NHS Reform & Health Care Professions

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Mr. Heald: In clause 14(3), the CHI is given the power to discharge any of its functions either via a committee, a sub-committee or an employee. However, an addition is made, referring to ''any other person''. We would like to know who this other person is likely to be. Is the Minister suggesting that another public sector body might become involved; for example, as we discussed earlier, the Audit Commission? Or is he referring—because of the way it is worded—to private sector providers? If so, does he intend that the CHI might want to involve in its work opinion research, private investigation agencies or some other body in the private sector? Can the Minister tell us what type of persons he has in mind?

Mr. Peter Atkinson: Lawyers.

Mr. Heald: Personally, I see no harm in involving knowledgeable individuals concerned with the law in any arrangements. I should be grateful to the Minister if he declared his interest as a lawyer. Is the measure simply to make work for lawyers, as he put it earlier?

Under clause 14(3)(c), the CHI's committee and sub-committee members will be known as the Office for Information on Health Care Performance. Why is it necessary to give legislative cover to that office? Will it have a separate budget? What is its legal status? Will it be a separate body within the commission? Will it have the ability to contract? What is the relationship between it and the Office for National Statistics? Will it publish statistics and, if so, what safeguards will there be in terms of the independence and methodology of such statistics?

Dr. Harris: I should like briefly to discuss the annual report. In earlier debates, the Minister mentioned the wider issues that I felt might be missed because of the relatively narrow scope, in terms of examinable tiers, of the commission's inquiries. The Minister prayed in aid the annual report, which might allow the commission's commentary on the state of the NHS to touch on issues that go wider than the microscopic level of inspection of individual hospitals. However, it is not clear that the proposed statute will grant such a power. Clause 14(4)(b)(1A) merely specifies that

    ''the Commission must also make a report to the Secretary of State and the National Assembly for Wales on what it has found in relation to NHS bodies and service providers in the course of exercising its functions during the year.''

Perhaps the Minister intends that the report should think out of the box—I hate that term when it is used by management-types—that he has drawn for the commission by insisting that individual inquiries must not take into account the terms of reference to which trusts must work. However, it might not be clear to the commission that it can do more than summarise its findings. If the Minister takes this opportunity to reassure me—or otherwise—on that question, we will know more clearly where we stand.

Dr. Richard Taylor (Wyre Forest): May I, too, ask for some clarification? I am very confused by paragraphs 7 and 4 of schedule 2 to the Health Act 1999. Paragraph 7 states that

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    ''the Director for Health Improvement is to be appointed by the Commission, but his appointment requires the consent of the Secretary of State.''

Paragraph 6, which is being deleted, implies that the commission can appoint lesser employees with a free hand, but under the terms of paragraph 4 it is clear that the Secretary of State will retain control of appointing the chair and members of the commission. What is the explanation for those potential inconsistencies, and why will the independent NHS Appointments Commission not be involved in such appointments?

Mr. Hutton: May I, for the benefit of the Committee, summarise the changes that clause 14 will make? I shall then try to address the concerns that were raised.

Clause 14 is at the heart of what we mean by decentralisation. The Commission for Health Improvement will be released from the control of the Secretary of State, as it were, and in that regard there are four or five important changes. Clause 14(2)(a) will remove the requirement for the Secretary of State's consent in appointing the commission's chief executive. I should tell the hon. Member for Wyre Forest (Dr. Taylor) that there is no confusion about that; the question of who to appoint as chief executive will a matter for the commission itself. Clause 14(2)(b) will remove the Secretary of State's power to direct the appointment of employees and their terms and conditions of employment, and it is clear that that relinquishment applies to the chief executive as well.

Clause 14 (3)(a) and (b) will extend the commission's ability to delegate to any other person, and will allow the CHI to pay remuneration or allowances. That relates to the point made by the hon. Member for North-East Hertfordshire, who intervened to ask to whom the phrase ''any other person'' referred.

Subsection (3), and (3)(c) in particular, refers to such matters as the Office for Information on Health Care Performance. In such areas, there are many bodies outside the commission—such as the medical royal colleges, universities and other academic research bodies—that have developed considerable expertise in analysing data. It would be broadly inefficient for CHI to duplicate that detailed work, so it is important to give it the flexibility to involve outside organisations in discharging its responsibilities.

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The final responsibility must be with the Commission for Health Improvement, but we do not want to reinvent the wheel. It makes sense to allow further delegation of responsibilities so that we can make full use of the expertise of other bodies. That must, and will, be done under the auspices of the commission, but the facilitating provision will allow the commission to use outside expertise as it develops its work. I think that that is a positive, consensual idea. The fullest possible range of expertise that exists in the country must be made available to the CHI. That is what we mean by ''any other person''.

Clause 14(3)(c) relates to and names the new

    '' 'Office for Information on Health Care Performance'.''

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The hon. Member for North-East Hertfordshire raised questions about its legal effects. The office will not have a separate legal status from the CHI; it is part of the commission and will not contract separately from it. The hon. Gentleman asked me why it was included in the Bill. There are various reasons. There is an analogous precedent in how we set up the National Care Standards Commission, with the children's rights director separately identified in the Care Standards Act 2000.

It is important that the CHI develop its role and function in this area. To emphasise the importance that we attach to it, we have identified the function and office in the Bill. That will attach the greatest significance to it, just as the creation of the children's rights director in the 2000 Act attached great significance to that post. The provision does not set up a separate or free-standing entity, but it signals the importance that the Government and, I hope, the House attach to improving this aspect of the CHI's function.

Clause 14(4)(a) makes it clear that the commission will continue to publish a standard annual report on how it has carried out its functions. Clause 14(4)(b) requires it to make a further annual report to the Secretary of State and the National Assembly for Wales on the quality of services to NHS patients. The clause requires the Secretary of State to lay both annual reports before Parliament, and the National Assembly to publish the report on the quality of services.

It will be for the commission to decide what issues it wants to raise in the report. The Secretary of State will not write the report, but the Bill clearly obliges him to lay it before Parliament. That is one reason why the clause is important. This will be the first time that this place will have access to such evidence. There has never been an annual ''state of the NHS'' report produced in such a way. I am sure that it will show a mixture of things; some good and some poor performance, and many people working hard to improve matters.

It is important for the quality of our future debates on the NHS that that provision is in the Bill. It will aid and abet our work in Parliament and is a positive sign of the Government's commitment to improving the quality of debate on the future of the NHS. It will also serve an important secondary function; ensuring that the public have greater confidence in the information reported to them. The commission is being positioned further away from the Department of Health so that we can avoid the usual unpleasant allegations that Ministers are torturing the data until it confesses and tells them what they want to hear about the NHS. That is not what we are interested in. There is a strong case for having a warts-and-all argument about the NHS because that is the best way to engage with the issue that matters to the people of this country; the future of our most cherished of all public services.

Dr. Taylor: The Minister has not answered my question on the appointment of the chairman and members for the Commission for Health Improvement.

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Mr. Hutton: No, I have not; I forgot. We do not propose any changes to that system. They are Nolan appointments, and I hope that the hon. Gentleman is satisfied with that reassurance. Appointments will be carried out in the right way.

Dr. Harris: Will the Minister address my point about the ambit of the annual report? I asked whether it would be restricted to a summary of findings or whether it would, as he hinted—perhaps I misheard earlier—be more wide-ranging and broader in its thrust.

Mr. Hutton: It will be more wide-ranging and broader in its thrust. I thought that I had made that clear.

Dr. Taylor: May I register concern about the Minister's reply about the appointments being Nolanised, as it were? I am not sure whether I speak for the whole country but, in our area, appointments made by the Nolan commission have not always been as free from political influence as they were supposed to have been. I should have much preferred the new appointments to be made by the independent NHS Appointments Commission. The Minister has not said why that will not be so.

Question put and agreed to.

Clause 14 ordered to stand part of the Bill.

Clause 15

Establishments of patients' forums

 
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Prepared 4 December 2001