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Mrs. Eileen Gordon (Romford): I cannot resist commenting on the contribution of the right hon. Member for South-West Surrey (Mrs. Bottomley), and I am sorry that she is not in her place now. I sympathise with her constituents and their health care concerns, but I am confident that the money that the Government are investing in the NHS will feed through and improve the situation. I would almost have felt sorry for her if I had not spent years as a member of a local community health council, leading a campaign to save the accident and emergency unit at Oldchurch hospital in Romford.
With the support of the CHC, I wrote, lobbied, demonstrated and collected signatures. All appeals fell on deaf ears--the right hon. Lady's ears, as it happened, as she was Secretary of State for Health in the Tory Government. I am proud that a Labour Government have saved that service and given the go-ahead for a £148 million new hospital at Oldchurch, which is progressing very well.
I, too, welcome many of the Bill's provisions, because we are making progress in modernising the NHS. I also welcome the Government's investment in and commitment to the NHS. The strength of the national plan, on which the Bill is based, is largely due to a great deal of consultation. However, therein lies the weakness of the proposals on patient representation: there was no consultation--at least not with the CHCs--which is why changes are already being made. The first that CHCs knew about the proposal to get rid of them was when the national plan landed on their desks. Imagine how those people, most of whom work tirelessly to represent patients' interests, felt. It was seen fit to involve CHCs in the consultations on all parts of the plan except their own future.
I was a member of Barking and Havering CHC for many years as a local authority nominee and as a co-opted member, and I hope that that has given me some insight into the way in which CHCs work. I have been critical of CHCs, and no one would deny that they need reform--I often complained about the lack of reform when I was a member--but most of the problems were caused by lack of resources and support, the work load put on volunteers, and the limitations on the remit of CHCs, such as not having the right to inspect primary care facilities.
The best of the CHCs carry out the roles of advocacy, scrutiny and inspection extremely well. Those with high street shop fronts have a high profile, and the fact that they make a nuisance of themselves with trusts and health authorities when things go wrong is a sign of success. Therefore, I have a real problem with the proposals. The roles of advocacy, scrutiny and inspection are
I have read all the papers and, like most MPs, have received representations from many groups, but I still think that the suggested new structure, although it has to be put in place in just over a year, is far too complex, and that there is little obvious connection between the parts. Currently, if a problem is identified, it can be dealt with at all levels by one body--the CHC. Patient advocacy can take place and an unannounced visit may be made, but I am not sure who, under the Bill, will have the power to make such visits, which can be valuable.
A CHC is based in one office, so all the people involved can talk to each other. If a problem is identified as having wider implications, the National Association of Community Health Councils in England and Wales--NACHCEW--can take up the concerns on a national scale. For example, Casualty Watch has been useful in identifying problems in accident and emergency departments.
My preferred option for reform of the CHCs would have been to keep their current structure, widen their remit, improve their staff levels, build on their expertise and increase their resources so that they can do the job properly. Instead, we are faced with fairly vague proposals that have not been thought through. For instance, I find it hard to come to terms with the fact that half of the patient forum members will be chosen at random from people who write to trusts and health authorities. I am sorry, but that seems too haphazard to be of any value. Members of Parliament probably write more letters to health trusts and authorities than anybody else. Does that increase our chances of being picked at random? As my son Peter would say, "What's that all about?" I could make a selection of constituents at random from the letters that I receive each year. They might turn out to be an interesting group of people, but I am not sure whether they would necessarily represent all my constituents.
As for patient advocacy and liaison services, I am not confident that PALS staff sitting in a hospital reception area and paid for by the trust can be truly independent. I am not clear about what networking will occur between PALS in hospitals and those in primary care trusts. The arrangement seems to contradict the holistic approach that we are now advocating for patient care. I do not oppose the involvement of local government in scrutiny; more of that is needed. I am, however, concerned about how independent local government will be, especially as it, too, commissions services. I am especially concerned about that in connection with care trusts, although their creation is a policy with which I agree. I worry that patients will be bounced between the new bodies, and that their complaints and concerns will be lost in the bureaucracy. Rather than empowering patients, we could be silencing them.
I shall support Second Reading, as the Bill contains many good measures. I shall, however, consider the legislation carefully when it returns to the House from Standing Committee. If patients are to be at the heart of health care--as they should be--we must get the Bill right. I believe that establishing an enhanced CHC structure, with one body dealing with the whole range of patients' interests, would be far preferable to splitting up the services. I hope that the Committee will review and rethink the proposals.
Mr. David Amess (Southend, West): Oh dear, oh dear, oh dear. Yet again, we are considering deeply flawed legislation, introduced by a deeply flawed Government. At a time when the national health service has been brought to its knees by this rotten Government, it is amazing that the Secretary of State has treated the House with such utter disdain.
When this was a proper debating Chamber and Members came here to scrutinise legislation, a Secretary of State would not have introduced a Bill with 66 clauses and five schedules by participating in a brief knockabout session and then clearing off with the public relations people to get the right spin in the media. In the past, the Secretary of State would have taken time to speak about the clauses. He would have realised that he had huge problems among his Back Benchers in terms of their opposition to the abolition of community health councils, and would at least have tried to persuade them to accept the policy. That is not, however, the Government's style. They find coming to the Chamber an absolute bore--fancy having to have any proposals considered.
God help those hapless individuals who will serve on the Standing Committee that considers the Bill. The Committee will be the first on such a Bill to which I shall not offer my services. I have found serving on such Committees to be a deeply depressing experience and their proceedings to be a shambles. Ministers would come to them without understanding the legislation for which they were trying to argue, and civil servants would be scratching their heads and the whole thing would turn out to be a fiasco.
Of course, the current proceedings are also a fiasco. We all know that the Government will cut and run and have an early general election. I understand that there will be a programme motion and all the rest of it, but unless they ensure that the House of Lords is completely silent, there will be no results. Yet again, this rotten Government are trying to hoodwink the general public into believing that they will do something with the health service that they have brought to its knees. Instead, we are merely going through the motions yet again. The Chamber no longer talks to anyone other than itself. It has come to resemble a glorified lounge where hon. Members sit and chat with one another and where nothing counts.
For instance, the fiasco of deferred votes has been introduced because some hon. Members cannot even be bothered to stay here late at night. If the Secretary of State seriously wants to do something about the health service, he could at least have done the House the courtesy of explaining in detail what the Bill is about. Earlier, he answered one of my hon. Friends by praying in aid three or four people who thought that the abolition of CHCs was a good idea. One of those people was an out-and-out Labour supporter. I cannot remember who the others were, but I do not think that their remarks impressed anyone.
Mr. Stephen O'Brien (Eddisbury): As I recall, the Secretary of State prayed in aid comments made in support of reform of CHCs' functions. I do not recall any quotation in support of their abolition. His remarks were interestingly selective.
It is a pity that the Government and Health Ministers do not spend more time walking around our hospitals and finding out what is going on. I would like to challenge the Health team to visit Southend hospital. How did it find out how it was affected by the Bill? One week after the start of the summer recess, the Government decided to shame it, which destroyed morale in the local health service. Ministers should speak to people who work in the health service and find out whether they think that all the provisions will do them any good. Instead of being named and shamed because it did not reach the Government's ridiculous targets, Southend hospital needed more experienced staff and more incentives to keep its current staff. Instead, those in charge had a disgraceful attitude and brought in a time and motion person who delivered nothing at all, but brought morale to its knees.
I recognise, however, that the Government will not listen to anything that the hon. Member for Southend, West has to say about the matter. If they did so, they would probably join their fellow partners in crime--those in the Liberal party--and take a long walk off Southend pier. I hope, however, that they will take notice of the excellent analytical briefings on the Bill that every hon. Member has received. If the Minister reads them, he will find that what the experts have to say is not reassuring.
It is Labour's style now that it is in government to dismiss the British Medical Association, the Royal College of Nursing and community health councils because they do not suit its agenda. The Government are at least consistent on one front: when things occasionally go right for them they take the credit, but when things go wrong it is all the fault of the previous Conservative Government. [Hon. Members: "Too right."] I note what Labour Members are saying, but the manifesto that they peddled to the British people at the previous election did not say, "Vote Labour. We'll fiddle about for four years because it will be so difficult to put things right in that time." It told the British people, "Vote Labour and the national health service will be saved." As a result of the treachery of this rotten Labour Government, it will take a Conservative Government to save the NHS.