Health Bill [HL]

Amendment 126, moved by the noble Baroness, Lady Masham, would establish in statute a new national bed bureau to oversee the commissioning of services for spinal injuries. I am grateful to the noble Baroness for raising the important issue of spinal injury services and for her contribution to the improvement of services for those with spinal injuries through her presidency of the Spinal Injuries Association. I found the contribution made by the noble Lord, Lord Tebbit, very moving. He will not remember, but we had a conversation some years ago when he was campaigning on behalf of Stoke Mandeville Hospital. I expressed my support for his campaign because my grandfather returned from the war and was put back together at Stoke Mandeville. He lived for 25 years in a wheelchair and visited Stoke Mandeville Hospital two or three times a year, so I may have been six years old when my noble friend had her accident, but at that time, I was sitting on the knee of a grandfather in a wheelchair, so I am very sympathetic to this. I wrote to the noble Baroness on this matter last week, and I hope she will forgive me if I repeat for the record some of the points I made in that letter. I fully sympathise with the situation she described but, at the moment, we are not convinced that primary legislation is the best route to achieving her objectives. In May 2006, Sir David Carter published his Review of Commissioning Arrangements for Specialised Services in response to a request from the noble Lord, Lord Warner, then Minister of State at the Department of Health. This report resulted in the establishment of the National Specialised Commissioning Group, the National Commissioning Group, and 10 new specialised commissioning groups, including one for spinal injuries. The noble Baroness, Lady Cumberlege, is correct that commissioning is the answer. The new arrangements offered significant improvements in the organisation and governance of specialised services commissioning at local and national level. Specialised commissioning groups plan collectively, share risk through pooled budgets and co-ordinate strategic commissioning across PCT boundaries. No primary legislation was needed to establish them, and one of our concerns is that to place the arrangements for spinal injury services on a statutory footing might undermine the work being undertaken across the breadth of specialised services. That is not to say that we are by any means where we wish to be on this matter. I understand that the Spinal Injuries Association sits as a partner on the south of England board for the commissioning of spinal injury services. The board has discussed making proposals to the National Specialised Commissioning Group for an English forum for spinal injuries, in similar terms to the proposed amendment, which could help set a strategic direction and address concerns across organisational boundaries. No formal approach has yet been made to the National Specialised Commissioning Group or its support team. I am pleased to inform noble Lords and the noble Baroness that the director of national specialised commissioning is keen to meet representatives from the Spinal Injuries Association to discuss these proposals. The director is currently in consultation with the south of England board to explore how its existing collaborative arrangements are working, what wider applications they might have and a range of other options for improving commissioning arrangements, all of which has the potential to improve the experience of patients across the country in the way the noble Baroness and other noble Lords described and which we envisage. The noble Earl, Lord Howe, and my noble friend Lady Wilkins both mentioned the lack of data about the number of spinal injuries. We recognise that this is a problem. The clinical coding for spinal injuries is weak, but the NHS is making bids for new codes which will better identify spinal injury patients and the severity of their cases. There is a strong case for improving the co-ordination of the commissioning of spinal cord injury services and we are looking to the National Specialised Commissioning Group to lead that. We want to facilitate the meeting as soon as possible to take those arrangements forward. I hope that this offer of further consideration within the existing structures and further discussion with the noble Baroness will go some way towards reassuring her, and that she will withdraw her amendment.