HC Deb 10 May 2001 vol 368 cc269-86

Lords amendment: No. 6

Insert the following new Clause—

Reform of Community Health Councils

  1. (1) The Secretary of State shall by regulations provide for the reform of Community Health Councils established for districts in England under section 20 of the 1977 Act
  2. (2) The regulations shall provide for—
    1. (a) renaming Community Health Councils as Patients' Councils (referred to in this section as "Councils");
    2. (b) the information which local National Health Service bodies must provide to Councils;
    3. (c) the funding of Councils and the provision of premises and other facilities by the Secretary or State;
    4. (d) the membership of Councils.
  3. (3) The functions of a Council are—
    1. (a) to establish sub-committees for each National Health Service trust and Primary Care Trust in the district of the Council, to be known as Patient' Forums (referred to in this section as "Forums");
    2. (b) to facilitate the co-ordination by Forums of their activities;
    3. (c) to make reports and submit recommendations to Health Authorities, local authorities and their committees, National Health Service trusts, Primary Care Trusts, the national patients' body for England and to the Secretary of State in accordance with the regulations;
    4. (d) to carry out such arrangements as may be made with the Council under section 19A of the 1977 Act (independent advocacy services);
    5. (e) to appoint, for each Forum within its district, one member as a non-executive director to the board of the trust to which the Forum relates;
    6. (f) to appoint a representative, having such functions as may be prescribed. to attend meetings of each relevant Health Authority;
    7. (g) to arrange for functions of Forums to be performed under joint arrangements between Councils, where such arrangements are appropriate to meet the needs of their communities;
    8. (h) to receive and respond to disclosures under the Public Interest Disclosure Act 1998 (c.23) where such disclosures reveal matters of concern for patients in the health service or for the wider community;
    9. (i) to refer issues of concern to patients to Health Authorities, local authorities and such national quality assurance bodies as the regulations may prescribe and to the Secretary of State;
    10. (j) such other functions as the regulations may prescribe.
  4. (4) The functions of a Forum are to—
    1. (a) monitor and review the operation of services provided by, or under arrangements made by, the trust to which it relates;
    2. (b) obtain the views of patients carers and the wider community about those services and report on those views to the Council and to the trust;
    3. (c) having regard to the views obtained in accordance with paragraph (b), provide advice and make reports and recommendations about matters relating to those services to the Council. the relevant Health Authority, and the trust;
    4. (d) make available to patients and their carers advice and information about those services;
    5. (e) carry out such functions in relation to primary care services as may be prescribed by regulations made by the Secretary of State:
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    6. (f) in prescribed circumstances, to perform any prescribed function of the trust with respect to the provision of a service affording assistance to patients and their families and carers;
    7. (g) carry out such other functions as may be prescribed.
  5. (5) Regulations shall provide for the membership of a Forum. which shall comprise—
    1. (a) as to at least a quarter of its membership, members or representatives of voluntary organisations whose members or client groups have an interest in the health service;
    2. (b) as to at least a quarter of its membership, patients;
    3. (c) as to at least a quarter of its membership, carers;
    4. (d) such other persons as may be prescribed.
  6. (6) References in subsection (4) to "services" are references to—
    1. (a) services provided as part of the health service (within the meaning of the 1977 Act) in England,
    2. (b) services provided in England in pursuance of section 31 arrangements in relation to the exercise of health-related functions of a local authority, and
    3. (c) services provided elsewhere (and not part of the health service in England) in pursuance of section 31 arrangements with a local authority in England.
  7. (7) In this section—
    1. (a) "relevant Health Authority" in subsection (4)(c) in relation to a Forum for a Primary Care Trust, means the Health Authority whose area is, or includes, the area for which the trust is established;
    2. (b) "prescribed" means prescribed by regulations made by the Secretary of State;
    3. (c) "section 31 arrangements" means arrangements under regulations under section 31 of the Health Act 1999 (c.8) (arrangements between NHS bodies and local authorities);
    4. (d) "carer", in relation to a patient, means a person who provides care for the patient, but who is not employed to do so by any body in the exercise of its functions under any enactment;
    5. (e) "the health service" has the same meaning as in the 1977 Act;
    6. (f) "patient" includes (as well as a patient within the meaning of that Act) a person who receives services provided in pursuance of section 31 arrangements in relation to the exercise of health-related functions of a local authority."

12.44 pm
The Minister of State, Department of Health (Mr. John Denham)

I beg to move, That the House disagrees with the Lords in the said amendment.

Mr. Speaker

With this it will be convenient to consider the following: Lords amendments Nos. 7 and 8 and consequential amendments Nos. 1 to 7 thereto; Lords amendments Nos. 9 to 15 and Government motions to disagree thereto; Lords amendments Nos. 16, 17 and 68; Lords amendments Nos. 82 and 83 and Government motions to disagree thereto.

Mr. Denham

In setting the scene for the amendments, it is important to stress that this is a major Bill. It puts in place many of the measures and powers that are needed to modernise the NHS and to implement the NHS plan, which was launched last July with widespread support from the NHS, its staff, professional organisations and patients groups. The plan underpins the unprecedented investment in the NHS that this Government are making, but which the Conservative party would put under threat.

Miss Anne McIntosh (Vale of York)

I am grateful to the Minister for allowing me to speak. I gather that the Bill is the flagship Bill of the Government in their dying days. Is there any particular reason why the Secretary of State is not here to present the Bill and speak to the amendments?

Mr. Denham

The hon. Lady knows that I have handled the great bulk of the stages of the Bill, and I am doing so today. My right hon. Friend the Secretary of State is taking part in a visit which in principle has been planned for many months.

For the first time in the history of the NHS. nursing care for the elderly will become free in nursing homes from October this year. Just in the past few days, the Conservative party has again made clear its preference for private insurance as the answer to long-term care. The Bill will protect patients and be fairer to GPs by improving the regulation of GPs and other primary care professionals. It will extend prescribing rights. It will strengthen joint working between the NHS and social services by allowing care trusts to be established. It will protect the essential work of cancer registries and other vital parts of the NHS by protecting the information flows that it needs. [Interruption.] As we approach the closing stages of the Bill none of those must be put in jeopardy. [Interruption.]

Mr. Speaker

Order. The Minister knows that we are talking not about the general terms of the Bill, but about Lords amendments to it. He should speak to them.

Mr. Denham

I am grateful to you, Mr. Speaker. I was about to point out that because the Bill is so important we must not put its provisions in jeopardy at this stage in its progress through Parliament. The Lords amendments deal with two substantive issues: the reform of patient representation and patient information. This group of amendments deals with patient representation.

In all the challenges we face in modernising the NHS, the need to make the NHS patient-centred is one of the most fundamental. In the past 25 years too little progress has been made in that area. No matter how good each individual episode of clinical care is, too often patients feel that they have to make their way round the system instead of the system being built around their needs. They have to wait for an appointment that is inconvenient instead of being able to book one. They return time and again for different tests instead of having all the tests done on one day. Their passage from one part of the system to another, perhaps from the health service to social care, is not smooth and seamless as it should be. Too often simple problems, complaints and misunderstandings are not dealt with quickly, some then becoming major problems.

We are already taking action to tackle those issues, but we know and patients know that change will be faster, more effective and more lasting if patients and carers have a voice at the heart of every part of the NHS.

In the NHS plan we set out proposals for a radical change to the system of patient representation. In each trust and primary care trust a patient advocacy and liaison service will be able to tackle emerging problems there and then. A practical answer—

Mr. Patrick McLoughlin (West Derbyshire)

On a point of order, Mr. Speaker. Would it be in order for the Minister to tell us whether he is agreeing or disagreeing with the Lords amendment and, indeed, what he is talking about? We have one hour only.

Mr. Speaker

The Minister is in order at the moment.

Mr. McLoughlin

Only just.

Mr. Speaker

The Minister is drawing a fine line.

Mr. Denham

I have sought to set the context. The Lords amendments set out proposals and amended proposals for a system of patient representation and empowerment. I hope that it will be possible to set out the Government's intentions in this Bill in trying to reform the system of patient representation, how the Lords amendments would affect that and the reason for the position that we take on the Lords amendments. I am very much in your hands, Mr. Speaker, but I hope that that approach will be acceptable.

Mr. Speaker

In my experience amendments tend to be narrow and it is best to keep to the amendment before the House.

Mr. Denham

We set out radical reforms to the system of patient representation in the NHS plan. As the Bill progressed, the system was incorporated in many amendments. The Bill provided for patients forums, and we said that we wished to co-ordinate their work locally. We established a group to consider the representation of patients through a national patients body. It recommended that the body should be statutory, and such a provision was included in thy; Bill in the House of Lords. Government amendments and those tabled by others, such as my hon. Friend the Member for Wakefield (Mr. Hinchliffe), led to a radical and powerful Bill for patient representation. However, the amendments that were made in another place wreck the Government's approach, to which the House of Commons had made amendments.

The key amendment is technically and legally unworkable, and it would not provide the structural change based on independent patients forums or the important shift towards the direct representation of patients and carers that lie at the heart of the Government's proposals. The part of the Bill that we are considering is controversial, and I believe that, before the Lords amendments, the measure was a significant improvement on the original. It reflected much of the discussion that took place inside and outside Parliament. Many people, including many in community health councils, will be disappointed that the provisions will be withdrawn.

At this stage of a Parliament, progress on Bills depends on the rapid agreement of both Houses. Several Bills have already fallen because such agreement was unattainable. The most disgraceful example is the Tobacco Advertising Bill, which has fallen because of Conservative party—

Mr. Philip Hammond (Runnymede and Weybridge)

On a point of order, Mr. Speaker. Is it pertinent for the Minister to mention a different Bill when we have only one hour to debate the measure?

Mr. Speaker

Regardless of the time available, all hon. Members, including Ministers, must keep to the amendment that we are considering. It is a narrow amendment.

Mr. Denham

I hoped to draw attention to the fact that other Bills had suffered the same fate as the part of the measure that we are considering. We made significant efforts to find an agreed way forward in the light of the Lords amendments. However, given the time constraints imposed by an impending general election, it is clear that the Bill would be jeopardised unless we removed the clauses that related to patient representation.

We are determined to empower patients more. However, we are also determined to lift the burden of nursing costs from elderly people and their families as soon as possible; indeed, from October. We shall give up the clauses because we are not prepared to put at risk free nursing care for the elderly. We are determined to fulfil our commitment to pensioners.

The amendments that we have tabled, alongside the Lords amendments, will remove the necessary clauses from the Bill. We agree with Lords amendments Nos. 7 and 8, which remove the clauses on patients forums and patients councils. We disagree with Lords amendments Nos. 14 and 4 to remove any link between independent advocacy and patients councils. Lords amendments Nos. 16 and 17, with which we agree, ensure that CHCs will continue. We must therefore disagree with Lords amendment No.15, and thus remove the national patients body. We regret its loss and believe that the proposed wider role and membership, and the opportunity to include voluntary organisations that represent patients, would be a considerable step forward. However, we cannot have two national statutory bodies that both seek to represent patients and the public. We must therefore withdraw the proposals for the new body.

We must reconsider how to pick up the proposals from the feasibility study, that we established on national patient representation. It was carried out for the Department by a consortium of leading patients' organisations. We do not wish to lose sight of the vision that it set out in its report.

We oppose Lords amendment No.6, which seeks to transform CHCs into patients councils and reduce patients forums to mere sub-committees of CHCs. As I said earlier, that does not offer the basis of a realistic or workable way forward. The clause is technically deficient. If it were left on the statute book, it would lead to future arrangements for patient representation being decided in the courts rather than in the House. Consequential to that position and the removal of patients forums and councils are our amendments Nos. 1, 2, 3, 5, 6, 7, 82 and 83, which remove clauses 14, 15 and 16, and further technical changes. The Government also disagree with Lords amendments Nos. 10, 11, 12 and 13, which would have amended the clauses relating to patients councils and forums.

It might be helpful if I summarise the effect of the Government's proposals on the relevant legislation and policy. Although the effect of the amendments would be to leave the legislation governing community health councils as it stands, the Bill will still introduce significant changes. Overview and scrutiny committees of democratically elected councils will scrutinise the NHS, a change that has been supported in both Houses and was unaffected and unchallenged by the Lords amendments. The change has broad support and we will want to ensure that it is implemented. Among other things, overview and scrutiny committees will be given the role of referring local service change proposals to the Secretary of State and the independent reconfiguration committee when the committee does not think the proposals are in the interests of the local population.

The Secretary of State will still have the responsibility introduced in this place to ensure the provision of an independent patient advocacy service, which also will be widely welcomed. The first patient advocacy and liaison services are now being established in trusts across the country, often involving former CHC staff.

My right hon. Friend the Secretary of State has recently set out our plans to have far fewer, but more strategic, health authorities. The move to 30 strategic health authorities has been widely welcomed.

Mr. Hammond

On a point of order, Mr. Speaker. Could the Minister be asked to clarify to which Lords amendments those specific points relate?

Mr. Speaker

We must allow the Minister to express himself as he wishes to express himself.

Mr. Denham

It might be useful to the House and for the benefit of Conservative Members—I have no intention of talking out this debate—if I set out as clearly as possible the legal and policy position that would pertain if the House were to follow the advice that I am giving on the Lords amendments that we wish to accept, the Lords amendments with which we disagree, and the Government's own amendments. I am briefly setting out that scenario.

I have made it clear—perhaps I need to repeat the points—that, although the legal position governing CHCs would remain as it is, there would be consequential changes to the Bill. Overview and scrutiny committees would take on the role that we have set out for them, and the Secretary of State will have a responsibility to provide independent patient advocacy services.

The move to 30 strategic health authorities is one of the matters that will govern change in the future. The change has been widely welcomed as part of our commitment to devolving power and resources to the front line. It would be ludicrous to assume that patient representation can be championed effectively by ever-more remote committees. What is needed is patient representation within every NHS organisation. We shall still seek to establish patients forums, which are an essential tool if patients are to challenge and change each part of the NHS. Although we would need further legislation to give them the statutory independence that we would like them to have, non-statutory forums can be established in the interim.

Change is therefore inevitable. We will have to return to those matters after the election and further legislation may be necessary. However, as we have said from the beginning, any change must be as seamless as is practical and make the best and most appropriate use of the skills and expertise that are already within the system.

Mr. Speaker

Before I call the next hon. Member, I must draw the House's attention to the fact that privilege is involved in Lords amendments Nos.15 and 66. If the House agrees to either of those amendments, I shall ensure that the appropriate entry is made in the Journal.

Dr. Liam Fox (Woodspring)

I shall be relatively brief. None of us expected quite such a rapid victory for common sense as we have been seeing in the Chamber today. I share my hon. Friends' disappointment that the Secretary of State could not attend this debate and eat humble pie himself. It seems that he finds that diet unpalatable, and that the Prime Minister's three-week humility does not apply to all his Cabinet Ministers.

The Minister was scrambling round for a description of the Government's position as a consequence of their position on the Lords amendments, but I shall try to help him. Climbdown, U-turn and humiliation are all reasonable descriptions of his position today.

1 pm

As for the Minister's unmitigated drivel about the need to protect free nursing care, which is Conservative party policy, it really was a very poor excuse indeed. However, I am sure that he will have the gratitude of at least some of his Back Benchers for abandoning one of the most ridiculous and disastrous policies to emerge from the Department of Health in the past four years. We shall not divide the House, as we agree with the position that the Minister has taken on the Lords amendments. The effect of what the Government are saying today will be simply to return us to the status quo, which is where we wanted to be all along.

There would have been no need to have ridiculous and lengthy debates on the subject only to arrive back where we started, if only Ministers had been willing to listen to representations that were made the length and breadth of the country, by those of all party political persuasions and none, to the effect that this was a poor decision that was not in the interest of patients and only in the interests of those who wanted a lapdog rather than a watchdog for patients.

The Lords amendments will return us to the position that community health councils are currently in, acting as a one-stop shop for patients. The community health councils that were created by a Conservative Government in 1973 offer free labour to the NHS worth £8 million a year. Each year, community health councils assist about 30,000 people, yet they were kept in the dark about the Government's plans.

When Ministers were asked about consultation they did not accept that ACHCEW—the Association of Community Health Councils for England and Wales—or the CHCs themselves had any legitimate expectation of consultation on the proposal that CHCs should be abolished through primary legislation to be introduced in Parliament in due course. That arrogance was one of the main reasons why their Lordships were unwilling to accept the Government's plans. In addition, apparently the Government had no idea of what would happen to CHC staff or the records that were kept by CHC. All that made a poor situation overwhelmingly unsatisfactory. The overwhelming view on both sides of the House, which is held by everyone except those on the Government Front Bench, is that there should now be a reform rather than abolition.

Government Back Benchers who might have taken some short-term comfort from the Minister's words may not be so happy when they read the Department of Health press release that says that, should the Government be re-elected, they propose to continue with the abolition of community health councils. It will therefore be increasingly clear up and down the country that those who have been helped by community health councils, those who assist community health councils and those who work for community health councils will know that a vote for the Conservatives will keep the community health councils and a vote for Labour will abolish them.

Mr. David Hinchliffe (Wakefield)

I very much welcome the fact that the Government are going back to the drawing board on this issue. That will come as no surprise to anyone who has heard my previous comments on the Bill. On Second Reading, I said that the Bill contains many positive measures, but also some that need to be given further thought … Of particular concern are the proposals in clauses 7 to 14, regarding scrutiny and complaints … I feel that there has not been adequate public consultation and discussion … I get the distinct impression that the proposals regarding CHCs and scrutiny were something of an afterthought."—[Official Report, 10 January 2001; Vol.360,c.1104-105.]

As the Minister is well aware, my main concerns related to the fragmentation of the system that was being proposed to replace CHCs—the lack of independence and the lack of clear proposals for independent patient advocacy. I welcome the fact that the amendments on advocacy reflecting the concerns of the Select Committee on Health have been retained. We all accept that that is a major step forward.

On Report, I moved the new clauses in respect of patients councils in order to create an umbrella body that would draw together the various forums, reflecting the role that CHCs have undertaken over many years and the advocacy service to which the Government have agreed. I said: I make no bones about the fact that I am proposing a framework that needs to be examined in more detail. I recognised that a lot more work needed to be done and said: We must consider continuity between any change and the new system. I genuinely hope. that some of those who have served so well on CHCs will make a major contribution within the new system."—[Official Report, 14 February 2001;Vol.363,c.395–96.]

That was what I felt needed to be done in the House of Lords. I am conscious that the deliberations in the other place were constructive, because the official Opposition changed their position between the Commons and the Lords. The Conservatives in the Lords actually backed the idea of patient councils as a reform that could improve the position of patients. I recognise that there were differences over du detail, including the issue of the relationship between patients councils and forums.

The Lords amendment does not reflect the importance of the patients forums, which will be front-line bodies that will play an important role. I understand the reservations of my right hon. Friend the Minister on that point and I also understand the difficulties involved in the continuity question. I welcome the Government's willingness to make further proposals in that area.

The hon. Member for Woodspring (Dr. Fox) said that we were back to the status quo, but he is wrong. He nodded a moment ago when I mentioned independent advocacy, which is a major step forward, and I am sure that he—and the Liberal Democrats, given their previous position—will support that reform.

Dr. Fox

If I may clarify the position, I meant that we are back to the status quo for the CHCs, and we welcome the additional proposals. Will the hon. Gentleman return the favour by telling us whether he will campaign in the general election on his party's ticket to abolish CHCs?

Mr. Hinchliffe

I made my position clear on Second Reading, when I said that the CHCs' functions need to be radically reformed, and the hon. Gentleman is well aware of that. I was a member of my local CHC for many years, and its members know that I believe that we need to modernise that scrutiny function and reflect the marked change in the whole direction of the NHS that has taken place, rightly, under this Government

I would welcome the assurance of my right hon. Friend the Minister on whether the advocacy arrangements proposed in the Bill will ensure, as the Health Committee suggested, that the advocacy function can be placed temporarily with CHCs, so that patients have a clear, independent voice. I would also welcome his comments on where the advocacy function will be placed, as the Bill stands, and on the current position of CHC members, who are hard-working volunteers and need some assurances about their future role.

I am also concerned about the position of the staff of CHCs and of the Association of Community Health Councils for England and Wales. Serious questions have been raised about their their job security and future role. Those people have done a good job in many respects and I would be grateful for my right lion. Friend's comments. I also wish to praise the work of Donna Covey at ACHCEW; she has attempted to work closely with the Government and other parties, in difficult circumstances, to reach some solution that will reflect the concerns of those who want a modernised system.

Patients also need some assurances about the interim period. Will they still have access to CHCs carrying out the functions that they now perform? Can my right hon. Friend confirm my hope that the advocacy function will be available, once the Bill takes effect, within CHCs to assist patients in a way that many of them are not now assisted?

Mr. Nick Harvey (North Devon)

The Government's proposals started out as a curate's egg and ended up as a dog's breakfast. We have taken the view from the beginning that what the Government proposed had three essential flaws. The first was a lack of independence in the arrangements. The second was a lack of cohesion—we were concerned that the system would be so fragmented—and the third was that no national body was proposed that would provide a voice for patients at national level.

During the progress of the Bill, some of those issues have been addressed in part. For example, the patients forums were taken away from the trusts, which originally were to fund and establish them. The provisions for independent advocacy also increased the independence of the new arrangements. The Government conceded in the other place that there should be a national body to represent patients at national level.

Just as the Bill was leaving this House, an amendment tabled by the hon. Member for Wakefield (Mr. Hinchliffe) proposed the creation of patients councils. That would have gone some way towards addressing the point about cohesion. We believe that patients councils could have become very worthwhile bodies, especially given the bigger health authority footprint that is now being talked about, and that they should have been responsible for the independent advocacy service.

The House of Lords, when it considered the amendment, wanted to put patients councils on a firmer footing. Their Lordships wanted the councils to be clearly marked out as successor bodies to the community health councils. It is regrettable that the Government did not feel able to accept that, but they seem to have concluded that it would be better to go back to a blank sheet; and we do not intend to obstruct them in that.

We will have to return to this matter, both during the election campaign and after it. If we are going to start from a blank sheet of paper, I hope very much that any decision made by the House about future arrangements for patient representation will provide for a set-up that is strong, independent, coherent, properly funded and represented by a national body.

The Government will feel some embarrassment that they have had to withdraw their proposal at this stage of the Bill's progress. The proposal was always flawed, but I have every hope that, after the election, we will arrive at an arrangement that is in the best interests of patients.

Mr. Stephen O'Brien (Eddisbury)

There are times when one's faith in the democratic process is confirmed, even in this Parliament under this Government. I raised the matter of the widespread opposition in the country to the Government's peremptory proposal to abolish CHCs at one Prime Minister's Question Time last year. I received a dusty answer and was told that consultation was being held and that a report on that consultation would be made to the House. Only three days later, the Prime Minister sent me a grovelling letter signed. as seems to be his habit, "Yours ever. Tony". In it, he admitted that a decision had been made and that the Government were not going to consult on the abolition of CHCs after all.

The abolition proposal was set out in the small print of the middle chapters of last summer's NHS plan. I am delighted that the Government's craven climbdown at this late hour means that the excellent Chester and Ellesmere Port and Cheshire Central CHCs will be able to continue their good work, under their respective chief officers Mr. Geoff Ryall-Harvey and Mrs. Jean French.

Those chief officers have not been assisted by the Government's brutal and mindless approach to the welfare of CHC staff and volunteers. I talked to Mr. Ryall-Harvey this morning. I thought that today's debate might turn out as it has, but of course was not able to say as much. The irony is that Mr. Ryall-Harvey told me that he had just returned from an out-placement session that was held because it was believed that the Government were confident that they would succeed in getting the abolition proposal through the House.

I am glad to say that the Government have failed, and that opposition to the proposal has emerged among hon. Members of all parties, including Labour Back-Bench Members, and in the other place. We have been deeply upset on behalf of patients, staff and NHS users at what amounted to an appalling attack on the independence of patients and on their confidence that they can discuss the difficult issues that arise when things go wrong. That is when people with grievous and worrying problems are at their most vulnerable and need people of independence and authority who can inspire confidence that solutions can be found.

These issues were highlighted during an excellent debate in Westminster Hall. I pay tribute to my hon. Friend the Member for Woodspring (Dr. Fox), the shadow Secretary of State for Health, and his team for having championed the retention of CHCs so successfully. It is common ground across the House and among CHCs that they need updating and reform. However, all the good work that they have done does not need to be undermined by the Government's wish to abolish them, which has done untold damage. The wind-down, in anticipation of abolition, has caused grievous morale problems.

1.15 pm

It must be made clear that, despite this shoddy process, the Government's shabby conduct and a shameful policy, this is only a temporary reprieve. If a Labour Government are returned, they will again campaign for the abolition of CHCs, and it will cause their Back Benchers no end of difficulty. We, however, will be saying. in any campaign and challenge that is put to Conservative party candidates in the forthcoming election, that we will retain CHCs, reform them and commit ourselves to their independence.

I am proud to have played a small part in the campaign to retain CHCs, and I am glad that the Government have given way at last on this terrible policy.

Mr. Peter Bottomley (Worthing, West)

The House is grateful to my hon. Friend the Member for Eddisbury (Mr. O'Brien) for getting the Prime Minister, in effect, to mis-speak. In the follow-up letter, it was made clear that there had been no consultation before the Government's decision to abolish community health councils as legal entities.

I think that the reaction of the Association of Community Health Councils for England and Wales, which joined in the campaign strongly after a slow start, was based on what my hon. Friend the Member for Eddisbury did and also on the actions of the Worthing district community health council. It wrote to the association asking what action it would take. Then we discovered that what the Government assumed to be a done deal across the country was not one, and that community health councils had been objecting strongly. [Interruption.] Some Government Back Benchers must have pager messages saying "smile" at this point, but it is no laughing matter. It matters a great deal to people with hospital appointment problems, those who have concerns or who want to draw Ministers into the reconfiguration of hospital services. If the Government said that they had a fragmented responsibility to the CHCs to bring general practitioner services into their field, that would make sense.

I have in my hand a letter from one of my constituents, who is 71. His family doctor referred him to a specialist clinic. The letter he got back said: You have been referred to … the Pain Management Unit at St. Thomas's Hospital. We are writing to confirm that you are now on our waiting list, and we hope to be able to offer you an appointment in 15 months' time. [Interruption.] The Government Whip may ask what this has to do with community health councils. CHCs would, rightly, ask how on earth that person was supposed to bear his pain for 15 months while the hospital decides whether it can offer him an appointment. That does not necessarily mean treatment. The Minister looks upset about this. He jolly well should be; so is my constituent.

People are doing more and more at Worthing hospital, but it should be plain. even to a Health Minister, that more is being left undone than was the case four years ago. The right hon. Gentleman may say that that is not so, in which case I refer him to his own answers, which show the proportion of people waiting for in-patient treatment for more than a year, how that figure compares with four years ago, and how it compares with the figure for the health authority covering the Prime Minister's constituency.

It would be propel for the Worthing district community health council to take up the question of a 47-week delay in seeing a consultant in Worthing hospital. If the Government want to extend CHCs' powers to include the family practitioner service, the overload there is probably just as great. Regrettably, family doctors in Worthing, south of the railway line—which has probably the greatest concentration of those over 85 in the country—have closed their lists to new patients and will now take only those referred through the health authority. For that to happen, after four years of the Government's stewardship, is something that CHCs should take up.

Ministers know that holding the election 12 months early has helped to save community health councils. They should drop the Labour party desire to abolish community health councils and seek all-party agreement to extend the CHC role to cover family doctor services. CHCs can thus help health workers—doctors, nurses and others; they are willing to take up complaints and, most of all, they ensure that there is a public, independent, knowledgeable and continuous voice to make plain that what is happening at present is unacceptable.

Ministers seem to fear people saying that what is happening is unacceptable, but waiting 15 months or 47 weeks to see a consultant and the closing of GP lists are certainly not acceptable to me. I doubt that they are acceptable to Labour Members either. CHCs have a proper role to play in ensuring that the situation changes and changes fast. Do not abolish CHCs.

Mr. John Gunnell (Morley and Rothwell)

I add my voice to that of my hon. Friend the Member for Wakefield (Mr. Hinchliffe). When we considered this matter in the Health Committee, we were convinced of the need for a less haphazard advocacy system that was genuinely independent. Advocates must be independent of the hospital trusts that employ them and which they investigate. We certainly need the advocacy system to be more widespread. The system must be strengthened by making it coherent and common to all trusts. It must be genuinely independent. I am glad that the Government have listened and that more acceptable proposals have been made.

Mr. Hinchliffe

I am grateful to my hon. Friend for reinforcing the points that I made in my speech. As this may be my hon. Friend's last contribution in the House, I feel it appropriate to pay tribute to him for his work on the Health Committee, and in representing his constituents in Morley and Rothwell and in local government over many years. He is still widely respected for his work as a member of West Yorkshire county council. I am sure that we all wish him well in his retirement.

Hon. Members

Hear, hear.

Mr. Oliver Heald (North-East Hertfordshire)

I join in the tribute to the hon. Member for Morley and Rothwell (Mr. Gunnell) for his work on the Health Committee. As he will remember, he and I have jousted in Committees on several occasions. I, too, wish him well in his retirement.

I am extremely pleased that there has been a reprieve for the East Herts and North Herts community health councils, both of which have a valuable function in my constituency. They check on cleanliness in hospitals, investigate food quality and, at their statutory meetings with the health authority, have been instrumental in teasing out some of our financial problems.

My concerns about the proposals related to independence and continuity. The CHC representatives who carried out inspections of Queen Elizabeth II hospital in Welwyn Garden City and highlighted problems with cleaning contracts have a continuity of experience with that hospital. The representatives of the North Herts CHC who inspected Lister hospital, looking into diet and the quality of food preparation, also have that continuity of experience. They are independent; they say what they see.

It may not be convenient for Governments to have such independent people telling them what is right or wrong with local health services. However, as a Member of Parliament, it is helpful to me to know that there is a truly independent sounding board, which has continuity. The statutory meeting of the East Herts CHC certainly brought out—through questioning and contributions from the health authority—some of the financial difficulties that had occurred during the past few months in East and North Hertfordshire. That process was extremely helpful.

Mr. Denham

Can the hon. Gentleman identify a single way in which the patients forums or the patients councils, as we proposed them, would be less statutorily independent than CHCs?

Mr. Heald

One of the greatest achievements of the community health councils has been casualty watch. It is to have a national body—

Mr. Denham

rose—

Mr. Heald

Let me finish the point. It is to have a national body. which will be able to co-ordinate these matters, and which will be independent and able to communicate fearlessly the picture for the country as a whole. Governments do not like that, but the public at large and Members of Parliament certainly appreciate it.

Mr. Denham

Why would the national body as set out in the Bill have been in any way less, able to do casualty watch than the CHCs are at the moment? We have made it clear that it could do so equally well.

Mr. Heald

We want something that is genuinely independent, and we want it—[Laughter.] The Minister laughs, but independence is important. We are used to a Government who constantly spin figures and change the basis of figures—a Government who are all about spin rather than reality. If it is independent—

Mr. Hammond

Does my hon. Friend agree that the problem is that the patients councils and patients forums as proposed in the Bill would be established by secondary legislation—regulations introduced by the Secretary of State—and would not be enshrined in primary legislation, as CHCs are?

Mr. Heald

My hon. Friend is right about that. All too often, we are asked to accept assurances. We know what the community health councils and the national body do at the moment. We are expected to give the Government carte blanche because they are nice people giving us assurances, but that is unacceptable. We want it in the law.

I am grateful to have had the opportunity to make this short contribution to the debate.

Mr. Patrick Hall (Bedford)

I am very disappointed with the situation that we now face. People have put a great deal of work into trying to find answers to a multitude of questions, but those questions remain on the table and all the work will have to start again.

A lot of work has been put in over the past 10 months to make sense of a set of proposals that, to start with, were fragmented and posed more questions than they answered. When the Bill left the House on Third Reading, it contained a much better set of proposals. The new structure for patient representation was not nearly as fragmented as it was when it was first suggested, thanks to the Government's acceptance of the amendment tabled by my hon. Friend the Member for Wakefield (Mr. Hinchliffe), and thanks to a great deal of work that had been done outside this place, by civil servants and others, to which the Government paid attention. With patients councils forming the overview and the administrative cohesion that was missing from the initial set of proposals, we had a structure that would have worked and would have made sense locally.

The statutory, independent patients forums would be very important for every part of the local health service. They would not perpetuate the traditional emphasis on hospitals—the acute sector—but would give equal importance to the primary care sector, and to community health services. Patients councils would have been well able to play the important role of fitting that structure together. They would also provide a means of disseminating and receiving information, locally, regionally and nationally, and a means of informing local authority scrutiny committees.

We have not returned to where we started, but the situation is unsatisfactory and unresolved, and people will still have in mind questions that they will pose in the weeks and months ahead, to which the Government will need to return in future.

Will the Minister give one assurance? Will he acknowledge that no system that deals with patient representation and patient empowerment will work unless it has the good will of all the people who are already involved in those areas? Most of them serve on CHCs and most are volunteers, but many work for other voluntary organisations, as my right hon. Friend will know. Their good will and work needs to be acknowledged. The Government could have begun the process in a better way with regard to those people. The process began 10 months ago and there has been constructive consultation since, but there will certainly have to be a great deal more of it to deal with these matters when the Government return to power.

I should like an assurance from my right hon. Friend that the views of those in the voluntary sector—voluntary members of CHCs as well as staff—will be taken on board, so that such people will be fully involved in returning to the drawing board to consider the new structure. We need the involvement of those people to make any new structure work.

1.30 pm
Mr. Hammond

We really should not be having this debate. If the Government had listened to what people had to say and genuinely consulted at the outset, as they pretended they had, they would have realised that the Bill's proposals were unacceptable. They are unacceptable to the Conservative Opposition, to all other parties in the House and, indeed, to the great majority of Labour Back Benchers. They are unacceptable to outside bodies representing patients and to most commentators on the subject. It is only the Government's arrogance that has resulted in their having to make such a humiliating climbdown at the 11th hour.

The Minister is wrong to suggest—indeed, the Labour party was wrong to suggest in last night's press release—that the climbdown is somehow in order to save the principle of free nursing care. I believe that all parties in the House have expressed their support for the introduction of free nursing care.

Clause 56 removes from local authorities the statutory duty to provide or procure free nursing care, and the power to do so. There is no reason why, if clause 56 had fallen and the Bill had not become law, the Government could not have introduced free nursing care by directing health authorities to pay for it—unless the Minister is suggesting that the country is littered with local authorities that would insist on paying for such care even when their health authorities were offering to do so and to provide it.

I do not want to take up too much of the House's time, but I should like to ask the Minister one or two specific questions: he has come to the House supported by the usual invisible army, and I know that he would be disappointed if I did not do so. How has he reconciled the retention of community health councils with the creation of overview and scrutiny committees? There will be significant overlap of their functions and a potential for conflict between them.

Will the Minister explain Government amendment No. 4, which proposes to leave out subsections (6) and (7) of proposed new section 19A, under clause 17, which deals with the introduction of independent advocacy services? Proposed new subsection (6) provides that, before making arrangements for independent advocacy services, the Secretary of State should consult the relevant patients council and any other persons "as he considers appropriate". Obviously, there will be no patients councils to consult, so it is entirely appropriate to remove that reference. However, why should the Secretary of State not consult such other persons as he considers appropriate"? By removing the subsection, the Minister will be allowing the Secretary of State to introduce regulations for the provision of independent advocacy services without a requirement to consult anybody on doing so.

Government amendment No. 7 addresses schedule 5. It is not clear why the House should be minded to agree to the removal of a definition of a patient advocacy and liaison service, and to giving the Secretary of State free rein to define such a service through any regulations and in any way he chooses. I would be grateful if the Minister could elaborate on those two points, because they are not merely consequential amendments, but significant changes to the process that the Secretary of State will have to undertake.

Throughout, the Government's case for abolishing the CHCs is that they want to introduce something that is much stronger and much more effective. Their problem has been that no one believes them. It is true that CHCs are a thorn in the side of Health Ministers. The Minister knows that and my tight hon. and hon. Friends have told me the same thing. The function of CHCs is to be a thorn in the side of Health Ministers.

One of the most common outputs of CHCs that Members receive is the excellent publication "Casualty Watch". Let us consider the Government's version of their motivation. The Secretary of State was sitting one morning in his office reading a copy of the Daily Mail with the headline, "The abandoned patients—Catalogue of shame as hospitals leave elderly waiting on trolleys". The article beneath it added: A survey by Community Health Council workers across London revealed horrific examples of sick patients and so on. We are asked to believe that the Secretary of State said to his advisers, "I have a great idea. Why don't we strengthen these bodies? Why don't we make them more independent and more effective so that they can produce more of this type of documentation and circulate it to the press and Opposition Members of Parliament?" That is a totally implausible scenario.

Mr. Clive Efford (Eltham)

Instead of waving about the publications of the CHCs, would the hon. Gentleman explain why the previous Conservative Government cut the budget of CHC News, which kept the members of CHCs, like myself, informed of the issues that the CHCs were taking up with the Government? That measure made CHCs less effective.

Mr. Hammond

The hon. Gentleman might remember that the previous Conservative Government created CHCs precisely to undertake a scrutiny function.

The Government have got themselves into a position in which Labour candidates will go into the general election pledging to abolish CHCs. Those candidates will have to defend the indefensible position that the Government have adopted in wishing to destroy these independent watchdogs and voices for patients. As the hon. Member for North Devon (Mi. Harvey) said, the Government have created a dog's breakfast.

We are delighted that CHCs have been reprieved by the Government's climbdown today, but we would much prefer to hear that the Government permanently accept the advice that they have received from both sides of the House and from all sections of opinion outside that the CHCs should be retained and reformed, Instead, I hear from the Minister that this is a measure of expediency and that a Labour Government, if re-elected, would move swiftly to abolish the CHCs and remove the independent voice that they provide for patients.

Mr. Denham

When I outlined the Government's position, I was able to set out exactly what would happen as a consequence of the amendments. I shall not respond to the Conservative party's caricature of our position as I have set out the policy that we shall pursue in the weeks to come.

The debate has been revealing because not a single Conservative Members has engaged with the fundamental challenge that we set out to tackle. The fact is that, despite much hard work and good will, 25 years on, we do not have a patient-centred NHS or the structures that mean that it has been organised around the needs of patients. Nothing other than that fact motivated my right hon. Friend the Secretary of State, me and other Ministers to introduce the proposals in the NHS plan. They remain our commitment.

I do not criticise hon. Members who want to praise the work of their local community health council, but the debate revealed the extent to which the Conservatives have tried to caricature what the Government proposed. It simply is not true that we wanted lass independent and less powerful bodies, that were not as able to speak up for patients or to carry out activities—such as those performed by Casualty Watch—as the CHCs. We wanted to achieve a system of patients councils, patients forums and a national body that, taken together, would have been stronger, more powerful and, indeed, more independent than today's arrangements. I believe that we could have achieved that and had greater consistency across the country because everyone accepts that services are patchy and inconsistent. The hon. Members for Worthing, West (Mr. Bottomley), for Eddisbury (Mr. O'Brien) and for North-East Hertfordshire (Mr. Heald) clearly had not attempted to read or understand the Bill before it went to the other place or after it was initially amended there.

There is one reason—and only one—why the Government have reached this decision. Everyone knows that, at this stage of a Parliament, unless both Houses of Parliament agree on all aspects of a Bill, it will fall. In this case, the provisions for free nursing care would have fallen with it. If the hon. Member for Runnymede and Weybridge (Mr. Hammond) really believes that this primary legislation is not needed, it is a little late for him to speak up now. He did not say that previously. We need primary legislation so that we have a secure statutory base for what we intend to do. We are not prepared to lose free nursing care because both Houses cannot agree on other aspects of the Bill. That is a fundamental principle and the right position to take.

Mr. Hammond

Will the Minister acknowledge that I raised that point in Committee?

Mr. Denham

I had not realised that the hon. Gentleman was also wrong in Committee, but if he wants me to confirm that, then fine. Doing things by direction does not provide a satisfactorily—

Mr. Hammond

On a point of order, Madam Deputy Speaker. The Minister asked why I did not raise the matter before, and I told him that I had in Committee.

Madam Deputy Speaker (Mrs. Sylvia Heal)

That is not a matter for the Chair

Mr. Denham

I apologise for not realising that the hon. Gentleman was wrong twice. I thought that he was wrong only once. For the record, however, I confirm that he was wrong twice.

Let me stress that we are not prepared to lose free nursing care because the two Houses of Parliament fail to agree.

I suspect that I will not have time to cover in detail all the issues raised. On the overview and scrutiny committees, we will need to consider in depth, after the election, the way in which their new powers will fit with the legal powers of CHCs. That is important. We will have to consider the best way of delivering advocacy services, to which my hon. Friend the Member for Morley and Rothwell (Mr. Gunnell) referred. Given the support of the CHC staff association for the Bill a few weeks ago, I regret the fact that there might be some uncertainty about it. We will want to work with them in the weeks and months to come to ensure that their position is properly looked after.

It being one hour after the commencement of proceedings, MADAM DEPUTY SPEAKER put forthwith the Question already proposed from the Chair pursuant to Order [this day].

Lords amendment disagreed to.

MADAM DEPUTY SPEAKER then put the Questions necessary for the disposal of the business to be concluded at that hour.

Lords amendments Nos. 9 to 15, 62, 73, 74, 82 and 83 disagreed to.

Remaining Lords amendments agreed to [one with Special Entry].

Consequential amendments Nos. 1 to 9 agreed to.

Committee appointed to draw up Reasons to be assigned to the Lords for disagreeing to certain of their amendments to the Bill: Mr. John Denham, Maria Eagle, Mr. Philip Hammond, Mr.David Jamieson and Mr. Peter Luff; Mr. John Denham to be the Chairman of the Committee; Three to be the quorum of the Committee—[Mr. Jamieson.]

To withdraw immediately.

Reasons for disagreeing to certain of Lord amendments reported, and agreed to; to be communicated to the Lords.