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Lord Roberts of Conwy moved Amendment No. 5:
- After Clause 1, insert the following new clause—
The noble Lord said: With all the changes proposed in the Bill to
the 1977 Act, I am not at all sure where we stand with regard
to the composition and membership of CHCs. Is a change
proposed?
I suggest in the new clause that half the members be drawn from
local authorities within the council's district, a third
from voluntary organisations with an interest in health
matters and the remainder as prescribed.
I listened carefully to what the noble and learned Lord, Lord
Morris of Aberavon, had to say at Second Reading about his
disappointment with local authority nominations for
appointment to CHCs and
As was said earlier, local authorities have an important role to
play in health. It is a growing role. We recognise the close
relationship between health and housing and other areas of
local government responsibility. The new unitary authorities
in Wales, established by my noble friend Lord Hunt of Wirral,
are responsible for social services, housing and education.
Local authorities must, therefore, be well represented.
Whether it should be half the membership is open to question,
but certainly each local authority in the community health
council's district should be represented in order to
ensure smooth working. The voluntary organisations with an
interest in health matters—disability groups and so
on—also have a claim to membership although they cannot
all be represented as they are too numerous.
I am equally clear in my own mind that those bodies responsible
for the delivery of healthcare should not be represented. I
should hope that there is general agreement on that point.
The CHCs are guardians of the public interest in the health
service and must be independent of the providers and seen to
be so. I beg to move.
Lord Thomas of Gresford: I noted that the noble Lord, Lord
Roberts of Conwy, was rather attracted by the name
"patients' forum". That being the case, I am
rather surprised that he wishes to place such an emphasis on
local authority representation when both he and the noble and
learned Lord, Lord Morris, have reservations about the
interest that local authority representatives have taken in
community health councils in the past. We should leave it to
the good sense of the National Assembly to decide how these
councils are made up. We in this House should not be
prescriptive.
Baroness Finlay of Llandaff: I also have difficulty with the
notion of prescription. Although guidance should be given on
the way in which people are appointed to CHCs, it is
important that no CHC is locked into a set number of members
appointed by a set number of people. I hope that community
health council appointees will be even further removed from
the providers of healthcare than is suggested in the
amendment, even if the amendment is considered in terms of
guidance rather than as a directive. To be able to represent
patients adequately, appointees must be as independent as
possible of any conflict of interest.
There are many voluntary bodies in Wales. I declare an interest,
having been employed by Marie Curie in Wales. I am concerned
that voluntary bodies also need to be inspected where they
are contributing to the provision of healthcare. It may be
difficult for them to be inspected by someone with whom they
are competing for funds. CHC appointees need to be able to
stand back from the whole system. Therefore, I oppose the
amendment.
Lord Hunt of Kings Heath: I say to the noble Lord, Lord Roberts,
that high calibre local authority appointees or nominees are
to be welcomed in assisting in decision-making in the health
service, whether on local health boards, the boards of
hospitals or community health councils. Certainly as far as
England is concerned, while splendid members have been
appointed from a local authority background, that is not
uniform. There has been a rather patchy response from local
government.
The substantive point of the debate is whether this Committee
should determine the composition of CHCs in Wales or whether
it is best left to the National Assembly. I am convinced that
it should be left to the National Assembly, the members of
which are better placed than noble Lords to determine the
kind of community health councils that they wish to see in
the future. My problem with the noble Lord's amendment
is that it goes too far in seeking to constrain the National
Assembly.
I make it clear that currently CHC membership is made up of one
half local authority nominations, one third voluntary
organisation nominations and the remainder are appointed by
the Assembly. The Assembly recognises the importance of local
authority nominees. It wants to retain the experience of
local authority nominees. It also wants to create
opportunities for people—in particular those from
under-represented groups in the community—to serve on
community health councils. I understand that the proportions,
which it currently has in mind, are that the councils should
initially consist of one quarter local authority nominees
and one quarter voluntary organisation nominees, with one
half left for open competition.
The National Assembly wants gradually to move to more open
methods of member recruitment and to ensure that CHCs have
members that are more representative of their communities.
CHC members will be recruited in accordance with the
Assembly's published code of practice for ministerial
appointments to public bodies. Vacancies are advertised in
the media, both locally and nationally. Interviews are held
by the Assembly's public appointments branch in
accordance with Nolan principles.
It is clear that the National Assembly has thought considerably
about the issues. It has a clear view regarding its
direction. It wants to see more open competition for some of
the places. It also recognises the importance of
local-authority nominees. The Chamber should have confidence
in the Assembly's ability to sort this matter out
properly.
On a couple of occasions the noble Baroness, Lady Finlay, has
raised the issue of the right of CHCs to enter premises. I
understand that for the first time CHCs will be given the
right to enter any premises where NHS-funded services are
provided. That will include doctors' and dentists'
surgeries and private nursing homes. It is a crucial
definition and returns us to the Community Care (Delayed
Discharges etc.) Bill, on which we had a similar debate. It
depends on the
Baroness Finlay of Llandaff: I thank the noble Lord for giving
way. Can he confirm that that situation relates to the
situation where there is NHS funding towards the service, but
that it is not restricted to a set quota of patients?
Therefore, where a service is part funded by voluntary
donation and part funded by the NHS, will the patients
receiving care within that service and not paying for it be
able to make representations to the CHC or whoever represents
them if there are matters of concern about the quality of
their care and what is happening to them?
"MEMBERSHIP OF COMMUNITY HEALTH COUNCILS
After section 20 of the National Health Service Act 1977 (c. 49)
(Community Health Councils) insert—
"20B MEMBERSHIP OF COMMUNITY HEALTH COUNCILS
The membership of Community Health Councils shall be constituted
as follows—
(a) at least one member of the Council shall be appointed by each
local authority of which the area or part of it is included
in the Council's district, and at least half of the
members of the Council shall consist of persons appointed by
those local authorities;
(b) at least one third of the members shall be appointed in a
prescribed manner by bodies (other than public or local
authorities) whose activities are carried on otherwise than
for profit;
(c) the other members of the Council shall be appointed by such
bodies, and in such manner and after such consultations, as
may be prescribed; and
(d) no member of the Council shall also be a member of a Health
Authority, a Local Health Board, a Strategic Health
Authority, a Primary Care Trust or an NHS trust.""
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