NHS Reform & Health Care Professions

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Mr. Hutton: I beg to move amendment No. 124, in page 17, line 42, after 'providers' insert

    ', and persons who provide or are to provide health care for which NHS bodies or service providers have responsibility,'.

The Chairman: With this it will be convenient to take Government amendments Nos. 27 to 30.

Mr. Hutton: In our earlier debates the hon. Member for North-East Hertfordshire raised his concern about who has responsibility for inspecting independent providers providing services to NHS patients. You, Miss Widdecombe, need no introduction to the subject; I remember you speaking eloquently on it in previous Committees.

I shall not detain the Committee long on these amendments. I hope that they substantially meet some of the recent concerns expressed by Opposition Members. We are trying to preserve consistency and continuity and to ensure that the public interest is properly safeguarded. The amendments place CHI's new inspecting functions on broadly the same footing as its existing functions. The commission already has these powers of inspection in relation to its existing clinical governance reviews of independent sector

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providers. The amendments allow it to exercise its new inspecting functions in relation to independent sector providers of NHS services in exactly the same way. In that sense they promote consistency and continuity.

However, there is one important difference; I hope that the Committee will bear with me while I explain it. If the commission finds that services provided by an independent provider are of an unacceptably poor quality or that there are serious failings, the amendments will not allow it to recommend that the Secretary of State take special measures in relation to those failing independent sector providers.

We should not lose sight of the fact that such providers are not accountable to or managed by the Secretary of State. A different set of arguments applies in relation to NHS units, on which there is clearly a direct accountability arrangement. Failure of an independent sector provider to provide services of the right quality should ultimately be a matter for local commissioners to respond to once the commission has identified a quality problem with those services.

The amendment provides continuity and consistency but we have decided, in the interests of common sense, to ensure that the appropriate action consequent on such a negative report from the commission is for local commissioners to respond, not the Secretary of State directly. He is not in a direct position to influence the service provided by the independent sector provider.

4.45 pm

Mr. Heald: We have some doubts about the overall structure that will apply, as a result of the amendments, to inspections of private sector premises used for NHS purposes and pure private provision. The issue is important, given the Government's announcement—or leak—about BUPA and the hospital in Redhill. The use of our capacity to deal with the needs of patients in the private sector as well as the public sector is clearly welcome, but further use of that approach raises issues about inspection and quality.

Last year, the Government set up the National Care Standards Commission, which starts work in April. Its job is to inspect and regulate health care in the independent and voluntary sectors, as well as social care premises. I do not understand the sense of two bodies inspecting the same premises. The NCSC will go into private premises and examine conditions. Why should it not consider what has happened to the NHS patients? Equally, the Commission for Health Improvement will no doubt inspect the premises on behalf of NHS patients, and will find things that it might feel are also relevant to the private sector. Should the inspections not be co-ordinated so that only one body visits each premises? Joint working is possible under section 9 of the Care Standards Act 2000, so may we have an assurance that that will always happen?

Do we need two regulatory bodies? The Government are keen on setting up committees in response to current issues, and several quality and safety bodies have been established. Historically, the

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decision might have been sensible. About a year ago, when the Government had set their face against the use of the private sector, I remember the Secretary of State for Health saying that the NHS was thankfully a monopoly provider, and that it would long remain so under Labour. Now we hear something different. Given that circumstances have changed, is there not an opportunity to reconsider whether we need two bodies to do the same job on one group of premises? We could merely have one body for the private and public sector.

Today's issue of The Independent suggests that the ambition of the Secretary of State is to turn the Department into a health regulator. It states:

    ''The Department of Health is to be turned into an 'arms length' regulator of health standards in an attempt to release hospitals from the grip of central Government control''.

There is no sign of that in the Bill, but if it is the Government's intention that it genuinely be the regulator, that prompts two questions. First, why have a separate body—CHI—if the Government will carry out regulation at arm's length? Why not simply let the Department of Health do it? I suppose that the answer is that there is at least a flavour of independence about CHI. Secondly, why are numerous bodies needed?

I understand that, when the Minister and his officials gave instructions to the draftsmen, the NHS may always have been intended to be a monopoly provider. However, now that we know that the plan is different, should the thinking be reconsidered?

Dr. Harris: I have looked through the amendments. I am clearly experiencing a mental block, but I should be grateful if the Minister would explain in what way they do not imply that CHI's powers to report on NHS bodies to the Secretary of State will not apply to private bodies that provide health care for which NHS bodies or service providers have responsibility. I struggle to follow how the distinction comes about.

Will the Minister clarify the position on patients treated within the NHS estate but as private patients? Has that position changed? Is the NHS body—the hospital in which those patients are treated—responsible only if the patients are treated by NHS staff, or also if the wing is managed by the chief executive, or even if it is in the same curtilage but has a different management because there is a separate subsisting private hospital in the NHS grounds? The subject has been raised before, but it will be even more important to clarify it when we consider what the Government intend in terms of reporting the relevant bodies and providers to the Secretary of State.

In light of this morning's announcement about a privately managed hospital contracting for NHS work and presumably still being responsible to its shareholders, I should be grateful if the Minister would say whether that will be covered simply by virtue of the contractual relationship. The relevant body would not appear to be the NHS within the hospital, but the hospital doing its own thing for the NHS by means of a contract, service agreement or whatever the new jargon is.

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Mr. Heald: Does the hon. Gentleman agree that one of the problems with a multiplicity of inspection bodies is that one of them could discover a piece of extremely worrying information but not tell another, for whatever reason? Patients could miss the full coverage of inspection that one would expect, and there would be gaps in the system. It would be good to do something to avoid that problem.

Dr. Harris: I agree. The hon. Gentleman knows that my view—I think that it was also that of his party at the time of the passage of the Health Act 1999 and the Health and Social Care Act 2001—is that a unified inspectorate should consider only the quality of health care provision. The Government rejected that idea due to their aversion to lump the private and public sectors together, even for the purposes of quality assurance, which was initially understandable. As they seem to have got over their concerns on that lumping together, it seems mysterious that parallel structures are being set up. Given that the Government are not afraid to make structural reforms, even for their own sake, let alone to ensure quality, the simplest thing to do would be to unify the two bodies.

Mr. Hutton: Obviously, I failed to make the simple case for the amendment. It would simply promote consistency and continuity. CHI already has the powers in relation to its existing ability to inspect. We are simply extending those in relation to the new range of inspections that CHI will be able to carry out.

The hon. Member for North-East Hertfordshire raised a philosophical but fair question about the reasons for having two distinct bodies—the National Care Standards Commission and the Commission for Health Improvement. That is Parliament's decision. The hon. Gentleman disagrees with that distinction, but our arguments in favour of it are well rehearsed. He will be aware of them, as will every member of the Committee. I do not want to go into detail on that, because we can deal with the matter either in a clause stand part debate or on another occasion.

The amendments are simple in their intention and effect. They do not affect the issue of access to private sector premises. The hon. Gentleman was expressing concern about that, but they have no bearing whatever on the issue. The issue of access to premises is dealt with in clause 13(2). If the hon. Gentleman wants to raise any concerns about that, we can deal with the matter when we debate that clause.

The hon. Gentleman wants to debate the rationale behind having two inspection agencies, but those arguments are well rehearsed—we have been round that house. However, there is one issue that he was right to draw the Committee's attention to. CHI is not a registration authority. That is the fundamental difference between its role and that of the NCSC. The NCSC registers providers and gives them the authority to provide a service that meets the national minimum standards. CHI does not have that function in relation to the NHS.

When we were legislating to set up the NCSC we wanted, as any sensible person would, the two bodies that we felt were necessary to be able to co-operate.

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That is what section 9 of the Care Standards Act 2000 is about. The two organisations are sensibly discussing the way forward and how their co-operation can be developed before the NCSC assumes full executive responsibility in April 2002. We would reasonably expect the majority of health care expertise to reside with CHI, so it makes sense for the two agencies to consider carefully how the work can be shared between them, in the best interests not only of the public but of the taxpayer. I have no doubt that they will do so.

I was thrilled and interested by the use of the word ''curtilage'' by the hon. Member for Oxford, West and Abingdon (Dr. Harris). It reminded me of the many months that I spent studying land law at university. I did not understand the term then and I have no recollection whatever of the learned lectures that I listened to on the subject. Without getting tripped up—there are many other better and more recently practising lawyers on the premises—[Hon. Members: ''No!''] I was fishing for that compliment, and I am grateful.

The issue that the hon. Gentleman raised is an unnecessary distraction, because the provision is not dependent on where the private hospital is located, and whether the hospital is within the curtilage of an NHS hospital is completely irrelevant. The only relevant issue is whether it provides services to NHS patients. The precise physical location of the independent sector unit—whether it is within the grounds of an NHS hospital or not—is irrelevant to the issue of CHI's competence and jurisdiction. All that matters is whether the unit provides a service for NHS patients.

The provision is not consequent on any other complicated set of equations, such as the precise nature of the managerial connection between the private unit and the NHS. It is certainly not determined by the physical location of the private unit. To base powers on that type of distinction would be absurd. That would make the system impenetrably obscure and would not serve anyone's interests.'

5 pm

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