Health and Social Care

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Mr. Hutton: The hon. Gentleman is right to say that the Government have a strong interest in ensuring the effectiveness of the new care trusts. He put it very well. We discussed the relevant proposals at length on Tuesday. Of course there is some cynicism, doubt and uncertainty about the value that care trusts will bring. We remain strongly of the view that they will provide an important new opportunity for closer partnership working.

We had a long debate about the merits and principles underlying the proposals. We believe that closer partnership and working between those two very important pillars of our welfare society will enhance the patient and service user experience.

In making his argument, the hon. Gentleman probably dropped into it the seed of its own destruction. The hon. Gentleman's assumption in the new clause is first, that the existing review arrangements are not robust enough, or secondly, that they are somehow not publicly available, or thirdly, that the Government, for reasons that he would probably describe as ideological, would force the new system down the throats of a reluctant health and social care community against the evidence of whether they were working effectively.

We do not want to revisit the old debates about how his party ran the national health service, but that is not how we intend to run it. I will deal with his argument on three levels. Are there sufficient review arrangements and are the robust enough? Yes is the answer to that question.

Mr. Hammond: That is very good.

Mr. Hutton: Yes, it is a persuasive argument. The hon. Gentleman does not have to take my word for it. He needs to look at the breadth and depth of the review arrangements that are in place. I say to him again that they are much more robust and substantial than has previously been the case in respect of our ability to monitor the performance of public services.

Mr. Hammond: I am grateful to the Minister and I would love simply to be able to accept his yes. However, the Minister is a fairly rigorous person. Is he really satisfied with the review process that has been applied to NHS Direct? Does he believe that NHS Direct has been rigorously and independently assessed and that its cost effectiveness has been properly evaluated prior to the announcement of the nationwide roll-out?

Mr. Hutton: Yes, I do. The benefits of NHS Direct are becoming clear to patients. In my constituency recently a man and his young family contacted NHS Direct. The young boy was developing meningitis, and if it had not been for that call to NHS Direct there is some doubt as to whether he would have survived.

I am using that as an example of the value of the benefits of NHS Direct, not to confirm the hon. Gentleman's point about the robustness of the review arrangements, but simply to highlight the benefits that NHS Direct undoubtedly has. NHS Direct has saved lives. I should be interested to know how the hon. Gentleman's benefit-cost analysis would put a value on the price of those lives. Perhaps he will tell us what he thinks that might be.

Dr. Brand: If I could bring the discussion back to the review of care trusts, will the Minister tell me whether the same arrangements that are so robust in his view will apply to voluntary care trusts as well as imposed care trusts? Last week I asked whether the dissolution of a care trust, which is allowable under Government amendment No. 418, applies only to voluntary care trusts, or whether, after sensible assessment through the robust procedures of which the Minister spoke, is also available to the imposed care trust.

3.45 pm

Mr. Hutton: Yes. The same review arrangements will apply. I shall list them briefly. Local authorities have a statutory duty to provide best value. NHS trusts are under a statutory duty of quality. The Commission for Health Improvement and the social services inspectorate each have a role. The local authorities have a scrutiny role, and the work of performance management is conducted by the regional office. We now have published data on performance assessment in local authorities and the NHS.

Performance tests and the assessment framework, best value reports, the role of the Commission for Health Improvement and of the social services inspectorate are all in the public domain. I assure the hon. Gentleman that there is no question of the Department of Health somehow cobbling together review arrangements and keeping them secret, thus making local government and the NHS follow the course of conduct that we want them to pursue. We want to put in place properly conducted, robust, independent review arrangements to demonstrate our case for closer partnership working. We have everything to gain from that approach.

The hon. Gentleman may be aware that the Department has a research and evaluation programme that will allow it to take a strategic view of the impact of care trusts. For example, we have commissioned the national primary care research and development centre in Manchester, in conjunction with the King's Fund, to undertake a survey of 72 primary care groups and trusts. That survey is now in its second year. The first report highlighted some of the issues that arise from partnership working, and provided some valuable information. The results of that research will be in the public domain, so that we can establish the benefits of closer partnership working.

The Committee has a simple choice on new clause 16: it must decide whether that material should be included in the Bill. I say that it is not necessary. We have strong arrangements in place to review the performance of care trusts and to allow that information to be in the public domain. If the hon. Gentleman presses the new clause to a Division, I ask my hon. Friends not to vote for it. However, I hope that the hon. Gentleman will feel sufficiently mollified and reassured not to press it.

Mr. Hammond: I cannot say that I feel especially mollified by the Minister's words. He has his emollient days and his less emollient days, but I do not feel particularly mollified. He started by saying that the Government will review the arrangement objectively and rigorously, but went on to assert that they are strongly of the view that care trusts are a positive development. That is exactly my worry: the Government are, in effect, writing the verdict before evaluating the case.

In answer to my intervention on NHS Direct, the Minister cited an example—a good one—of a benefit that NHS Direct has achieved, but he will know, because he is a rigorous thinker, that one example, or even 100 examples, does not prove or disprove a case. He will know also that it was fairly scurrilous of him to ask me if I would tell the Committee what price or value I would put on a life. That was a horrendous question. However, because of the nature of the Department's work, cost benefit analyses have to address such difficult questions, because directing resources into one area necessarily takes them from another. It is a question not of how much value we put on a life, but of how many lives can be saved or enhanced with the available resources. The Minister knows that very well.

I shall look forward to the National Audit Office report on NHS Direct. We shall then discover whether the NAO, an independent and well-respected body, believes that the review process—the assessment of NHS Direct that took place before the announcement of the nationwide roll-out—was indeed a properly rigorous process that addressed objectively the costs and benefits of the service.

I am far from reassured by what the Minister said. I accept entirely that he will want to review the workings of care trusts. I wonder, however, whether the Government will be objective enough to allow that information into the public domain if it does not support their strongly held view, as clearly outlined by the Minister, that care trusts are a positive development. If that review process does not support that view, I would be surprised if Ministers rushed to get the results into the public domain.

Having listened to the Minister, and given that we shall have an opportunity to reconsider these matters next week on Report—perhaps, in the case of review mechanisms, on a slightly broader basis than just care trusts—I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.

New Clause 17

Observer status at meetingsof health authorities

    ``Health authorities shall extend observer status, with voice but no vote, to representatives of all statutory patient representation bodies.''--[Mr. Burstow.]

Brought up, and read the First time.

Mr. Burstow: I beg to move, That the clause be read a Second time.

The new clause is brief and clear. I hope that the Minister can accept it.

Mr. Swayne: Will the Minister confirm my understanding that health authorities conduct much of their business in public—in which case, observer status exists. For business that is taken in private, my understanding is that the Bill will ensure that statutory patient bodies will have a representative on the board of the health authorities.

Mr. Denham: I congratulate the hon. Member for New Forest, West on paying such close attention to our proceedings. It is indeed our intention that patient bodies should be able to elect a member to be on the board of the trust, rather than the health authority. That may be the distinction made by the hon. Member for Sutton and Cheam.

We do not accept the new clause because our approach is different. We want to create an advisory forum to work with the health authority. It will certainly include representatives from patients' boards and a wide range of other local representatives. We want it to be a guiding organisation and a sounding board when health authorities develop the strategic direction of the local health authority. Much of the business of health authorities is, of course, conducted in public, though not all of it. We think that the place for patient representation is within the local advisory forum rather than through observer status on the health authority.

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Prepared 8 February 2001