, local authorities have an important role to play in health. It is a growing role. We recognise the close relationship between health and housing and other areas of local government responsibility. The new unitary authorities in Wales, established by my noble friend Lord Hunt of Wirral, are responsible for social services, housing and education. Local authorities must, therefore, be well represented. Whether it should be half the membership is open to question, but certainly each local authority in the community health council's district should be represented in order to ensure smooth working. The voluntary organisations with an interest in health matters—disability groups and so on—also have a claim to membership although they cannot all be represented as they are too numerous.

I am equally clear in my own mind that those bodies responsible for the delivery of healthcare should not be represented. I should hope that there is general agreement on that point. The CHCs are guardians of the public interest in the health service and must be independent of the providers and seen to be so. I beg to move.

Lord Thomas of Gresford: I noted that the noble Lord, Lord Roberts of Conwy, was rather attracted by the name "patients' forum". That being the case, I am rather surprised that he wishes to place such an emphasis on local authority representation when both he and the noble and learned Lord, Lord Morris, have reservations about the interest that local authority representatives have taken in community health councils in the past. We should leave it to the good sense of the National Assembly to decide how these councils are made up. We in this House should not be prescriptive.

Baroness Finlay of Llandaff: I also have difficulty with the notion of prescription. Although guidance should be given on the way in which people are appointed to CHCs, it is important that no CHC is locked into a set number of members appointed by a set number of people. I hope that community health council appointees will be even further removed from the providers of healthcare than is suggested in the amendment, even if the amendment is considered in terms of guidance rather than as a directive. To be able to represent patients adequately, appointees must be as independent as possible of any conflict of interest.

There are many voluntary bodies in Wales. I declare an interest, having been employed by Marie Curie in Wales. I am concerned that voluntary bodies also need to be inspected where they are contributing to the provision of healthcare. It may be difficult for them to be inspected by someone with whom they are competing for funds. CHC appointees need to be able to stand back from the whole system. Therefore, I oppose the amendment.

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Lord Hunt of Kings Heath: I say to the noble Lord, Lord Roberts, that high calibre local authority appointees or nominees are to be welcomed in assisting in decision-making in the health service, whether on local health boards, the boards of hospitals or community health councils. Certainly as far as England is concerned, while splendid members have been appointed from a local authority background, that is not uniform. There has been a rather patchy response from local government.

The substantive point of the debate is whether this Committee should determine the composition of CHCs in Wales or whether it is best left to the National Assembly. I am convinced that it should be left to the National Assembly, the members of which are better placed than noble Lords to determine the kind of community health councils that they wish to see in the future. My problem with the noble Lord's amendment is that it goes too far in seeking to constrain the National Assembly.

I make it clear that currently CHC membership is made up of one half local authority nominations, one third voluntary organisation nominations and the remainder are appointed by the Assembly. The Assembly recognises the importance of local authority nominees. It wants to retain the experience of local authority nominees. It also wants to create opportunities for people—in particular those from under-represented groups in the community—to serve on community health councils. I understand that the proportions, which it currently has in mind, are that the councils should initially consist of one quarter local authority nominees and one quarter voluntary organisation nominees, with one half left for open competition.

The National Assembly wants gradually to move to more open methods of member recruitment and to ensure that CHCs have members that are more representative of their communities. CHC members will be recruited in accordance with the Assembly's published code of practice for ministerial appointments to public bodies. Vacancies are advertised in the media, both locally and nationally. Interviews are held by the Assembly's public appointments branch in accordance with Nolan principles.

It is clear that the National Assembly has thought considerably about the issues. It has a clear view regarding its direction. It wants to see more open competition for some of the places. It also recognises the importance of local-authority nominees. The Chamber should have confidence in the Assembly's ability to sort this matter out properly.

On a couple of occasions the noble Baroness, Lady Finlay, has raised the issue of the right of CHCs to enter premises. I understand that for the first time CHCs will be given the right to enter any premises where NHS-funded services are provided. That will include doctors' and dentists' surgeries and private nursing homes. It is a crucial definition and returns us to the Community Care (Delayed Discharges etc.) Bill, on which we had a similar debate. It depends on the

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provision being NHS funded. Obviously the details will follow, and the National Assembly will need to work the matter through with community health councils. The key is that it is an NHS funded service.

Baroness Finlay of Llandaff: I thank the noble Lord for giving way. Can he confirm that that situation relates to the situation where there is NHS funding towards the service, but that it is not restricted to a set quota of patients? Therefore, where a service is part funded by voluntary donation and part funded by the NHS, will the patients receiving care within that service and not paying for it be able to make representations to the CHC or whoever represents them if there are matters of concern about the quality of their care and what is happening to them?


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