The
Chairman: It is not a question of moving new clause 2. If
it were to be moved, it would be at a later stage. You will see from
the selection list that the debate takes place now. The debate is on
clause stand part, and new clause 2 is considered as part of that
debate. Mike
Penning (Hemel Hempstead) (Con): On a point of order,
Mr. O’Hara. I was intending to speak on new clause 5,
not new clause
2.
The
Chairman: The hon. Member for Eddisbury spoke to new
clause 2. I was explaining that he was not moving it but simply
speaking to it. You may now speak to new clause
5.
Mike
Penning: Thank you, Mr.
O’Hara.
New clause 5
would give notification to Parliament of the impact of quality accounts
on the NHS. It would give Parliament an opportunity to scrutinise the
implementation of quality accounts within three years of their coming
into force. The Secretary of State would be required to make a
statement, written or oral, to the House or to the excellent Health
Committee, on the demand for quality accounts from patients. He will
need to make it clear what improvements have taken place in NHS bodies
in those three years and what impact the policy objectives of the
quality accounts set out in the impact assessment, which has already
been published, has had on the NHS. Finally, the Secretary of State
will need to show how these documents reflect the health care needs of
patients served by these bodies and the
NHS.
Mr.
Mike O'Brien: I am concerned that the hon. Member for
Eddisbury was worried about tired chief executives cutting and pasting
things. Let me assure him that there will be no dodgy cut-and-paste
dossiers from this Government— [Interruption.] I thought I
would get that in before another Committee member did.
New clauses 2,
5 and 7 would oblige the Secretary of State to carry out an impact
assessment of quality accounts and make a report to Parliament,
covering the manner of publication, impact on services and demographic,
social, economic and geographical factors. That is a worthy objective,
but we do not need primary legislation to obtain it. It is worth
emphasising that the quality of the care offered to patients is
fundamental to the delivery of health care. High-quality care is better
for patients and offers better value for money for the taxpayer.
Despite that, historically the quality of health care has not been as
high on the agenda as the discussion of the performance and operational
efficiency of the NHS. That brings me back to the narrative that I gave
of the development of the NHS, moving from dealing with underfunding,
the need to get targets in, to the need to restructure it and now the
need to move on to a new, higher agenda that is basically about
bringing quality into the NHS as the focus of its
activities. Where
elements of quality have received significant attention—for
example, in respect of health care-acquired infections or reduced
waiting times—we have seen significant improvements. Quality
accounts enable quality improvement by promoting local accountability
and transparency. They should enable clinical teams to open up dialogue
with their community, which means that a large element of the quality
accounts will be for local determination. That is why I am a little bit
concerned about the requirement for overall reviews that would be
brought in under the
amendment. The
legislation as drafted provides a broad framework with broad
principles, with the details to be determined later and set out in
regulations and guidance. The current engagement in the testing
processes is shaping these products. We will consult on our regulatory
proposals later this year. It is clear at this point that the data
required for a quality account are simply the existing service quality
data that providers already report to Department of Health
commissioners or the regulators. The legislation therefore sets out
minimum requirements. There is no added burden on the NHS beyond the
cost of preparing the document; all other work is or should be
happening
already. The
ambition is to make quality accounts a vehicle for quality improvement.
That is why we are working closely with stakeholders in designing the
format. More than 1,000 stakeholders have been consulted so far,
including NHS managers, clinicians and patients. We will, of course, be
implementing and developing ideas through secondary legislation. The
process obliges us to present evidence of the real-world impacts
resulting from our policies. So the sorts of data and information that
the Opposition are currently seeking will need to be provided to
Parliament, in any event, during the course of developing the detail of
our policies on the quality accounts
agenda. The
current testing process is the key to what we want to achieve. We have
already started evaluating it. The first report will be available in
the next eight weeks and will enable us to move to the detailed design
phase. Thus, by autumn we will have firm proposals, strong evidence of
their likely impact and an engaged and informed provider community
waiting to implement
them. The
consultation process—design, testing, implementation, evaluation
and revision—will continue. One by-product
of that process will be an annual impact assessment over the next three
to five years, dealing with the impact of the policy against the wider
criteria set out in the provisions tabled by the hon. Member for
Eddisbury. That will become apparent when we publish our evaluation
later this summer. However, I am happy to give a commitment now that I
will ensure that we consider all the criteria in our impact
assessments. He need not worry about that. We have taken on board some
of the concerns that he has raised; indeed, they are concerns that we
had before. Some of the information he requires will therefore come
forward, and it is our intention to make an annual impact assessment
over the next three to five years in any event. I hope that, on that
basis, he feels able to withdraw his new
clauses. 2.45
pm
The
Chairman: It is not a matter of withdrawing them as they
were not moved. To be clear, should the Opposition wish to press the
new clauses, they would be moved formally later, as they have been
debated. Question
put and agreed to.
Clause 9
accordingly ordered to stand part of the
Bill.
Clause
10Regulations
under section
8
Mr.
Stephen O'Brien: I beg to move amendment 122, in
clause 10, page 6, line 34, leave
out ‘annulment’ and insert
‘approval’. Thank
you, Mr. O’Hara. We move to clause 10, which deals
with more regulations under clause 8. The premise of amendment 122 is
simple: the House should be given the opportunity to debate the
regulations proposed in clause 8 regarding the form and content of the
quality accounts. Presently, the regulations will be introduced into
the Bill by way of a statutory instrument that the House will have the
opportunity to annul. If we were given the chance to debate the
regulations through approval of the secondary legislation rather than
annulment, the Government could benefit from the views of the House on
the scope and content of their
regulations. Without
sight of the regulations, it is impossible to ascertain whether quality
accounts will be rigorous and objective enough to paint an accurate
picture of a trust’s services, or indeed the quality of those
services. Although we endorse the notion and principle of quality
accounts, we have not yet been given the opportunity to scrutinise the
detail of the proposal. The regulations would raise a number of issues
for debate, such as the circumstances in which the Secretary of State
might exempt a trust from producing a quality account and the extent to
which the regulations provide for an objective account of quality based
on outcomes. In previous debates, we have certainly touched on the
former, and the Minister, in responding to a previous proposed
amendment, stated that the Secretary of State would have the power to
exempt a trust from producing a quality account.
I think that
the Government have in mind very small suppliers of NHS services who
might find that producing quality accounts is neither proportionate nor
particularly relevant to the service supplied. We must be
extraordinarily
careful that that cannot be used to exempt from producing quality
accounts pioneer technological suppliers or those at the riskier end of
providing services to the NHS, as more innovative suppliers can often
be. If quality accounts are not produced, there would at least have to
be no expectation that quality assurance—or the requirement for
patient safety, of course—would be lessened by the granting of
the exemption. It is easy enough to imagine a small operation for which
it would be disproportionate or a terribly minor part of an overall
service given, but we need some reassurance that the measure is not a
potential way to get out of the obligation to produce quality
accounts. As with so
much of the Bill, we do not have the draft secondary legislation or the
proposed detail of the quality accounts. We have some examples, but the
Minister rightly observed that that is not what is expected in the
final iteration and analysis. The amendment would therefore be helpful
in giving the Government, and indeed the House, the opportunity to take
a view on whether the approach is working well, rather than simply
using the process of annulment.
Mr.
Mike O'Brien: Our original proposal was to use the
affirmative route on the first occasion and the negative route
thereafter. We amended the Bill in the other place to address
recommendations by the Select Committee on Delegated Powers and
Regulatory Reform that the negative route would suffice in this case.
We have responded to that by taking our present position. Of course, we
will want to engage extensively with external stakeholders on the
design of the rules for quality accounts. We have already heard the
views of more than 1,000 interested parties, and we want further
consultation when appropriate before bringing things forward.
I do not see
that much would be added by using the affirmative route for approving
these often detailed regulations and procedures. We need to ensure that
the various stakeholders are engaged; if they have concerns, they will
doubtless bring them not only to our notice but to that of Opposition
Members. The stakeholders will therefore be able to ensure that
appropriate discussions are held should regulations prove
controversial. However, we envisage that the development of the
regulations would not usually be a matter of considerable
controversy.
The hon.
Gentleman said that we must not create a process under which various
organisations can get out of providing quality accounts, and I agree
with him. We need to be careful how the exceptions are used. That is
why we want to consult on their detail, and when we should use them and
when not. We do not want to impose unnecessary burdens on small
organisations or small providers of limited services; but we want to be
sure that if there is an issue about the quality of service that a
patient may receive, there is an opportunity to consider whether
quality accounts ought to be delivered. That may well be the outcome of
the consultation on the particular providers of equipment that the hon.
Gentleman mentioned.
I hope that
the hon. Gentleman understands why we took the route that we did in our
approach to statutory instruments, which was in response to the
suggestions by the Select Committee on Delegated Powers and
Regulatory Reform in the other place. We have taken that view on board
and responded to it. To some extent, I believe that we deserve credit
for having done so. Mr.
Stephen O'Brien: I recognise how the position reached in
the Bill came about, but it was necessary to probe to obtain that
confirmation. The intent is clear and I agree with it. The main thing
is to ensure that there is no opportunity for misunderstanding. That
exchange, in itself, should suffice. I beg to ask leave to withdraw the
amendment.
Amendment,
by leave,
withdrawn. Clause
10 ordered to stand part of the Bill.
Clause
11Direct
payments for health
care
Mr.
Stephen O'Brien: I beg to move amendment 186, in
clause 11, page 7, line 7, leave
out
‘securing the
provision to a patient of’
and insert
‘enabling a
patient to
secure’. We
are forging rapidly through the amendments, and we have reached clause
11. The Minister will recognise that we are likely to find ourselves
engaged for a while, as we have reached the subject of direct payments.
It is known across the House to be an extremely important development
in health policy. However, it raises a number of concerns because it
relates sensitively to some of the most vulnerable people in our
society—be they the elderly in need of care, or those with
long-term conditions who need the confidence of knowing that their care
packages will be sustained and that they will receive them in a quality
way. The
amendment addresses the heart of the principle behind direct payments.
The substantive question is whether the Secretary of State is still in
charge, or whether patients are truly empowered to commission their own
care. We would argue that the Government have come somewhat late to the
party on direct payments; we have been calling for them since 2004. The
Government rejected them as recently as 2006, when we debated the White
Paper entitled “Our health, our care our say”. The then
Secretary of State for Health—there have been several—the
right hon. Member for Leicester, West (Ms Hewitt), called them
a
“revival
of the patient’s passport”.—[ Official
Report, 30 January 2006; Vol. 442, c.
29.] She could
think of nothing ruder. Can the Minister explain his party’s
change of
heart?
In fairness
to the Minister, the Government are going only as far as piloting
direct payments. I think that that is a way of saying that they are the
right thing to have, but I also think that they have been concerned
about a number of issues that have been raised with them, not least by
those on the Government Benches and some people outside the House who
represent groups of
interests. Given
that we know where the two major parties stand on the issue, it will be
useful, in the course of this process, to have equal clarity from the
Liberal Democrats. I know that there are a number of amendments to the
clause that the Liberal Democrat spokesman will be
leading on. I have been concerned that perhaps we have not been
completely as one in our approach to direct payments, which has always
struck me as being absolutely in the line of Hobbes and Hume. I would
be very surprised if the Liberal Democrats did not support this, but we
shall see as the debate
proceeds. The
point is about enabling the patient—the person who needs the
care—to be empowered and, as the expert in their own care, to be
in charge of the care with which they are provided. In addition, we
should not forget that often the family and friends who are their
carers are equally
expert. It
is interesting to note that the former Health Minister, Lord Warner,
said in Committee in the House of
Lords: “I
have often thought that the NHS, which, as a Minister, I sometimes
found a somewhat inward-looking organisation, is rather slow to learn
from local government, which has often been much more
innovative”.—[Official Report, House of Lords,
2 March 2009; Vol. 708, c.
GC212.] I hope
that the Minister will agree with his noble Friend’s assessment
of our NHS, that we can now move rapidly to much greater clarity and
expansion of the principle of making direct payments, and that that
will become much more central to Government policy. As we shall develop
the point through succeeding amendments, I shall not take up the time
now, but we need to ensure, in relation to the patient being in charge,
that we have the ability to make direct payments effective and move
beyond the current pilot stage to something more
full-blown.
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