NHS Reform & Health Care Professions

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Dr. Murrison: Morale in general practice is a big problem. There is a huge turnover in general practice, which is becoming an increasingly unattractive proposition for clinicians. GPs face an immediate burden of bureaucracy of the kind that hospital management would take over were they hospital clinicians.

The concern is that regulation that is unnecessary or perceived to be badly thought through will dent GPs morale even further and affect recruitment and retention in primary care at a time when the Government, rightly, are putting greater emphasis on such care. Total quality is an important notion that has been well grasped by industry and is also applicable to the health care sector. For total quality, one needs to consider all health care functions as a whole. The concern is that by splitting those functions up among various inspectorates, one will not only put a huge burden on practitioners, but reject the notion of total quality. I take issue with the Minister's remarks about health and safety being separate from health outcomes in general. I hope that he will take a more holistic view of the work of the health service.

Dr. Taylor: I would like to ask the Minister a question in relation to amendment No. 162. We believe that the Government are keen for the CHI to become increasingly independent. Is that not a reason to remove not only paragraphs (2)(a) and (b) from section 20 of the 1999 Act—as my hon. Friend the Member for Oxford, West and Abingdon suggested—but subsections (3) and (4)?

Mr. Hutton: There are two separate amendments, which propose completely opposite things. I want to return to that point shortly.

In essence, amendment No. 162, tabled by the hon. Member for Oxford, West and Abingdon, is about improving the independence of the Commission for Health Improvement. Sadly, it is my duty to point out to him that his amendments would not actually achieve that, because they leave in the original legislation the power of the Secretary of the State to

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give directions with respect to the exercise of any of the commission's functions. His amendments are deeply unhelpful for another reason, and I will deal with that point in a moment.

I have a great deal of sympathy with amendment No. 155, which deals with the need for proper co-ordination in relation to the inspection functions. My starting point is that we must ensure that the inspection process for the national health service adds value to the quality of patient care. I agree with the hon. Member for Westbury (Dr. Murrison) that it is not part of the Government's intention or ambition to have—as he might put it—an army of inspectors trampling across the NHS on a routine basis, 24/7, disrupting patient care. That would be ridiculous.

I take issue with the hon. Gentleman's remarks as I did with those that he made on Second Reading, when he queried the value of much inspection work. On primary care, he said that inspection was already having a negative impact on the quality of care delivered by GPs. The Commission for Health Improvement has conducted only pilot reviews of primary care groups. It intends to consider primary care trusts more widely later next year through the existing clinical governance reviews, not the wider reviews that we are discussing in relation to the Bill because the necessary provisions will not be on the statue book by then.

Primary care provides a poor example of the deleterious effect of the bureaucracy of inspection. The hon. Member for Westbury is wrong about that. I accept that he has a valid wider concern about the nature of the inspection function; what it is designed to do, who does it and how often. However, his remarks contain a strong undercurrent of opposition to what we are trying to achieve. We are attempting to provide the public with a more reliable and effective way of ensuring that quality and standards are consistent across the NHS.

Dr. Murrison: The Minister is trying to suggest that I said things that I did not say, and is trying to put a spin on my remarks. I am concerned that having a multiplicity of regulations will detract from patient care. I stand by that 100 per cent. Practitioners want some thought to be given to how inspections might be streamlined so that they do not have to take their eye off the ball and can get on with patient care.

Mr. Hutton: I agree with the hon. Gentleman. I am not trying to spin anything; the hon. Gentleman is not a bad spinner himself. I am trying to make a number of basic observations about why we are doing this and to identify some common interests on all sides of the Committee. Whatever view we take on the detail of the proposals, I am sure that we share the common interest that they add value to the whole process.

These are new areas for us to go into in the NHS. As has been widely commented, Professor Kennedy's report, together with the work of many other bodies, has drawn attention to deficiencies in the way in which we deliver health care services in the NHS. We have an insufficient emphasis on national standards and an ineffective way of ensuring that standards are met. Our

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constituents rightly expect those standards to be universal because that is the nature of the national health service. To find such wide variations in performance should call for an effective response from any Government. That is what we are trying to achieve. The Bill takes the responses forward in an important way, widening the remit of the CHI and giving it a greater independence from the centre.

I have a great deal of sympathy with amendment No. 155, moved by the hon. Member for West Chelmsford. It seeks to achieve an essential aim, and we will have to make sure that there is effective co-ordination. As the hon. Gentleman will be aware, Professor Kennedy said that we should look into these issues in relation to how the inspection process develops. He referred to the need for a council for quality. We are looking carefully at those issues in response to Professor Kennedy's report. We have the power under Section 20(2)(a) to do precisely what the hon. Gentleman is asking us to do. Those are the powers to which the hon. Member for Oxford, West and Abingdon has taken such grave objection.

One part of the Opposition says that we should have these powers—I say that we already have them—while the other part of the Opposition says that we should remove them. There is obviously a difficulty in that position; however, I know that the Opposition parties do not co-ordinate their amendments. I have sympathy with the hon. Member for West Chelmsford's amendment No. 155, although for reasons I have outlined we already have the power to do what he is asking us to do.

I have absolutely no sympathy with the hon. Member for Oxford, West and Abingdon's amendment No. 162, because it cuts across the need to ensure effective co-ordination of the work of the various inspection functions. It is important that the Secretary of State has responsibility for this area because he is responsible for the inspection arrangements that apply across the national health service. That is perfectly legitimate.

Mr. Burns: I was interested to hear the Minister say that he believes that, under the 1999 Act, the Government already have these powers. Will he tell the Committee whether since 1999 there has been a move to use these powers in a co-ordinating role or whether he sees them as powers that will be used and developed once the Bill becomes law?

Mr. Hutton: We have not used the powers to specify issues relating to co-ordination. We have, however, issued two sets of regulations under the powers that deal with how the commission should carry out its functions of advice or information on clinical governance arrangements, local reviews, national service reviews and investigations. We have used the powers in those areas but we have not exercised them in relation to the areas sought by the hon. Gentleman. If we need to do so, we shall. That is why the powers exist; we will not hesitate to use them if that will ensure proper co-ordination.

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Dr. Harris: The Minister believes that he is being clever in pointing out that I am seeking to remove a paragraph under which this amendment hangs. It is surely not beyond the wit of Government to ensure that the Commission for Health Improvement and the other bodies co-ordinate without sacrificing the supposed independence that the commission is given by the retention of subsection (2)(a) and (b) and, as the hon. Member for Wyre Forest pointed out, subsections (3) and (4). I am grateful to the hon. Gentleman for showing how the amendment could be made even more inclusive with respect to independence. The choice is not one or the other. The commission or the other bodies concerned could act as amendment No. 155 would require, or the Government could establish limited powers specifically to secure co-ordination, without the need for the wide range of powers that they want to take and retain under the clause.

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Mr. Hutton: That is the hon. Gentleman's view, but not mine, of my argument and the powers in question. I understand that the hon. Gentleman wants to secure the greater independence of the commission. So do we, and that is what we are bringing about by the Bill. The argument between the hon. Gentleman and me is probably about who is best placed to ensure, overall, the co-ordination of the work. It is perfectly reasonable to expect the Secretary of State to have responsibility for that function. He could discharge the responsibility for ensuring effective co-ordination, assuming that that is the hon. Gentleman's aim, without compromising the independence of the work done by the commission when it inspects local trusts and reviews arrangements as he described. We disagree on the point and I cannot explain it in any other way.

Mr. Burns: I understand that the Minister must be careful in his use of language. However, given that he has expressed sympathy with our amendment, and given that the powers that he says already exist to carry out its intention have been used in other contexts, does he anticipate that the Government are likely to issue regulations to co-ordinate visits to minimise disruption and other problems?

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