Health and Social Care Bill

[back to previous text]

Mr. Denham: Again, I am happy to reflect on that. The hon. Gentleman makes a reasonable point. There are good reasons to resist tying organisations down to specific timetables. The hon. Gentleman was wondering what circumstances one might have in mind, so let us take an example. Last year, the Government set an in-year objective of achieving a 60 per cent. immunisation target for the over 65s. That was not linked to any performance system—other than there was a service payment for GPs to carry it through. It is conceivable that the Government might have chosen a different means of incentivising that, perhaps through a payment to health authorities. That hypothetical example—which is not one that we have considered nor do we have plans to do so—would be a case of a criteria and target being set in year with the exact way of assessing performance being made public somewhat later.

Mr. Burstow: The Minister's example of the immunisation programme is quite unfortunate as it took me the best part of two months to get a written answer about the extent to which that programme was successful. That reflects the concern of the hon. Member for Runnymede and Weybridge about getting information into the public domain at the earliest opportunity. Would the Minister consider ensuring specifically that community health councils and their successor bodies are notified of changes in year to objectives and criteria? Clearly, as the local agency for evaluating the performance of the NHS, from the patients' perspective, they need to know.

Mr. Denham: Those are perfectly fair points. I have tried to give reasons why the wording of the amendments would not be acceptable. Clearly a patients forum would need to know what is driving a trust or health authority, or setting its priorities. Our intention is that supplementary letters would be publicly available in the same way as the annual letter to the health authority is available. I will go back through the system to assure myself, the Committee and, if necessary, the House, that the information will be in the public domain. I am sure, however, that that would be the case under our normal proceedings.

Mr. Hammond: I am grateful to the Minister for the tone of his response to these amendments. They are intended to allay concerns that the Secretary of State is acquiring considerable powers, which could be exercised to mean that, in time, a larger proportion of total health funding would be distributed on a discretionary basis, instead of through formulae. Although we complain about them, we accept that the calculations are done by officials and are neutral. We are attempting to ensure that the way in which the Secretary of State operates these funds is transparent, and that he is therefore accountable for his actions. Can the Minister reassure the Committee that it is his intention that all health authorities are set the same criteria and objectives? It will then be possible to see an objective or a criterion set, the performance of different health authorities in achieving it, and the payments that are then made to them.

5 pm

Will the payments be flat rate—so that each authority that meets the objective gets £10,000—or related to the authority's weighted capitation payments under the formula? Will the payments reflect the broader needs of an area, or will they be at the Secretary of State's discretion? If it is the latter, I believe that there will be considerable concern about very large sums being dispensed on the basis of the achievement of objectives or criteria that may differ between health authorities. If the Minister can clear up those questions, we will have made a fair amount of progress.

Mr. Denham: Although I have some sympathy with what the hon. Gentleman is saying, it is important that we do not use the clause to attempt to rewrite the entire basis of the National Health Service Act 1977. As I said earlier—when I think the hon. Gentleman was briefly absent from the Room—the clause gives considerable discretion to the Secretary of State to consider a broad range of factors in deciding what allocations are made to health authorities. The clause relates specifically to the ability to make performance-related payments and, even more specifically, to making payments related to performance in any particular year.

The entire debate has been based on the premise that the criteria for measuring performance will be published, and we have discussed the timing of the exact measurement of those criteria. Therefore, it follows that there will be published criteria, but it would be irresponsible to go from this narrow provision to making fundamental statements about the whole system of laws surrounding health authority allocations. In the context of the clause, it is our intention that there would be published criteria for making awards.

Mr. Hammond: I am grateful to the Minister. He has said that the same criteria are applicable to all health authorities, and that they are not separate criteria negotiated and agreed with different health authorities. Will he also answer my question about payments?

Mr. Denham: It would be possible under the clause for the Secretary of State to set specific objectives for individual health authorities. Under the current system, several health authorities receive additional funds through a competitive process to implement health improvement plans aimed at reducing coronary heart disease. The funding of those plans is dependent on achieving objectives. The clause might allow in-year performance to be taken into account for those individual health authorities. Thus, as part of this process, it must be possible to identify specific criteria for individual health authorities—and I assure the hon. Gentleman that it would be an open process.

Mr. Hammond: I appreciate the Minister's tone in his earlier remarks. However, partly by what he said, and partly by what he avoided saying in relation to the payments, he has reinforced my worst fears that the intention of the clause is to enable the Secretary of State to approach health authorities and—under clause 3 trusts and primary care trusts—effectively negotiate bilateral deals with them relating to specific aspects that are relevant to them. That is not to say that specific aspects might not need to be covered in one trust and not in another, but I am sure that the Minister will appreciate the accountability anxieties involved in moving to a method of funding the NHS that essentially involves the Secretary of State in a series of bilateral contracts with NHS providers, negotiating deals with them. Perhaps, for example, two trusts might be set similar criteria but paid different amounts if they achieved them. Perhaps the two trusts might be set different criteria. Although that may make sense in some cases, in terms of a public accountability framework, a public spending programme and the demands of equity of access and treatment in services such as the NHS, it might be difficult for the Government to sustain in practice, and it gives me considerable cause for concern.

Mr. Hilton Dawson (Lancaster and Wyre): I have some sympathy with the hon. Gentleman's amendment, but does he not agree that he would be on much surer ground with the line that he is trying to take if his party recognised poverty as a major cause of ill health in this country?

Mr. Hammond: The hon. Gentleman makes a point that the funding formula recognises. As I said a few moments ago, we all recognise that the funding formula is not perfect, but at least it takes into account in a formulaic way different circumstances. What is now being proposed is that a part of the budget of health authorities and trusts will not be subject to such a formula, but will be subject to bilateral negotiations with the Secretary of State—because inevitably that is what it will boil down to—on achieving what may not necessarily be clinical criteria, but whatever criteria the Secretary of State wants to impose. That seems a rather retrograde step that I should have thought would give the hon. Member for Lancaster and Wyre (Mr. Dawson), as well as Opposition Members, some cause for concern.

I was hoping for an assurance from the Minister, because the tone of his earlier remarks suggested that the process would be across the board and that we would be discussing trusts having to reduce their waiting lists by 10 per cent., for example, in order to receive a payment of x. As a result of our debate so far, however, it is not clear whether the Secretary of State would be able to impose different values for x on every trust and that trusts would receive different sums of money by way of reward if they achieved those targets.

In the absence of a formula, such a system is open to abuse. We are making legislation not only for the present, but for the future, and I do not want a system to develop that gives politicians ever greater discretionary control over large areas of funding. At the moment we are dealing with relatively small amounts. However, let us consider personal social services spending, a subject on which the Minister asked me a question at the Dispatch Box a week or two ago, so he obviously knows a lot about it.

We have seen a dramatic growth in the proportion of total personal social services funding, which is funded through ring-fenced grants allocated by the Department of Health and bid for by social services authorities. Can the Minister confirm that it is not the Government's intention to place increasing amounts in funds allocated on the basis of performance and meeting criteria and objectives? Everything that I have heard from the Government suggests that that is part of their agenda. It may not be wrong, but it means that an increasing sum will be allocated on the basis of performance. We are merely seeking to ensure that the allocation mechanism is fair and not vulnerable to political manipulation—political with a capital ``p'' and with a small ``p''. We want the allocations to be fair and transparent, in what I might call—in an old-fashioned way—the best traditions of British public finances. I do not feel that the Minister has given us that reassurance.

I am, however, grateful to him for agreeing to consider the thinking behind the amendments. The wider concerns that I have expressed go beyond the amendments to the broader operation of the clause. Therefore, in anticipation of what the Minister has to say when he has had a chance to explore that thinking, and in the hope that we may discuss the matter further in the clause stand part debate, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Previous Contents Continue

House of Commons home page Parliament home page House of Lords home page search page enquiries ordering index

©Parliamentary copyright 2001
Prepared 23 January 2001