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Standing Committee A
Tuesday 4 December 2001
[Miss Ann Widdecombe in the Chair]
Further functions of the Commission for Health Improvement
Question proposed [this day], That the clause stand part of the Bill.
Question again proposed.
Mr. Oliver Heald (North-East Hertfordshire): I welcome you to the Chair, Miss. Widdecombe.
I asked the Minister two further questions about the clause. The first question related to the vexed issue of the effect of clause 12(5) on the role of the Audit Commission. Under section 21 of the Health Act 1999, the Commission for Health Improvement can undertake Audit Commission work or work jointly with the Audit Commission. Subsection (5) requires the Audit Commission to consult the commission about its value-for-money studies. The notes refer to that as ''better co-ordination''. Will the Audit Commission continue in practice to undertake its value-for-money studies when the CHI is, or could be, competent under section 21 of the 1999 Act? If the Minister is prepared to give a clear statement on that, we will be happy; or relatively so.
Secondly, clause 12(2)(c) adds a provision for the CHI to report 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''.
Does that provide a route by which the problems encountered by bodies such as the national confidential enquiry into perioperative deaths might have their concerns addressed, or is it simply designed to discover why the information that the Health Department receives is less accurate than it might be?
I will give a taste of the problems that the cancer study revealed. The NCEPOD study referred to the problem of data and explained that it found
''poor hospital information systems. Medical records and their content are one of the building blocks of our medical system and problems with the organisation and content of medical records have a considerable impact on clinical care and education. The report contains evidence that medical record keeping is falling below acceptable standards. Unfortunately, poor record keeping will inevitably lead to poor completion of NCEPOD questionnaires, which might call into question the validity of some of the data in the Enquiry.''
The report has become a huge media story, and it is obviously not helpful to the Government to be told that cancer is dealt with in such an appalling way in this country. If a problem exists with the methodology,
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data and medical records, it would be good to sort it out so that we know where we are. The study draws conclusions such as:
''Most patients with cancer who die within 30 days of an operation are admitted as an emergency or urgently and many are not referred either to a surgeon with a subspecialised oncology interest, a multidisciplinary team, medical oncologist or specialist cancer nurse when it is indicated. Clinical networks and local guidelines should be constructed in order to ensure that all patients with cancer receive and early and appropriate referral to specialists.''
There is obviously a serious concern about the treatment of cancer.
Will the provision in subsection (2)(c) help reports such as the NCEPOD one, or is it designed for internal Department of Health purposes?
The Minister of State, Department of Health (Mr. John Hutton): I, too, welcome you back to the Committee, Miss Widdecombe. You have missed many interesting debates, but I hope that we will entertain you this afternoon.
The hon. Gentleman claims to ask two further questions, although only one of them is a genuine further question, as his remarks about subsection (5) have been exhaustively debated. He described it as a vexed question, but there is nothing vexed about the intent or purpose behind that subsection. To put the hon. Gentleman and his hon. Friends at ease, the Bill makes no changes to the value-for-money responsibilities of the Audit Commission.
Mr. Heald: I asked whether the Audit Commission would continue in practice to undertake its value-for-money studies when the CHI is, or could be, competent under section 21 of the 1999 Act.
Mr. Hutton: That is precisely the point that I have just made, so I hope that we can move on. I have spent the best part of 45 minutes answering that question in a variety of ways, and I hope that we have now put the issue to bed.
The hon. Gentleman asked about confidential inquiries. In the main, the CHI's role will be to follow up specific issues relating to service provision that can be traced to individual providers, when it can make sensible recommendations. As the hon. Gentleman probably knows, the information from confidential inquiries is anonymised. Such inquiries do not state, ''This hospital is doing X and that hospital is doing Y, and it is all terrible.'' It is anonymised information, so the issues raised by those inquiries are different from issues relating to individual service performance in individual trusts, hospitals or units.
The responsibility for oversight of confidential inquiries lies with the National Institute for Clinical Excellence, which makes sense, given that organisation's other responsibilities. There is no prospect of confidential inquiries coming within the remit of the clause, because CHI's purpose and function is different.
The issues that the hon. Gentleman raised relating to the confidential enquiry report on cancer services will be addressed differently, in ways that will involve the Commission for Health Improvement. For
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example, the Government have published their cancer plan, which earmarks investment for improved cancer services. The NHS plan addresses the issue of cancer services and the importance of speed of access to specialist care in the event of suspected cancer. The Commission for Health Improvement will have an expanded role in relation to the performance of the NHS, the cancer plan and meeting the plan's objectives. It will be able to pursue the issues of quality care provided to patients who have cancer with a similar jurisdiction or remit in relation to other hospital-based service provision. The CHI will have an obvious role to play in the areas to which he referred, but is unlikely to develop responsibilities as regards confidential inquiries.
Mr. Heald: Clearly, subsection (2)(c) exists because the Government are unhappy with the quality of information that they are receiving from some NHS bodies and providers. They are sending in the CHI to review and report on that and to ensure that information is as accurate as possible. The National Institute for Clinical Excellence has a supervisory role for the study to which I referred, but, if that body is frustrated because the quality of information that it receives for its studies is no good, will it be able to send in the CHI, or does it have its own arrangements for improvement of quality?
Mr. Hutton: Certainly, the CHI has an important responsibility in relation to quality of data that the NHS uses, and the confidential inquiry reports produce important messages about the quality of service. However, that information is anonymised and, although I do not dispute that the CHI may want to consider the data that is assembled, and will be able to do so if it so chooses, we do not have any intention to transfer responsibility for the confidential inquiries from NICE to the CHI.
Dr. Evan Harris (Oxford, West and Abingdon): I am interested in this information. I remember how useful NCEPOD, the national confidential enquiry into perioperative deaths, CESDI, the confidential enquiry into stillbirths and deaths in infancy, and other inquiries were when I was working in the health service. They are powerful tools. Because they are confidential, they have a ''Heineken effect'', whereby they can reach parts of the health service and data that other inquiries cannot reach. I listened carefully to the Minister's remarks, but surely it would be sensible to concentrate and co-ordinate all such inquiries, whether confidential or not, within one body. NICE seems to be set up for a rather different purpose from CHI and these confidential inquiries.
Mr. Hutton: I apologise if I have not made my point clearly. That type of data collection is fundamentally different from most other types, which are not anonymous. That is why there is a difference and why we have drawn the line in a different place. NICE has the overall responsibility for this issue in the NHS and that is an appropriate place for the confidential
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inquiries to lie. CHI's responsibilities are slightly different. It has a remit to improve data quality and it may want to consider that in relation to the confidential inquiries. However, the responsibility for overseeing them lies in the right place.
Dr. Harris: I remember debates in which the Minister lamented the fact that there was no amendable primary legislation governing NICE or its remit. I hope that the Government will reconsider the issue. It would be useful to have the same type of debates and scrutiny over the role, limits, powers and independence of NICE that we are having about the remit and role of the Commission for Health Improvement regarding audits of quality.
Mr. Hutton: I am not trying to prevent the hon. Gentleman from having that debate if he so chooses, but we look in vain for any sign that he wishes to have that debate in relation to the Bill; he has not tabled any amendments to that effect. He is free to table whatever amendments he likes on these issues; then we may have the debate that he is seeking. We are clear in our mind about where responsibility should lie. I have explained to the hon. Gentleman some of the thinking behind that and why we are not proposing any amendments along those lines. However, the hon. Gentleman is perfectly free to do so at any time.
This has been a long debate. I have tried several times to respond to the points raised. I have nothing further to add and I hope that the Committee will support the inclusion of the clause.
Question put and agreed to.
Clause 12 ordered to stand part of the Bill.
Commission for health improvement: inspections and investigations