NHS Reform & Health Care Professions

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Mr. Hutton: We certainly need to think carefully about that, although I shall not announce that regulations are being prepared; they are not. With the greatest respect to the hon. Gentleman and the Committee—I am not trying to hoodwink the Committee—some of the issues that have been raised relate to the way in which the Government should respond to Professor Kennedy's recommendations. He was concerned about those issues. The Government have not yet responded but will do so, I hope, in the near future. We shall then be able to conduct the appropriate debate and reflect on any need for further action.

The argument is about ways and means. The argument made by the hon. Member for Oxford, West and Abingdon is a more fundamental one about

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principle and independence. I think that we can secure the greater independence of the commission, but I also think that we need to retain the power to secure effective co-ordination. Those two elements are not contradictory.

The concern of the hon. Member for West Chelmsford is effective co-ordination. We have the powers to secure that, and will use them if that is necessary, and in the light of our response to Professor Kennedy's report.

Mr. Heald: The bodies for which, according to the BMA, co-ordination is needed are the medical royal colleges, the Audit Commission and the patients forums. We shall later debate a provision dealing with consultation with the Audit Commission, so perhaps that matter is less pressing, but what of the medical royal colleges and the patients forums? Would co-ordination be possible, or is their remit so independent that they would be entitled to visit at any time, and would they perhaps not welcome co-ordination, because of their role? Is there a problem in that respect?

Mr. Hutton: There is not a problem. There just are no statutory powers. The Secretary of State has no statutory powers to specify where, and in what circumstances, the medical royal colleges should exercise their functions, and nor should he have any. Those are properly issues of professional regulation and they should be matters of professional expertise within the medical royal colleges. The same is true of the General Medical Council, which has a remit and responsibility in the same context. We need clarity as to whom we are talking about. There is clearly a responsibility on the Secretary of State to co-ordinate the agencies for which he has responsibility, to avoid some of the negative effects that Opposition Members have identified. However, the extent of that responsibility should be clear, and it does not reach the medical royal colleges.

The issues have been pretty widely aired. I have sympathy with the point made by the hon. Member for North-East Hertfordshire. We do not think that it is necessary to amend the Bill to achieve what he wants. We already have the necessary powers. We shall consider all the issues in the round soon, when we respond to Professor Kennedy's report.

Mr. Burns: The debate has been extremely useful. I am grateful to the Minister for the points that he has made, especially his commitment—I hope that that does not misrepresent him—that, once the Government are in a position to reflect further after responding to Kennedy and on any other relevant issues, he and his colleagues will remember the debate and the sympathy that he had for the aims of our amendment, which he believed were already covered by the Health Act 1999.

Mr. Hutton: I shall certainly do that. I should have referred to the fact that the current process of inspection is co-ordinated. There are already

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memorandums of understanding at work between CHI, the Audit Commission, the health service ombudsmen, the General Medical Council, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, the National Clinical Assessment Authority and other agencies.

Mr. Heald rose—

Mr. Hutton: I am intervening on the hon. Member for West Chelmsford, so the hon. Member for North-East Hertfordshire cannot intervene on me.

We have not used our statutory powers to oversee the co-ordination, but we have developed protocol to ensure that people do not tread on each other's toes.

Mr. Burns: I am grateful to the Minister for that interesting information.

Dr. Harris: Will the hon. Gentleman give way?

Mr. Burns: I should like to finish my point first. What the Minister said came as a surprise to me. Would he be prepared to place the guidance in the Library so that we may all benefit from reading it?

Mr. Hutton: If it helps the hon. Gentleman, I will write to him and other members of the Committee to set out the memorandums of understanding.

Mr. Burns: I am extremely grateful to the Minister for that commitment.

Dr. Harris: I do not plan to press my amendment, but I want to ask the hon. Gentleman whether he shares my concern that the Government say that the only way to achieve the aims that he, the BMA and I want in terms of co-ordination, to varying extents, is to retain powers in the Bill that I would like removed in the cause of greater independence for the Commission for Health Improvement. There is at least a strong argument that co-ordination could be made much more specific without the wide-ranging powers that the Government seek to retain, perhaps as a crumb to deliver some of the co-ordination that the hon. Gentleman wants.

Mr. Burns: I should like to reflect on what the hon. Gentleman has said when I have read the guidance that the Minister has kindly offered to make available.

Mr. Hutton: It is not Department of Health guidance. It is protocols and understandings reached between the various bodies.

Mr. Burns: I should like to reflect on the subject once I have seen that guidance. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Mr. Heald: The Opposition support the extension of the powers of the Commission for Health Improvement. However, we are concerned about the co-ordination issues, some of which we have touched on, and we should like the Minister's response on two other issues.

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Subsection (5) refers to CHI co-ordinating or consulting the Audit Commission about its studies for improving economy in services. There has been some comment on that, and some concern has been expressed that it might reduce the role of the Audit Commission. Page 13 of this month's Health Service Journal prints an article that suggests that the real losers will be other inspectors at the Audit Commission, which will now have to consult CHI on its value-for-money inspection programme. The article refers to the commission's role as being to identify failings in the way in which NHS bodies are run, and that seems like a move into corporate governance that could push the Audit Commission to the margins.

The Audit Commission has a proud role in exposing the state of the NHS, as the Minister will no doubt recall from its recent report. Can he assure us that the role or at least the function of the Audit Commission will not be diminished, and that we will continue to have the active and independent scrutiny of what occurs in the NHS so that we know the waiting time position and how hospitals perform in terms of provision of service?

A great deal of power has been given to what remains a fledgling organisation; one that is still developing. Although many of us would say that the CHI has had its successes, it would be wrong if work such as that done by the Audit Commission did not continue. Will the Minister assure us that at least the nature of the work will remain?

The National Care Standards Commission will have a role in considering independent and private sector premises, in much the same way as the CHI does where patients are cared for under the NHS. However, I want to ask the Minister about the overlap. The NCSC starts work in April 2002, and will inspect and regulate health care in the independent and voluntary sectors. The BMA has suggested that it might be better to avoid the overlaps and have a single inspection regime that merged the CHI and the NCSC. It suggests that that would have the significant benefits of ensuring a uniform and consistent standard between the NHS and other sectors, standardising the quality of care and avoiding the anomaly of two different bodies inspecting a pay bed in an NHS hospital and a private hospital where NHS patients are often treated.

Today's leak on the possible BUPA contract is relevant. If patients were to go to diagnostic centres in the private sector and have operations in free-standing surgical units, the commission would clearly want to examine such services from time to time.

Dr. Harris: As would the Audit Commission.

Mr. Heald: Indeed.

Dr. Harris: We do not want to become too distracted, but the Audit Commission might want to consider whether such services gave value for money. The subject is interesting, as the hon. Gentleman is rightly saying, because of the split functions between the CHI and the NCSC.

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Mr. Heald: The hon. Gentleman makes a good point, although it struck me that he might almost be trespassing into party-political territory for a moment. Perhaps not.

Dr. Harris: Heaven forfend.

Mr. Heald: Heaven forfend indeed. Two bodies—one set up to deal with the private sector and the other to deal with the state sector and treatment under its aegis—could inspect the same premises. Of course, the commission would be able to use the expertise it gained from NHS inspections in dealing with the private sector. The same limited pool of expertise might be used more effectively, and it would complement the Government's plans to expand the involvement of the private sector in the NHS.

Section 9 of the Care Standards Act 2000 dealt with co-operative working. It is true that the CHI and the NCSC cannot carry out functions on each other's behalf but the measure, as with so many health service measures, is a cumbersome way of doing things. Would it not be possible to establish a single regime for the NHS and the independent health care sector?

Will the Audit Commission's role be diluted? Would it not be wise to merge the roles of two bodies that will do the same work in different sectors?

12.15 pm

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