Mr.
Stephen O'Brien: We could discuss staff and contracting at
this point, but to some degree we have dealt with that satisfactorily.
Prompted by my experience in Cheshire, I want to cover something raised
by provisions in subsection (8), although it does not warrant an
amendment. Because of Government edict, we ended up having to abandon
the historic county of Cheshire and impose two new unitaries—the
East Cheshire unitary authority and the West Cheshire and Chester
unitary authority. I want to ensure that the Minister knows that the
list in subsection (8) includes county councils, district councils,
London borough councils, the common council of the City of London and
the council of the Isles of Scilly, but not unitary councils. Where,
therefore, in that list do the new East Cheshire unitary authority and
the West Cheshire and Chester unitary authority sit? That might be a
drafting point, which has a consequential effect on Government
legislation in other areas. If the Minister does not have an immediate
answer, I am happy to accept a
letter.
Mr.
Mike O'Brien: I am glad that the hon. Gentleman is happy
to accept a letter. I will look at
it.
The
Chairman: Indeed, in the north-west we have to learn to
refer to the
Cheshires.
Mr.
Stephen O'Brien: But the Cheshires will only get one
allocation of
money. Question
put and agreed
to. Clause
3 accordingly ordered to stand part of the
Bill.
Clause
4Other
revisions of NHS
Constitution 6
pm Question
proposed, That the clause stand part of the
Bill.
Mr.
Stephen O'Brien: I wish to address subsection
(3). What assurance can the Minister give that the Secretary of State
will ensure that those who will be consulted will
include “patients,
staff, members of the public and other persons as appear to the
Secretary of State to be affected by the proposed
revision”? I
am not aware of how that will be done objectively. At the worst end, a
whole load of yes-men would be selected, who might give the answer that
the Secretary of State first devised, and at the other, it would be a
completely random unrepresentative body of people. If we are going to
have other revisions, it is important that the consultation process is
seen to access not only stakeholders and appropriate patient groups.
Given the other discussions that we have had in relation to LINks and
those in the list in clause 3(3)(a), it is important that some
assurance is given, even if only by placing on the record at this point
that the selection is intended to be objective, and that there is no
possibility of either cronyism or of trying to select the people to
consult in order to produce the first answer thought of by the
Secretary of
State.
Mr.
Mike O'Brien: The appropriate word in
subsection (3) is “include”. There is a
non-exhaustive list of those who need to be consulted. Particular
attention is drawn the requirement to consult those who are directly
affected by the revisions. However, there are others who are generally
consulted on revisions who would also need to be consulted. The list is
not exhaustive; on the contrary, it merely draws attention to the
obligation on the Secretary of State to ensure that those directly
affected are directly
consulted.
Mr.
Stephen O'Brien: I am grateful for that perfectly fair
response. I dare say that the Minister will be aware of others in
addition to LINks and patients having a voice, which we have discussed.
For instance, on the Health and Social Care Bill we took evidence,
because it was not a Bill generated in the House of Lords, from, among
others, institutions such as Which?, and consumers who might have a
patient’s view. That is an interesting point and could therefore
be
included. The
other point relates to where formal staff representational positions
are in place. I am sure that the Minister is as aware as I
am—those of us from the north-west, Mr.
O’Hara, are particularly aware of this—that the
Association of Professional Ambulance Personnel continues to rail
against the fact that it is never consulted. There has always been a
great turf war between various effective union representations of
ambulance staff, and the association continues to fail to be
represented. That is an example of how a real effect could be achieved.
Therefore if the association were to be included it
would be extremely pleased, as that would be an improvement in its
position that it has sought for many
years. Mr.
Mike O'Brien: I hesitate to get involved in turf wars. We
intend to undertake the appropriate broad-based consultation and
ensure, in particular, that those who are directly affected are
consulted. Question
put and agreed
to. Clause
4 accordingly ordered to stand part of the
Bill.
Clause
5Availability,
review and revision of
Handbook
Mr.
Stephen O'Brien: I beg to move amendment 110, in
clause 5, page 4, line 16, leave
out ‘continues’ and insert ‘and
the Statement of Accountability
continue’.
The
Chairman: With this it will be convenient to discuss the
following: amendment 111, in clause 5, page 4,
line 19, after ‘Handbook’, insert
‘and the Statement of
Accountability’. Amendment
112, in
clause 5, page 4, line 21, after
‘Handbook’, insert ‘and the
Statement of
Accountability’.
Mr.
O'Brien: The amendments are brief. They do the same thing
and would insert the statement of accountability into clause 5 on the
same terms as the handbook. Clause 5 is about the availability, review
and revision of the handbook. Through the amendments, the statement of
accountability would also have a legislative foundation for its
availability, review and revision. We had many discussions about that
when we debated amendment 3 and I will not rehearse those, except to
ask the Minister why the handbook is in the clause when the statement
of accountability is not. Logically, it should be both or neither. I
hope his reply will clarify
that.
Mr.
Mike O'Brien: There is no need to place a duty on the
Secretary of State to make available, review and update the statement
of accountability because the Government are already committed to it.
Principle 7
reads: “The
system of responsibility and accountability for taking decisions in the
NHS should be transparent and clear to the public, patients and staff.
The Government will ensure that there is always a clear and up-to-date
statement of NHS accountability for this
purpose.” The
seven principles in the constitution, including that one, cannot be
changed except by regulations laid before Parliament. Therefore, no
Government can renege, without parliamentary approval, on the
commitment to keep the up-to-date statement of accountability. That
provides ample clarification. It would be unhelpful in terms of
timeline to insert into the Bill when the statement of accountability
needs to be reviewed, since it describes the structure of the NHS,
which might not change at all in any three-year period, or conversely
might change sooner. Flexibility is needed to keep the statement up to
date and so keep it useful for the audience with which it is supposed
to engage.
The answer to
the hon. Gentleman’s key concern is that the issue is covered by
principle 7. The three-year period would just add unnecessary
bureaucracy. Why, if the statement of accountability has been reviewed
after two years and nine months, review it again after three years? It
does not make sense. There is an obligation; it is required to be
constantly updated and that is the best way to deal with
it.
Mr.
Stephen O'Brien: I am satisfied with the explanation. I
beg to ask leave to
withdraw. Amendment,
by leave,
withdrawn.
Mr.
Stephen O'Brien: I beg to move amendment 113, in
clause 5, page 4, line 20, at
end insert: ‘and may address the impact of the
Handbook on National Health Services
including— (a)
dentistry; (b)
audiology (c)
podiatry’.
The
Chairman: With this it will be convenient to discuss the
following: amendment 114, in clause 5, page 4,
line 20, at end
insert: ‘(3A) The review may assess
the cost savings made as a result of the NHS
Constitution.’. Amendment
115, in
clause 5, page 4, line 20, at
end insert: ‘(3A) In reviewing the
Handbook and the Statement of Accountability the Secretary of State
must consult the bodies listed at section
3(3).’.
Mr.
O'Brien: This series of amendments seeks to put in the NHS
handbook strong indicative markers for performance. They might also be
markers for any report on the effect of the NHS constitution under
clause 6. Amendment 113 takes three areas in which the Government have
consistently underperformed; I am sure that hon. Members could
add others—health inequalities, malnutrition, single-sex wards
and superbugs, for instance.
With regard
to dentistry—a subject on which my hon. Friend the Member for
Hemel Hempstead has repeatedly called the Government to
account—the failure of the Government is becoming a byword.
Access has declined since the Government’s new dental contract
was introduced in 2006. Patient outcomes have worsened considerably and
the dental professional is feeling, somewhat justifiably,
disfranchised. More than 36,000 children with tooth decay are admitted
to hospital each year and the figure is rising. It is now the third
most common reason children are admitted to hospital, with a 13 per
cent. rise in the incidence of hospital admissions relating to tooth
decay in five years.
My hon.
Friend and our party have pledged to restore access to an NHS dentist
for the million patients who have lost it under the Government’s
current failed system, by slashing bureaucracy and cutting waste and
creating new incentives for dentists to spend more time on preventive
dental care, improving oral health and reducing long-term costs. It is
important to use money that is currently spent on carrying out
unnecessary treatments to reintroduce dental screening for children in
schools, so that children aged five can have their oral health
addressed. That is also part of a scheme that would
give
dentists the freedom to charge patients who repeatedly miss
appointments—a counterpoint to what we were discussing a moment
ago—and ensure that taxpayer-trained dentists work for the NHS
for at least five years. If this were a benchmark for the performance
of the handbook and the constitution, we might get a real sense of what
improvements they can bring. To take
another example, in January 1,849 people were still waiting more than
18 weeks for digital hearing aids, 585 of whom had waited more than a
year. That has been a long-running scandal which has particularly
affected older people. The ability of the constitution and the handbook
to deliver on that would also be a mark of their value; failure to
deliver would be a mark of their failure.
To emphasise
the need for the three amendments we also need to look at podiatry
services, where older people have long been neglected. Age Concern has
been campaigning for years on podiatry services and its “Feet
For Purpose” document, published in August 2007, shed light on
the horrific circumstances of many people. It found that one in three
of the 2 million people in England over the age of 65 cannot cut their
nails. Lack of even the most basic foot care can lead to complications
resulting in dangerous falls, severe restrictions on mobility and
social isolation. Proper foot care is key to the dignity and freedom of
so many older people and, yet again, the dignity challenge is silent.
The press has reported that at least 12 PCTs have cut podiatry
services, and the Government’s national service framework for
older people in 2001 highlighted the need for podiatry as part of old
age specialist care. Functioning podiatry services would make a real
difference to older people and the NHS, and would be a good benchmark
for measuring the effectiveness of the constitution and the
handbook.
I also pay
tribute to Diabetes UK, which made a particular point of emphasising
the need for better and more accountable podiatry services. One of the
many unseen challenges and afflictions that affect the many people who
suffer from diabetes is the difficulty, not only in making sure that
they can cut their nails, but in keeping healthy feet when facing so
many other challenges.
Amendment 114
would enable the Committee to explore two intriguing statements in the
Department of Health cover note to the impact assessments on the Bill.
Paragraph 3
states: “The
benefits of each of these proposals are expected to outweigh the
associated
costs.” Paragraph
7 of the NHS constitution
states: “These
may have both costs and benefits; there is currently insufficient data
to make a realistic
estimate.” I
hope the Minister can explain that contradiction and tell the Committee
how much the constitution has cost to date; otherwise he might want to
add that to his letter pile.
Finally, as
with so much in the Bill, the review seems to be left at the potential
whim of the Secretary of State. Amendment 115 would ensure that all the
bodies and persons who feed into the tenure review of the constitution
also support the review of the functioning of the handbook. It is right
that such a review should be open, informed and honest, and I hope that
the Minister will accept that and our other
amendments.
Sandra
Gidley: While I cannot argue with the hon. Gentleman, I
find amendment 113 a little confusing. It is fairly weak because the
wording states that it “may address the impact”, so it
hardly seems worth putting in the Bill. It seems to be a “do it
if you want to” approach. He mentioned areas of neglect and
quite rightly highlighted three that are of concern. However, by
putting those into the Bill, he may be neglecting other important
areas. For example, we could easily add “access to talking
therapies” or “availability of NICE
medicines”—it would be interesting to force a review of
that because implementation is patchy. Others may prefer “access
to IVF services” to be listed. Those three examples immediately
sprang to mind, but if we brainstorm—I am not sure that we are
allowed to use that phrase anymore—we could come up with a long
list of underfunded services. I am concerned about supporting the
amendment, although I recognise the intention behind
it.
6.15
pm Similarly,
I am concerned about amendment 114, which again contains the weasel
word “may”. I have sat in many Committees in which the
Conservatives tried to strike out each “may” and replace
it with “must”, so I am surprised to find the word here.
I would not necessarily support a “must” in this case.
The constitution is not about finance, and the unnecessary bureaucracy
involved in assessing the financial implications of the constitution
runs counter to everything we hear about the Conservatives wanting to
reduce regulatory burdens, but I may have missed something. I find it
difficult to support the amendment.
Amendment 115
is perfectly sensible. It may be superfluous, but I have no difficulty
supporting it.
Mr.
Andrew Turner (Isle of Wight) (Con): I am concerned about
dentistry, because it is very poor on the island, despite attempts by
Ministers to do something about it. The problem is that the recording
system is based entirely on the number of appearances before a dentist.
We no longer have a system that looks at each person; instead it looks
at the number of visits. That tells us how many appearances, not how
many people, there are before the dentist. That is the wrong system and
it gives the wrong impression. It appears that more people have
inspections, but in fact they are the same people—the same
people are going to the dentist more and the same people are going to
the dentist less. We must fix that problem by recording the number of
visits that each person has, not just the smaller number of people who
have regular
visits.
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