HL Deb 20 December 1990 vol 524 cc914-7

11.23 p.m.

Baroness Hollis of Heigham asked Her Majesty's Government:

Whether they are satisfied that health service users are sufficiently represented at meetings held by health authorities.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)

My Lords, all members of health authorities are users, or potential users, of health services. The members of the newly-constituted health authorities have a wide range of individual experience and abilities. Their knowledge and links with the local community make them well equipped to ensure that the needs of patients are sympathetically understood and that an effective range of services is provided to meet them.

Baroness Hollis of Heigham

My Lords, I thank the Minister for that reply. However, is she aware that until the latest reorganisation took place, about 90 per cent. of community health councils were allowed to attend the full meeting of their health authorities but that following reorganisation the figure is now barely 35 per cent? So the interest of the patients which they were statutorily established to represent is being neglected. Will the Minister correct the situation?

Baroness Hooper

My Lords, I am certainly not aware of the statistics put forward by the noble Baroness. In fact, there has been no change in the legal status of community health councils. I am aware that the Association of Community Health Councils recently issued a survey. However, as the new authorities were only constituted in September, it is rather early days to come to a conclusion as to how things are working. It is probable that many authorities have met only once during that short time and that some meetings have been taken up with confidential matters such as appointments. That is not necessarily the pattern which will be followed at future meetings.

Lord Auckland

My Lords, is my noble friend aware that the abolition of the house committees in national health hospitals is making itself tragically felt? I should declare an interest in that I served on two such committees. Further, is she satisfied that the community health councils which are much larger and which do not have so much local representation really fulfil the requirements implied in the noble Baroness's Question?

Baroness Hooper

My Lords, authorities are being encouraged to test consumer opinion and to act upon their findings. In addition, the department is funding various initiatives and working with health authorities to develop effective ways of ascertaining consumer views which we recognise as being most important. Community health councils play a key role in representing the local community and channelling the views of consumers to health authorities. We are very much encouraging collaboration between the community health councils and the health authorities.

Lord Glenamara

My Lords, is the noble Baroness aware—I am sure that she is not—that in the past year I attended hospital twice for interviews? On one occasion I waited three hours and on the next occasion I waited for four hours from 9 a.m. to 1 p.m? Does she feel that that sort of experience should be represented in health authority meetings?

Baroness Hooper

My Lords, I am now aware of the noble Lord's personal experience. Of course it is the role of community health councils to ensure that that sort of thing does not happen.

Baroness Masham of Ilton

My Lords, with five members of district and regional health authorities now working as paid officers for the first time, does the Minister think that the authorities may seem rather bureaucratic and remote to the communities they serve?

Baroness Hooper

No, my Lords. Our impression is that a very wide range of individual experience and abilities is now evident in the composition of the boards all over the country. There is also a wide representation of local knowledge. People have been appointed for the personal contributions that they can make. We believe that they will be extremely effective in that respect.

Baroness Gardner of Parkes

My Lords, is it not a fact that many health authorities open their meetings to the public? Is my noble friend the Minister aware that I serve on such an authority? Is she further aware that it is not only a matter of members of the community health council attending; indeed, any member of the public may attend? In addition, there is considerable consultation with local people on any issue both through the community health council and directly through the health authorities.

Baroness Hooper

My Lords, I am grateful to my noble friend. Of course, health authorities are subject to the provisions of the Public Bodies (Admission to Meetings) Act 1960. It has been made clear to them that they have legal obligations under that Act and that there should be a presumption in favour of open and public discussion. However, it must be left to authorities to decide how often they meet and what should be discussed in public or in private. I have already quoted the example of appointments which require confidential arrangements. The authorities concerned bear the responsibility of deciding whether the public and press should be excluded from meetings, bearing in mind the requirements of the 1960 Act.

The Countess of Mar

My Lords, can the Minister say how she equates the statements made when the National Health Service and Community Care Act was going through Parliament that there would be no change to the observer status of community health councils with those in the new guidance circular No. EL(90)185 which indicate that the rights of community health councils to attend the confidential parts of meetings have apparently been withdrawn?

Baroness Hooper

My Lords, I have already said that the legal status remains the same. That is true in relation to admission under the circumstances to which the noble Countess referred.

Baroness Cumberlege

My Lords, I am chairman of the South West Thames Regional Health Authority. Is my noble friend the Minister aware that I held a meeting with all my community health council chairmen three weeks ago at which I asked them whether they were less involved in such matters and they replied emphatically, no? Does she agree that there are many other initiatives taking place involving the public, including, for the first time ever, question time at the end of health authority meetings; seminars held for voluntary organisations and the public; exhibitions mounted in shopping precincts to involve the public; and consumer surveys which have now become commonplace within all FHSAs and district health authorities?

Baroness Hooper

My Lords, I am most grateful to my noble friend who speaks from direct knowledge and responsibility in this area. I would also point to an example where the secretary of a CHC has been appointed to the board of a health authority. Flexibility and the adoption of a variety of solutions are the keynote.

Lord Ennals

My Lords, I do not know who it was that the noble Baroness invited. To be invited to a meeting is quite different from being involved in decision making. Does the Minister accept that much of the public's lack of confidence in the Government's disorganisation programmes for the NHS is due partly to the fact that people feel that decisions are taken over their heads and that they are not brought into the process of decision making?

Secondly, in view of the fact that the new Minister, Mr. Waldegrave, is, in a welcome way, considering which parts of the NHS reorganisation should be scrapped and which should be kept, is this not a good time for him to take a new look at the role of consumers in the decision-making process in the NHS in the future?

Baroness Hooper

My Lords, I have always been aware of the noble Lord's lack of confidence in our reforms but I am not aware that there is a general public lack of confidence in them. I believe that the reforms have wide support. As to the latter part of the noble Lord's question, I reaffirm, as we have always said, that the whole process is evolutionary. We shall monitor closely how the reforms develop, and we shall make sure that the public and users of the health service have the best possible service.

Lord Ennals

My Lords, has the Minister seen a single public opinion poll that suggests that the public is other than opposed about three-to-one to what the Government are doing?

Baroness Hooper

My Lords, we shall have the most valuable public opinion poll of all within the next couple of years. I can guarantee that.

Lord Wallace of Coslany

My Lords, is the Minister aware that the Government rely very heavily on local voluntary bodies to help to keep the health service going? Does it not therefore follow that the health authorities' constitution should be enlarged to include representatives of local opinion rather than, as at present, appointed individuals who are not necessarily involved with local hospitals?

Baroness Hooper

My Lords, members who are appointed are all expected to live, work or have some other link with the local community in which they serve. The results of the appointments show that to be true.

The Earl of Halsbury

My Lords, can we make a happy return to the Order Paper by taking the next Question?

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