Commission for Health Improvement (Functions) Regulations 2003

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The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I shall be as quick as I can, so as not to detain the Committee too long, but equally I shall try to deal with the points that hon. Members have put.

I shall begin with the questions posed by the Conservative spokesman, the hon. Member for Epsom and Ewell (Chris Grayling). He legitimately asked why we should bother with the regulations now, when we hope to legislate to introduce CHAI from next April to replace CHI. The key lies in the phrase ''hope to legislate''. We are the genuine parliamentarians and democrats, and we do not assume that we are going to get our legislation. We assume that we must work with the legislation that is on the statute book until such time as Parliament grants us permission to move on and change it.

Chris Grayling: If that is the case, can the Minister explain why the Government advertised a number of the posts that are set out in the Health and Social Care (Community Health and Standards) Bill while it is still going through Parliament?

Dr. Ladyman: Because as well as being good parliamentarians, we are also pragmatists—we believe in hoping for the best and preparing for the worst. We are making our preparations on the assumption that Parliament will allow us to have our Bill, but we are not assuming that Parliament will do

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so. That is one primary reason why we continue to legislate to improve the powers of CHI.

As the hon. Gentleman said, the regulations came into force in July this year. However, there are eight months between July and next April, when we hope CHAI will come into being, and those are eight important months in the development of the national health service. We made a commitment to the electorate that we would not waste a day in improving standards of health care in this country and we shall certainly not allow a hiatus of eight months just because it would be administratively convenient to us not to introduce the regulations now. We are pushing ahead and we take those eight months seriously.

Another reason why we are introducing the regulations now is that there are things that CHI can do during those eight months that will prepare us better for when CHAI takes over. That will make the transition between the two as seamless as possible. The more we improve the powers that are given to CHI, the easier the transition will be.

The second issue that both Opposition speakers raised was independence. There are a number of provisions in the regulations that I believe make CHI more independent from the Secretary of State than it was before. The regulations remove the powers of my right hon. Friend the Secretary of State for Health in the appointment of the chief executive, which is no mean influence on the organisation. They also remove his powers over the appointment of employees to CHI. Both provisions represent a significant increase in the organisation's independence.

The hon. Gentleman mentioned streamlining organisations and greater independence in future. However, the rationale behind the decision to legislate to create CHAI to replace CHI and the current health functions of the Audit Commission is to achieve precisely that: rationalisation of the inspection of health services in future. Powers also exist in the Health and Social Care (Community Health and Standards) Bill to make CHAI work very closely with the Commission for Social Care Inspection. They will be able to act for each other, to ensure that only one inspection of an organisation takes place. They will be able to delegate part of their role to each other, as necessary—indeed, they have a duty to work together to streamline inspections. I believe that we are dealing with the hon. Gentleman's concerns. No doubt we shall debate them further when the Bill returns to the House from the other place.

The hon. Member for Cheadle made some points about commissioning. The regulations make it clear that CHI has a responsibility to inspect all providers of health care services. None are excluded. Therefore, the commissioners of health services will be included.

The hon. Lady also asked about making reports of investigations available to, for example, local authority scrutiny committees. The reports will be public, and will be published on the relevant bodies' websites. Assuming that scrutiny committees have

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access to the internet, they will be able to obtain the information, even if they do not receive it directly.

The hon. Lady's final and substantive point—the reason for her praying against the regulations—concerned confidentiality. The Conservative spokesman said that he did not share that concern, and he and I are of one mind on that matter. The regulations are every bit as strong as the original Act. Indeed, it is my understanding that the regulations cannot override the 1999 Act, so they must be as strong as it required them to be. We have it on the assurance of parliamentary counsel, who helped us to draft the provisions, that they impose on those individuals who are involved in the release of information a duty to maintain individuals' confidentiality.

The hon. Lady asked about regulation 20(2)(a) and (b) and whether an either/or choice was presented therein. It is not. There is just one ''or''; the two provisions can apply separately, but only in accordance with the overall functioning of the regulation.

As for the circumstances in which information would be made publicly available, my reading of paragraph (3) is that, substantively, information would identify an individual only if that individual had consented. The only exceptions would be if it were for some reason necessary to publish the information; if it was beyond the ingenuity of man to hide the individual's identity or to make it impossible to identify them; and if there was no possible way to trace the individual to obtain their permission.

I cannot imagine such circumstances arising, so I can assure the hon. Lady that it is the Government's intention, as it was when we drafted the relevant paragraphs, that no individual's identity should be disclosed against their wishes when information is published. I hope that she accepts that as the assurance that she seeks.

4.54 pm

Mrs. Calton: I am remarkably impressed by the Minister's ability to tell a good tale about the bridge between CHI and CHAI, and I look forward to finding out whether a backstop, or, indeed, a bridge, will be available. It is interesting that the Minister can conceive of the Health and Social Care (Community Health and Standards) Bill not becoming an Act. If it does not, it will be a first, and of great interest to all of us.

As the Minister would expect, I remain concerned, as are other Opposition Members, about the independence of both CHI and CHAI—today we are considering only CHI. The removal of the power to appoint the chief executive is not really an issue when the Secretary of State has such overwhelming powers that he can dictate what is—and, more important, what is not—in the organisation's work programme. I should have thought that his suggestions would be difficult to ignore, given that he has a power of veto over everything.

I am pleased that the regulations make it clear that commissioners and commissioning are included in the

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ability to inspect. The Minister says that all providers are included. The problem is with the terminology. Commissioning and providing have clear and specific meanings: when providers are mentioned repeatedly, it is possible, given the specific meanings of provider and commissioner, that that could be misread by some. However, I am happy to have the Minister's assurances that commissioners are also involved.

I am also happy that reports will be available on the internet, but am slightly concerned that local authority scrutiny committees, patients forums and other bodies will not be able to feed into the process as the programme is being developed. I hoped that the Minister would say something about that.

I am pleased that the Minister has placed it on the record that he does not share the concerns about confidentiality and that the regulations cannot override the Health Act 1999. I hope that the fact that we have had this discussion means that more care will be taken in future than might otherwise have been taken.

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There is a slight difference between the Minister's saying that there is ''no possible way'' to trace an individual and the words of regulation 20(3)(c), which refers to

    ''despite the taking of all reasonable steps'',

to trace an individual, and of regulation 20(3)(d)(i), which provides for cases in which

    ''it is not practicable to disclose the information''

in a form that prevents identification of the individual. People will feel aggrieved when, as will undoubtedly happen, their identity is divulged, so I hope that great care will be taken to ensure that, when decisions are made in future, the power is not used lightly.

Question put and agreed to.


    That the Committee has considered the Commission for Health Improvement (Functions) Regulations 2003 (S.I., 2003, No. 1587).

Committee rose at two minutes to Five o'clock.

The following Members attended the Committee:
Benton, Mr. Joe (Chairman)
Calton, Mrs.
Chaytor, Mr.
Cunningham, Mr. Jim
Francois, Mr.
Grayling, Chris
Griffiths, Jane
Knight, Jim
Ladyman, Dr.
Lepper, Mr.
Reed, Mr.
Ryan, Joan
Trickett, Jon

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