HC Deb 23 June 2003 vol 407 cc835-44

Motion made, and Question proposed, That this House do now adjourn.—[Derek Twigg.]

11.3 pm

Mr. Stephen O'Brien (Eddisbury)

I am grateful to Mr. Speaker for granting me this debate about the needless and deeply resented closure of Cheshire's three excellent community health councils.

This is a case of the Government springing on the country a final decision, as at paragraph 10.35 on page 95 of the NHS plan, which was published in July 2000, just as the House rose for the summer recess, as it happens—an amazing coincidence. In the plan, the Government said: community health councils will be abolished and funding redirected to help fund the new Patient Advocate and Liaison Service and the other new citizens empowerment mechanisms". On 15 November 2000, during Prime Minister's questions—or PMPs, as they are more commonly known these days—

Mr. George Osborne (Tatton)


Mr. O'Brien

Yes: Prime Minister's porkies. I asked the Prime Minister the following question: Is the Prime Minister aware that his proposals to scrap community health councils—independent watchdogs for NHS patients, such as Cheshire Central and Chester and Ellesmere Port—are bitterly opposed by my constituents, patients and staff? Will he drop those plans? He replied, most sincerely: I am aware that there is bitter opposition, which is why the proposals are being consulted on. If he goes round the country, however, the hon. Gentleman will find that people in certain areas do not believe that community health councils have been as effective as they might be. It is precisely because we want to consult that we have issued the health plan. We will report back to the House in due course on the consultation."—[Official Report, 15 November 2000; Vol. 356, c. 937.] Later that day, the Prime Minister's office briefed all the journalists and regional media. Lo and behold, on the following Monday I received a three-page letter from the Prime Minister in which he had to retract his statement to the House. Of course, he did not come here to explain: he just sent me a personal letter, which started "Dear Stephen" and ended "Yours ever, Tony"—not that I had ever met him before—in which he had to admit that there had not been prior consultation leading up to the Government's decision cavalierly to scrap community health councils. The letter said: I thought it would be helpful if I clarified the nature of the consultation on which we are currently engaged … Our proposals mean that Community Health Councils are to be abolished, subject to legislation … We have now embarked on a process of consultation to involve key stakeholders, including the Association of Community Health Councils in England and Wales and Community Health Council staff and members in developing the detail of these new arrangements … This process will build on the best practice from Community Health Councils and others". He concluded: This better describes the consultation I alluded to in my answer during Prime Minister's Question time. I believe that the campaign that ensued was the result of deep anxiety about that extraordinary retraction and doublespeak, which was exposed the following week in a Westminster Hall debate that I was fortunate enough to secure. A long campaign followed.

Does that all sound rather familiar to the Minister? Was not the Prime Minister's botched Cabinet reshuffle yet another case of, "Here we go again: decision first, consultation to follow"?

Two and a half years later, what has it all come to? It is a tale of woeful incompetence by this Government—yet again, under Labour, patients last, Government shambles first. In Cheshire, we are losing three very good CHCs—Chester and Ellesmere Port, Cheshire Central and Macclesfield, all with excellent professional and volunteer staff who are well known to my hon. Friends the Members for Macclesfield (Sir Nicholas Winterton), Congleton (Ann Winterton), Tatton (Mr. Osborne) and North Shropshire (Mr. Paterson), all of whose constituents have cause at times to use hospitals in Cheshire and therefore need those independent and valued services. At least, they did, until the Government put them on death row. Now that their execution has been drawn out for a further three months from 1 September to 1 December, it is typical that under this Prime Minister all the Ministers responsible have moved on ahead of their shambolic mistakes—namely, the former Secretary of State for Health, the right hon. Member for Darlington (Mr. Milburn), the hon. Member for Salford (Ms Blears) and, most recently, the hon. Member for Tottenham (Mr. Lammy). I dare say that the hapless new Minister has been sent to defend the decision, yet the only remaining member of the Government who is still responsible for the chaos and confusion is the Prime Minister himself. He should be here justifying why he has not got the replacements for community health councils up and running on time.

What is really important to patients who often still feel vulnerable and are in continuing need of NHS treatment is an independent and experienced body, as the CHCs in Cheshire have been, to give them the trust, the confidence and, above all, the confidentiality to chart their way through the self-defensive nature of the NHS. That is what patients need when things go wrong, as is inevitable in any organisation, especially the biggest in Europe. That is a blunt fact: it is not to decry the doctors, the nurses and all the staff. At the moment, the Government are so fearful of any criticism of the NHS that they want to take the CHCs away because an independent voice might just expose the truth, which is not what they are keen to hear.

Sir Nicholas Winterton (Macclesfield)

As my hon. Friend knows, I have tremendous respect for the CHC in Macclesfield, which has been staffed by professionals, and to which many local people have given up a great deal of time. Is not the truth of the matter that the Government have been frightened of the success and efficiency of the CHCs and the way in which they have represented the best interests of patients?

Mr. O'Brien

Indeed it is. Given that there are more than 100 CHCs across the country, it is inevitable that the performance will be patchy, but we have excellent CHCs in Cheshire. There was no need for the Government to throw out excellence for the sake of dogma, or to try to put something in its place simply because they could rely on one or two examples that were not up to the excellent standard set by Cheshire.

Another reason why the Labour Government said they wanted to scrap CHCs was to bring in more local community representation in their replacements. The Government have ditched that provision in their recent legislative proposals and, worse, removed the mandatory requirement for local patients forums to monitor their local trusts. So far, the Government have made no resources available for this monitoring role. I have received a letter from the chief officer of Chester and Ellesmere Port CHC, Mr. Geoff Ryall-Harvey, who says: You will be aware that the scrutiny and monitoring function of CHCs should be taken over by Local Authority Overview and Scrutiny Committees. The Cheshire CHCs have worked very closely with Cheshire County Council and the County Council has developed an excellent proposal to set up their OSC structure. Unfortunately, the Department of Health has been extremely vague over the months about the detailed arrangements for the function of OSCs and, particularly, about what resources might be available. We have now been informed that the establishment and operation of an OSC is a power and not a duty. So there is no obligation to replace the CHCs, which were already functioning very well.

Mr. Ryall-Harvey's letter continues: We are concerned that in the absence of new funding for OSCs they will simply not be established in many areas. In Cheshire, having regard to the County Council's"— various priorities— it is likely to delay its progress in establishing an OSC until these difficulties are resolved. He goes on to say that that is probably the case across the country. He continues: You will recall that OSCs were part of the package that the Government offered in order to get its legislation on the abolition of CHCs through the Commons and the Lords last year. He is particularly tilting at the various Labour rebels who were determined to give this matter a bit of attention, but who were bought off. However, this provision at least became part of the package. He goes on: I would suggest that if parliamentarians had known that these particular measures for the replacement of CHCs were an option and not a duty then they would not have withdrawn their opposition. I also seem to recall that the Government gave an undertaking that CHCs would not be replaced until there were robust new structures in place to take on the various aspects of their role. Does this mean that CHCs will remain in those areas where the local Social Services Authority has not set up an OSC? He then asks whether it will be possible to make the Minister honour his earlier promises". Of course, I exonerate the present Minister from having to live up to the promises made on this subject by the string of Ministers who have preceded him. Given that all this started with the Prime Minister having to correct an answer that he gave me at Prime Minister's Question Time, the precedent is riot good, however.

Mr. George Osborne

My hon. Friend is making an excellent speech, and I am only sorry that the Prime Minister has not turned up to listen to it. Is my hon. Friend aware that many of my constituents have written to me to say that they are not sure who they will be able to complain to once the CHCs go? There is considerable confusion among the people I represent as to exactly what the Government have in mind to replace CHCs.

Mr. O'Brien

My hon. and neighbouring Friend makes an exceptionally important and valid point. Indeed, my constituents have expressed the same concern. Part of the problem is that it is not only potentially vulnerable patients, but the whole country that feels that it has been duped yet again by the Government on this issue.

My hon. Friend the Member for Woodspring (Dr. Fox) has said: The Government has utterly betrayed CHCs, those who work in and depend on them, and those who accepted at face value the Government's promises on what would replace them … The abolition of CHCs is not only unwelcome, but indefensible. The morale of GPs and other health professionals is known to be at an all time low. Removing an established, successful and independent method for patients to raise concerns is hardly likely to improve matters. Worse still, to do so out of spite, in order to silence a potential critic of Government policy, adds insult to injury. Patients' Forums will"— of course, that is now "may", rather than "will"— be acting as monitors, and reporting back to Trusts. This does not constitute a direct relationship with the patient. And we know from the Government that PALS will not be a complaints service. Labour doesn't care about patients' rights. The NHS can be a bewildering institution, and it is absolutely vital that patients are able to navigate their way through the maze. Having to work out which of sixteen bodies they should turn to will be hugely unhelpful. This precisely confirms the point made by my hon. Friend the Member for Tatton.

Ann Winterton (Congleton)

Does my hon. Friend agree that it is essential that patients should have confidence in the national health service and in the services that are provided locally? Does he agree that the Government have kicked this issue into touch by getting rid of the one body that has been effective in putting forward the fears of patients, and, so far as we know, replacing it with absolutely nothing? Will this not be most damaging to the confidence of patients?

Mr. O'Brien

My hon. Friend is absolutely right. Not only do the replacements lack independence, but CHCs did good work on the casualty watch survey, monitoring the position on trolleys and beds. That was part of their tremendous added value. They were able to give patients, often vulnerable patients, the feeling that they could have confidence in the NHS but that was only because it was accountable through an independent body.

While I believe that the Government's decision to scrap CHCs has always been stubborn, spiteful and wrong-headed, we have to move to the present crisis as closure looms. With staff and volunteers managing casework and doing their best to secure an orderly transition, the Government are acting in a crass and totally incompetent manner, as predicted, and as predictable as the Government's shambles and incompetence on their tax credit system.

In politics, it is said that there are no rewards for saying, "I told you so" but perhaps the Minister, the media and vulnerable patients throughout the country, especially my constituents in Cheshire and those of my hon. Friends in other parts of Cheshire and Shropshire, will listen to Mrs. Jean French, chief officer of the Cheshire Central CHC. She wrote to me on 5 June and said: Dear Stephen Whitehall Farce—Final Act You've no doubt heard that, yet again, CHCs have been seriously disrupted, distressed and dismayed by a ministerial decision. In the light of criticism of the gap between the closure of CHCs and the coming on-line of Patients' Forums, a decision has been taken not to concentrate resources on developing the new system but to waste money requiring CHCs to continue to fulfil their statutory duties for three months beyond the announced closure date. This smacks of unbelievable incompetence. Yet again, we were not informed in a proper manner. Staff had been told they would receive redundancy notices by the end of May in line with the closure of CHCs on 1 September. When these did not arrive by 31 May, we suspected a problem. We were then left speculating what was happening until yesterday, 4 June when it was announced that the new closure date would be 1 December. As you would expect from any reasonably efficient organisation, CHCs, having been given 6 months notice of closure at the end of January 2003, embarked on a sensible, structured exit strategy. This is well underway now. Some staff have left for new jobs; files are being sorted through for shredding or archiving; contracts for equipment on lease have been given notice of termination; final monitoring projects have been written-up and submitted to Trusts for comment and action. We have a farewell event for members booked for mid-July. By ironic coincidence, our final Annual Report came back in first draft from the printer yesterday. Also yesterday, we held what should have been our final public meeting! This process cannot now be reversed. We have reached the end of our monitoring and visit programme before the summer break for members. July and August were to have been spent clearing the office. The community drugs team is waiting for our premises to be vacated so they can have more office space for their expanding staff. Three further months 'to continue the monitoring function' would be a farce. Some CHC Members are likely to resign in protest. Others will become members of local authority Health Scrutiny Committees—another of the mechanisms set up partly to replace CHCs. They believe this makes them ineligible for continued membership of the CHC. (The Minister has not addressed this point.) We have been told not to take on any more NHS complaints work after the end of May. This instruction has not been countermanded by the Department of Health. A national Independent Complaints Advocacy Service was promised from 1 September. Do we restart complaints work now? Will there be a new service in September? (The Minister has not addressed these points.) I enclose a copy of the Minister's letter to CHC Staff. He says he has decided 'to make the position absolutely"— can hon. Members believe this?— unassailable'." Whose position and 'unassailable' from whom? Is he trying to protect himself from criticism? That is not me speaking but someone who is deeply affected by the Government's cack-handed attempts to try to manage their way out of a deeply embarrassing and needless problem. She goes on: Since the announcement of abolition in July 2000 which you will remember well, I have lost four members of staff, one of them a temporary replacement. I am lucky to have one member of staff still with me but there are CHCs with one or no members of staff. Also, I am lucky in having 20 loyal Members who have wanted to see the CHC through to the end but it is absurd for the Minister to pretend we can fulfil our statutory duties for a further 3 months. Remaining in existence would be mere tokenism in order for the Minister to save face. Remaining in existence would also be a waste of public money. 700 staff will have to be paid for a further 3 months with more of them becoming entitled to redundancy payments during this time. (Staff who were taken on after the abolition announcement are now entitled to redundancy payments!!) The extra three months mean that public money has to be allocated, properly, but because of the Government's incompetence, the whole thing will cost taxpayers more. Mrs. French continues: The CHC budget for this year is shared with the new Commission for Patient & Public Involvement in Health. Money spent retaining CHCs as a token gesture would be money lost to the Commission for developing the new systems. This does not make sense. She then mentions the appalling upheaval, disappointment and deep distress that have been caused. She says: We can have no trust in the competence of current decision-making in the Department of Health. The only reason can be that they see CHCs as too insignificant to care about. They are trading on the goodwill of caring volunteers. It is not acceptable. The Minister has the power to change his mind … He has done it once. Dare he"— the new Minister— be brave enough and sensible enough to do it again? She adds: Please, if you can … make use of this letter in any way to expose this government incompetence or to forward the cause of CHCs by arguing for a dignified and professional exit on 1 September— this year! That letter deserved a public airing, given this absolute outrage from the Government.

I replied to Jean French's letter, pointing out that the appalling way in which she had been dealt with was in stark contrast with Labour Ministers repeated claims of how much they value those who work in the NHS. Such comments lie ill in their mouths in the light of their actions in relation to CHCs.

At a stakeholders' meeting involving the Department of Health, the Association of Community Health Councils for England and Wales, CHCs and trade unions, Sharon Grant, the chairman of the Commission for Patient and Public Involvement in Health—the Government's supposed flagship replacement—did not turn up. Instead, the commission sent along someone who had been in her job for only eight days. What sort of commitment does that reveal on the part of a Government-created commission to deliver on the Government's promise to learn from the knowledge of CHCs' experienced staff? Despite what the Prime Minister said to me in November 2000, the commission has refused invitations from ACHCEW to discuss the transition. Now that they are being killed by this Government, CHCs want an effective transition, with a work programme that the commission must, in any case agree with the Department of Health. But no, this Government have ditched 28 years worth of the dedicated knowledge and experience of CHC staff without a care—just as they ditched 1,400 years of constitutional experience by trying to scrap the post of Lord Chancellor, botching the process in doing so. Even a trade union representative said today that he has never seen such a process handled this badly.

Things could have been different; there could have been negotiation and the process could have been orderly. The prolongation of the death of CHCs has led to more than the bitterness of 2000; now, there is real anger. What has it all been for? One need only read the miserable answers given by the former Under-Secretary of State for Health, the hon. Member for Tottenham to the Chairman of the Health Committee on 15 May. The hon. Gentleman admitted that patient advice and liaison services were at the front of the new system; however, they are not even independent. After ringing more than 100 areas in the past week in respect of PALs, ACHCEW found that just 51 have any form of telephone answering system. Of those, the telephone number given for independent complaints was—lo and behold—that for CHCs.

This is a travesty of decision making, and an illustration of the worst sort of administrative incompetence by this Government. My constituents, the people of Cheshire and those in the country as a whole will conclude that this Government's brutal, chaotic, stubborn and arrogant approach to the prolonged death of CHCs typifies all the reasons why the Government have breached the trust of the people; indeed, they care even less that they have done so. They should be giving a wholehearted apology, and agreeing to an inquiry in order to learn the lessons from this appalling administrative incompetence.

11.22 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman)

I begin by congratulating the hon. Member for Eddisbury (Mr. O'Brien) on securing this debate. I know that this is an issue in which he has taken great interest; indeed, he has pursued it on several occasions. I am also grateful to him for giving me my first opportunity to come to the Dispatch Box. If one is to get over first night nerves, it is better to do so in the calm environment of an Adjournment debate than in the bear pit of Question Time. I was not quite so keen on his description of the reshuffle as botched, however; from my point of view it was astute and far-sighted. Nor was I too keen on his describing me as hapless, but I suppose that that fits with the description of me in the Daily Mirror as obscure.

The hon. Gentleman raised several issues of concern relating to community health councils in Cheshire that I shall try to deal with in the time available. If I do not manage to deal with them all, I will give him answers if he writes to me about them. Indeed, I shall certainly read the account of our debate to check whether I missed anything that I should have dealt with.

I should perhaps remind the House about what we are doing and why we are doing it. Several of those who intervened gave me the impression that they are perhaps not fully aware of the full range of methods that we are putting in place to involve patients. Because the national health service is publicly funded, in our view the public have the right to be involved and consulted about how services are delivered.

Through the new arrangements, the Government are moving the NHS into a new era of patient involvement whereby patients themselves are the watchdogs of the NHS. In future, involving the public will become the norm.

In the past, the community health councils have indeed been the principal NHS watchdog for nearly 30 years. Frankly, however, empowering the public to speak up for themselves or providing opportunities for them to do so was never part of the CHCs' remit. A CHC might have found mechanisms to do so in some areas, but not in others. It is also worth pointing out that CHCs never had an obligation to follow up complaints on behalf of patients. Again, they did it very well in some areas, and not so well or not at all in others.

Our programme of improvement addresses issues of influence, control and accountability for patients and the public across the NHS and beyond. We do not underestimate the task of ensuring that patients and the public have greater influence and control. Change will not happen overnight. Our aim is to put in place a programme that will stand the test of time. Neither do I underestimate—in response to what the hon. Member for Macclesfield (Sir Nicholas Winterton) said—the work that CHCs have done, nor the quality of the contribution made by some CHC teams, including the Cheshire team, in the past. We expect much of the expertise and knowledge of staff and members to be of benefit to the new system.

However, the programme of change aims to achieve a cultural shift in which patient and public involvement is real and meaningful, so it will have to be more than just passing on knowledge and experience. The new mechanisms for patient and public involvement will enable patients to be as involved as they want to be in decisions about their care and enable communities to be involved in their local health service in a way that they have hitherto been unable to do.

Mr. Osborne

The Minister is new to the job and the civil servants have not yet got their claws into him. Surely he does not believe the rubbish that he is reading out to us. Should he not take an early ministerial decision and restore CHCs, at least in Cheshire.

Dr. Ladyman

No, I should not take that decision, because I honestly believe that the new system leaves us with a range of mechanisms for involving the public and will, for the first time, allow them to stand up and have their say in a way that was not possible with CHCs.

If I explain the various steps that we are taking, perhaps Opposition Members will become more convinced. The key is to put the patient at the centre of everything that the NHS does. In that way, we are trying to deliver our modernisation programme as set out in the NHS plan and we also want to respond to the Bristol Royal Infirmary inquiry report, which recommended representation of patient interests "on the inside" of the NHS and at every level. That is exactly what we have put in place.

The new system for patient and public involvement system will be achieved through trust, community and national arrangements, which have already started. The Commission for Patient and Public Involvement in Health, in operation since 1 January, will represent the patients' voice nationally and establish its nine regional offices. It is the first ever national body representing patients. Local authority overview and scrutiny committees will be scrutinising the NHS, and they have had those powers since January 2003. That is also a new power and it has been long sought by local councils. Speaking as a former local councillor, I know that it is a power and a duty that local councils have wanted for a long time—and they will have it in the future.

The NHS will also carry out its new duty to involve and consult the public, which has been a legal requirement since January 2003. Patient advice and liaison services have been in place for some time now and exist in almost all trusts. Again, PALS are a new organisation. In Cheshire, for example, PALS are in place in many NHS trusts—the Cardiothoracic Centre, North Cheshire hospitals, the Cheshire and Wirral partnership, the Clatterbridge Centre for Oncology, the Countess of Chester, the Mersey Regional ambulance service, the Eastern Cheshire trust and others. In addition, primary care trusts in Halton, Birkenhead and Wallasey, Bebington and West Wirral, Cheshire West and Central Cheshire all have PALS in place.

In addition, we will have a new structured monitoring of the NHS by the Commission for Health Improvement and by patient environment and action teams. There will also soon be independent support for complainants from the independent complaint advocacy services. Pilots are running already in 60 per cent. of the country. A new national system is planned from September. That is new, and part of legislation.

A national helpline has been set up by the Commission for Patient and Public Involvement in Health, which will provide advice, information and signposting for the public about where to get independent complaint and advocacy services and other support. Again, that will be new. The local network providers, supporting patients' forums, will act as one-stop shops for patients and they will be in place from September and will also be established by the CPPIH. The new patients forums—one for each of the 571 trusts will be in place from December to monitor and review the NHS and do much more. In other words, more than 500 patient-centred bodies will be set up to replace the180 CHCs.

NHS trusts and primary care trusts will have patient advice and liaison services, providing on-the-spot help and information about health services. In addition, they tell people about the independent complaints advocacy services that are available. PALS are already up and running in all but a handful of trusts. Patients' forums will be set up for every NHS trust and PCT to influence the day-to-day operation of health services by the trust. The commission has committed to have those in place across the country by 1 December.

The Commission for Patient and Public Involvement in Health will establish, support and facilitate the co-ordination of patients' forums. The forums of PCTs will, in due course, when they have settled down in their role, have the responsibility to provide independent complaints advocacy services and commission them where appropriate. In each community, patients' forums will be a key resource for local people, helping and supporting community groups and promoting better public involvement.

Mr. Stephen O'Brien

The Minister has described the aspirations for what should come after CHCs, but that has been delayed. What really matters is the manner in which the whole issue has been handled, and all that people want to hear is an apology for all the distress and upset.

Dr. Ladyman

The hon. Gentleman should think about who we were responding to when we extended the life of CHCs by three months. Among many others, it was the Opposition, here and in the other place, who said that we should extend the life of the CHCs by three months. The Government's view was that we would have a structure in place by 1 September to replace the CHCs, but the Opposition said, "Do something extra for the transition. Try to take extra steps." So we put in place a belt and braces process and extended the CHCs for three months—

The motion having been made after Ten o'clock, and the debate having continued for half an hour, MADAM DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-seven minutes to Twelve o'clock.