|NHS Reform & Health Care Professions
Mr. Peter Atkinson (Hexham): My hon. Friend expressed many of the concerns that I was going to express on the relationship between CHI and the Audit Commission, but the Minister may be able to help me on one or two details. Subsection (5) is opaque, in that it amends the Audit Commission Act 1998 to allow CHI to do something that it was allowed to do under the Health Act 1999. However, the explanatory notes, which are always helpful in such matters, say that
Mr. Heald: Does my hon. Friend agree that the Audit Commission's role should not be diminished, especially if the weekend press reports that the NHS is wasting between £7 and £10 billion are accurate?
Mr. Atkinson: Indeed so. My hon. Friend emphasises the crucial role that the Audit Commission plays in the NHS.
The 1999 Act empowers the Commission for Health Improvement to commission the Audit Commission to investigate value for money. Does the new relationship detract from the Audit Commission's right to do its own fishing expeditions? Is all its future research and investigation to be done at the behest of the Commission for Health Improvement? Conservative Members worry that CHI, for various reasons, could restrict the Audit Commission from doing what it wanted to do with a free hand, and restrict it to
Column Number: 193investigating areas that were priorities for CHI. That would represent a loss of independence and effectiveness for the Audit Commission.
Dr. Taylor: May I ask the Minister about the extension of functions for the Commission for Health Improvement? Would he regard it as that body's duty to comment on reports from other bodies? As an illustration, I refer to the Whipps Cross report, which came out a few weeks ago but does not seem to have had the publicity that it deserved. It contained three important lessons for the NHS, and if the commission was allowed to comment on them, they could be given more publicity. The report blamed in part the rift between clinical staff and management, the use of agency nurses and the adverse effect of rating NHS hospitals for waiting times in accident and emergency departments. The commission should be able to comment on such reports and to make the facts more widely known.
Dr. Harris: I have a number of questions. The first is about subsection (2)(a), which replaces the phrase
My second question relates to subsection (2)(c), which provides for an extra function for the commission:
Subsection (2)(c) concludes by stating that the commission will have the function of conducting reviews and making reports on
Mr. Heald: Does the hon. Gentleman consider that it might be worth questioning the Minister on whether, for example, the provision would cover the confidential national inquiry into perioperative deaths and cancer treatment, which was publicised today by the media? One of the inquiry's conclusions is that the quality of data and the difficulties faced as a result of poor hospital information systems has been a substantial problem. Should not the CHI be investigating such issues?
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Dr. Harris: Certainly. It would help if the commission could consider the quality of audit data and information in the NHS. That function might also allow the commission to compare the comprehensive, careful work done by successive confidential inquiries into perioperative death, which are based on clearly established data collection with rational end points, rather than investigate whether accident and emergency beds have wheels. The latter point has never been of much interest to those patients whom I have treated. They want to know when they will be triaged, when they will see a doctor, when they will be given a management plan and when they will get a bed on a ward to receive the privacy and care that they require. They do not particularly care what sort of bed or trolley they happen to be on. Will the Minister reassure me that that function will bear down on the rationality of outcome measures to which the NHS is subjected, which are of variable quality?
My third question is why the clause does not repeal sections 20(3) and (4) of the 1999 Act. Subsection (3) states:
Mr. Atkinson: The hon. Gentleman raises a pretty good point, which I tried to raise earlier. Like him, I cannot understand why the Secretary of State needs so many powers of direction. I am also concerned that, at the next stage, the commission can instruct the Audit Commission. In effect, a ministerial chain of command runs right down to the independent Audit Commission.
Dr. Harris: I listened carefully to the hon. Gentleman's valid points, and I come now to the provision that he mentioned.
According to the explanatory notes, clause 12(5)
Column Number: 195between the Audit Commission and the Commission for Health Improvement is a direct consequence of the clause. I accept that there might be concerns about subordinating the power of the Audit Commission, but whether or not that is a good thing, co-ordination is possible.
My argument earlier was that a duty of co-ordination could be placed on other bodies, even non-statutory ones. The Minister suggested that the Government were not keen to do that in the way that I suggested. I think that that was an excuse to allow the Secretary of State to retain much wider regulatory powers. That would enable him to curtail the independence and range of functions that we want for the Commission for Health Improvement. That perhaps explains the plea in the Kennedy report for the commission to be independent.
FinallyI should perhaps have raised this subject in relation to my second pointclause 12(3) refers to the additional functions
(b) the assessment of performance against criteria.''
Alternatively, will it mean comparison of like with like across a range of hospitals, with attention paid to including all those that are comparable? That would seem to entail a large programme of work, carried out, in principle, by commissioners, who should be checking performance, and either by what are to become strategic health authorities, or under some of the performance functions of what will soon be only four regions of the NHS executive, or whatever it will be called in future.
The clause raises a series of issues that the explanatory notes do not deal with in sufficient detail. Specific examples of the powers that the Government envisage with respect to the new Commission for Health Improvement would provide helpful elucidation.
|©Parliamentary copyright 2001||Prepared 4 December 2001|