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Baroness Northover: I welcome the amendment. The Select Committees of the Houses of Parliament have already developed an important scrutiny role. They should in future develop that function further, acting on behalf of Parliament, and be able to specialise in particular areas and report to Parliament.
If CHI answered to a Select Committee such as that suggested in the amendment, the Minister would not need to worry about needing to protest that no undue control or influence is exerted over what all agree should be an independent body. Therefore, I strongly welcome this proposal.
Lord Hunt of Kings Heath: This has been an interesting debate about the accountability to Parliament of CHI and of the patients forums, on which we shall no doubt have an interesting discussion in some four weeks' time.
The amendments proposed by the noble Baroness, Lady Finlay, seek to assume that Parliament would decide to create what is referred to as a health Joint Select Committee. Later, we shall debate also the group of amendments dealing with the council for the regulation of health care professionals in relation to this committee. What in effect the amendments would do would be to have the Commission for Health Improvement and patients forums present their annual reports to the Joint Select Committee.
The current position is that CHI makes an annual report on the exercise of its functions to the Secretary of State, like other non-departmental public bodies. But it is an important measure of its great
independence that, under Clause 14(4), CHI will also in future be required to complete an annual report on the quality of services to NHS patients, which the Secretary of State will be under a duty to lay before Parliament. So, even if Parliament decided to set up a Joint Select Committee as proposed in the amendment, it would not add anything if CHI were to send its report there as well as to Parliament.Equally, patients forums will make an annual report to the Commission for Patient and Public Involvement in Health, as well as to the Secretary of State. These reports will feed in to the commission's own annual report, which the Secretary of State will be under a duty to lay before Parliament.
I understand what the noble Baroness is getting at. However, we are in an extremely difficult position if we seek in the Bill to suggest how Parliament might establish Select Committees in the future. That is not the way in which Parliament operates, and it is not the way in which decisions are made about the agreement to set up Select Committees of either House or Joint Select Committees.
Of course, if Parliament decided to establish such a Select Committee, it would be the duty of NHS bodies to co-operate with it. That is what happens at the moment. For example, the Select Committee on Health is currently undertaking an inquiry into the work of the National Institute for Clinical Excellence. I spent two and a half happy hours before the committee a week or so ago undergoing what might be described as effective scrutiny. There is nothing to prevent Parliament holding organisations such as the Commission for Health Improvement to account through its normal processes. Our aim in the Bill is to enhance the reporting of those organisations to Parliament. For that reason, while I certainly understand what the noble Baroness is getting at, I urge her to consider not pressing the amendments.
Baroness Finlay of Llandaff: I am most grateful to the Minister for his reply and for his generosity in understanding what I am getting at, as I am a novice to the parliamentary system. I am grateful for his explanation. I shall consider the issues further and may return to them later. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Noakes moved Amendment No. 99:
- After Clause 12, insert the following new clause—
The noble Baroness said: The amendment would extend the remit of the Commission for Health Improvement to public health. It would enable the Secretary of State to prescribe functions relating to the
CHI's functions under the Health Act 1999 are expressed in terms of healthcare, as are the amendments in the Bill. Notable by its absence from CHI's remit is public health, yet public health issues are as important as—some would say more important than—those involved in the delivery of healthcare.
The Committee has already debated the importance of public health in relation to the roles of the strategic health authorities, primary care trusts and regional directors of public health. It is fair to say that our debates on earlier amendments left a number of concerns hanging relating to whether those public health responsibilities would in practice be discharged effectively.
We know that the Government's intention is that PCTs will take the lead on health issues and that they will have a director of public health. We know that they will be encouraged to work in public health networks and that the directors of public health will come new to their responsibilities in PCTs from a variety of backgrounds, some medical and some non-medical.
It seems inevitable that the public health function of PCTs will need some strong oversight. CHI seems the obvious organisation to provide that. However, the amendment is not just about keeping an eye on PCTs and their new public health functions. We know that there are major public health issues to be grappled with. The amendment would give CHI, as an independent inspectorate, the responsibility for finding out what is being done on various public health issues to achieve public health aims, as well as disseminating best practice and reporting when not enough is being done.
I hope that the Minister will accept the amendment as one based on plain common sense. If he resists it, will he explain why public health must remain outside CHI's remit and what alternative arrangements would give the same oversight and rigour? I beg to move.
Baroness Northover: I support the amendment. Several key issues are emerging as this Bill rolls along. Noble Lords are giving a guarded welcome to the notion of devolving resources and decision-making in the NHS, but there is enormous concern about the speed with which that is happening and whether PCTs are anywhere near being ready to take up their key tasks. There is increasing concern about matters that particularly require a national overview. Public health is one such matter.
Public health—like teaching and research, as we debated the other day—is too often likely to be squeezed out by what seem to be more pressing concerns. Devolution is one thing, but fragmentation is quite another. What we are hearing about the parcelling out of public health responsibilities to one lead official here and one there obviously causes
Even then, however, the way in which PCTs exercise that responsibility will have to be carefully scrutinised. I fully agree with the noble Baroness, Lady Noakes, that that is where CHI may be able to assist. That is why it is being proposed that CHI's role should be extended to cover the monitoring, inspection, reporting, co-ordination, management and quality of public health. I therefore very much welcome the amendment.
Baroness Finlay of Llandaff: In supporting this amendment, I shall approach it from a slightly different angle: public health's importance, as we have discussed, to national defence. I know that Ministers have recently received many questions on smallpox vaccine. In the event of a sudden catastrophic epidemic of any sort, the public health services will be called on to be the plank on which catastrophic infections are controlled. The public health services co-ordinate, for example, the control of meningitis outbreaks.
The organisation of public health services is absolutely crucial in their ability to respond. I support the amendment because the organisation of such services must be in good order at all times so that they are not found wanting when called on in an emergency.
Baroness Masham of Ilton: Public health covers so many important aspects. There is a strong feeling that PCTs will be overloaded, but everyone working in the National Health Service and social care should be helping with public health. I am sure that the Commission for Health Improvement can help improve public health as it goes about its work. It can look, encourage and report if not enough is being done. I hope that the Government will support the amendment.
Lord Hunt of Kings Heath: I agree that this is a very important matter, although, as the Committee will know, I am more optimistic than some noble Lords about the capability of primary care trusts to accept the very important public health role they are being given. The term "public health services" goes very wide and might include protection against communicable diseases or other hazards to health and health promotion. The ambit of the expression is not entirely clear because the term is not currently defined in the Health Act 1999.
Noble Lords will recall that on 10th January the Chief Medical Officer announced proposals for a health protection agency to streamline the services involved in the prevention and control of infectious diseases. This agency will provide an integrated approach to all aspects of health protection, including chemical and radiological hazards as well as infectious disease control. The agency will take over functions
The new agency will work closely with regional and local services and the expert government advisory committees. It will also work with CHI where there are serious deficiencies in standards of infection control in hospitals, primary care or other health service premises. That will give us a great deal of confidence about the national arrangements and the integration of public health protection surveillance services, as well as infectious disease control, about which I know that noble Lords are anxious.
Alongside that we shall have robust performance management of the public health function throughout the National Health Service. From this April the regional directors of public health will design, develop and maintain public health networks. They will be responsible for the overall tackling of the root causes of ill-health inequalities through the health component across government policies. They will manage and co-ordinate the health protection and emergency planning functions in their regions. The focus of the directors of health and social care performance management function will be to take a national overview of performance, negotiating performance agreements with strategic health authorities, holding strategic health authorities to account for performance and supporting the development of individual organisations and the whole system to help them to deliver improvements to patients.
While not duplicating the work of directors of public health in primary care trusts or that of regional directors of public health, strategic health authorities will also have responsibility for performance management of public health action within primary care trusts and in hospital trusts. In future, we shall have a strong performance management system with clear performance management relationships coming down from the regional directors of public health, reporting to the directors of health and social care and to the Chief Medical Officer. That provides an effective way of ensuring that the public health function is properly integrated, managed and monitored.
However, I accept that the noble Baroness raised important issues in favour of giving recognition to the importance of public health service in the way that she suggested. I readily acknowledge that there are complex issues in terms of clarifying the range of public health services that might appropriately be brought within CHI's remit, the relationship between the bodies responsible for those services and those currently responsible for their inspection and regulation. I have already mentioned the creation of the new national agency.
The view that the Government take is that there are a number of important matters which need to be worked through over the next few months. While I
"PUBLIC HEALTH FUNCTIONS OF THE COMMISSION FOR HEALTH IMPROVEMENT
The Commission for Health Improvement shall have such further functions as may be prescribed relating to the management, co-ordination, provision or quality of public health services for which prescribed NHS bodies, service providers, local authorities or other bodies have responsibility."
10.15 p.m.
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