2 Core Tasks
13. In accordance with a Resolution passed by
the House in May 2002, the Liaison Committee has set Select Committees
certain core tasks to perform which are designed to provide a
framework to encourage "a more methodical and less ad-hoc
approach to the business of scrutiny".[5]
The following section describes the core tasks and gives a commentary
on how our work relates to them.[6]
14. They are grouped under four separate objectives:
Objective A: To examine and comment on the policy
of the Department;
Objective B: To examine the expenditure of the Department;
Objective C: To examine the administration of the
Department;
Objective D: To assist the House in debate and decision.
It is for each individual Committee to determine
how it meets these objectives. This Report describes the work
the Health Committee has done in relation to these core tasks
and to our inquiries.
Objective A: To examine and comment
on the policy of the Department
TASK 1: EXAMINATION OF POLICY PROPOSALS;
AND TASK 4: EXAMINATION OF DEPARTMENTAL DOCUMENTS AND DECISIONS
15. The first core task is "to examine policy
proposals from the UK Government and the European Commission in
Green Papers, White Papers, Draft Guidance etc., and to inquire
further where the Committee considers it appropriate". Core
task four, which is linked closely to task one, is to "examine
specific output from the Department expressed in documents or
other decisions".
16. We scrutinise the Department of Health's
policies through inquiries on specific proposals, typically resulting
in a Committee Report. In 2007 Professor the Lord Darzi of Denham,
the Parliamentary Under Secretary of State at the Department of
Health, began "to conduct a nationwide review of the NHS
in England", and to set out a "vision for health services
in the 21st Century". This review was heralded
as a major piece of work which would have a significant effect
on the future of the NHS. Accordingly, we decided to undertake
an inquiry into his review and did so following its publication
in the summer of 2008. Our Report, published in January 2009,
concluded that although there was much to commend in the review,
notably its emphasis on quality, we doubted whether PCTs had the
ability to implement the proposed reforms.
17. We have examined policy proposals in a number
of other inquiries. Our inquiry into Top-up fees considered
the Richards Review on Improving access to medicines for NHS
patients. We concluded that while the proposal to allow patients
to buy additional end-of-life drugs was the best option for the
NHS, it would be difficult to achieve in practice and could disrupt
patients' continuity of care and the coordination of information-sharing.
Meanwhile, our inquiry into Health Inequalities considered
EU proposals in respect of food labelling. Our current inquiry
into the future of social care services examines the Government's
Green Paper Shaping the Future of Care Together.
TASK 2: IDENTIFICATION OF EMERGING
POLICIES OR DEFICIENT POLICY
18. Core task two requires the Committee "to
identify and examine areas of emerging policy, or where existing
policy is deficient, and make proposals". Almost all of our
inquiries in 2008-09 fulfilled this objective, as we typically
examine subject areas which have either attracted criticism, or
within which new policies are emerging. For example, the Committee
identified commissioning as a weak link in the health service
in a number of inquiries in recent years, and as a result elected
to launch an inquiry specifically into this subject in 2009. A
further example is our current inquiry into Alcohol, where
we are examining possible policies to tackle the alarming increase
in recent years in alcohol-related deaths. Our inquiry into Health
Inequalities looked at concerns that current policies were
unlikely to meet Government targets.
TASK 3: SCRUTINY OF DRAFT BILLS
19. The third core task is "to conduct scrutiny
of any published draft bill within the Committee's responsibilities".
The Department of Health did not publish any draft bills during
2008-09. However, as part of our inquiry into Alcohol,
we considered measures contained within the Policing and Crime
Bill to tackle the misuse of alcohol. Furthermore, our examination
of the NHS Next Stage Review included scrutiny of the NHS
constitution outlined in the Health Bill 2009.
Objective B: To examine the expenditure
of the Department
TASK 5: EXAMINATION OF EXPENDITURE
20. Core task five is "to examine the expenditure
plans and outturn of the Department, its agencies and principal
NDPBs [Non-Departmental Public Bodies]". We consider this
responsibility central to our work. With a budget of over £90
billion in 2009-10, the Department is Whitehall's second largest
spender of public money.[7]
As in previous years, the Committee undertook an inquiry into
the Department's finances as part of its Public Expenditure
Questionnaire (PEQ) inquiry. Each year we send the Department
a questionnaire asking for answers to a range of finance-related
questions. The answers were published in hard copy as well as
on our website.
21. In January 2010 the Committee will hold an
evidence session with senior Departmental officials, including
the Permanent Secretary and the NHS Chief Executive, on the PEQ.
As in previous years, it is anticipated that this session will
allow us to explore important areas of financial expenditure by
the Department in greater depth than is possible in other inquiries.
Our previous PEQ inquiry resulted in the Committee publishing
a Report on The use of management consultants by the NHS and
the Department of Health. We were pleased that the Government
partially agreed to the Committee's recommendations, and agreed
to publish NHS data from 2010.
22. In addition to our Public Expenditure
Questionnaire, our other inquiries considered NHS expenditure
and, in particular, value for money. Our Health Inequalities
inquiry looked into the cost-effectiveness of Government interventions
to tackle inequalities. We concluded that we could not know whether
money had been well spent, since the Government had not only not
adequately assessed its policies, but also had failed to design
them in such a way that they could be evaluated. As a result it
was possible that money had been wasted on ineffective and possibly
damaging interventions; we recommended the introduction of a more
rigorous culture of piloting and evaluation, together with the
use of clearly defined goals and robust measures of success.
23. Similarly, our inquiry into Patient Safety
found that the NHS had failed to collect evidence about whether
patients were actually any safer, despite a decade of investment
in initiatives to stop harm. We were concerned at the nature of
the National Patient Safety Agency's remit, and that it was not
using its resources as effectively as it could have.
Objective C: To examine the administration
of the Department
TASK 6: EXAMINATION OF PUBLIC SERVICE
AGREEMENTS AND TARGETS
24. Task six is "to examine the Department's
Public Service Agreements, the associated targets and the statistical
measurements employed, and report if appropriate".
25. Our inquiry into Health Inequalities,
which we completed in March 2009, was focused on a key Public
Service Agreement (PSA) target. The PSA target is: "By 2010
to reduce inequalities in health outcomes by 10 per cent as measured
by infant mortality and life expectancy at birth".[8]
Our Report noted that this represented a particularly tough target,
and that there was a significant degree of scepticism that it
would be achieved. Our inquiry also looked at a number of other
targets, including those relating to infant mortality, obesity
and teenage conception rates.
26. As usual, we examined the Department of Health's
PSA targets in our PEQ exercise. Chapter 8 of the Questionnaire
covers PSA targets. The Committee expects to pursue a number of
these targets in oral evidence with the Permanent Secretary and
NHS Chief Executive during the oral evidence session scheduled
for early 2010.
TASK 7: MONITORING OF ASSOCIATED
BODIES
27. Task seven is "to monitor work of the
Department's Executive Agencies, NDPBs, regulators and other associated
bodies". We monitored the work of a number of the Department's
agencies and arm's length bodies during 2008-09. In fact, given
that the NHS itself is a federation of arm's length bodies, our
scrutiny of such bodies is a feature, to at least some extent,
of all our inquiries.
28. Two of our inquiries, however, have focused
closely on the work of specific arm's length bodies. Our inquiry
on Top-up fees examined the role played by the National
Institute for Health and Clinical Excellence (NICE) in implementing
the Richards Review on Improving access to medicines for NHS
patients. NICE is the body which is responsible for providing
national guidance on promoting good health and preventing and
treating ill health, and our scrutiny of it in this inquiry followed
an earlier inquiry into it in 2007-08. Meanwhile, the Committee's
inquiry into Patient Safety saw us monitor a number of
arm's length bodies, the National Patient Safety Agency and the
Care Quality Commission among them. A full list of the associated
bodies we took oral evidence from is included in the list of witnesses
in Annex 3.
TASK 8: SCRUTINY OF MAJOR APPOINTMENTS
29. Task eight is "to scrutinise major appointments
made by the Department". In July 2009 the Committee held
a formal appointment hearing, according to the procedures agreed
by the Liaison Committee, in respect of Lord Rooker, the candidate
for Chair of the Food Standards Agency. We questioned him about
how he saw the role, his independence, his relevant expertise
and experience, and his priorities for the organisation. Immediately
after the meeting we published a report in which we concluded
that he was a suitable candidate, and recommended that the Secretary
of State make the appointment.
TASK 9: EXAMINATION OF THE IMPLEMENTATION
OF LEGISLATION AND MAJOR POLICY INITIATIVES
30. Task nine requires committees "to examine
the implementation of legislation and major policy initiatives".
This year the Committee has devoted a good deal of time to this
task. As we have discussed, our inquiry into Health Inequalities
found serious weaknesses in the Government's policies in this
area. Our Report on Patient Safety looked at policy developments
in the field over the past decade. We credited the NHS for having
led the way for healthcare systems throughout the world in the
development of patient safety policy but concluded that, in practice,
significant progress was still necessary to make NHS services
safer. Included within the scope of the Committee's inquiry on
Alcohol was the consideration of the Government's "Alcohol
Reduction Strategy".
31. In July 2009, we launched an inquiry into
Commissioning. This was prompted by the Government's launch
of "World Class Commissioning", an initiative designed
to radically improve the quality of commissioning across the health
service. Our inquiry, which is ongoing, is examining the effectiveness
of commissioning by Primary Care Trusts, and the rationale behind
the purchaser / provider split. We held one oral evidence session
on this inquiry in 2008-09, with several more to follow in 2010,
prior to the publication of the Committee's Report.
Objective D: To assist the House
in debate and decision
TASK 10: INFORMING PUBLIC DEBATE
32. Task ten requires us "to produce reports
which are suitable for debate in the House, including Westminster
Hall, or debating committees". During 2008-09, three of the
Committee's Reports were debated by the House. Our report on Dental
Services was debated on an Estimates Day in the House on 16
December 2008, while our Reports on NHS Next Stage Review
and Health Inequalities were the subject of Westminster
Hall debates on 14 May 2009 and 12 November 2009 respectively.
The Committee welcomes the opportunity for its reports to be debated
and hence given greater exposure. We also recognise the opportunity
that debates present to question ministers further on the Government's
response to our recommendations. However, we must note that the
time for the Estimates Day debate was severely curtailed to under
two hours by several Government Statements; as a result several
Members who wished to speak were unable to do so.
33. We are keen to hold debates on our reports
into Patient Safety and on Social Care (we expect
to publish our report on Social Care in January 2010).
5 Liaison Committee, Second Report of Session 2001-02,
Select Committees: Modernisation Proposals, HC 692, para
16 Back
6
The table in Annex 2 provides a summary of the core tasks and
how our work related to them. Back
7
Department of Health Departmental Report 2009 (CM 7593) Back
8
www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Healthinequalities/
Healthinequalitiesguidancepublications/DH_064183 Back
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