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Standing Committee E
Tuesday 3 June 2003
[Mr. Win Griffiths in the Chair]
The Minister of State, Department of Health (Mr. John Hutton): I beg to move amendment No. 148, in
clause 14, page 6, line 14, leave out from 'for' to end of line 17 and insert
'purposes related to the provision of health care.
( ) But the authorisation must secure that the principal purpose of the trust is the provision of goods and services for the purposes of the health service in England.'.
The Chairman: With this it will be convenient to discuss the following:
Amendment (a) to the proposed amendment, in
line 5, leave out 'in England'.
Amendment No. 2, in
clause 14, page 6, line 18, leave out subsection (3).
Government amendment No. 149.
Amendment No. 3, in
clause 14, page 6, line 23, leave out 'or require'.
Amendment No. 4, in
clause 14, page 6, line 27, leave out subsection (6).
Amendment No. 5, in
clause 14, page 6, line 37, leave out subsection (7).
Amendment No. 11, in
clause 15, page 7, line 18, leave out subsection (5).
Government amendments Nos. 256, 257 and 259.
Mr. Hutton: Amendments Nos. 148 and 149 take us back to that happy time long ago when we started deliberations on this Bill, and to an issue that hon. Members on both sides of the Committee have raised and to which I promised to give further consideration.
Under clause 14(1) and (2), the regulator has discretion over whether to authorise NHS foundation trusts to provide goods and services, for purposes relating to health care, that are not provided to the NHS in England, including services to the NHS in Wales, Scotland and Northern Ireland. There is a proviso that their principal purpose is to provide health care services to NHS patients in England.
The effect of amendment No. 148 would be to remove any discretion that the regulator had about the provision of other health care services. It says that every NHS foundation trust must be authorised to provide health care services, including services for NHS patients from other parts of the United
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Kingdom. As with the current clause, it is subject to the requirement that provision of services to NHS patients in England remains the principal purpose.
As we discussed what seems to have been a long time ago, the Bill will allow for people who live on the borders of Scotland to be treated in an English hospital if that is most convenient. More importantly, it allows for NHS patients from any part of the UK to receive care in national specialist facilities in England, if those facilities are being provided by an NHS foundation trust. I hope that that issue has now been put beyond any reasonable doubt.
That is also why I urge the Committee not to accept amendment (a), tabled by the hon. Member for West Chelmsford (Mr. Burns), which would delete the words ''in England'' from the revised text of clause 14(2). I hope that the hon. Gentleman will appreciate from my remarks that that is simply not necessary.
It may be that the hon. Gentleman intended his amendment to have a completely different effect, which was to make sure that NHS foundation trusts can be established for the purpose of providing health care services other than in England. That is not what we intend, as it is a devolved matter. As the hon. Member knows, the NHS in Wales and Scotland is a matter for the Welsh Assembly and the Scottish Executive, respectively, and they have made their position clear.
Government amendment No. 259 is a purely technical amendment that gives NHS foundation trusts the same powers as NHS trusts to provide accommodation and services to NHS patients. There is nothing new in this provision. Similar provisions have applied in the NHS since the National Health Service Act 1977; section 63 is the relevant provision. Obviously, foundation trusts will be limited to using these powers in a way that complies with the terms of that authorisation.
The new subsection 14(2)(a) is also relevant in this context, as it makes provision for NHS foundation trusts to carry on other non-clinical services and activities. Training and research is, of course, an important part of what the NHS does, and certainly falls within the Secretary of State's responsibilities under the 1977 Act.
Under the current version of clause 14(5), the regulator has discretion about whether to authorise educational, training and research activities by NHS foundation trusts. Government amendment No. 149 changes the emphasis by requiring the independent regulator to authorise such activities. The ''may'' is replaced with a ''must'', and I know that Opposition Members will welcome that.
Government amendments Nos. 256 and 257 are technical drafting measures, and are required to ensure that NHS foundation trusts can hold or receive gifts of property on trust to be used for the NHS in both England and Wales. NHS trusts enjoy that power at present, and NHS foundation trusts should not be in a different position. Amendment No. 256 allows them to accept gifts of property to be held on trust for the
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purposes of the NHS in both England and Wales. Amendment No. 257 provides for the appointment of trustees for that property.
Amendments Nos. 2, 3, 4, 5 and 11 are more substantive and more objectionable to me. This is one of the areasthere will be several this morningin which we come up against the ''freedoms and safeguards'' argument. We included the provisions in clause 14, which these amendments want to delete, precisely to balance the new freedoms with appropriate safeguards. I would go as far as to say that these amendments seem like wrecking amendments, but perhaps they are probing amendments. We will come to that point when Opposition Members speak to their amendments.
The amendments would remove important safeguards and put at risk the integrity of NHS services. I shall explain why I believe that to be so. In order to safeguard essential NHS services, under the terms of authorisation, the independent regulator will require NHS foundation trusts to offer certain protected services to NHS commissioners on a continuing basis. Protected services will include essential education, training and research programmes as well as NHS clinical services. The regulator will take decisions on what should be classified as protected, based onamong other thingsthe criteria set out in clause 14(7), which Opposition amendments would remove from the Bill.
A regulator must protect services in line with his general duty under clause 3, which we have already approved, to act consistently with the Secretary of State's duties under the 1977 Act. Amendments Nos. 2 and 3 would remove the regulator's powers to protect those services altogether. That would jeopardise the regulator's ability to protect the interests of NHS patients; therefore, the amendments are not acceptable to me, nor, I hope, to any of my hon. Friends.
The effect of the amendments could be that NHS patients would be denied essential services, which is clearly unacceptable. Amendments Nos. 4, 5 and 11 are consequential to amendments Nos. 2 and 3 and should be rejected for those reasons.
Chris Grayling (Epsom and Ewell): Welcome back to the Chair after our period away, Mr. Griffiths.
As the Minister rightly said, amendments (a) and No. 2, together with Government amendment No. 148, take us back to our previous debate on the duties of NHS trusts in border areas to those patients who live in Scotland or Wales or to those coming from Northern Ireland to take advantage of services at specialist tertiary centres.
The Minister remarked how strongly Members on this side felt about the necessity to make provision in the Bill for trusts in those border areas to be mindful of the needs of people on the other side of borders. That is particularly important. We debated the Countess of Chester NHS trust, one example of a trust with a catchment area. The hon. Member for the City of Chester (Ms Russell) is in her place.
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Since that debate, I have communicated with the trust and was told that approximately one third of the practices in Flintshire use the Countess of Chester hospital as their local referring hospital. About 10,000 patients from north Wales are admitted there annually, and there are approximately 40,000 out-patient attendances from the Flintshire area. Therefore, the importance of getting this part of the Bill correct is extremely significant. We cannot inadvertently set the wrong duties for those trusts.
I am greatly reassured by the Minister's comments. I have reflected on the various amendments before us and am happy to accept the Minister's word that the matter is being addressed. When the Bill goes to another place, I hope he will ensure that any previous elements of the Bill that have been debated can be adjusted accordingly so that the same duties are written throughout this measure. However, I am happy to accept that he has taken on board the points made in that debate, and I am grateful to him for doing so.
Amendment No. 3 is designed to take out the requirement to carry out research or to make facilities and staff available for the purposes of education and training. There is an important purpose behind that, and I hope that after I have spoken, the Minister will be willing to give it due consideration. Our concern is that this is unnecessarily prescriptive and could cause operational difficulties within the medical educational world owing to the unique structure that exists for our medical schools.
The Minister will be aware that in most cases medical schools are part of universities and, as such, they receive their funding from the Higher Education Funding Council for England. The decisions taken about the amount of funding that they receive ultimately flow from the Department for Education and Skills. In February 2003, the Secretary of State for Education and Skills decided to skim off 2.2 per cent. of the teaching budget to invest it in a deposit budget to promote a programme of social inclusion. He said that any institution, including medical schools, that does not have a full and proper wide-ranging programme of social inclusion in place for the next financial year will not receive any money from that pot.
As a result, medical schools have lost about 2.2 per cent. of their budget for this year. The medical schools are saying that they will have insufficient time between the issue of the edict by the Department for Education and Skills and the start of the next academic year to get such programmes in place.