Mr. Hutton: I do not intend to go into further detail about clause 11. I hope that I spelled out the issues a few minutes ago. The hon. Gentleman raised the
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important issue of access to and around NHS sites for people with a disability. He gave the example of people who are blind. I strongly agree with his sentiments.
Given the extension of the definition of health care to the patient environment, the issues that the hon. Gentleman raised will fall well and truly within what we are trying to achieve. Issues such as providing signage sites and ensuring that blind and other disabled people have proper information to help them to get around sites fall four-square within the definition of the patient environment that we seek to add to clause 18. The hon. Gentleman made a fair point, and the commission will want to consider it.
Question put and agreed to.
Clause 11 ordered to stand part of the Bill.
Further functions of the Commission for Health Improvement
Mr. Burns: I beg to move amendment No. 155, in page 17, line 29, at end insert
'(3A) In subsection (2), at the end of paragraph (b) there is inserted ''including co-ordinating visits to Primary Care Trusts or to NHS Trusts with other bodies carrying out monitoring or inspections of those premises''.
The Chairman: With this we may discuss amendment No. 162, in page 17, line 30, after '(2),', insert
'paragraphs (a) and (b) are omitted, and'.
Mr. Burns: The amendment is in my name and those of my hon. Friends the Members for Woodspring (Dr. Fox) and for North-East Hertfordshire (Mr. Heald). I make no bones about the fact that the British Medical Association recommended it to us. In many ways, it is a probing amendment. As the Minister is aware, the British Medical Association supported the establishment of CHI in 1999, and has not wavered in its support. As was said when we debated the previous clause, the main function was to consider the question of duty of care and enhance the quality of care, and a function of CHI is to monitor the quality of care provided in the health service to ensure that it meets the highest standards.
I hope that the Minister can reassure us on the danger that may result from the fact that several different bodies have responsibility for visiting, inspecting and monitoring the services and quality of care provided by NHS trusts and GPs' surgeries. Those bodies include CHI itself, the medical royal colleges and the Audit Commission. If the relevant clauses remain in the Bill and the Bill becomes law, patients forums may also carry out inquiries into areas of health care at all levels. Most visits that those bodies make will be appropriate to the fulfilment of their functions, but there is a danger that without co-ordination, visits from and inspections by the various organisations and bodies will cause disruption to trusts and GPs' surgeries. The amendment would ensure that co-ordination. I am sure that the Government do not intend such disruption to be the
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by-product of their changes, which should improve and enhance patient care and the performance of the health service.
The Minister is probably aware that when Ofsted plans to visit a school, it gives the school advanced warning. Teachers, parents and pupils in all schoolsI say ''all schools'' because I cannot believe that the school of which I am a governor in Chelmsford is an exceptiongive a great deal of time and effort to ensure that they are ready for a visit. That causes some disruption and a distortion of effort and energy that would otherwise be given to the education of young people. One can imagine something similar happening in the health service. A trust or a GP's surgery, in which employees are less familiar with visits from people who inspect their activities, will make preparations in time for the visit. That will involve extra effort when GPs and their staff already feel overburdened with bureaucracy and rising patient expectations, and may distort and even diminish patient care in some circumstances.
Therefore, without seeking to undermine the functions and duties of the bodies and organisations that carry out inspections or visits, there is a logic to seeking to co-ordinate the activities of those bodies to avoid placing an undue burden on trusts or GPs' surgeries. Will the Minister consider that point? I shall be interested to hear whether he shares the BMA's concern or regards it as an unfounded worry and thinks that, in practice, everything will be fine.
Dr. Harris: I have nothing to add to the hon. Gentleman's remarks on amendment No. 155, but I should like to speak to amendment No. 162. That amendment would insert a provision that section 20(2)(a) and (b) of the Health Act 1999 be deleted. Those paragraphs specifically state:
''The Secretary of State may by regulations make provision
I was concerned about those paragraphs when the 1999 Act was passed and I imagined, when the Government said that they would make CHI more independent, that they would be deleted. They give the Secretary of State power to restrict the ability of CHI to talk to the people to whom it needs to talk, to make investigations and reviews when it wants, and to consider cases as it wants. I can think of no issue governing the making of reviews and investigations that is not covered by paragraphs (a) and (b). To persuade me that the amendment is unnecessary, the Minister must justify those paragraphs, give examples of when the Secretary of State might make those provisions by regulations, and demonstrate that in doing so he does not threaten the remit, independence, scope and ability of CHI to make such investigations.
(a) as to the times at which, the cases in which, the manner in which, the persons in relation to which or the matters with respect to which any functions of the Commission are to be exercised,
(b) as to the matters to be considered or taken into account in connection with the exercise of any functions of the Commission''.
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The paragraphs that I would delete are different in nature from paragraphs (c), (d), (e) and (f). Paragraph (c) dictates to whom the ''advice, information or reports'' are given, while (d) covers
''the publication of reports and summaries of reports'',
which is subject to a welcome amendment in the Bill. Paragraph (e) relates to charges made to the accused for an investigation made into them and (f) to
''the exercise of functions . . . in conjunction with the exercise of statutory functions of other persons.''
That paragraph may relate to some issues raised by the hon. Member for West Chelmsford.
The worry is that the Secretary of State may find it convenient to make provision that the Commission for Health Improvement should not consider aspects that it might want to consider in the interests of ensuring that adequate inspection is made of the quality function. For example, if CHI considered the potential risk of the transmission of new-variant Creutzfeldt-Jacob disease from surgical instruments, it might like to look at a report that the Government wanted to suppress. Indeed, a recent ''Panorama'' programme showed that the Government might be keen and willing to suppress such reports. It also alluded to issues in my previous amendment, but I will not cover that argument again.
Paragraphs (a) and (b) seem to give the Secretary of State the power to restrict the commission's ability to examine departmental policies, guidance to the service, executive letters and health service circulars. The Minister will have to provide clear reasons, with examples, of why such wide-ranging powers must be retained. If the Government were serious about ensuring that the commission was truly independent and had wide-ranging powers, they would think seriously about removing paragraphs (a) and (b).
Dr. Murrison: I wish to return to the BMA's reasoned comments on the clause. Its position on the clauses that we have discussed so far has been extremely thoughtful and generally supportive. However, the BMA is concerned about the provisions in clause 12 for multiple inspections.
From my experience as an inspector and inspectee, I know that inspections are hugely disruptive and take one's eye off the ball when it comes to what the job is all about; treating patients. The BMA draws a nice analogy between inspectors in the health sector and the men who dig up the road. An effort is being made to ensure that gas men, electricity men and plumbers dig up the road at the same time. That is because nothing is more irritating than having one's road dug up by one lot of men one week, another lot the next week and yet another lot the week after. If we can amalgamate the regulators, there is likely to be far less disruption to health care. I am sure that we would all want that.
GPs in particular are subject to a vast panoply of regulation and inspection from their royal colleges and, potentially, patients forums. They are also subject to additional regulation and inspection because they run what are, in effect, small businesses. GPs to whom
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I speak in my constituency are heartily fed up with that. They are worried that inspection is, paradoxically, detracting from patient care.
I should like to return briefly to the notion of total quality.
Mr. Oliver Heald (North-East Hertfordshire): I have been present since the beginning of my hon. Friend's remarks, although I apologise for not being here earlier. As regards inspection bodies, does my hon. Friend agree that one must bear in mind other burdens on GPs? The recent BMA survey showed great unhappiness among GPs about the arrangements under which they must work, particularly the level of bureaucracy. Does he agree that the Government might be putting the last straw on the camel's back by adding numerous inspections to the burden of bureaucracy and rising patient expectations that GPs face?