NHS Reform & Health Care Professions

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Dr. Harris: I have been looking through the Health Act 1999, and I can find no reference in that Act, which the clause amends, to the sort of health care covered by the measure; services delivered to NHS patients. The Act states that duty of quality applies to providers of health care to individuals. Although I may be revisiting another debate, I would be grateful if the Minister clarified the basis for his assertion that what matters is who pays for the care rather than who provides it or has responsibility for its provision.

Mr. Hutton: There is something in the Health Act 1999 about that; I am sorry that I cannot lay my hands on it right now. Perhaps I can resolve the hon. Gentleman's difficulty during the clause stand part debate.

Amendment agreed to.

Mr. Hutton: I beg to move amendment No. 125, in page 18, line 6, at end insert—

    '(za) a review under subsection (1)(b),'.

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The Chairman: With this it will be convenient to take Government amendment No. 126.

Mr. Hutton: The amendments extend the CHI's new duty to make reports to the Secretary of State where it is of the view that services are of unacceptably poor quality or there are serious failings in the way in which the responsible body is being run in terms of one of the commission's existing functions, contained in section 20(1)(b) of the Health Act 1999. The effect of the amendments will be that the commission will also have that duty in carrying out a clinical governance review. The commission will also be able to recommend to the Secretary of State that he take special measures in the event of such a report being made.

The intention is simple. The requirement on the commission to make a special report to the Secretary of State under such circumstances should apply not only to the CHI's new range of service inspections but to its current programme of clinical governance reviews. The amendments seek to achieve that extension. I accept that it is likely that it will be some time before the commission is able to develop a comprehensive programme of service inspections. That is obvious. In the meantime, it will need to continue to focus on the completion of its planned programme of clinical governance reviews and it has an objective to complete 500 of those by 2004. It makes practical sense that, if, when carrying out a clinical governance review, the CHI reaches the view that services are of an unacceptably poor quality or that there are serious failings, it should be required to make a report to that effect to the Secretary of State.

Mr. Heald: On the face of it, the amendment seems to add a report under section 20(1)(b) of the 1999 Act to the list already contained in subsection (1D), which the clause inserts into that section 20. That list includes reports made under section 20(1)(c), those made under 20(1)(e) and inspections carried out under 20(1)(db), which clause 13(1)(a) inserts. Clearly, there is a difference in character between a (1)(c) report, which involves

    ''carrying out investigations into, and making reports on, the management, provision or quality of health care for which Health Authorities, Primary Care Trusts or NHS trusts have responsibility'',

and a (1)(b) report, which is what the amendment refers to, which involves

    ''conducting reviews of, and making reports on, arrangements by Primary Care Trusts or NHS trusts for the purpose of monitoring and improving the quality of health care for which they have responsibility''.

The (1)(b) role is linked more closely to the (1)(a) role, in which advice is given. The commission's role is to give advice and promote best practice, as well as to point out the faults and mistakes committed by a health authority, primary care trust or NHS trust. Does the Minister not feel that the (1)(a) and (1)(b) functions should more properly be paired together, as they are both about improving quality through advice and help and then monitoring any improvement? Why should it be necessary, in that process, to make a report

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and introduce special measures? I appreciate that under section 20(1)(c) of the 1999 Act, which is about the

    ''management, provision or quality of health care'',

one might want to make a report for special measures to be taken. However, I cannot understand why that would be necessary, given the more constructive approach of subsections (1)(a) and (1)(b). I should be grateful to hear the Minister's response. Bodies such as the Royal College of Nursing have said that if the provision moves us too far from the encouraging and advising role and becomes too much of a policeman role, problems may arise in the relationships that are necessary to deliver what we and the Government want, which is better health care.

Dr. Harris: On the same theme, I should be grateful if the Minister could explain why (1)(d) functions are not subject to the duty to report.

Mr. Hutton: That is the best way to ask a question and to get a Minister off balance. I hope to answer the hon. Member for Oxford, West and Abingdon in a minute, although there are no guarantees.

The hon. Member for North-East Hertfordshire was right; various issues are raised by the different sorts of inspection. Recognising the obvious differences, the judgment call that has to be made is whether serious deficiencies identified by the commission should be drawn to the attention of the Secretary of State for him to take action. Although there are differences, the quality and standard of care needs to be considered in all inspections and reviews, and we have judged that some consistency is necessary when weakness and failure is identified.

Putting it in crude terms, the hon. Gentleman is right that we need a balance between the carrot and the stick, because people do not usually respond only to the stick; nor should the carrots be sticks painted orange, because that does not help either. We are trying with the amendment to achieve an effective inspection service. It could result in the commission identifying a serious failure. If it did not, the hon. Gentleman and others would rightly argue that it would be a rather fruitless exercise, but it should not be confused with a desire to beat up people in the event of poor performance being identified. The commission may identify a number of special measures that it believes the Secretary of State should take, and they may not be simple, stick-type solutions.

Mr. Heald: When I first looked at the provision, I thought that the balance had a certain logic; that one would make reports on (1)(c) situations but not those of (1)(b). The Government obviously think the same, hence the drafting. What has caused the Government's change of mind? Why is it now thought necessary to amend the clause?

Mr. Hutton: I thought that I had explained that. As the hon. Gentleman knows, if it is to be sensible, the process of legislation should involve Ministers looking again at the provisions of legislation. I was chided earlier about a reluctance to change our minds. We have considered this provision, and given what I have

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said about consistency, about making the inspection process meaningful and about the consequences of serious failure, and given what the hon. Gentleman said about the public interest, I should have thought that he would be a little more enthusiastic about it. I am sorry that I cannot generate more enthusiasm.

I tread quickly to the point raised by the hon. Member for Oxford, West and Abingdon about the private sector, and his inability to find any reference to it in the Health Act 1999. Section 20(1)(d) of that Act refers to

    ''care for which NHS bodies or service providers have responsibility''

and section 20(5) describes what is meant by responsibility, and includes ''another person'' providing health care ''at his direction'', or ''on his behalf'', or

    ''in accordance...with arrangements made by him''.

That is the reference in the Health Act to providers ''other than NHS bodies''. There is continuity between that Act and the Bill.

The hon. Gentleman also asked a direct question about (1)(d) inspections.

Dr. Harris: Clearly, (1)(d) has been replaced by (da) and (db). I was asking why the amendment covers only (da) and not (db),

Mr. Hutton: I will have to explain that to the hon. Gentleman and to the Committee in writing.

Amendment agreed to.

Amendments made: No. 126, in page 18, line 8, leave out 'equivalent function' and insert

    'function equivalent to one referred to in paragraph (za) or (a)'.

No. 127, in page 18, line 12, leave out 'or service provider' and insert

    ', service provider or other person reviewed,'.

No. 128, in page 18, line 20, leave out 'or service provider' and insert

    ', service provider or other person'.

No. 129, in page 18, line 22, after 'provider' insert 'or other person'.

No. 130, in page 18, line 27, leave out 'or service provider' and insert

    ', service provider or other person'.—[Mr. Hutton.]

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

Mr. Peter Atkinson (Hexham): I would like to discuss two aspects of the clause that were not allowed in our debates on the amendments. First, I wish to clarify the range of the commission's power. In the 1999 Act, the commission was limited to entering NHS premises, but the Bill proposes widening the category of premises to include

    ''premises owned or controlled by a service provider and used for purposes connected with the services provided''.

The phrase used in the 1999 Act and in the Bill is responsibility for ''health care''. I wonder whether the new power will allow the commission to enter premises

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not directly involved in the provision of health care. Health care is defined in section 18(4) of the 1999 Act as

    ''services for or in connection with the prevention, diagnosis or treatment of illness''.

That could be interpreted widely. To use a slightly odd example, would the commission be able to enter the premises of a company that provided special dietary food for hospital patients? How much more widely can the commission's powers be thought of in terms of providers of health care?

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