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Lord Hunt of Kings Heath: Perhaps I may respond to that. First, we are earmarking £175 million for investment in NHS LIFT over four years. That is a very substantial degree of investment and it shows the degree of commitment which we have to making NHS LIFT work. Equally we want to move on as quickly as possible the refurbishment of primary care facilities in this country. That will certainly not happen overnight. Therefore, the City can look to continuing support and enthusiasm for what is planned from the Government.
The point I am trying to make is that, if the Government have a shareholding in a particular company, they can do what other shareholders can do in companies, no more than that.
Earl Howe: I hear what the Minister says. We both hope that it will never come to that. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 28 and 29 not moved.]
Baroness Northover moved Amendment No. 30:
- Page 4, line 23, at end insert--
The noble Baroness said: This amendment provides that the Secretary of State must make regulations to ensure that systems are in place which safeguard patients' interests, especially in ensuring adequate standards of care, accountability and transparency. It states also that before making such regulations, the Secretary of State,
In particular, this amendment would ensure that commercial interests were not put ahead of patients' interests. In another place, it was implied by the Minister in Committee that that provision is mainly about the provision of premises. I thought that might have been an accidental slip, but the noble Lord, Lord Hunt, with a long history in the NHS, also emphasised that in his reply to my noble friend Lord Clement-Jones. However, that is not what the Bill says.
The Bill includes services. Clause 4 permits public/private partnerships to employ doctors and nurses and to provide clinical services. The remit of the private sector extends there into the mainstream NHS. I have severe reservations about that and the fact that this has been slipped in here and, therefore, there has been very little debate on the issue.
However, given that that is what it does, we must make explicit that patients' interests are paramount. Such arrangements must provide the highest standards of care. It is vital also that arrangements should be transparent and accountable. That is what this amendment would help to achieve.
The NHS should place patients and their interests at the heart of its thinking, regardless of how and where that patient is treated. I beg to move.
Lord Peyton of Yeovil: I do not wish to disturb the rather excessive calm of the afternoon but I find myself on what I hope is the Government's side. I hope that the noble Lord will not accept the noble Baroness's amendment for the very good reason that while I do not fall over backwards ever to applaud the inborn intelligence and vision of any Secretary of State, I
I will go so far as to say that Secretaries of State are not absolutely congenital idiots. To suggest that they need to consult those who represent the interests of those likely to be affected by the regulations is somewhat superfluous, to put it very mildly, and I hope that the Minister will reject the amendments.
Lord Hunt of Kings Heath: I find myself in agreement with the noble Lord, Lord Peyton. Indeed, perhaps it is an opportunity for me to plug again his excellent autobiography of ministerial life which no doubt he would consider to be a pattern of consistency across his own work as a Minister and what is being proposed here today.
He is absolutely right. Clearly, it is difficult to conceive of any circumstances in which a Secretary of State would agree to any of the proposals under these clauses were he not to believe that they were in the best interests of patients.
I do not want to go through a whole list of responsibilities, obligations, current regulatory checks and financial legal requirements that exist in relation to any action that is undertaken by the Secretary of State or NHS bodies in relation to the NHS generally and the use of these new powers, but they are extensive. There is the legal duty of the quality of care, clinical governance, the role of the Commission for Health Improvement, the NHS performance assessment framework, the NHS clinical governance support work and the establishment of the National Institute for Clinical Excellence. All those mechanisms--some noble Lords believe there are too many--are in place to ensure that the NHS operates in the best interests of the public.
I want to make it clear that Clause 4 does not seek to establish new ways of working for the private sector. Any service or facility delivered as a public/private partnership will need to be to a specified standard. That specified standard will be no different from that required of any other provider, whether in the NHS or the private sector. The sanctions that are in place within any contract to ensure a high quality of service and the requirement and duty on the Secretary of State and NHS organisations always to act in the best interests of patients and the public surely are safeguards enough.
Lord Peyton of Yeovil: Courtesy obliges me to say how much I am indebted to the noble Lord for his kind reference to my autobiography. In fairness to the
Baroness Northover: It is refreshing to hear such trust as the noble Lord, Lord Peyton, has expressed. I am obviously of a cynical, younger generation.
Lord Peyton of Yeovil: The noble Baroness speaks of "such trust". My tribute to Secretaries of State was that I thought that they were entitled to the assumption that they were not congenital idiots. I did not go very far!
Baroness Northover: I hope that he will be proved right. We shall see. The Minister reassures me and at this stage I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 31 to 33 not moved.]
[Amendment No. 34 and 35 not moved.]
Clause 6 [Terms and conditions of employment by health service bodies]:
On Question, Whether Clause 6 shall stand part of the Bill?
Earl Howe: At Second Reading the Minister took me to task for describing this Bill as a series of centralising measures. However, like it or not, in Clause 6 we have a classic example of a centralising measure. The clause creates a new power for the Secretary of State to intervene in laying down the terms and conditions of the staff employed by NHS trusts and primary care trusts. The explanatory notes speak of the need to modernise the NHS pay system--the word "modernise" is greatly overused--and the Government's desire to deliver better, fairer awards for staff.
No one can argue with the desire for fairness in the awards for staff, but why it is thought to be fair to have a uniform set of terms and conditions imposed from above on each area of the country is not explained. To me it is self-evident that different conditions of employment exist in different areas. Someone living in the south-east of England will have a higher cost of living than someone in the north of England. The quality of life in low-cost areas is often a great deal better than in high-cost areas. I am baffled as to why the Government want to treat those two cases as identical, instead of doing exactly the opposite, which is to recognise that the NHS needs local structures and local flexibility to address the problems that it faces in different areas.
The health service suffers from many difficulties, but in my opinion at the heart of all of them is the problem of recruiting and retaining staff. That problem will not be solved by regulation and direction-making powers that seek to determine the way in which every NHS trust and PCT deals with its staff.
When NHS trusts were first set up an important element in the design was operational freedoms. Managers of NHS trusts run complex businesses in which staff costs represent a major part of the annual budget. To deny local freedoms, as proposed by this clause, is a significant inhibition. Once you tell managers that they must abide by national regulations and directions, it is difficult to see what real freedoms exist.
I shall be glad to hear from the Minister that I have interpreted this clause in an over-literal way and that local flexibilities in the setting of pay and conditions will still be allowed to continue. Can the Minister tell the Committee how the Government view the future shape of pay structures being determined and the extent to which managerial discretion will play a role in such matters?
"(6) For the purpose of subsection (1) above, the Secretary of State shall make regulations to establish and require systems of operation that safeguard patient interests, in particular to ensure adequate care standards, accountability and transparency.
(7) Before making any regulations under subsection (6) above, the Secretary of State shall consult such bodies who represent the interests of those likely to be affected by the regulations."
"shall consult such bodies who represent the interests of those likely to be affected by the regulations".
4 p.m.
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