Mr.
O'Brien: The hon. Member for Romsey raised a number of
issues, which I will take one by one.
First, there
is no intention to have league tables, but a quality account will set
out the various improvements needed in individual NHS organisations. As
a result, there will be an ability to make comparisons, particularly
across the core set of criteria, as opposed to the local set of quality
criteria. That is part of the objective, in the sense that quality
accounts are about driving up quality. Organisations will want to look
at what other organisations are doing and measure themselves against
them, but given the variability and the number of permutations that are
possible across the breadth of quality accounts, I do not think that
any sort of league table would be possible. I cannot guarantee what the
media will do; on today of all days, it is appropriate to say that
control over that force of nature does not lie with this House.
However, the ability of peer groups to assess the quality of what
others do, which exists across medicine now, needs to
continue. Who
performance manages the documents? The strategic health authorities do
not have a role in drawing up the quality accounts. That is done and
has to be validated by the organisation that draws up the accounts. The
SHAs are able, however, to intervene if something in their data
contradicts what is in a quality account. They will be able to examine
and challenge the validity of the information presented in quality
accounts. The
Care Quality Commission has a greater role. It will receive
considerable amounts of data, which will form much of the core data
that every organisation in that sector of the NHS—acute
hospitals for example—has to provide. The CQC will examine those
data and will be able to look at a quality account and say whether the
data presented are appropriate. There will also be local information
for which the CQC does not have data, and its role will not be to
intervene in relation to that; that is the responsibility of the
provider
organisation. The
Department of Health will set out its priorities and seek to determine,
as it already does, national policy, with the consent of Parliament. It
will also be able to indicate what it wants to see in quality accounts
to drive up particular areas of quality. The hon. Lady asks who checks
that the Department of Health is providing quality. Well, she does, and
so does every other MP in this House. The Public Accounts Committee
does—it has produced a number of reports on many aspects of how
the Department operates. It has issued its strictures where
appropriate, and sometimes where it might not be entirely appropriate,
but it is entitled to do that. Select Committees too, such as the
Health Committee, have a responsibility for that level of oversight.
There is a level of supervision of the Department and it is
here. Question
put and agreed
to. Clause
8 accordingly ordered to stand part of the
Bill.
Clause
9Duty
of providers to publish
information
Mike
Penning: I beg to move amendment 92, in clause 9,
page 6, line 4, after first
‘State’, insert ‘and
simultaneously laid before
Parliament’. The
amendment provides for greater parliamentary scrutiny of quality
accounts by ensuring that they are laid before Parliament at the same
time as they are submitted to the Secretary of State. That is an
important principle for all parliamentarians, and one to which
the Minister should give consideration. It is clear that if quality
accounts are to be successful, widespread engagement with them is
needed, including by parliamentarians, especially if we are to
represent our constituencies
correctly.
Mr.
Mike O'Brien: The amendment would place a responsibility
on the Department of Health to lay copies of quality accounts before
Parliament. That is clearly not for the purpose of public
accountability, as copies will be publicly available locally from the
provider, and nationally when we publish them on the NHS Choices
website. Public accountability is there. It is open to any Member of
the House to access any of the documents that are on the NHS Choices
website, so Members will be able to find out what is in the quality
accounts.
I cannot
emphasise enough the production process that we envisage. Our testing
and engagement process has shown that the NHS wants to ensure that
quality accounts are a success. The final version of quality
accounts has already been subject to local scrutiny by patients and the
public. What will be sent to the Secretary of State will therefore be
the best account that can be given. It is
certainly open to any Member of Parliament to request that a particular
quality account be placed in the Library of the House. I am not sure
that having large numbers of quality accounts from, in due course,
every dentist, doctor and health organisation in the country piled up
on the table in the Chamber is what is needed. If anyone wants access
to a document, it will be easily accessible to Members of Parliament
and members of the public, so the level of accountability is actually
considerably greater than almost anything else that is available to
MPs.
I do not
think that it is necessary for the accounts to be laid formally before
the House. There will be so many of them that I do not think that that
would be the appropriate way to
proceed.
Mr.
Stephen O'Brien: In support of my hon. Friend the Member
for Hemel Hempstead, the amendment is probably informed by the fact
that those of us who share the privilege of being shadow Health
Ministers find that much of the difficulty of furnishing ourselves, as
would be expected, with the information that helps us to scrutinise and
hold the Government to account arises from the fact that so much
information is held not at ministerial level or even departmental
level, but at SHA and trust level. Very often, we have found that
asking written parliamentary questions has not enabled us to elicit
that information, particularly on all the various accounts that relate
to the wide panoply of trusts. As a result, freedom of information
requests have tended to be the methodology used and, as the Minister is
well aware, that is a very time-consuming and burdensome operation.
What lies behind the amendment is the desire to short-circuit some of
the hard slog that is needed just to make the information available, as
any proper Opposition should be doing to hold any Government to
account.
Mr.
O'Brien: I am hurt by the suggestion that asking
parliamentary questions does not elicit all the information
required.
Mr.
Stephen O'Brien: Not always. It is
unreliable.
Mr.
O'Brien: I am also aware that it is in everybody’s
interests that Opposition Members, particularly shadow Health
spokesmen, are able to do their work. Certainly, we want to ensure that
that is the case in future.
Mr.
Stephen O'Brien: I am glad I raised the
subject.
Mr.
O'Brien: Let me take the point on board and consider, with
the Secretary of State, whether we can talk to the Library and see
whether it would be prepared to take all the documents. They have the
information in the sense that it is on the internet, so they have easy
access to it. I am sure that the Library would be able to print off
from the internet any document and any quality account that is
required.
Mike
Penning: It might not be suitable for the Library to be
doing that. The Vote Office, which has publishing facilities and
capacity in the House to print off the relevant forms should a Member
require that, is probably the logical way
forward.
Mr.
O'Brien: The Secretary of State will have a copy of the
quality accounts and we will look at ways to ensure that Members have
easy enough access to them. I think that there is easy enough access
anyway through NHS Choices. I doubt that there is a need to publish or
print them internally in the House, given that they are so easily
available, but I will consider what the hon. Gentleman has
said.
Sandra
Gidley: Is the Minister saying that all of the information
will be in one place on NHS Choices? That is fine, because the problem
now is that it is held in all the different trusts and collating
information is usually very
difficult.
Mr.
O'Brien: NHS Choices will need to have all the reports and
make them all available. They will be accessible via the website, so if
the hon. Lady wants a report on a trust, the website is the route that
I envisage her using. I am not sure whether that deals with her point,
but the information should be easily accessible on NHS
Choices.
Sandra
Gidley: The point is that all the quality accounts
information should be in one finite place, rather than listed
separately under each trust, which makes it far more difficult to
collate and
compare.
Mr.
O'Brien: That is a fair point, and I will take it back to
the Department. The hon. Lady seems to be suggesting that not only
should the reports be available in relation to other data on particular
trusts and other organisations, but that they should be identified
separately on the website, so that it is possible to access just
quality accounts. That is a reasonable suggestion, and I will talk to
NHS Choices about whether that can be
arranged.
Mike
Penning: I thank the Minister for listening to the
arguments. The purpose of the amendment was to extrapolate what we have
extrapolated. It is crucial to have accessibility to documents in one
place, whether in the Library or on NHS Choices, so that we can
cross-assess trusts. I beg to ask leave to withdraw the
amendment. Amendment,
by leave,
withdrawn. Mike
Penning: I beg to move amendment 158, in
clause 9, page 6, line 6, at
end insert— ‘( ) A document
(whether in whole or in part and whether alone or jointly with others)
made available to the public by the Secretary of State must be
accompanied by such information as may be recommended to the Secretary
of State by the National Institute for Health and Clinical Excellence
with a view to enabling the public to assess the document’s
contents by reference to relevant and meaningful standards of
comparison.’. For
the first time in the two days that I have sat on this Committee, an
amendment refers to NICE and its role in providing better information.
The amendment, which was tabled in the other place by my noble Friend
Earl Howe, makes a simple proposal. If NICE has relevant information
that would be suitable, necessary
and perhaps informative to individual trust users, it should be placed
in or alongside the quality accounts, so that the quality improvement
focus that NICE may want to recommend would allow the public to
understand better the facilities that they
receive. Mr.
Mike O'Brien: Amendment 158 would impose on NICE a role in
helping people to understand providers’ quality accounts by
providing further information to allow a comparison between accounts
and to oblige the Secretary of State to publish NICE’s guidance.
Our view is that NICE is not best placed to provide the comparability
tool. That is not its role. NICE provides standards. It does not
measure against them subsequently. It sets
them. Having
said that, we are looking closely at how to facilitate comparison in
other ways. We have given a commitment that quality accounts should be
published on the NHS Choices website specifically to allow for informed
and meaningful comparisons to be made. We are also considering
providing more explanatory material to the public and a toolkit for
publishers of quality accounts to draw on to ensure that their
documents are reader friendly and to enable comparability by the
public. We intend to do that by guidance rather than prescriptive
regulation. One
factor in the production process for the toolkit is evaluation of the
current quality accounts testing process being led by NHS East of
England and Monitor. We expect to have the final report within the next
eight weeks. That will help us to identify any problems, and thus
solutions, in aiding public understanding of the meaning and import of
the information used in quality accounts. That will then inform our
consultation on draft regulations and guidance later in the year. We
believe that the role proposed in the amendment would not be welcomed
by NICE and would not fit easily with its current role in the
NHS.
Mike
Penning: I have listened carefully to the Minister, and
although he will not accept the amendment in its present form, it
sounds as though work is being done on what NICE could do to help to
inform NHS users. With that in mind, I beg to ask leave to withdraw the
amendment. Amendment,
by leave,
withdrawn. 2.15
pm
Mike
Penning: I beg to move amendment 163, in
clause 9, page 6, line 6, at
end insert— ‘(4A) A document
(whether in whole or in part and whether alone or jointly with others)
made available to the public by the Secretary of State shall contain
information about the choice of services available to
patients.’. This
amendment gives additional provisions for quality accounts and would
put the principle of patient choice on the face of the Bill. This is
mentioned in the impact assessment, but is not explicit in the Bill due
to the emphasis on powers by
regulation. I
am sure that the Minister has had time to read the work that the
King’s Fund has done on the Bill. They have put forward four
suggestions to help us address the points raised in the impact
assessment. These are, first, patients and carers should make choices
based on better information; secondly, providers and commissioners
should determine priorities for improvement; thirdly, the boards
of NHS trusts and non-NHS equivalents should place quality at the heart
of their procedures for planning and delivery; and, fourthly,
clinicians and clinical teams should evaluate and compare their
performance. Eminent
authorities and think-tanks, such as the King’s Fund, would like
to see such processes on the face of the Bill. The impact assessment
indicated that they would be there, but they are not. Could the
Minister assure me that such processes will be addressed even if they
are not on the face of the
Bill.
Mr.
Mike O'Brien: Patient choice is important and we want to
ensure that it is at the heart of a number of the initiatives that we
are taking. The NHS Choices website is the core way in which that data
is made available to members of the public. The website has information
well in excess of what will be provided in quality accounts. When
making a choice of where to have an operation or what medical service
to use, NHS Choices is the source for that information. Quality
accounts would only be a fraction, a part, a component of the wider
information that is provided by NHS Choices. They can look at quality
accounts on the NHS Choices website, but we do not envisage that that
would be the basis on which all choices would be
made. We
need to make clear the limitations of quality accounts as well as their
purpose. Quality accounts will help to shape services on offer from
each provider and make each provider account for the quality of those
services. That is linked to patient choice, but choice is just one of
the ways in which providers will be held to account. There has to be
broader support for quality accounts coming from our engagement and I
am concerned that using them for a purpose for which, of themselves,
they were not intended could detract from the objective of improving
quality in the NHS. Choice is important, but there are other ways of
delivering it. Quality accounts will be a component of the choice
equation, but only a part of
it.
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