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Mr. Burstow: I listened carefully to the Under-Secretary and I am now picking up on another defence—the definition defence—which is that either the proposal is not defined at all in current legislation or that the definition would have unintended consequences.
If the Department had an intention or desire to legislate in this regard, a definition would be forthcoming. There are definitions in place. That there are a variety of definitions of the term ''vulnerable adults'' is not in itself a reason not to seek to have a definition in this part of the Bill. That is the case not least because when it comes to the issue of personal care, for example, there are several definitions that operate in different pieces of legislation. Indeed, in previous debates on that very issue in other Committees, Ministers were entirely relaxed about the multiplicity of definitions: it did not seem to be a problem.
The question of passing responsibility from the Secretary of State to CHAI, which is the argument that the Minister advanced for not accepting my amendment regarding continuing care, misses the point that was picked up on by the hon. Member for
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West Chelmsford (Mr. Burns). He rightly put his finger on a concern that I suspect that hon. Members on both sides of the Committee have. As a result of the coverage of the health service ombudsman's report that was published earlier this year, constituents are contacting us to ask whether they or their relatives fall on the right side of the line and whether they are entitled to free funding of their health care and all their accommodation costs in the nursing home or, in some cases, the residential care home in which, as a result of their circumstances, they find themselves.
As hon. Members, we are not equipped to give that answer. However, the concern is that that answer would vary across the country. In some parts of the country people have to be at death's door before they are entitled to continuing health care funding. In other areas, the rules are more generous.
At the moment, we have an NHS with stipulated statutory entitlements that are not being followed faithfully through by all health authorities in a consistent way, and a Department of Health that does not seem at all bothered by that and that does not seem to wish to inquire too closely into what is being done in the Government's name around the country.
Having listened to what the Minister has had to say about the amendments, it is an issue to which those of us on these Benches will wish to return. I am not certain that it would aid the progress of the Committee today to push the amendment to a vote, because I am not certain that Ministers are really listening to the anxiety that many people have about this issue.
On the issue of the proper use of the word ''correct'', which the hon. Member for Westbury (Dr. Murrison) raised, I take his point entirely and in future drafting I will draw that to the attention of my hon. Friend the Member for Oxford, West and Abingdon. I will ensure that we do not make such grammatical mistakes again, which can lead to the construction that the hon. Gentleman placed on that amendment.
We are not minded to press any of the amendments to a vote today. However, we will probably wish to return to some of these issues at a later stage.
Amendment agreed to.
The Chairman: Did the Minister say that he did not wish to move Government amendment No. 286?
Mr. Lammy: Yes.
Amendment made: No. 285, in
Clause 49, as amended, ordered to stand part of the Bill.
Clause 50
National performance data
Mr. Burstow: I beg to move amendment No. 417, in
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The Chairman: With this it will be convenient to discuss the following amendments: No. 418, in
clause 50, page 17, line 37, at end add—
'(2) For the purposes of this section data relating to the provision of health care shall include all data relating to performance by NHS bodies.
(3) The Secretary of State may by order exclude certain categories of data relating to the performance of English NHS bodies and crossborder SHAs from the responsibility of the CHAI under subsection (1) on the grounds that publication of such data would prejudice the efficiency of the NHS.
(4) Any power of the Secretary of State to make an order under subsection (3) shall be exercisable by statutory instrument.
(5) A statutory instrument containing an order under this section shall (unless a draft of the statutory instrument has been approved by a resolution of each House of Parliament) be subject to annulment in pursuance of a resolution of either House of Parliament.
(6) The National Assembly may by subordinate legislation, made by statutory instrument, exclude certain categories of data relating to the performance of Welsh NHS bodies from the responsibility of the CHAI under subsection (1) on the grounds that publication of such data would prejudice the efficiency of the NHS.'.
No. 479, in
clause 50, page 17, line 37, at end add—
'(2) For the purposes of this section data relating to the provision of health care shall include all data relating to performance by NHS bodies.
(3) If the Secretary of State or the Assembly wishes to exclude certain categories of data relating to the performance of NHS bodies from the responsibility of the CHAI on the grounds that publication of such data would prejudice the efficiency of the NHS, then it must lay regulations before Parliament setting out what data it proposes to exclude, and the specific reasons for doing so.'.
Mr. Burstow: These amendments deal with the issue of data and the way in which data are published and reported on by CHAI. The amendments are intended to seek further clarification from the Government on their thinking and on the purpose of the clause.
I hope that the Under-Secretary will be able to elaborate further about the way in which it is intended that CHAI will publish these reports. In the previous debate, the Under-Secretary said that CHAI would be empowered to make decisions about when it would publish material in an abbreviated or summarised form. Amendment No. 418 seeks to go further and clarify whether the Government intend that particular categories of data, relating to the performance of NHS bodies, especially cross-border SHAs, will be published, and I look forward to hearing what they intend to do in respect of amendment No. 418.
9.45 am
Chris Grayling (Epsom and Ewell): Amendment No. 418 in the name of the hon. Member for Oxford, West and Abingdon would permit the Secretary of State to exclude certain categories of data, relating to the performance of English NHS bodies and cross-border SHAs, from the responsibility of CHAI, under subsection (1), on the grounds that publication of such data would prejudice the efficiency of the NHS.
Clearly, these probing amendments have been tabled to extract from the Under-Secretary clear information about performance data. He said earlier that he did not believe that it was the responsibility of
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CHAI to measure the quality of treatment, and I will return to that in the debate on the next two clauses.
Will the Under-Secretary clarify whether he expects national performance data from CHAI to reflect the quality and outcomes of health care, as well as the provision and nature of the processes that take place in the NHS? It is fundamentally important that in all the data and measurement of action that take place in the NHS trusts, there is a significant swing of the pendulum away from the process towards quality. We have already debated that, but I want clarification from the Under-Secretary on how far the Government will go in permitting CHAI to assess the quality and outcomes of health care and whether the NHS actually makes people better.
Dr. Murrison: The Audit Commission recently published several authoritative reports about data collection in the NHS, and I would be interested to know to what extent the Minister, when drawing up this part of the Bill, has taken them into account. Does he agree that Government bodies need to be consistent on whether they publish data? The Audit Commission, which presumably will have an ongoing interest in what goes on in the NHS and could very well carry out investigations requiring data in the future, must operate to the same guidelines as CHAI. It would be unfortunate if CHAI were required to publish its data in one way and the Audit Commission in another way, especially as they might sometimes be assessing more or less the same thing. I hope that the Under-Secretary will attempt—so far as possible—to ensure that those two bodies behave in the same way.
Mr. Lammy: The amendments make a complicated provision that appears to require CHAI to publish all performance data available in the NHS, but allows the Secretary of State, or the National Assembly for Wales, to exclude certain data by statutory instrument if they think that collecting it would prejudice the efficiency of the NHS. Finally, they provide for either House to annul that instrument. In a sense, that broadly contradicts the arguments of the hon. Member for Sutton and Cheam and his hon. Friend the Member for Oxford, West and Abingdon about the independence of the new inspectorate. We provided for CHAI to publish the performance data but we have not attempted to restrict what that data should or should not cover. The Opposition amendment is thus contradictory in trying to tie CHAI's hands and to burden it with the requirement to publish all performance data. That, frankly, is cumbersome, overly bureaucratic and risks increasing the burden on the NHS.
Much performance data is collected at the moment and published locally by the NHS. To require CHAI to collect and publish that data again is a waste of resources, and the NHS can do without that. That relates to the point that was just raised. We want inspectorates to work together across the board to reduce the burdens on bureaucracy. That is why we included that requirement in the Bill. As the hon. Gentleman knows, that was also the aim of the Cabinet Office report, ''Making a Difference:
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Reducing Burdens in Hospitals''. That work continues.
My hon. Friend the Member for Ealing North has sought to rectify some of the drafting defects of his own and other amendments, but the difficulty remains. If those amendments were carried, they would distract CHAI from its primary focus of assessing and reporting on the performance of the NHS.
To answer the point raised by the hon. Member for Epsom and Newell (Chris Grayling), CHAI has a function to publish data. It decides what to include and takes account of all the factors in clause 49(2). He knows that CHAI will publish further performance data later this year. Having looked at the range of indicators, the hon. Gentleman knows that there is, for example, data for acute and specialist trusts on a clinical focus relating to deaths within 30 days of heart bypass operations; emergency readmission to hospital following discharge; and thrombolysis treatment time. Those are clinical indicators against which acute and specialist trusts must, at present, indicate their performance. Alongside those are patient-focused indicators such as better hospital food, day case booking, cancelled operations and so forth.
The hon. Gentleman, therefore, knows that CHAI currently asks our acute and specialist trusts to collect data for a broad range of indicators, and that will undoubtedly continue. First and foremost, however, what to include must be up to CHAI, and I do not intend to prescribe that now. Furthermore, the Audit Commission may continue to publish data on financial management but it will not carry out comparative studies on the economy, efficiency and effectiveness of English bodies.
I hope that the hon. Member for Sutton and Cheam will withdraw those amendments.
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