NHS Reform & Health Care Professions

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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

    ''the Audit Commission must consult the Commission for Health Improvement on its programme of Value for Money studies in relation to the National Health Service as part of better co-ordination of regulation of the NHS.''

I am confused by the question of regulation, as the Audit Commission is not a regulatory body but a body that considers issues related to value for money.

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

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investigating 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

    ''particular types of health care''

with the words ''health care''. I presume that it is not simply a desperate desire to save words. Did the original wording restrict what the Commission for Health Improvement could investigate?

My second question relates to subsection (2)(c), which provides for an extra function for the commission:

    ''the function of conducting reviews of, and making reports on, the quality of data obtained by others relating to the management, provision or quality of, or access to or availability of, health care for which NHS bodies or service providers have responsibility''.

What is covered by ''others''? Does it include some of the questionable performance figures that resulted from the star performance traffic-light system of nonsense performance management to which the health service was recently subjected, which was mentioned in the Whipps Cross report referred to by the hon. Member for Wyre Forest? What is envisaged?

Subsection (2)(c) concludes by stating that the commission will have the function of conducting reviews and making reports on

    ''the validity of conclusions drawn from such data, and the methods used in their collection and analysis''.

Will that be a review of whether performance monitoring is rational—if so, it would be welcome—or is it based on some other proposal? It would be useful if the Minister were to give some examples.

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:

    ''The Secretary of State may give directions''—

it does not even say that he should make regulations—

    ''with respect to the exercise of any functions of the Commission.''

Subsection (4) states:

    ''The Commission must comply with any directions under this section.''

The hon. Member for Wyre Forest originally raised the issue. The provisions give the Secretary of State wide-ranging powers to tell the so-called independent Commission for Health Improvement what it should do and how and when it should do it, and the commission must comply. Why must those powers be retained if the commission is still independent? Under what circumstances would the Secretary of State's directions be so lacking in obviousness that an independent commission would not see the need to comply with them? What directions has the Secretary of State already issued under section 20?

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)

    ''provides that the Audit Commission must consult the Commission for Health Improvement on its programme of Value for Money studies in relation to the National Health Service as part of better co-ordination of regulation of the NHS.''

That may be sensible. Indeed, when we debated the previous group of amendments we discussed the need for greater co-ordination. In response to an intervention by the hon. Member for West Chelmsford, I argued that it was possible to specify a requirement for greater co-ordination in the Bill. According to the explanatory notes, the co-ordination

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between 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.

Finally—I should perhaps have raised this subject in relation to my second point—clause 12(3) refers to the additional functions

    ''of conducting reviews and of carrying out investigations''.

Those include:

    ''(a) the collection and analysis of data, and

    (b) the assessment of performance against criteria.''

I should be grateful if the Minister would explain what is behind that. I do not know what he is after, so I make no judgment about whether it is a good or a bad thing. Does he want the Commission for Health Improvement to have a wider performance-management function? That would mean a large commission undertaking regular inspections in some detail. I am not making a criticism, but I should be grateful for an explanation. Will that mean assessment of performance against criteria in individual cases—something that I should have thought would be already covered by the functions of the Commission for Health Improvement?

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.

12.30 pm

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.

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