Sandra
Gidley: The amendments provide a useful opportunity to
probe whether the list of bodies in the Bill that must have regard to
the constitution is sufficient.
Amendments
107 and 108 widen the remits. The point about arm’s length
bodies is valid, because many organisations within the NHS that do not
have direct patient contact are or should be responsible for driving
forward quite a bit of change. We could perhaps include
a body such as the National Patient Safety Agency.
It is not clear how such organisations fit into the wider picture. Some
clarification would be
useful. The
hon. Member for Eddisbury is quite correct: I was taken by the remarks
made by the hon. Member for Basingstoke on Second Reading. She made
some very good points. She
said: “The
Apprenticeships, Skills, Children and Learning Bill establishes
children’s trusts as statutory bodies that have an important, if
not vital, role to play in the commissioning of services, including NHS
services, for children in local
communities.”—[Official Report, 8 June 2009; Vol.
493, c.
581.] I cannot
see the difference between a primary care trust and a children’s
trust in that role, if they are both commissioning NHS services. The
Minister made much earlier of the fact that there was almost a
catch-all, because the PCTs would be commissioning services and those
services would effectively be covered by the constitution. By
extension, therefore, one could argue that services commissioned by a
children’s trust would not be covered by the constitution. I
find that slightly alarming. It could be that we are not doing as well
for our children as we could.
Sure Start
centres, although they do not commission services, have been a key part
of delivering services to children, many of which are public
health-related. I struggle to see why NHS trusts, which provide
services, must have regard to the constitution, but Sure Start does not
seem to have to. I am also unclear where organisations or
establishments such as independent sector treatment centres fit.
Clearly, they are delivering treatments paid for by the NHS, albeit
under an independent banner, so it seems somewhat perverse that,
apparently, they do not have to have regard to the
constitution.
The
amendments are designed to tease out a little more of the thinking and
to seek reassurance that there are no parts of the health delivery
service, or even the more strategic parts of the health service, that
are falling through the
gaps.
Mr.
Mike O'Brien: The amendments are interesting, and they do
probe whether the NHS constitution reaches the parts that other
constitutions do not reach. Amendments 7, 8 and 164 would
place a duty on something called the NHS board, NICE, the
children’s trusts, Sure Start centres and other organisations
providing NHS
services. Turning
first to the point about the obligations of NHS employees. I hoped that
I had made this clear, but let me reiterate. An NHS employee does not
have any new legal obligations as a result of the constitution. Boards
will be in a position where they are required to comply with the
constitution: they will have to have regard to it. An NHS employee will
have the duties of an employee of an NHS trust or board, or whatever
the organisation in the NHS is. As part of their contract of
employment, they will have to deliver what they are obliged to do under
that contract, but they do not, as individuals, acquire any new legal
obligation under the constitution themselves. The board will and they
are employees, therefore the board will have an obligation to ensure
that they deliver the constitution. Were they to fail to do so, they
would be dealt with in the normal manner as employees. It does not
impose an additional duty on employees that does not exist today. I
hope that makes the position very clear.
In relation to
amendment 7, I need to point out that there is no such thing as an NHS
board, so there is therefore no point in referencing one in the
legislation. However, I understand that in their policy document the
Conservative party have the objective of creating such an NHS board.
They are getting a bit presumptuous—they think they are going to
win the next general election. I say wait for the electorate’s
opinion before proposing amendments that are supposed to take effect
after the election. I suspect that the hon. Member for Eddisbury may
find that the electorate will make their own mind up and he should not
try to jump ahead. Let me be clear that I do not think that the
amendment and that reference to the NHS board is
necessary. We
do not want to have a broader, longer debate about greater operational
independence for the NHS. Suffice it to say, however, that I do not
agree that the NHS should be completely removed from any meaningful,
democratic control. The NHS is responsible for spending more than
£100 billion of taxpayers’ money every year. As long as
policy and spending decisions are taken by democratically elected
Ministers who are accountable to Parliament, there will be an
obligation to subject their decisions to proper scrutiny. We believe
that there must be a continuous thread of accountability through the
system to the Government of the day and, through them, to
Parliament. The
NHS needs a period of stability. We do not believe that now is the
right time to impose further top-down changes to its structure. It is
more important that there should always be clarity and transparency in
the accountability of the NHS. The statement of NHS accountability
published alongside the constitution will help to achieve
that. None
of that is to say that the Government are in favour of centralising
power in Whitehall. We have consistently demonstrated our commitment to
a more devolved system: for example, through the establishment
of NHS foundation trusts, through devolving commissioning
responsibilities to PCTs and GP practices, and by looking at ways to
put more control in the hands of patients, which we will discuss later
under the proposals on direct
payments. Amendment
8 is unnecessary because NICE is already included. It is a special
health authority and is therefore captured in subsection (2)(d). Our
aim is to ensure that all organisations that are part of the NHS are
obliged to take proper account of the NHS constitution. NICE will have
that obligation. A number of special health authorities will be
covered, including the National Patient Safety Agency, the NHS Blood
and Transplant organisation and the NHS Litigation
Authority. The
right to NICE-approved drugs articulates the existing legal duty on the
NHS to provide such drugs when clinically appropriate. NICE will
therefore be obliged to have regard to the constitution. NICE will also
be obliged to ensure that QALYs, where they are used, are in compliance
with the
constitution. Turning
to amendment 164, I am aware that the Apprenticeships, Skills, Children
and Learning Bill requires local authorities to establish
children’s trust boards. I assume that the hon. Member for
Romsey was referring to those bodies, rather than to children’s
trusts. I assure her that we at the Department of Health are working
closely with colleagues in the Department for Children, Schools and
Families to make children’s trust boards a
success. The
hon. Lady’s interpretation of children’s trust boards is
incorrect. Although they will become a statutory entity, subject to the
approval of Parliament, they will be strategic bodies. Their only
functions will be to prepare, publish, review and revise local children
and young people’s plans and to monitor their implementation.
They will not be involved in their delivery, which she suggested we
should have regard to. Children’s trust boards will not hold
budgets for commissioning, nor will they provide services, so it would
not be appropriate to place them under a legal obligation to have
regard to the NHS
constitution. Sure
Start children’s centres will also be given a specific statutory
basis through the Apprenticeships, Skills, Children and Learning Bill.
However, like children’s trust boards, they will not be
providers or commissioners of health services. It is important to be
clear that children’s centres, as provided for in that Bill, are
places where services are provided by a range of organisations. They
are not bodies with an identity or functions separate from the
organisations that provide those services. A legal duty will therefore
not be placed on children’s
centres. It
is the responsibility of the relevant local authority and its statutory
partners, including primary care trusts, to ensure that
children’s centres provide integrated services for young people
and their parents. Of course, all providers of children’s NHS
services, and primary care trusts as commissioners of children’s
NHS services, are captured by clause 2. When a service is delivered by
or for the NHS, it will be captured. However, organisations such as
children’s trust boards and children’s centres are not to
be subject to the constitution because they are not part of the
NHS. Finally,
let me make it clear that clause 2 already captures any other
organisations providing NHS services, either directly or through the
commissioning functions of the NHS bodies listed in clause 2. I hope
that hon. Members agree with me that in the absence of an NHS
board—for the time being or otherwise—there is no need
for amendment 7; that NICE is already captured by the clause and a duty
on children’s trust boards and Sure Start children’s
centres would be inappropriate. So I hope that they will withdraw their
amendment. 4.30
pm
Mr.
Stephen O'Brien: I said at the outset that I was hoping to
tease a number of things out of the Minister, and tease I certainly
did. I slightly regret amendment 7 now, on the basis that it gave rise
to an unsolicited party political broadcast on behalf of the Labour
party, which I will not respond to because it would detain us too long,
as I would like to have challenged almost every sentence. That said, I
was only seeking to be helpful. It might be a very efficient way of
providing the means to put an NHS board in place, should the
contingency arise. We have had an opportunity to air that and I have no
difficulty in begging to ask leave to withdraw amendment 7.
With regard
to amendment 8, it was important to make sure that we understood that
the special health authorities encompass the National Patient Safety
Agency,
the NHS Blood and Transplant organisation and the NHS Litigation
Authority, as well as NICE. I do not think that the Minister said that
was the exclusive list. I assume he read those out as examples. It
might be helpful to make a list
available. Mr.
Mike O'Brien: For the record, yes that is
correct.
Mr.
O'Brien: I am grateful to the Minister because it could be
helpful to the Committee. I do not need to press this to a vote but it
has helped to make sure there is clarity as to why those particular
categories have been used in the Bill. It would be useful to have a
list of the current special health authorities to know where we start
and to have a baseline of information for the future. When anyone
invents any other new bodies—NHS boards or otherwise—they
will have to consider when drafting whether it is a special health
authority or not.
I will wait
to see whether the hon. Member for Romsey wishes to press amendment
164, but it was helpful to have that discussion. It was fascinating to
hear the Minister say that the Government do not believe in any further
top-down processes in the NHS, knowing that we are also totally against
further unnecessary organisational change. It looks as though the NHS
can take some comfort if those words are to be believed, and I regard
him as someone who does not use his words lightly.
Most
importantly, it is clear, at least from the Department of
Health’s perspective, that the bodies referred to, such as the
children’s trust bodies and Sure Start, are non-commissioning,
non-provider bodies and are therefore strategic in nature rather than
those that need to be brought within the ambit. It might be helpful to
ensure a bit more cross-departmental discussion. My hon. Friend the
Member for Basingstoke, with responsibilities relating to another
Department, had been led to believe that there were to be some
commissioning processes from these children’s trust bodies. She
raised the point on Second Reading because she had been given the
impression that that was to be the case. As they would have some
commissioning responsibility they would potentially be in the place of
a PCT with regard to some health services for children. As long as
there is absolute clarity we do not need to bring them within the
ambit. If there is no clarity, the Minister might want to reflect on
that. In the light of those comments, I beg to ask leave to withdraw
the amendment, and I am happy if the Liberal Democrat spokesman does
not press her
amendment. Amendment,
by leave, withdrawn.
Amendment
proposed: 5, in
clause 2, page 2, line 8, at
end insert— ‘(3) The core
principles of the NHS are
that— (a) the NHS will
provide a universal service for all based on clinical need, not ability
to pay, (b) the NHS will
provide a comprehensive range of
services, (c) the NHS will
shape its services around the needs and preferences of individual
patients, their families and their
carers, (d) the NHS will
respond to different needs of different
populations,
(e) the NHS will work continuously to improve
quality services and to minimise
errors, (f) the NHS will
support and value its
staff, (g) public funds for
healthcare will be devoted solely to NHS
patients, (h) the NHS will work
together with others to ensure a seamless service for
patients, (i) the NHS will help
keep people healthy and work to reduce health
inequalities, (j) the NHS will
respect the confidentiality of individual patients and provide open
access to information about services, treatment and
performance.’.—(Mr. Stephen
O'Brien.) Question
put, That the amendment be
made. The
Committee divided: Ayes 7, Noes
8.
Division
No.
2] Question
accordingly
negatived.
| 
