Health Bill

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The Chairman: Order. The amendment has been ruled out of order and not selected. If the hon. Gentleman wants to raise the issues that he intended to raise in relation to that amendment, he will have to wait for a clause stand part debate.

Dr. Murrison: Thank you for that clarification, Mr. Illsley. I will raise the amendment as part of the clause stand part debate and I am grateful for your willingness to hear comments on it in that debate, because it is quite important.

May I deal with what I am enjoined to discuss: the three amendments in this group? I hope even now that the Minister may be able to smile favourably on the amendments, which relate entirely to choice. I hope that she will reconsider her remarks about audit and inspection, because she seemed to be quite dismissive of the cost that may be involved, through the PCT, in overseeing her arrangements to do with the contract. It seems counterintuitive to suppose that, if someone enters into a contractual arrangement with a provider, they will not have any obligation to check the arrangement more thoroughly than if they simply have somebody on a list.

I think that we deal with the list in a little more depth later in the Bill and I would be grateful to know what it means in terms of primary care trusts. We maintain that such a list would perhaps be better held centrally, by which we mean nationally. That might be a way of getting around some of the expense that I identified earlier. With that, all that I need to do at this juncture is to withdraw amendment No. 29 and look forward to the clause stand part debate, which I am sure will be exhaustive. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Several hon. Members rose—

Dr. Murrison: We are all leaping to our feet. We now come to the bit that I thought we were at. My apologies, Mr. Illsley: my lunch was obviously rather better than I planned and I got ahead of myself in my enthusiasm to get to amendment No. 32. You will recall that that amendment was ruled out of order for technical reasons that are slightly lost on me because I do not have the abilities of the parliamentary draftsmen available to the Minister, or the paraphernalia that supports her performance in this Committee. Essentially, the amendment would insert the following:

    ''Regulations under section 16CD(4) shall direct that the remuneration paid to providers for each sight test shall be a nationally negotiated fee as agreed from time to time by the Secretary of State.''

The Minister might say, ''Well, that is funny, because the Conservatives are keen on deciding things locally.'' Indeed, there is cross-party consensus that we should,
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where possible, negotiate things locally. That is right and proper, and it is nice that we should have such consensus, but it might seem a little odd that we should insist on a national fee.

It seemed to me, although I am not entirely sure, that the Minister suggested in her remarks earlier today that, de facto, that is what will happen. I hope so, for a raft of reasons, which we have dealt with to some extent, such as that such a system would get around the problem of different fees being negotiated in different primary care trusts. The Minister said that it was her intention that that should not happen, but admitted that it might. She is vastly more experienced than I am, but it seems to me that it would be strange to rely on her assurance in this Committee that there is a theoretical possibility that a particular outcome might happen, but that it is not her intention that it should. That is unacceptable. We must close such loopholes. That is why we spend hours and days going through the Bill bit by bit, clause by clause, and comma by comma.

In the light of the Minister's earlier remarks, I should have thought that she welcomed the amendment, which you, Mr. Illsley, disallowed for technical reasons. Nevertheless, I recommend to her the burden of what it says. I am sure that she and her parliamentary draftsmen colleagues could craft a form of words that got around that apparent technical difficulty and ensure that the figure is negotiated centrally and will apply to all PCTs, thus getting away from the possibility of competitive advantage and disadvantage applying from one place to another. It would prevent guileful people such as me from getting tests more cheaply in one part of the country and going to another part for their specs, and would prevent the big providers from acting in a similar perverse fashion. I am sure that it is not the Minister's intention that such situations should arise. More particularly, for the public service, it would mean a saving for PCTs. This morning, we rehearsed the argument, which I do not want to go over again too much, that PCTs are overburdened with administrative cost and bureaucracy. They have the dental contract coming in a few weeks. It will be interesting to see what happens with that. The National Audit Office is rather concerned about PCTs' capacities for managing those contracts, and here is another one on which they have to negotiate—potentially on individual terms.

Before I withdraw the amendment that was not selected and which I did not move, if I may make that tautology, will the Minister give some assurance that she hears what I say, that it is categorically not her intention that the fee should be different from one PCT to another and that she will, in some way that she can describe, make sure that that illogicality is not built into the Bill? It seems to us that a central contract administered through the Business Services Authority might be a more appropriate and cheaper way of doing things. It would certainly be a lot more cost-effective in terms of PCTs and in the context of trying to save money. The Minister admitted that she wants to save
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money on fraud. We need to find savings where we can. We must not, in the course of that, burden organisations with more bureaucracy and cost, thereby diluting any efficiency savings that might be achieved. I am sure that we are all singing from the same hymn sheet on this issue, and I commend our general thinking to the Minister.

4.15 pm

There are a few technical points relating to the clause that it was not appropriate to deal with through amendments, but I hope that the Minister will expand on them. Proposed new section 28WB contains no reference to qualifications or registration levels for practitioners, which seems a bit strange. Clause 36, which we will come to shortly, deals with the issue in a little more depth but is really not that specific. This morning, we talked about entering into contracts with various people and the Minister talked about expanding the opportunity for various organisations to provide services. It is important to know about the qualifications and registration of those operating the services, and to know what the Minister is expecting to see.

Across the whole range of medical health services we rely on qualifications and registration, yet these seven clauses seem to be fairly qualification-light. We have not talked much about the differences between the various practitioners, except to get tongue-tied over some of them. It would be interesting to know why the Minister has not felt it necessary to stipulate the qualifications of the various persons who may be involved with the contracts. As far as I recollect, that stands in contrast to the Government's changes in relation to pharmacies. I recall spending a considerable time talking about qualifications in that context. Some comment on that from the Minister would be most welcome.

Proposed new section 28WC refers to the disqualification of persons from entering into a GOS contract, but it does not really tell us much about the grounds for those disqualifications. Are they professional? Are they to do with probity, which the Minister mentioned earlier; with negligence, although the incidence of complaints is very low, so I suspect that that issue would not come up often; or with contractual disputes? If the latter, that is when the provision potentially becomes a little more sinister, because applications for disqualification could be based on organisations that are perceived as being a little difficult. For example, a high street single-handed practitioner might be regarded as more difficult to work with than Specsavers. We seek reassurance about what the Minister means with regard to disqualification, and what the grounds might be for disqualification.

We know that there is an appeals mechanism through a committee set up by the Secretary of State for Health, and that is right and proper, but such a committee would, of course, involve considerable outlay by the appellant, and would mean time, effort, anxiety, uncertainty, and potentially lost trade. It is important to understand the grounds for disqualification, so perhaps a little detail from the Minister might be appropriate.
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We have not talked at great length about the cost of the contract. That is strange, because in general when we discuss legislation we are used to having a regulatory impact assessment that goes into that subject in some detail. The Minister has assured us that she does not think that the new arrangements will involve a great cost. The more I think about it, the more I think the costs will be considerable. We are breaking down the contract into a myriad little bits that will have to be individually negotiated and worked through by primary care trusts. It will be new for the PCTs, which will have to set up new structures as a result. That will take manpower time. We all know what happens in such circumstances. Before anyone is appointed, the position has to be advertised. The PCT—the trust in my area is quite small—will suddenly have to take on additional staff to deal with ophthalmic services. That will represent a significant increase in the overheads that PCTs will be expected to shoulder.

Blithely to say that the proposals will be cost-neutral—that it will be a zero cost venture—is somewhat disingenuous. Considerable costs will be involved, and it is appropriate to set them against the £12 million identified as fraudulent, especially as the Minister gave that as the cornerstone for these seven clauses, and one of two reasons identified this morning. If it is so very important to save that £12 million, we need to consider setting it against the costs resulting from the implementation of chapter 2. My ''back of a cigarette packet'' calculations—if I may use such a phrase, given our earlier deliberations—suggest that the cost of the provisions might start to approach that sum. A more reflective assessment by the Minister of the cost of implementing the GOS contract through the continuing myriad of PCTs would be appreciated.

I am grateful, Mr. Illsley, for your indulgence in allowing me to expound at length on the clause. It deals with a number of important issues and I look forward to the Minister's assurances on the points that I have raised.

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