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Baroness Jay of Paddington: I support the noble Baroness, Lady Robson, in this amendment. It is a very good opportunity to emphasise that the new arrangements for health authorities should in no way diminish the contribution which community health councils can and should make to the operations of the National Health Service, particularly given the abolition of the regions and the enlargement of some of the purchasing authorities to bring the concerns of the health service down to the level of the users and the patients.
As the noble Baroness, Lady Robson, said, it is very important that these purely volunteer bodies should not be given excessive burdens to administer. As I understand it perhaps the noble Baroness the Minister will correct me if I am wrongit is not yet clear from the regulations or schedules who will employ the one executive director of the community health councils now employed from the regional health authority.
I believe that all this is sending a message to community health councils who are extremely hard pressed and who do an enormous amount of good work. As the noble Baroness, Lady Robson, said, and as I have just mentioned myself, they are entirely staffed by volunteers with the exception of the one staff person. They should not be asked to extend their responsibilities beyond the areas which they now embrace which sometimes are quite large, given the few people involved.
The other side of the coin is that if the CHCs have to extend to a larger area than that embraced by their present responsibilities they will become more invisible to the very people who want help in gaining access to the organisation of the health service. I know, particularly in large cities, that the community health council often tends to be slightly anonymous. It is not so apparent as the council located in the main high street of smaller towns and villages. It is very important that the CHC should remain close to the local population it seeks to serve. I hope very much that the Government will be able to accept the amendment which I support.
Baroness Cumberlege: The Government recognise that community health councils must be accessible to their local community and be able adequately to represent that community. There is nothing in this Bill to reduce the number of CHCs. It is a matter for discussion between the CHCs and their establishing body how many CHCs there are in an area.
The establishing body for England at the moment is the regional health authority. From the 1st April 1996 it will be the Secretary of State, acting through the regional offices of the NHS executive. In considering how many CHCs there should be we shall be seeking to ensure that the CHC can represent the community within its boundary.
We shall take account of factors such as the geographical size of the area and the diversity of the population. Guidance issued by the NHS executive in January 1994 made that clear. The provisions in Schedule 1 make clear that a CHC can be established to cover the whole area of the health authority or any part of it. The establishing authority, in consultation with health authorities and the CHC themselves, will review CHC boundaries to see whether the CHC can be more effective if its boundaries are changed. That may mean reducing or even increasing the number of CHCs. In some places it will mean changing the areas of some CHCs so that they have only to relate to a single health authority or to part of a single authority. With those words I hope that the noble Baroness will be reassured and that she will choose to withdraw the amendment.
Baroness Jay of Paddington: Perhaps I may briefly intervene again. I may have rather foolishly not followed exactly what the noble Baroness said. Did she say that the CHC paid official will now be employed by the regional office of the Department of Health? Is that the way it will work?
Baroness Cumberlege: No, the contract will be held at health authority level. The terms and conditions and the monitoring of it will be dealt with at the regional office. We believe it inappropriate that CHC secretaries should become civil servants.
As the community health councils have worked well under the district health authorities, with each community health council serving one district health authority, I wanted an assurance that, if they are to be amalgamated, there will be two community health councils and that nobody else could interfere with that decisionwhether the Secretary of State or the regional outposts of the Department of Health.
I shall have to return to this issue, having read carefully what the Minister told us. I could not quite follow the basis of the decision-making as to how many community health councils there will be. In the meantime, I beg leave to withdraw the amendment.
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