Community Health Councils

HC Deb 28 November 2000 vol 357 cc163-87WH

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Robert Ainsworth.]

10 am

Mr. Stephen O'Brien (Eddisbury)

I am extremely grateful for the opportunity to hold this debate, hard on the heels of my question to the Prime Minister on 15 November about his plans to abolish community health councils. The questions raised by the Government's proposals are important and urgent for national health service patients and users, NHS staff and those who are employed by, or who do voluntary work for, CHCs. They are important to the people of this country in general. I know that I have support from right hon. and hon. Members of all parties in my concern about the planned scrapping of CHCs. I am glad that so many are present this morning. In particular I welcome the shadow Secretary of State for Health, my hon. Friend the Member for Woodspring (Dr. Fox).

Given the importance that the Secretary of State for Health attaches to the Government's proposal, and with due respect to the less than lucky junior Minister, the hon. Member for Birmingham, Edgbaston (Ms Stuart), who has been sent to reply to the debate, it is to be noted and regretted that—notwithstanding the embryonic conventions of this parallel Chamber, which are admittedly not yet settled—the Secretary of State is not here to answer for his and the Prime Minister's unpopular, unjustified and peevish policy of scrapping CHCs. It would have been better to see the Secretary of State here, with the courage of his convictions, defending the indefensible before his party's Back Benchers, let alone the massed ranks of the Conservative Opposition and other parties.

I start my remarks in such a tone, despite the expectation that this Chamber attempts to force consensus, because the Government's proposals to scrap CHCs are contentious and flawed. The issue is not of my, or the Opposition's, invention. That dubious honour belongs to the Government. Those who care about NHS patients' needs and their representation are bitterly opposed to the Government on this issue.

Some of my first constituency visits, since being elected to this House 16 months ago, have been to the two CHCs in the Eddisbury constituency. They are Chester and Ellesmere Port CHC and Cheshire Central CHC. I have maintained regular contact with them ever since. I am greatly impressed by their work and expertise, their care and volunteerism, their independence, the respect in which they are held by NHS providers across south and west Cheshire and their effectiveness in achieving real and proportionate results in a sober and professional way. They are led by experienced, expert, committed people. I am glad that Geoff Ryall-Harvey, who heads the team at Chester and Ellesmere Port CHC, is attending the debate. Mrs. Jean French runs the team at Cheshire Central CHC.

Community health councils were established as part of the major re-organisation of the NHS in 1974 under a Conservative Government. That was a positive and pioneering step. The councils have a statutory duty to represent the local community's interest in the health service, which includes acting as patient advocates in complaints involving the NHS. They are rightly often referred to as the independent health watchdogs. Most recently, South East Kent CHC played a pivotal role in the exposure of the Kent gynaecologist Rodney Ledward. In another well-known case, the CHC ensured that the victims of Harold Shipman were supported.

There are 204 CHCs in England and Wales. Similar bodies—local health councils—exist in Scotland. Northern Ireland has health and social services councils. I shall restrict my remarks to the English and Welsh bodies. Community health councils are made up of between 16 and 30 lay members, from all walks of life, with a chairman, a chief officer and varying numbers of staff. The chief officer is a paid employee of the NHS and sometimes one other worker is paid. Half the membership is made up of people appointed by the local authority, although they need not be councillors. A third are appointed by voluntary organisations and a sixth by the NHS. The employees and 5,000 unpaid, committed volunteers have a full work load. It is estimated that the volunteer CHC members contribute free labour worth nearly £8 million to the NHS.

Crucially, CHCs are independent of health authorities and boards, and of NHS trusts, which CHCs monitor. CHCs' functions are to visit NHS premises and make representations to health care managers about improvements in patients' interests, to consult on and review planning and development of local health services, to provide information about those services, and to monitor their quality through, for example, consumer surveys to find out what local people need from the NHS.

Ms Hazel Blears (Salford)

Does the hon. Gentleman agree that, in many cases, community health councils operate on a shoestring? For 12 or 15 volunteers and, perhaps, one and a half paid members of staff to carry out that list of functions is unrealistic. We should resource CHCs better.

Mr. O'Brien

The hon. Lady makes an extraordinary accusation. Most hon. Members would agree that CHCs have been extremely cost-effective, as well as effective on behalf of patients. It is extraordinary to suggest that they are failing because they do not have enough money to carry out the functions that they have been designed to achieve, and have successfully achieved.

I shall finish the list of what community health councils do effectively, admittedly with small financial resources, by saying that they must assist with complaints. Each year, CHCs assist around 30,000 people with complaints against the NHS by giving free, independent and confidential support.

Since 1974, CHCs have enjoyed generally widespread support, including from Members of Parliament of all parties, as evidenced by the 90 signatories to early-day motion 595 in the previous Session, which congratulated CHCs on their 25th anniversary.

The chief officer of Cheshire Central, one of my local CHCs, wrote to me on 17 August, saying: We were looking forward to the arrival of the government's NHS Plan, which was published at the end of July. However, hopes were shattered when we eventually found the paragraph at the end of Chapter 10 which states bluntly that CHCs are to be abolished. The option of abolition had not been discussed with CHCs or their national association and in fact comments had been made by ministers and civil servants indicating a strong future for us. No consultation has taken place on this and CHC staff have still (3 weeks later) had no direct communication from the Department of Health to say their jobs are to disappear. There are two problems. The first is the absence of a proper democratic and consultative process that provides a rational basis for the Government's peremptory decision to scrap CHCs. The second is the substantive question of whether there is justification for the Government's plan to scrap independent CHCs and replace them, in-house at the NHS, with the so-called patient advocacy liaison services—PALS for short—and a plethora of sundry forums, representatives, committees and other bodies. That is, I suggest, yet another example of this Government's passion for complexity and divide-and-rule tactics, in this case against NHS patients' interests.

Let me deal with the failure of due process. Through the now Secretary of State for Health, the Government repeatedly stated before the publication of their NHS plan that they envisaged No immediate changes to Community Health Councils.—[Official Report, 8 December 1997; Vol. 302, c. 454W.] Also relevant is column 262W of the Hansard for 17 June 1998. It was later stated: Community health councils are independent statutory bodies whose role is to represent the interests of the public in their districts in health service matters.—[Official Report, 30 June 1998; Vol. 315, c. 167W.] One can imagine the consternation and despondency of those who work in CHCs on reading the Government's brusque, dismissive decision in July. The staff of my local CHCs have made that reaction clear to me in our regular discussions. However, the growing realisation of others carried the most weight for me. I was contacted by several constituents with NHS complaints and concerns, on whose cases I had worked in tandem with local CHCs. Naturally, the obligations of confidentiality preclude the identification of individuals, but their common reaction was to be aghast that their local CHC, which they regarded as a friend in need, was to be abolished. As CHCs are independent of the NHS, those patients, who felt vulnerable and let down, relied on them primarily because they felt that they could trust CHCs to guide them through the NHS maze and ensure that their complaints were addressed.

I tested the matter further. Like other constituencies, Eddisbury contains a number of NHS administrative areas, so I have convened the so-called Eddisbury health forum, which brings NHS service providers to my constituents together for regular meetings. At the last meeting, a month ago, the health authority, the two NHS hospital trusts, the two community health care trusts and the two primary care groups said, as the minutes of the meeting record: South Cheshire Health Authority were disappointed at the demise of CHCs in March 2002 and appreciated the role they played in assisting patients with complaints. Concern was expressed that there could be a conflict of loyalty between Trust Boards and PALs and it would be helpful if those advising patients retained some degree of independence. On 15 November, I asked the Prime Minister at Question Time whether he was aware that his proposals to scrap community health councils—the independent watchdogs for NHS patients—were bitterly opposed by my constituents, patients and staff, and whether he would drop those plans. He responded: 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.] That is a surprising and encouraging reply. Despite the language and process adopted by the Government up to that point, the Prime Minister clearly intended to convey that he agreed that his proposals were bitterly opposed, but that they were being consulted upon. The report back to the House carried the hope that the issue remained open. I sensed, I fear wrongly, the prime ministerial hand on the steering wheel, about to execute a U-turn. I was not alone. On Monday 20 November, Ms Donna Covey, director of the Association of Community Health Councils for England and Wales, or ACHCEW—it could be read "atchoo", which would be appropriate if one thought that it was catching a cold— wrote to the Prime Minister: CHC members and staff were interested in your response to the parliamentary question on the abolition of CHCs, from Stephen O'Brien MP, on 15 November 2000. Many people, including members of the public who have contacted us, interpreted your response as indicating that the abolition of CHCs will be subject to consultation. We have, to date, been given the opposite advice by health ministers on many occasions and in quite specific terms. As I am sure you will imagine, this is a very difficult time for CHC members and staff, who face tremendous uncertainties over their future. Members of the public are also asking questions about how their views will be represented in the health service in the future. The Welsh Assembly is consulting on how best to deliver patient empowerment and public involvement, before making a decision on the future of CHCs. If your government is now intending to do the same prior to making a final decision on whether to place abolition of CHCs before Parliament, that will be very welcome indeed. However, this is not what we understand the situation to be. There clearly needs to be clarity on the processes around this part of the national plan, and I would be grateful for any advice that your office can give. I am not aware whether the Prime Minister has responded to Ms Covey, but hon. Members will be as surprised as I was that, late on the same day, I received a three-page letter from the Prime Minister. I shall quote the essential elements, which best demonstrate the Government's failure to conduct a democratic, consultative process: Dear Stephen, I thought it would be helpful if I clarified the nature of the consultation in which we are currently engaged…Our proposals mean that community health councils are to be abolished, subject to legislation… This better describes the consultation I alluded to in my answer during Prime Minister's Question Time. Apparently, an Evening Standard journalist was subsequently told that the Prime Minister's response to me was a "slip of the tongue". Oh dear, what a tangled web the Prime Minister weaves.

The disappointment for English CHCs is huge. We have heard that, under the Welsh Assembly's process, the Welsh CHCs are at least being spared this failure of consultation. The Prime Minister raised the hopes of CHC members and staff in his answer to me, but he and his Government have now backtracked and, in effect, are saying that they have decided to abolish CHCs, come what may. They will use the fig leaf of "consultation", but no matter what anyone says, they will not listen.

In this sorry tale of the Government saying one thing and doing another, ACHCEW published a note on its website entitled, "The abolition of CHCs—consultation or imposition?" That note reaffirms that the abolition of CHCs has not been the subject of consultation, by highlighting certain facts. First, there has never been any consultation around the statement in the National Plan that "Community Health Councils will be abolished". The National Plan statement came completely out of the blue. The process that took place prior to the publication of the national plan did not touch on the possibility of abolishing CHCs. Indeed, on 26 June, a month before the publication of the National Plan, the Under-Secretary, the hon. Member for Birmingham, Edgbaston, advised: CHCs … will be essential in ensuring the representation of patients during the implementation of the National Plan and in the new NHS. They will also be involved in the work on patient empowerment which will be taken forward as part of the National Plan. It is, therefore, clear that no consultation took place on the abolition of CHCs prior to the publication of the National Plan. Richard Gordon QC advised ACHCEW that In my opinion, the consultation process over the new NHS plan was … legally flawed."Secondly, there has been no consultation on the decision since the announcement of the abolition of CHCs. Following that announcement, ACHCEW wrote to the Secretary of State for Health, expressing particular concern about the failure to consult. The response from the Under-Secretary was: There are a number of questions we still need to resolve as regards the transitional arrangements for CHCs and ACHCEW. We shall ensure that you and all CHC staff and members are kept up to date with decisions as they are made. Some time later, the Under-Secretary contacted the Association, and advised: On the understanding that the Secretary of State will not be reviewing the decision put before Parliament to abolish CHCs, I nevertheless agree with your earlier suggestion that a meeting would be very useful. That was the only meeting between ACHCEW and the Under-Secretary. She responded to the opinion of Richard Gordon, QC by saying: We do not accept that ACHCEW or Community Health Councils had any legitimate expectation to be consulted in relation to the proposal that CHCs should be abolished in primary legislation to be introduced in parliament in due course … the Secretary of State will not be reviewing his decision to put legislation before parliament to abolish CHCs. Thirdly, the dialogue on patient empowerment that has taken place since the announcement of he National Plan has not dealt with the decision to abolish CHCs. Following the announcement of the national plan, five national seminars have taken place. One of them was a repeat of the first seminar, because it was held at such short notice— but we have heard that before. The seminars were supposed to give participants a say on the key issues that need to be addressed as we develop the new mechanisms for patient empowerment." They have covered the following four topics: PALS and the Patients Forum The Independent Local Advisory Forum Representing the views of patients— and—can you believe it?— Bringing it all together. There has been minimal paperwork for these seminars, in some cases nothing more than an agenda. There has been no space on any of the days to reopen the debate around the abolition of CHCs. Attendance at these seminars has not been open, with participants being individually invited by the Department of Health. ACHCEW is holding a seminar on 4th December to discuss the National Plan. Whilst The Under-Secretary has agreed to speak at the meeting. she has made it quite clear that: I will be unable to answer questions relating to the Government's proposal to abolish CHCs".

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

I would find it helpful when summing up if the hon. Gentleman explained his semantic interpretation of the distinction between consultation and participation at a number of seminars, which were all attended by representatives of the CHCs.

Mr. O'Brien

The Under-Secretary makes a fundamental point, which goes to the heart of the argument—and, indeed, to the heart of democracy. I draw not only on my relatively short parliamentary experience but on my business experience. There is a massive misunderstanding about the word "consultation". It is applied differently in many countries.

Consultation is generally expected to mean, "I have a proposal. I wish to listen to everyone's views and, in the light of those views, I shall reach a decision"; so everyone has the right to be involved in the decision-making process. The consultation that we are faced with is the sort of consultation that I am used to finding in continental Europe. There—for instance, in consultation with European workers' councils — it often means, "You have a right to your point of view. We shall have an exchange of views, but I will not change my decision as a right of management." That is a direct response to the Under-Secretary's challenge on semantics. In my experience, the word "consultation" is appallingly abused; those who, in the hope that the word means something, would like an influence on decision making are often excluded from that process.

Mr. Nick Hawkins (Surrey Heath)

Does my hon. Friend agree that in the House, within the last 24 hours, a worse example has occurred of the way in which the Government have pursued their attitude to community health councils? In last night's debate on the mistitled Freedom of Information Bill, the Government tabled an amendment, in the third group, that referred to the very community health councils that they had announced that they were abolishing. That was a nonsense, as was the fact that we did not debate the third group of amendments because we got only as far as the first two of nine groups — due to the Government's ludicrous guillotine, in national guillotine week. The Opposition did not have the opportunity to point out how ludicrous it was for the Government to change their Bill to refer to community health councils that they had already decided to abolish.

Mr. O'Brien

I agree with my hon. Friend. The Government are demonstrating, in national guillotine week, that they hold in contempt the democratic traditions and checks and balances enshrined in our valuable and ancient constitution. It is a great shame that bodies as valuable as community health councils have become trapped by the Government's arrogant mentality. The Minister responsible for the letters that I cited earlier is present and it must be said that, by any test, the process—or lack of process—that the Government have adopted is a complete and abject failure to achieve what is expected in a democratic country. The Government appear arrogantly hell-bent on implementing that fundamental change. Their actions are more those of the playground bully than of a responsible, listening Government.

Mr. Nicholas Winterton (Macclesfield)

I have been listening to my hon. Friend's argument, with which I entirely agree. Why does he believe that the Government seek to abolish CHCs, which are popular in my constituency and throughout the country? Is that popularity not due to their genuine independence and patient empowerment? The Government do not want that, and that is why they are abolishing CHCs.

Mr. O'Brien

I am grateful to my hon. Friend, who represents, as I do, a Cheshire constituency. I hope that the hon. Member for Ellesmere Port and Neston (Mr. Miller), who also has a Cheshire constituency, will entirely endorse those sentiments. We are extremely blessed in Cheshire with the quality and dedication of our local CHCs. As my hon. Friend the Member for Macclesfield (Mr. Winterton) said, it is their independence, patient empowerment and, above all, the quality of the work that they deliver for patients that gives them such strength of repute in our county.

Mr. Andrew Miller (Ellesmere Port and Neston)

I endorse the hon. Gentleman's comments about the Chester and Ellesmere Port CHCalthough —it is a pity that its chief officer did not tell me that he was coming today. On what experience does the hon. Gentleman draw in extending his praise of that CHC to the rest of the country? Are not CHCs throughout the country failing?

Mr. O'Brien

The obligation to respect confidentiality precludes naming those who have benefited from our experience in Cheshire, particularly with regard to complaints. Of course some of the 204 CHCs across the country are not working well, but they are the exceptions that prove the rule. The sense of independence is valued. When patients using the NHS have a concern or find that the service that they are entitled to expect has been wanting, their knowledge of that track record of independence enables them to put their faith in the CHC, at what is often a vulnerable time when they need all the support and professional help that they can get.

As for parliamentary scrutiny of the proposal to abolish CHCs, right hon. and hon. Members—to date, no fewer than 137—have put their names to early-day motion 1103—including the Conservative Front Bench amendment—since it was tabled less than a month ago. The signatories are Members from both sides of the House, representing English and Welsh constituencies. However, considering the Government's approach to early-day motions, that is hardly scrutiny.

The only debate to date was in the other place a month ago, when the Minister, the noble Lord Hunt of Kings Heath, sought to defend the Government's decision but avoided any mention of the consultation process — or lack of it—other than the prospect of some so-called stakeholder meetings. I look forward to the Minister's apology for the Government's woeful lack of consultation. Will the Government listen to representations on the proposals and confirm their willingness to be swayed to change their mind? That is what I would expect the word "consultation" to mean; if not, the only rational conclusion — this is partly in answer to my hon. Friend the Member for Macclesfield — is that the Government are determined to use their large majority in the House to ram through the unjustified abolition of community health councils. They want to rid themselves of the effective, independent watchdogs for national health service patients that properly criticise the NHS — and the Government — when it fails patients. That is perhaps not surprising in an institution as large, complex and unwieldy as the NHS.

We must ask with what the Government plan to replace CHCs and why they plan to do so, given, as the Prime Minister agreed, that there is bitter opposition to their proposals that the patient advocacy and liaison service will be set up and run within NHS trusts and their reporting lines. Those and other new bodies are characterised by their lack of independence from the NHS; they will operate from hospitals and other NHS premises, including customer service-type desks in hospital reception areas. The proposed new system is fragmented and the new structure will thus be more expensive, more cumbersome and less effective. The new bodies will lack statutory powers: the powers currently vested in CHCs are destined to disappear, so the new bodies will be little more than focus groups.

Patients with complaints frequently say that they do not trust anyone employed by the hospital. Many complainants, especially the bereaved, are reluctant to enter hospital premises because of the painful memories that they revive. The new bodies will lack independence and thus lack credibility with patients and their families.

Mr. Tim Loughton (East Worthing and Shoreham)

My hon. Friend is absolutely right. I sat on a CHC for four years and am closely allied with the CHCs in my constituency. Their attraction for the ordinary patient is that they are seen as the patient's friend because they are at arm's length from the health service, in separate shops in high streets away from health authority buildings, manned by people who are not seen as employees or lapdogs of the local health authority. That attraction will be entirely lost under the Government's proposals.

Mr. O'Brien

I am grateful to my hon. Friend; that point has been made to me frequently in my constituency and by hon. Members who were conscious of this debate.

The Government propose that PALS should be hospital-led, not patient-led, as CHCs are at present, and it will inevitably suffer from the strains of providing a service, for example to primary care trusts, which will be developed from the present smaller primary care groups and are likely to cover between 30 and 50 surgeries.

What will be the consequences of the Government's ideas on local authority involvement? Local authority members already feel relatively free to act in the best interests of patients, in conjunction with their colleagues in the voluntary sector. The Government's proposals will tilt the local authority committees into acting in allegiance on party political lines, thus doing nothing for, and probably distorting, local authority scrutiny.

One reason given by the Government for abolishing CHCs is that they are not known to the man on the street, but I assure the Minister that in Cheshire they are known, and respected, especially by patients who need them. I hazard a guess that a poll to discover how many people know who is the Secretary of State for Health would reveal that only a small percentage could name him—perhaps less than those who are aware of CHCs.

Mr. Loughton

Like the Minister.

Mr. O'Brien

I shall not trespass on that territory and find out how many would know the Minister by name.

I am not aware that the Government propose to scrap the Secretary of State for Health. He is reported as saying in a television interview that CHCs are dinosaurs without relevance in the modern health service. Leaving aside the gratuitous insult to the thousands of dedicated CHC workers in this country, the CHCs fully accept, and were pushing the Government to accept, that they can and should change and improve. They are not dinosaurs. As I mentioned, some CHCs are not working well, but they are the exceptions that prove the rule.

The Government's peevish plan to replace CHCs with a plethora of supine bodies has incurred the dismay of many important third parties, of which I highlight but a brief sample. The Law Society said: if CHCs are abolished there will be no local body with sufficient independence, responsibility and power to help to resolve patients' complaints. Abolishing the CHCs will reduce patient rights and incur greater costs. Despite being a signatory to the NHS plan, Dr. Ian Bogle, chairman of the British Medical Association, said that the proposals would seriously threaten patient advocacy. Age Concern says: The independence of PALS is open to question given that they will be employees of the NHS, and could even be an added layer through which a patient needs to take a complaint. It is vital that advocacy services are independent and can deal with all aspects of care.

Mr. Miller

I accept the hon. Gentleman's point about independence, but current CHC employees are NHS employees. Has he thought of any other possible solutions to promote independence?

Mr. O'Brien

The hon. Gentleman is right in that the funding for the chief officer comes from the NHS budget. Not only has the arm's length relationship been created, but the way that CHC appointments are balanced ensures that they are considerably influenced and guided by the volunteer sector. Only a sixth of CHC members come from the NHS. There is a crucial link. They are required to have local knowledge, familiarity and a sense of participation, but they have a reputation for being at arm's length. CHCs are not an in-house NHS creature and they sit aside from the NHS with statutory powers. That crucial difference gives them the proper reputation as independent and to be respected.

The Age Concern letter concluded: There are concerns that being hospital based, they— the PALS— could be less effective in fulfilling the role of 'watchdog' in terms of primary and community health. So, Madam Deputy Speaker—[Interruption.] I see that there has been a change since I last looked up from my notes. I apologise, Mr. Gale. The Conservative party is pledged to retain CHCs, provided they have not been scrapped before the general election. If they have, the Conservative Government will reinstate a means by which patients can have a truly independent voice beyond the control of the NHS bureaucracy and politicians in Whitehall. I look forward to the shadow Secretary of State reinforcing that commitment and sharply delineating Conservative policies, putting patients' interests first, in stark contrast to this Government's politicians' first approach.

At Health questions a week ago, every hon. Member who asked the Secretary of State questions about CHCs—including no fewer than four Labour Members—supported their retention and urged the Secretary of State to think again. The Labour party is split on the issue and the Government are riding roughshod over their own Back Benchers. They plan to railroad these ill-thought-through proposals on their payroll vote. Constituents in Labour-held seats have the right to ask their MPs why they wish to scrap their local CHCs.

Why change something that works? Why put politicians before patients? Why destroy patients' trust by removing the independence of their NHS watchdog? Why should a Government long on employee relations rhetoric, cause such distress to CHC employees and volunteers? They are clearly a Government short on responsible employment practice. Why should there be such a complex and supine new system?

The Government's plan to scrap independent CHCs and replace them with a plethora of NHS in-house bodies is a thoroughly bad proposal, which is opposed on the broadest of fronts. The Government should think again and have the courage and confidence to admit that they got this wrong, rather than arrogantly ram through the abolition of CRCs for their own political convenience at the expense of the interests of NHS patients in Cheshire and the length and breadth of the country.

10.34 am

Mr. Patrick Hall (Bedford)

I congratulate the hon. Member for Eddisbury (Mr. O'Brien) on securing this important debate, which many hon. Members, including myself, have sought to obtain.

We can all agree from the outset that there is concern, inside and outside Parliament, about the future of community health councils. The work of CHCs is important for individual health service users and for the community. CHCs and their equivalent in Scotland and Northern Ireland cover every parliamentary constituency, which helps to explain why the all-party parliamentary group on community health councils, which I have the honour to chair, is one of the largest in this place.

If we can all agree about the concern, we can also agree about the wider context of the debate—the national health service plan, which is welcomed by community health councils and others throughout the country. The plan is ambitious and far-reaching and aims to create a national health service in which the patient is the most important person. The plan is underpinned by the most generous and sustained commitment of additional resources ever in the history of the national health service.

Dr. Liam Fox (Woodspring)

If the plan is so important to the future of health care in the United Kingdom, why has the House never been given an opportunity to debate it?

Mr. Hall

I am sure that there will be many opportunities to do so, and we are debating aspects of it now. The hon. Gentleman will have many opportunities to secure further debate on the subject. It is because of the importance of the NHS plan and its positive context that the issues raised in our debate today deserve such careful attention.

We are talking about the future of community health councils in England. Health matters are devolved in Scotland, Wales and Northern Ireland: in each case, the devolved authorities, instead of committing themselves to the principle of abolition, decided to consult on methods of adding to and reforming the basic health council structure.

My approach to the proposals on patient empowerment and community health councils in England is set out in early-day motion 1103, which is tabled in my name and has attracted more than 100 signatures to date. It is intended to demonstrate the measured and serious intention of parliamentarians to deal with the many issues and questions that arise from the Government's proposals. I refer, in particular, to the need for independence, local and national integration, appropriate statutory powers and access to information and support mechanisms to identify and promote best practice. Those considerations must be widely and carefully probed and then addressed—not least because, as they stand, the proposals beg more questions than answers and are notably thin on detail. That is widely understood.

I want to make it clear that these matters must be dealt with seriously and in detail, because I want the system to work. I want the national health service user and the communities served by the NHS to take a greater interest in their service, to participate more in it and to be listened to more by it. The mechanisms must be in place to deliver that desirable state of affairs. I want that to happen because it is right in principle and because it would provide greater depth and meaning to the widespread public support and good will felt for the NHS in this country.

The key question is: will the proposals for the new system of patient empowerment and community involvement provide the necessary mechanism? More important, will they do so better than community health councils?

Community health councils have done good work since they were established in 1974, but they certainly cannot deliver the necessary changes without reform. That is not at issue. The councils themselves and their national organisation in England and Wales have said for some time that that is the case. That is why the Association of Community Health Councils for England and Wales established, in March 1999, an independent commission to consider public interests in the national health service. That is also why several councils have taken useful initiatives about better ways of working and why, in June, ACHCEW submitted a document to the Department of Health's modernisation action team on patient empowerment. I am unsure to what extent those contributions have informed the NHS plan. Will the Under-Secretary tell us what notice was taken of them during the plan's preparation?

Many questions relating to the future of community health councils and the proposed new structures are already well rehearsed. I do not propose to cover all that ground today. I shall focus my remarks on the fragmentation that results from the redistribution of CHCs' functions between PALS, patients' forums, advisory committees, local council scrutiny committees and the Commission for Health Improvement. As the proposals stand, the first four bodies to which I referred—probably all five — are in danger of being isolated. They will need integration, information sharing, co-ordination and support. Something is missing from the proposals in that respect.

I served for several years on the social services committee of Bedfordshire county council. At the same time, I was a member of the North and Mid Bedfordshire community health council. The cross-fertilisation of ideas and information that I gained from my involvement in both bodies was invaluable. I am convinced that, to carry out the scrutiny function effectively, local councils will need easy access to independent and reliable sources of information about the national health service scene in their locality. I have given some thought, as have many others, to how that might be provided, for not only local councils but all the players and partners in the Government's proposed new arrangements.

The Commission for Health Improvement is an independent, national public sector organisation charged with inspecting, reviewing and developing the quality of every national health service trust every four years — more frequently, when problems develop. It also considers clinical governance issues and, as part of that duty, examines trends in complaints. For example, it is carrying out a root and branch inspection of the acute sections of Bedford general hospital, meeting with stakeholders, staff, service users and the trust board. The body is expected to produce draft recommendations for improvement during the 15-week inspection, and a final report, which will be made public. That report will set out a programme for improvement, which will require careful and detailed monitoring.

The Commission for Health Improvement will require a local presence to perform that essential and welcome task; it will surely not be able to do so from its national headquarters on the tenth floor of Finsbury tower. Given that it needs to maintain a local presence, why should it not use the offices of the local community health councils? Why not increase that presence by providing a secretariat service to carry out co-ordination, integration and information-sharing functions, which are essential if the new arrangements are to work, and which are currently missing from the NHS plan? We could call it CHI-plus, but I am sure that others will come up with a better name.

Mr. Philip Hammond (Runnymede and Weybridge)

Is the hon. Gentleman aware that the Commission for Health Improvement is not an independent body? Its constitution—the Act that established it—requires it to take directions from the Secretary of State.

Mr. Hall

I understand it to be an arm's length body—among those interested in such matters, it is perceived as having an element of independence. Such issues can be developed. The CHI-plus solution is worth considering and exploring. CHI-plus, locally distributed, could also house PALS, so that patients and their families could be confident about the independence of patient advocacy, as the Select Committee on Health has strongly argued that they should be.

The debate on these important matters is now clearly engaged. There will be primary legislation. There is a great deal to do. They are important matters and we must get them right.

10.45 am

Ms Hazel Blears (Salford)

I am honoured to be secretary of the all-party group on community health councils. Before I came to Parliament, I was a member—and chair for four years—of Salford community health council, so I have personal experience of the tasks that are facing CHCs in an ever-changing and rapidly developing national health service and the ever-changing world of local government. The two functions are interrelated in many ways in terms of how they affect local people's health.

I am delighted that the hon. Member for Eddisbury (Mr. O'Brien) secured the debate, because there are important issues for us to consider. I am disappointed, however, that the debate seems to be developing into arguments for the status quo versus arguments for change. I do not think that that is where we should be going—nor should the debate be about the success or failure of community health councils. In my experience, CHCs throughout the country do a fantastic job with the resources available to them.

The debate should be about CHCs growing, evolving, developing and building on their best practice. Whether we call them community health councils ought to be an irrelevance. We should be directing our minds to finding the best way to ensure that local people have a real say in the way in which their health service develops and in the services that are available locally—a democratic accountability of the NHS to the people that it serves. I hope that all of us, in all parties, can share those aims. We want a national health service that is democratically accountable to local people and that shapes the development of its services based on the real needs of local communities.

Mr. Desmond Swayne (New Forest, West)

Does the hon. Lady agree that her aspiration that we could all work together to achieve that laudable objective might have been enhanced had there been genuine consultation, which clearly there has not? We have been offered abolition, not exciting development.

Ms Blears

I would have preferred the hon. Gentleman to use terms similar to those that I used, such as evolution, organic change, and growing and developing—"abolition" is a harsh word. I hope that we can move the debate on to discuss the growth and development of services and I am interested to hear the Minister's view of the future. On a personal level, I am passionately committed to local people having their say. The NHS is such a massive organisation and there has been a danger of it becoming remote and distanced from those that it serves. It does not have the same democratic structure as local government and it can sometimes be hard to call it to account.

I also believe, and I know from experience, that local people can help to make the national health service more effective, responsive and efficient. As patients, users and carers, local people know about the quality of local services because they have to use them on a daily basis, so they are the best people to inform us about what needs to be changed and improved. They also know clearly, sometimes from personal experience, where things are going wrong. We have a duty in the health service to learn from patients' own experience and to try to ensure that we do not repeat mistakes that can cause such massive personal distress.

Mrs. Caroline Spelman (Meriden)

Does the hon. Lady accept that replacing the community health council with a patient advocacy service ignores the point of there being a forum aspect for the community? For example, Solihull community health council was successful in persuading the health authority to increase the number of magnetic resonance imaging scan hours to ensure that the waiting list for such scans was below one year. Such actions will be lost as a result of the Government's decision to abolish community health councils.

Ms Blears

The hon. Lady makes an important point. One of my worries is that, if patients forums are to be established in each trust, we could be in danger of losing the overarching nature that represents the community—something larger than individuals. Will the Minister say whether a structure could be set up along the lines of that being proposed in my community to ensure that a collective as well as an individual voice is based in each trust? Although it is right to have forums in each trust, I am worried that they will not be enough to secure the wider voice of the community.

Putting people at the heart of the NHS is the direction in which we should be moving. However, community health councils have had to operate on a shoestring budget for many years. My community health council had two members of staff, one full and one part time. It served 250,000 people. We were often inundated with complex complaints that had to be followed up through a labyrinthine system that took hours. We were expected to monitor the quality of five different trusts and the whole range of services that they provided. Given that Salford provides teaching facilities, regional specialties and adult forensic services that serve the entire country, the poor community health council was sometimes left struggling to provide a high-quality service. Moreover, we had to participate in consultations and deal with legal issues and other complex matters.

The Government's proposals under the NHS plan should ensure that patient empowerment and citizens' involvement are better resourced. There is certainly a commitment to put extra funding into the system and, at long last, I am delighted that it has been recognised that the duties placed on CHCs have been not only burdensome, but not in the best interests of the community, as a result of which people have often not been able to provide such a huge range of services. It is right to pay tribute to the hard work of not only CHC staff, but volunteers. Their commitment throughout the country is enormous. I urge the Government to ensure that, in whatever proposals replace CHCs, we do not undervalue, denigrate or lose the tremendous commitment of people who want to be involved in their local health service. It is hard enough to encourage people to participate in public service. It is a real challenge for all of us. When people want to have their say about the health service and communicate with their local community, we should welcome them with open arms and ensure that the facilities give them the chance to be involved.

I am proud of the CHC in Salford. It is progressive and forward looking. It is excited by the Government's proposals and Manchester, Salford and Trafford CHCs, of which there are five, are all in the health action zone, which is undertaking tremendously progressive work. They have recently set up a project to commission research—on a proper evidence base, not only on anecdotal issues—into what should be the shape of future mechanisms for ensuring patient empowerment and citizenship involvement. That began in October and will be running for the next six months. In March 2001, we should have the results of that in-depth consultation with local people about what they want in terms of their ability to participate in such mechanisms.

We should be encouraged by the fact that the base of such research sterns from the NHS plan, which states that the NHS will shape its services around the needs and preferences of individual patients, their families and their carers…respond to different needs of different populations…work together with others to ensure a seamless service for patients…help keep people healthy and work to reduce health inequalities, and, my goodness, we need to reduce health inequalities much faster than we have done. We must also recognise that the NHS does not operate alone. The factors that influence good health are much wider than the health service. They include good housing, decent education, safe, warm and affordable homes and safe streets in terms of accidents and crime and disorder. All those factors affect people's well-being and health. Whatever system we have for consulting local people, it must take into account that the NHS works with local government, voluntary groups and local businesses, all of which go to make up a community. In the past, we have been guilty of putting the NHS, local government and education in separate boxes. All those matters are integrated and the community's views on them must draw everything together.

In inner-city areas such as my constituency, extra complications are involved, such as the neighbourhood renewal strategy, education action zones, the single regeneration budget and Sure Start—wonderful Government initiatives, but they all require consultation. We should like to ensure that NHS consultation keys into all those other consultation mechanisms, otherwise we will be in danger of developing consultation fatigue.

We ask the same few people all the time to be involved in the consultation process. In Salford, we propose something quite radical—SPAN, the Salford participation network, which will involve local people coming together to form a community voice in addition to the individual patient forums. We shall have a blend of advocacy, support services, and, crucially, the authentic voice of local people, which will be independent and challenging. It will certainly not be a Government poodle. It will point out where we are going wrong as well as where we are going right. With support—it will require funding and resources—I hope that it will be a vibrant democratic body at the heart of the entire range of consultation, including not only the NHS but local government and all the crucial functions involved.

We must face up to the fact that the world is changing. Services and the way in which they are delivered in communities are changing. We cannot simply argue for the status quo. We need better consultation mechanisms. I am extremely worried that the voices of many marginalised and excluded people are never heard. Even in our community health council, we have done some analysis and found that people whose voices are not heard include adults in residential care. When are such people consulted? They also include children under 12, people who are homeless, frail older people, people who are illiterate, people whose first language is not English, people with dementia—difficult to consult, but it can be done—people with learning disabilities, refugees, asylum seekers and travellers. How often are the voices of such people heard in shaping local services? It is hard to consult those groups, but that does not mean that we should not try to do so and be imaginative and creative in the mechanisms that we put in place to do so. Those people deserve as much of a voice in the health service as mainstream members of the community.

The Government are well intentioned and the new proposals will help to give more people a voice in shaping the health service. Advocacy must be a top priority, because many people need support to make their case and advocacy services have been drastically underfunded, existing on perhaps an even shorter shoestring than community health councils.

Effective scrutiny is essential. That will be a new role for local authorities and they will need support to exercise it properly. Involving local authorities in examining how the health service functions in their communities may even take us back to the days when those authorities had much more of a say in the health service—not something that I consider bad. The relationship needs to be closer.

I hope that the Government will achieve the necessary balance between ensuring that our empowerment mechanisms reflect changes in services while retaining the authentic democratic accountability that gives our service integrity. We must not end up with a bland service that people do not trust or have faith in and that they do not feel that they can go to in times of need.

The system must change, but we must be brave enough to recognise that on occasion the community will be right and the Government and the NHS will be wrong. The community has the right to have that say. We must set in train proper consultation mechanisms to draw in as many people as possible, because what will improve our health service is a constant process of renewal and dialogue, talking and listening to one another and changing our services to reflect the real needs of local communities.

That is the way forward. Much creative work is under way and I hope that across parties we can look to the future. I believe that the proposals are about more power to the people, and I say to Opposition Members, "Have courage, have faith. Look to the future, not the past, and welcome the proposals."

Mr. Hammond

The hon. Lady has been talking about consultation. Is her message to the Government that she would have preferred proper consultation before the Government announced arbitrarily the abolition of CHCs?

Ms Blears

My message to the Government is that the proposals that are set out in the NHS plan reflect the principles that I enunciated earlier. I agree entirely with those principles. It is right to look to the future and to set up mechanisms that are appropriate for the modern world.

11 am

Mr. Nick Harvey (North Devon)

I, too, congratulate the hon. Member for Eddisbury (Mr. O'Brien) on securing this important first opportunity for Parliament to discuss the future of community health councils. I warmly echo the tribute that he paid to their work over the past 25 years. He was right that there was shock and consternation when they discovered the sting in the tail in the NHS plan, which heralded their demise. It is not completely unprecedented under Governments of any colour for announcements to be made in a rather sudden manner. Indeed, such a bounce is part of politics, but it would have been more acceptable if the announcement were followed by meaningful consultation. I agree with the hon. Gentleman's criticisms of the present consultation process.

The Under-Secretary has talked about the seminars that are taking place, but there are only four of them, with a hand-picked list of attendees in each case. It would be far more satisfactory if the Government issued a consultation document explaining the options that they are willing to consider and invited representations from all and sundry, whatever their particular perspective—whether they were patients, patient groups, people working in the health service or those who have had experience within the CHC world.

Since the announcement was made, I have spoken to many people involved with CHCs and with a good number of CHC chief officers. Every person to whom I spoke recognised the need for fundamental reform of the CHC. Not one person argued for the retention of the status quo and, if the hon. Member for Eddisbury will forgive my saying so, in the course of making a powerful case he strayed once or twice into the realms of viewing the current situation through rose-tinted spectacles. Undoubtedly, there is a need for fundamental reform. If the Government embarked on meaningful dialogue and consultation, it would be reasonable for us to ask ourselves whether their proposals offer a satisfactory blueprint for what might follow.

The Government propose that the local authorities should take over the role of statutory consultee on service levels and changes. That in itself is not inherently a bad idea, but to perform that function satisfactorily, they must have the relevant information at their disposal. I am concerned about the separation of the role of the statutory consultee from that of patient representation and resolution of individual complaints. If the statutory consultees are not those who are going out on inspections, are not those who are in regular dialogue with patient groups and are not those who are handling the individual complaints, it is difficult to understand on what the basis they will carry out their role as consultees. Unless that matter can be dealt with, there is a fundamental weakness in the suggestion that local authorities should take over such a role.

The hon. Member for Salford (Ms Blears) spoke sensibly about patient advocacy. The Select Committee on Health, in its report on complaints procedures within the NHS, identified the need for much improved patient advocacy. That is particularly apt for mental health patients, frail elderly patients and those who are not able, for one reason or another, to look after their own interests. It is far too important a role to be put in the hands of an employee of the health service trusts that are supposed to be under scrutiny. It has been put to me that it would be all together far more effective if the patient advocate were an employee of the health trust. The chief executive of the trust will respond more positively if the patient advocate can go to him and say, "We have a problem and if we do not sort it out by 5 o'clock this afternoon, the local press will be on our back." The advocate would be more effective if he could go to the chief executive and say, "If you do not solve the problem by 5 o'clock this afternoon, 1 shall involve the local press."

Mr. Miller

I was trying to tease that out of the hon. Member for Eddisbury (Mr. O'Brien). I agree with the hon. Member for North Devon (Mr. Harvey) about the line of accountability, but, as the spokesman for his party, does he have any proposals? Given the accusation of an absence of consultation, the hon. Gentleman may as well tell the Minister now how he thinks that line of accountability should work.

Mr. Harvey

I shall be happy to do so. The NHS plan describes a set-up in which the patient forums will be serviced by the patient advocates—I presume that they will provide the secretariat—who will be employees of the hospital trust or the primary care trust. That is an unsatisfactory way of setting up such bodies. If the patient forum or patient advocates are to have any credibility, it is essential that they are independent. Their funding must be provided independently and they must be employed independently. The Government's description of patient forums and patient advocates may provide a sensible foundation, but only if they are separate from the trusts that they are supposed to scrutinise. That is essential if they are to have any credibility.

My greatest concern is that the disparate set-ups proposed by the Government will not hang together effectively. The complaints system in the NHS is profoundly unsatisfactory and very few patients are able to pursue complaints to a helpful outcome. Many CHC chief officers have been candid enough to tell me that individual complaints have often been the poor relation on their list of priorities. They are labour intensive and use up a lot of their resources. They often feel that dealing with such complaints does not achieve as much for the local community as putting the greater part of their efforts into inspection and scrutiny of the wider health service picture. It is essential that work on individual complaints is properly resourced, and if that means taking it out of the organisation that provides local representation, so be it. I am not convinced that that is necessary and it should be possible for it to sit within a patient forum set-up, but only if it receives ring-fenced resources and adequate staff to do the job. I am not convinced that the job is being done well at the moment. Citizens advice bureaux have a good record and their involvement was mooted, but their effectiveness is patchy. At their best they are very good, but in other areas they are not so effective.

The Government's plans may have shreds of logic here and there, but the whole will be less than the sum of the parts. Unless the Government can satisfy us that there will be some institutional mechanism by which they are linked together and can guarantee that there will be proper independence for those carrying out the roles, the plans are not supportable in their current form. However, I recognise the need for change and, if the Government would engage in open consultation, they could find a way forward that would enjoy wide support.

11.9 am

Dr. Liam Fox (Woodspring)

I, too, begin by congratulating my hon. Friend the Member for Eddisbury (Mr. O'Brien) on securing the debate. It is a disgrace that we have had no opportunity to debate the NHS plan in the House, despite the Government's oft-repeated claim that it is the most significant change in the running of our health care system since the inception of the NHS. The House has been treated with a combination of arrogance and cowardice. The Government treat Parliament with contempt, so it is little wonder that people who have given so much time and effort to CHCs are treated with similar contempt.

As my hon. Friend said, three facts are clear. There been no consultation on the abolition of CHCs, which is contained in the national plan, and no consultation on the decisions taken since the announcement of abolition, and the dialogue on patient empowerment has not dealt with the decision to abolish CHCs. I understand that ACHCEW is holding a seminar on 4 December, but the Minister has written in advance to say that she will be unable to answer questions about the Government's proposals to abolish CHCs. So far from consultation, the Minister will attend a seminar held by the body that represents the organisations that are about to disappear, having warned it that she will not answer any questions about abolition. That clearly shows the Government's view of consultation.

In early-day motion 595, the House congratulates the CHCs on the occasion of their 25th anniversary and marks its appreciation of their work. When the Prime Minister was asked by South Durham CHC to sign it, it received the following response from an agent: I am replying on behalf of Tony to your letter…concerning the Early Day Motion congratulating CHCs on their 25th anniversary. Unfortunately the Prime Minister is unable to sign EDMs as they are a vehicle for back bench MPs to voice their feelings on an issue. However in this case of course Tony agrees with every word of the motion. Tony would certainly like to add his congratulations to the work the CHCs have done over the last 25 years and wishes them every success in the future. The next time that the Minister receives a message from the Prime Minister wishing her every success in the future, I suggest that she thinks about the imminent prospect of her unemployment.

Important points have emerged from our debate. Many community councils have been effective, though some could be improved dramatically. There is a strong case for reform. For example, there should be more standardisation of CHC work and better resourcing. Had the Government proposed the reform of appointments to CHCs, their resourcing and operation, they would have received wide support across the House. Instead, they proposed simple abolition without prior consultation.

CHCs must have an independent role, a community role and a better patients' complaints service. Many people who have worked on the medical side of the NHS recognise that it is difficult for patients to make effective complaints within the service. Health care delivery is becoming increasingly politicised. It is extraordinarily naive to believe that a body set up for patient advocacy under the auspices of an NHS trust will feel independent enough to question and attack the trust when necessary on behalf of patients. I cannot believe that Ministers are naive enough to believe that. It is more likely that they well understand that the new bodies will not cause so much trouble, which is precisely why the new mechanism is being put in place.

As I said, there is increasing party politicisation in the NHS today. In a damning indictment of the Government's handling of appointments, Dame Rennie Fritchie pointed out that, between March 1997 and November 1999, 284 Labour councillors were appointed to NHS trust positions compared with 23 Conservatives and 36 Liberal Democrats. The Government now ask us to accept that the Labour party cronies appointed from the local government pool into the NHS can be scrutinised by the cronies left behind in the same pool. That is a new Labour culture, not a means of improving patient care.

Ms Blears

Will the hon. Gentleman give way?

Dr. Fox

Yes, I will give way to the hon. Lady, whose speech gave naked careerism a bad name even in this place.

Ms Blears

Just to correct the hon. Gentleman, I am fully clothed. Is the hon. Gentleman impugning the integrity of all local government in Britain? Many hard working local authority representatives would be extremely concerned at his suggestion that they lack integrity and would fail to carry out proper scrutiny. Are his comments directed at the whole of local government, including Conservative party councillors?

Dr. Fox

No, they apply to new Labour and the disgraceful abuse of the way in which appointments are made. If the hon. Lady believes that it does not happen, she should take the matter up with Dame Rennie Fritchie, whose recommendations were supposedly to be accepted by the Secretary of State.

Having been in government, Conservative Members know how effective CHCs can be in their role of reviewing and opposing plans for reorganisation. Secretaries of State and Ministers do not like it when CHCs say, "We do not like the way in which this reorganisation has taken place, and we are referring it back to the Secretary of State. There must be ministerial responsibility." One reason for the new arrangement is that Ministers find such comments uncomfortable; they would rather that that role disappeared altogether. That is typical of how the Government do business.

We have made it clear that, if the Conservative party wins the general election before CHCs have been abolished, they will not be abolished. If we win the general election after the Government have done their dirty work, we shall reinstate an independent body, but reformed in a way that would have the agreement of both sides of the House.

The hon. Member for Salford said that abolition is a harsh word, but it is also a good description. It is a harsh word because it is a harsh policy. That is what we shall find in the primary legislation. The hon. Lady and her hon. Friends will hold the key to whether CHCs are abolished. She and they will need to consider where their loyalties lie—to their communities and to their experience, or to their Whips.

11.16 am

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

I, too, congratulate the hon. Member for Eddisbury (Mr. O'Brien) on securing the debate. It is a measure of the importance of the subject that so many hon. Members are here this morning.

We should focus not on the future of CHCs but on the future of effective public and patient involvement in the modern national health service. A number of good contributions have been made. To my surprise, I agreed with the hon. Member for Woodspring (Dr. Fox) that the complaints procedure set up under the Tory Government needs to be improved, and the King's Fund and York university are consulting on that. However, if he were to read carefully our proposals about the overview and scrutiny committees, he would realise that final referrals can still be made to the Secretary of State in those uncomfortable cases to which he referred.

Dr. Fox

How apt that the Under-Secretary should begin with a matter that she would rather the debate was about. We are here to discuss the Government's plans for abolishing CHCs. It would help if she were to deal with that subject rather than the fancy debate that she would prefer to take part in.

Ms Stuart

Perhaps the hon. Gentleman should have waited a little longer before accusing me of not addressing the subject.

The hon. Member for Eddisbury raised a number of issues. I am sorry that he is disappointed that it is I who will answer the debate, but that is as good as it gets this morning. I am honoured to have been asked to reply.

I want to focus on the important speeches of my hon. Friends the Members for Bedford (Mr. Hall) and for Salford (Ms Blears). I also thank the Members and officers of the all-party group, who have played an important role; it was important that I met the group as soon as possible after the recess. I also thank the hon. Member for North Devon (Mr. Harvey) for his clear and welcome statement that the public recognise that the status quo is unacceptable. Fundamental and radical change is needed. No organisation, not even a statutory body, has the right to exist just because it is there. They must continuously change in order to fulfil the function for which they were set up. That is why we must consider the past contribution of CHCs.

The NHS plan was the result of a huge and unprecedented consultation exercise. No previous Government have engaged in such a consultation with the public, staff and members of the professions, many of whom signed up to the plan. As a result, we examined the CHCs' important contribution over the past 26 years.

It must be recognised that changes that have occurred in the modern NHS mean that the organisations within the NHS need to change too. We now have primary care groups and primary care trusts. Things are changing. Let us examine the proposal and the criticisms.

Dr. Fox

For the sake of clarification, did the Government at any time discuss with the CHCs the possibility of their abolition?

Ms Stuart

It is important to put on record that there was CHC representation on the modernisation action teams, including the one that I chaired on patient empowerment. However, it was clear that, after the consultation period in which the teams met, any decisions made would be the responsibility of Ministers. [HON. MEMBERS: "Yes or no?"] Perhaps hon. Members will allow me to make a little progress, to put the wider picture.

Despite the significant changes in the NHS, CHCs have not changed. I commend the hon. Member for Eddisbury on setting up the Eddisbury health forum. In bringing together all those disparate organisations he demonstrated the need to scrutinise existing structures. Some health authorities are represented by as many as five CHCs. It is not unusual for one CHC to approve a reconfiguration plan while another opposes it. There is a need for fundamental restructuring.

Performance has doubtless been patchy. I am grateful to my hon. Friend the Member for Salford for identifying the need for co-operation with other organisations. What we are doing concerns not just one organisation. Health provision involves more than that. The response to complaints is variable. Dealing with complaints is not and never was part of the statutory duty of CHCs. There has been an evolution of what is needed, and the time has come to re-examine the issue.

The fact that CHCs have had no rights within primary care has been a huge disadvantage. Given that 70 per cent. of patient contact occurs through primary care, councils had no right to become involved in 70 per cent. of the patient experience.

Mr. Stephen O'Brien

First, I reaffirm that it would be common ground across the House that CHCs need reform, but they do not need to be abolished. Secondly, even though there is no statutory provision for NHS complainants to make use of CHCs, they do so because those bodies have come to be trusted for their independence.

Ms Stuart

It would have been helpful if the hon. Gentleman had made it clear in his speech that he recognised the need for fundamental change, instead of making a pre-election Tory manifesto pledge.

There is clearly a democratic deficit in the current structure of the CHCs. Where is the structured involvement with the local authority? What is needed is not the politicisation of the NHS, or an adversarial system. It is strange to complain that the proposed new arrangements will lack independence, while claiming that CHCs—which are in fact funded by local health authorities—are totally independent. No one, for example, would accuse Marks and Spencer's complaints department staff of lacking effectiveness and efficiency just because they are employed by Marks and Spencer.

We need to consider what the Government intend to put in the place of CHCs. Hon. Members want and ought to hear how patient representation at every level, and the issues that have been raised today, will be dealt with by the new structure.

Mr. John Randall (Uxbridge)

As an ex-retailer I know that people making complaints often make the additional complaint that they are being dealt with by staff who are not independent.

Ms Stuart

What is important is whether organisations learn from complaints and are responsive. Watchdogs play an important role, but more are needed. The public—patients and citizens—have a right to be represented at every level of the NHS because it is a public service. Under the national plan for NHS modernisation, patients and citizens will have a third level of representation, the Commission for Health Improvement. I shall carefully consider the suggestion made by my hon. Friend the Member for Bedford in that respect. Also at national level, there will be the new, independent reconfiguration panels, and at local level, the independent local authority forums—I was interested to note that they have not been mentioned— and the overview and scrutiny committees. At trust level, there will be patient forums; the patient satisfaction service will continue.

Contrary to what the hon. Member for Woodspring (Dr. Fox) suggested, the Government have no commitment to divide and rule. Patients' and citizens' representation will not be treated as an add-on, to be taken note of or ignored as we choose, but will be woven into the structure. The NHS is a public service, and the public must be consulted as a matter of course, so that there is continuous feedback. That is one the reason why we want a continuous relationship between local government and elected representatives. I am sorry that the hon. Member for Woodspring cast aspersions on the integrity of local government. Local authorities are very powerful; their right to summon chief executives to explain their actions is vital, as is their continuing involvement.

The Local Government Association is happy for me to quote its belief that the plan offers an opportunity to tackle the democratic deficit in the NHS. The proposals to extend the local authority's scrutiny role to local health organisations will give communities a real say in the planning and provision of health care. The LGA is committed to working with member authorities and health partners to drive forward the agenda.

The original CHCs had three distinct functions, the first of which was inspection. The primary care sector was excluded, but the world has moved on after 26 years. The patient advocacy liaison service and patient forums will be set up not only in every NHS trust but in every primary care trust. The second function of CHCs was the reconfiguration of services, and the third was to deal with complaints. We genuinely wanted to strengthen all three strands of that work and we had to ask whether the natural tensions within those bodies could be combined in one structure, to which the answer was no.

The patient advocacy liaison service and patient forums will have a rolling membership, composed of 50 per cent. patients and voluntary sector groups and 50 per cent. of the most recent users of the health service. The long-term users of the health service tend to be forgotten, but they have huge experience. Our plans are not adversarial, but will improve the services provided.

At health authority level there will be independent citizen forums for strategic development, which I hope will allay the anxieties of some Members, and overview and scrutiny committees. The ongoing scrutiny of the health service is important. Health bodies will have a duty to consult and they will retain the right to refer contested changes, and—if something really has gone wrong—complaints, to the Secretary of State. That is why we are reviewing the complaints procedure and why we talked to the National Association of Citizens Advice Bureaux. If something has gone wrong it needs to be addressed quickly and effectively. It is a whole package. CHCs were just part of that jigsaw. I hope that hon. Members are convinced that we are putting patients back at the centre of decision making where they should be and where they should have been a long time ago.