HC Deb 22 July 2004 vol 424 cc578-84

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

6.4 pm

Dr. Richard Taylor (Wyre Forest) (Ind)

I have to express a little disappointment. A few moments ago, I thought that we were going to have an audience of four or five hon. Members, but I now discover that they have melted away, as if by magic. May I thank through you, Mr. Deputy Speaker, Mr. Speaker for selecting me for this debate, because it comes at an absolutely crucial time? I also thank the Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield (Miss Johnson), for delaying her well earned holiday for an extra few minutes. She is welcome on the Government Front Bench.

The last debate of the day has been given lots of names. It has been called the last-ditch stand and the last post. Even worse, it has been called the graveyard debate. I hope that that is not prophetic. After the Secretary of State for Health's announcement this morning, it appears that the Commission for Patient and Public Involvement in Health is being abolished. I hope that this debate is not the death knell of that organisation.

There is still time for the Government to rethink and change their mind. They were recently generous in changing their mind considerably on one Bill with which I was involved—the Human Tissue Bill. Although we achieved no reasonable amendments in Committee, some useful amendments were accepted before Third Reading.

Although I am on the Opposition Benches, I hope that the Minister might recognise me as an ally in some ways. I support the Government on NHS spending and on many NHS reforms. By convention, a solitary Independent Member does not have any hon. Friends in this place. I was caught out early on in my career here by calling the hon. Member for Wakefield (Mr. Hinchliffe) my hon. Friend, but I really thought he was. A former hon. Member for Plymouth, Sutton wrote in his diaries: There are no true friends in politics. We are all sharks circling, and waiting, for traces of blood to appear in the water. I hope the Minister accepts that, as an Independent, I can be a friend on occasions to both sides of the House. I also hope she accepts that my comments are given in a spirit of friendship and helpfulness, not in opposition.

I genuinely want to prevent the Government from making a foolish step, to the detriment of patients. Many will see their decision as a U-turn, or wasteful of money already spent. It might be seen as dictated by a desire to spike the Opposition in their claims, but that is not necessary. I would say the same thing even if Conservative Members were present: the Government do not need to be frightened of the main Tory Opposition on the NHS. Every time the subject is raised in Prime Minister's questions or Health questions, the Government score total, annihilating victory.

The abolition of the commission is a disaster for patients, the NHS and the Government. Let me give a brief history of the situation. After my election to the House, the hon. Member for Salford (Ms Blears), who was a junior Health Minister, wrote: The culture within the NHS needs to change so that the views of patients and citizens are not only valued but listened to and acted upon as well. When the Government introduced the NHS Reform and Health Care Professions Bill, which was to abolish community health councils, they faced a tremendous revolt. The House of Lords tabled an amendment. To cap that, the Government sensibly tabled a much better amendment, which led to the foundation of primary care trust patient forums. They gave them huge powers and advantages that CHCs did not have.

Inevitably, the Government then formed the Commission for Patient and Public Involvement in Health in January 2003 and gave it the enormous task of establishing itself and more than 570 patient forums, with a minimum of seven members each, by 1 December in that year, which was 11 months later. By that time, they had succeeded with about 550 of the 570 forums, from a budget of £34.9 million, £8 million of which had gone to support existing CHCs in their prolonged existence, £5.2 million to the independent complaint and advocacy services and £5.7 million to their own national centre, with the rest being spent on forums.

The commission's focus is so in line with Government thinking on empowering people that I cannot understand the Government's decision. They wish to empower citizens to be active, and not just middle-class retired people but the disadvantaged and the silent voices, such as single mums and the disabled. There is a very useful report in The Guardian today, in which two key advisers to the Prime Minister say that the Government must end the democratic deficit caused by the disengagement of the working class from almost all forms of community involvement", and that Democracy and citizenship had to move from the periphery of progressive politics to its heart". I believe that the commission is going some way towards doing that. A grossly disabled person serves in one of the PCTs in my area. I do not believe that the alternative, the NHS Appointments Commission, could do that. Would it go out and find that sort of person when it is used to finding those pillars of society who become non-executive directors, and who find that they immediately lose their true independence because they have to work under rules of consensus?

I want briefly to go through some of the other things that the commission does that are so vital. I had a letter from its chair just before Christmas, when I had written to ask how she was getting on with the tremendous task before her. She wrote: I hope that you will agree with me that we have achieved a great deal this year. I hope that the New Year will see the new system finding its feet and fulfilling its promise. There you have it—it is a system, which needs a head as well as a body and limbs, so that it can function as a whole. It is a national body. It has to liaise with Government, strategic health authorities and other national organisations.

An example of that, and its effectiveness, is a recent memorandum of understanding, dated 29 April, between the Local Government Association, which is so vital because of the formation of overview and scrutiny committees, and the commission. The document describes the wider role of the commission, saying: The Commission is responsible for submitting reports to and advising the Government on how the PPI system is functioning. It liaises with national bodies on patient and public involvement issues and makes recommendations to these bodies and the Department of Health as appropriate. National liaison facilitates local liaison. Overview and scrutiny committees are a tremendously welcome innovation by the Government, because they improve public involvement and bring some democratic accountability into health service decisions. But one cannot have every such committee and every forum reinventing the wheel on co-operation all over the country.

To me, there is no argument about the vital role of forums, but I still believe that they have to have a fully independent national co-ordinating body, which the commission shows every sign of becoming. Abolish it, and patient involvement will be set back by months, if not years. If primary legislation were involved, we would be in for months or years of uncertainty, lowering the morale of the very people who are necessary to inspire those on the forums, particularly the disadvantaged, the disabled and the inarticulate—the silent voices that we are desperate to tap into.

To give an example, local groups that do not work without central leadership are patient participation groups set up by many general practices. In my experience, they are regarded by the GPs as a way of telling patients what they want, rather than of patients telling the GPs what they want. Recently, a constituent writing to me about a different subject mentioned patient participation groups. She wrote: Those of us who have spent any time on Patient Participation Groups, for instance, have found it a great waste of time because the consumer is not listened to. Rulings come down from above! At a recent meeting with professional representatives of the NHS Modernisation Agency and the NHS Confederation, I was alarmed to realise that they did not know what real patient involvement is. Unbelievably, they felt that it was limited to an individual patient's decisions about his or her own health care. I am delighted that the Government have not fallen into that trap. Today's statement says that Patients' Forums will remain the cornerstone of the arrangements we have put in place to create opportunities for patients and the public to influence health services. I appeal to the Government to pull back from a decision which was taken unilaterally and without consultation and which was opposed by 71 per cent. of those who replied to a Health Service Journal online poll. Is abolition a political imperative? Can it be that the Government are frightened that forums with national backing would be able to expose some of the NHS's shortcomings? Surely not.

I want the Minister to state whether primary legislation is necessary to confirm abolition. How long will it take to run things down, only for the new arrangements to restart them? I remind the House of the question that the right hon. Member for Walsall, South (Mr. George) put to the Secretary of State for Defence yesterday: who was the idiot who thought that we could cut the infantry at a time when the pressure on it was enormous?"—[Official Report, 21 July 2004; Vol. 424, c. 356.] I turn that question around and ask the Under-Secretary of State for Health: who was the idiot who thought that we could remove the generals and officers from the ordinary soldiers of the forums when the pressure on them to succeed is enormous? I ask her to take all the points I have made on board and to persuade the Secretary of State for Health that it is in the interests of the Government, patients and the national health service to cancel this abolition, which will remove at a stroke the one vital, promising and truly independent arm's length body.

6.19 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)

I congratulate the hon. Member for Wyre Forest (Dr. Taylor) on securing this debate. It is not a graveyard slot, even though the House is about to rise for the summer. I assure him that Ministers do not go on holiday quite as soon as ordinary MPs do; I seem to find myself at work next week.

Today, we set out our proposals for all the Department of Health's arm's length bodies. It is probably worth while running through some of the background.

The NHS plan 2000 heralded a period of investment and reform. I am glad that the hon. Gentleman recognised that that has significantly improved outcomes for patients. I am delighted to hear of his support for these changes. At a national level, the Department of Health has driven the reform. It has set a clear and ambitious framework for doing so. In addition, the arm's-length bodies from the Department—a national network of statutory organisations—have been deputed to regulate the system, improve standards, protect public welfare and support local services. These ALBs have contributed significantly to the pace of change described in "The NHS Improvement Plan", which was published last month.

The wider network of ALBs built up over the years has become too cumbersome in the context of devolution. The hon. Gentleman will recognise that quite a lot has changed. The ALB sector must recognise and reflect the shifting balance of power towards the front line and towards patients. Again, I welcome the hon. Gentleman's recognition of the shift that is taking place and the Government's vision and support for that.

The thinking that underlies the first thorough review of ALBs for many years reflects that. The ALB sector as a whole needs to remain coherent and fit for purpose. It needs also to enable itself to engage easily and efficiently with the service and the support that it gives to services.

Arm's length bodies have often been interventionist in their backgrounds and high profile. That has meant they have had a maximum impact in their areas of responsibility. That has been right while the momentum for change was being created, but the price has tended to be, as time has moved on, an increasing burden on the NHS, and has led to some poor co-ordination of agendas. We therefore took the view, entirely rightly, that ALBs need to be streamlined both in number and functions. I can reassure the hon. Gentleman that we are doing this not in response to anything that the Opposition are doing, but merely to reflect the fact that we are succeeding on the pace of change, reform and investment that we set ourselves. The results of that have moved forward significantly enough at this point to be able to reflect those factors in the changes that we are proposing and have outlined today.

The streamlining goes hand in hand with that. The lifting of burdens is linked with efficiency. The ALB review is a significant component of the Government's drive to make the public sector more efficient, and a key part of the implementation of the recommendations in the Gershon efficiency review.

In the report "Reconfiguring the Department of Health's Arm's Length Bodies", which we published today, we have described our plans for the future of all the Department's ALBs. There will be a reduction in their number by almost a half to 20. We are confident that the reduction will lead to savings that can be invested in front-line services of £0.5 billion by 2007–08. It is easy to lose sense of how much money that is, even in today's health service, and the advantages of reinvesting it in front-line services.

As our earlier written ministerial statement set out, the Commission for Patient and Public Involvement in Health will be abolished. Patients forums will remain the cornerstone of the arrangements that we have put in place to create opportunities for patients and the public to influence health services. Stronger, more efficient arrangements to provide administrative support, advice and training will be put in place after consultation. These will enable forums to concentrate on their core functions, maximising the resources available for spending on real involvement rather than on administration. These changes fit well within the overall objectives of the ALB review.

A clear quality framework for forum activities in monitoring and reviewing services will be established and will be communicated to forums. We are working closely with key stakeholders—forums in particular—to take this work forward and identify the best body to do that. The NHS Appointments Commission will become responsible for making appointments to patients forums. To pick up the hon. Gentleman's point about the search for members of the commission and nonexecutive directors, the commission has been a useful body in establishing the forums. However, another of its key tasks is to work with Government Departments to make sure that its work and the work of the patients forums is fully reflected in the cross-Government work on citizen engagement.

The timetable for implementation has not yet been set, and we will work closely with key stakeholders to ensure that there is minimum disruption for staff, people who support the forums and forum members themselves. I emphasise that our decision to abolish the commission was not borne out of concerns about its performance, nor does it indicate a reduction in our commitment to patient and public involvement. The Government share the hon. Gentleman's enthusiasm about empowering patients—I am an enthusiast myself—and there are many examples of that empowerment, not least the expert patient programme, which is a fantastic initiative that changes the emphasis of the doctor-patient relationship that he described. The commission's performance, particularly its achievement in setting up the forums and recruiting about 5,000 members within a tight time scale, is highly commendable. Our commitment to empowering patients and the public by providing opportunities to influence change and increasing care choices is a key theme of the NHS improvement plan and the continuing modernisation of the NHS.

We decided to abolish the commission and make better use of existing organisations to support, promote and implement patient and public involvement and ensure that it develops in the widest context possible. Effective involvement builds trust and confidence in public bodies, and helps public services to adapt to the needs and expectations of their users. The NHS Appointments Commission is the expert body that was set up to make public appointments, so it is logical that recruitment on the scale necessary to maintain forum numbers is carried out by an organisation that is expert in making appointments.

Patient and public involvement is not just about patients forums, although they are an important part of the arrangements that we have set up. The NHS is the key implementer of patient and public involvement, and it, too, needs advice and support to do so better and to learn from the experiences of others. It is not a statutory function of the commission to advise the NHS about patient and public involvement, and there should be a more strategic and joined-up approach to providing that advice to forums, the NHS and other organisations that provide health care so that patient and public involvement is embedded in their services. We will therefore ensure that those functions are covered for all providers as well as forums, and that work is developed with other bodies more generally involved in community engagement so that the lessons from patients forums and from NHS experience of public involvement are shared across sectors. Primary legislation will be required to abolish the commission, and it will be introduced in the usual way when parliamentary time allows. In the meantime, we will explore alternative options on the implementation of the decision.

Patients forums are currently supported by a wide range of local providers. There have been some difficulties with that approach, not least the inconsistencies in the support that forums receive. The hon. Gentleman mentioned the importance of consistent support, but inconsistencies are inevitable, given the large number of contracts. The problem must be addressed so that all forums can benefit from strong local support and carry out their functions as effectively as possible. By learning from the commission's experience we will ensure that forums all receive high quality support and can make even more of an impact.

The current budget for the commission is £33.3 million. There will be no cuts to that budget, I can assure the hon. Gentleman. We will invest more resources in patients forums, and any savings that accrue from the abolition of the commission will be invested in patients forums and in providing expert advice on patient and public involvement.

In the time remaining, I shall describe how patients forums will be affected. As I said, they are the cornerstone of patient and public involvement. They will not be abolished, nor will their independence be undermined. Rather, the support they receive is to be strengthened. It is key in the new arrangements that forums remain as independent as they currently are, so that they can continue to be responsive to the views of local people. That is the essence of what they are about.

The 5,000 current members of patients forums are beginning to get their work under way, so we are just beginning to see the results of that work. The all-party group on patient and public involvement hosted a reception for forum members earlier this month. The hon. Gentleman was in attendance on that occasion, I think.

Dr. Richard Taylor

indicated assent.

Miss Johnson

The purpose of the event was to celebrate the achievements of forums so far. We need to retain and build on the momentum that already exists. The key to doing that will be to ensure that disruption is kept to a minimum during the implementation of our recommendations.

I know that the hon. Gentleman works closely with the patients forum in his constituency. I am very encouraged by the work that that forum has been carrying out. The forum and sixth-form drama students in the area worked together to produce a video on wasted medicines. A copy of the video was, I understand, sent to every GP surgery in the area in January, to be played in their reception areas and waiting rooms. That is an excellent example of the kind of work that forums are carrying out and demonstrates the value of that approach.

I emphasise that we are committed to patients forums and their work. We are beginning to see them influencing change locally, considering patients' views and the services and reflecting those. They need strengthened and more consistent support to carry out their work and they need to work to consistent, high standards. Of course, they must continue to be independent. The proposals that we will bring forward following consultation will ensure just that.

I conclude by reassuring the hon. Gentleman that the interests that he has represented in the debate and our interests entirely coincide. There will be advantages to the new arrangements as we develop the detail and give patients forums the support due to them. The emphasis will change towards more support for the patient—a trend that we all welcome in the health service of today, and which will drive the health service of the future.

Question put and agreed to.

Adjourned accordingly at twenty-seven minutes to Seven o'clock.