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8.15 pm
About a week after I had written my second letter to the Secretary of State, I received a letter from the NHS executive headquarters about the code of practice on openness in the NHS. It was addressed to all Members of Parliament, and it said:
Mr. Malone:
I have listened to the debate on new clause 4 wondering whether I would hear any new or more compelling arguments than we heard in Committee. With respect to hon. Members, who pressed their suits as vigorously as they did in Committee, I have to disappoint them, and say that I did not hear much to persuade me that I should accept the new clause. I shall explain briefly why, but first let me turn to two specific points that were raised by the hon. Member for Bolton, North-East (Mr. Thurnham).
In the context of this evening's debate, I shall not respond to his point about reconfiguration of services in which he has an interest. However, I have noted his comments, and I shall reply to him through other channels and let him know the up-to-date position.
The hon. Gentleman made another point about dental pilots, which could be relevant to the debate in terms of amendment No. 9. I envisage the pilots to which he referred dealing with problems of oral health care in centres of population where oral health is poor. That is the purpose of the Green Paper that preceded the Bill. I can give the hon. Gentleman the assurance he seeks, that the pilots are specifically designed to solve such problems.
As I have said many times, we are committed to evaluating the pilot schemes in a open and consultative manner. I remind the hon. Member for Edinburgh, Leith (Mr. Chisholm) that there is a statutory underpinning for that in that clause 7, which commits us to evaluating each scheme within three years of its beginning to provide services. The question is whether we should set out criteria on the face of the Bill. I have not changed my view, although we have every intention of setting criteria for evaluation.
The hon. Member for Cannock and Burntwood (Dr. Wright) described the national consultative group as a small committee. I was trying to signal to him that a large, wide group will consider criteria that will apply to all schemes.
The universal criteria will be based on the advice of the groups and the local criteria on the work of health authorities and providers. They are likely to cover issues including quality of services, the wider impact on the provision of local general practitioner and dental services--returning to the point made by the hon. Member for Bolton, North-East--administrative efficiency and value for money. With a wide variety of schemes, some of them fairly small, an elaborate system of reports for each would be unnecessary, and out of proportion to other scrutiny arrangements. There is no need for such a requirement.
We believe in using the established mechanisms, well known to the House--Select Committee inquiries, parliamentary questions and debates. From nearly three years' experience as a Minister for Health, I know that some hon. Members are not slow to use such devices to air their concerns. Those are the appropriate ways to deal
with such matters, ensuring that information is made available to Parliament and obtained in the form required. The process envisaged in the amendments is likely to be unwieldy and bureaucratic. It may be appropriate for large schemes, but not for the many smallish schemes that we anticipate.
The hon. Member for Leith asked about community health councils. I looked carefully at what I said in Committee, when I answered the point in another way. Community health councils will be consulted in two ways. I expect them to be consulted in the general sense, but I also pointed out in Committee that they have a statutory right to consultation if what is being proposed in a pilot amounts to a major service change. They are reassured by that.
I should like to clarify the Government's position on the issues exposed by new clause 7 on local representative committees. They will play an important role in the development of the new arrangements. Health authorities will need to seek their views on the impact of pilots on existing arrangements and when pilots are evaluated. They will definitely be involved, continuing the long-standing relationship between health authorities and LRCs in the provision of general medical and dental services.
I have an important opportunity this evening to set out my views on the future arrangements and the statutory role of LRCs. The statutory role and funding of LRCs relates to the existing general medical services and general dental services contracts, and various functions performed under them. However, they have also voluntarily undertaken other roles relating to professional matters outside those that are statutory and funded, in which they have been a helpful forum for seeking representative views of GPs and general dental practitioners. That has grown up without the protection of statute.
Health authorities will continue to need to seek representative views on such non-statutory matters that affect all GPs, GDPs and dentists working elsewhere. In doing so, they will need to embrace all those providing primary care services. The mechanisms for securing that should be decided locally by GPs and dentists. I expect LRCs to continue to demonstrate their strength as representative organisations across a spectrum of activity outwith their statutory responsibilities.
In the light of what I have said, I hope that hon. Members will accept that the arrangements in the Bill are the best way forward, showing our strong and genuine commitment to the principle of consultation. I hope that they will not press the amendments.
Mr. Chisholm:
I have two points in response to the Minister. First, he repeated the claim that evaluation was already provided for in clause 7. Leaving aside the issue whether a review is evaluation, the fundamental point is that there is no provision for adequate consultation in the clause. That is our main objection, quite apart from the lack of any mention of criteria.
The Minister persists in repeating his assertion in Committee that we wish to put criteria in the Bill. There is no mention in the amendments that we moved in Committee or in the new clause of putting criteria in the Bill. We are merely asking the Secretaries of State for Health, for Scotland and for Wales to make a report on
the criteria. The Minister has conceded that criteria for evaluation will be set out by the national consultative committees. Why cannot that be presented as a report for proper consultation? The Minister has not answered that point, because he has no valid objection to our proposal.
Clause 7(4) says:
Motion and clause, by leave, withdrawn.
Mr. Rhodri Morgan (Cardiff, West):
I beg to move, That the clause be read a Second time.
Mr. Deputy Speaker:
With this, it will be convenient to discuss Government amendments Nos. 61 and 64.
"Dear Member of Parliament . . . I enclose a copy of the Code of Practice on Openness in the NHS.
I have some advice for the NHS executive. It should send out a few more copies to chief executives of NHS trusts, chairmen of health authorities and many others who
are not applying the code. I know about the code, but it is fairly obvious that many in the health service do not. That is why it is even more important that we restore some credibility to the health service by ensuring that there is proper evaluation, and, more importantly, proper meaningful consultation with all groups, including local medical committees.
A report by the Health Service Commissioner on access to official information in the NHS was recently considered by the Select Committee on the Parliamentary Commissioner for Administration. The Committee were concerned over the Commissioner's findings that there appeared to be a lack of public awareness of the Code of Practice on Openness for the NHS and therefore asked me to arrange for a copy to be sent to each Member of Parliament for information."
"the procedure on any review is to be determined by the Secretary of State."
That reminds us that the best safeguard for the clauses is a new Secretary of State in a new Labour Government. In view of that, I beg to ask leave to withdraw the motion.
'.--(1) In the 1977 Act, before section 28C (as inserted by section 21(1)), insert--
"Prior approval of agreements by Medical Practices Committee
28BB. Before making an agreement which relates to the provision of personal medical services under section 28C below, a health authority shall submit the proposed agreement to the Medical Practices Committee, and an agreement shall be subject to the approval of the Committee as if section 30 applied to the services proposed to be provided under that agreement.".
(2) In the 1978 Act, before section 17C (as inserted by section 21(2)), insert--
"Prior approval of agreements by Medical Practices Committee
17BB. Before making an agreement which relates to the provision of personal medical services under section 17C below, a health board shall submit the proposed agreement to the Medical Practices Committee, and an agreement shall be subject to the approval of the Committee as if section 20 applied to the services proposed to be provided under that agreement.".'.--[Mr. Chisholm.]
Brought up, and read the First time.
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