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Standing Committee E
Tuesday 10 June 2003
[Mr. Peter Atkinson in the Chair]
The Chairman: A considerable number of Government amendments will be moved formally this morning, so I should be grateful for the Committee's forbearance, although I hope that we will not get too muddled.
Reviews of data
Mr. Paul Burstow (Sutton and Cheam): I beg to move amendment No. 396, in
clause 44, page 15, line 32, leave out from 'publish' to end of line 33 and add 'a report'.
The Chairman: With this it will be convenient to discuss amendment No. 402, in
clause 53, page 19, line 16, leave out from 'publish' to end, and insert 'a report'.
Mr. Burstow: This group of amendments seeks clarification from the Minister and the Government about their intentions under clause 44. The explanatory notes state:
''This clause enables the CHAI to review the quality of any data collected by others on health care provided by the NHS or for bodies and to make a report or publish a summary of its findings.''
However, clause 44 seems to suggest that the commission has the discretion to publish if it wishes rather than be under an obligation to publish. Our amendment seeks to delete the words in clause 44(2) after ''publish'' to the end and to insert the words ''a report''. That would make it clear in the Bill that a report should be published.
Will the Minister clarify the Government's intention in the matter and say whether the amendment is acceptable or give us an assurance that a report will, in all normal circumstances, be published?
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): It is the Government's intention that CHAI should publish reports that deal with the needs of its audience, and that means that in a particular case a summary of its findings will be published. For example, were CHAI to perform a large-scale technical evaluation of a hospital trust's data set, a great deal of complicated material would be generated that may need to be summarised. Indeed, because of the long time over which the data are gathered they may be of little public relevance. In drafting the subsection in this manner, we are giving CHAI the flexibility to target its intended audience effectively in order that it can determine how best to disseminate its findings; we also wish to give it the discretion to make a determination on the audience for its report. The requirement is for CHAI to publish a
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report, and the purpose of the subsection is to allow it to make that assessment.
Mr. Burstow: My hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris), gives his apologies for not being here this morning. Having read the summary, I am sure that he would wish to see the technical detail from which the summary was drawn in order to satisfy himself that it was an adequate representation of the full results. I share that desire. Will the Minister clarify whether the detail that led to the summary would also be available on request?
Mr. Lammy: The hon. Gentleman will know that CHAI is an independent body and that clause 44 allows it the discretion to determine its audience. I hope the hon. Gentleman will agree that in the performance of the Commission for Health Improvement and the manner in which it disseminates its reports there have been no suggestions that it is not willing to provide those lengthy reports in detail to the hon. Gentleman or to his colleagues. We want CHAI to operate in a transparent way, and I am sure that I can give an undertaking today that it will supply information on request.
I acknowledge the good intentions behind the proposal, but I hope that the hon. Gentleman will understand our intention and will consent to withdraw the amendment.
Mr. Burstow: This exchange has been useful in illuminating the intention behind the clause. As a result of the Minister's assurance, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 44 ordered to stand part of the Bill.
Amendment made: No. 275,
That Clause 44 be transferred to the end of line 14 on page 20.—[Mr. Hutton.]
Information and advice
Amendments made: No. 276, in
clause 45, page 15, line 37, leave out 'which is provided'.
No. 277, in
Clause 45, as amended, ordered to stand part of the Bill.
Amendment made: No. 278,
That Clause 45 be transferred to the end of line 14 on page 20.—[Mr. Hutton.]
The Chairman: The question is that clauses 46, 47 and 48, which we have already debated, stand part of the Bill.
Mr. Simon Burns (West Chelmsford): On a point of order, Mr. Atkinson. I thought that the purpose of the Government's amendments was to leave out these clauses, not for them to stand part of the Bill.
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The Chairman: They must be dealt with formally. We intend to deal with them by moving that they stand part of the Bill. If the Government are sensible they will say that they should not.
Clauses 46 to 48 disagreed to.
Amendments made: No. 282, in
clause 49, page 17, line 22, after first 'the', insert 'general'.
No. 283, in
Mr. Lammy: I beg to move amendment No. 284, in
clause 49, page 17, line 24, after 'under', insert 'subsection (1) and'.
The Chairman: With this it will be convenient to discuss the following: Amendment No. 413, in
Government amendment No. 285.
Amendment No. 374, in
Amendment No. 398, in
Amendment No. 165, in
clause 49, page 17, leave out line 31.
Government amendment No. 286.
Amendment No. 166, in
Amendment No. 377, in
Amendment No. 167, in
Amendment No. 375, in
Mr. Lammy: I will deal first with the Opposition amendments. The Government amendments are largely technical, and I shall return to them.
The Opposition amendments propose to add substantially to clause 49 by seeking to extend the matters that CHAI will have to consider when carrying out some of its functions. I remind the Committee that CHAI is there to deal with the
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availability of and access to health care; the quality and effectiveness of health care; the need to safeguard and promote the rights and welfare of children; the economy and efficiency of provision; and the effectiveness of measures taken for the purposes of the body in question and any other person who provides health care for that body.
Amendments Nos. 166 and 167 would effectively require CHAI to consider whether doctors made the right decisions in their treatment of patients and whether their decisions were ethically correct. Amendment No. 166 would require CHAI to consider whether clinical priorities determine health care interventions. I hope that Opposition Members know that clinical priorities are a matter for clinicians to determine; it is not the role of an inspectorate to second-guess clinical decisions.
CHAI will, however, be interested in the outcomes of clinical decisions, and we expect that in undertaking its functions under this chapter it will want to work with clinicians. That, in turn, will influence its review and investigation methods and other criteria.
Amendment No. 167 will result in CHAI examining the application of ethically correct practice, which is fundamentally a matter for the General Medical Council, the medical royal colleges and other professional associations. I am sure that CHAI will work closely with them in carrying out this and other functions.
Moreover, I am certain that, had the Government proposed the amendment, several Opposition Members would—quite rightly—have been up in arms. The medical profession has since Hippocrates had a tradition of self-regulation, and that must be right. There have been, unfortunately, a few notable exceptions such as Harold Shipman and Beverley Allitt, but by and large that self-regulation has been exercised very well. I am sure that GMC hearings are going on as we speak.
If CHAI becomes aware of or suspects something amiss with the behaviour of NHS professionals, it will report that to the appropriate body, which can investigate further. Clause 126(2)(g) explicitly provides for CHAI to disclose information to another body for the purpose of its statutory function, including bodies such as the GMC. To the extent that amendments Nos. 166 and 167 concern the broader issue of the quality of health care, they are already covered by subsection (2)(b). The amendments are, therefore, unnecessary.
Amendments Nos. 374 and 375, and No. 165—a consequential amendment—respectively propose to extend the list of factors to be taken into account by CHAI in clause 49 and to extend in clause 100 the duty placed on CHAI in the discharge of its functions, under the Care Standards Act 2000, to have particular regard to the need to safeguard and promote the rights and welfare of vulnerable adults.
I have some sympathy with those proposals, but we must draw a line somewhere in listing patient groups to which CHAI should pay particular attention. That was, to some extent, debated in Committee last week, and I do not want to revisit the arguments. We have,
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therefore, chosen to continue to ensure that the most vulnerable group in society, which is identified in the Care Standards Act as children, is effectively covered. However, singling children out for particular attention does not mean that CHAI will not have the rights and welfare of other vulnerable groups in its sights. CHAI will be expected to focus on them as well.
Amendment No. 377 seeks to place a duty on CHAI to ensure that the NHS fully discharges its legal function of providing continuing health care under the National Health Service Act 1977, but the Secretary of State can already issue directions to NHS bodies on how they exercise their health service function with a view to ensuring that they provide appropriate health care for patients.
Furthermore, it seems that Opposition Members have failed to grasp the significance of the duty of quality introduced by the Health Act 1999. As a consequence of that duty and its replacement in clause 40, which we debated last week, NHS bodies are under obligation to put, and keep, in place arrangements to monitor and improve the quality of the health care that they provide. Under clause 53(2), CHAI already has the function of reviewing the arrangements made by NHS bodies to discharge that duty of quality.
Government amendment No. 284 is, effectively, a technical amendment, which makes it clear that the factors with which CHAI is to be concerned under clause 49(2) apply to its function under clause 49(1) of encouraging improvement.
Last Thursday, I made it clear that we would consult parliamentary counsel with a view to tabling an amendment on Report to ensure more generally that the factor is taken into account in the exercise of functions other than those in clause 49(1) and clauses 50 to 54.
It is also our intention that CHAI, as the inspectorate of health care, should focus on health care. It is right that CHAI's primary focus should be on how economically, efficiently and effectively NHS care is provided. That does not mean that CHAI's resources should be diverted to examining NHS accounts: that is clearly a matter for the Audit Commission. The Audit Commission identifies clearly the examination of accounts and other management functions as an audit consideration outside the value for money exercise.
Amendment No. 285, therefore, is a technical one that seeks to clarify that position by removing financial and other management functions from the primary focus of clause 49. Of course, it does not mean that CHAI will be unable to consider those matters if they impact on the quality of patient care.
Finally, amendment No. 286 is simply a drafting amendment proposed by parliamentary counsel. On further advice from counsel, we have decided not to proceed with it.