Health Bill [HL]

My Lords, in moving this amendment, I realise that I run the risk of crossfire from other noble Lords for seeking to add to the list in subsection (2). I am looking in particular at the noble Baroness, Lady Howarth, but luckily she is not paying attention. I am prepared to accept the risk because, when we debated the NHS Constitution in Grand Committee, I drew the Committee’s attention to a remarkable omission, which is that nowhere in the constitution is there even a mention of specialised services. This seems to me quite extraordinary and I thought that we ought to return to the subject today. It might be helpful if I were just to outline the way in which specialised services are commissioned in the NHS. What happens is that within each strategic health authority area, PCTs delegate responsibility for commissioning these services to specialised commissioning groups. In so doing, they pool their commissioning budgets. The point of doing that is to share risk and to ensure that the care that is delivered is of high quality. We are talking here about a very considerable range of conditions; for example, cystic fibrosis, complex disability, haemophilia, HIV, various neurological conditions and certain types of cancer. Serious burn injuries and spinal injuries also fall within the category of specialised conditions for the purposes of the national definition set. Collectively the services involved account for 10 per cent of NHS expenditure and the treatment of hundreds of thousands of patients. The handbook to the constitution mentions these services only in passing. A short paragraph on page 15 talks about, ""the small number of people who suffer from rare conditions"." From his reply in Grand Committee, I rather took it that the Minister privately agreed with me that this was inadequate recognition of a category of services which he himself referred to as being the "jewel in the crown". However, these services are important in another sense. We have to remember that the way in which the NHS commissions specialised services involves a diverse range of providers, many of them from the independent sector. That fact places even greater weight on the need for commissioning arrangements to maintain the standard of the services that are delivered, and, over time, to enhance them. Against that background, it is surely of great importance that the bodies required to have regard to the NHS Constitution should include specialised commissioning groups. I understand that the PCTs participating in the specialised commissioning groups remain the statutory bodies, and the Minister may well say that my amendment is inappropriate for that reason alone. However, I would still argue that the quality and safety of specialised services is dependent on the effectiveness of the specialised commissioning groups acting on their behalf, which is why I am proposing an explicit reference to them in the Bill. I hope the Minister will be able to give me a reassuring reply on this matter, which I do regard as significant, and I beg to move.