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Sir Patrick Cormack: On a point of order, Madam Deputy Speaker. Could we have English spoken in this Chamber, not these extraordinary mnemonics and so on? Can the Minister explain what he is saying?
Madam Deputy Speaker: Order. Perhaps Dr. Ladyman can respond to that point of order.
Dr. Ladyman: I certainly can. The Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection are often referred to as CHAI and CSCI for the sake of speed.
We wish to allow for the growth of organisations where those two services will have joint responsibilities. We want them to have the flexibility to be able to work together. For example, we may choose to provide in regulations that all adult mental health services provided under a section 31 partnership should be subject to a joint performance review under the clause. The Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection would be responsible for drawing up criteria under that section, which might include aspects such as how joined up and seamless was the provision of services under the partnership. The services provided under the partnership would still receive separate performance ratings for their health and social care elements, but we felt that it would be useful to have a separate rating to be able to judge the added value that the partnership had given to the service provision. We will consult all relevant stakeholders closely before drawing up any regulations under the provision and prescribing the services that will be subject to a joint review. I hope that that goes some way towards tackling the anxieties that the hon. Member for Sutton and Cheam (Mr. Burstow) expressed earlier about our determination that both organisations should work closely together.
Government amendment No. 359 has been tabled in response to a commitment that the former Under-Secretary of State for Health, my hon. Friend the Member for Tottenham (Mr. Lammy) made in
Committee. That shows the hon. Member for West Chelmsford (Mr. Burns), who has unfortunately left his place, that my hon. Friend listened in Committee and was prepared to respond to good points.The amendment makes it clear that the Commission for Healthcare Audit and Inspection will be concerned with all the factors in clause 43(2) when it exercises any of its functions that relate to NHS health care, not only the functions to which that provision currently refers.
The list of the Commission for Healthcare Audit and Inspection's functions in clause 43(2) will be extended to include giving advice and information under clauses 49 to 50 to the appropriate authority—my right hon. Friend the Secretary of State, the Assembly or the regulator—reviewing data obtained by others in relation to providing health care and any conclusions drawn from such analysis under clause 51; and promoting the effective co-ordination of reviews or assessments that other bodies undertake under clause 52.
The amendment will therefore ensure that, in discharging those functions, as well as the functions under clauses 44 to 48, the commission will pay particular attention to availability and access; quality and effectiveness; and the economy and efficiency of providing health care. In discharging those functions, the commission, as specified in clause 43(2)(d) and (e), will also concern itself with the need to safeguard and promote the rights and welfare of children and the effectiveness of NHS bodies or persons who provide—or are to provide—health care.
We gave assurances in Committee that we would consider further the application of the clause and I therefore hope that Opposition Members will support amendment No. 359.
Government amendments Nos. 360 and 361 are among the cluster of amendments that we are considering. Amendment No. 360 amends clause 46 to ensure that the Commission for Healthcare Audit and Inspection can undertake a review of the overall provision of health care by and for NHS bodies in England and Wales. We are taking the opportunity to clarify the function because the clause as currently drafted technically enables the commission to review only health care of a specific description. Without the amendment, the commission might carry out a review of cancer services in England and Wales but not of NHS care more generally.
Amendment No. 360 aligns clause 46 with clause 47 when amended by amendment No. 363 expressly to enable the commission to review the overall provision of health care by or for English NHS bodies and cross-border strategic health authorities.
Amendment No. 361 would ensure that my right hon. Friend the Secretary of State could request the commission to undertake such a review, should he consider one necessary. That will enable my right hon. Friend to ensure that the commission undertakes such necessary work so that issues of interest to the public or Parliament will receive the required attention from the inspectorate.
I shall not speak in detail about the other Government amendments, but, if I get the opportunity to do so, I shall happily respond to any points later in the debate.
Chris Grayling: In the few moments available, I want to concentrate on new clause 2 and amendment No. 1. Before I do that, I emphasise that it is a shame that the Government did not see fit to include in new clause 38, which deals with joint annual reviews, provision for joint reviews between England and Wales to avoid the huge duplication that the measure will cause across borders.
New clause 2 gives CHAI the right to participate in the process of setting standards. Under the Bill, it is the duty of the Secretary of State alone to prepare standards for health care. Conservative Members believe that that is unacceptable. That is doubly true when the Bill gives the new Secretary of State, who, by his own admission, has limited knowledge and experience of health care, the power to frame standards. There is no involvement of the Commission for Healthcare Audit and Improvement, which has the job of monitoring and tracking the performance of our health care system and understanding when it is and is not doing well. We believe that CHAI should be formally involved in the process, and new clause 2 would enable that to happen. I intend—with your consent, Madam Deputy Speaker—to press new clause 2 to a vote.
5.45 pm
Amendment No. 1 returns the debate to what is, in our view, one of the big handicaps and impediments confronting the health service: the star-rating system, an ill-judged, ill-thought-out process that sets hospital against hospital, causes confusion in both clinical and management sectors, and throws up extraordinary anomalies.
Let me, in the few minutes available to me, give a clear explanation and a clear example of the problem, with reference to the Audit Commission's recently published report "Achieving the NHS Plan". Three hospitals are cited. Of the first it is said:
- "This Acute Trust performed poorly in relation to NHS Plan targets, and was rated as poor managerially".
- "This Specialist Acute Trust achieved most NHS Plan targets, and was rated as 'very good' on the majority of measures of financial and performance management".
- "This Acute Trust has performed poorly in relation to NHS Plan targets, and the auditor noted significant financial management failings, without identifying any substantial signs of imminent improvement."
The current star-rating system is a disgrace, which is founded on poor statistics and bears no relation to the true clinical performance of hospital trusts. As my hon. Friend the Member for Woodspring (Dr. Fox) said this
afternoon, there are good hospitals in this country that are stuck with zero star ratings and all the handicaps that that entails. The star-rating system should go. It should be replaced by a system shaped by CHAI, on the basis of its experience of what is good and what is bad in our health service. CHAI should be given an active role in helping to shape the standards for health care.I want to press new clause 2 and amendment No. 1 to the vote, because I believe that they would make a real and positive difference to health care, and would help to get the politicians out of the health service.
Mr. Burstow: I want to speak, exceedingly briefly, on amendments Nos. 38, 39, 56 and 59. In all of them the key issues are who decides standards, the process for setting them, and whether that should be entirely within the Secretary of State's remit or the commissions should play a role. That goes to the heart of the question whether the commissions are genuinely independent from the Secretary of State, or independent only at the pleasure of the Secretary of State. At present the Bill is inadequate, because the commissions are beholden to the Secretary of State in regard to much of what they must do.
Amendments Nos. 38 and 39 would require the Secretary of State or indeed the commissions, when publishing standards, to have an evidence base and to refer specifically to the evidence. That strikes me as a sensible proposition, on which a thinking Minister might wish to reflect.
We will support both the amendments that will shortly be put to the vote, not least because we believe that the star-rating system is deeply corrosive of the national health service. It misleads patients, and does not provide an adequate or reliable measure of what NHS performance actually is. It should be swept aside, and replaced by something that is more objective and more independent. We presented that argument in Committee in rather greater detail than I can present it now, but I hope that there will be more time to discuss it in the other place.
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