|Health and Social Care Bill
Dr. Brand: Will the Minister give way?
Mr. Denham: Let me finish my reply to the hon. Member for Runnymede and Weybridge first. The hon. Gentleman's second question was about the number of organisations that should have red-light status. I doubt that as many as 25 per cent. of trusts would get that status. We are consulting with the service, through the document that was published last week, about the exact composition of the core list of measures,the must-dos against which performance should be assessedand the category and weighting of different measures in the wider performance assessment framework. It is wrong, at this stage, to try to predict exactly what the number of red-light trusts will be and I reinforce his earlier point that it is not a fixed figure that will always be there from one year until the next.
Mr. Hammond rose
Dr. Brand rose
Mr. Denham: I should make progress, but I give way to the hon. Member for the Isle of Wight.
Dr. Brand: I am slightly concerned that the Secretary of State says that one particular failure may not lead to intervention. However, if there were a deliberate failure to provide a serviceand I am going back to the points made by my hon. Friend the Member for Sutton and Cheamwhere, for instance, a trust said that no-one over the age of 60 should be dialysed, or that it would not provide adequate services for people with HIV, even though all the other services were wonderful, hopefully the Secretary of State would consider exercising his powers of intervention.
Mr. Denham: We need to be careful about taking too many specific examples. In general, if a service was failing, but it could be put right immediately or put on the right track by measures short of those in clause 16, we would wish to do that. If a management failure showed complete unsuitability to do the job, although there might be a power in the Bill, perhaps the trust should deal with the problem through normal employment measures. Clause 16 is essentially to be used as an immediate response to major failure across a series of services. In effect, it completes the armoury of measures that can be taken when any services are shown to be failing.
Mr Hammond: This is terribly important to our understanding of how this will work. It is still not clear to me whether the criteria for red lighting are to be absolute or relativewhether there are to be fixed hurdles so that theoretically in an awful situation 50 per cent., 60 per cent. or 70 per cent. of NHS organisations could be red lighted because they failed to meet the Government's hurdles, or whether there is always to be only a bottom decile or whatever.
Mr Denham: The consultation document says that red organisations will be those that are failing to meet one or more of the core national targets or that demonstrate serious service failure. This document is out to consultation. It is possible to produce a core set of targets whereby unless three, five or seven targets have been met, the organisation will automatically be deemed to be red light. It is equally possible to have a situation where a failure to meet one target would not necessarily trigger red-light status. The point of consultation with the NHS is to invite views on the group of services to be linked to the measures and the way in which the red-light traffic light should be applied. I acknowledge that the hon. Gentleman has a fair point, but it is not one that we need to resolve now. It would be better to have input from the service.
The Chairman: Before I call the hon. Member for Runnymede and Weybridge, I should point out that some of the interventions were slightly long. I remind Committee members that although they are at liberty to speak in debates on amendments in the Committee as often as they wish, it might be better if they made speeches rather than interventions.
Mr Hammond: Thank you, Mr. Maxton. We are grateful to you for reminding us of our ability to speak more than once in Committee.
This has been an interesting debate. I understand that because of the Byzantine architecture of the Bill, the clause 61 provisions on order making will not apply to an order made under clause 16. I am disappointed that that means that there will be no opportunity for parliamentary scrutiny. Nor, indeed, as the hon. Member for Isle of Wight has pointed out, will there be a requirement for formal reporting of orders made by the Secretary of State. Whatever we may think about parliamentary approval before or after the event, we all think that Parliament should be informed of such orders. I am sure that hon. Members will want to return to that matter on Report.
Having listened to the exchanges between the hon. Member for Isle of Wight and the Minister, and to the Minister's closing remarks about the minimum requirements, failure to comply with which could put a trust or health authority into the red-light category, I fear that the model that the hon. Member for Isle of Wight has in mind is subjective and flexible in its approach to the quality of service provided by NHS organisations, whereas the Government propose a mechanistic procedure for measuring not whether trusts do a good job and provide good care, but whether they comply with targets set by the Government. Those could be quite artificial targets relating, for example, to changes in numbers on waiting lists.
I am grateful to the Minister for clarifying whether the red-light numbers will be based on an absolute hurdle or a proportion of the relevant total. I think that the answer was that a mixture of the two would be used. I do not envisage that the Minister would feel comfortable with the knowledge that 70 per cent. of NHS bodies were in the red-light category, although it is fairly clear from the draft list that has been submitted for consultation that if all the criteria were selected, and failure in one of them meant going into the red-light category, most NHS bodies would be there.
The Minister has perhaps deliberately misinterpreted my question about the involvement of the private sector. He gave the example of renal services and of course the private sector already has a substantial role in providing renal services to the NHS. I really wanted more to consider management and leadership of NHS trusts. Whom will the Secretary of State appoint, and to what bodies will he delegate the functions of health authorities or trusts that are subject to intervention orders? I hoped that he might come clean on the organisations that he had in mind to take over the powers of failing NHS bodies.
The Government need courage when they see a need to do things differently. When we believe that they are doing things right, we shall say so. We shall not attack them for doing what is common sense. There may be circumstances in which it is appropriate to bring in suitably qualified consultants or organisations to run failing organisations within the NHS. The essential characteristic of the NHS is to ensure universal access to health care, free at the point of need. The patients could not care less who provides or manages it, as long as they get it when they need it, and it is free at that time.
I hope that the Minister will be a little more open with the Committee about the Government's intentions. We shall need to return to this broad area of consideration on Report. Perhaps there are practical reasons for the Government to have made it clear that they would not agree to prior parliamentary approval, and we shall need to explore a mechanism for ensuring that Parliament is at least informed when orders are made. With that in mind, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Question proposed, That the clause stand part of the Bill.
Mr. Hammond: I want to raise a couple of technical points about how clause 16 will work. It is not clear to me how an intervention order will be brought to an end. Will it contain provisions showing what will have to be achieved before it is terminated? Will the relevant bodies revert to their former status, run by a trust board or health authority board? Will the persons or bodies with interim control be informed of clear targets that must be reached before autonomy is re-earned? How would the Minister deal with the perverse incentive that there would be for an outsider who was appointed to and remunerated for a job in a failing NHS body? Such a personor bodywould know that on completion of the task the remuneration would cease. What mechanism would ensure that the special measures under an intervention order would function as a convalescent ward, from which the patient would eventually emerge, rather than as a long-term asylum, from which there would be no hope of escape?
Mr. Denham: I have two points to make in reply to the hon. Gentleman. The duration or other details of an order would be matters for the Secretary of State, who would, I understand, have some discretion over how the order was laid. It could be time-limited or open-ended.
As to securing the prime object of the case, which is an important question, the trust would still exist as a legal entity and would be subject to all the same powers of intervention and support that we debated earlier and which I am sure we shall discuss under later clauses. The Secretary of State would maintain a built-in interest in the performance of the trust. That mechanism would enable the Secretary of State to monitor performance under the order and take whatever measures were necessary.
That is probably enough for now, but other issues that arise under clause 2 might provide elaboration on those points.
Question put and agreed to.
Clause 16 ordered to stand part of the Bill.
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