A proposal by opposition peers and supported by independent and some Labour peers to create patients councils in each English area with an overview and scrutiny committee was approved - in the face of government opposition- by 227 votes to 136, a majority of 91.
The councils would consist of people drawn from local primary care trust patients' forums and NHS trust patients' forums and representatives of local community groups. The amendment to the National Health Service Reform and Health Care Professions Bill also gives the health secretary power to establish patients' councils in areas other than those represented by a local authority with overview and srutiny functions.
Proposing the amendment, Liberal Democrat spokesman Lord Clement-Jones said it was similar to one put forward by David Hinchcliffe, Labour chairman of the commons health select committee, during debate on the Health and Social Care Bill before the last general election. It had received cross-party support in both houses of parliament.
Lord Clement-Jones said patients' councils would be accountable to patients' forums. Because they had lay members and statutory duties, they would be more accountable to local patients and communities than the government's planned local networks of the Commission for pateient and Public Involvement in Health. As independent statutory bodies, they would help to reinforce the independence of patients' forums at local level.
The would be able to provide help and advocacy for people wishing to make a complaint about the NHS in line with provisions for the independent advocacy service contained in the Health and Social care Act 2001.
'As well as providing an identifiable point where the public can raise concerns about the local health service, patients' councils could also act as one-stop shops where members of the public could get independent advice and advice', explained Lord Clement-Jones.
They would also appoint members to sit on overview and scrutiny committees and strategic health authorities. This would ensure coherent representation of patients' forum members concerns at a strategic level. They would reduce bureaucracy and simplify the system.
Lord Clement- Jones added: 'Overall, there is an extremely strong case for a local, lay-led organisation which would pull together all the various fragmented functions of the system; provide and arrange complaints support; represent the local community; and be a visible, accessible and approachable point of contact for the local community.
'In contrast, the government's model, relying on a national commission, is built from the top down. In the government's model there is no in-built reason why the national commission or its local manifestations should take any notice at all of the views of the local community on any issue. Community health councils currently provide easily accessible one-stop shops. In contrast, the government's scheme involves a confusing array of fragmented bodies from which to seek help'.
Former Labour minister Lord Stoddart, who no longer takes the party whip, said patients' councils would believe in themselves and those they represent 'and not cosy up to the National Health Service or the entrenched bureaucracy'. They would not be afriad to voice their own and patients' concerns about the organisation of the NHS, 'which needs a very great shake-up indeed'.
Lord Hunt said the problem with community health councils was that they were 'a big tent approach' and meant to encompass a range of functions. Often they did so inadequately.
'That is why we think it better to separate the functions that CHCs have traditionally been given and ensure they are better organised in a much more professional and effective way - hence the establishment of PALs [patient advocacy and liaison services] within NHS trusts to deal with problems as they arise; in other words, to nip them in the bud. We also have the establishment of patient forums, independent advocacy services, as well as the overview and scrutiny committees of local government'.
Patients' councils risked undermining patients' forums, which were intended to operate where patients were being treated within the NHS trusts. That was the point where patients needed help and support.
However, said the minister, that did not mean that co-operation between patients' forums was unimportant. If Lord Clement-Jones would withdraw his amendment the government would make it clear in the Bill that patients' forums would meet regularly on the lines of s tanding conference. That would enable all the forums within an area to consider together their views, findings and perceived trends.
The offer was declined and the government was heavily defeated. Report stage of the Bill continues.
Hansard 30 Apr 2002: Column 574-658