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Stephen Hesford: It is political opportunism to take that backward-looking view. Confusion reigns because, interestingly, the hon. Member for Macclesfield (Mr. Winterton), who has put his name to new clause 2, has also put his name to new clause 5. He cannot have it both ways.
Mr. Peter Atkinson: Perhaps I can enlighten the hon. Gentleman as to why my hon. Friend the Member for Macclesfield (Mr. Winterton) has signed his name to both new clauses. He made it clear that he supported new clause 2, but as it is unlikely to succeed he supported new clause 5 as a second option. That is perfectly logical.
Stephen Hesford: I hear what the hon. Gentleman says, and I credit him for supporting his absent colleague, but I am afraid that he has not dealt with the illogicality of the position adopted by the hon. Member for Macclesfield.
I must tell my hon. Friend the Member for Wakefield that new clause 5 is over-fussy, over-lengthy and shares with new clause 2 the problem of not grasping the nettle that the Government have grasped in introducing the reform of community health councils. Both new clauses seek a delay.
Dr. Evan Harris: The hon. Gentleman described new clause 5 as over-lengthy. To avoid comparisons with a certain king and accusations of having too many notes, perhaps he will say which bits of it are redundant to achieving the purpose sought by the change. Or does he think that there is a limit to the length of new clauses that hon. Members should introduce in principle?
The strong support that my hon. Friend the Member for Wakefield received from Liberal Democrats shows that, in effect, his new clause has not grasped the issue; it is a compromise too far. The Bill is not the same as the one that came before the House in the last Parliament. I commend my hon. Friend's tribute to the Under- Secretary, my hon. Friend the Member for Salford (Ms Blears), who has indeed clearly listened. The Government have travelled a long way on reform; I urge the House to accept that she and the Government have travelled far enough. Some problems that were rightly identified have now been addressed. The Commission for Patient and Public Involvement in Health, for example, is a valuable addition.
I know that other Members want to participate in our debate so, to conclude, I will say only that new clauses 2 and 5 seek delay; they do not get to grips with the problem. The Government were right to introduce their proposals and I urge the House to reject both new clauses.
Why abolish community health councils? That question has never yet been answered. The hon. Member for Wakefield (Mr. Hinchliffe) takes a charitable view which, I am sure, is right. CHCs have achieved patchy success, are variable and could certainly be improved. The hon. Member for West Chelmsford (Mr. Burns) takes a more powerful view, which I share; in some instances, CHCs have been a thorn in the side of the Government. I know that only too well; my own CHC, of which I was a member at the time, had the resources to take the local health authority to judicial review. What did civil servants do locally? A high-powered officer of the NHS executive in the west midlands came to visit the little Kidderminster and District CHC, threatening that if it took the local health authority to court, that could cost it £220,000 to £250,000. The local CHC was sufficiently strong-minded not to bow to that threat.
I should like to explore a little more what we shall lose when we lose CHCs. At the moment, we have a thoroughly independent voicean independent citizens' watchdog. I am deeply suspicious of the Secretary of State's attempts to establish independent bodies. To get him out of reviewing and making the final decision on hospital reconfigurations, we now have an "independent" reconfiguration panel. It is too early to know how independent it is. On the other hand, we already have an independent NHS Appointments Commission. This week, the Health Service Journal shows that it has appointed the 28 chairs of strategic health authorities, 24 of whom are already trust or authority chairs. Remarkably, 17 of them are health authority chairs who will be out of a job on 1 April. However, 24 of those 28 appointments were previously made by the Secretary of State and have just been rubber-stamped by the independent commission.
We are also losing a one-stop shop. I should like to illustrate that with an example from Worcestershire. The hon. Member for Wakefield implied that there will be a difficulty. In Worcestershire, we have three CHCs, conveniently situated in the major conurbations. We shall have six forumsI should love to know whether the plural is forums or forabecause we have three primary care trusts, a county-wide acute hospital trust, and an ambulance trust, and we shall have a mental health trust. Because the PCTs are sharing out health authority functions, one can see that a single patient might need to consult or take advice from three, possibly four, patients forums. That is the strongest reason for having a drawing-together body. The patients council, as suggested in new clause 5, appears to be a body that could draw together functions and situations, making it easier for individual citizens to express their concerns.
To conclude, as I have already said, I would much rather that CHCs were reviewed and strengthened, as is the case with Wales and with the equivalent of CHCs in Scotland. However, I have been in the House long enough to begin to realise what is possible and what is not. New clause 5, which would establish patients councils, appears to offer the chance of retaining independence and bringing organisations together within the overall framework of the Bill, so I commend it to the House.
Mr. Patrick Hall (Bedford): I should like to comment on the context of new clause 5, which seeks to co-ordinate and integrate locally a replacement system for community health councils. I am tempted, but shall not go down the road of trying to summarise what has happened since July 2000, when the abolition of CHCs was first announced in the NHS plan. We have come a long way since then; much time has been spent trying to understand a replacement structure and system that, for too long, was over-complex and unclear.
After last year's general election, and notably in the Government's response to the listening exercise, which was led by my hon. Friend the Under-Secretary, we got to a point where we recognised that the fragmentation that had characterised previous thinking was unsatisfactory. The essential functions were integration; co-ordination; and informing and supporting patients forums, patient
However, the Bill does no more than provide a framework. Many of the matters about which there are concerns in the House and outside will not be clarified until regulations are published. That is the problem. I suggested on Second Reading that perhaps draft regulations could be published during the Committee stage, to give people an idea of how the picture would emerge. We need to see how the mechanism might operate. I want it to work, and I know that the Government do as well. My suggestion was not taken up, but that is up to the Government.
I do not know for sure how the integration and support function of the Commission for Patient and Public Involvement in Health, through its local networks, working with lay reference groups and operating local outreach teams, will work. The intentions are clear, as I have acknowledged, but the mechanism has not yet been clarified sufficiently. We need some examples of how the local networks will work and the sort of geographical area that they will cover. It has been flagged up that they should be at PCT level, but that needs to be confirmed. I know that the Government do not wish to be prescriptive. I understand that, but the danger then is that we are too vague and we cannot see the picture, yet here we are, deciding on legislation tonight. We need to know also about the resourcing of the local networks of the commission, and about the staffing.