| Previous Section | Index | Home Page |
8.45 pm
One hopes that the Commission for Health Improvement will give advice to all the health bodies in the country. If it has the role of providing advice and support, it is surely odd to set up yet another new agency to give advice on public health when we already have a body that meets and liaises with all the other bodies and authorities to deal with the issues. We therefore suggest the rational approach of dealing with the matter through one body.
The Government have recently, belatedly, produced a strategy on sexual health. However, there has been great criticism of it. The response from the George House Trust has been to say that the Government are following the "wrong strategy". It states:
- "Much is made by the Government of the need for the 'joined-up working' . . . but not so on HIV."
- "the long term aims of a reduction of HIV transmission and the best possible quality of life for people with HIV requires a cross-Government approach."
- "The document almost doesn't deserve the name 'national strategy'."
Mr. Hutton: I understand that the hon. Gentleman's new clauses and amendments deal essentially with the role and responsibilities of the Commission for Health Improvement for what he described as public health areas. He has now moved on to the sexual health strategy and sexual health services, but that is one issue for which the Commission for Health Improvement already has competence and jurisdiction.
Mr. Heald: The point that I am making is that we should join up the functions. If the Minister had attended the debate in Westminster Hall, he would know that public health is a well recognised field. Like the Select Committee on Health, we went through the history of the subject and back to 1850 and the earliest steps taken in public health. We reached the conclusion—and a consensus even with the Minister's colleague who attended the debate—that sexual health was part of public health. It obviously has a medical dimension too.
On haemophilia, the fact that recombinant factor 8 is not available across the whole United Kingdom has been a failure of public health policy. So the public are right to be concerned that the Government do not know what they are doing for public health. The Select Committee on Health has done an important job of highlighting the vital nature of the issue, but I return to my central point. Why do we need yet another new committee? Why not give the Commission for Health Improvement the job of being a combined inspectorate that brings together the four bodies mentioned in new clause 3, while having additional responsibilities for public health?
The British Medical Association has expressed concern that the new arrangements in the Bill may lead to some areas having no public health doctor advising either the PCT or the strategic health authority. Will the Minister address the issue and tell us whether he is satisfied with that? The national tracker survey mentioned in previous debates concluded that
- "most PCGs and PCTs feel they need more public health support".
Other new clauses and amendments are before the House, and I shall leave it to other Members to describe them. However, I hope that the Minister will, for once, move away from the Government's gimmicky, soundbite approach that we see so often. Every time there is a problem, they set up a committee. Why can we not rationalise and at least bring all the powers together in one body?
On a non-partisan note, when financial controls and checks were disparate and a plethora of bodies dealt with financial regulation, the Chancellor of the Exchequer considered the problem and decided to bring those bodies together with a strong regulator, the Financial Services Authority, to cover all financial regulation. If that is good enough for financial regulation, why is it not good enough for health regulation? Let us bring the bodies together, give them some teeth and have real expertise. I ask the Minister to look on the new clause with the same affection as he showed for our proposals on consultation.
Dr. Evan Harris: Before addressing the new clause and amendments that the Liberal Democrats have tabled, I want to deal with new clause 3, which would amalgamate the functions of the Commission for Health Improvement, the National Care Standards Commission, the National Institute for Clinical Excellence and the Council for the Regulation of Health Care Professionals. I am half with the Conservatives on that. The hon. Gentleman knows that for a long time we have thought that there should be one quality regulator for both the private sector and the NHS. Such an inspectorate would have specialist departments to deal with, for example, the inspection of care homes, on which my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) is an expert. We believe that the nature of the inspectorate should be to consider issues of quality in both sectors, with powers to be discussed and arranged later in our proceedings.
We also believe, however, that NICE and the Council for the Regulation of Health Care Professionals are separate bodies with separate functions. We have made it clear to the Government that we support their quality initiative, even if it means more acronyms. That is the price we have to pay for the previous lack of machinery to deal with quality assurance in the health service. So we accept that two of the bodies could be combined, which is the purpose of amendments (a) and (b) to new clause 3.
Mr. Heald: Does the hon. Gentleman agree that when the Government thought of having two bodies, they favoured a monopoly supply in the NHS, so there would have been little overlap? Now that they are coming forward with changed proposals, it is far more important that one body should deal with such matters; otherwise, more than one body will survey the same premises.
Dr. Harris: The hon. Gentleman is too generous. I do not think that the Government provided a rational reason for the separation, especially with regard to the fact that NHS patients in private hospitals would be subject to Commission for Health Improvement inspection, which means two separate bodies going to similar sectors. It is true that the then Secretary of State took a separatist view of the private sector, but I do not think that that approach was ever rationalised. I do not believe that it can be.
Mr. Hutton: The hon. Gentleman, like the Conservatives, overlooks the implications and consequences of section 9 of the Care Standards Act 2000, which prevents the duplication to which he refers. In the present situation, it offers a sensible way to deal with his reasonable concerns and criticisms.
Dr. Harris: That section might deal with one form of duplication, but it does not address the duplication of
structure. I am concerned about the duplication of two bodies that could more easily pool best practice and identify lessons to be learned from each other by being in one inspectorate. I am sure that if we revisited this issue, the Government would accept the establishment of one body, albeit with different specialisations.New clause 10 is important and touches on matters that we raised in Committee. The Government say that they want the CHI to be more independent. Together with amendments Nos. 88 and 89, the new clause would ensure that they deliver on that and that the body really is independent. Under the cloak of greater independence, the measures would have the commission doing the Government's bidding, because it will be put in charge of measuring hospitals against performance criteria laid down by the Government, but it will have no duty to ensure that those criteria are sensible.
Amendment No. 89 seeks to ensure that those criteria would be discussed and agreed by the commission, the Government and the royal colleges. The commission, rather than simply measuring how well hospitals, trusts and PCTs jump through hoops and how high they jump, should have some input, with the royal colleges, in determining the nature of the hoops.
In the past, there have been ridiculous performance criteria with political objectives. In fact "ridiculous" is a polite description. For example, trusts that put patients ahead of political targets by treating urgent cases quickly, even at the expense of creating a few more long waiters—I accept that in general waiting times are too long—get marked down in performance tables compared with those that deal with long waiters, and have no one waiting over 15 months, by delaying waiting times for urgent operations from one month to three months. Patients come out worse in the second case, but the trust scores higher on the crazy performance criteria.
I accept that there must be some performance monitoring, but let us have sensible criteria. Politicians will do as they do, so it would be sensible to ensure that the commission is able to agree criteria with the Government and the royal colleges. The Government have made efforts to engage the royal colleges in such discussions, but it is clear, as the Minister said in Committee, that the criteria in the Bill will be set by the Government and they will be designed to meet Government targets.
The Government should not be allowed to get away with imposing distortions on the health service unless they are satisfied that they can pass muster with the newly independent commission. New clause 10 would give the commission the power to conduct reviews and draw up reports on the guidance on NHS priorities set out by the Secretary of State and the people to whom he delegates those powers. If priorities and planning guidance emerged that would not inevitably lead to improved quality but merely dealt with subsidiary matters unrelated to patient outcomes, they could be subject to a report by the commission. The Secretary of State could, of course, choose to ignore that report, but at least the information would be out in the open, and the Minister would have subjected the priorities emanating from his Department to the same scrutiny as the conduct of the trusts that seek to meet those criteria will be subjected to.
One amendment seeks to ensure that when setting the criteria some regard would be paid to resources and their effect on the ability of hospitals, trusts and PCTs to meet
those criteria. There is nothing more invidious and depressing for trusts than to be named and shamed, as the Government indicate they will do and as they have done through the zero rating, when they fail to meet performance criteria, solely because they do not have the necessary staff or capacity. Delayed discharges, for example, are well beyond the control of even the best public sector or even—dare I say it?—private sector managers. That amendment should not be a threat to the Minister; indeed, he may argue, as I do, that it would be a benefit because it would ensure that trusts get a fair deal. Without performance monitoring that does not have a devastating effect on morale, we will not have the health service that we require.I hope, Mr. Deputy Speaker, that at the appropriate moment you will allow us to call a vote on new clause 10, if the Government oppose it.
| Next Section
| Index | Home Page |