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Lord Chan: I, too, support the work of CHI. Previously in Committee I asked who will review CHI and received the answer that it will be the National Audit Office. There are therefore sufficient safeguards in regard to CHI's position. It is doing an excellent job. The amendment can certainly be supported.
Lord Hunt of Kings Heath: The noble Lord, Lord Peyton, again draws to our attention the
problems involved in following different legislation. I sympathise with him. I am anxious to see a consolidated measure on NHS legislation generally. I shall see whether between the Committee stage and Report stage we can produce some guidance to enable us to follow this legislation more clearly.The noble Lord has never been very keen on any of the committees for which I have sought parliamentary support. But, as the noble Baronesses, Lady Northover and Lady Finlay, said, the appointment and establishment of the Commission for Health Improvement has been a great advance in driving up standards in the National Health Service.
Despite having had a national service for 53 years, it is interesting to note that we have never had any kind of national inspectorate. One of the reasons why, historically, there has been such patchiness and inconsistency between different parts of the NHS is that we have not had a robust inspectorate.
The noble Lord quoted from the annual report of the Commission for Health Improvement. I commend to him some of the reviews it has undertaken of clinical governance in a considerable number of NHS trusts. As has been suggested by other noble Lords, CHI has identified unsafe practices. It has identified certain organisations whose boards have not been getting the information required to make proper judgments and decisions, and it has raised issues of poor leadership within individual organisations.
But the commission has not had a wholly negative impact. It has also identified many examples of good practice. It has a role in helping to spread good practices as much as in identifying problems in particular NHS organisations.
The commission is a crucial part of the Government's strategy to drive up standards in the National Health Service. In that context, there is no reason at all why the Government should seek to undermine the independence of the commission. My own experience, as the Minister responsible for the commission, is that the chair, Dame Deirdre Hine, who used to be the Chief Medical Officer in Wales, and the chief executive, Mr Peter Homa, are extremely vigorous people, well able to embark on rigorous discussions with the Department of Health. In the reviews that they undertake of NHS organisations they are wholly independent in what they seek to do.
The Government have always sought for CHI to be at arm's length from Ministers and the Department of Health. That is why we established the commission as an executive non-departmental public body. CHI is no different from other executive non-departmental public bodies across government. It is a key feature of its establishment that the Secretary of State remains fully accountable to Parliament for the performance and the governance of the body in question. There is no justification for the Secretary of State abdicating that responsibility in the case of the commission. It is a vital part of constitutional arrangements and of ensuring public accountability that the Secretary of State appoints the chairman and other members of the commission. CHI is in no respect different from any of
the department's other executive non-departmental public bodies—the General Social Care Council, the Human Fertilisation and Embryology Authority, the National Radiological Protection Board, the Public Health Laboratory Service Board and the National Care Standards Commission.I do not believe that it would be appropriate for appointments to be undertaken by the NHS Appointments Commission, which was set up essentially to make appointments to local NHS bodies.
4 p.m.
Lord Peyton of Yeovil: The Minister's speech takes little account of Section 20(2)(a) of the 1999 Act:
- "The Secretary of State may by regulations 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".
Those are sweeping powers. One might say that the Secretary of State was entitled to give guidance but those are detailed powers. If the Minister says that the Secretary of State would never do such things, why not accept my noble friend's amendment and abandon a position that, from what the Minister is saying, is quite unnecessary?
Lord Hunt of Kings Heath: It is quite appropriate for the Secretary of State, in his role of directing the National Health Service and in accounting to Parliament, to set the parameters within which CHI works. Of course we have regular discussions with the commission about its workload, budget and the number of reviews that it undertakes each year.
The substantive point is that there is no suggestion and there will be no suggestion of any ministerial interference in the conduct of reviews undertaken by CHI. The basis for the robustness of the changes that we are making depends on a vigorous, independent inspectorate.
As to the new direction-making powers that the new clause would remove, I stress that those are reserve powers. There has never been any suggestion that they should be used as a matter of routine. It has always been our intention that they should be used only rarely, if at all. There has to be a backstop of reserve power if a situation ever arose where there was a serious problem in relation to activities or governance that the commission, for whatever reason, failed to address.
As the Secretary of State is accountable to Parliament for how the commission acts, surely it is right that he should be able to take whatever action is necessary at the time. I stress that such a power would be used in extremis. Not only is CHI already independent but—as the noble Baroness, Lady Noakes, suggested—its independence is enhanced by the Bill.
Baroness Finlay of Llandaff: Will the Minister confirm that the appointment of chief executives to the commission will be done by CHI itself, not by the Secretary of State or the First Minister of the National Assembly for Wales?
Lord Hunt of Kings Heath: CHI's chief executive had to be appointed with the consent of the Secretary
of State. The Bill will leave it to CHI to make the appointment without requiring that consent. The Bill also gives CHI control over the terms and conditions of its employees. The commission will be able to delegate its functions and will for the first time publish its own independent annual report on the quality of services to NHS patients—which will be presented to Parliament.With those changes, CHI's degree of independence and powers of direction compare favourably with other executive non-departmental bodies. The Public Health Laboratory Service and the National Care Standards Commission must comply with any directions given by the Secretary of State for their staff terms and conditions. The Bill abolishes the power to give such directions to CHI.
It is in the Government's interest to have an independent inspectorate which will be tough and robust and will ensure that the NHS pays careful attention to its reviews and inspections. Nothing in any of the Government's plans for the future of the NHS would, in any circumstance, seek to undermine those independent reviews. We have the balance right between the necessary accountability of the Secretary of State to Parliament and the considerable independence of the commission. On that basis, I invite the noble Baroness to withdraw the amendment.
Baroness Noakes: I thank the Minister and noble Lords who have supported the amendment—particularly my noble friend Lord Peyton for his usual powerful contribution. He pointed that CHI has extensive functions but without freedom because potential use of the powers in the 1999 Act take away the commission's freedom and independence.
The Minister likes to describe CHI and the powers held over it in terms of an ordinary, non-departmental public body but he is making the wrong comparison. He says that it is appropriate for the Secretary of State to set the parameters and proper for Ministers to have powers of direction. If one compares CHI with a body such as the National Audit Office or Audit Commission, those are genuinely independent inspectorates. There are no powers of direction over those bodies and the same degree of proposed ministerial control over the money that they receive to undertake their work.
The Department of Health's view of CHI can be characterised as having its own poodle, not a watchdog over the NHS.
Lord Hunt of Kings Heath: Surely the noble Baroness agrees that since CHI's resources come from money voted by Parliament and given the Secretary of State's responsibilities, there must be discussions between him and CHI about the budget—based on CHI's likely workload over a financial year. That seems a perfectly proper and appropriate relationship. I have stressed that in the actual conduct of reviews and the reports that it writes, CHI will be wholly independent.
Baroness Noakes: I thank the Minister. I can see that he has been trying to make a distinction between the
powers over the body and the work that it does. But if powers of direction exist, they can infiltrate into the work in a way which may not be seen.I agree that the Secretary of State should not be able to write CHI a blank cheque—the Secretary of State would be accountable for moneys voted to him. However, if we look at the way in which the Audit Commission is financed and the different way in which the National Audit Office is financed, we see that there are different sources of income, not dependent on the decision of the Secretary of State. My amendment seeks to replace the process of agreement. That could be made transparent; it could be brought into the open if there were disagreement. However, the Bill as drafted merely says that the Secretary of State determines the amount of money. I am attempting to move that into an environment where the debate which may well be taking place behind closed doors will properly take place in public, with CHI stating what it believes it needs to do the work that is implied in its functions. That should be wholly in the open in order to enhance the independence of CHI.
I can see that the Minister has not listened to the reasoned arguments of noble Lords who have supported the amendment. I should like to reflect on his remarks, as I am sure others would. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
4.15 p.m.
Earl Howe moved Amendment No. 105:
- Before Clause 15, insert the following new clause—
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