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Clause 10
Health care provision: standards
Question proposed, That the clause stand part of the Bill.
Dr. Murrison: This clause deals with the inspection of the agency by the Commission for Healthcare Audit and Inspection and will be a bit of a departure for the latter body, because CHAI normally examines other parts of the NHS that have to do with patient care—hospital trusts, by and large. This function will be something separate.
CHAI's function in relation to hospital trusts is now clear. The path is a well trodden one and the expertise that CHAI has built up is extremely useful. I am a little concerned that the new departure will entail a new set of skills for CHAI, as well as a new way of working. I am also interested to know what form the Minister thinks the inspection and report will take. Given the sensitivity of some of the work that will be carried out by the agency, it will be interesting also to know whether any report by CHAI will be considered not to be in the public domain—and, in that case, to whom it will go.
It is all very well to say that CHAI will be involved in the inspection of the agency, but we need more detail about exactly what part of its work will be inspected. The Bill gives no real clue about that. I hope that the Minister will be able to give us some insight into how she envisages CHAI operating in the context of the Health Protection Agency—what reports might be presented, or, indeed, withheld. Furthermore, will
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she assure us that the skills that CHAI currently has will be adequate and sufficient for the inspection of what is a rather unusual organisation for it to be concerned with?
Miss Johnson: I can reassure the hon. Gentleman on those points. The Commission for Healthcare Audit and Inspection already inspects the Health Protection Agency special health authority, so the clause will not present a major departure for CHAI. It is established to give performance ratings to all bodies that count as NHS bodies for the relevant purposes, which includes the Health Protection Agency.
CHAI is not required until April 2006 to give performance ratings to excepted trusts such as the three learning disability trusts, the special health authorities or the cross-border special health authorities, but they are already covered by the inspection arrangements. As to what those arrangements will be, I have not seen detail of what CHAI is proposing for the future, but it is for it to decide on them. That is right and proper; we have given the work to a body independent of the Government to ensure that the public have confidence and trust in its work. It needs to be seen as independent of the Government and political processes.
10.45 am
Dr. Murrison: I am particularly concerned about sensitive areas that the HPA might be involved with. I am thinking in particular of Porton Down, which is not far from my constituency. I have visited it. It obviously conducts extremely sensitive work and it is expanding the work that it does. What role will CHAI have in the context of an establishment such as Porton Down and the National Radiological Protection Board's functions, given their sensitivity? Will the information that it garners be regarded as privileged in any way? I would be grateful if the Minister could address that specific point.
Miss Johnson: I am sure that those points have already been borne in mind in the current inspections. I undertake to ensure that CHAI is aware of the issues that the hon. Gentleman has raised. However, I believe that how it takes forward such things is a matter for CHAI, and it is important that there is no political interference in the processes and the way in which they are carried out. I appreciate the sensitivity of the sites and the work such as that carried out at Porton Down, but I do not believe that there has been a problem up until now. I see no particular reason why there should be in the future.
Dr. Murrison: The Minister is being patient. She says that CHAI is already involved with the special health authority—she is quite correct—and I was wondering whether there are reports currently made by CHAI that are not in the public domain. In other words, is CHAI looking at areas that could be regarded as sensitive? I would expect any reports that it makes to be regarded as sensitive. If the reports are not being made with that caveat, I suspect that CHAI is not looking at the special health authority in as comprehensive a way as perhaps it ought.
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Miss Johnson: I am grateful for the hon. Gentleman's comments. I will write to him about the points that he has raised about current practice, and I will copy that to the members of the Committee. As I say, CHAI should take forward the arrangements for future practice, but insofar as information is disclosable, I will write to him about the current arrangements in more detail and will do so before Report.
Mr. Francois: Subsection (2) says:
''Health care must be construed in accordance with section 45 of the Health and Social Care (Community Health and Standards) Act 2003.''
That is fair enough. Subsection (5) then says:
''Section 57 of that Act (studies as to economy and efficiency, etc.) does not apply to the Agency.''
Can the Minister explain why that provision is in the Bill? For instance, is it because the agency would be subject to different examination by the National Audit Office or some other body? Why is there a particular exemption for the HPA?
Miss Johnson: Subsection (5) provides that section 57 of the 2003 Act does not apply to the agency. That is because section 57 provides for CHAI to carry out studies as to the
''economy, efficiency and effectiveness in the exercise of any of the functions of an English NHS body, other than a Special Health Authority''.
In the case of the Health Protection Agency, as I think the hon. Gentleman suspects, such studies will be a matter for the Comptroller and Auditor General and the National Audit Office.
Question put and agreed to.
Clause 10 ordered to stand part of the Bill.
Clause 11
Amendments and repeals
Question proposed, That the clause stand part of the Bill.
Dr. Murrison: This is a brief clause, and I suspect that it is of a technical nature. It deals with schedules 3 and 4. As the Opposition clearly do not have the formidable civil service research capability that is available to the Minister, there is a risk that measures that may have implications for the Bill might be slipped in unbeknown to us. I am flicking through the list of Acts that are going to be amended or repealed as a result of the Bill, and I wonder what the implications are. I hope the Minister will not pass the clause without making any comment. Perhaps she could give us a résumé of the measures that are being repealed or amended. It is an extensive list of changes, so will she assure us that there will be no negative effects through the changes proposed under the clause?
Miss Johnson: I will do my best.
The amendments and appeals are all consequential on the creation of the agency as a non-departmental public body from its predecessor bodies, with one exception. The exception is the amendment of paragraph 3 to schedule 3. That will allow the Secretary of State to direct his function of
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appointing medical inspectors under the Immigration Act 1971, which is also exercisable by persons specified in the direction who exercise functions in relation to health in England or Wales. That delegation takes account of the fact that the arrangements for identifying medical inspectors are best made locally. The intention is to delegate appointments in England to the HPA—initially a special health authority and subsequently the agency as established by the Bill—and in Wales to the National Assembly for Wales. I reassure the hon. Gentleman that is the only change of any significance—it is not really a change of significance, but I draw it to hon. Members' attention. Otherwise, the matter in question is consequential on the creation of an NDPB.
Dr. Murrison: I am grateful to the Minister for mentioning the Immigration Act 1971. Immigration is a sensitive issue and she is right to raise it, particularly since the relevant measure stands out from the rest. Although it is consequential, it is of great importance.
What is meant by the term ''medical inspectors''? Are they the sort of medical people who are positioned at ports and airports to deal with those seeking to migrate to this country and perhaps claim asylum? If so, I am slightly concerned, because such matters are controversial. Many of us would say that medical inspection facilities at airports ought to be enhanced. We certainly need to tread warily if we are changing the legislative framework under which such inspectors operate. Could the Minister say how the proposed change might affect how medical inspection is done on the ground?
Miss Johnson: The hon. Gentleman is right in his supposition that the medical inspectors are those who deal with the health of migrants to this country. Those medical inspectors are being singled out for the purposes of identifying who they are. Local PCTs have a huge input into port authorities' arrangements for such purposes, as I am sure that he is aware. Essentially, the provisions do not change the situation and still provide the existing flexibility. On some occasions, appointments and the identification of those who might carry out the role are best made locally.
Dr. Murrison: I would be interested to know how the appointments are made now, as I am a little unclear about that. I agree that appointments are best made locally. I suspect that most appointments will generally be local doctors. Is the Minister saying that that will change? I am a little unclear about that. In her previous remarks, she seemed to suggest that the agency would still make the appointments, but we now understand that they will be made locally. Does that mean by the PCT? If so, that will cause difficulties in places such as Heathrow, which I suspect might cover more than one PCT—it is such a vast site that that is almost certainly the case. The same is probably true of other ports and airports. If PCTs make the appointments locally, as I think the Minister said, how does that pan out in places such as Heathrow?
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