Local Government and Public Involvement in Health Bill

moved Amendment No. 242G: 242G: Clause 233, page 163, line 36, after ““the”” insert ““public”” The noble Earl said: I will speak also to the other amendments in this group, Amendments Nos. 242H, 242HA and 242J. In this final group of amendments we have reached Clause 233, which relates to PCTs and the reports that they are to be required to make on any consultations that they may have carried out. I begin with a very simple issue flagged up in Amendment No. 242G. What do the Government mean by consultation? Consultation in the minds of most of us is a public process. If we take the Bill as it is, a PCT might be allowed to suppose that it could confine its consultations to an internal audience, merely sounding out the views of trusts, GPs or local authorities. That kind of narrow exercise would not meet most people’s ideas of a proper consultation. I think the Bill needs to be clearer about this. In Amendment No. 242HA, I am raising another issue. I must apologise to the Committee that the amendment is rather clumsily shoehorned into Clause 233 in this fashion. I should have taken the time to compose a completely separate new clause to deal with the point, which is to ask the Minister why, if PCTs have a duty to report on consultations, no corresponding duty is placed on strategic health authorities. Strategic health authorities, as we know, are directly responsible for commissioning a range of services, not least specialist and tertiary services. A duty to consult is quite rightly imposed on them in Clause 232. Why should they not have to account for such consultations in a transparent and public way exactly as PCTs will have to do? Finally, in Amendments Nos. 242H and 242J, I want to flag up a particularly serious concern about the kind of commissioning that may or may not be covered by this clause. In subsection (3)(e), the Secretary of State is given a power to define what counts as a commissioning decision and he can do so by using his powers of direction. I worry about this on several levels. First, the Secretary of State can act without any public consultation and without the discipline of any parliamentary process. Secondly, there is a huge potential here to erode the accountability of the NHS to the public over a period. What is the Minister’s response to that and in what way do the Government intend this power of direction to be used? I beg to move.