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Lord Clement-Jones: The noble Lord, Lord McColl, explained the amendment extremely cogently, with his great knowledge of the theatre face, so to speak. Medical specialists are confused about how commissioning will work. In discussing the functions of the PCTs, the Minister and the noble Baroness touched on some of the specialist services, dealing not only with the definition but also with what they encompass and what the department intended the PCTs would be able to commission by way of specialised services. She mentioned in particular AIDS and HIV treatment and several other areas. However, other so-called tertiary services will not be in the purview of the PCT but within the purview of the NHS region.
It is a difficult problem, no doubt in the course of being resolved. The consultation paper was published some considerable time ago and there has been a lot of time to put the whole thing together. Any clarification which can be given at this stage will be helpful because there is not a huge amount of time for the matters to be resolved.
Baroness Hayman: I am certainly happy to give as much clarification as I can. I must confess to the Committee that on reading the amendment we believe that it dealt with the provision of specialist medical services by primary care trusts rather than the commissioning role. The noble Lord's explanation in introducing the amendment made it clear that he wished to deal with the commissioning of specialist services, which are an important and difficult issue.
The broad policy commitments were made clear in the White Paper, The New NHS, and regional offices are now reviewing existing collective health authority arrangements for commissioning specialist services. Health authorities standing outside such arrangements where it would be clearly appropriate for them to join will be required to do so. Additional new arrangements should be introduced only where there are agreed plans supported by the necessary data and funding flows have been identified.
In preparation for the year 1999 to 2000, regional offices are paying particular attention to the commissioning of cancer services, paediatric intensive care and the soundness of plans for renal services. Regional specialist service leads will collectively peer review arrangements in the spring of this year in order to ensure a consistency of approach and to share best practice. The list of services to be commissioned, which was put out in HSC198/98, forms a working brief and will be further defined in discussion with the field, and the national specialist commissioning advisory group will provide advice as required. National priorities for action will be identified, but regional offices should now be agreeing an annual programme of work of which services they will review and how they will develop arrangements for commissioning newly identified specialist services.
Obviously regional offices will be accountable for ensuring that there are effective arrangements for commissioning these specialised services in each region. There are a number of ways in which such arrangements have been and could be established, but the principles are clear. Clear, too, is the principle that health authorities and primary care groups, and in due course primary care trusts, will be required to participate in them. The arrangements should be capable of commanding the confidence of the clinical units concerned while being held accountable to the health authorities and primary care groups on whose behalf they will be commissioning specialised services. Regional offices will need to ensure that there is clear quality control and assurance mechanisms in place while minimising bureaucracy wherever possible.
These are complicated areas, but I hope that the Committee will be reassured that work is going forward to ensure that the proper arrangement for these difficult areas of specialist commissioning is being taken forward.
Lord McColl of Dulwich: I thank the Minister for that reply and I shall certainly study closely what she said. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
10.15 p.m.
Lord Harris of Haringey moved Amendment No. 55:
After Clause 4, insert the following new clause--
(" . After section 18A of the 1977 Act (inserted by section 4) there is inserted--
"Inspection of premises by community health councils.
18B. Community health councils may enter and inspect any relevant Primary Care Trust premises at such times and subject to such conditions as may be agreed between the council and the Trust or, in default of such agreements, as may be determined by the Secretary of State."").
The noble Lord said: This amendment deals with the issue of rights of inspection by community health councils of relevant primary care trust premises. As this
Since their creation in 1974 community health councils have been able to inspect NHS hospitals and other healthcare premises managed by the health service. Indeed, Clause 20 of the Community Health Council Regulations 1996 specifically states that community health councils may,
My concern in moving this amendment is that it is not entirely clear what is the status of primary care trust premises under these circumstances. The amendment seeks to achieve the right of CHCs to enter and inspect such premises in the same way as they are currently able to enter and inspect other NHS premises. It would be anomalous not to provide for CHCs to do so. It would potentially reduce public confidence in the services provided and indeed in the reforms brought forward in today's Bill. I beg to move.
Baroness Hayman: I hope to deal briefly and satisfactorily with the amendment moved by my noble friend. We are absolutely in tune with the intention of this amendment. Provision has been made in paragraph 27 of Schedule 4 to the Bill for the power of CHCs to which he referred. That gives powers to include primary care trusts among those bodies who may be subject to inspection by community health councils. Paragraph 27 provides for the amendment of the NHS Act 1977 to place primary care trusts in a similar position to health authorities and NHS trusts on a number of matters relating to CHCs. We will be consulting on amendments to the appropriate secondary legislation in due course.
In the light of that, I hope that my noble friend will not feel it necessary to have a provision on the face of the Bill. I am happy to give him a clear commitment that we will amend the community health council regulations to give effect to the proposal in his amendment. I hope therefore he will not feel the need to press it.
Lord Harris of Haringey: I am grateful to the Minister for her extremely helpful reply. I shall study in detail the section of the schedule to which she refers and ensure that I understand it. However, under the circumstances, and given that assurance, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord McColl of Dulwich moved Amendment No. 57:
The noble Lord said: By preventing trustees of primary care trusts from managing any hospital, the purchaser/provider split is reinforced. If PCTs are allowed to manage hospitals, an inefficient situation is likely to emerge whereby the same body is responsible for the commissioning and delivery of care; indeed, not just primary care but hospital care also. The overwhelming consensus among health economists is that the purchaser/provider split has been good for our health service and resulted in an increased efficiency and better patient care.
Although the effects of the Bill are likely to be minor in the medium term with regard to the extent to which the split is compromised, the fact that it would be technically possible for a primary care trust to take over and run a major acute hospital has to be seen as a retrograde step.
The Minister may have already mentioned this topic when I was not in attendance, but perhaps she would comment on it. If the Government really do believe in the purchaser/provider split, and the benefits it brings to the National Health Service, how exactly will a PCT at level four enjoy the advantages of the purchaser/provider split? I beg to move.
Baroness Hayman: I was somewhat unclear about whether the amendment was seeking to restrict the trustees of primary care trusts from applying funds for the management of acute hospitals or for the benefit of patients in acute hospitals generally. If the former, the amendment is superfluous because charitable funds may not be used to substitute Exchequer responsibilities, which include the management of an acute hospital. I fear that perhaps we are a little at cross purposes. However, I am addressing the effects of the proposed amendment as I understand it to be. If the latter is the case, the restriction would be wrong. It would prevent the trustees from applying funds to provide a seamless service between the acute and primary care sectors and we would expect trustees for NHS trusts to apply funds held for any NHS purpose across this boundary, where appropriate.
Trustees are personally and severally liable for their actions. They have to apply funds for the purposes specified by donors. Applying funds for the management of an acute hospital would not be a proper use of such funds. Trustees must apply charitable funds in accordance with donors' wishes. It would be wrong for the amendment to restrict the trustees.
In replying in those terms, I am conscious of the fact that I am not exactly meeting the argument put forward by the noble Lord, Lord McColl. However, I think I am speaking to the effect of his amendment because it deals with trustees.
"enter and inspect any premises controlled by a relevant Health Authority or relevant NHS trust at such times and subject to such conditions as may be agreed between the Council and the Health Authority or NHS trust".
Page 5, line 39, at end insert ("other than the management of any acute hospital").
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