 House of Commons |
Session 2008 - 09 Publications on the internet General Committee Debates Health Bill [Lords] |
The Committee consisted of the following Members:Chris Stanton, Committee
Clerk † attended the
Committee Public Bill CommitteeThursday 18 June 2009(Afternoon)[Mr. Edward O’Hara in the Chair]Health Bill [Lords]Clause 8Duty
of providers to publish
informtion Amendment
proposed (this day): 159, in clause 8, page 5,
line 24, leave out paragraph (c).—(Mike
Penning.) 1
pm 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 commission’s 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
Minister’s 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withdrawn.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 Government’s 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 trusts—especially foundation
trusts—publish 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 Health’s
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 year’s account bills someone and
reports on its predecessors,
so that there is a follow-through in each report. Over time, a narrative
arc will build up showing a dynamic improvement story in relation to
quality within that NHS organisation. We are discussing with trusts,
patient groups and regulators how best we can ensure effective public
availability of quality accounts without overburdening the NHS.
Regulations and guidance will set out how that can best be achieved. I
entirely accept the point made by the hon. Member for Hemel Hempstead
that not everybody has access to the internet. We need to ensure that
people who do not have access to IT can none the less obtain access to
quality accounts, and we intend to make sure that that
happens.
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 Monitor’s 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. Gentleman’s 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 today’s 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
published. As so much of this will not be on the face of the Bill, it is
important to do so. With those assurances, I beg to ask leave to
withdraw the amendment.
Amendment,
by leave,
withdrawn. 1.15
pm
‘( ) 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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