NHS Reform & Health Care Professions

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Mr. Peter Atkinson: I am grateful to the Minister for explaining that. As my hon. Friend the Member for North-East Hertfordshire said, I made my point only fairly well, so the Minister may not have understood what I meant. However, to give an example, a special diet or food provider would not, from what he has said, be included in the powers that the commission has for right of entry.

Mr. Hutton: I am not quite sure what premises the hon. Gentleman is describing.

Mr. Atkinson: Kitchens, or the company that provides food in them.

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Mr. Hutton: I am reasonably sure that if a private, or even NHS, provider were using a contract supplier in a kitchen, it would be clear whether the definition in subsection (2)(c)(ii)(c) covered those premises. I am not trying to be judge and jury; I will not be making the decisions. Ultimately, it is for the commission to decide whether the premises are covered by that definition. If there is a challenge, such questions will have to be resolved in the normal way. The commission might decide that it wanted to look at premises if, for example, they had a bearing on the nutrition of patients staying in a hospital in terms of whether the food was of the right standard. However, such matters will be dealt with on a case-by-case basis; the judgment will not be mine. In the main, the definition is intended to catch those premises that the commission potentially will be able to inspect.

5.30 pm

Mr. Heald: As usual, our concern is that subsection (2)(c)(ii)(c) is very widely drawn. Reference is made to

    ''any other premises used for any purpose connected with the provision of health care for which persons mentioned in paragraph (a) or (b) have responsibility''

and those two paragraphs are also widely drawn. The Secretary of State has the power to direct the commission; he could, if he wished, direct it to go and report on some kitchen premises that were only vaguely associated with health care.

Mr. Hutton: No, that is not the case. The Secretary of State cannot use a direction or regulation-making power to overcome an express provision of primary legislation. On the example of the kitchen supplier given by the hon. Member for Hexham, subsection (2)(c)(ii)(c) makes it clear that the premises that he cited would have to be the under the responsibility of the person who is providing the service. If the service provider had no responsibility for the premises, he would be outwith the remit of the Bill's powers of entry and inspection.

We are not a bunch of Nazi stormtroopers, sending an army of inspectors around the country to poke their noses into every nook and cranny of corporate and business life. The hon. Gentleman is a man of immense common sense, and I am sure that he understands that. Without trying to answer his question, because I am not fully aware of all the hypothetical circumstances surrounding it, the test that will have to be satisfied in order for his example to be defined as premises for these purposes is set out in the Bill. The service provider must have some responsibility for those premises. That is a reasonable line to draw. If he has such a responsibility, it is fair that the commission should have the power of entry.

The hon. Member for Hexham also referred to charging. He expressed some surprise about that matter, but it was dealt with when the commission was established, so there is nothing new about it. As far as I am aware, there have been no arguments about responsibility for charging. The CHI seeks to recover the costs incurred by the inspection, and those costs are shared with the host trust. That is the right way to fund the commission.

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I was asked what we mean by unacceptable standards. Essentially, we have to appreciate who is doing the inspection work; it is driven by clinicians and by clinical standards. Those standards will be published so that service providers, patients and the public are clear about the CHI's expectations. The fundamental question—whether services are unacceptable—will be made by the inspection team. It will be a clinical judgment based on what they have observed and what the data tells them about the service.

On the next point, I have to agree with the hon. Member for North-East Hertfordshire. We must not allow this proposal to become a barrier to innovation and change. The NHS is a service driven by science. Both science and technology change, sometimes daily, and it is in nobody's interests to have an inspection and regulatory mechanism that imposes a straitjacket on change across the service. There is no evidence that the CHI is discharging its responsibilities in that way. If the hon. Gentleman wanted me to put that on the record, I am happy to do so. The whole exercise must add value; it must improve patient safety, clinical outcomes and standards of care across the NHS. We will not do that by placing a ball and chain around the neck of the innovators and entrepreneurs in the health service who want to move it forward, and we have no intention of doing so.

I was also asked about special measures. We have not defined those in the Bill, and rightly so, because we need to allow as much flexibility as possible. Such measures could include further involvement by the commission in relation to the body or service provider. They could include special action by the NHS Modernisation Agency in terms of re-engineering or improving aspects of services being provided; they could involve the use of the Secretary of State's powers of intervention under section 84 of the National Health Service Act 1977. Specifically in relation those powers, the measures could involve the replacement of board members and involve services provided by a third party or by franchising, including management function or service provision. The CHI will make the judgment on what special measures are necessary. The measures should be interpreted not simply as a range of big sticks to bludgeon blameless people, in the sense used by the hon. Member for Oxford, West and Abingdon, but as sensible measures to help to improve services for patients.

Mr. Heald: Is the Minister suggesting that the CHI would set out in its report what special measures were needed, rather than simply saying that there is a case for special measures and leaving it to the Minister to decide what they are, so that we would all know what is being proposed in each case?

Mr. Hutton: I think that that would be the case, but the decision on what special measures should be taken will be a judgment for the Secretary of State. We shall not do that in a dark and smoke-filled room because the matter should be open to public inspection. We are trying to improve the public's national health service. The NHS does not belong to us or to the hon.

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Gentleman, but to the whole country and we have a responsibility to the public to conduct the debate as openly as possible.

The final point that was raised is the familiar hobby-horse of the hon. Member for Oxford, West and Abingdon; blame. The hon. Gentleman is obsessed with blame. That is a disappointing reaction and repetition of a flawed analysis based on a mistaken assessment of what the provisions are about. It is motivated essentially by a purely partisan assessment of the Government's actions. On each of those three counts, he is wrong. This is not about a blame culture, but about the necessary actions that the Government must be able to take to move from a position in which services are constantly criticised to putting in place the measures to address those complaints.

We have a responsibility, and the hon. Gentleman and I have a completely different view of that. Whatever his judgment about the direction of policy in the national health service--he disagrees fundamentally with it, as is his right--it is fully the responsibility of Ministers in any Government to suggest solutions to the problems. We can argue and argue about the nature of the problems, but we must go beyond the historic dilemma of poor results and performance in the NHS. That has always been addressed by Ministers in previous Governments, Labour and Conservative.

We know where the poor performance is and we can identify it. The hon. Gentleman can identify it in his own constituency. We need to put in place the measures to address such poor performance. Part of the solution is investment and we are providing that. Part of it is reform and we are making reforms; the provision is part of those reforms. We are constructing a mechanism to identify failures quickly; not subjectively, but informed by clinical assessment by the best people available to do that work. We will then construct the solutions. That is not blame; it is the Government discharging their responsibility to the public to put right poor performance. To characterise that as blame is to traduce and trivialise the arguments. It is a schoolboy debating point. The hon. Gentleman needs to go beyond that and engage with the serious issue of how we put right service deficiencies.

Part of the solution involves money, but money is not the whole solution. The Liberal Democrats think that everything can be solved with a shed load of cash, but that is simply not so. We must provide the cash, investment and reform and we must take measures that are sometimes difficult for people in the service. I accept that, but we must not flinch from taking the tough decisions required to put right poorly performing NHS providers. If we do not do that, we sell the pass and negate our responsibility to the House and our constituents, which is to address problems with public service delivery.

Mr. Simon Burns (West Chelmsford): Perhaps I can help the Minister, who is being a little unfair to the hon. Member for Oxford, West and Abingdon. Is the Minister aware of the comments that one of his harshest critics, the hon. Member for Winchester (Mr. Oaten), made at the Liberal Democrat party

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conference? He said that he thought that we needed to debate public services. He said that although the audience would not like it—I am sure that the hon. Member for Oxford, West and Abingdon does not like it—when we look at the health service we need to look at ''issues of insurance'', ''issues of charging'' and ''issues of hypothecation''.

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