House of Commons
|Session 2008 - 09|
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General Committee Debates
Health Bill [Lords]
The Committee consisted of the following Members:
Chris Stanton, Committee Clerk
attended the Committee
Public Bill Committee
Thursday 18 June 2009(Afternoon)
[Mr. Edward OHara in the Chair]
Health Bill [Lords]
Duty of providers to publish informtion
Amendment proposed (this day): 159, in clause 8, page 5, line 24, leave out paragraph (c).(Mike Penning.)
Question again proposed, That the amendment be made.
The Minister of State, Department of Health (Mr. Mike O'Brien): With regard to the role of the Care Quality Commission and quality accounts, the commission receives a lot of data that will go into the quality accounts, and it will, of course, check that data. Other data, which it is not the commissions role to check and oversee, will be put into quality accounts on a local basis. That is the responsibility of the organisation that puts that data in. The data required to be submitted to the CQC, which may well be in excess of the data that are required in the core of the information that has to be in the quality accounts, will be looked at by the CQC. However, I want to make it clear that there may be other things that the trust or another NHS organisation puts in that it will not be the responsibility of the CQC to audit, check or evaluate.
Mike Penning (Hemel Hempstead) (Con): I thank the Minister for that clarification. The matter was slightly confusing to me earlier. I am still not completely convinced that I understand what the role of Monitor will be within foundation trusts, but perhaps we will consider that as we progress. With that in mind, I am minded to accept the Ministers assurances. I indicated at the start that this is a probing amendment. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Mike Penning: I beg to move amendment 88, in clause 8, page 5, line 26, after publish, insert (electronically and in paper form).
The Chairman: With this it will be convenient to discuss the following: amendment 174, in clause 8, page 5, line 28, at end insert
(3A) The regulations may specify that the information relevant to the quality of NHS services is to be published within the annual reports of NHS Trusts and, subject to the direction of the Independent Regulator of NHS Foundation Trusts, within the annual reports of NHS Foundation Trusts..
Amendment 100, in clause 8, page 5, line 34, at end insert
( ) In this section to publish includes to make available to the public in paper form, and by means of a website..
Amendment 157, in clause 9, page 6, line 6, at end insert
( ) In subsection (4) to make the document available includes in particular
(a) to publish electronically and in paper form;
(b) to take reasonable and appropriate steps to ensure that patients and the public are informed of the manner in which they may access the document;
(c) to take reasonable and appropriate steps to make the document readily accessible to patients and the public..
Amendment 162, in clause 9, page 6, line 6, at end insert
(4A) In subsection (4) to make the document available includes in particular taking reasonable steps to ensure that the document is alternatively available in the appropriate form for any person that may have difficulty accessing an electronic or paper copy..
Amendment 160, in clause 9, page 6, line 19, leave out 2 and insert 3.
Mike Penning: Through amendment 88, I want to consider how the accounts are published each year. The Secretary of State can determine the form, content and timetable for publication. If the accounts are to be looked at each year in order to give some confidence about what progress or lack of progress has taken place, there must be some confidence that like is being compared with like as the years go on. I seek clarification on the role of the Secretary of State. The powers are here for him to make these changes, but I wish to know in exactly what circumstances he can do so. The impact assessment acknowledges that there is a risk to patients and that the public might be confused about the relationship between quality accounts, if the information is changed this year. The Governments impact assessment acknowledges that fact. Will the Minister explain how he will square that circle?
Amendment 174 relates to concerns that people might have about cost and the multitude of publications. When the trustsespecially foundation trustspublish their end-of-year accounts, they should be able to publish their quality accounts in the same document. That would make it much easier for the public to understand exactly what has been going on within that trust during the year. Of course, a comparison with the quality accounts would be in sight. At the same time, that would establish more of an overseeing role for Monitor in relation to the quality accounts, because foundation trusts would have to submit their end-of-year accounts to Monitor. As I said earlier, these are probing amendments to find out exactly what the Government intend to do with their Bill.
On amendment 100, the impact assessment states that there would be a risk if patients and the public were confused. Amendment 100 would, I hope, establish the exact form in which quality accounts should be published. Not everyone has access to electronic information. I am not being derogatory to the older population of the country, but if I were to ask my grandfather to go on a website and look at some quality accounts, he would wonder what planet I come from. It is important that access to quality accounts is included in the Bill so that everybody, whether they are a stakeholder, patient or Member of Parliament, can see them either electronically or on paper in the form of a written report.
Amendment 157 follows amendment 42 in the other place. Regarding the timetable for the publication of quality accounts, it will not be useful to have them dripping out all through the year from different trusts and parts of the NHS. It would be useful for those accounts to be published together and on time within a month, for example, so that the public can see them. That matter was looked at by the Department of Healths impact assessment, as the Department was concerned about the myriad publications taking place throughout the year.
Amendment 162 looks at the manner in which the documents are published. The impact assessment stated that there were concerns about possible confusion, and the amendment would address that. Amendment 160 looks at the aims of the Department regarding providers in cases where patients believe that the providers are falling short of the quality that they expect from the NHS. Earlier, the Minister spoke extensively about the top end and looked at how well the NHS is doing. No one praises the NHS and its staff more than me for their professionalism, but mistakes happen, and the amendment would address any shortfall in quality.
Mr. Mike O'Brien: Amendments 88, 100, 157, 162 and 160 look at quality accounts and their means of publication, on a website as well as in paper form. Amendment 174 would enable NHS trusts and foundation trusts to combine their quality accounts with their annual reports and accounts.
The Bill requires providers to submit a copy of their quality account to the Department of Health. That is for the explicit purpose of making the quality account available to the public on the NHS Choices website, in addition to its publication by the provider. That will ensure that the public have access to all quality accounts published by providers through a nationally recognised website.
Clause 9 already addresses the manner in which patients and the public may access a copy of a quality account. It is important that we obtain the right balance between ensuring that patients and the public have easy access to quality accounts, without unduly increasing the cost and burden of quality accounts to the NHS. Our impact assessment estimated publication costs of around £180 for every 100 paper copies of a quality account published. These days, a local hospital of a significant size should be able to print off a copy of what is on the website on request.
Providers will need to estimate the number of requests for paper copies of the quality account that they expect to receive, based on a local knowledge of the likely needs of their community. We do not envisage that a record of a quality account will only be available on a website; it must also be available in written form. There will be no pass record, just a paper-based one.
The question was about what has happened over the past three, four or five years and how people will be able to access certain information. That is a valid point, but not one for primary legislation. That issue, along with much of the detail regarding how this will be done, will be addressed in the guidance. We will explain to providers that their reporting will bear greatest credibility if each years account bills someone and reports on its predecessors,
As I noted in relation to the earlier amendments to clauses 3 and 5, the NHS routinely provides its documents in formats accessible to people with disabilities, and we intend to do that in future. There is no need for extra legislation on the face of the Bill. As I have said before, the Disability Discrimination Act 1995 already requires public authorities to take reasonable steps to provide disabled persons with an auxiliary aid, where that aid would facilitate receiving any benefits. A further duty is therefore unnecessary.
Although the Bill sets out a basic requirement for the publication of quality accounts, we will supplement that with subsequent guidelines, to which providers will need to have regard when drawing up their quality accounts. The default position of requiring a copy to be sent to the Secretary of State does not preclude our requiring foundation trusts to follow Monitors instructions and publish their quality accounts alongside their financial accounts. A parallel arrangement could be put in place for those trusts outside the FT regime. I hope that we can accomplish that laudable ambition as well as many other innovative and exciting ideas for enhancing public accountability. After our current design phase has concluded and we come to draft the guidance and regulations, we will be able to give some detail as to precisely how, and in what form, these quality accounts will be published.
I am sympathetic to the hon. Gentlemans point about documents being produced at around the same time, so people know when documents are coming out and can access things reasonably simply. The best approach is to consult the various organisations and see whether there are problems that we have not anticipated. The idea that he is putting forward seems to be reasonably good. Let us see what those organisations say as part of the consultation. In due course, we can put what needs to be added into regulations or guidance.
I do not wish to set todays good ideas in stone. We need to be flexible about what the NHS will look like and how it will behave, be managed and communicate in the future. I would not want to see tightly defined details about reporting methods on the face of the Bill. The hon. Gentleman has indicated that he wants probe how we intend to get that information out. I hope that I have reassured him that the Department is sympathetic to his points but wants to introduce them into the rules in a more appropriate way than placing them on the face of the Bill.
Mike Penning: I thank the Minister for that assurance, and for listening carefully to the arguments on this set of amendments. Perhaps as we progress through the Bill the Minister will be kind enough to indicate when he thinks the guidance from the Department is likely to be
Amendment, by leave, withdrawn.
( ) The Care Quality Commission shall, in a manner which the Secretary of State shall prescribe, review and report on the accuracy and completeness of any information contained in a document published in accordance with subsections (1) and (3)..
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