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Lord Peyton of Yeovil: I should like, first, to make what is becoming my habitual protest about the way in which this Bill—along with others—has been drafted. It would be desirable to provide at least some kind of Keeling schedule to indicate to anyone taking part in discussing a Bill what the law will look like if the Government's proposals are carried. I cannot repeat too often or say too strongly how revolting I find it that successive governments show such total contempt for Parliament that they will not provide even the modest degree of furnishing for which I am asking. I hope that the noble Lord, Lord Hunt, who is good about these matters and who does listen, will pay attention to my remarks. He should realise that some of us will simply go on and on and on until Bills are produced which can be readily understood by people who do not have eyes in the back of their heads so that they can read two Bills at the same time. Such improvements will make it possible for sensible discussion to take place.

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I should like to congratulate my noble friend on her amendment. Personally, I have long believed that the National Health Service suffers from an excess of investigation, monitoring and examination by persons who, although sometimes skilled in examination, have seldom any concept of the disruption, delay and waste of time that their interventions cause.

Recently I took the opportunity to conduct a superficial examination of the body known to its friends as CHI. For myself, because it has a slightly ironic title, I give the name in full: the Commission for Health Improvement. The noble Lord will correct me if I am wrong, but there was a time when I suspected that the duty of the Department of Health was, to put it quite simply, to improve health. Either the officials found themselves so incompetent that they could not do that, or they so wished to introduce reinforcement that they set up this body, which has huge powers.

However, while the body's functions are declared under Section 20(1) of the 1999 Act, in subsection (2) it is made quite clear that the Secretary of State may, by regulations, make provision. Thus, in effect, the Secretary of State may tell the commission what it can do, when it can do it and how it should be done. Other points are covered, but I shall not bore your Lordships by relating the detail of the entire contents of the clause. I refer also to the subsection to which my noble friend's amendment refers. The Secretary of State can regulate and direct the commission with regard to what it does and when it does it.

What is the commission for? It does not have even a pretence of independence. It is the lackey of the Secretary of State. I see that the noble Lord is shaking his head. I shall be most interested to hear how any body can possibly enjoy independence when it is subject to ministerial direction of the kind set out here and of the kind against which my noble friend is protesting.

A brief examination of the commission on my part has revealed that, as a paper mill, it is deserving of quite a high place. Within two years it has established itself as a major source of paper. I have just some of it with me, from which I propose briefly to weary noble Lords with one or two paragraphs. The chairman, whom I am told enjoys a good reputation outside the commission, has written a foreword which is an astonishing piece of optimism:

"You are warmly invited to this exciting prospectus"—

when was a prospectus ever exciting?—

"that we hope captures the essence of the Commission for Health Improvement's . . . properly demanding responsibilities for 2001-2004. CHI's"—

at this point the commission's "nickname" is used—

"first year . . . was rich in challenge and included the requirement"—

here there is a split infinitive—

"to simultaneously design and establish the organisation, construct wide ranging methods, and employ them across the breadth of our responsibilities. As CHI sets its goals for the next three years, the scale of challenge increases as we commit ourselves to deliver substantial elements of our long term work programme. We have increased the volume and complexity of our activities to support the high levels of performance required".

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I do not doubt that those who suffer from the visits and investigations of this body are enduring increasingly sharp nightmares as a result of that phrase.

3.45 p.m.

Lord Hunt of Kings Heath: I am most grateful to the noble Lord for giving way. Would he not agree that the very appearance of a split infinitive in the foreword to the report demonstrates the wholly independent nature of CHI? If the department had been as interfering as has been suggested by noble Lords opposite, then the split infinitive would never have appeared.

Lord Peyton of Yeovil: I say only that in the Act of Parliament passed in 1999, Parliament was induced by the Government to give this body extremely large functions and then to tell it exactly how to perform them. If that is freedom, then I simply do not understand the language. The fact that so far the Government have not seen fit to follow what it has done in every detail is neither here nor there. The Secretary of State has powers which he ought not to have and which make a nonsense of the commission's alleged independence.

I should like to refer to what is called the Executive Summary which states fairly briefly what the commission did during its first year. It,

"published pilot clinical governance review reports . . . five investigations . . . research and field work on NHS progress . . . recruitment of over 180 permanent staff, and assessment and training of over 240 reviewers".

All those people are going to run around like scorpions, annoying those trying to do a decent job for and near to patients.

Its last claim is that it has established,

"effective internal management arrangements to ensure high standards of performance including corporate governance".

I dare not weary the Committee with the chairman's introduction to its next report.

The commission claims to have looked at itself in the mirror. It must have been a nice, friendly mirror. Amazingly, it saw reflected a very good view of itself and was quite fascinated.

But there is another view. I asked one or two people of eminence whether they endorse and share the view which the commission takes of itself. "Nothing of the kind", they say. Some regarded it as superficial and aggressive, devoting itself to investigating problems which were well known. The effect of its investigations, they say, is not to cure problems but to delay tackling them. What the commission does often enough, although I have not been able to follow its tracks myself, follows disruption and frustration. The efforts to put things right by those in a position to do so are therefore delayed.

I hope that the Minister will not attribute to me a desire to sound off and oppose efforts to put things right, which deserve respect, but people whose duty it is to investigate need to be careful that they do not

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greatly upset, disturb and frustrate those who are trying to do an important job of work. I support most warmly what my noble friend said.

Baroness Northover: I support—perhaps more straightforwardly—the amendment of the noble Baroness, Lady Noakes.

Professor Kennedy concluded in his report on the Bristol cases:

"The quality of healthcare should be regulated through bodies such as the National Institute for Clinical Excellence and the Commission for Health Improvement. These bodies should be independent of government".

He states that it is essential that CHI,

"should be suitably structured so as to give it the necessary independence and authority",

to carry out its work.

In my view, CHI is already doing a useful and commendable job. The Government should be supported. They set up these bodies in the first place and we welcome the extension of CHI's independence proposed in the Bill. However, we agree with the noble Baroness, Lady Noakes, that the Secretary of State's role should be removed in order that genuine independence is, and is seen to be, the order of the day and to ensure that there are no loopholes through which a Secretary of State might be tempted to squeeze. We are happy to support the amendment.

Baroness Finlay of Llandaff: I, too, support the amendment, which seeks to increase the independence of CHI and other such organisations.

The noble Baroness, Lady Northover, quoted from the Kennedy report. That report also states:

"The various bodies whose purpose it is to ensure the quality of care in the NHS (for example, CHI and NICE) and the competence of healthcare professionals (for example, the GMC and the Nursing and Midwifery Council) must themselves be independent of and at arm's-length from the DoH.

"All the various bodies and organisations concerned with regulation, besides being independent of government, must involve and reflect the interests of patients, the public and healthcare professionals, as well the NHS and government".

I reinforce the view that the work undertaken by CHI has been very valuable. It has highlighted deficits in care and deficits in the management of services for patients. All the improvements in patient care are long overdue and welcomed by everyone. Everyone in this Chamber—just as everyone in the population as a whole—will, on one day or another, be a patient in a service which is absolutely crucial to the well being of the country.

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