Clause
106
Constitution
etc. of
Council
Kelvin
Hopkins:
I beg to move amendment No. 250, in
clause 106, page 52, line 7, leave
out ‘one executive member’ and insert ‘two
non-executive members’.
The
Chairman:
With this it will be convenient to discuss the
following amendments: No. 52, in
clause 106, page 52, line 13, leave
out ‘three non-executive members’ and insert ‘one
non-executive
member’.
No.
251, in
clause 106, page 52, line 13, leave
out ‘three’ and insert
‘seven’.
No.
53, in
clause 106, page 52, line 14, after
‘State’,
insert—
‘( ) two
non-executive members appointed by the Appointments
Commission.’.
No.
163, in
clause 106, page 52, line 14, after
‘State’
insert—
‘( ) one
non-executive representative of the regulatory
bodies.’.
No.
252, in
clause 106, page 52, line 15, leave
out ‘two executive members’ and insert ‘one
executive
member’.
Eagled-eyed
Members will have noticed that amendment No. 365 refers to leaving out
“one executive member”, when it should say, “one
non-executive member”. I mention that to ensure that we are all
singing from the same hymn
sheet.
Kelvin
Hopkins:
The amendments deal with the membership and
composition of the CHRE, and would, among other things, increase the
number of Scottish members from one to two and the number of English
members from three to seven, and cut the number of CHRE executive
members from two to one. If the overriding objective is a UK-wide
approach to professional health care regulation, we need to acknowledge
the need to continue and strengthen the relationship with Scotland,
something that I suggest is politically important at the
moment—I do not think that any Scottish Members are present
today, but I hope that if there were they would support what I am
saying—by having a more Scotland-specific view. Other UK-wide
bodies, such as the Food Standards Agency, have two non-executives from
Scotland, so why not the
CHRE?
5
pm
There is
increasing fragmentation of health care across England, and CHRE needs
to be able to reflect that in its composition, diversity and size. The
extra English members will also provide reassurance that the CHRE
council has the capacity to reflect a range of experience and expertise
to span existing and additional functions indicated in the Bill. The
CHRE’s senior executives already prepare council papers, attend,
contribute and sit alongside council members and have considerable
opportunity to influence CHRE decision making before, during and after
council meetings. It would be more appropriate, and in keeping with the
spirit of the White Paper, to focus on strengthening the CHRE’s
lay membership. Our amendments are designed to achieve that through
increasing English and Scottish membership, and therefore the
council’s capacity 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”.
I
think that I have made the case, and hope that my hon. Friend the
Minister will be sympathetic to it.
Mr.
O'Brien:
I think that what the hon. Member for Luton,
North is trying to achieve is not dissimilar to what we want to
achieve. The power of appointment is always a difficult area, because
at this stage it can look rather benign, but it can in practice prove
very influential and representative.
Our
amendment. No. 52 would limit the Secretary of State to appointing one
non-executive member in line with one from Scotland and one from Wales.
Amendment No. 53 is consequent on that, giving the Appointments
Commission the power to appoint the other two. The question that the
provisions pose to a Government who purport to believe in devolution is
why the devolved Administrations are in this context subordinate to the
Secretary of State. Our amendments Nos. 52 and 53 are intended to
obtain equality, in effect, between the Secretary of State and his
counterparts in the devolved Administrations, notwithstanding the fact
that, to go by the Secretary of State’s response when challenged
on Second Reading, all appointments are likely to be devolved to the
Appointments Commission in any event. I seek some guidance about
representative capacity.
Amendment No. 163 would leave
on the CHRE some representative of the regulators. While in my view,
currently, the council of 19 members, with every regulator represented,
might be unwieldy, surely it is not right that their voice should be
completely silenced, which is why the amendment would preserve
it.
Mr.
Bradshaw:
The reason we are reforming the Council for
Healthcare Regulatory Excellence is to ensure that it fits with the new
regulatory landscape, including shifting its role from being the sum of
the existing regulators to being the independent voice of the patient.
Part of the change, we believe, merits reducing the size of the council
from the rather large membership of 19 to nine—seven
non-executive and two executive. That is consistent with the
Government’s general approach in trying to make the professional
regulatory bodies more board-like and strategic.
The
amendments would significantly increase the size of the council,
bringing it back up from nine to 16, and would alter its make-up by
adding a non-executive member representing the regulatory bodies.
Amendment No. 53 specifically would add two further non-executives
appointed by the Appointments Commission alone. As I have said, it is
already our intention for the Secretary of State to arrange for his
appointments functions to be exercised by the Appointments Commission
anyway, which I hope renders the amendment unnecessary.
I am
particularly concerned about amendment No. 163, because of the point
that I have just made. I am not clear whether the regulatory bodies
would collectively nominate the member. The important point to note,
however, is that the function of the council is changing, so that the
CHRE can promote the interests of patients and members of the public in
relation to the performance of regulatory bodies and be an
authoritative independent voice on the regulation of professionals. It
is not appropriate for regulatory bodies themselves to delegate or to
send a representative to the body that regulates the
professions.
On the
point about Scotland, I hope that I can reassure my hon. Friend the
Member for Luton, North. The change has already been agreed, and the
Scottish Parliament has agreed to legislate a consent
motion for the Bill. It is therefore content with the level of Scottish
representation. I was trying to find out about the size of the FSA
board and whether there are similar plans to downsize it, but I have
not managed to do so in the time available. If I can find that out
offline, I will let my hon. Friend know. Amendment No. 252 would
decrease the number of executive members to just one. That would not be
consistent with usual practice among other arm’s length bodies
sponsored by my Department and others. For example, it is common
practice for regulatory bodies to include their finance director on the
board or council, and it obviously makes sense to allow the CHRE to
follow that example if it so
wishes.
In the light
of those reassurances, I hope that my hon. Friend and the hon. Member
for Eddisbury will not press their
amendments.
Kelvin
Hopkins:
I thank my hon. Friend for his response,
particularly on the Scottish point, and I entirely accept what he says.
As he may recall, emphasis was placed during the hearings on the
importance of having diverse representation on all health bodies,
particularly in constituencies such as mine, and it is important for
people from minorities to be genuinely represented. I will not press my
amendments to a vote, but I hope that my hon. Friend will seek to
ensure that diversity in gender and everything else is properly
reflected in public appointments to all these
bodies.
Mr.
O'Brien:
I shall not press my amendments to a vote because
we have had our debate, and it has been helpful to have a bit more
clarity from the Minister on the issue, although we may return to it.
Clearly, this is an important issue, and I dare say that we shall all
do some more thinking about it.
Kelvin
Hopkins:
I beg to ask leave to withdraw the
amendment.
Amendment, by leave,
withdrawn.
Mr.
O'Brien:
I beg to move amendment No. 164, in
clause 106, page 52, leave out line
27.
The amendment can
be dispatched very quickly, and I almost feel inclined to say,
“Give us a break.” The clause seeks to replace the word
“chairman” in the 2002 Act with the word
“chair”. I could do a complete rant about political
correctness. We have all moved on and we do not need to go back and
completely redraft everything. I really think that the provision smacks
of “Animal Farm”, and we could do without it. I therefore
hope that the Minister will accept my amendment so that we can move on
quickly.
Mr.
Bradshaw:
I imagine that the Equal Opportunities
Commission would take exception to being compared to “Animal
Farm”—
Mr.
O'Brien:
I was not talking about the commission.
Mr.
Bradshaw:
Yes, but it is the commission’s
recommendation that we are carrying out by replacing the term
“chairman” with the term “chair”. If the
hon.
Gentleman really wants to take up the Committee’s time by
debating the issue at length or putting it to a vote, that is his
call.
Mr.
O'Brien:
It is not worth the time. I beg to ask leave to
withdraw the amendment.
Amendment, by leave,
withdrawn.
Clause 106 ordered to stand
part of the Bill.
Clause
107
Powers
of Secretary of State and devolved
administrations
Mr.
O'Brien:
I beg to move amendment No. 207, in
clause 107, page 53, leave out lines 13 to
17.
The amendment
seeks to remove the Secretary of State’s power to direct the
CHRE. The council is another of those so-called independent bodies in
the Bill whose governance leads inexorably back to the Secretary of
State. In response to a question from my hon. Friend the Member for
Tiverton and Honiton during the evidence sessions, Lady Justice Smith
said that,
“it is
important, particularly in the health sphere, that the adjudicatory
body should be seen to be independent of Government because the
Government are a huge customer of healthcare; the biggest customer of
healthcare. Therefore, it is important that there should be no
suspicion that the Government are in a position to pull strings behind
the scenes, as to what goes on. Absolute clarity and absolute
independence are really important. ——[Official Report,
Health and Social Care Public Bill Committee, 8 January 2008; c.
42.]
On the basis of that, I
rest my
case.
Mr.
Bradshaw:
As I have said before in relation not
just to the CHRE but to the Healthcare Commission, there is no
intention to fetter the body’s freedom. The reason for this
power is to ensure that, where necessary, a Secretary of State can ask
the council to prioritise certain areas of its work load over others:
for example, in cases in which there is particular public concern about
a certain regulatory issue, or in which the expert input of the council
is required in a particular Department of Health project. The powers
could also be used to require the council to consult specific bodies,
including the public, in undertaking its duty to inform and consult,
which we discussed earlier. I hope that in the light of that
explanation the hon. Gentleman feels reassured enough to withdraw his
amendment.
Mr.
O'Brien:
Yes. We will probably have to allude to the
matter on another occasion. I beg to ask leave to withdraw the
amendment.
Amendment,
by leave,
withdrawn.
Clause
107 ordered to stand part of the
Bill.
Clause
108
Duty
to inform and consult the
public
Kelvin
Hopkins:
I beg to move amendment No. 255, in
clause 108, page 53, line 37, leave
out ‘seek the views of’ and insert
‘consult’.
The
Chairman:
With this it will be convenient to discuss the
following amendments: No. 256, in
clause 108, page 53, line 40, at
end insert—
‘(c) such other
organisations representing patient and public interests as the
Secretary of State shall by regulation
specify.’.
No.
257, in
clause 108, page 53, line 41, after
‘matters’, insert ‘of
policy’.
No.
258, in
clause 108, page 53, line 41, at
end add—
‘(5) The Council
must—
(a) consult with
public and patient organisations in England, Scotland, Wales and
Northern Ireland on its work programme,
including—
(i) the
standards,
(ii) minimum
requirements, and
(iii)
supporting evidence, to be used in its regulatory performance review,
and
(b) publish at least
annually a report on its consultations in England, Scotland, Wales and
Northern Ireland held in accordance with this
section.’.
Kelvin
Hopkins:
The amendments seek to strengthen clause 108 by
inserting in subsection (4) the word “consult” instead of
“seek the views of”. It seems strange that the word
“consult” is included in the clause heading and is then
softened further down to “seek the views of”. The process
of seeking views is less active, less mutual and weaker than the
process of consulting. Consulting is a two-way process; “seeking
the views of” is a one-way process. I, therefore, ask my hon.
Friend the Minister to consider seriously this
amendment.
The other
component of my amendments would give more powers to my hon. Friend, or
the Secretary of State, to specify other organisations that might be
consulted. Proposed subsection (4)(c) would give the Secretary of
State—in addition to the council—powers to specify other
bodies that might represent patients and the public. It seems to me
that giving extra powers to the Secretary of State might appeal to my
hon. Friend, and I hope that he accepts the amendments. The firming up
of the clause would be welcomed by those who are concerned about public
and patient representation in health.
Mr.
Bradshaw:
As my hon. Friend has rightly pointed out, the
CHRE will have a new duty to inform and consult the public about the
exercise of its functions in the clause. That comes on top of the new
main objective that we have already discussed about aligning the
exercise of its duties with the interests of both patients and the
wider public, and the improvement in the new board structure, which
will be mainly lay with no regulatory body representatives. His
amendment, however, would tie the CHRE’s hands as to how it
consults. The view of the council’s current chief executive,
which we share, is that such formal consultation as my hon. Friend
refers to may not always be the most appropriate way to take soundings
from
people.
5.15
pm
I am sure that
my hon. Friend will know from his own experience that formal
consultation with particular groups can be dominated by what one might
unkindly call groups of self-selecting busybodies,
rather than reflect a true sense of public feeling in a particular area.
The council’s chief executive thinks that it may need the
flexibility to use a quorum, academic studies, focus groups and other
means of engaging with patients, the public and stakeholders, depending
on the gravity and complexity of the issue at hand, as well as
traditional formal consultations. It would not be helpful to tie the
council to the
latter. We believe
that the CHRE will be capable of making the right decisions about how
to consult on particular issues, but as my hon. Friend has probably
noticed, it will be possible use the new Secretary of State power to
issue directions to the council on the manner in which it must exercise
its functions. We have that safeguard if we feel that it is not
consulting properly. As we discussed earlier, the council also has the
obligation to promote best practice and good regulation, which will
include good
consultation.
Mr.
O'Brien:
As the Minister has seen, I did not participate
in the debate on the amendments, but he has just prayed in aid the fact
that he could use the Secretary of State’s reserved power to
direct. That is what causes us some concern about independence. There
is tension in the Bill between seeking to protect by having a power of
direction and convincing many of us that there will be sufficient
independence.
Mr.
Bradshaw:
We think it a sensible balance, which will meet
the concerns expressed by my hon. Friend that the body might not
consult adequately. It will provide a way for hon. Members to express
their concerns, so we think that it is a sensible power to keep. We do
not expect to have to use
it.
On
my hon. Friend’s amendment No. 258, paragraph 16 of schedule 7
to the 2002 Act already requires the council
to
“prepare a report on
the exercise of its functions during each financial
year”,
so
we do not think the amendment on that matter is necessary. The report
that the council is required to table under the 2002 Act should include
details about how it has undertaken its duty to consult and inform the
public.
Although the
amendments in the group are well intentioned, they are not strictly
necessary. They are more prescriptive than the proposals in the Bill
and would not enable anything that is not already possible given the
council’s existing powers. In that light, I urge my hon. Friend
to withdraw the
amendment.
Kelvin
Hopkins:
I am rather disappointed that my hon. Friend has
not at least accepted the amendment to substitute
“consult” for “seek the views of.” There is
a difference, and I know from my experience of dealing with health
bodies in my constituency and local area that some health
officials—I shall not name names—are less than
enthusiastic about consulting the public. They will receive a letter
and say, “Thank you very much”, but when it comes to
consultation they are less enthusiastic. Sometimes we want to get our
point across; we have an active patient and public involvement forum,
with a redoubtable chairperson who would undoubtedly be considered a
busybody by the health authority but is a fine representative of my
constituents and a personal friend of mine.
Angela
Browning (Tiverton and Honiton) (Con): I wish to
articulate the thought that went through my mind when the Minister
talked about “busybodies”. I can think of several people
whom he might describe as busybodies, who are usually fine women of a
certain age past whom no detail goes without their ensuring that it
gets to the right desk. We need a few more busybodies examining what is
going on in the health service. The fact that they do that in their
free time is an
asset.
Kelvin
Hopkins:
I did not want to start that hare running, but I
say to the hon. Lady that I will not pass on the word
“busybody” to my dear friend locally who is chair of our
PPI forum and does a splendid job, especially as she happens to be,
privately, a member of our party as well, which would probably
automatically come under the general category of busybody. Our job as
representatives is sometimes to be busybodies and I am a bit of a
busybody myself. I hope that the Minister will think further on these
matters and the wording of the provision and perhaps return with an
improvement to the clause at a later stage. I beg to ask leave to
withdraw the
amendment.
Amendment,
by leave,
withdrawn.
Clause
108 ordered to stand part of the
Bill.
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