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Most telling was the Ministers admission that the nutritional benefits of a cash payment are better in early pregnancywe entirely agree with that, of coursealthough the Prime Minister, then the Chancellor, announced at the outset that support was needed in the last months of pregnancy, on the basis that nutrition is most important then. Not only was the Prime Minister wrong, but answers to parliamentary questions suggest that the Minister was initially wrong as well. The change made during the proceedings in Committee was a fair reflection of the evidence. All of us who have looked at the issue carefullyparticularly women, who are the ones most affected by such issuesrecognise that, when focused on the health of the to-be-born child, the most important time for nutrition to be right is both pre-conception and in the
early weeks and months of pregnancy, more than in the last weeks, as the Prime Minister suggested.
The Bill includes a huge number of miscellaneous provisions and refers to much secondary legislation. However, it has received worthwhile scrutiny, and Parliament has done the job that it must do by seeking to improve the Bill and to elucidate what lies behind it so that the right pointers are given on how further scrutiny can take place with the wisdom that those in another place can bring to bear. I hope that many of our debates will flag up the areas on which those preparing for such scrutiny will need to focus their attention. I also hope that the arguments that we have tried to make will help their deliberations.
I thank those who served on the Public Bill Committee, especially my Conservative colleagues and my hon. Friend the Member for Guildford. Although this is not very usual, I pay tribute to those in our research offices who do a lot of work in the background and are often unsung. It is important that we in opposition are supported, given that we must contend with the fact that the Minister is rightly supported by a full Department. I thus pay tribute to the researcher who has helped my hon. Friend and to Sam Barker, who has been a tremendous help to me during the passage of the Bill.
David Taylor (North-West Leicestershire) (Lab/Co-op): I apologise for not being in the Chamber for about a minute at the start of the debate. We moved on to Third Reading rather more speedily than most people had expected.
Public trust is central to rebuilding public confidence in our system of professional health regulation. However, the way in which the Department of Health has gone about addressing that challenge in the past two years has sometimes had the opposite effect. My contribution on Second Reading and the amendments tabled to clauses 105, 106 and 108 were designed to support the capacity of the Council for Healthcare Regulatory Excellences to be, in the words of the White Paper, a truly
authoritative independent voice for patients on the regulation of professionals, providing expert advice on policy.
At the citizens councils meeting that I organised in Committee Room 17 on 8 January 2008, underlying a great many issues raised by informed patients and public members, on which reassurance is sought, were five themes that are particularly relevant to the aspirations set out in the original White Paper. I wrote to the Minister about these matters on 6 February and I will no doubt hear from him.
First, astonishingly, the CHRE is yet to agree a patient and public involvement strategy. How will the patient and public arrangements that it puts in place be sufficiently independent and at arms length from the Government, regulators and the CHRE itself to provide an assurance that the real concerns of informed patients will be addressed?
Secondly, will the process be sufficiently well resourced to cut through often complex technical jargon so that participants are informed and have a capacity to develop a patient-centred position? Thirdly, how will the CHREs
PPI arrangements enhance existing public and patient engagement strategies in Scotland, England, Wales and Northern Ireland with a commitment that they will actively facilitate communication among representatives from each country, respect the differences and similarities between each country, and be tailored to meet their specific needs?
Fourthly, we know that the number of the oldest and most vulnerable people requiring care will inevitably increase substantially. What assurances have the Government sought and received from the CHRE that it will be able to ensure that such vulnerable groups are identified and that specific measures are put in place to address their needs?
Fifthly, what further systems of parliamentary accountability will the CHRE and the regulators be subject to if the Bill is passed in its current form? If there is a Division on Third Reading, I shall vote for the Bill. I voted against amendment No. 131, to which I put my name, because I accepted the Governments reassurances. However, if we are to have a Standing Committee, why is it to be of both Houses of Parliament? What is meant by oversee? Does the Minister agree that there is a need for innovative techniques to ensure that the public and patient voice is heard in the process?
Sixthly, is the Minister aware of the implications of the CHRE not putting in place an effective PPI strategyincluding independent arrangements and practical support to ensure that a strong patient voice is heardthat will command public confidence and the support of the devolved Administrations in Scotland, Wales and Northern Ireland? The proposed CHRE membership is far too small for the council effectively to reflect the diversity and breadth of views in a sector employing 2 million people and stretching across four countries. In the Bill, officials propose an inappropriate NHS trust-type model, which will have insufficient members to ensure a clear distinction between remuneration and audit committee functions. That is why it is disappointing that the Minister did not respond positively to the amendments to clause 106 tabled in Committee by my hon. Friend the Member for Luton, North (Kelvin Hopkins).
authoritative independent voice for patients on the regulation of professionals, providing expert advice on policy,
when all CHRE executives already speak at council meetings? Why has the White Paper implementation website been such a calamity, preventing anyone outside a magic, private policy circle from contributing to debates preparing us for discussions such as this one, despite the promise of inclusivity given at the national White Paper implementation advisory conference on 5 June last year?
The lack of urgency means that work streams have made very little progress, giving the impression that they are window dressing while real decisions are being taken elsewhere. How can Parliament debate health regulatory corporate governance issues properly when the internal report sent to Ministers in November last year is unavailable for this debate? If the report proposed a Standing Committee of both Houses of Parliament, why are we being denied the opportunity properly to scrutinise that recommendation?
Does the Minister agree that it is no longer good enough to continue to define lay as not on our register? If so, what changes are required in the criteria to be used in appointing new lay and public members to the regulatory bodies and the CHRE, and when will Parliament and the wider public be able to comment on such criteria before the Appointments Commission adopts them? Why are lay and public members expected to reflect a wider perspective across the four countries, rather than representing the interests of patients and the public?
It is a well-intended Bill, no doubt, and it will tackle some of the concerns that were well debated in CommitteeI attended some sittings, as well as Second Reading and tonights debatewith a degree of competence and professionalism, but I shall back the Bill and go through the Lobby, if there is a Division on Third Reading, without significant enthusiasm. I believe that in the Labour Governments fourth term, in two and a half or three years time, another Minister will be back to tackle the matter yet again with community health councils, mark 4. I do not think that the Bill is the way ahead. An opportunity has been missed. Although the Minister has explained the Governments rationale very well to the House and the Committee, I find it unconvincing.
Sandra Gidley: I thank all those involved with the Bill, including my hon. Friend the Member for Leeds, North-West (Greg Mulholland), who led debate on various aspects of the Bill in Committee. I also thank Conservative Members and the Minister for what have been on the wholethere were a couple of notable exceptionsrelatively good-natured proceedings. A genuine attempt has been made to get to the bottom of some of the issues, and I thank the Minister for taking on board some of our concerns. I would also like to put on record my thanks to the Committee Clerks, who were unfailingly helpful and approachable. My only concern is that the selection of amendments on Report left a little bit to be desired. Some of us would have liked to discuss certain aspects of the Bill in greater depth, such as the health in pregnancy grant, but that was not to be; that pleasure has been reserved for the other place.
Although the bulk of the Bill is involved with the setting up of the Care Quality Commission and deals with health care regulation, it is also worth mentioning in passing the bits that were also important but have not attracted as much attention. I am thinking of health care-acquired infections and the public health measures as well as the health in pregnancy grant, which I have mentioned. The Bill also includes provisions on the measurement of childhood growth and the way in which the global sum is allocated to PCTs for pharmaceutical services.
Although the evidence sittings were useful, the Committee stage was somewhat frustrating because not a single Opposition amendment was accepted. However, I have to be fairwhen the Minister said that he would reflect on an issue, he sometimes came back with Government amendments. They did not always meet all our concerns, but they were a welcome step in the right direction. Those amendments dealt with reports to the commission, and we have seen movement on legally qualified chairs. We have been promised some movement on the issue of
human rights in care homes, which concerned hon. Member on both sides of the Committee.
I should like to conclude by talking generally about the Care Quality Commission. The Liberal Democrats supported the principle of the commission three years ago. As the Minister said earlier, we were asking the Government, Why do you not do this now? Both the Healthcare Commission and the Commission for Social Care Inspection are starting to perform well. Although I support the principle of joined-up administration and regulation, there are genuine concerns about how the transition should be handled. In the changeover, we should not lose the efficiency and effectiveness of the two organisations.
We already know that the transition costs are likely to be £140 million. What concerns me more is the massive disruption to the two organisations and the staff involved. At this point, it is pertinent to reflect on Ian Kennedys statement for the Public Bill Committee:
What we will see will be a period of flux: senior staff will need to be recruited and then appoint others; managers will be organising away-days and locked in meetings over organisational design and conditions of employment, instead of meeting the accelerating demands and expectations of patients. Morale in existing organisations will be increasingly hard to sustain. Good members of staff are already leaving, taking with them the knowledge that it has taken three years to develop.
The issue is a concern to us all. The memory of the organisation of PCTs is still fresh: there was a period of stasis in many areas, while people, rightly, fretted about their jobs and reorganised. That put a halt to some parts of what the Government were trying to achieve.
We must not make the same mistake with this reorganisation. Much has yet to be decided by secondary legislation, so there is still great uncertainty. All the people who work in the field and are likely to work for the new commission need as much certainty as possible as early in the process as possible. To deny that certainty would have a knock-on effect on patients and the public.
the reasons for the Bill are unclear...the costs are high...the distraction is very considerable...the risk of harm to patients is significant. We believe that the Committee should seek to be satisfied that each of these matters has been properly taken account of and that the concerns expressed here are unwarranted.
While the reasons for the Bill are fairly clear, as regards costs, distraction and potential harm to patients, I am not sure that I can put my hand on my heart and say that we have done full justice to those concerns in Committee. There will be continued scrutiny in the other place, and we may yet see aspects of the Bill come back. I give a cautious welcome to the Bill but seek reassurances that some of these concerns will be addressed.
Stephen Hesford (Wirral, West) (Lab):
Along with other Members who are here, I served on the Public Bill Committee, and I want to put before the House one or two comments about my experience of listening to evidence at that stage, which is a relatively new procedure. It was useful in informing our proceedings,
not least when we saw the Minister cross-examining people who came to give evidence and then giving evidence himself. That was a useful exercise for him to go through in the knowledge that he would be on both ends of it.
I want to pick up four points, three of which deal with the evidence that we heard. I commend the Minister for the successful way in which he dealt with part 1, which establishes the Care Quality Commission. That is one of the reasons why I wish the Bill well from now on as it leaves this place, in contradistinction to the hon. Member for Romsey (Sandra Gidley). The Liberal Democrats welcome the change in principle and then go on to quibble about the timing of the merger and how it is going to take place, and say that the staff who are being reorganised want certainty.
Sandra Gidley: I am slightly bemused by the hon. Gentlemans comments about having a boy to do my work for me, but I will not press that point. I think that he is being a little unfair. He was not here for the whole Report stage and has just come in for Third Reading, and he is not doing his own Government a service if he dismisses some of the legitimate concerns that have been raised. I am merely reflecting the concerns of people who know far more about this than he or I ever will.
Stephen Hesford: Three commissions are to be mergedthe Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission. That is a major step forward. It reduces what people in other places have called the quangocracy. It pools expertise and creates the certainty that has been mentioned. It creates what will grow into a one-stop shop, which will be a major step forwarda place to which the public will know that they can go if they have problems with social services, the NHS or mental health services. It is also consistent with the Governments rightly made efforts to bring the NHS and social care closer together; it will pool such expertise.
Let me come to the reform of the General Medical Council in part 2. In Committee, one piece of evidence informed that process, but unfortunately it did so in a negative way. Evidence was submitted by the British Medical Association, which tried to persuade the Committee that it would not be right to change the standard of proof in disciplinary proceedings for doctors from the high standard of beyond reasonable doubt to the civil standard. The evidence that we
heard from doctors frankly bordered on the self-interested. It was not helpful to the Committee, and closer examination showed that it made the case for the change.
A positive, informative and impressive piece of evidence came from Dame Janet Smith, who spoke about the need for legally qualified chairs to help in the restoration of public confidence in the procedure for making complaints about doctors. She made a powerful case. I am pleased that my hon. Friend the Minister recognised that there was a case to be made, as we all did in Committee. I was saddened slightly by a recent article in one of the national newspapers from the GMC that seemed to be still arguing against the reform process. That is a bit of a hangover from the GMCs previous position. It has recognised that reform is necessary, but it is slightly unhelpful that it is still clinging on to former glories as that reform moves on.
As the hon. Member for Eddisbury (Mr. OBrien) said, the health in pregnancy grant was not mentioned on Report. I welcome that grant, and from listening to the evidence, it seemed that one could make a case for giving the grant to help a prospective mother at any stage of pregnancy. The Minister gave evidence, which I found credible and persuasive, that that stage should be located at the point set out in the Bill. Prospective mothers will know that they will benefit from the health in pregnancy grant at the 26-week stage, and by accessing the grant, they can access help and information about diet and other factors. That is a good thing and it will help less prepared mothers to look after their children. Once the grant becomes well known, mothers will know that they can get money at that time, and take it into account for their budget during the entire pregnancy. That deals with the pointand the criticismthat it could be done at some other time. In some ways, it does not matter when the money arrives as long as the prospective mother knows that it is coming. It helps to spread the load.
Mr. Jenkins: I shall not detain the House. Having sat through many hours in Committee, I can honestly say that I welcome the Bill. I especially welcome the merger of the regulatory authorities, perhaps leading away from the silo mentality to a cross-area concept.
I hope that when the Minister, who now has substantial regulatory powers, meets groups, he will realise that some are self-interested. Although they are professionals who purport to want to do their job and to need some authority and power to do it, I hope that he will bear it in mind at all times that patients are the people whom we look after. That is our current difficulty: we lack a strong patient voice. I therefore ask my hon. Friend not to be a stranger to us in the Chamber, because many of us have at least a little experience of patients concerns from their visits to our surgeries.
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