Health and Social Care Bill

moved Amendment No. 29: 29: Clause 4, page 2, line 39, leave out ““provision of”” and insert ““commissioning and provision of services related to”” The noble Lord said: I shall also speak to Amendments Nos. 33, 36, 69, 73, 84 and 86—but not 85—91, 98 and 103, which are in my name. I am grateful to my co-signatories for their support. Most of these amendments are designed to bring the commissioning of health services, not just their provision, more clearly within the scope of the Care Quality Commission’s regulated activities. Amendments Nos. 33 and 36 would clarify and widen the meaning of ““health services”” covered by the Bill. In tabling the amendments, I have done no more than attempt to put the Bill in the shape that I would have preferred if I had continued as the responsible Minister, so in mitigation I claim at least intellectual consistency in my position. Let me start with the commissioning amendments. In any local area, commissioners of health services can do more damage to that community’s health than any individual provider. It is their capacity and competence in assessing local health needs, identifying appropriate service responses, contracting for the necessary services and dealing with poor providers by terminating contracts that most affect local health. Commissioners have been given the authority and the access to resources to effect real change. About 80 per cent of the NHS budget of some £110 billion a year passes through their hands. If the Government want a risk-based regulatory scheme for health services, with which I agree entirely, as I think do many Members of the Committee, it seems to me perverse to exclude commissioners or to leave matters unclear as to the new commission’s role and powers in this area. This has been a contested area, with some in senior NHS positions arguing that oversight of commissioners is a performance management matter for strategic health authorities—and so it is, up to a point. When the original consultation document, with which I was heavily involved, was issued in November 2006, it showed, on page 63, commissioner assurance as a shared responsibility between strategic health authorities and the new regulator in the proposed future structure. That remained the position when Alan Johnson published his response to the consultation in October 2007, as set out on page 36 of that second document. I am told that nothing has changed and that the new commission can still intervene with commissioners. However, I do not consider that the current wording of the Bill adequately makes it clear that the commission can take action in respect of failing commissioners where SHAs do not take sufficient action. We will come to some of that later. I also do not think that the Bill makes it absolutely clear that the commission has rights to intervene in various functions in relation to commissioning. The performance of commissioners under successive Governments has been less than convincing. Too often, commissioners have been out-muscled by a powerful acute trust and too often in some of our most deprived communities they have failed to replace inadequate and failing primary care services. Sometimes, a cosy relationship within the so-called NHS family has worked against the public interest. The Government’s new World Class Commissioning initiative is extremely welcome. It certainly has my support and I hope that it will improve matters. I was pleased to see in Ben Bradshaw’s recent Health Service Journal interview the recognition of the need for clear dividing lines between commissioning and providing, because primary care trusts are too often conflicted in this area. However, if, as I think we should be, we are providing for a future regulatory system for health services, I believe that we must clearly state in the legislation the ability of the commission to be involved in, and to take action on, commissioning and not simply leave matters to strategic health authorities. Similarly, we should not leave in doubt the commission’s ability to intervene and take action in this area. Amendment No. 29 would bring commissioning clearly within the scope of the commission. Amendment No. 69 would ensure that the standards that the commission inspected against included commissioning, as they do now. Amendment No. 73 would ensure that the commission’s periodic reviews of primary care trusts covered commissioning as well as PCT provision of services. Amendments Nos. 84 and 86 would bring commissioning within the scope of special reviews and investigations that the Care Quality Commission may need to carry out. Amendment No. 98 would require the commission to keep the Secretary of State informed of commissioning. Amendment No. 103 would ensure that inspectors could get involved with commissioning. I hope that the Government can accept these improvements, which put the commission’s role on commissioning well beyond doubt. Indeed, I think that these changes will reduce ministerial frustration when the NHS family declines external therapy for failing PCT commissioners. I confess that I may have overdosed with Amendment No. 96 by including PCTs in the definition of ““health authorities””. I am not totally inclined to pursue this amendment but it would be helpful if I had the Minister’s reaction to it. I turn briefly to Amendments Nos. 33 and 36. My reading of Clause 5 is that ““health care”” is too narrow a term for defining the activities of the new regulator. My amendment would broaden the term to ““health services””, which include preventive services, and it would bring into the definition the issue of commissioning, for the reasons that I have explained. Amendment No. 36 would carry this broadening into Clause 5(4). The whole area of genomic medicine is developing at a phenomenal pace and is likely to reshape health services in ways that we cannot fully envisage at present. Therefore, in my view, we need a broader definition than is currently provided for in the Bill. I regard these amendments as important ways of strengthening the Bill and giving the commission a clearer remit in the area of commissioning. I beg to move.