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Mr. Hutton: I shall speak to the Government amendments before I turn to those in the names of Opposition Members. Amendments Nos. 29 to 32 are technical amendments that relate to the Commission for Health Improvement. Amendment No. 29 concerns the commission's investigatory role, and the remaining amendments deal with its role under the new system of local health boards to be established in Wales.
Amendment No. 29 is designed to ensure that confidential information can be disclosed to the Commission for Health Improvement when it is carrying out investigations in relation to special health authorities or other bodies that may in future be prescribed in regulations under section 20(1)(e) of the Health Act 1999, not only when it carries out investigations in relation to health authorities, PCTs and NHS trusts. Whenever we discuss confidential information and its disclosure, it is important that we address the essential safeguards needed to ensure that there are no abuses. Those safeguards have already been built into the existing legislation.
The Commission for Health Improvement may obtain personally identifiable confidential information only in the circumstances specified in 23(2)(d) of the 1999 Act. Broadly, those circumstances are where it is not practicable to disclose the information in an anonymous form; where there is a serious risk to the health or safety of patients; and where the risk and urgency involved mean that the information needs to be disclosed without consent. Those are stringent and necessary safeguards.
Amendments Nos. 30, 31 and 32 are technical drafting mechanisms to address the fact that local health boards will be set up at a future date in Wales. Amendments Nos. 57 and 58 are also technical amendments, consequential on the creation of local health boards. The practical effect of amendment No. 57 would be to ensure that CHI's functions in relation to local health boards under section 20 of the 1999 Act operate once such boards are established and given responsibility for health care. The practical effect of amendment No. 58 would be to ensure that local health boards are subject to the appropriate provisions of existing legislation.
The principal debate and arguments in relation to this group of amendments has concerned new clauses 3, 4 and 10. New clause 3 seeks to create a new health inspectorate by bringing together a number of current or proposed
My overall concerns about the new clauses, especially new clause 3, are to do with the mixture of distinct functions and the disruption that that kind of change would inevitably cause at this moment in time, particularly when the National Care Standards Commission has not even begun to discharge its statutory functions and CHI has not taken on its new and expanded role under the Bill. While there is no doubt at all that the sort of collaboration and co-ordination that the hon. Gentleman and I want must continue and be strengthened, the proposed health inspectorate would create a new body with what might be described as an indigestible and confusing mixture of NHS and wider regulation and inspection roles. As I said in an intervention on the hon. Member for Oxford, West and Abingdon (Dr. Harris), we should not lose sight, in our rush to reform, of other ways in which we can facilitate the type of operation that he and I want to see, especially the use of section 9 of the Care Standards Act 2000.
We have already made provision for greater co-ordination between CHI and the Audit Commission in the Bill. Additionally, we have provided powers for the sharing of functions between the National Care Standards Commission and CHI, which has entered into important memorandums of understanding with a range of organisations, such as the royal colleges. We were able to send copies of those memorandums of understanding to members of the Standing Committee; I hope that they found that useful. In the present circumstances, that is the right way to proceed.
I wish to make it clear to the House that we are considering, as part of our response to Professor Kennedy's report on the Bristol royal infirmary inquiry, what further steps might be taken to improve the co-ordination of the activities of those various bodies. As the hon. Member for North-East Hertfordshire, and, I hope, the House, knows, the Government's response to the report will be published in the near future. While I fully understand his arguments and strongly sympathise with them, I am not in a position to support his particular attempt to resolve those problems. As I said, the difficulties can be addressed in the present circumstances in other waysless bureaucratic ways than the drastic changes and upheavals proposed. That is particularly true in relation to the National Care Standards Commission, which has not yet started its work.
Amendments (a) and (b) tabled by the Liberal Democrats to new clause 3 would mean that the new health inspectorate would perform the functions of the Commission for Health Improvement and the National Care Standards Commission, but not those of the National
I have tried to explain to the hon. Members for North-East Hertfordshire and for Oxford, West and Abingdon that we are examining the issues closely, but there are genuine difficulties with the new clause. The hon. Member for North-East Hertfordshire may or may not be prepared to accept that, but I assure him and the House that the Government are studying these matters carefully.
New clause 4 would allow CHI to be given new functions in relation to what are described in the new clause as "public health" services. That is not a term defined in the Health Act 1999, which set up the Commission for Health Improvement. The hon. Member for North-East Hertfordshire was right to draw attention to the chief medical officer's report last week, which announced plans for a new national infection control and health protection agency, which is designed to streamline the services involved in the prevention and control of infectious diseases.
The agency would subsume the functions of a number of the bodies of expertise which currently provide health protection services, including the Public Health Laboratory Service, the National Radiological Protection Board, the Centre for Applied Microbiology and ResearchCAMARand the National Focus for Chemical Incidents.
The establishment of such a new agency would clearly raise important questions about its relationship to the Commission for Health Improvement, to which we are not yet in a position to give a final answer, but which we will consider carefully. I accept that new clause 4 raises an important issue, which requires serious consideration, alongside the issues raised by the hon. Member for North-East Hertfordshire in relation to new clause 3.
There are undoubted arguments in favour of giving recognition to the importance of public health services, as proposed in new clause 4. However, complex issues are involved in clarifying the range of public health services that might appropriately be brought within CHl's remit, the relationships with both the bodies responsible for those services and those responsible for their inspection or regulation now and in future, and the legislative consequences arising.
I therefore propose that the new clause should not be accepted tonight, but I am happy to give an assurance to its proposers and to other right hon. and hon. Members that we are giving serious consideration to ways in which the issues that it raises might best be taken forward. I intend to keep right hon. and hon. Members fully informed of progress on the matter.
The hon. Member for North-East Hertfordshire will not be surprised that I take issue with his general description of the Government's record in relation to public health. That traduces the policies that the Government are taking forward and fundamentally misrepresents them. The
Mr. Heald: Does the Minister agree that there is a TB epidemic, vaccinations are down, and the sexual health of the nation is worse than it has been for a good deal of time? There are numerous public health issuesthe re-use of surgical equipment is another, and all the diseases in hospitals. The Government's record does not look good. How would he defend it?
Mr. Hutton: The hon. Gentleman gives a highly selective account. He did not mention, for example, the enormous success of the introduction of the meningitis vaccine into the NHS. He did not refer to the flu vaccination policy that we have successfully introduced, and which has made a significant impact on dealing with winter pressures across the NHS. He did not mention the introduction of new public health strategies and policies for young people, including the policy to ensure that children at school have access to fresh fruit.
The hon. Gentleman can pick and choose and describe that record as a failure, but that is not an impressive argument. It overlooks the positive achievements. Of course, there is always more to do in the public health arena, but to say that the Government are doing nothing and that the public health of the nation has deteriorated is a travesty of the facts.
In Committee, we had a revealing discussion with the hon. Member for Oxford, West and Abingdon about new clause 10, which would give the Commission for Health Improvement the additional function of reviewing guidance on NHS priorities issued by my right hon. Friend the Secretary of State, directors of health and social care regions and strategic health authorities. It would ensure that the commission reviews, investigates and reports on that guidance in carrying out its other functions. There is genuine disagreement between us about the proper and effective role of the commission and of Ministers and the House in holding the specified people to account. This is an important point to thrash out. He might say that I am presenting a travesty of his argument, but I must put it to the House that the new clause is about transferring responsibility for scrutinising the work of Ministers to the Commission for Health Improvement. That is the wrong thing to do.