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1.13 pm

The Minister of State, Department of Health (Mr. John Denham): I congratulate the hon. Member for Beckenham (Mrs. Lait) on having secured the debate. I am grateful to her for her kind remarks at the beginning of her speech. I know that this is an area in which she has continued to take a great interest since she became the Member for Beckenham. I pay tribute also to my hon. Friend the Member for Hastings and Rye (Mr. Foster), who has written on several occasions on the future of Health Services Accreditation, which is located, as the hon. Lady has recognised, in his constituency.

I shall take, first, the national picture. Quality in the NHS is a subject which the Government take extremely seriously. Quality improvement is a central plank of the programme for modernising the NHS. That was set out in the White Paper "The New NHS" in December 1997. Last summer, as a follow-up to the White Paper, we published our consultation document entitled "A First Class Service: Quality in the new NHS". This document set out a three-pronged strategy to support the delivery of more

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consistent and higher quality care to patients. The main elements of that strategy are as follows: first, clear national standards for services and treatments through national service frameworks and a new national institute for clinical excellence; secondly, local delivery of high-quality health care through clinical governance underpinned by modernised professional self-regulation and extended lifelong learning for health professionals; thirdly, effective monitoring of progress through a new commission for health improvement, an NHS performance assessment framework and a new national survey of patient and user experience.

We shall shortly be publishing feedback on the results of that consultation exercise, but overall the reaction of the more than 600 respondents was overwhelmingly positive. It has demonstrated strong support both for our overall aim of driving up quality standards in the NHS and for the specific proposals that we have put forward to help to achieve that.

The House will be well aware that the Queen's Speech set out the Government's intention to bring forward legislation to establish the new commission for health improvement and to create a new statutory duty of quality for NHS organisations. Regulations will also be laid shortly for the establishment of the national institute for clinical excellence as a special health authority.

The Government have sent a clear signal that we are committed to putting quality of care back at the heart of the NHS, and we are putting in place a national framework to support and monitor that process. Locally, however, it must be for NHS organisations themselves to choose which of the range of quality improvement tools that are now available--including various accreditation mechanisms--they use to help them improve their services.

I shall now take up some of the points made by the hon. Member for Beckenham. The hon. Lady has recognised that I am fairly new in my present position. However, I shall ascertain whether there is outstanding correspondence from her and from my hon. Friend the Member for Hastings and Rye and endeavour to reply to it as swiftly as possible.

Before I turn to Health Services Accreditation, I shall refer to Health Quality Service, which was mentioned by the hon. Lady. It is a new organisation which was launched last year by the King's Fund. Essentially, it offers consultancy support to health service organisations on quality improvement, quality assurance and service development, building on the work of the well-established King's Fund organisational audit process.

It appears that HSA's sponsoring health authorities feel that the impression was given at the HQS launch that HQS has absorbed HSA. There may be a misconception that HQS is a formal part of the Government's NHS quality improvement strategy, perhaps arising from press reporting of the launch, and that it has been unfairly singled out for support. That is not the case. The King's Fund and HQS are independent of the Government. In the speech that my right hon. Friend Baroness Jay made at the launch of the new organisation, she was careful to emphasise that local services must be able to explore and adopt those methods and resources that best fit their needs. As was the case with the King's Fund

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organisational audit, NHS organisations that enter into arrangements with the new HQS will do so on their own initiative.

As the hon. Member for Beckenham has outlined, HSA is a ground-breaking organisation which was originally set up by the South East Thames regional health authority as a mechanism for maintaining and improving quality in the NHS. It operates by developing standards for particular services using multi-disciplinary working to help develop these standards and accreditation instruments to assess whether they have been achieved. In 1996, when regional health authorities were disbanded, local health authorities in the then South Thames region took over responsibility for HSA. The task of managing it fell to the East Sussex, Brighton and Hove health authority, and it has invested a considerable amount of both management effort and resources to ensure HSA's continued existence.

Over time, HSA developed an income stream by selling its accreditation process to trusts and health authorities throughout the United Kingdom, but it has needed an income guarantee to ensure that it could carry out its work effectively. That was provided by local health authorities within the South Thames region.

However, with HSA's increasingly nationwide focus, the local health authorities did not consider it appropriate to continue to fund and underwrite HSA. Accordingly, with HSA's agreement, the decision was taken for its transfer out of the public sector to another, more appropriate organisation. That has, understandably, caused concern not only to hon. Members, but to those currently working for HSA and some members of the working groups who helped to develop standards.

We recognise and understand those concerns. That is why, when it was decided that the transfer was the appropriate way forward, a firm timetable was agreed and an evaluation panel was set up to ensure that there was the utmost propriety and that all interested parties received equal treatment. That reflected the guidance set out in the health services guidelines, "NHS Trading Agencies: Future Arrangements", a copy of which is available in the Library. It was also important for the panel to ensure that the NHS maximises the value of the techniques that HSA has worked to develop over the past few years--work that was undertaken voluntarily by a considerable number of clinicians and others in the NHS.

As regards consultation, I understand that the health authority wrote to all customers and contributors on 7 May last year advising them of the planned disposal, and that there was ample opportunity to respond to the health authority expressing views about HSA's disposal.

Mrs. Lait: I have seen a copy of that letter. It informed people that HSA was up for disposal--stop and end.

Mr. Denham: I shall look into that point again, but, given the time scale that evolved, people who might have been concerned about the disposal could certainly have expressed their views on the consequences of that disposal.

In line with the timetable set for the transfer, formal proposals were received and, initially, 32 organisations asked for information packs. Five organisations subsequently expressed an interest in taking over HSA. Of those, three were shortlisted and invited to tender

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through a formal tendering process. All three were assessed by the panel, which considered one to be unsuitable. In accordance with standing instructions, an offer was made to the preferred bidder of the remaining two--a consortium outside the NHS--to proceed to due diligence. Sadly, during this stage, just before Christmas, the consortium withdrew its bid.

Following that withdrawal, there seem to be four options. The preferred option is to find another appropriate organisation that will take on HSA. The East Sussex, Brighton and Hove health authority wasted no time and, as soon as possible, entered into discussion with one of the other bidders. I understand that that organisation has written to the health authority today outlining its decision on whether to proceed, and that the health authority is considering its response. That is the current position, but it is probably appropriate to review the other options that have been suggested at various times.

The second option, which I believe was proposed by the hon. Member for Beckenham, is for the Department of Health to absorb HSA into one of the two new bodies that we are creating, the national institute for clinical excellence or the commission for health improvement. I understand why the suggestion was made, but I have strong reservations about that course. Neither NICE nor the commission are intended to be accrediting bodies, and both will need to develop their own ways of working that best fit the purposes for which they were established. I am not convinced that either could comfortably absorb HSA.

The third option, which I believe was suggested by my hon. Friend the Member for Hastings and Rye, is for the Department of Health to take on the role of supporting HSA. Again, I am not convinced that that would be an appropriate course. Several other players are active in providing quality assurance and improvement services to the NHS. Indeed, it is worth noting that when the South Eastern regional health authority was abolished, a consortium of local health authorities was seen as performing that function more appropriately than the Department of Health. It is to the health authorities great credit that they continued to support HSA beyond the terms of their original commitment.

The fourth and least attractive option for everyone concerned, including those working for the organisation, is for HSA in its present form to wind up. I understand those concerns. I know that the local health authority and the NHS executive will do all that they can to find an appropriate home before that happens.

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I am sorry that I cannot give more reassurances today to the hon. Lady and my hon. Friend. I can, however, reassure them on a number of points. First, the Government are committed to doing all that they can to drive and support improvements in the quality of clinical care in the NHS. To that end, we are putting in place a comprehensive national package of measures. The work carried out by HSA and other organisations in the area of quality improvement provides a range of options that the NHS can use in helping to improve and assure quality.

Secondly, we do not see a conflict between our proposals for quality improvement and the continued existence of free-standing, self-financing accreditation schemes. Indeed, the renewed focus on service quality should give NHS organisations an even stronger incentive to examine ways in which they assure themselves and their patients of the standard of services provided.

Thirdly, we believe that decisions on the use of particular quality improvement tools are, in general, best taken by services themselves, drawing on the range of products available. As I stated earlier, there was little in the response to "A First Class Service" that would lead us to alter that view.

Fourthly, the hon. Lady did not make any allegations about the process, but raised concerns about it. The NHS Executive has looked into the transfer process which, in its view, is robust, with all information being shared equally. There is little scope for undue influence or conflicts of interest to arise.

I am aware that the hon. Lady has written to the Comptroller and Auditor General expressing her concerns about the transfer process, and that those concerns are being investigated. Under the National Audit Act 1983, the National Audit Office has a responsibility to ensure that public money is spent wisely and properly. One aspect is to determine whether good value for money has been achieved when public assets are sold. I can assure the hon. Lady that both the Department and the East Sussex, Brighton and Hove health authority will provide every assistance to help the National Audit Office with any investigations.

Finally, the health authority has put in a considerable amount of both management effort and resources to ensure HSA's continued existence. The authority will happily discuss the transfer with hon. Members and will continue to do all that it can to transfer HSA out of the public sector to the best advantage of the NHS.

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