HC Deb 29 April 1988 vol 132 cc652-70 11.17 am
Mr. Hugo Summerson (Walthamstow)

I beg to move amendment No. 4, in page 3, line 18, at end insert '; and

  1. (d) whether or not the member has any financial interest in the affairs of any health authority served by the council to which the member has been appointed.".'
Clause 2(1) provides:

A Community Health Council shall maintain a register containing the name and address of every member of the Council and of every committee appointed by the Council whether alone or jointly with another Council and stating in the case of each member of the Council". Then there are three paragraphs (a), (b) and (c). I should like to add a fourth paragraph, (d), as set out in my amendment.

This is an important amendment. We all know that those who serve on public bodies, in any shape or form, and have a financial interest in industry, or whatever, should declare any financial interest. After all, for right and proper reasons, hon. Members must declare their interests in a register.

Mr. Richard Holt (Langbaurgh)

My hon. Friend, who is a new Member, would not wish to mislead the House. We do not have to register our interests; if asked, we do so voluntarily.

Mr. Summerson

I thank my hon. Friend for that correction. Nevertheless, whether or not it is compulsory, it is right and proper that hon. Members should register their financial interests and the register should be open for public inspection.

Exactly the same principle applies to this amendment. Community health councils exist to serve local communities and to represent them and their interests. Members of a community health council are, as the name implies, drawn from the local community, which is as it should be. Otherwise, the health authorities which serve the community could become remote from the members of the community. Many members of the community know nothing about their health authority. Indeed, authorities, divided as they are into regions and districts, can appear to be far away. For example, the offices of my regional health authority, which covers my constituency of Walthamstow, are based in Paddington. None of my constituents wishing to get in touch with it would think that it was based there; they would expect it to be based locally. Indeed, the offices of my district health authority, although based a little more locally, are some considerable distance away in a place not well served by public transport.

Community health councils have been set up to represent the interests of local people. They serve these vital interests. I was about to say all too frequently, but I shall amend that. Now and again local people have cause for complaint and it is right and proper that they should have a body of citizens who can put those complaints to the relevant authorities and ask for action.

Clause 2 states: A Community Health Council shall maintain a register containing the name and address of every member of the Council". That is right and proper because local people must know who their representatives are. It makes life much easier for them and in many ways for the authorities, both regional and district, to be able to look at the register and see who the members of the community health council are.

The clause goes on to say that the council shall maintain a register … of every committee appointed by the Council". It is important that those serving on the community health council should declare any financial interest they may have in the affairs of any health authority. Bearing in mind the immense sums spent these days on the National Health Service, it is important that those with a financial interest in the affairs of health authorities should have to declare it publicly through the medium of the register. The sums are of the order of £22 billion a year—

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)

Twenty three billion pounds a year.

Mr. Summerson

The sum is £23 billion a year. That is an immense amount and all too often people and hon. Members do not realise that. It is only too easy to say £23 billion. It is only six syllables and it does not sound an enormous amount. One should think of all those noughts and remember that they are being spent not just once, but every year, and they are increasing. When such huge sums are involved it is only right and proper that local people should have a say in how the money is spent. Indeed, they will want to be assured that their representatives do not have any pecuniary interests.

I know a man whose company is busy putting up advertisements for various medical products in NHS hospitals. For example, if he wishes to advertise baby foods, where more appropriate than in the waiting room where expectant mothers are congregating? He is getting right to his target market. He is not directly taking money from the NHS; he is providing a supplement to it to ensure that when expectant mothers finally have their babies they have a good idea of what sort of products are available for feeding their babies so that, I hope, they have strong, healthy families.

Obviously, with huge sums in the system, there must be opportunities for speculation. A member of a community health council will have access to all sorts of information about the goings on in his local area, in which I include districts. If he has some sort of financial interest in the affairs of the health authority, that could be greatly to his advantage. We should not put temptation in his way. That is not to say that merely because members have their names on a register, temptation will automatically be removed, but that would act as a good, strong, firm check on any action which could perhaps transgress or infringe the rules.

My amendment seeks to provide that the register shall state whether the member has any financial interest in the affairs of any health authority served by the council to which the member has been appointed. That means that a member does not have to register his interest until he has been appointed. That is right. Someone may have been asked to join a community health council and it would be absurd to require him to register any financial interest before being appointed. Once he has been appointed his financial interest can be seen and taken into account.

I think that I am right in saying that any hon. Member wishing to speak in a debate on a matter in which he has a financial interest, although he has declared his financial interest through the register, must state openly in the House that he has that interest. That is right. My amendment does not mean that merely because someone has put his name on the register, he should not declare his interest in the community health council's proceedings.

The paragraphs all form a coherent clause 2. Paragraph (a) states that for each member the register must contain the name and address of the body which appointed him". It is hoped that bodies which appoint members will know in advance or will at least ask the provisional appointee about his financial interests. It is important that the process is started from the beginning. There is no point in taking a cuckoo into the nest, and suddenly realising that he is the chairman of the regional health authority. I realise that that is not likely, but the point of the law is to be certain.

Paragraph (b) states that for each member the register shall state whether or not he is a member of that body". That is clear, and I have covered it in my remarks. Paragraph (c) provides that the register shall state: in the case of a member appointed by a voluntary organisation (within the meaning of the National Health Service Act 1977), that he has been so appointed. I have some difficulty in understanding what that means. It appears to be a non sequitur. The latter part of clause 2(1) provides: and stating in the case of each member of the Council"— which meaning has to be carried to each of the paragraphs. In regard to paragraph (c), therefore, the clause reads: stating in the case of each member of the Council…

  1. (c) in the case of a member appointed by a voluntary organisation (within the meaning of the National Health Service Act 1977), that he has been so appointed."
Some of those words are redundant. I have to consider the meaning of clause 2 and establish whether amendment No. 4 adds to it what I hope it adds. It would ensure that all members of community health councils are there solely to represent the interests of the local community. They should be able to be single-minded in their deliberations and representations and have no possible form of financial speculation niggling away in the backs of their minds.

Service for the community is what CHCs are about and I hope that it will be strengthened by the amendment.

11.30 am
Mr. Andrew Faulds (Warley, East)

I have listened carefully to the arguments adduced by the hon. Member for Walthamstow (Mr. Summerson) in support of his amendment. He is a personable young Member, eager to serve the House and his community. I am sure that he accepts that the only offence that I hold against him is that he replaced one of the most admirable hon. Members of this House—Eric Deakins—and will have a great deal to live up to to meet the performance and service that that former colleague brought to the House.

On first hearing, the hon. Gentleman's arguments appear reasonable. I urge the House that, on closer examination, the amendment is not at all necessary. The purpose of it appears to seek to ensure that financial impropriety by members of community health councils is prevented—an admirable aim, but it is not necessary in this case. I want to make some adverse comments on the arguments as to the advisability, as the hon. Gentleman sees it, of the amendment.

In the first place, CHCs are not established to serve health authorities, as is implied in the amendment. Their function is to represent the interests of the Health Service and of the public in the districts for which they are established.

Secondly, it would be difficult, to follow the argument that the hon. Gentleman advanced, to identify anybody who does not have a financial interest, in the broadest sense, in the affairs of a health authority, either as a consumer of services, or as a supplier of goods and services, or as an employee or even as a taxpayer.

The third argument is whether the answer on the register as to financial interest is yes or no. This is what the hon. Gentleman wants included. It is not at all clear how that information would be used or how it would affect the status of members.

The fourth point in rejection of the amendment is that community health councils are not strategic decision-taking bodies. They do not control the allocation of NHS resources as I think might be suggested in the hon. Gentleman's argument.

In view of my adverse comments, I must ask the hon. Gentleman to withdraw the amendment. I hope—dare I say I suspect—that I shall receive the Minister's support for my rejection of the amendment.

Mrs. Currie

I congratulate the hon. Member for Warley, East (Mr. Faulds) yet again on getting his Bill this far. As I said in Committee, the Government have an interest in seeing that legislation that reaches the statute book is satisfactory. The amendments that we discussed in Committee did not cover the area of work that my hon. Friend the Member for Walthamstow (Mr. Summerson) has brought up. The amendments that we discussed then were purely technical. They did not affect the substance of the Bill.

I understand that the Bill is designed to provide greater access to the work of community health councils than is currently provided by the Public Bodies (Admission to Meetings) Act 1960, and that it strengthens the rights of members of the public to attend CHC meetings and inspect agendas, minutes and background papers, copies of which can be provided for a reasonable fee.

In an eloquent and succinct presentation, my hon. Friend the Member for Walthamstow discussed the role of the membership of CHCs and rightly said that, if they are to function properly, their membership must be correct and they must be seen to be working above board. In that respect, I have much sympathy with what he said.

Before I comment in detail on the amendment, perhaps I could pick up some of the points that my hon. Friend made, confirm some of them and put them in context. My hon. Friend was right about the growth in health care. It means that the efforts of watchdog bodies such as CHCs to ensure that the growth in money and staffing goes to patient care are that much more important.

Expenditure on the Health Service has risen to £23.5 billion this year, mainly because of the additional money required for the pay review body agreements. They have given 15 per cent. extra to our nurses and 8 per cent. extra to our doctors. A sister's basic scale will now start at a higher level than the top rate of the previous scale. Our senior staff are about to experience some substantial increases in pay.

The net result is that spending on the NHS this year is yet again the second largest element in Government spending—it is second only to social security. It has been larger than defence and education for some time, although in respect of defence there is perhaps not a consumer as there is in the NHS.

The Health Service involves a substantial number of people, many of whom are perhaps not best placed to argue with the producers of the service when they need it, so the role of CHCs is important. There is also growth in the private sector. We should remind ourselves that CHCs examine the state sector, but I have no objection to their taking an interest in the private sector in so far as it impinges on health care needs in a neighbourhood.

A lot more staff have come into the NHS recently. We have 60,000 more nurses—whole-time equivalents—more doctors, more physiotherapists and more occupational therapists. Indeed, we have more of just about everything, and yet many health care plans are predicated on more people entering the service. One of my worries is that that might not be quite so easy to achieve. We have previously recruited heavily among school leavers, but the number of school leavers is now dropping. That is presenting problems where the job market is active, as it is in London and my hon. Friend's constituency.

It will be important for consumer watchdog bodies to be aware that we cannot simply expect to recruit large numbers of staff as we have in the past, for they simply will not exist. That is particularly true of young girls. Therefore, it follows that some patterns of care and treatment and some patterns of work in the NHS may have to change. The role of the more mature workers in the NHS will become relatively more important. The implication of that is that there will have to be more in-service training and perhaps a switch from the intensive efforts on initial training to in-service training, such as has occurred in teaching and education. I hope that our community health councils will note that changing pattern and will not expect our staff to look exactly the same in future as they have in the past.

The main role of the CHCs are in representing patients' interests and seeing the patient as a consumer. Certainly there are many more patients now in whom they should take an interest.

In recent years we have been looking after an in-patient load of about 6.5 million a year, taking account of the fact that some people are likely to be readmitted. As lengths of stay shorten, particularly in psychiatry, people will seek help if they have acute bouts of difficulty. That is not a bad policy; in fact it is a good policy and has been pursued for some time.

Even if we take into account that there may have been some readmissions, it is certainly clear from research studies that the number of patients being looked after is far higher than it used to be. That means that the pattern of work is changing and the volume of work in some specialities is rising very fast, particularly in orthopaedics. The pattern of work between the hospital services, the community services such as the domiciliary health visitors and district nurses, and the work loads of GPs are tending to shift and the role of the community health councils has become more complex.

We do not expect that health care will cost any less in future; it will continue costing us more. We do not expect that in future we will be able to manage with fewer staff. We shall continue to need to use our staff very heavily and seek ways of rendering their efforts and their skills even more productive. I expect that we shall have to look after more patients in future.

Later today we are to have a short debate about the health authority in Eastbourne. On much of the south coast the proportion of people over the age of 65 has risen to a quarter of the population and is rising fast. For that reason we are obliged to look at patterns of care and service which are a particular reflection of the increased needs of our rising elderly population. That is a problem in Walthamstow, in Warley East and in Derbyshire, South, but it is a particular problem in some parts of the country where large numbers of elderly people have chosen to settle and spend what they thought would be their last few years, but have become their last decades.

Mr. Robert Hayward (Kingswood)

My hon. Friend said that the problem of the rising proportion of the population who are elderly is moving away from what one might describe as retirement resorts. That is an important matter. Whereas previously it was assumed that there were concentrations of elderly people only in such places as Bognor Regis, Littlehampton and Eastbourne, in many parts of the country well over one in five of the population are of retirement age, and in some cases more than a quarter of the population are elderly people who are concentrated not only in retirement towns but in constituencies such as mine where people have chosen not to move away from their native communities.

Mr. Holt

Will my hon. Friend note that that phenomenon occurs not only on the geriatric coast but in northern industrial towns such as my constituency where so many young people are moving away to find work elsewhere leaving behind the older population who are less mobile and create just as many problems as they do in Eastbourne?

Mrs. Currie

Both my hon. Friends have made serious and important points. I must confess that I hope to do my best in the time that I hold this post to increase the proportion of elderly people in Britain. If I am successful in persuading people that by sensible modifications of their lifestyles in early and middle age they may thereby reduce the risks of preventable disease which stands at a high level in this country, it will not only be in Eastbourne where 25 per cent. of the population is over 65, it will be all over the country. In many parts of the country there is a rising number of people over 85. That offers us exciting opportunities.

Perhaps we should ask our CHCs to take that into account and ensure that at least some of their members are drawn from the older age groups so that the needs of this group are not ignored. People do not lose their wits or their citizenship when they reach retirement age and it is important that the services are responsive to their needs.

11.45 am

One aspect of the improvement going on in the Health Service to which the community health councils have contributed in their watchdog role, is the fact that we have much greater life expectancy. That means that the typical patient is no longer a young person. The typical patient is an older person and a women—in other words, an old lady. In the past women have tended to be a little acquiescent in their responses to care and treatment. As the patterns of demography and patient care have shifted in the directions that I have described, the role of a watchdog body becomes more important.

The National Health Service is a huge organisation which employs 1.25 million people. It employs more people than any other organisation in this country. In fact it is the third largest employer in the world. I understand that it is third only to Indian Railways and the Red army.

In any large institution the producers tend to have a very large say in the pattern and development of service. lf we want to know what to do about medical services we tend to ask doctors—

Madam Deputy Speaker (Miss Betty Boothroyd)

Order. I should be obliged if the hon. Lady would refer rather more to the community health councils, which are what the clause is really about.

Mrs. Currie

I apologise. At the end of that sentence I intended to show exactly how it relates to the debate.

If we wanted to develop services in pharmacy we would ask a pharmacist, and if we wanted to develop services in nursing we would ask nurses, if we wanted to develop services in optical work we would ask opticians. In other words, there is built into any major organisation the supposition, the implication and the inevitability that when we want to change a service we should ask the producers of that service. In future, we need to ask those who use the service what they think.

This is a small Bill, to which our official approach is neutral. We would not have introduced it ourselves, but we do not object to it—other work offered to us later intends to redress that balance. Just as it has been said in the past that war is too important to leave to the generals, I would say that the medical health of our people and the circumstances that we are discussing are so important that we cannot leave them only to the producers.

Mr. Robin Corbett (Birmingham, Erdington)

The Minister has spoken about listening more to the users of our National Health Service. Did she see the fascinating opinion poll in The Independent yesterday which revealed that 29 per cent. of Conservative voters think that things are getting worse in the National Health Service and that 65 per cent. of the total population said the same?

Mrs. Currie

The hon. Member for Birmingham, Erdington (Mr. Corbett) should address that question to the people who commissioned the poll. When another organisation which is concerned about the role of the consumer in the NHS—the National Association of Health Authorities in England and Wales—commissions its poll every May or June, it finds that 88 per cent. of people who use the Health Service say that they were satisfied or very satisfied with it. I suspect that it has a lot to do with the way one asks the question.

We hope that by developing our services and by developing an increasing responsiveness to the needs of consumers and potential consumers we may be able to get better value for money and satisfaction in some of those services. In the end, our overall objective must be better health, not just better opinion polls.

The problems of ensuring the interests of the consumer in health care are not quite the same as they are for cornflakes or chocolate. Health care is not an everyday product. In this area, the producer, the doctor, the optician or the dentist, has all the knowledge on his side. The consumer is at a considerable disadvantage. He is often in no position to argue because he—or, more likely she—is frightened or unwilling to complain and may find that he does not even know how to answer questions, let alone understand them, even though he may be in a great hurry to get something done.

That is why community health councils were set up in 1974. Their role has been discussed and in 1981 it was reaffirmed in health circular HC81/15. It was reaffirmed again in 1985, particularly by my hon. Friend the Member for Oxford, West and Abingdon (Mr. Patten) who confirmed that the status of community health councils would not be changed during the lifetime of that Parliament. I am glad to confirm that view.

My hon. Friend the Member for Walthamstow commented at length on the membership of the community health councils. It would be helpful to remind the House that the regional health authorities appoint the community health councils, and that about 50 per cent. of the nominations come from the local authorities, although not all of them are councillors. Many of them will be people who have connections with the local council but who are not councillors. Their membership can be extremely valuable. The rest come from voluntary organisations and other interested bodies, including such august bodies as the Socialist Medical Society. Some of them make a worthwhile contribution. However, the community health council is intended to be composed of lay people. Our statutory instrument of 1985 made that absolutely clear.

People are disqualified from appointment as members of a community health council if they are members of a regional health authority or of a district health authority. They cannot be members of both. They are also disqualified from appointment as a member of a community health council if they have been dismissed otherwise than by reason of redundancy from any paid employment with bodies that include a health authority, the Dental Estimates Board, the National Radiological Protection Board and an area health authority. There are strict rules about who can be a member of a community health council.

We do not mind in the least if the members of a community health council are professionally qualified, but their job on the CHC is not to represent any professions. It is important that that should be so. Their job is to look after the interests of patients. There are other people on other bodies whose job it is to represent the professions. For example, on a teaching district health authority—the kind that I chaired in Birmingham from 1982—there are people who are nominated and appointed at the request of the teaching university. There is a nurse member, a consultant member and a general practitioner member. It is on the district health authority that we expect the professionals to make themselves heard, if they so wish, as representatives of their professions, not as members of the community health council.

It is also important that the membership should bear in mind exactly what are and what are not their responsibilities on the CHC so that they may discharge their work well. They have wide responsibilities which we expect them to exercise. They do not have to work entirely within the National Health Service. For example, a community health council in the city of Birmingham during the time that I was health chairman decided to investigate why patients were complaining bitterly about out-patient waiting times, particularly in the maternity hospital. There were a number of good reasons for that, some of which have been put right, although the others have not.

One reason was the difficulty of getting to the new maternity hospital. The CHC negotiated with the transport authority and managed to arrange that buses should run into the main hospital complex and right up to the door of the maternity hospital, so that pregnant ladies could get off the bus and walk inside. That was of considerable benefit to them.

Many community health councils have also become directly involved with employment linked to consumer needs. I have seen the work being done in east London. The community health council has joined with the district health authority to employ link workers and facilitators. It felt strongly that many local people, particularly the women whose English is inadequate, were having great difficulty in understanding the medical advice that was given to them. I thought that that work was excellent.

I saw what was being done in the east end, met the community health council and was very impressed.

Many CHCs are signing up with us for the Look After Your Heart campaign and for conferences on particular aspects of health care in their neighbourhoods. The people in east London whom I met were organising a conference on the health needs of the ethnic minorities and helped to reawaken my interest in haemoglobinopathy, from which some members of the minority communities suffer. Partly as a result of the discussions during my visit, we were able to launch the sickle cell anaemia and thalassaemia cards a couple of weeks ago.

Most important of all, the community health councils have an important statutory right, almost the right of veto. That is why it is important that their activities should be open to public scrutiny and that is why I have not resisted the Bill. It is also why my hon. Friend's amendment is unnecessary. The statutory responsibilities clearly set out what the members are expected to do. I hope that my hon. Friend will therefore understand that I cannot commit myself to supporting his amendment.

The right of veto is set out clearly in the 1985 statutory instrument. If there is a major change in health care in a neighbourhood, the district health authority has to issue a consultative paper and consult the local people. That does not necessarily mean closure, but usually it involves a major closure, or a shift of service, or a transfer of service between one hospital and another. There have been occasions when CHCs have protested to me about a change that they consider to be a major change under the statutory instrument. I have shared their view and have told the district health authority that it must consult the community health council, which has the right to suggest alternatives to the proposal.

Those alternatives must be considered by the district health authority. If the district health authority sticks to its original view, or to a view with which the CHC does not agree, and the regional health authority confirms what the district health authority wants but the community health council still objects, the matter must come before Ministers. That is a very important right, though not quite a veto because the responsibility remains with Ministers. However, it is the right to force consultation with Ministers. We take that right very seriously, with the result that I frequently meet members of community health councils to listen to their views on various proposed changes.

There was a good example recently. I went back to the district health authority with the community health council's proposals, and I believe that we have managed to persuade the DHA that the CHC was right. That occurred in Liverpool where major changes are taking place. The city of Liverpool has 10 hospitals within a mile of the city centre, but the population is declining quite fast. Nevertheless, there are serious health problems that need to he addressed. A marvellous new £44 million hospital was built recently. The DHA now wishes to move some of the services on to that hospital site. That leaves it with the problem of what to do with the older and, very often, rather tatty facilities that it has in the city centre.

One proposal involves turning Myrtle street hospital into a minor injuries day centre, thereby serving the city centre as a minor accident and emergency department. The proposal was that it should be open until 8 o'clock in the evening. The community council told me that it felt that the injuries centre, which is currently open all night, provides during the late hours an excellent, sensitive and caring service to the children of the inner city, some of whom are seriously at risk of being hurt by their parents. They drift in during the evening to seek help from the nursing and other staff, either because they are in fear of going home and being hurt or because they feel that they need sanctuary. The members of the community health council told me that they regarded the service as invaluable and that it would be tragic for it to be lost for the sake of a few thousand pounds. I listened to what they and their Members of Parliament had to say, came to the conclusion that they were right and communicated my views to the district health authority. I told the district health authority that the community health council had contacted local GPs who were willing to provide some of the services. On that basis, we were able to agree that the Myrtle street day centre should remain open much later. I left it to the community health council, local GPs, consultants and the district health authority to decide what time it should close.

12 noon

Not all community health councils are good. It bothers me that some of them oppose everything as a matter of course. That is a pity, because much of what we are all trying to do is intended to improve the Health Service. We now have the largest ever capital hospital building programme and we are slowly replacing grotty buildings in Warley, Walthamstow and Derby with new ones fit to take us into the next century.

I hope that community health councils—particularly in areas where the Health Service has been neglected but is now rapidly coming up to scratch—will realise that they are not Her Majesty's Opposition. Their job is to represent the interests of consumers, who may be better served by the construction of new buildings, getting rid of grotty old properties and trying to keep to budgets rather than trying to break them. Not everything in health care can be a priority, and a community health council that realises that fact is serving local people better than one that opposes everything as a matter of course.

The role of community health councils does not conflict with that of district and regional health authorities or family practitioner committees, as my hon. Friend the Member for Walthamstow mentioned. I suspect that sometimes the role of community health councils becomes confused. The regional health authority is the strategic planning authority. We provide it with money for hospital and community services—the system is different in Scotland. We allocate money directly to family practitioner committees, which cover services that are not provided by hospitals, particularly those relating to independent contractors, family doctors, dentists, opticians and local pharmacists. The regional health authority allocates money and delegates responsibility to district health authorities, which run local and hospital services and community services such as district nurses and chriopodists. District health authorities also contribute to planning.

District health authorities normally cover a population of 200,000, although in London the figure tends to be smaller. I am sorry that my hon. Friend the Member for Walthamstow feels that the DHA is not situated centrally in his constituency. In Derbyshire, the district health authority covers 500,000 people in an area ranging almost from Manchester down to Birmingham. There are only two district health authorities, two community health councils and a single family practitioner committee. However, I reckon that it offers a jolly good service. The fact that some of my constituents must travel 20 miles to the headquarters of the district health authority is a matter that we must accept. We envy the concentration of services in London.

The amendment confuses the roles of community health councils and health authorities. It talks about serving health authorities, but a community health council is not established to serve a health authority. Its function is to represent the interests of the public. The Bill serves a purpose because it is intended to open the activities of community health councils to the public in certain significant and small ways.

The amendment mentions "any financial interest". The word "any" is dangerous in legislation as the courts always interpret it in its broadest possible sense. I suspect that it would be almost impossible to identify someone who does not have any financial interest in the affairs of a health authority, partly because almost all of us are consumers of the National Health Service, partly because many of us are suppliers of goods and services—the National Health Service is the largest employer in the country and many of us have family connections with people who work for it —and partly because as taxpayers we are all interested in it. The average family, not only people who pay income tax but those who pay VAT, contributes £1,600 a year to the Health Service.

The wording of the amendment suggests that the only answer to the question that it poses would be yes or no. It is not clear how the information that it seeks would he useful or what difference it would make to the status of members of community health councils. I do not know whether the amendment would result in people who have a financial interest or those who do not have a financial interest being excluded. In the light of the comments that I made earlier, my hon. Friend might accept that, as we are all taxpayers and have a financial interest in the National Health Service it would be wise to think that only people with a financial interest should be members of community health councils.

Mr. Summerson

I shall give an example to help my hon. Friend the Minister. My father died two years ago, in a National Health Service geriatric hospital in Inverness. The care and treatment that he received was quite outstanding. If my mother, who still lives in Inverness, were a member of a community health council and a director of a company supplying services to the regional health authority—and perhaps, therefore, to that hospital —would it not be right that she should have to declare an interest?

Mrs. Currie

As a general principle, we would always expect members of public bodies to say whether some aspect of their personal or business lives might influence the opinions that they are offering. My hon. Friend is going too far, as the good lady that he mentioned would have a strong interest in ensuring that the local health service was cost-effective and efficient, that it delivered health in response to the health needs of local people and that it was available when she needed it. In that regard, other interests would be affected.

Should anybody serving on a public body such as a community health council or a district health authority have a financial interest in the outcome of a discussion—particularly if there was to be a vote—we would expect him to declare it and take guidance from the chairman about whether it was sufficiently relevant for him not to vote or be present. The community health council does not take such decisions, except with regard to its right of veto and to delay any major changes in the health authority. Its role is to take decisions about somebody else's decisions. It does not run a hospital or employ staff directly, except in very small numbers. Its main job is to make representations about the interests of consumers.

I do not see any overriding need to legislate along the lines that my hon. Friend the Member for Walthamstow has suggested. Community health bodies are not strategic, decision-making bodies and do not control the allocation of National Health Service resources. Therefore, the amendment is unnecessary.

Mr. Corbett

I suspect that my hon. Friend the Member for Warley, East (Mr. Faulds) had a wry smile on his face when the Minister congratulated him on the Bill and made it clear that she was not opposing it. It will be within his memory, as it is within mine, because I was here on the same Friday, that a Government Whip on the Treasury Bench shouted "Object" and blocked progress. That led to my hon. Friend getting up on a point of order and venting his anger. Better one sinner who repenteth—

Mr. Faulds

My hon. Friend must not go too far. I very rarely vent anger in the House. I occasionally vent disagreement.

Mr. Corbett

My hon. Friend did it, so he will know what he was doing.

The Minister paints a picture of the NHS with which few members of community health councils could agree. Apparently there are no waiting lists, no closed wards, no cancelled operations, no shortage of specialist nurses, no shortage of midwives and no shortage of training opportunities. Indeed, this is heaven. I can tell the Minister, if she needs telling, that my local community health council has a much more realistic view. In the Good Hope hospital, which the Minister will know, which serves people in my constituency and in the constituency of the hon. Member for Staffordshire, South-East (Mr. Lightbown), a Government Whip, a ward was closed temporarily about 10 months ago, and remains closed.

I was interested in what the Minister said about the value that the Government attach to community health councils. Presumably, as soon as the hon. Lady leaves the House, she will get in touch with the South Manchester health authority. She will probably know that the South Manchester health authority agreed, on the casting vote of the person in the chair, to close immediately geriatric and rehabilitation wards at Burton house at Withington hospital, and psychiatric beds at the same hospital. There is nothing new about that. However, it was done without proper consultation with the community health council. Because of what the Minister said and the tales that she told about Liverpool, I expect her now to get in touch with that health authority and make known her displeasure at its lack of proper consultation with the community health council. I hope that in her usual quiet and persuasive manner she will persuade the authority to undo that decision until there has been adequate time for consultation. I do not know whether the Minister wants to rise to give me that assurance, or perhaps I can take it on the nod. That is how I shall take it.

Mrs. Currie

The hon. Gentleman should never take my nods on the nod. We are in touch with all Manchester health authorities. In fact, I had the pleasure of meeting a small delegation led by my hon. Friend the Member for Altrincham and Sale (Sir F. Montgomery) this week, and we have been in touch with the three Manchester health authorities more recently. They have a statutory obligation not to overspend, and I have no doubt that they will also bear in mind the recent ruling in the courts that because a change may be temporary, that does not rule out any possibility of consultation.

Mr. Corbett

I am grateful to the Minister for that. They have a statutory duty not to overspend, but they also have a statutory duty to consult. The recent court decision underlines that point. I have no doubt that my hon. Friend the Member for Manchester, Withington (Mr. Bradley) will be delighted when he reads the Minister's words on Tuesday.

There is an even simpler argument against the amendment of the hon. Member for Walthamstow (Mr. Summerson) than that put by my hon. Friend the Member for Warley, East and the Minister. The purpose of the Bill is to open up the proceedings of community health councils and their papers to members of the public. I would hope that that is totally unexceptionable. If that is the case, and if the hon. Member for Walthamstow has worries about the misuse of a position on a community health council by one of its appointed members, the amendment will not stop that. If somebody is looking for naked commercial advantage from the proceedings of a CHC, he, or she, under the terms of the Bill, has only to sit at the back of the room when the council is discussing an item out of which he or she may see an opportunity to make a bob or two.

I find myself in the embarrassing position of agreeing with the Minister's arguments against the amendment. Also, it is not often that my hon. Friend the Member for Warley, East and I are able to agree. I hope that on that basis, the hon. Member for Walthamstow will take all the advice that has been offered in such a free and kind manner and see the wisdom of withdrawing his amendment.

12.15 pm
Mr. Summerson

I have listened with the greatest care to all the advice that has been flooding in for the past hour or two. As the hon. Member for Warley, East (Mr. Faulds) referred to my predecessor in Walthamstow, Eric Deakins, I hope that I shall be allowed to refer to him briefly. On the occasions when I met Eric Deakins, I always thought that he was a pleasant man. Indeed, on one occasion when we were both invited to address a large gathering of teachers who set up a howl of rage and execration as soon as I entered the hall, it was a great relief to see the friendly face of Mr. Deakins smiling at me from the platform. It is now a matter of history that the good people of Walthamstow preferred a Conservative candidate to a Labour one.

Mr. Corbett

Not for long.

Mr. Summerson

We shall see.

As I said, I have listened carefully to what has been said. Huge amounts of money are being spent on the Health Service. Indeed, £23.5 billion is now being spent on the NHS, which I think I am right in saying is about three times more then when we came to power in 1979. Community health councils doubtless have a great deal of influence, especially in these days of putting more services out to tender to get better value for money and to provide even more funds to be ploughed back into the NHS. Nevertheless, having listened carefully to what my hon. Friend the Minister has said, her usual charm and perspicacity have persuaded me to withdraw the amendment, and I beg to ask leave to do so.

Amendment, by leave, withdrawn.

Order for Third Reading read.

12.17 pm
Mr. Andrew Faulds (Warley, East)

I beg to move, That the Bill be now read the Third time.

Now that we have at long last come to this happy stage of the Third reading, I do not want to detain my colleagues for too long from the later-in-the-day constituency engagements. The Minister has played a notable role in that. I have heard some extraordinarily lengthy pronouncements on a number of Third Readings, but I think that today's must take the biscuit.

I want briefly, because of the interesting history of the Bill, to enlarge slightly on how it came about. My hon. colleague the Member for Worsley (Mr. Lewis) was responsible in the previous Parliament for introducing this Community Health Councils (Access to Information) Bill which he thought was an admirable little measure, and of course I shared that view. But the Prime Minister, towards the fourth year of that Parliament, decided that things were a bit sticky for the Government and that they had better go to the country before they got worse. She went to the country, and, unfortunately for us and the people of Britain, won the election. [Interruption.] I am glad that I have the agreement of the majority of hon. Members in the Chamber.

One of the unfortunate results of that victory was that this minor Bill fell, before it got to the Lords, on the dissolution of that Parliament. Although I have been here now for many many years and have put my name forward for most of the ballots over those years, I have never once been drawn earlier than 14th. I cannot remember what I did with that effort. In the first ballot of this Parliament I drew the 19th place. It was clear that, with that number, I was unlikely to be able to introduce a major matter of personal or public interest that would ever land on the statute book. I was fortunate enough to engage in discussions with members of the Public Bill Office. Out of that sagacious exchange came the suggestion that I should support an admirable little Bill that had fallen in the previous Parliament and stood a good chance of getting on to the statute book in this Parliament. That was how my support for and introduction of the Bill came about.

The Bill's purpose is explicit in the title. I need not enlarge on that too much, but perhaps for the record I should say that this legislation would require all meetings of the community health councils and their committees to be open to the public, and that is admirable. The Bill would require them to publish agendas—again, that Is admirable—and permit the public to inspect and copy reports and the background papers to those reports, and permit meetings and documents to be closed to the public only for specified genuine reasons.

I am delighted that I have the broad agreement of the House and the Minister's support in introducing the Bill and furthering its advance on Third Reading. Because of the Bill's rather strange history, I should say that when I discussed the advancement of the Bill in Committee I was advised by parliamentary counsel that the earlier version had certain technical errors that should be put right. We pursued those errors in Committee and put them right.

Parliamentary counsel's arguments were based on the understandable reason that the Bill applied the Local Government Act 1972, as amended by the Local Government (Access to Information) Act 1985, to comunity health councils. Legislation of this kind, which picks up bits of Bills by reference to earlier Acts, tends to be untidy, especially as the Local Government Act was not intended to cover community health councils. Minor modifications to that Act were necessary to accommodate the different nature of community health councils. The Department of the Environment, which takes the lead interest in the Local Government Acts, drew attention to some "drafting infelicities", which I think is the phrase, and parliamentary counsel suggested amendments that secured technical improvements to the Bill in Committee. They affected neither the substance nor the objectives of the Bill.

As I have made clear, this is not a major piece of legislation. It is a tidying-up, good little Bill that provides public access to the proceedings of CHCs and their reports. I am sure that I shall have the Chamber's support. I very much commend the Third Reading, with the earnest hope that none of my colleagues will hold us too long in further discussion on this issue.

12.23 pm
Mrs. Currie

I cannot allow the Third Reading of this important Bill to pass without uttering a few comments, starting with congratulations to the hon. Member for Warley, East (Mr. Faulds). I mentioned in Committee that when I was a child he used to frighten me. I listened to "Journey into Space"—

Mr. Corbett

Now the hon. Lady and my hon. Friend have swopped places.

Mrs. Currie

That is a line for the gossip columns this Sunday.

I used to clutch my father's hand while listening to that dreadful science fiction rubbish, as I now realise it to be, and there was the sainted voice of the fine actor that the hon. Member for Warley, East was once, and I suspect still is, scaring the life out of the nation's children. It was a very long time ago. On those occasions and in his sensible, intelligent remarks today he has done much better than he has when my right hon. Friend the Prime Minister has been at the Dispatch Box and he has felt obliged to use his actor's training to try to shout her down. On those occasions, he does his erstwhile profession a disservice.

Mr. Faulds

The Minister is being naughty because she is provoking me into further utterances which I had hoped not to have to make. I am not interested in her comments on my previous profession. I was an extremely distinguished actor and I still am. I still have those talents, but of course I do not abuse them in this Chamber. I simply use them to a limited extent.

If the hon. Lady thinks that my interventions when the Prime Minister is speaking are made simply from a wish to create a small performance, she could not be more wrong. I profoundly disagree with the Prime Minister's philosophy and thinking and consequent damage that she has done to the community of Britain.

Madam Deputy Speaker

Order. Will hon. Members please return to the Bill.

Mrs. Currie

The community health councils to which the Bill refers were established in 1974. They operate under current legislation—the National Health Service community health council regulations 1985, some of which I quoted earlier, and the current circulars HC81/15 and HC85/11. Their duties are to represent the interests of the public in the Health Service in their districts. They are not by themselves strategic bodies or decision-making bodies. They do not run any parts of the Health Service, although one or two have decided, commendably, to use some of their allocation of funds to employ staff in a role that helps to facilitate the relationships of patients to the Health Service, especially when there are some communication problems. I commend that, although we would not want them to expand that role to the point where they were trying to vie with the district health authority which perhaps should have been fulfilling that role in the first place.

The community health councils have certain rights. A CHC has the right to relevant information from the local district health authority and the family practitioner committee. I sometimes wish that the CHCs spent more time looking at the work to which the family practitioner committee relates. The bulk of our patients see their GP rather than have contact with the hospital. That is one of the best parts of our system. Our GP system acts as a gateway system. It is one reason why we have better health and more effective use of health care money than many other countries.

The CHCs have the right of access to district health authority premises. They have asked for rights of access to private sector establishments and homes. I am minded to resist that because I want them to exercise their statutory duties as regards district health authority premises. I have noticed with interest that in some parts of the country, especially where there has been a growth in the private sector for residential care and nursing homes, the community health council has been able to obtain the co-operation of the owners of those homes. In one place—I think it is Blackpool—a consumers' guide to the homes has been drawn up stating what is available and what is not. Local people, especially in areas where there is a large proportion of elderly people, perhaps even very elderly people with elderly children trying to look after them, have found such publications extremely useful. That is a fruitful aspect of work where CHCs can make progress.

As I said, the CHCs have a right to be consulted by the district health authorities on proposals for substantial developments or variations in local services, and that right extends to family practitioner committees; the CHCs must be consulted by the FPCs on proposals for substantial change.

The CHCs also have the right to meet their district health authorities and family practitioner committees once a year, and the Bill refers to such meetings. That is extremely valuable. It is to be hoped that that will be the minimum, especially in areas where there is much substantial change. It was deemed wise by my predecessors to write it into legislation that the community health council has the right to an annual meeting and the right to be consulted by the local family practitioner committee about changes in the provision of general practice and pharmaceutical services. In the next couple of years, as the reforms outlined in our White Paper on the primary health care services, "Promoting Better Health", are introduced, the community health councils may well be directing rather more of their attention to the services outside hospitals, especially those provided by local doctors. I hope so; they have much that is valuable to contribute.

There are 194 community health councils—rather more than the number of district health authorities, partly because since the reorganisation in 1974 it has been regarded as wise in some parts of the country, especially in London, to amalgamate some of the smaller health authorities that were losing population very quickly. We have just done that by amalgamating Brent and Paddington and North Kensington district health authorities to create the Parkside health authority. None of the boundaries of the community health councils have changed, so there are slightly more of them.

In 1986-87, the community health councils spent a total of £7.2 million, which works out at about £37,000 per community health council. That has tended to increase slowly, but it has kept roughly in line with inflation. My hon. Friend the Minister of State, Home Office, who was then Under-Secretary of State for Health and Social Security gave a commitment on 29 April 1985 that we would retain community health councils for the life of this Parliament. That was reaffirmed by my right hon. Friend the Minister for Health at the annual general meeting of the Association of Community Health Councils of England and Wales on 3 July 1986. We have no proposals to change in any substantive way the work that the community health councils do, although we recognise that there my he some benefit in the minor changes proposed in the Bill. While we would not have chosen to legislate on CHCs, we feel that the Bill does no harm. Perhaps the hon. Member for Warley, East should not attribute to me quite such ecstatic support as he suggested, but the Government are neutral, and we would not seek to oppose the Bill.

It has been suggested that the Bill's provisions are onerous for small bodies such as community health councils. I do not agree. Apart from anything else, the community health councils have budgets of £37,000 on average. Provided that they are well-organised, it is quite within the CHC's resources to implement the Bill's provisions. The CHCs themselves advocate openness and are bitterly critical of lack of openness elsewhere. Therefore, provided that they sincerely wish to be as open as possible with the public they serve, they will not need bureaucratic mechanisms to comply with the Bill. I had better repeat that the community health councils must comply with the provisions of the Bill within existing resources. Having said that, I await the decision of the House on Third Reading.

12.33 pm
Mr. Corbett

I hope that my hon. Friend the Member for Warley, East (Mr. Faulds) will take no offence if I say that modesty is not one of the traits normally associated with him. However, he is being far too modest in describing the Bill as modest. He may have noticed that his is a 90p Bill; that is the price that members of the public pay for it. The Bill with which we started the day was a 45p Bill and the one that we shall be discussing very soon, I hope, is a £1.60 Bill. My hon. Friend need not be too modest because he has pitched it about right and his Bill is clearly exceptionally good value for money.

My serious point touches on the Minister's remarks about community health councils having to carry out their-obligations under the Bill within existing resources. It relates to the provisions for councils to charge a fee for copies or extracts of various documents. If the councils decide that it is proper to make a charge for documents, I hope that they will relate that charge to the ability of the person making the inquiry to pay. The House will recall that as recently as a week ago we were debating ability to pay. It is important that we should not let unreasonable charges be an impediment to people obtaining documents to which it is proper for them to have access. Perhaps may put it this way. So far as I know, no councils charge members of the public for copies of council minutes and I should deprecate such a practice very much. I hope that, by and large, community health councils will find no need to impose any charge.

Mr. Faulds

Before my hon. Friend sits down, may I ask him just to back me in saying that although I cannot refer to my colleague the hon. Member for Worsley (Mr. Lewis) as the only begetter of the Bill, I think we should remember that it was originally his and that he has had assistance since then in getting his Bill, with my help, on to the statute book? I would be very grateful if my hon. Friend would just make a word of commendation.

Mr. Corbett

I am grateful to my hon. Friend. It often happens that a Bill falls by the wayside for one reason or another and is then picked up by someone else. As my hon. Friend has said, that is basically what happened in this case. Perhaps one should take a more relaxed view of these matters—if it is nice to have one father, it must be even better to have two. I congratulate my hon. Friend. I hope that the House will give the Bill a Third Reading and that a general election will not stop it reaching the statute book.

Question put and agreed to.

Bill accordingly read the Third time, and passed.

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