NHS Reform & Health Care Professions

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Mr. Hutton: We should remind ourselves of the purpose of clause 12. In several important respects it is a significant provision. It would extend the commission's functions so that it could review any aspect of NHS care. Opposition Members have not mentioned its provisions with respect to publication of reports; a subject that I should have thought would be

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dear to their hearts. It also requires the Audit Commission to consult the commission with respect to its value-for-money studies.

There has been some misunderstanding about what subsection (5) is intended to achieve. Clause 12(5) does not in any way affect the functions of the Audit Commission, or what it chooses to do and the way that it discharges its functions. It is intended simply to advance the cause of co-ordination, which I understood that Opposition Members supported, and which we have spent the past hour and half discussing.

At the moment, the Audit Commission has an obligation to consult the Secretary of State. We want, under the Bill, to shift responsibility so that it becomes more independent of the Government. It makes sense, in the pursuit of co-ordination, for the Audit Commission to be given a responsibility to consult the CHI, which will discharge the relevant aspect of the work of monitoring the national health service.

We are not trying to bamboozle anyone or engage in a cloak-and-dagger operation to neuter the Audit Commission. The Audit Commission does an important job and highlights the issue of value for money in the national health service. Clause 12(5) does not affect the discharge of the Audit Commission's functions at all, but simply speeds and aids the process of co-ordination.

Mr. Heald: As I explained in my opening remarks, the worry is that the Minister is trying to bring about a situation in which a body is inspected either by the Audit Commission or the CHI, but not by both—thus diminishing the role of inspections on value-for-money issues and of the Audit Commission—and that the consultation in question is intended to be about commissioning issues of the type referred to by my hon. Friend the Member for Hexham (Mr. Atkinson). Will the Minister toy with those points a little longer?

Mr. Hutton: I shall not toy with them longer, because I have already made matters clear. The clause does not affect the responsibility of the Audit Commission for conducting value-for-money inspections. That stays with the Audit Commission. The Bill does not propose that responsibility for value for money should move to the Commission for Health Improvement. The Bill simply ensures that the Audit Commission, which now has responsibility for performance monitoring in the NHS—as it will under the Bill—has a responsibility to notify the Commission for Health Improvement about its value-for-money exercises. It does not seek to shift responsibility for value-for-money exercises and studies to the CHI. That is clear from the Bill.

Mr. Atkinson: It is a fine point, but if the Audit Commission decided to investigate an aspect of the health service on a value-for-money basis, would it have to submit its proposal for an investigation to the Commission for Health Improvement and seek its approval? If the commission withheld its approval because the Audit Commission's investigation might obstruct another investigation, would the Audit Commission withdraw? That is the central issue.

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Mr. Hutton: If the hon. Gentleman had read the Bill, it would be obvious to him that it did not affect those issues. The Bill does not state that the Audit Commission must get the approval of the Commission for Health Improvement before it conducts a value-for-money study. Is the hon. Gentleman looking at the same Bill? I have a strong suspicion—I do not want to labour the point—that there is a make-work scheme under way among Opposition Members. They must be looking at a different Bill.

Mr. Heald: On a point of order, Mr. Hurst. Is it in order for the Minister to say such a thing when the Health Service Journal has raised this important issue?

The Chairman: It is in order. In debate, Members hear what other Members say.

Mr. Hutton: I accept that ruling, Mr. Hurst. However, it is clear that the points raised by Opposition Members have nothing to do with the Bill.

Mr. Atkinson rose—

Mr. Hutton: I have already given way to the hon. Gentleman. He wants to detain the Committee, whereas I want to move on. The Committee understands—I hope that my hon. Friends do—that clause 12(5) simply provides for sensible co-ordination. It does not affect functions or responsibilities. It does not transfer responsibility for value-for-money studies from the Audit Commission to the Commission for Health Improvement. Anyone with a fair mind who examines clause 12(5) would reach that conclusion.

The other point raised by the hon. Member for North-East Hertfordshire concerns the National Care Standards Commission. Nothing in clause 12 affects that body. I understand that he might want to explore the wider issue of who inspects, for example, private hospitals. That would be sensible, as private hospitals may be providing more care for NHS patients in future. Those issues are dealt with by amendments that I have tabled to clause 13, which makes it clear that the responsibility for the inspection function in relation to NHS-funded patient care lies with the Commission for Health Improvement.

I can understand that there is an argument about the wider issue of the co-ordination of functions between the National Care Standards Commission and the CHI—Opposition Members have expressed their views on that. We have made it clear in the Bill that the NCSC and the CHI can co-operate in the discharge of their functions, particularly in relation to the functions that we have discussed today. Parliament has left those matters to those bodies in previous legislation and a sensible and fair balance has been struck.

The hon. Member for Oxford, West and Abingdon raised several questions about aspects of the clause. Subsection (2)(a), in which he was interested, will enable CHI in future to carry out more general reviews of services provided to NHS patients. That is why we have included that wording in the Bill. The hon. Gentleman also referred to subsection (2)(c), which will enable the CHI and the new Office for Information

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on Health Care Performance within that body, for which clause 14 makes provision, to carry out clinical audits for the first time, including those currently within the work programme of the National Institute for Clinical Excellence. The hon. Gentleman asked me who might be covered by the term ''others''. The term includes not only NICE, but the work of the royal colleges in that regard.

The hon. Gentleman's third point concerned clause 12(3), one of the most important provisions in the clause, which was barely referred to by Opposition Members apart from the hon. Gentleman. The subsection relates to an important part of the CHI's new functions, which I want to elucidate for the hon. Gentleman's benefit. The Commission for Health Improvement, through its new Office for Information on Health Care Performance, should take over responsibility for publication of NHS performance ratings and indicators. The clause will facilitate that.

The Department is working closely with the commission to ensure a smooth period of transition towards independent publication of those data, which includes consulting the commission on the content of the next set of performance indicators, which are due next year. We expect the commission to continue working closely with the Department toward a joint publication of performance ratings and indicators in the summer of 2002. From the summer of 2003, the commission will take over full responsibility for publishing performance ratings and indicators on criteria agreed with the Department that reflect Government priorities for the health service. It is part and parcel of the greater role and independence of the commission that it should assume responsibility for what I acknowledge—as I am sure does the hon. Gentleman—is a crucial area in determining progress toward higher quality in the NHS.

Dr. Harris: I welcome most of the Minister's comments, for reasons that I have previously given in terms that were intended to be acerbic about the current quality of the outcome measures and performance indicators. The Minister referred to criteria set out by the Government to reflect their political priorities. It is arguable that that is the wrong approach and that the criteria should be oriented towards quality and value for money, not political priorities. Surely it will be difficult for an independent commission to stomach basing its work on political priorities rather than better quality health care and value for money.

Mr. Hutton: There is a tautology in the hon. Gentleman's argument. Throughout the debate he has bemoaned the fact that the clause is about shifting the blame, but he has a go at us when we say that it is our responsibility to fix the priorities for the national health service. It is our responsibility to do that. It would be quite inappropriate and wrong for this House to shift lock, stock and barrel the responsibility for setting the priorities for the national health service to the Commission for Health Improvement. I am sure that, if we did so, the hon. Gentleman would be popping up and down at Health questions, saying that

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we can no longer hold Ministers to account. He obviously has not thought through his position. It is appropriate and right for Ministers to set the priorities for the national health service. He describes those as political priorities; of course they are, because we are operating in a political context, but they are motivated purely by the desire to improve patient care. The two are not inconsistent.

Dr. Harris: We are having a useful discussion in which there is a difference of agreement. I accept some of what the Minister says. I am prepared to meet him halfway: it would be legitimate for the Minister to set priorities for the health service if he ensured that there was the same extent of independent scrutiny as there is for those who are forced to do the Government's bidding when those priorities are set. I made that point when speaking to a previous group of amendments. The Government cannot set priorities reckless as to their effect on the quality of health care and expect those who are subject to monitoring of performance and quality of delivery by the Commission for Health Improvement to take the blame. The more independent the commission is, the more important it is that the Government's priority setting and directions are subject to inspection.

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Prepared 4 December 2001