Mr.
O'Brien: Whatever party the Secretary of State comes from,
I hope that mere whimsy would not be the criterion by which such things
are determined. We have some precedent in terms of quality accounts.
Cambridge University Hospitals NHS Foundation Trust has had an early
shot at putting together a quality report for 2009-10. I will see
whether I can get copies of it for Committee members, because it is an
early attempt to put one
together. The
aim is to ensure that people have access to the account and that local
organisations have some input. Page 12 of the quality report, as the
Cambridge trust calls it, states that the Cambridgeshire local
involvement network was involved. Such organisations were included in
how the document was put together, and they were consulted. I will see
whether I can get copies of that document, but it is not necessarily
identical to what we envisage quality accounts will eventually become.
We will want to consult fully on that; this is just an early shot at
seeing what sort of thing could be put together and published. East
Anglia and East of England appear to have done a lot of consultation in
putting together their documents. We will be considering how local
communities were involved in order to learn some lessons from the
documents and hopefully to improve them in the
future.
Mr.
Andrew Turner (Isle of Wight) (Con): I am worried. The
problem is that it is moving away from the ordinary person, the
consumer of the health service, to something up at the top. One can
imagine something from Cambridge setting out what is right for
Cambridgeshire. That is all very well, but the problem is that it will
be sorted out by the kind of people who work in the NHS rather than by
the consumers. How will the Government ensure that it is the consumer,
not the NHS person, who is represented?
Mr.
O'Brien: In a sense, the document gives information from
the NHS to the consumer—the patient and members of the public
who are potential patients—to give them some idea how their
local NHS is operating. The aim is not for the consumer to provide the
data, except through recognised ways, but for the NHS to make available
information that it has now but that is not readily available to
members of the
public. Sandra
Gidley (Romsey) (LD): The Minister has said that the NHS
has this information now. I have just been reading Lord Darzi’s
comments when quality accounts were discussed in the other place. He
admits that the way in which pharmacies and other small providers now
collect data might not be same and that there might be an additional
cost, but that we do not yet know the details. It is clear that, over
time, extra information could be
added.
Mr.
O'Brien: I think that the hon. Lady was on the Health
Committee this morning. I referred to the fact that a cost would be
involved in relation to an acute hospital, for example, and we envisage
an additional cost to a trust of about £3,000 in order to
provide a report. I also mentioned this morning that dentists and
others providing services to the NHS would, after three years, and
following a period of consultation, be required to provide a quality
account. However, I also mentioned that we are considering whether
exemptions would be appropriate in relation to sole providers who might
provide services to a very small number of NHS patients and whether, in
such circumstances, it would be appropriate to require them to publish
a quality account.
The hon. Lady
makes a reasonable point, however, and it is one that we have
considered already. We want to ensure that quality accounts fulfil a
purpose, and do not merely require people to fill in forms for the sake
of it. This is about ensuring that the public get the information that
they are likely to want. There is not much point in having quality
accounts from an organisation, if the public are not interested in
knowing the quality of its service because it is so small or de
minimis. We need to put this into proportion and ensure that local
people get the information that they
want. We
shall also ensure that the commissioners are legally required to
validate the quality of the quality accounts. The hon. Member for Hemel
Hempstead raised this issue. Prior to publication, the commissioners
will have to show that they have overseen the documents and are
satisfied with its validity. This is not just about providing a whole
load of data, but about saying, “This is what we are good at;
this is what we are mediocre at; and in both cases, this is where we
shall make improvements during the coming period.” It will
require the commissioners of the documents to exercise a degree of
intervention and policy initiative. They will not simply provide
information about the current situation. The purpose of that
information is to improve the quality of NHS service
delivery. I
do not envisage the CQC having quite the audit role envisaged in
amendment 99. It will want to assess the quality of the data that it
receives, but it will not be in a position to intervene in every single
NHS provider, wherever it is and no matter how small it is. For
example, in five years’ time, when all these dental practices
are providing quality accounts, should it be the CQC’s role to
validate them all? That is not how we envisage it
operating. The CQC has a role in validating the data that it receives,
but it is important also that the provider of the data ensures that it
is
valid. We
need to strike the right balance—I think that we
have—with regards to the involvement of local involvement
networks in quality accounts. We are not far from the
Opposition’s position on LINks. There is a difference of view on
the extent to which subjective data ought to be introduced. I am not
entirely clear as to how that will be done, but we want the public to
be able to view and use the quality of the data in the document in a
sensible, straightforward way. We also want the document to avoid
unnecessary jargon, although there is always some jargon involved in
providing such information. Furthermore, we want the document to enable
members of the public to know what is going to be done in their local
NHS, as well as the way in which it seeks to improve the quality of
what it delivers in the future.
1.45
pm
Mr.
Stephen O'Brien: I am grateful to my hon. Friend the
Member for Hemel Hempstead for moving the amendment. The Minister
listened carefully, but he is obviously still struggling with the idea
that any kind of subjective patient information should be a part of the
data input process, because he made an analogy that the other data on
more professional and detailed clinical measures would be part of the
ownership of others in clinical practice. I will not press the
amendment to a vote, but I hope that our discussion means that the
Minister and his officials will have reflected upon the issue by Report
stage. The
Government are quite rightly exploring many areas and, as the Minister
has admitted, are trying to move from the former, brutish target regime
to a much more sensitive outcome measure regime. It is highly likely
that, over time, LINks will become one of the key sources in a number
of areas where patient outcome measures will be marshalled, understood
and, above all, de-atomised from individual patient experience to a
point where we can learn policy lessons from the more subjective parts
of the patient journey. We recognise that the great thrust will be the
objective test of clinical health care and social care outcomes, but
the patient reported outcome measures will inevitably be part of that
and will need to be input in order to have a full and—to use a
word that was used earlier—holistic approach to an account of
the delivery of quality in care in its broadest sense. In his report
and reforms, Lord Darzi has urged us to look at care, meaning not just
health care or social care, but a total care
approach. It
would be disproportionate to press the amendment to a vote, but I hope
that, by Report stage, the Minister will have reflected upon whether,
in the absence of anything in the Bill, there will be enough
expectation, as well as discretion under clause 8(5), to enable
marshalled, sensible and almost semi-professional subjective patient
reports and outcome measures to be part of the input process, which
would help in all
care.
Mr.
Mike O'Brien: The hon. Gentleman has just stated that
LINks and other patient organisations could provide data that are not
merely the subjective view of individuals, but are, as he put it,
de-atomised in order to provide more reliable data. That certainly
would be the
sort of data that organisations might well wish to use in their quality
accounts. I do not differ with him greatly on
that.
Mr.
O'Brien: I am grateful for that clarification. It may or
may not be necessary to take the issue further, but this exchange has
given some
clarification.
Mike
Penning: We have had an interesting discussion, especially
about the LINks issue, and I pay tribute to my hon. Friend the Member
for Orpington for his thoughtful comments on that. LINks have had a bit
of a struggle, to say the least, to get going in certain parts of the
country, and, in order to feel confident about them, the public need to
feel that they have some clout and rigidity in relation to holding the
NHS to account. I also pay tribute to my hon. Friend the Member for
Isle of Wight, because it is important that the public have confidence
in the provisions under this part of the
Bill. I
was slightly concerned that the Minister made no mention of Monitor in
his remarks, although I will not push him on the matter. Monitor has a
role to play in looking at the accounts, not least if a trust is asking
to become a foundation trust. The quality accounts are one thing among
others that should be looked at in those circumstances. With that in
mind—I have listened carefully to the Minister’s
comments—I beg to ask leave to withdraw the amendment.
Amendment, by leave,
withdrawn.
Mike
Penning: I beg to move amendment 155, in
clause 8, page 5, line 33, at
end insert— ‘( ) The
Secretary of State must undertake appropriate consultation with
appropriate bodies listed under, but not limited to, subsections (2)
and (3) before requiring them by regulation to publish in respect of
each reporting period a document containing prescribed information
relevant to the quality of
services.’. The
amendment would require the Secretary of State to consult the bodies
producing quality accounts prior to the regulations coming into effect.
As I said earlier, the two consultations that have taken place cannot
be described as full and satisfactory. The first had only 299
responses, of which 11 were from GPs, and clearly a lot of specialist
NHS professionals were not consulted. The second consultation had only
39 responses, including 15 from NHS foundation trusts, four from NHS
trusts, nine from primary care trusts and one from a strategic health
authority. Other important groups responded, but they could not in any
way be described as representing the NHS. The amendment would ensure
that before the legislation is brought into effect, further
consultation across the NHS would take
place.
Mr.
Mike O'Brien: I assure the hon. Member for Hemel Hempstead
that we intend to have extensive consultation on the development of
quality accounts. We have already had an initial period of
consultation. There has been a reasonable level of interest, but
nowadays people often wait until the legislation has passed before
engaging seriously with it, because then they know it is coming. We
want to have an appropriate level of engagement with all the various
stakeholders, including organisations such as LINks, on the way in
which quality accounts will develop.
I must add
that Monitor is the first line of regulation in NHS foundation trusts.
It asks trusts to submit an annual plan and their regular reports and
then monitors how well they are doing against those plans. Monitor has
asked that foundation trusts publish, for example, their quality
accounts with their annual reports, as I said. It has played a key role
in the design of the quality reports that are being produced by
foundation trusts this year. Details are on its website along with
seven quality reports recently published by various foundation
trusts. Consultation
is needed on the future development of quality accounts, not only for
acute trusts—we are reasonably far forward in terms of what they
will do—but certainly before we move to the next stage, when we
look at GPs, consultants, dentists and other parts of the NHS. We will
require quite extensive consultation to ensure that their views on what
should be in quality accounts are taken fully on
board.
Mike
Penning: I thank the Minister for his comments on Monitor.
My question was not about what happens when a body becomes a foundation
trust—I am very aware of the excellent work and monitoring that
takes place after that happens—but about trusts that are trying
to become foundation trusts. I asked him to make it clear that quality
accounts are taken into consideration by Monitor when it is considering
allowing trusts to become foundation trusts.
I accept
fully what the Minister said—he has been very open and honest
about the amount of consultation he intends to undertake—and I
beg to ask leave to withdraw the
amendment. Amendment,
by leave, withdrawn.
Question
proposed, That the clause stand part of the
Bill.
Sandra
Gidley: I shall make a few general comments and I
apologise if some of them were covered this morning, when I had to be
elsewhere. I hope to use the opportunity, first, to get an assurance
from the Minister that the quality accounts will not be used in any
league table format. I do not think that that would be helpful in the
greater picture, because trusts and hospitals tend to take their eye
off the ball and concentrate on what they are being compared
with. Secondly,
a slightly wider question is: why are we starting with family care
trusts, NHS service trusts, special health authorities and NHS
foundation trusts? I understand that it is completely right to wait a
while to see how the quality accounts process beds down before
incorporating the smaller bodies, but who will performance manage that?
Who will ensure that quality accounts are useful? Where do strategic
health authorities fit into the picture? Whenever I have written to the
Department of Health about a problem with my local PCT, the Department
has said, “It is nothing to do with us. You’ve got to go
to your SHA, because they are responsible for performance
managing.” To be blunt, the quality of performance management by
the strategic health authorities has been very variable in the past,
although that has improved, thanks to the reorganisation and the fact
that there are fewer strategic health authorities.
Then we have
the question of the Department itself. The impact assessment
says:
“Part
of the Quality Account will be specified by the Department of Health
and the content will be set out in
regulations.” That
is fine. Then it
says: “This
part will focus on key Departmental
priorities.” I
am not quite clear how we are monitoring the quality of the Department
of Health. The assessment
continues: “The
purpose of the DH-specified part of the Account is to ensure that
patients, the public managers and clinicians have easy access to
information on a provider’s performance against key Departmental
priorities in a way which allows Account users to compare a
provider’s year on year performance and to compare the
performance of similar types of
provider.” We
are getting into league-table territory there. What I want to home in
on is
“easy access to
information on a provider’s performance against key Departmental
priorities.” The
other day, I was talking to a gentleman who voiced concern about the
Department of Health managing the NHS Plus contract. I do not want to
go into great detail, but there are quality aspects to the account of
which the Department has failed to take note, and a note I have says
that there have been no management quality issues on this contract
managed by the Department of Health contract management
board.
There seems
to be no accountability of the Department. For example, the guidelines
said that patient groups, with their specific knowledge, should have
been involved, but they have not. The contract for the occupational
health clinical effectiveness unit—I will follow this up with
the Minister later—was placed with the Royal College of
Physicians, but two specific quality requirements have not been
enforced by the
Department, It
seems a little rich for the Department to making trusts jump through
hoops of producing quality accounts—although they are a good
thing—when the Department itself is not being open and honest
about how it is managing quality. Moreover, strategic health
authorities, which might have a useful role to play, are being
ignored. 2
pm
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