HC Deb 21 November 2000 vol 357 cc156-60
3. Mr. Simon Hughes (Southwark, North and Bermondsey)

What recent representations he has received on the future of community health councils. [137638]

The Secretary of State for Health (Mr. Alan Milburn)

A number of representations have been received about the future of community health councils and the new structures outlined in the NHS plan. A series of national seminars involving discussions with the Association of Community Health Councils for England and Wales, and others, is currently taking place to determine how best to implement the new arrangements for increasing patients' influence and representation in the health service.

Mr. Hughes

The Secretary of State noticeably failed to tell us how many representations and expressions of opposition he has received. Perhaps, in his second answer, he will come clean about the level of opposition of which he is aware in the country. Has he accepted any of the arguments put forward by me, by many hon. Members on both sides of the House, and by patients, constituents, pensioners' groups, doctors, consultants and local organisations that say that people want an independent organisation, free of staff employed by the NHS, and able to stand up to the NHS and take complaints. The Government's proposal is entirely unacceptable, as is the way in which they introduced it, because they did not ask anyone before they came up with the idea.

Mr. Milburn

The hon. Gentleman is wrong on that count, at least. I remember Opposition Members raising the fact that we had an extensive consultation about the future of the national health service, which covered all aspects of NHS care, treatment and structures. Structures for improving patient representation were among the issues raised by patients, NHS organisations and others. The hon. Gentleman is profoundly wrong in making that charge. I, and many other hon. Members, have long argued that there is a democratic deficit in the NHS and that it should be properly scrutinised by the local communities that it is supposed to serve. Who better, then, to undertake that scrutiny and monitoring function than those not appointed by Ministers but elected by the local communities served by the local health service? That is what local government is for. It is right and proper that we should locate that function with local authorities regardless of political party. If the hon. Gentleman thinks that local government is not independent of central Government, why on earth did the Conservative party spend 18 years trying to destroy local government?

Mr. David Hinchliffe (Wakefield)

When the Health Committee considered patient complaints, we proposed that patient advocates should be based within community health councils. My concern is that it is proposed that patient advocates should be placed within trusts, where they will not be seen to be completely independent, as patients need them to be. The NHS plan contains many positive proposals. Will the Secretary of State reconsider that issue?

Mr. Milburn

As I said in my reply to the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), we are considering how best to take forward those elements of improving patient representation and the patient's voice in the NHS. As my hon. Friend will recall, there are three separate proposals. First, we will locate the scrutiny and monitoring function with the elected representatives of the local people—it is best located with those democratically elected by local communities, the local councils. Secondly, we are giving patients, for the first time, a patients forum within every NHS and primary care trust so that patients are elected directly to the trust board in each and every case, thereby increasing patient representation within the NHS. Thirdly, we propose a patient advocacy and liaison service, which we already have in some NHS trusts, which is designed to deal with patient complaints and nip them in the bud. Discussions are continuing on locating the PALS in the NHS locally, or slightly outside it. Where we have patient advocacy and liaison services and active mediation, the number of patient complaints and counts of clinical negligence brought against the health service declines. The system works.

Mr. Stephen O'Brien (Eddisbury)

The Secretary of State will be aware that I asked the Prime Minister a question about community health councils last Wednesday. In his reply, he seemed to want to ensure that we all understood that the matter was out for consultation. He agreed that the proposal in the NHS plan to scrap community health councils was bitterly opposed. Yesterday, I received a letter from the Prime Minister, who was clearly embarrassed by his answer—[Interruption.]

Mr. Speaker

Order. The hon. Gentleman is not going to get away with that. The Minister will answer him.

Mr. Milburn

I did not think that it was a good question, so I shall not give the hon. Gentleman a good answer.

Mr. Barry Jones (Alyn and Deeside)

Does my right hon. Friend accept that community health councils do good work in our national health service? Does he also accept that those councils genuinely represent the patients and their families—the consumer? As he is engaged in some necessary, far-reaching reforms throughout the health service, could he delay deciding his approach to community health councils until he has advanced his other reforms? As the system is working, perhaps we should not fix it too soon. Will he bear that in mind?

Mr. Milburn

With the greatest respect, I am not sure that the system is genuinely working. When community health councils were formed in the 1970s, they were way in advance of any other form of patient representation in any health care system. Time moves on. It has become increasingly obvious to many inside the NHS, in local government and elsewhere, that trying to combine three distinct functions in one organisation has not delivered the goods for patients. Of course, the discussions that are taking place between the Department of Health and the Association of Community Health Councils for England and Wales will seek a smooth transition from the existing to the new arrangements, which will increase patient representation and improve the patient's influence within the NHS, rather than diminish it.

Mrs. Ann Winterton (Congleton)

Does the right hon. Gentleman agree that to abolish CHCs is a retrograde step, bearing in mind that they are the only independent advocate for patients, and that they are needed to give expert advice and to try to identify poor practice? Will he think again about those flawed plans? I hope that he will tell the House that he will amend what exists already—that body of expertise in the CHCs; otherwise, he risks throwing the baby out with the bathwater.

Mr. Milburn

Of course we shall try to ensure a smooth transition from the existing CHCs when introducing the new proposals advocated by the Government. Of course we shall try to maintain expertise where it exists; that is the right thing to do. However, no organisation has a God-given right to exist in perpetuity; time moves on. I certainly will not accept lessons about patient representation or independence within the NHS from the Conservatives, who when in government sanctioned gagging clauses on NHS staff.

Mr. Paul Truswell (Pudsey)

Does my right hon. Friend accept that Leeds CHC has an excellent record for providing support to patients? As a former member of the council, I can testify to that. Does he agree that the CHC is concerned not so much about its own abolition, or about the loss of the services that it provides, but about the possibility that those services will be fragmented among a range of providers and that the patient's voice element will be dissipated rather than co-ordinated? There will be serious questions as to the independence of those service providers. Is there not a real danger that we shall create a tower of Babel rather than a tower of strength for the representation of patients' views?

Mr. Milburn

I do not think that is the case, for two reasons. First, I cannot imagine organisations that are more independent than Conservative, Liberal or Labour local authorities. My hon. Friend would only need to look through my postbag from local councils to realise that they are pretty independent organisations and that they will remain so.

Secondly, the patients forums will be independently appointed—not by me, but by the independent appointments panel. The panel will decide on the membership of those organisations. Furthermore, patients themselves—for the first time—will decide who should be the patient representatives on each trust board. There will be more independence, more patient power and more patient influence on NHS structures, locally and nationally, than ever before.

Finally, it is true that we need more integration in patient advocacy and within patient organisations more generally; we need more coherence nationally. There are 300 cancer charities alone, so we need more co-ordination. However, that is a matter for patient organisations to sort out. If they make positive proposals, we shall do everything within our power—including our financial power—to help them.

Dr. Liam Fox (Woodspring)

The Secretary of State does not seem to understand that the real problem is that, in the real NHS, those who are under the auspices of a trust board will not feel free to criticise that board. Let us be clear that CHCs are being scrapped because the Labour Government dislike criticism from any quarter—especially from independent bodies.

The Prime Minister told the House:

I am aware that there is bitter opposition, which is why the proposals are being consulted on.—[Official Report, 15 November 2000; Vol. 356, c. 937.]

Are any genuine consultations taking place that might prevent the abolition of CHCs, or is the Prime Minister's idea of consultation merely to ask the condemned man about the manner of his execution?

Mr. Dennis Skinner (Bolsover)

That is not very original.

Mr. Milburn

As my hon. Friend points out, the hon. Member for Woodspring (Dr. Fox) did not make a very original comment.

On consultation—as I pointed out earlier—discussions are taking place and a series of seminars are being held throughout the country involving the Association of Community Health Councils, CHCs, patient organisations and NHS organisations. I should have thought that the hon. Gentleman—as a genuine Conservative radical—would support change in the NHS when it is appropriate, rather than trying to conserve structures that have not always been beneficial to the service.

Mr. Peter L. Pike (Burnley)

Although I accept what the Secretary of State has said, does he recognise that the good community health councils do an excellent job, that all CHCs should be brought up to that better standard and that he should tread warily before he changes something that has widespread public support throughout the country?

Mr. Milburn

I am sure that there are very good CHCs, and there is no doubt that CHCs have played an important role in the national health service during the past 25 or 30 years, but I genuinely think that if my hon. Friend were to ask most members of the public whether they had heard of their CHC—let alone contacted it—he would find that the answer would be a resounding no.

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