Schedule
1Direct
payments: minor and consequential
amendments
Mr.
Stephen O'Brien: I beg to move amendment 140, in
schedule 1, page 38, line 32, at
end insert— ‘(za)
regulations under section
12B’. Amendment
140 would bring all regulations in new section 12B under the
affirmative resolution process. These are the regulations we discussed
at length concerning the nature of the direct payment pilots. Unless
this amendment is made, neither this House nor the upper House will
have the chance to debate the substance of the pilots. It is unlikely
that we would want to vote down the regulations supporting the pilots
by praying against them. It is likely that we would want to see them
amended, depending on how the Government act in the debates we are
about to
have. On
Tuesday the Minister suggested I was presumptuous in moving an
amendment directly referring to the NHS board, something the country is
crying out for. Here I offer him the chance to make the life of Health
Ministers in the next administration, whoever they may be, more
difficult in the interests of Parliamentary scrutiny. I will not repeat
the debate we had about new section 12B, but I think there are
significant concerns about these issues and we should consider
asserting an affirmative power regarding
them.
Mr.
Mike O'Brien: We do need to develop regulations to set up
the pilots. It is likely that these would have to be amended in light
of the review of the pilots if a decision is made to roll out direct
payments nationally. We would expect to hold a public consultation on
draft regulations for the normal 12-week period. It is our intention to
control direct payments with the regulation-making power and that these
should be subject to the negative resolution process. I reassure the
Committee that it is our intention to use the affirmative resolution
procedure for any order either extending direct payments nationally or
abolishing the power to grant them. The big issue would come back to
the House through the affirmative resolution procedure. If any decision
is made to abolish direct payments or to extend them nationally, that
would be via the affirmative resolution. As that would be a significant
decision for the NHS, we think it is vital that before an order is made
it should be approved after a proper discussion in both Houses. We
think that many of the rules would be very detailed and although we
want to give discretion in the way direct payments
are piloted, we do not want to have a level of unnecessary pedantry
involved in looking at the detail of what could be mundane rules.
Applying the affirmative resolution procedure to all of that would be
quite likely to clog up this place for a significant period of
time. With
the assurance that any large-scale decision about national roll-out or
not proceeding with direct payments would come back under the
affirmative resolution procedure, but the detailed regulations would be
subjected to a negative resolution procedure after a 12-week
consultation with the relevant stakeholders, I hope the hon. Gentleman
feels that amendment 140 can be
withdrawn. 11.30
am
Mr.
Stephen O'Brien: I have listened to the Minister and it
was semi-reassuring. However, there is an issue of principle here about
making sure that Parliament has the opportunity to look at these
regulations, particularly as we will want the opportunity, not just in
terms of regulations, but to hold the Government’s feet to the
fire in converting pilots into action. This is an opportunity to state
our earnest on this and therefore I would like to press the matter to a
vote. Question
put, That the amendment be
made. The
Committee divided: Ayes 5, Noes
10.
Division
No.
5] Question
accordingly negatived.
Question
proposed, That the schedule be the First schedule to the
Bill.
Mr.
Stephen O'Brien: After the excitement of that vote, I
would like to make the point that, in looking at the 20 May memorandum
from the Department of Health on health budget pilot programmes and
provisional pilot sites, I am pleased to see that the first one on the
alphabetical list is the Secretary of State’s constituency. That
will be piloting NHS continuing health care on life care, learning
disabilities, mental health and physical disabilities. That will be
helpful to give him an insight. I am also pleased to see that Western
Cheshire, which covers part of my Eddisbury constituency, is also
looking at continuing health care on motor neurone disease, multiple
sclerosis, neuro-degenerative conditions and Parkinson’s disease
as well as end-of-life care. I shall do my best to follow that
closely.
I urge the
Minister to see whether he can get something in North Warwickshire
included, because the more of an insight we have from our own
constituents’ point of view on the way this is working, the more
helpful it will be as we try to move pilots into a
roll-out.
Mr.
Mike O'Brien: I am not sure whether I should deliberately
seek to land these in my constituency, but I will certainly bear in
mind the urgings of the hon. Gentleman. It is important that we look at
the way in which these pilots proceed and that we make sure that if we
are to have a national roll-out it is in the interests of patients
everywhere.
Question
put and agreed
to. Schedule
1 accordingly agreed
to.
Clause
14Innovation
prizes
Mr.
Stephen O'Brien: I beg to move amendment 18, in
clause 14, page 10, line 37, at
end insert— ‘(za) work in
any field relevant to the
NHS; (zb) work conducted by any
individual, group(s) or organisation(s) employed by the NHS or
affiliated to
it’.
The
Chairman: With this we may discuss the following:
amendment 136, in
clause 14, page 10, line 40, at
end
insert— ‘(c)
work done promoting innovation.’.
Amendment
137, in
clause 14, page 10, line 40, at
end insert— ‘(2A) A prize
may be paid in instalments relating to subsections (2)(a), (2)(b) and
(2)(c)
above.’.
Mr.
O'Brien: We now move away from direct payments into
innovation, and in particular this one-clause provision in chapter 4 on
innovation prizes. I welcome attempts to aid the spread of innovation
in the NHS and recognise that this is not only an area in need of
improvement but an area with a large amount of potential. Innovation in
the NHS, if given the chance to flourish, can motivate and incentivise
staff to drive forward improvements to services and it can also furnish
British business and industry with opportunities to develop NHS
innovations, many of which may have been inspired by the ideas of NHS
staff. In that respect, I declare an interest as the parliamentary
adviser to the Manufacturing Technologies Association, who manufacture
some extraordinarily precise, very small instruments which are used as
part of NHS innovations. Through amendments 18, 136 and 137, I want to
address gaps in the legislation concerning the scope of the prizes. I
will address my queries on the prizes themselves later on.
The
amendments seek to ensure that the innovation prizes are open to all
NHS employees and to any groups or organisations affiliated to that
service. They broaden the scope of prizes to include the promotion of
innovation, and enable them to be paid in instalments so that staff can
develop a long-term strategy for the uptake of their ideas.
Amendment 18
addresses Lord Darzi’s clarification on the fourth day of the
Lords Grand Committee, that the prizes could be awarded to
“people working
in the health service but not necessarily employed by
it.”—[Official Report, House of Lords, 5 March
2009; Vol. 708, c.
324.] He said
he was aware of
“many people with
university appointments who do full clinical work in the health service
on honorary contracts.”—[Official Report, House of
Lords, 5 March 2009; Vol. 708, c.
324.] I can
confirm that in a non-remunerative position. I am the vice-chairman at
the Liverpool School of Tropical Medicine. I also sit on the board of
the Innovative Vector Control Consortium, a research organisation
trying to find an alternative molecular structure to DDT. The research
going on there will have a direct impact if there is success. The
Liverpool School of Tropical Medicine is already having an impact on
many things in the health service and there is a fantastic
collaboration between it and the university hospitals in
Liverpool.
Lord Darzi
was right to cite these people as a potential source of innovations,
but there is a danger that they could be discriminated against if it is
not overtly stated in the Bill that prizes are open not only to NHS
employees. The British Medical Association expressed its support when
it said that amendment 18 would clarify that medical academics are
eligible for the prizes.
I am also
concerned that the challenge of an innovation prize decided on by the
committee might limit the pool of applicants to a particular field of
specialism, and in so doing, discriminate against other NHS staff. By
emphasising the breadth of the prize in primary legislation through the
amendment, I hope to guard against its application to a specific group
of NHS employees or a particular field of expertise. The prize’s
potential would, therefore, be maximised to inspire everyone in the NHS
to innovate. Will the Minister give an assurance that the Committee
will not limit the scope of applicants to the prizes by defining too
stringently the discipline from which the innovation must
originate? By
extending the remit of the prizes to award the promotion of innovation
through amendment 137, NHS staff who play a significant role in
generating uptake of innovative ideas, and encouraging others to
innovate, may be rewarded through the prize. While promotional work
will be harder to define, its inclusion in the prize will encourage not
only potential innovators, but those with the potential to facilitate
the spread of innovation across the organisation. In the next group of
amendments, I hope to have the opportunity to discuss the idea that the
problem facing the NHS is not so much the dearth of innovative ideas,
but their uptake across the service. Promotional activities can greatly
aid the spread of innovation, which is why I propose to include them in
the scope of innovation prizes. In parenthesis, from my own experience
in the manufacturing industry, there is a great concentration on the
word “innovation”, but people readily forget that a lot
of that comes through developments of existing technology and building
on prior innovations. There is often a great problem in giving the
developments the same weight as blue-sky thinking innovations. We need
to recognise that often 90 per cent.—in most fields—of
what is regarded as innovation is in fact a development of an existing
practice or
idea. There
is a good example of how promotional activities can be fundamental to
the spread of innovation in my own constituency at Leighton hospital
near Crewe—the Leighton exposition. Since 2004, Mid Cheshire
Hospitals NHS Foundation Trust has used its research and development
office to set up an effective information dissemination forum to
provide opportunities for local clinicians and researchers to network
with one another
and discuss their practices, ideas and collaborations. The event also
showcases the work of local health care research and audit. I attended
the last evaluation and am grateful to David Cade and Sasi Willmott,
who always produce a brochure with everything set out and documented.
There is a prize for the winning entry that is judged by three
external, high-powered academic adjudicators. The 60 innovations that
were exhibited at the 2008 event bear witness to the fact that
innovative ideas are alive and kicking in the NHS. Events such as the
Leighton exposition help innovators to promote those ideas among
colleagues and, therefore, generate
uptake. The
Leighton exposition also demonstrates that it is the clinicians and
researchers who are best placed to identify the challenges across the
NHS. Innovations at the exposition included identifying reasons for
delays in in-patient ultrasound scans, improving access to community
services for elderly people after discharge from hospital and an
analysis of whether proposals from the National Institute for Health
and Clinical Excellence are useful in clinical practice. All these
topics originated from staff who identified independently an area of
research or a problem in need of a solution. If innovative events such
as these are going ahead in trusts such as Mid Cheshire, and if
innovators are succeeding in identifying areas of the NHS that are in
need of innovation, it questions why the Government are investing in
costly prizes that might inadvertently rob innovators of their role. By
identifying a challenge for innovators to tackle, the innovation prize
committee may be meddling unnecessarily in the innovation process. I
hope to seek an assurance from the Minister that the creation of a
national prize for innovation will not detract from home-grown,
grass-roots initiatives such as the example I have outlined from my
constituency—at Leighton hospital, near Crewe.
Amendment 136
would enable the organisers of events such as the Leighton exposition
to apply for innovation prizes as the promoters of innovation. I hope
the Minister will acknowledge that the promotion of innovation at a
local level can be as effective in aiding the spread of innovation as
rewarding the innovators themselves. The example of Leighton raises
questions over whether innovation prizes will really overcome the
obstacles that inhibit innovation in the NHS. The Secretary of State
identified the problem with NHS innovation on Second Reading. He said
that “the
NHS is good at invention, but it can be slow to adopt new technologies
and treatments, and the spread of new ideas is
variable.”—[Official Report, 8 June 2009; Vol.
493, c.
542.] I
wholeheartedly agree with the diagnosis of the problem but I question
the remedy. Prizes may reward innovation that has already taken
place—which, if I understand it correctly, is the main
legislative purpose of the Bill—but I fail to see how this
change in the rules will encourage the spread of innovation. The
problem is surely one of morale. The uptake of innovation is negligent
because morale among staff is low. Too often staff have seen their
ideas go nowhere, which is disheartening and dispiriting. A recent
report by the NHS Confederation called “Future of leadership:
Leading innovation” highlighted the lack of uptake of ideas as a
source of low morale among staff. It pointed to the preponderance of
risk-averse middle managers in the NHS whose work loads are orientated
towards short-term targets, rather than encouraging and championing
innovative ideas
among their staff. It also emphasised the overly bureaucratic mechanisms
through which innovators must pass before they can generate uptake for
their innovation. The requirement for the clinician to write a business
case was seen as a significant obstacle: it is perceived by staff as a
way of saying no to innovation rather than as a vehicle to secure funds
and uptake. Amendment 137
aims to aid staff in generating uptake of ideas by allowing prizes for
innovative ideas to be paid in instalments. Each instalment could be
dependent on a new stage of implementation, thereby encouraging staff
to support an innovative idea and see it through to completion. The
problem facing the NHS with regard to innovation runs much deeper than
generating ideas. A prize is a great way of rewarding the few
innovators who have made it through the gauntlet of securing the
support of their colleagues and managers. Only a small number of people
can successfully negotiate a heavy target-driven work load to find the
time and resources to innovate. However, for the majority of NHS staff,
an innovation prize in and of itself will not enable them to overcome
these barriers.
I hope the
Minister will mention in his response the newly established innovation
funds held by the SHAs. He may well say that the prizes are designed to
work in conjunction with these funds to spread innovation. I welcome
that funding and I hope it will provide much-needed capital for those
seeking to develop their innovations. I hope he will also take the
opportunity to give an indication of how he intends to change the
culture of resistance amongst managers and other NHS staff—a
culture that, we would argue, is hampered through a somewhat
target-centric NHS. This is an issue that runs much deeper than simply
the cash that comes with the prize.
11.45
am
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