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Baroness Hayman: Both of these amendments seek to place on the face of the Bill arrangements to ensure
that community health councils are involved with, and informed about, the commission's work. My noble friend has made clear why he thinks that that is appropriate. I recognise and welcome the interest that CHCs and other groups representative of users, carers and local communities will have in the work of the commission and their potential to contribute. However, I must advise my noble friend--this is something of a current refrain--that I do not think that this is a matter for the face of the Bill or that individual organisations should be singled out in this way.The regulations under Clause 15(2)(a) will provide for the manner in which, and the persons in relation to whom, the commission will perform its functions. We do not want unduly to restrict the commission's independence with regard to how it carries out its function to review clinical governance arrangements. In assessing how clinical governance is supporting the drive for high quality services, it will no doubt want to have regard to the knowledge and experience of CHCs. As my noble friend said, that is particularly relevant. Community health councils will be able to contribute to that assessment, as will a number of other community groups and patient and carer representatives.
Equally, it does not seem necessary to require on the face of the Bill that the commission, when conducting a national service review, should make its reports available to the relevant community health council. As was discussed earlier, we intend to provide for the publication of the commission's findings. Therefore, they will be available as public documents to CHCs and other interested organisations. On that basis, I hope that my noble friend will accept that I understand and sympathise with his intentions, but believe that the Bill already covers his concerns. I hope that he will feel able to withdraw his amendment.
Baroness Fookes: I have considerable sympathy with the amendment. It seems to me that responsibility for making available, and publication of, such reports rests very much with the Secretary of State. As the Minister indicated earlier, on the face of the Bill, the Secretary of State has total discretion about what is published, not just some discretion. It is important that we are clear that publication should generally take place. It may be that the present Government are much committed to open government, but we are making provisions for the future--and a future Secretary of State might be of a more secretive nature. That is why we are relying on what the Bill states.
Baroness Hayman: We covered this issue earlier. It is our intention to act publicly and openly in such areas. The provisions on how the recommendations should be made public, quickly if necessary, relate to simply functional arrangements. We have a code of practice on access to government information and we may well have more far-reaching freedom of information legislation to deal with such areas. Therefore, in the long term, I believe that these points will be covered. However, again, I do not think that we can deal with the general
issue to which the noble Baroness refers by amendments such as these, which deal only with community health councils.
Lord Harris of Haringey: I am grateful to the Minister for that response, I take her point that it may not be appropriate specifically to single out community health councils on the face of the Bill. However, I hope that it may be possible either in regulations or in guidance to the commission to suggest that it should be a priority for the commission to listen to, and to seek representations from, local community health councils when considering what work to carry out, and to direct the attention of local CHCs, where appropriate, to the reports published. I appreciate that the reports will be in the public domain, but there is a difference between that and reports specifically being drawn to the attention of local bodies which can keep track of what has happened as a result of them. I hope that the Minister will revisit some of these questions in terms of regulations or guidance. In the meantime I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 97 to 107 not moved.]
The Deputy Chairman of Committees (Viscount St. Davids): Before calling Amendment No. 108, I should point out to the Committee that, if Amendment No. 108 is agreed to, I cannot call Amendment No. 109.
Lord Clement-Jones moved Amendment No. 108:
The noble Lord said: This is, unashamedly, a probing amendment. It would clearly remove the power of the Secretary of State to issue regulations enabling the commission for health improvement to recover money in respect of expenditure it incurred in the exercise of its functions. The effect would be that the commission could not charge fees or be self-financing, but would have to be government funded.
Our interest was drawn to this provision allowing the Secretary of State to make regulations in this way as it is not clear who will be charged or what institutions will be charged by the commission. Clarification is required about the degree of funding that the commission will receive, on the one hand from central government and, on the other, from the charges that it makes. If it is expected to become self-financing over a period of time, what is that time period? What charging structure does the department believe is appropriate? Can the Minister clarify whether Ofsted or HM Chief Inspector of Prisons are charged for inspections? What is the practice across government? Is it a common practice? Is the commission being singled out for this kind of purpose and what is the broad time scale?
Major sums could be involved. If, in looking at the GMC Bristol-type case, the commission also looks at the non-competency related aspects, the sums incurred could run into millions. Are we saying that that particular hospital would be responsible for the charges of the commission? We want to elicit the basis upon
Lord McColl of Dulwich: I should like to speak to Amendments Nos. 109 and 110 which do not go nearly as far as Amendment No. 108. The Bill allows CHIMP to recover from any individual costs incurred in the course of its duties. In theory this would permit individual GPs to be billed for the work of CHIMP. In exceptional circumstances, this could exhaust the entire budget of a PCT, if a particularly lengthy report or investigation were undertaken.
By changing the word "persons" to "bodies", the amendment does not give total protection against such circumstances, particularly for PCTs. However, it allows a greater degree of protection to individuals who could otherwise face very large bills for investigation by CHIMP which they did not request and over which they had no control.
There is an additional worry that the powers of CHIMP to recover costs could be used to recover the costs of NICE in situations where CHIMP has followed up the work of NICE in a particular area. That would represent an additional cost and would take away money from frontline services in order to finance bureaucratic activities. As NICE is not included in the Health Bill and is not a statutory body, it would be quite wrong to use CHIMP as a means of clawing back the costs of NICE.
If the Secretary of State had intended NICE to be part of the statutory body with powers to cover its own costs, that should have been included in the Health Bill. As the Government have decided that NICE does not need to be included in the Health Bill and can be dealt with by order, one has certain suspicions as to the actual powers and scope for action and cost recovery that NICE will have.
Baroness Hayman: I hope to be of assistance to the Committee on the general probing issues and the specific points about recovery of funds from other bodies, and the possibility of charging individuals, which was raised by the noble Lord, Lord McColl.
Initially, while the commission is developing its role we do not envisage that it would charge any individual organisations for the bulk of its local review work. But in the longer term, once the commission has demonstrated its effectiveness as a body to help the NHS improve quality and tackle service problems, we see merit in moving towards a system where more of the commission's work is directly funded locally.
It is not an unusual arrangement. For example, it applies in the case of work carried out by the Audit Commission for NHS bodies, and that would include the
Lord Clement-Jones: NHS trusts are charged on an individual basis by the Audit Commission for value-for-money work, are they not?
Baroness Hayman: They certainly are, and the rates, the number of days and all sorts of things are determined for you. The trusts pay individually to the Audit Commission.
Lord Clement-Jones: This is work that they commission of their own volition; it is not imposed on them that they should invite the Audit Commission in; they invited the Audit Commission in, and it is only fair in those circumstances that they should pay.
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