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Baroness Northover: I thank the Minister for those comments. The Government certainly deserve credit for setting up CHI, given that no previous government did so. I am happy to give the Government that credit.
However, if we consider the model of the Chief Inspector of Prisons, we can see what may happen down the track. The Government might be relieved to see the amendments proposed by the noble Baroness, Lady Finlay of Llandaff, which really would remove CHI from the control of the Secretary of State and make it answerable to a Select Committee of Parliament. If it were directly answerable to Parliament, there would be no temptation for the Secretary of State to exercise—or otherwise—any influence over CHI, should pressures arise down the track. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Noakes moved Amendment No. 98:
- Page 18, line 15, leave out subsection (5).
The noble Baroness said: Amendment No. 98 is a probing amendment. It would remove subsection (5) of Clause 12.
At first sight, the clause is innocuous, simply requiring the Audit Commission to consult the Commission for Health Improvement on its programme of value for money studies in relation to the NHS. However, the Audit Commission is a fully independent body with statutory duties to carry out audit. In arriving at its programme, it consults many people and organisations, as one would expect a responsible public body to do. I hope that few would argue with the proposition that the Audit Commission is an effective and responsible public body.
Why do the Government feel that it is necessary for statute to prescribe whom the Audit Commission should consult? Do the Government feel that the Audit Commission is not doing its job properly? Will the Minister say what the Government's view is? Why is the Audit Commission treated differently from the National Audit Office? The National Audit Office is not required by statute to consult over its audit programme.
Such clauses raise concerns about other agendas. We know from the Government's response to the Bristol report, which has been quoted several times
during our deliberations in Committee, that the Secretary of State does have an agenda with regard to the relationship between the Audit Commission and CHI, because he said that there needed to be closer working and, over time, organisational integration between CHI and, inter alia, the Audit Commission. That raises very serious issues about the integrity of public sector audit.I ask the Minister to explain what are the Government's precise intentions in relation to the Audit Commission. I ask him also to say what is meant by "closer working" and when "organisational integration" might take place. Can he confirm that no changes are intended which would undermine the independence and effectiveness of the public audit function in relation to the NHS? I beg to move.
Lord Hunt of Kings Heath: The question of the intention of my right honourable friend since his speech concerning the integration of inspection functions has been made clear in my response to the amendment moved a short while ago by the noble Baroness, Lady Northover. I said then that I thought her amendment was premature because the detailed work that will have to be done to develop ideas about future integration has only just started. That is because the Bristol report is not old and we have had to consider our comments on the work programme that needs to follow. In a sense, therefore, I do not think that I can answer the questions raised by the noble Baroness because this is work in hand and we shall need to consider these matters very carefully.
However, I can say to the noble Baroness that of course I greatly respect the work of the Audit Commission. I have had long experience of dealing with the commission and reading its reports. I know of the benefits that it has brought. Equally, as noble Lords themselves have pointed out, and just as the noble Baroness argued earlier, I believe that we need to sort out inspections at local level and national level. We need to avoid duplication. The whole purpose of including the clause in the Bill was not in any way an attempt to restrict the independence or decision-making process of the Audit Commission, but rather merely to ensure that consideration would be made of CHI's work programme so that the organisations themselves could best consider how to avoid duplication and hold general discussions about their respective work programmes.
I should stress that there is no suggestion whatever that in doing this we are seeking to undermine the independence of the Audit Commission, which I agree is an extremely important facet of its work.
Lord Clement-Jones: Perhaps I may pick up on a point just made by the Minister. I welcome what he has said about the Audit Commission because I am sure that he is aware that considerable value is put on the commission's value-for-money audits as a specific exercise, quite apart from any health aspect. It has that
specialism. I believe that strong opposition would be brought to bear on any attempt to try to over-integrate in that respect.
Lord Hunt of Kings Heath: One thing that I have learned over the years is that the Audit Commission is a very powerful defender of its own interests. I am sure that in any discussions about its future role, it will be well able to put across its own point of view.
I should also have said to the noble Baroness, Lady Noakes, that I understand that in the relevant section of the Audit Commission Act 1998, we are adding to the names of the Secretary of State for Health and the Comptroller and Auditor-General in relation to the National Audit Office. Given the importance of the Commission for Health Improvement in relation to inspections in the health service, I should have thought that it was appropriate to add CHI's name to that list.
Baroness Noakes: I thank the Minister for that reply. I do not feel very much the wiser for it because I still do not quite understand why this particular consultation requirement needs to be put on to the face of the Bill. However, often when we urge the Minister to accept amendments which seek to make things clear, we receive a response which states in effect that of course the Government already do that and so it is irrelevant to put anything on to the face of the Bill. Here we are trying to take something off the face of the Bill in circumstances where a responsible Audit Commission would almost certainly consult, and yet we have the argument put back to us in a different way.
I am very surprised that the Secretary of State could have said what he did on 17th January in relation to the organisational integration between CHI and the Audit Commission, and yet here we are, two months later, and the Minister can give the Committee no details whatever. I find that surprising. I want to reflect further before Report stage. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
10 p.m.
Baroness Finlay of Llandaff moved Amendment No. 98A:
- Page 18, line 17, at end insert—
The noble Baroness said: In moving Amendment No. 98A, I shall speak also to Amendment No. 114A. I should make it clear that I shall not be speaking to the other amendments in the group. They will be addressed in due order later in the Marshalled List.
Lord Hunt of Kings Heath: It may help the Committee if I make it clear that the other amendments have been degrouped and that we are speaking only to Amendments Nos. 98A and 114A.
Baroness Finlay of Llandaff: I thank the Minister for that. I am grateful to the noble Baroness, Lady
I am grateful to the Minister for expanding on some of the increased freedom that CHI will experience. I understand that it will be able to appoint chief executives through the commission itself and that its reports are to be laid before Parliament. The Bill will enable CHI to undertake inspections, including where NHS services are provided from premises not directly owned by the NHS. The Minister has clearly outlined the need for CHI to be independent.
All the regulatory bodies concerned with the NHS—which is a national service—must be answerable directly to Parliament. Other regulatory bodies—the professions' regulatory bodies—will be discussed in detail later.
I am suggesting that a parliamentary committee should be drawn from both Houses, ensuring representation from the four countries of the United Kingdom, and that such a committee shall never have a majority of members from one political party. In the event of a coalition of two parties, it would be important to ensure that it did not operate in such a way as to create a majority on the committee. Thus the committee would be politically neutral in terms of pressure prior to an election. It is anticipated that representatives of the government of the day would not constitute more than 40 per cent of the proposed health Joint Select Committee.
Such details are suggestions only at this stage; it is the principle that is of concern. Currently, there is no professional regulatory body for managers. May I preface my next remarks by stating that I work for an NHS trust with excellent management, which maintains an open dialogue with all staff at all grades. However, our recent debate involving research and teaching highlights the need for resources such as rooms, photocopying and IT facilities.
The CHI reports have been excellent. Like the Kennedy report, they have outlined that the state of the NHS is in the hands of managers, and good management is integral to clinical governance. I sincerely hope that the recommendations of the Kennedy report will be followed and that such regulatory bodies will be directly answerable to Parliament.
CHI inspects the service and recommends improvements. It must be free to exercise its functions with rigour. CHI must report to Parliament in such a way that it can be questioned—it should not simply lay a report before Parliament—and hence the idea of the committee.
Amendment No. 114A seeks to ensure that the organisation referred to in the Bill as the "patients forum", which will have an important function in obtaining the views of NHS users, will also be answerable in such a way. The patients forum must seek the views of NHS users—be they patients, relatives or carers—and it must be allowed to be independent of service providers. I believe that it should have equal standing with the inspection roles of other inspection bodies. Therefore, it should be able to present its report to such a parliamentary committee. While the patients forums will be working with trusts, they must have the ability to be completely independent of the trusts, and of the government of the day.
Fortunately, the consultation processes that have taken place in Wales, which were outlined earlier in our debates, have been very effective in some areas. We are fortunate to have retained community health councils. I know that we are not to debate community health councils, but the report from such patients forums must have the high status and standing that we have been able to retain in community health councils in Wales. They have recently been involved in two important research projects—one with the Organ Retention Advisory Group, where they sought the views of the general public, and another where they have been working on the standards that patients and their relatives require from the health services in Wales. I beg to move.
"(6) The Commission for Health Improvement shall present annually its report to the health joint select committee."
"The NHS is quintessentially a statement of political values. Thus, it is inevitable and right that central government should seek to lay down the parameters of the NHS's activities, particularly in the realm of finance and priorities. But, once this is done, the systems for monitoring the extent to which it is meeting its stated aims must, in our view, be de-politicised, so as thereby to rekindle and maintain public confidence in the NHS".
It is this role that I wish to address.
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