NHS Reform & Health Care Professions

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Dr. Andrew Murrison (Westbury): Does my hon. Friend agree that the definition offered by the 1999 Act asks more questions than it answers? It does not define health care, but illness, which is equally problematic.

Mr. Atkinson: Indeed. My hon. Friend has greater knowledge of the subject than I, and he has put his finger on a further problem that the Minister might want to address.

The second aspect that I wanted to raise was a more general point about investigations. Other members of the Committee may already know this, but I was rather surprised to learn that if a hospital calls in the Commission for Health Improvement to help it cure a problem, it is charged for its advice. For instance, the St. George's NHS health care trust in London extended its heart and lung transplant programme in October 2000, and then called the CHI to discover the reason for the substantial increase in the number of deaths of transplant patients over the previous year. It took 11 months for the report to come out. The length of time that it took to prepare caused considerable morale problems at the hospital. At the end of the day, the hospital was presented with a hefty bill, which the trust had to pay. At the time the trust argued that this was unfair, because a great deal of the work carried out in the investigation was of wider use; there was a vast cost in terms of collecting large amounts of data that was in fact relevant to the whole of the NHS in terms of transplantation.

What does the Minister have to say about the ability of the commission to charge, on what basis it charges and whether hospital trusts that call in the commission and are then faced with a large bill are able to dispute that bill? Who ultimately is the arbiter of the level charged by the commission?

5.15 pm

Mr. Heald: Clause 13 provides that if the Commission for Health Improvements is of the view that a health care NHS body or service provider is of ''unacceptably poor quality'' or there are ''significant failings'' in the way it is being run, it must make a report to the Secretary of State, or, in Wales, the National Assembly for Wales, and the report may recommend ''special measures''.

Will the Minister give us some idea of how ''unacceptably poor quality'' and ''significant failings'' are to be judged? Is this a reference to the stars system, or will the basis be one of outcomes? Will he flesh out for us what these tests are and how they are to operate? I hope that he will address my concern that there

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should not be a barrier to innovation or new treatments. As he will know from his own experience in dealing with this area, in the mental health field there is considerable support for new therapies; talking treatments and other forms of counselling.

There is support for the provision of sanctuaries and holistic medicines as alternatives to more traditional therapies. There is also the cry that goes out for the latest medicines. The Minister will know that some traditionalists are less accepting of these new ideas than those who put them forward. Will the Minister assure me that quality will be based on a rigorous assessment of outcomes rather than on an approach that stifles new thinking?

Will the Minister explain what the special measures are? The Secretary of State obviously has the power of intervention under sections 84A and B of the National Health Service Act, which were also referred to in the Health and Social Care Act 2001. Is that what he has in mind or would other measures form part of the package described as ''special measures''? If he refers only to the power of intervention it would be helpful if that could be made clear. The Health Service Journal that he loves so well asks exactly what special measures are. The Bill states that the CHI can make recommendations where health care is ''unacceptably poor'' or where there are

    ''significant failings in the way the body or service provider is being run''.

The CHI communications director talks about a menu of special measures he is discussing with the Department of Health. The NHS Confederation is quoted as saying it is not sure what this will mean. It would be helpful if the Minister could explain what is referred to.

Secondly, could I ask him about the relationship between the Commission for Health Improvement and the Audit Commission? That subject has already been discussed, but in this context, if the CHI were to undertake Audit Commission work and prepare a report under the provisions of Section 21 of the 1999 Act, would it be possible to recommend special measures on the grounds that the value for money is very poor? In the light of the weekend's newspaper reports, it is clear that one great concern about the NHS is the high amount—£7 billion to £10 billion-worth—of waste. Evidence of very poor value for money should be reported immediately up the system, so that action can be taken. What special measures will be available on the ground that value for money for the taxpayer is very poor?

Thirdly, how widely are the powers of entry drawn? My hon. Friend the Member for Hexham (Mr. Atkinson) made the point fairly well; in fact, he made it very well.

Dr. Harris: Extremely well.

Mr. Heald: Any advance on that? As my hon. Friend said, we all appreciate that it is sensible to inspect premises such as hospitals and clinics, and there is indeed a great deal of concern about diet in hospitals. However, is the Minister suggesting that powers of entry will apply to a kitchen remote from hospital

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premises, where food is prepared and then shipped to the hospital, to a blood transfusion centre situated away from the hospital or to the headquarters of a cleaning firm, so that its records can be examined? Does the power have a wide scope, or will it be limited to clinical premises?

Dr. Harris: I would like to add my voice to the call for the Minister to clarify what is meant by special measures. Will they go further than the intervention orders set out in the Health and Social Care Act 2001? I am glad that the Minister has acknowledged that the fear exists that the Government are keen to decentralise blame. There is no better way to shift on to individuals the blame for the service's failure to meet expectations than to scapegoat, regardless of how much those expectations have been inflated by a Government who have failed to provide the necessary resources, whether in cash or staffing terms. There is no better way to scapegoat than to identify individuals and state that they are subject to special measures, be they franchising or discipline. That is why we have a duty to ensure that the Government set out the way in which they envisage that the special measures will be used.

Even with an increase in alleged independence, the Commission for Health Improvement will not be allowed to criticise Government policy—even where it considers that departmental guidelines, must-dos and regulations are responsible for a failure in delivery or in quality issues—and it will be left merely with the task of identifying individuals who were unable to deliver quality despite their best efforts.

Having worked in the service and seen some of the things that can go on, I am as tough as anyone else on the question of quality. However, the Kennedy report took a very different approach from the one that the Government might wish to take. They might decide that those involved in what was a major quality problem acted maliciously, or that the situation could have been improved if others had been involved in management. It is true that there was a management failure and a clinical failure, but the report was at pains to point out that those involved had to cope with significant under-resourcing and geographical limitations in the provision of service.

The worry is that the sanctions will be used not only to deal with important quality issues—I accept that they must be dealt with—but to get the Government off the hook through their power to draw attention away from other issues that the commission perhaps cannot deal with. Certainly, hospitals in my area are very concerned—this does not help them to do their job—that the Government are standing by, ready to cast the blame on them, when they may be blameless because the job that they are trying to do is impossible with the resources that they have. There is a duty to explain what powers the Government are taking, and what measures they are thinking of introducing in the clause.

We will discuss later, perhaps on Thursday, prisons and the partnership between the NHS and the Prison Service. If NHS care is to be provided in prisons—some might argue that that is not before time—what

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rights of access for the inspection of those premises will be covered by subsection (2)? It is hard to tell from the wording, without detailed cross-referencing, whether that will cover prison facilities where NHS services will be provided.

Mr. Hutton: The hon. Members for Hexham and for Westbury (Dr. Murrison) have referred to the powers of entry. We have tried to set out in the clause where we think that those powers are needed. There is a regulation-making power alongside that, but the terms within which the powers can be exercised are set out in the Bill. Let me make it clear to the Committee that the powers will not be wider than we think absolutely necessary. I know that the hon. Member for North-East Hertfordshire is concerned about the matter and so am I. I do not want to take powers that are not absolutely necessary for the proper discharge of the commission's functions. If Opposition Members want the Commission for Health Improvement to have an inspection function over private sector providers, which has been their mantra, the Committee must address the question of the necessary consequential powers. Quite transparently, there must be a power of entry or the inspection function cannot properly be discharged.

I know that the hon. Gentleman is a man of immense goodwill, fairness and common sense. I do not ask him to trust me—I am not naive—but I hope that, having looked at the clause, he will form the view that the powers of entry that we are taking for the commission are necessary. His hon. Friend, the hon. Member for Hexham, asked what we mean by ''premises'' for those purposes. It is defined in subsection (2)(c)(ii)(a), (b) and (c). We have tried not to hold anything back from Committee members; we have let them see everything so that they can decide whether we are taking unreasonable powers. A fair judgment would be that the powers in the Bill are reasonable.

The premises concerned will be clinical premises. I think that that is what the hon. Gentleman was concerned about. In the main, the premises that we have identified are those used to deliver clinical services that the NHS is commissioning from an independent provider.

 
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