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Standing Committee A
Thursday 13 December 2001
[Miss Ann Widdecombe in the Chair]
The Chairman: Following Mr. Hurst's ruling this morning, the Government have tabled manuscript amendments. They will be taken during the debate on clause 36 and they are available to the Committee on the Table.
Mr. Simon Burns (West Chelmsford): On a point of order, Miss Widdecombe. As you were not in the Committee this morning, you may not be aware that we held a further meeting of the Programming Sub-Committee when we had before us the motion
''That, pursuant to Sessional Order . . . of 28th June 2001, the Committee recommends that, notwithstanding the Order of the House of 20th November, proceedings on Consideration and Third Reading of the National Health Service Reform and Health Care Professions Bill be completed in one and a half days.''
My hon. Friend the Member for North-East Hertfordshire (Mr. Heald) and I requested that because we felt that the way in which the programme motion for the Committee had been set provided insufficient time to debate important issues such as clauses 8, 20 and 21. We did not have the opportunity to scrutinise those clauses at all, which it is the Opposition's duty so to do, and we thought it reasonable to request that on Report, instead of having the proposed one-day debate, we should have a one-and-a-half day debate so that we could properly scrutinise those important clauses. Regrettably, the Programming Sub-Committee, with a Government majority, did not agree with that view, so the status quo remains. However, I want to put on the record that we are most unhappy at the way in which those crucial clauses at the heart of the Bill will not have any scrutiny whatever in Standing Committee.
The Chairman: That is not a matter for the Chair. The Programming Sub-Committee met and came to a conclusion in a way that was completely within the rules. I certainly have no jurisdiction to do anything about it. If the hon. Gentleman is dissatisfied, no doubt he will make that known on the Floor of the House in due course.
Minor and consequential amendments
The Minister of State, Department of Health (Mr. John Hutton): I beg to move amendment No. 114, in page 79, line 27, at end insert
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'In section 18 (duty of quality), in subsection (1), at the beginning there is inserted ''It is the duty of each Strategic Health Authority to put and keep in place arrangements for the purpose of monitoring and improving the quality of health care which is provided to individuals in their area, and''.'
The Chairman: With this it will be convenient to take Government amendment No. 258.
Mr. Hutton: Amendment No. 114 amends section 18 of the Health Act 1999 and amendment No. 258 amends section 11 of the Health and Social Care Act 2001.
Section 18 of the 2001 Act currently places health authorities under a duty to put and keep in place arrangements for the purpose of monitoring and improving the quality of health care which they provide to individuals. The amendment amends that duty in relation to strategic health authorities so that each authority will in future be under a duty to put and keep in place arrangements for monitoring and improving the quality of health care provided to individuals in their area, instead of, as at present, the health care which the authority provides to individuals. That duty will better reflect the primary role of strategic health authorities as strategic bodies rather than as providers of services.
In a nutshell, I hope that the Committee will find amendment No. 114 straightforward. Its purpose is to ensure that the duty of quality contained in the 1999 Act applies to strategic health authorities in a way that reflects their new responsibilities.
Amendment No. 258 amends section 11 of the Health and Social Care Act 2001. That section currently confers on each health authority, primary care trust and NHS trust a duty to make arrangements with the aim of involving patients and the public in the planning and decision-making processes of those bodies, in so far as they affect the operation of the health services for which that body is responsible. In relation to health authorities, that would cover both the hospital and community health services for which they are responsible and the family health services provided by practitioners in those areas. The amendment imposes on strategic health authorities all the consultation-related duties of section 11, in so far as the strategic health authorities are themselves responsible for health services, and gives the authorities a new power to direct both PCTs and NHS trusts on how they should carry out consultations on services for which they have responsibility. The amendment adds strategic health authorities to the list of bodies to which section 11 applies.
New subsection (5) provides the new direction-making power for strategic health authorities, the scope of which is defined in new subsection (4). New subsection (6) makes it the duty of PCTs and NHS trusts to comply with directions given by the strategic health authority.
The amendment imposes on strategic health authorities all the consultation-related duties of section 11 of the 2001 Act in case the authorities might be responsible for health services and gives them a new power to direct PCTs as well as NHS trusts on how they should carry out consultation on services.
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It might be helpful if I explain a little more of the detail of amendment No. 258 because I understand that the Opposition are concerned about it. With resources and commissioning being handled in future by PCTs directly, strategic health authorities will not be responsible for such services in quite the same way, but they will be responsible for their overall performance management. It is our intention that strategic health authorities should be under a duty under section 11 in two respects. My explanation may be helpful to the hon. Member for West Chelmsford (Mr. Burns).
The first duty is broadly to oversee consultations carried out by PCTs and NHS trusts. That may, for example, include being able to require PCTs and trusts in their area to co-ordinate consultation on health service issues affecting the whole strategic health authority area. That is sensible. Secondly, and more generally, situations may arise in which the Secretary of State may wish to delegate certain strategic service functions to strategic health authorities. An example that arose previously was the public health function. In those circumstances, we would want strategic health authorities to be under a proper duty to consult local people.
That is what the amendments are designed to do. They do not change policy, but tidy up the Bill to ensure that those two provisions in earlier Acts properly reflect the new responsibilities of strategic health authorities. They will, as I hope the Committee now appreciates, take a step back from direct service provision, which is their current overall responsibility, to a more strategic approach.
Mr. Burns: I thank the Minister for his explanation of the amendments, particularly amendment No. 258. As he rightly said, my hon. Friend the Member for North-East Hertfordshire particularly wanted the Minister to explain the amendment.
So that there is no misunderstanding on the Opposition Benches, I want to paraphrase my understanding of what the Minister said to ensure that I am clear about the purpose of the amendment. Is it fair to say that the amendment will ensure that strategic health authorities are in the same position as health authorities at the moment, so that when they are created they will have the same sort of role as health authorities in this area?
Mr. Hutton: That is broadly right, but, of course, the role of the strategic health authorities is fundamentally different from that of the health authorities at present. The amendments tidy up the provisions to ensure that the duties of consultation and quality from earlier legislation apply appropriately to strategic health authorities with their new responsibilities.
It may be helpful if I confirm that the duty of consultation in section 11 of the Health and Social Care Act 2001 is a general duty to maximise public involvement in decision-making within the NHS. That is not the same as the specific statutory duty to consult on service reconfigurations in the National Health
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Service Act 1977. Section 11 of the 2001 Act laid some of the foundations for the wider reforms that we wanted in relation to public and patient involvement in the NHS. I accept that those are controversial issues, but the duty in section 11 of the 2001 Act is in addition to the statutory duty of consultation on service reconfigurations, so the responsibility for consultation in relation to service changes is not affected by the amendments. They simply re-align the two existing statutory duties of quality and consultation with the new responsibilities of the strategic health authorities. The amendments do not constitute a substantive change of policy or a withdrawal from the duty of quality or of consultation.
Amendment agreed to.
Amendments made: No. 133 in page 79, line 27, at end insert
'In section 21 (arrangements with the Audit Commission), in subsection (1)(a), for ''20(1)(b) or (d)'' there is substituted ''20(1)(b), (d), (da) or (db)''.'
No. 258, in page 79, line 34, at end insert
'In section 11 (public involvement and consultation)
(a) in subsection (2), before paragraph (a) there is inserted
''(za) Strategic Health Authorities,'', and
(b) after subsection (3) there is inserted
''(4) Subsection (5) applies to health services for which a Strategic Health Authority is not responsible by virtue of subsection (3), but which are provided or to be provided to individuals in the area of the Authority, and for which
(a) a Primary Care Trust whose area falls within the Authority's area, or
(b) an NHS trust which provides services at or from a hospital or other establishment or facility which falls within the Authority's area, is responsible by virtue of subsection (3).
(5) A Strategic Health Authority may give directions to Primary Care Trusts falling within paragraph (a) of subsection (4), and NHS trusts falling within paragraph (b) of that subsection, as to the arrangements which they are to make under subsection (1) in relation to health services to which this subsection applies.
(6) It is the duty of each Primary Care Trust and each NHS trust to which such directions are given to comply with them.'' '.[Mr. Hutton.]
Schedule 8, as amended, agreed to.