Standing Committee E
Tuesday 30 January 2001
[Mr. John Maxton in the Chair]
Mr. Paul Burstow (Sutton and Cheam): On a point of order, Mr. Maxton. The Secretary of State is taking part in a conference organised by the Department that will deal with the matters covered by the clauses that the Committee will be considering today. Is it in order for the Secretary of State to hold such a conference while the Committee is scrutinising those very provisions, especially as I imagine he will be setting out in much more detail than we have before us how the new arrangements will work?
The Chairman: That is not a point of order for me. The Committee is here to debate what is listed on the amendment paper.
Abolition of community health councils in england
Dr. Liam Fox (Woodspring): I beg to move amendment No. 241, in page 11, line 19, at end add
`(8) This section may not be brought into force until the Secretary of State has issued a certificate stating that it is his opinion that the bodies established under sections 7 and 10 are fully functional and performing their duties effectively throughout England.'.
The Chairman: With this it will be convenient to debate the following: Clause stand part.
Amendment No. 97, in clause 15, page 11, line 21, after `abolish', insert `or reform'.
Clause 15 stand part.
Amendment No. 248, in clause 10, page 8, line 9, after `(1)', insert
`Before the commencement of section 14 of this Act,'.
Amendment No. 254, in clause 13, page 9, line 26, after `(1)', insert
`Before the commencement of section 14 of this Act,'.
New clause 1Reform of community health councils
New clause 7Community health councils
`Following the provisions in this Act, Community Health Councils shall be reformed following consultation.'.
Dr. Fox: I shall speak briefly to the amendment, but I intend to speak mainly on clause 14 stand part.
The hon. Member for Sutton and Cheam (Mr. Burstow) has a touching naivety if he does not believe that Parliament is the last place where we are likely to find out the details of any part of Government policy; and the abolition of the community health councils could not be a better example. It is one of the most controversial parts of the Billif not the most controversialand it will cause the most difficulty in the other place. If the Government do not change their view on this part of the Bill, they will have a great deal of trouble getting it through the other place, as a substantial number of Cross-Benchers oppose the measure.
We accept that the Government's proposals are likely to remain in place, and we are in no doubt that amendment No. 241 would simply buy time to ensure that any new mechanisms are up and running and properly in place before CHCs are abolished and before those whom they help are abandoned to the new system. Nothing could be worse than to abolish something that works before putting safeguards in place to ensure that people will not suffer as a result of the changes.
In this debate, we shall examine exactly what CHCs do, how they work, what they have done, what functions they fulfil and whether those functions will be fulfilled by the new bodies that the Government propose. CHCs have 700 permanent staff and 5,000 volunteer members. They were created by a Conservative Government under the National Health Act 1973. It must not be forgotten that they effectively offer free labour to the national health service worth about £8 million a year. Each year, CHCs assist about 30,000 people with complaints.
In his briefing notes, the Minister accepts how well CHCs work. They say:
``While some CHCs have done a very good job, their effectiveness and breadth of service across the country is patchy and too highly dependent on individual officers and members. Only in some parts of the country do patients receive a high level of support from their CHC when making a complaint about NHS services.''
That surely is the best possible argument for reform and standardisation. We should raise the standard of all CHCs to that of the best, which the Minister accepts are already doing a good job in representing community interests and patients. If that is possible under the current model, it requires us only to ensure that the best practices apply equally across the whole system, not to pull the entire system apart. Such vandalism, undertaken for reasons that we can only guess at, is completely unacceptable.
We move from an easy and coherent system to one where the functions will be divided up between the patient advocacy and liaison services, patients forums and local authority scrutiny committees. The ensuing fragmentation will mean that no individual body will oversee the whole of the patient's experience. That may well result in increased litigation costs due to patients failing to receive appropriate advice. Elderly patients, for example, have complex problems, which can span acute and community care services. With the separation of scrutiny and complaints work the broader patterns of local health service problems are less likely to emerge and the exchange of information will be enabled only through the creation of yet another new quango. Under the current system, patients know exactly where to go for advice and their complaints are dealt with in a single, transparent manner. Under the new system, they willfor the first timehave to shop around for their rights, and that can only lead to increased patient confusion.
I am sure that the point of order raised earlier by the hon. Member for Sutton and Cheam about the information supplied to the Committee reminded the CHCs of the manner in which they were treated as they were kept in the dark until the Prime Minister announced the plan to abolish them. To add insult to injury, there is the Government'sand the Prime Minister'sconcept of consultation. Given that the Government refer to such Orwellian concepts as ``earned autonomy''whereby bodies are free to do things, but only with the Government's approvalI suppose that consultation might mean something different to them than it does to the rest of us.
The Prime Minister said in the House that the CHCs had been consulted about their abolition, but clearly nothing could have been further from the truth. The CHCs were not consulted. We are all aware of the subsequent exchange of letters between the Prime Minister and my hon. Friend the Member for Eddisbury (Mr. O'Brien). The Prime Minister said:
``I am aware that there is bitter opposition
that is to the abolition of the CHCs
which is why the proposals are being consulted on.''[Official Report, 15 November 2000; Vol. 356, c. 937.]
Even after the Prime Minister said that there was consultation, there was still no consultation on whether or not the CHCs should be abolished. During the debate on Second Reading, many Government Back Benchers were clear that there had been no consultation.
Mr. Philip Hammond (Runnymede and Weybridge): Where are they now?
Dr. Fox: It is interesting that none of those who sought to raise such complaints were selected to serve on the Committee. That is another triumph for the Whip system, but one in the face for the proper scrutiny of legislation.
In reply to my hon. Friend the Member for Eddisbury, the Prime Minister said of the CHCs:
We consulted widely on the run up to the NHS plan.
I look forward to hearing from the Minister details of his meetings with the CHCs on their proposed abolition, when they were told that they might be consulted and when it was made clear that the decision had been taken to abolish them. At least, my hon. Friend received a reply from the Prime Minister, unlike the Association of Community Health Councils for England and Wales. It is unacceptable for the body being abolished to have written to the Prime Minister and to have received no reply.
The association disputes the Prime Minister's assertion that consultation took place. It states that the Under-Secretary of State had written to them to say that CHCs would be essential to ensure the representation of patients during the implementation of the national plan and in the new NHS. When the Under-Secretary wrote that letter on 26 June, either she knew that they were about to be abolished or Ministers were kept as much in the dark as the CHCs. Perhaps the Minister could give us the detail of who knew what and when.
When Richard Gordon QC told the CHCs that,
``in my opinion, the consultation process over the new NHS plan was . . . legally flawed.''
Ministers responded by stating:
``We do not accept that ACHCEW or CHCs had any legitimate expectation to be consulted in relation to the proposal that CHCs should be abolished in primary legislation to be introduced in Parliament in due course.''
According to the Government, the body that is being abolished has
``no legitimate expectation to be consulted.''
What sort of consultation process is that? It is an absolute disgrace and an affront to any concept of natural justice for Ministers to adopt such an attitude towards employees whose jobs they are about to remove. Had something similar occurred in any other sector of our business or industry, Ministers would have been up in arms about it. However, they think that it is all right to abolish an organisation that employs 700 people, and to say that those people have no legitimate right to expect to be consulted by the Government. That says everything about the arrogance with which the proposal was carried through.
We must consider the funding of the new system. The association claims that by 2004-05 the new bodies that will replace CHCs will cost about £114 million, compared with the current CHC budget of £23 million. In 2002-03, patient advocacy and liaison services will absorb £23 million, with an additional £10 million from the Department of Health. The patients forums are estimated to cost £45 million, which is 0.05 per cent. of hospital budgets. The association also estimates that adding health to local authority scrutiny will cost about £70,000 per authority, or £14 million in total. It has been calculated that health authorities will need to budget £4.2 million for the independent local advisory forums, and a further £4.2 million for specialist advocacy services. The Minister shakes his head. I hope then that he will give detailed financial estimates when he replies to the debate, as we need to know what the cost of the changes will be to the public purse. The £100.4 million for 2002-03 would rise to £114 million by 2004-05, as more primary care trusts are formed.
We are told that the role of patient advocacy liaison services will combine the meeting and greeting in hospital reception areas with steering patients towards the complaints system. The body will be set up under NHS auspices, with staff employed by NHS trusts, and will be a creature of the system. That may create a conflict of interest, as the complaints system will appear independent but its real independence will have diminished. Many patients would prefer to raise complaints and concerns away from trusts. In the current culture of the NHS there is increasing control from the centre, and there will be less and less confidence in the ability of trusts to deal independently and objectively with such complaints.
That said, there is no reason why an improved advocacy and liaison service, as proposed in this part of the Bill, could not co-exist with the current CHC set-up. If a patient advocacy and liaison service were added to the CHCs that work to the best possible levelthose that the Minister says now operate well and effectively on their patients' behalfthat would seem to cover the reservations felt by the Government and other bodies. Therefore, why must there be such complexity of provisions?
The objectivity and independence of local authority scrutiny also concerns us. As care trusts become more common, conflicts of interest will inevitably arise when councillors are increasingly called on to scrutinise services for which their local authority has joint responsibility for funding and provision. Such councillors will not be independent of the services that they scrutinise. Many will be of the same political persuasion as the non-executive directors, and even the chairman, of the local trust. Either there will be a temptation for a lack of effective scrutiny for party political reasonswe all understand that it happensor the system could be used as a political football in way in which it is not used at present.
Although local authorities may accept the extension of local scrutiny powers, that does not necessarily mean that they also welcome the abolition of CHCs. Croydon borough council and the Greater London Assembly, for example, have passed motions criticising the abolition of CHCs, and judging from the tone of the debate on Second Reading, they were in tune with Government Back Benchers.
Patients forums will monitor services provided by trusts, with a substantial part of their membership coming from voluntary groups. We are told that their work in examining how services are currently functioning will be supported by the independent local advisory forums, which will monitor the development of services.
So far, the Government have been unable to confirm that the lone member of a patients forum to be appointed to a hospital trust board will be selected by the relevant patients forums. Perhaps they will now confirm that. They have also sought to reassure Labour Back Benchers by portraying the patients forums as mini-CHCs in some of their internal party briefing. That is a ludicrous argument. If patients forums are mini-CHCs, why are CHCs being abolished?
We know that there is considerable disquiet on the Government Back Benches. We have all seen the letter from the Prime Minister's agent, congratulating the CHCs and stating that the Prime Minister
``agrees with every word''
of a congratulatory early-day motion, and that he
``would certainly like to add his congratulations to the work the CHCs have done over the last 25 years and wishes them every success in the future.''
The sheer cynicism of that was best summed up in a letter from the South Durham and Weardale CHC, which states:
``The truth of the matter is, there has been no consultation either before, or since the NHS plan was drafted or published. We are concerned that the Government have announced the intention to abolish the CHCs as a cynical attempt to silence any negative publicity during the winter and in the lead up to the General Election, as they know they are most vulnerable in regard to the NHS. What better way to deflect attention away from any shortcomings than by silencing the only independent monitor that the public has for the NHS?''
That quote did not come from me, but from one of the CHCs. Labour Members should remember that many CHC members and staff are Labour activists. They have no party-political reason to criticise the Government, and they are genuinely worried that the measure is a mechanism for silencing dissent. If the Government are willing to silence and axe even their most prominent colleagues in order to keep the show on the road, the CHCs should not be surprised if they are treated in the same way.