|
Mr. Lammy: Although the intention behind amendments Nos. 466 to 468 is to protect those individuals who are transferring from other bodies to the new commission by ensuring that they are able to take redundancy where a significant change occurs to the detriment of their working conditions, I cannot agree that the amendments are actually necessary. For staff transferring from other bodies to CHAI and the new CSCI, the formal identity of their employer will have changed, but their employment rights and rights to redundancy will remain unchanged, which the Bill makes clear. That means that where individuals had a right to redundancy previously in certain circumstances, they will retain that right in their new job. I am not clear where the problem arises.
The amendments, particularly amendment No. 468, would have the effect that individuals would always have the right to employment in the case of significant change in their working conditions, but would not make it clear what the significant change was considered to be. The hon. Member for Epsom and Ewell gave an example concerning shift patterns. I suppose that it is reasonable to debate the significance of a change in shift patterns, but what comes to my mind when he talks about that is a factory setting, not the inspectorate that we are dealing with. I cannot see shift patterns having the weight that the hon. Gentleman seeks to give them.
Chris Grayling: I shall give the Under-Secretary a couple of hypothetical examples of changes that could take place. Let us suppose that the management of CHAI decide to change the pattern of inspections to four days instead of five and to longer hours. That would have an impact on the working hours of the people who work with the inspectorate. Equally, let us suppose that it changed the structure of the inspectorate teams from county to region. That,
Column Number: 537
again, would have a material impact on the working patterns of those teams. Does the Under-Secretary agree that it is reasonable to imagine that a new management team leading a new agency might decide that such changes should be part of their working arrangements?
Mr. Lammy: I hear what the hon. Gentleman says, but I am advised that the word ''substantial'' is used in employment law and that ''significant'' would cause difficulties. For example, could someone who was sharing an office with another person when previously they had had an office to themselves say that that was a significant change? The current drafting of the Bill is right and ''significant'' would complicate the matter and cause problems. The current position in the Bill with regard to the individual's existing rights and liabilities is simpler and will ensure that any move to CHAI or CSCI will not be detrimental to the individual's working conditions.
TUPE does not apply to the clause, but people will be transferred on similar principles to those of TUPE. The clause replicates the position under TUPE and meets the hon. Gentleman's point in terms of employment rights, but I must resist the amendments as drafted.
Chris Grayling: I am happy to accept the Under-Secretary's assurance—I know that he is a man of his word—that ''substantial'' is the word used in employment law and that the Government will not allow a measure to go forward if it would damage employment rights. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Schedule 7, as amended, agreed to.
Clause 39
Abolition of former regulatory bodies
Question proposed, That the clause stand part of the Bill.
Mr. Burns: I just want to ask the Under-Secretary one question. Which powers in the Bill allow for the two bodies to be abolished?
Mr. Lammy: If I may, I shall return to that question.
Question put and agreed to.
Clause 39 ordered to stand part of the Bill.
Clause 40
Quality in health care
Dr. Harris: I beg to move amendment No. 162, in
clause 40, page 14, line 12, leave out 'and'.
The Chairman: With this it will be convenient to discuss the following:
Amendment No. 163, in
Dr. Harris: The two amendments, effectively, are one. The first would omit the word ''and'' between the
Column Number: 538
two existing definitions. The second, which is the more substantive, would add ''the promotion of wellbeing'' to the existing definition, which states:
''(a) services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness; and
(b) the promotion and protection of public health.''
My argument is that the promotion of well-being for an individual is more than is already covered in subsection (2)(a) and (b). Paragraph (a) refers to
''the prevention, diagnosis or treatment of illness''
but that does not cover the promotion of well-being. The prevention of illness is part of the promotion of well-being, but not all of it. The World Health Organisation definition of health now extends to the concept of well-being. I would argue that health is not simply the absence of illness, particularly a medical model of illness; well-being and living healthily is more than just avoiding illness. It includes being able to make choices and to live as an autonomous individual. Indeed, there are big questions about how we safeguard the autonomy of individuals; that would not be covered by subsection (2)(a), but might be captured under the concept of the promotion of well-being. It is the job of NHS bodies to do that.
It might be argued that the concept of well-being is covered by the promotion and protection of public health, but I am not sure that that is so. What is meant by the promotion and protection of public health? It is better that I ask that now than in the clause stand part debate. I suspect that the promotion of public health relates to public health initiatives, which are important, but also to protecting public health from individuals, such as those with mental illness. Many of us would argue that the greatest threat to health from people with mental illness—especially those who are untreated—is to their own health rather than that of the public.
I accept that there is concern about the protection of the public, which is what subsection (2)(b) refers to. Public health initiatives on, for example, smoking cessation and the protection of the public and issues relating to the control of infectious diseases are also relevant. I do not disagree with anything in that subsection, but I question whether the wider duties that we want health care bodies to adopt would be better safeguarded if the Under-Secretary considered widening the definition.
I do not plan to spend a great deal of time discussing the concept of well-being. However, I shall give some examples of joint working. It has long been argued that NHS bodies need to work with other organisations in the public, private and voluntary sectors to secure the conditions associated with the prevention of illness and the promotion of well-being; for example, decent housing, a balanced diet, the right of children to a proper education and the right of families to live free from fear, whether it be from crime or impoverishment.
In a modern society, so much illness, and other demands on health care services, is caused by what is loosely described as stress from the factors that I have mentioned. That is one of the reasons why demand for health care is so much greater in areas of deprivation.
Column Number: 539
Some of the issues that I have raised contribute to a lack of well-being, subjectively and objectively measured.
When we define health care, it is important to stress the significance of looking holistically at it. Perhaps the Under-Secretary will be able to say that some of the new concepts relating to preservation of equity and tackling inequalities in health care are specifically provided for in the Bill. Given the background of the Under-Secretary and his constituency, I should hate a Bill to be passed without us making some attempt to check that the Government are looking for every opportunity to reduce health inequalities in communities that are deprived and do not have the same sense of well-being as other communities. We must take such opportunities to improve legislation.
The Under-Secretary will say that we are talking about an existing definition taken from previous Acts. I ask him to open his mind to the idea of developing new definitions to allow us to keep up with other countries and supranational organisations that have wider definitions. That is not just to deal with low-level issues. I am talking about a major factor in why there are such huge demands on the health service, even in the absence of what can objectively be measured as greater indices of actual disease. One problem with which we are struggling is that as we get better off and, arguably, less ill in terms of preventable illness, it does not seem to be having much impact on the demands for health care. I suspect that that is partly about feelings of stress and lack of well-being.
To conclude, the definition would focus the minds of those bodies that are due to be inspected against that quality standard on their duties to work closely with public authorities and voluntary sector organisations that are concerned with promoting well-being.
3.30 pm
Mr. Simon Burns (West Chelmsford): I listened carefully to the hon. Member for Oxford, West and Abingdon, and I have a lot of sympathy with the thrust of the points that he made. He is trying to push further forward efforts to improve the nation's health, which he describes in amendment No. 163 as ''wellbeing''. However, I am not persuaded that he is offering anything new in relation to the Bill.
I imagine that clause 40(2)(a) and (b) constitute a fairly wide, catch-all definition across the whole area of illness prevention and health promotion. Subsection (2)(b) deals with
''the promotion and protection of public health.''
That covers a vast area in seeking to enhance the nation's health. The hon. Gentleman may say that it is a belt-and-braces operation, but it looks like overkill, because the point that he makes seems—I certainly do not want to be the Under-Secretary's spokesman—to be already covered in the Bill. I am not persuaded that it is necessary to make the amendments basically to flannel out this aspect of the legislation.
Column Number: 540
| 
