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Baroness Noakes: I thank the Minister for that. Would he just say how long CHI has been trying to co-ordinate its visits? I ask this because the complaints about the duplication of visits, the multiplicity of visits, and the serial visits, are of relatively recent origin. The source of this amendment was not some long-forgotten complaint; rather it relates to current complaints, in particular by the British Medical Association. Even if CHI has been doing it for some time, it has not been doing it very well; and that makes one think that perhaps an amendment is needed.
Lord Hunt of Kings Heath: The Commission for Health Improvement has not been in existence for very long, so it is not surprising that there is, inevitably, a learning curve. One expects CHI to learn from some of the concerns that have been expressed. In recent discussions with officials in the department, I have
discussed the particular issue of the piloting of the clinical governance reviews of primary care trusts where the issue of light-touch visits to GP surgeries has been raised. I am satisfied that CHI is fully cognisant of the need to try to rationalise these as much as possible.The process is developing. It takes time to gain experience and for the inspection agencies to learn from that. I believe that learning is taking place. Noble Lords' comments tonight will certainly feed back to CHI and I think they will be very helpful.
Baroness Noakes: I thank the noble Lord for that, and I thank the noble Baroness, Lady Northover, for her support for this amendment. I am not convinced that the words actually match up with actions on the ground, but I am sure that those who have been particularly concerned about this matter will look carefully at the Minister's words in Hansard, as indeed shall I. In the mean time, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Northover moved Amendment No. 97:
- Page 18, line 12, after "(2)", insert—
The noble Baroness said: Amendment No. 97 seeks to delete two paragraphs of the Health Act 1999 in relation to powers held by the Secretary of State in regard to CHI.
As Professor Kennedy has said, it is essential that CHI,
The Government say that they are making CHI more independent. If so, how does this fit with these lines? They give the Secretary of State power to restrict the ability of CHI to talk to the people to whom it needs to talk, to make investigations and reviews when it wants, and to consider cases as it wants. Nothing, and certainly not a Secretary of State, should threaten the remit, independence, scope and ability of CHI to make such investigations.
When my honourable friend Dr Evan Harris introduced this amendment in the other place, the Minister there argued that removing these provisions cut across the Secretary of State's ability to co-ordinate inspection. However, they do not look to me like a series of powers which ensure co-ordination and, drawn as widely as they are, there has to be a risk that they could be used to undermine the independence of CHI. I therefore flag up this amendment as indicative
Baroness Noakes: I rise to speak briefly in support of this amendment. To some extent it anticipates a later amendment dealing with the independence of CHI, and we fully support that direction of travel. Indeed, one might say, looking at Section 20 of the 1999 Act, that this amendment singles out paragraphs (a) and (b) but one might even extend it further and look at the whole of Section 20 to discover why a Secretary of State should keep any of the powers to direct CHI in such a detailed way if it is decided to give CHI more independence.
I do not know whether the Minister is going to say that the powers need to be kept in reserve and would be used only in exceptional cases. If he does say that, I think that we have to take it with a pinch of salt because the mere fact of the existence of such powers, whether or not they are used in a formal sense, subtly undermines the independence of such bodies. If a body knows that the Secretary of State can issue directions or make regulations telling it what to do, the mere existence of that power tends to induce compliance and reduce independence. We support the amendment.
Lord Hunt of Kings Heath: I should state clearly to the Committee that we are very keen to enhance the independence of the Commission for Health Improvement. There is no reason for the Government to wish to inhibit that independence. The whole rigour of what we are seeking to achieve—namely, to drive up standards in the health service—depends to a great extent on the credibility of the commission and on the way it is regarded by both the public and those working in the health service.
There simply would not be any reason for the Government to wish to undermine the independence of the Commission for Health Improvement. When we debate Clause 14, Members of the Committee will discover that we are making moves to remove the requirement, for example, for the Secretary of State to consent to the appointment of CHI's chief executive, and the Secretary of State's direction-making power in respect of the terms under which the commission employs people. That is why we are providing for certain of CHI's functions in relation to the collection and analysis of data and performance assessment to be carried out by the Office for Information on Healthcare Performance.
At the same time, the performance ratings that we published last year will, this July, be jointly produced by the department and CHI. In July 2003, the performance ratings will be produced by the commission. We are most anxious that CHI should perform as rigorous a role as possible. There is no question of seeking to interfere in the inspection process that CHI undertakes. We have discussions with the commission about its workload because, from
Regular meetings take place between the chair and the chief executive of CHI to enable us to engage in mutual discussion about its work and the issues that have arisen. The department's Ministers are most concerned to learn from CHI what it has discovered in the health service. I particularly commend the CHI reports that comment on how much clinical governance, for example, is ingrained within the work of boards, and, indeed, whether boards have information strategies. Many other issues are identified in CHI reports, and that information can then help the department in its performance management of the NHS.
I turn to the purpose of the amendment. It seems to me that the noble Baroness, Lady Noakes, sought to forecast what I would say in response. She is absolutely right in that respect. Ultimately, the Secretary of State is accountable to Parliament for the performance of the Commission for Health Improvement. In the very unlikely event that any serious problem should arise in the way that CHI performed its functions, or in its general operation, the Secretary of State must have a power of intervention. That is why the power is in the Bill. It is no different from many other non-departmental public bodies.
I can assure the Committee that that is why the power is there; it is not there to intervene and to dictate to CHI what should be mentioned in its reports. The power forms a necessary part of Ministers' accountability to Parliament. For that reason, I urge the noble Baroness not to press the amendment.
Baroness Northover: I thank the Minister for his reply, and the noble Baroness, Lady Noakes, for her support. I reiterate that we welcome CHI; indeed, we very much welcome the developments that have come in its wake. However, we should consider what might happen as we come up to an election, for example, or consider the case of the Chief Inspector of Prisons. For a while, an inspector's reports may be welcomed, but, later, he may be out in the cold. The first inspections may be considered useful, but if there are repeated poor reports on hospitals, as we approach a general election, the temptation for a Secretary of State who has some direct control over an institution such as CHI will be intense.
Lord Hunt of Kings Heath: There are two safeguards against that. First, there is the integrity of the chairperson, chief executive and non-executive directors of the Commission for Health Improvement. Anyone who knows Dame Deirdre Hine, the chair of CHI, or Dr Peter Homa, the chief executive, would quickly come to the view that they are people of great integrity who would not bow to any influence of that kind.
Secondly, if powers of direction had to be issued, that would be in the public domain. I should have thought that that would create a much bigger noise than any adverse report by CHI on an NHS trust. CHI
The purpose of setting up CHI was to have a rigorous, independent process that indicated to the public and to the NHS that we had a system that really got to grips with problems in the health service. It is inconceivable that Ministers would wish to interfere with that process.
"(a) paragraphs (a) and (b) are omitted, and"
"should be suitably structured so as to give it the necessary independence and authority",
to carry out its work. The paragraphs that we seek to delete from Section 20 of the 1999 Act are ones which allow the Secretary of State by regulation to make provision,
"as to the times at which, the cases in which, the manner in which, the persons in relation to which or the matters with respect to which any functions of the Commission are to be exercised ... [and] as to the matters to be considered or taken into account in connection with the exercise of any functions of the Commission".
9.45 p.m.
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