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Health Bill [H.L.]
8.39 p.m.
House again in Committee on Clause 16.
Baroness Gardner of Parkes had given notice of her intention to move Amendment No. 119:
The noble Baroness said: I believe that my noble friend Lord Howe would want me to move this amendment in his absence; indeed, as I understand the procedures involved, I believe that anyone may do so. Unfortunately, my noble friend did not reach the Chamber this afternoon in time to move an earlier amendment. I do not want that to happen again. I believe that the amendment is self-explanatory. I certainly hope that it is. I am pleased to see that my noble friend Lord Howe has returned to the Chamber. I shall not move Amendment No. 119.
[Amendment No. 119 not moved.]
[Amendments Nos. 120 to 123 not moved.]
Clause 17 [Restrictions on disclosure of information]:
[Amendments Nos. 124 to 128 not moved.]
Baroness Thomas of Walliswood moved Amendment No. 129:
Page 13, line 25, at end insert ("from that document or information alone, or in combination with other information which is in the possession of, or is likely to come into the possession of the Commission,").
After Clause 18, insert the following new clause--
(" .--(1) The bodies mentioned in subsection (2) below must make arrangements to secure continuous improvement in the way in which their functions are exercised, having regard to a combination of economy, efficiency and effectiveness.
(2) The bodies are--
(a) Health Authorities;
(b) Special Health Authorities;
(c) Primary Care Trusts; and
(d) NHS Trusts.
(3) For the purpose of deciding how to fulfil the duty arising under subsection (1), a body must consult--
(a) representatives of persons who use or are likely to use services provided by the body; and
(b) representatives of persons appearing to the body to have an interest in any area within which the body carries out functions.
(4) The Secretary of State may by order specify--
(a) factors ("performance indicators") by reference to which a body's performance in exercising functions can be measured; and
(b) standards ("performance standards") to be met by bodies in relation to performance indicators specified under paragraph (a).
(5) In specifying performance indicators and standards, and in deciding whether to do so, the Secretary of State shall--
(a) aim to promote improvement of the way in which the functions of a body are exercised, having regard to a combination of economy, efficiency and effectiveness; and
(b) have regard to any recommendations made to him by the Audit Commission and the Commission for Health Improvement.
(6) In exercising a function a body must meet any applicable performance standard specified under subsection (4)(b).").
The noble Baroness said: This amendment forms a link between Clauses 13 to 18 which are about quality and Clauses 19 to 25 which are concerned with partnerships among NHS organisations and particularly between National Health Service organisations and local authorities. In brief, it introduces the concept of best value into NHS practice. The definition of that in the first part of the amendment concerns having regard in the actions that one takes,
As I said, this Health Bill creates a duty of partnership between National Health Service bodies and local authorities. When the Local Government Bill is passed, local authorities will have to conform to best value procedures. Best value principles include the need for meaningful consultation and the involvement of local communities in planning and providing services; the promotion of clarity about how service standards are developed in co-operation with the people using the services; and requirements for reporting on all the processes involved.
However, there is no similar best value requirement on health authorities and trusts at present. It is difficult to see how the new duty of partnership can work unless all the parties to it conform to the same obligations for best value. This difference of approach is part of the culture clash between local authorities and National Health Service organisations, to which reference was made by a number of speakers during the Second Reading of the Bill. Interestingly enough, other organisations have stepped in to support this amendment, which was put forward in collaboration with the consumer organisations. For example, a major drug producing group is worried that, faced with decisions on whether or not to recommend a new drug or a technological innovation, decisions will be made purely on the basis of cost rather than of cost benefit.
The language of the Bill is taken precisely from the language of the Local Government Bill which is going through another place. For example, the proposed new subsection (4)(a) and (b) is an exact replica of Clause 4(1) in that other Bill. The proposed new subsection (5) in this amendment is a replica of Clause 4(3) in the other Bill. During the Second Reading debate the Minister raised the topic of best value when she said,
"to a combination of economy, efficiency and effectiveness".
"The new provisions will provide space for health services and local authorities to think more inventively; to develop innovative solutions to long-standing problems; and to use local resources in new and imaginative ways. They complement those in the Local Government Bill which will introduce the duty of best value for local authorities and enable the Government to remove obstacles to joint working".--[Official Report, 9/2/99; cols. 112-113.]
1 Mar 1999 : Column 1459
Amendment tests the Government's commitment to ensuring that both partners in these partnerships work to the same song book. I beg to move.
Lord Harris of Haringey: This is an interesting amendment. Those of us who are currently involved in local government look forward to the legal introduction of the best value regime, which in many ways will be more testing than the previous system of compulsory competitive tendering. It is an important new regime in that it has as an integral part consultation with the people who use the services, the requirement that the authorities concerned challenge the way in which those services are delivered and think about innovative ways of providing them. It requires that there is proper comparison with benchmarks and other providers and it also involves competition. Those four "C's": consult, challenge, compare and compete, are extremely important. That is a discipline which local government is prepared to take on board. It could well be applied to much of the rest of the public sector. For that reason alone I believe that the amendment has merit and I look forward to hearing the Minister's reply.
However, there is a second reason, which was touched on when the amendment was introduced. If there is the expectation of increased joint working between local government and the health service, it will be extremely difficult, if not totally impractical, for one side of that joint working--the local authority side--to apply best value principles and for the health service not to embrace the principles in the same way. In the interests of ensuring that joint working between the health service and local government is as effective as we would all wish it to be, it makes sense for both the health service and local government to follow a similar regime. For that reason I have much sympathy with the amendment which has been proposed.
Baroness Gardner of Parkes: I have a certain sympathy with the language of the amendment, which I believe is interesting and probably quite effective. However, my sentiments are the opposite of those expressed by the noble Lord, Lord Harris. I am not at all satisfied that the concept of best value for local authorities is nearly as good as the concept of compulsory competitive tendering. I believe that the provision allows people to wriggle out of the concept of good value. They may say, "We thought it was best value bearing everything in mind". The best value element is the one part of the concept that I do not like. Fortunately the amendment does not appear to use those words. It appears to be the consumer organisation which is concerned with that phrase. I support the amendment not on the basis of best value but because it seeks,
- "a combination of economy, efficiency and effectiveness".
Those are the words which I value.
Baroness Hayman: It has been interesting to debate the amendment moved by the noble Baroness, Lady Thomas of Walliswood, and to consider ways in which the duty of partnership and the joint working that we wish to foster will take place on the ground. I do not
believe that there is so great a culture clash as the noble Baroness may have suggested in speaking to the amendment.While we want to see joint working it is important also to draw out the differences between the position of local authorities and that of NHS bodies in relation to best value. We must recognise that the relationship of the Secretary of State for Health to NHS bodies, including assigning the status of accountable officer to NHS chief executives, is different from that which exists between local authorities and the Secretary of State for the Environment, Transport and the Regions.
Best value is a duty owed to local people by elected members of councils, and the provisions of the Local Government Bill have been drafted to reflect that. I accept the point made by Members of the Committee, including my noble friend Lord Harris of Haringey, that the principles of best value should apply to the NHS. The Government are committed to driving up performance and standards across the NHS through continuous improvement in both the quality and the efficiency of NHS services. Where I would differ from my noble friend is that it is our belief that this does not mean that we could or should apply those best value principles in exactly the same way. The point is that the regimes should complement each other--I made this point in the Second Reading debate--and that the principles on which they are based should be the same but that we should not necessarily be taking through exactly the same regime.
We have set out in The new NHS White Paper our strategy for achieving the high quality and efficiency to which I have referred, with specific proposals to strengthen the existing statutory and performance management framework through introducing the duties of quality and of partnership on all NHS bodies, now being given effect to through this Bill; through requiring health authorities to lead the development of a local strategy for improving health and modernising services and for ensuring the active involvement of local service users and local communities in that process, which is covered by Clause 21 of the Bill and to which I know Members of the Committee pay particular attention; through setting clear national standards that will apply to all NHS bodies; through the establishment of the national institute for clinical excellence and the development of national service frameworks for assuring local delivery; through the introduction of clinical governance arrangements and to complement existing corporate governance arrangements to ensure probity and regularity; and, finally, through monitoring performance through a national performance assessment framework, the establishment of the commission for health improvement and the annual surveys of patient and user experience.
These measures will complement the Secretary of State's wide-ranging powers of direction over NHS bodies which are subject to external audit by the Audit Commission to ensure that they have proper arrangements in place to secure economy, efficiency and effectiveness--the criteria to which the noble Baroness, Lady Gardner of Parkes, referred--in the use of their resources. Taken together, they ensure that our approach
to improving performance in the NHS is consistent with those principles underpinning the best value regime being introduced for local government. However, as I said earlier, that does not mean that the detailed provisions should be the same for NHS bodies.
This amendment seeks to provide NHS bodies with similar duties of best value to those provided for local authorities in the Local Government Bill. I hope the Committee will understand that we can achieve this through the powers already available to us, including the Secretary of State's powers to direct NHS bodies. In a number of important respects, those powers are strengthened and those arrangements made more robust. I would therefore suggest to the Committee that importing wholesale the best value provisions from local government is not the best way forward. I trust that the noble Baroness will feel able to withdraw her amendment.
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