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Lord Clement-Jones: I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Carter: Perhaps I can interrupt with a short business statement concerning the Committee. It has been agreed between the usual channels that this evening we shall stop after Clause 46. Amendments Nos. 194 and following will be taken as first business on Thursday. The previously agreed dates for Report and Third Reading are not affected.
Lord Astor of Hever moved Amendment No. 74:
The noble Lord said: In moving Amendment No. 74, I shall speak also to Amendment No. 76. The first amendment will ensure that information monitored for the duty of quality is published. The primary objective of the clause is the duty of quality imposed on PCTs and NHS trusts. It appears that health authorities are exempt from that duty, which is odd given that in many cases they are the bodies that are best placed to monitor the standards of healthcare in their area.
A requirement to publish should make comparison easier across different PCTs and NHS trusts. Good and poor practice would be more easily identified, thus driving up standards. It is also the case that the so-called abolition of the internal market will mean that the tracking of costs within the health service will become much more difficult. That is despite the Government's evident retention of the purchaser-provider split. That will result in a situation where it is difficult to determine whether a PCT or NHS trust is making the best use of the funds allocated to them. Such a situation cannot mean that patient care is effectively delivered.
It is the duty of the Government to make any information on the quality of healthcare available to patients. If mechanisms are to be put in place to monitor that information, it would be unfair for it not to be available to the public to enable people to make informed choices in relation to their healthcare. This is a matter of widespread concern to the public, as I am sure the Government will be aware from their focus groups.
Amendment No. 76 aims to ensure that the reports of health bodies on the duty of quality explicitly take into account the views of the NHS, patients and their carers. Quality in the NHS should be firmly rooted in the experiences of patients and carers. To date, the Government's proposals for quality focus almost exclusively on the needs of professionals and managers. For instance, the consultation document, A First Class Service, briefly mentions the importance of taking account of the views of patients and carers in defining quality. In debating a Bill about the structures for the new NHS it is easy to overlook the fact that the most important objective is improved quality and delivery for patients and carers. That aim should be set out on the face of the Bill. I beg to move.
Baroness Sharp of Guildford: I rise to support Amendments Nos. 74 and 76. We echo the noble Lord's words entirely. It is right, where there is a duty of quality, that there should be some tracking and that publication in this case is appropriate.
Again, it is clear that we on these Benches support the noble Lord, Lord Astor, in relation to these amendments.
Baroness Pitkeathley: I am very supportive of the aim of reflecting the views of users and carers. However, perhaps I may enter a word of caution about the fact that that can be done by publishing reports. Eliciting feedback,
Baroness Gardner of Parkes: I feel that there can be too many reports, but we need enough for people to be able to find out what is happening and what the situation is. My memory of health service returns, which seem to be made constantly, is of an interminable quantity of paper going into the Department of Health. Such returns took an enormous number of hours to complete and no one quite knew what happened to them after that. I would make a plea for producing really useful statistics which can be used in a practical form.
Lord Winston: I fully support the sentiments with which the noble Lord, Lord Astor, moved this amendment. However, I fear that it is flawed. I am certain that this would be quite the wrong route to take. We already have a paradigm in the health service for such reports and it is deeply flawed. I am thinking of the figures given out by the Human Fertilisation and Embryology Authority which, although seemingly a comparison between units, have been shown to be statistically invalid by a publication in the British Medical Journal. And this is a very narrow area of clinical activity.
Such reports could deeply mislead the public. They would be not only potentially misleading but also very expensive for individual authorities and trusts to produce. There is every risk that unless there is extremely careful confirmation of exactly how the reports will be made, this would be an impossible exercise.
Different areas of cities, with different levels of poverty and environmental conditions, will treat different kinds of condition. All those factors could affect the outcome of clinical treatment. Under the circumstances, I do not believe that this would be a useful amendment.
Baroness Hayman: There has been universal agreement on the aim behind these amendments; namely, to ensure transparency and accountability by requiring NHS trusts and primary care trusts to publish information on the arrangements they put in place under this duty of quality. That is a concern that the Government share. However, we do not believe that it is necessary to specify this requirement on the face of the Bill.
The publication of annual reports (beginning in the year 2000) is a key part of the clinical governance arrangements we proposed in The new NHS and A First Class Service. Clinical governance will provide a framework for quality improvements locally, comprising both clear lines of responsibility and accountability and a comprehensive programme of quality improvement activities, as well as clear policies aimed at managing risk, including for the identification and remedy of poor performance.
We shall make it clear in guidance that we expect NHS organisations to publish annual reports on what they are doing to improve and assure quality through clinical governance arrangements. I do not believe that a statutory requirement for publication will be necessary to ensure that the bodies in question comply with this guidance.
Just as I believe it is unnecessary to specify a requirement to publish information on the face of the Bill, I also believe it is unnecessary to specify here what the contents of these reports should be. Other issues aside, there is always a danger that by specifying detailed content on the face of the Bill we will be seen to be excluding other important issues we do not mention and denying ourselves the opportunity to adapt to future changes.
However, I absolutely agree that the areas highlighted by noble Lords should feature in the information which bodies publish. The guidance which we shall publish shortly on the implementation of clinical governance will set out what we expect to be the core content of organisations' clinical governance reports. That will specifically include evidence of user and carer involvement in clinical governance arrangements--the point to which the noble Lord, Lord Astor, referred--and how the organisation has taken account of national service frameworks and NICE guidelines.
I hope that noble Lords will feel, in the very clear understanding of what we shall be putting in the guidance about clinical governance and the clear intention as regards the publication of annual reports, that we will cover these areas but that we shall not exclude any others by putting these, and only these, on the face of the Bill.
Perhaps I may say a word about the issue raised by the noble Baroness, Lady Gardner of Parkes, and my noble friend Lord Winston. We are committed to publishing information on the clinical performance of NHS trusts, not just locally but nationally, as a means of driving up quality in the service. Clinical indicators will be published later this spring as part of the new performance assessment framework for the NHS.
I believe that all three of us have worked in the service and therefore we all understand that it is important, first, to collect only that information which is necessary and useful; and, secondly, that we have to be very certain that the information is valid and robust and not able to be misinterpreted in terms of the quality of care actually being delivered. That is why we are working very hard to get clinical indicators that will command confidence both in the professional and public arenas. With those assurances, I hope that the noble Lord will perhaps feel able to withdraw the amendment.
Lord Astor of Hever: I thank the Minister for her detailed reply. This has been a useful debate. Of course, I am sorry that the noble Lord, Lord Winston, believes this to be a flawed amendment. I shall read Hansard carefully as regards both amendments. However, in the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 75 and 76 not moved.]
Page 11, line 9, at end insert ("and for ensuring the publication of this information.").
3.45 p.m.
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