Previous Section Back to Table of Contents Lords Hansard Home Page

Lord Clement-Jones: I thank the Minister for that reply and particularly for her undertaking to consider my comments. I understand the comments she has made. I also understand that a trust will become more involved in this matter if it is picking up part of the bill. But if at the end of the day budgets are effectively reduced, albeit not as regards patient care, that will constitute a considerable injustice when these organisations are trying to improve standards by inviting CHIMP to

1 Mar 1999 : Column 1423

monitor them. In many respects standards are improved as much through the money that is spent on patient care, as perhaps through the number of managers in a hospital, through IT or through other aspects.

Baroness Hayman: But the money does not grow on trees. If the commission were centrally funded by the Department of Health, the money would be top-sliced from the money that would go into patient care nationally. It is not that we suddenly have extra resources for patient care; it is a matter of whether the money is taken off through top-slicing or at the individual institution level. We should not think that there is a pot of gold to meet the cost if it is not met within the health service.

Lord Clement-Jones: I fully accept that and I shall not extend this debate any further. However, one faces a situation where one simply exchanges "wooden" money between trusts and the Secretary of State, unless the trusts which are under the greatest degree of investigation by CHIMP effectively pay CHIMP's costs in the future and therefore cut their budgets in some cases in the very areas where they need to make improvements. Therefore they are working with one hand behind their backs. I shall withdraw this amendment but I may return to it on Report. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 109 and 110 not moved.]

Lord Clement-Jones moved Amendment No. 111:

Page 12, line 15, at end insert--
("( ) Notwithstanding subsection (2) the Commission shall be entitled to exercise any of the functions set out in subsection (1) as a result of its own decision or on a complaint being made by a member of the public or of NHS staff.").

The noble Lord said: One of the key issues surrounding the powers of the commission for health improvement concerns whether it will be able to exercise its functions of its own motion, or whether in every case it will effectively work only at the behest of the Secretary of State. It is important that we should clarify for the purposes of this debate whether that is the case.

This amendment would mean that the commission could exercise any of its functions in response to a complaint from a member of the public or NHS staff. This could include complaints or concerns raised by CHCs or other groups representing patients or users. It is important that the commission for health improvement should be able to respond to concerns raised by members of the public, community health councils, NHS staff and the professional organisations that represent them. In the past staff have sometimes felt powerless to raise concerns about poor practices or low standards because of the fear that they would be victimised for whistle blowing and that no positive changes would result. Certainly such representations have been made to me. I welcome the steps the GMC has taken in this direction. A culture where genuine whistle blowers are shunned or bullied out of their jobs

1 Mar 1999 : Column 1424

must be consigned to the past and a more open culture of effective clinical governance must prevail. For the Government's agenda of improving quality in the NHS to succeed it will be vital that effective systems of clinical governance are created, but these need to be broadly based involving all professional groups with no single group having dominance. Clinical governance will need to incorporate clear procedures for staff to follow if they are concerned about failing standards.

For all of this to work it is vital that NHS staff and the professional organisations representing them are able to raise concerns directly with the commission. Although this provision may be rarely used, it is important that staff feel able to make changes from within the workplace and speak openly to their managers about standards and quality of care.

Therefore we believe that for the commission to carry public confidence it must have the power to respond to concerns raised directly by the public. A full investigation may not always be necessary in every case, but the commission must be set up in a way which allows it to be responsive to public concerns. This could lead in some cases to problems being nipped in the bud as public concerns could trigger early intervention from the commission rather than having to wait until the problems are so grave that they reach the attention of the Secretary of State. I beg to move.

Baroness Cumberlege: I understand the Government's wish to establish national bodies such as NICE and the commission for health improvement and to establish service frameworks. However, I think there is a penalty to be paid for all of this. I understand what the noble Lord, Lord Clement-Jones, said about whistle blowing and staff having an opportunity to express their concerns when they feel there is a low quality, low standard of service being provided. But the penalty of that is that all the time one is bypassing local management, and indeed management higher in the chain. Staff who wish to make a complaint have opportunities to do so. They can make a complaint to their immediate managers, the chairman of the board and the non-executive directors. They can also approach their professional bodies and trades unions. They can approach the ombudsman and local MPs. As regards employment issues, there is a whole legal framework in terms of tribunals and other such provisions. In certain circumstances they can approach organisations such as the Commission for Racial Equality.

I am concerned that if we give more and more power to these bodies that are being established, they may not adopt a light touch. If they are given more and more power I believe that to some extent they will undermine local management. We know that the NHS succeeds where it has managers who are imaginitive, who are prepared to take risks, who know their staff, who walk the wards, who are involved in the community and work with voluntary organisations. These are the people who inspire others and obtain a much better quality of service from their staff. We should support those people. I am concerned that if we build up these mega bureaucratic,

1 Mar 1999 : Column 1425

centralised organisations, we shall undermine the very people we should support. I am afraid that on this occasion I cannot support the amendment.

Baroness Hayman: This has been an interesting if short debate. I hope I can help by clarifying what I believe is the middle course that the Government envisage the commission taking between removing completely any idea of local responsibility for these issues and retaining the flexibility to respond when a matter that is raised by an individual, or a member of staff or anyone else is one that is appropriate for the commission to take forward.

The commission is being established as an independent body at arm's length from government. It is our intention that regulations made under Clause 15(2) will not prevent the commission exercising a discretion as to when it may carry out its reviews. This amendment raises the issue of NHS staff and members of the public being able to raise concerns directly with the commission. They will, of course, be free to do so. The commission will consider these and may decide to take action in a number of ways.

The commission's primary focus will be on organisational systems rather than the care provided to individual patients. But where an individual complaint indicates a wider significant clinical problem in an NHS organisation, the commission may wish to follow this up. It might, of course, wish to draw some complaints to the attention of the appropriate body; for example, the health service commissioner in cases of complaints about the care and treatment of individual patients, or the appropriate regulatory body where the concern is raised about the performance of individual clinical staff. The commission would, if it wished, be able to advance the place of an NHS trust or primary care trust within its rolling programme of local reviews as a result of concerns raised by the public or members of NHS staff about service problems that require continuing local action.

The commission may also wish to raise concerns about the public or a member of staff directly with the appropriate regional office, the NHS Executive or the health authority to check on progress made by the organisation concerned and to provide supporting evidence for the concerns. As a result, it might be agreed that the commission investigates further. The commission may also raise concerns brought to its attention by the public and NHS staff with the Secretary of State who will be able to direct the commission to investigate where necessary.

In all this, it will be important to ensure that the commission's help is targeted where help is needed most; that its approach is consistent with the objectives and priorities set for the NHS; and that the commission operates with regard to existing NHS mechanisms for assuring quality and tackling local service problems. I think that that is the issue to which the noble Baroness, Lady Cumberlege, referred. For example, there are already well-established arrangements for patient complaints, both locally and, ultimately, to the health service commissioner. The commission for health improvement is intended to complement these and not

1 Mar 1999 : Column 1426

to be a substitute for them. I agree with the noble Baroness that, where they are working properly, that is the proper route through which individual concerns should be addressed in the first instance.

The new clinical governance arrangements which we are introducing to strengthen arrangements to assure and improve quality will provide clear channels for staff to voice concerns and to take account of patients' views, including concerns raised through the NHS complaints procedure. The commission will of course look at these aspects of clinical governance as part of its general programme of reviews.

I hope that the noble Lord will feel that there is already ample scope for patients and staff to raise concerns and for these to be properly and appropriately followed through. I hope therefore that he will feel able to withdraw his amendment.

Next Section Back to Table of Contents Lords Hansard Home Page