§ [The page and line refer to HL Bill 27 as first printed for the Lords]
§ LORDS AMENDMENT NO. 6
§ 6 Before Clause 12, insert the following new Clause—
§ "Reform of Community Health Councils
§ (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) The regulations shall provide for—
- (a) renaming Community tiealth Councils as Patients' Councils (referred to in this section as "Councils");
- (b) the information which local National Health Service bodies must provide to Councils;
- (c) the funding of Councils and the provision of premises and other facilities by the Secretary of State;
- (d) the membership of Councils.
§ (3) The functions of a Council are—
- (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 Patients' Forums (referred to in this section as "Forums");
- (b) to facilitate the co-ordination by Forums of their activities:
- (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;
- (d) to carry out such arrangements as may be made with the Council under section 19A of the 1977 Act (independent advocacy services);
- (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
- (f) to appoint a representative, having such functions as may be prescribed. to attend meetings of each relevant Health Authority:
- (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;
- (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;
- (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;
- (j) such other functions as the regulations may prescribe.
§ (4) The functions of a Forum are to—
- (a) monitor and review the operation of services provided by, or under arrangements made by, the trust to which it relates;
- (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;
- (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;
- (d) make available to patients and their carers advice and information about those services;
- (e) carry out such functions in relation to primary care services as may be prescribed by regulations made by the Secretary of State;
- (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;
- (g) carry out such other functions as may he prescribed.
§ (5) Regulations shall provide for the membership of a Forum, which shall comprise—
- (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;
- (b) as to at least a quarter of its membership, patients;
- (c) as to at least a quarter of its membership, carers;
- (d) such other persons as may be prescribed.
§ (6) References in subsection (4) to "services" are references to—
- (a) services provided as part of the health service (within the meaning of the 1977 Act) in England;
- (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
- (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) In this section—
- (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;
- (b) "prescribed" means prescribed by regulations made by the Secretary of State;
- (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);
- (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;
- (e) "the health service" has the same meaning as in the 1977 Act;
- (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."
§ The Commons disagreed to this amendment for the following Reason—
§ 6ABecause it is inappropriate for Community Health Councils to he reformed in the way proposed by the Lords.1134
§ Lord Hunt of Kings Heath
My Lords, I beg to move that the House do not insist on their Amendment No. 6, to which the Commons have disagreed for their reason numbered 6A. In speaking to this Motion I shall also speak to Amendments Nos. 8A to 8G, 9 to 15, 82 and 83.
As noble Lords will know, in the NHS Plan we set out proposals for a radical change to the system of patient representation, including the establishment in every trust and primary care trust of a patient advocacy and liaison service, with a fundamental building block of a patients' forum for every trust and PCT. The intention was that the scrutiny function of community health councils would be transferred to the overview and scrutiny committees of elected local authorities and that an independent advocacy service would be established where current support for patients in pursuing concerns about patient services is patchy and inconsistent.
The new system would have replaced community health councils because the Government believe that, whatever their strengths and weaknesses, CHCs have not been able to deliver the strength, consistency and power of patient representation we believe to he essential. In discussions which have taken place both in the other place and in this House, the Bill has been amended and in many cases improved upon. However, other amendments made in this House had the effect of undermining that approach; some were technically and legally unworkable and do not deliver the change in the structure based on independent patients' forums.
We believe overall that we have made significant efforts to find an agreed way forward. It is now clear. given the time constraints with a pending general election, that the Bill would be jeopardised unless we removed clauses relating to patient representations. We are committed to greater empowerment of patients, but we are also determined to lift the burden of nursing care costs for elderly people and their families as soon as possible and it is essential that we meet our October timetable.
As a consequence, the Commons returned the Bill with further amendments. The effect of those amendments, in combination with amendments made in this House and accepted by the Commons, is to leave the existing law in relation to community health councils and the Association of Community Health Councils intact. They will also remove from the Bill the provisions relating to patient councils, patient forums and the new patient body. We regret the loss of the new national patients' body. We believe that the wider role and membership for the body and the opportunity to bring on board those voluntary organisations representing patients would have been a considerable step forward. But we cannot have two statutory national bodies to represent patients and the public. So maintaining the Association of CHCs means we must withdraw the proposals for the new body in the Bill. We will need to think again about how we pick up the proposals from the feasibility study on national 1135 patient representation that was carried out by the department and a consortium of leading patients' organisations.
Change is inevitable in relation to patient representation and patient involvement. We will still seek to establish patient forums. They are an essential tool if patients are to challenge and change each part of the NHS. We will need further legislation to give them the statutory independence we would like them to have. But in the interim, non-statutory forums can be established.
To improve patient representation change is inevitable. We shall need to return to these matters after the election. Further legislation may be necessary. As we said from the start of this long debate, if it is to be practicable any change must be as seamless as possible and we must make the best and most appropriate use of the skills and expertise already within the system. I beg to move.
§ Moved, That the House do not insist on their Amendment No. 6 to which the Commons have disagreed for their reason numbered 6A. — (Lord Hunt of Kings Heath.)
§ Earl Howe
My Lords, I thank the Minister for introducing this group of amendments. We have reached a position that I, and I expect he, would rather we had not reached on these vexed issues. I am perfectly certain that, but for the Government's obduracy, we could have reached an agreement that would have required them to move only a short distance from the position to which they have adhered so doggedly throughout the passage of the Bill.
In matters such as this I ask myself whether we are being unreasonable. I do not believe that we are. Particularly on Report, it was noticeable that not only were there no supporters of the Government's policy on this side of the House, but also no unequivocal supporters on the Government Benches, apart from the Minister himself. I submit that that is telling and reflects what I have found to be the opinion around the country at large.
Patient groups and informed commentators are, almost to a man and woman, unable to comprehend why the Government have chosen to reorganise patient representation from scratch rather than build upon and improve the current arrangements. The Government have themselves to blame for that situation. Had they engaged in proper consultation from the outset, the conclusion might have been a great deal happier.
In the situation in which we now find ourselves, my chief fear is that the uncertainty generated by the lack of a definitive conclusion in this Parliament will cause the key staff in community health councils around the country to vote with their feet and to decide that enough is enough. I genuinely hope that that will not happen and that, in the short time that they have left, the Government will discourage any such moves.
1136 The substantive debate is over, at least for now. We do not intend to obstruct the Government in removing from the Bill the clauses relating to patient representation. Clearly, to have had our amendments accepted would have been the ideal outcome for us. However, making the substance of those amendments an issue on which we can campaign during the weeks ahead is an outcome with which we can live quite comfortably. Whichever party wins the general election, it will want to introduce reforms to patient representation. I believe that there is a legitimate debate to be held during the election campaign on that issue.
I have one question for the Minister. With the Bill framed as it will be when it leaves this House, we shall have a situation in which overview and scrutiny committees will be brought into being alongside the community health councils, which will continue in being for the present at least. There would appear to be an element of overlap in the functions of each. Can the Minister comment on how that overlap will be reconciled in practical terms?
He also mentioned that patients' forums will be set up on a non-statutory basis. I would be grateful if he could give the House some idea of how they will be required to interact with community health councils. What timescale do the Government envisage for establishing patients' forums?
Once again, I thank the Minister for what he has told the House today and I look forward to a resolution of these issues at some future date, hopefully with a Conservative government on the Benches opposite.
§ 4 p.m.
§ Lord Clement-Jones
My Lords, like the Minister, I have regrets about the failure to agree a compromise arrangement in respect of Amendment No. 6 and the Government's original proposals. Unfortunately, there was too little time. I echo the words of the noble Earl, Lord Howe, and regret that discussions on these matters between the Government and the CHCs did not begin earlier. It is extremely difficult to negotiate at the kind of speed that was required.
Unfortunately, we have a grave situation in which the CHCs may be in limbo for a potentially long time, with difficulty recruiting staff, with uncertainty about their future and so forth. That is greatly to be regretted as a result of the failure of the parties to resolve the ingredients of the Bill.
On a more upbeat note, we should take the opportunity between the general election and the presentation of a new Bill to rethink the matter and to look again at the way in which patients should be represented. Will the Minister undertake to consult widely, to involve patients, CHCs, local government and others in discussions about those future arrangements, whether they relate to patients' councils, patients' forums, PALS or whatever.
It would also be useful if the Minister could indicate where he sees the balance lying between giving directions and primary legislation. Obviously, there is 1137 a great deal that a government in giving directions can do in terms of setting up patients' forums. An irreducible minimum of primary legislation is still required and I urge the Government not to take a headlong path down the direction route but to come back with a coherent comprehensive plan for patient representation in primary legislation.
It remains for me simply to say that I hope that out of the wreckage of this part of the Bill after the election we can secure a new system of patient representation which is strongly independent and coherent, and has a national body to co-ordinate it, which serves the interests of and empowers patients in the NHS. I look forward to considering the further legislation mentioned by the Minister, but I hope that it will be built on the best of the existing system rather than outright abolition. And we, too, on these Benches look forward to the inevitable public debate on these matters during the election.
§ Baroness Carnegy of Lour
My Lords, the noble Lord referred only to patient representation, but the community health councils serve the interests of the public at large, representing them as well as patients. It seems to me most extraordinary that the Government have not withdrawn the proposal about the joint overview and scrutiny committee and will expect CHCs and that committee together to represent public opinion. I look forward to hearing the Minister's reply to my noble friend Lord Howe as regards the extent to which the present statutory powers of the two bodies will overlap.
However, apart from that, there will be competition. I cannot see how the proposal can work. Will the Minister explain why the Government have not withdrawn the introduction of the joint overview and scrutiny committee? The question of how one democratises the health service is not an easy one to answer. I am not sure that it is good project but the way in which it is happening is bound to lead to a good deal of conflict. I hope that the Minister will be able to explain why the Government are leaving the situation as it now is.
§ Lord Rea
My Lords, from the beginning I was against the abolition of CHCs but, like many other noble Lords, I favoured their reform. I believe that our amendment which was accepted carried the seeds of that reform rather effectively, building as it did on many of the structures mentioned in the NHS Plan. The noble Earl, Lord Howe, is a little hard on the Government in saying that it is entirely their fault that the amendment was rejected. I understand that the Government would have been willing to accept a number of measures incorporated in our amendment but there was too little time and the operation of a number of forces, the details of which I shall not go into, made that impossible. I hope that the measures incorporated in that amendment will be considered in future discussions which I am sure will start soon after the election.
§ Lord Hunt of Kings Heath
My Lords, I believe that we first started to consider the question of community 1138 health councils in the debate on the Queen's speech some little time ago. It has been an enriching debate. I reject the charge made by the noble Earl, Lord Howe, because right from the start the Government have been concerned to put in place a much more robust system for patient and public involvement in the health service. At all times we have sought to ensure that the public have speedy access to internal trust mechanisms and advocacy and a powerful patient forum within each NHS organisation so that the views of patients and the public really can come to the fore.
We have worked very hard, particularly in recent days, to find a satisfactory way through. Like other noble Lords, I regret that it has not been possible to do that. It would be a pity if, as a result. there was uncertainty among staff who currently work within community health councils. Whatever we eventually arrive at by way of future arrangements, we shall always need good people with the experience to relate to, and act on behalf of, patients. I have no doubt that with the independent advocacy services and the establishment of patient forums, albeit by directions rather than primary legislation, in future there will be endless opportunities for staff and the people who at the moment work so hard on CHCs to play a full part in the NHS.
A number of questions have been asked about the relationship between local government oversight and scrutiny committees and community health councils. The noble Baroness, Lady Carnegy, asked why the OSCs were being retained in the Bill. There are two reasons, the first of which is purely technical. The clauses have been passed by both Houses. It would have been highly inappropriate, perhaps even impossible, to remove them. Secondly, and more substantially, we believe that local government must have a much stronger role in the affairs of the NHS in future and that the democratic deficit which has existed in the health service over its 52 years will be reduced by local authority involvement.
I accept that, given the current powers of CHCs and the guidance that we have given to the health service about what those bodies may do, there are issues to do with reconciling that responsibility with those of the OSCs. We shall turn to that as soon as we can, and certainly immediately after the election with a new Labour government, to ensure that there is no overlap or duplication. Obviously, we believe that patient forums are very important and we seek to ensure that they are in place in the National Health Service as soon as possible.
I take the point raised by the noble Lord, Lord Clement-Jones, about the use of directions. However, I believe that there has been almost unanimous agreement that patient forums will be an important element in future. We want to get on with that as soon as we can. As to future discussions, we shall talk to organisations and the people involved about how to take forward patient empowerment and public involvement. I therefore ask the House not to insist on its amendment to which the Commons have disagreed.
§ On Question, Motion agreed to.