Health and Social Care Bill

My Lords, this has been a useful debate. I should probably say straight away to the noble Lord, Lord Warner, that I am not convinced by the amendment. That is not because I do not believe that the issues that he has raised are important—I certainly do. Good governance is absolutely dependent on having good data and on the financial control that that data enable the board of directors to exercise. It is very much about ensuring throughout the health service that the QIPP agenda is pursued effectively. The QIPP agenda is all about ensuring the more efficient and effective use of money. This could not be a more salient topic at the moment. However, Amendment 102, which the noble Lord has proposed, would in my view introduce a new layer of bureaucracy. I hope to show that it is not required. My main reason for saying that is that accounting and disclosure requirements for the Department of Health and all NHS bodies are ultimately set by the Treasury. These are already based on independent advice. I am conscious that that is rather a condensed answer, so, if I may, I should like to go into a little detail as to how this will work. Paragraph 15 of the new Schedule A1 to the NHS Act, inserted by Schedule 1 to the Bill, enables the Secretary of State, with the agreement of the Treasury, to specify the form and content of the board’s accounts and the methods and principles to be applied in their preparation. The Bill places an obligation on the board to produce annual accounts, as well as in-year accounts covering shorter periods if necessary. In addition, the Bill provides powers for the Secretary of State to require such other information as is considered necessary for the purpose of exercising his functions in relation to the health service. This is what one might term management information—data required by those controlling funding or setting policy alongside the financial returns in order to provide an accurate picture of issues such as staffing levels. For clinical commissioning groups, it is the NHS Commissioning Board that sets the accounting and reporting requirements. It will do so in a way that is consistent with requirements set by the Secretary of State, and approved by the Treasury for the purposes of consolidation. My noble friend Lady Williams expressed the fear that CCGs may not be well equipped to handle that kind of reporting. The board will set the accounting and reporting requirements for CCGs, as I indicated. Paragraph 16 of Schedule 1A to the NHS Act 2006, inserted by Schedule 2 to the Bill, allows the board, with the approval of the Secretary of State, to give directions to CCGs as to the methods and principles of accounting which they must use and the form and content of their accounts. That will provide a means whereby much greater control can be had over the form, content and consistency of those accounts. These provisions are mirrored in relation to NHS foundation trusts, with Monitor or the Secretary of State specifying the form and content of the trusts' accounts, again with Treasury agreement. The noble Lord, Lord Owen, raised the extremely important issue of procurement. It is a separate issue to the one that we are discussing here, but it is allied to it. It is extremely relevant at the moment. He will be interested to know that a great deal of work is going on in the department on this. He asked where it might be best to discuss procurement issues. I suggest that we do so in Clause 71, which is within Chapter 2 of Part 3. Far be it for me to encourage any noble Lord to table further amendments, but if the noble Lord, Lord Owen, would care to do so, we could have a useful debate on that topic. Together, these requirements will ensure a high degree of consistency and comparability across all NHS bodies. That is the key point. Amendment 102 sets its sights on that idea and I do not disagree with that. The trouble is that it appears to override the line of accountability that I have set out, and the powers of the Treasury and Secretary of State to determine the standards of financial reporting. I cannot agree with the noble Lord that it would be helpful to move this responsibility to an entirely separate panel. Furthermore, the Treasury, the Department of Health and Monitor are under a specific duty under the Government Resources and Accounts Act to consult with the Financial Reporting Advisory Board in arriving at reporting requirements. That advisory board is independent and would seem already to fulfil the role that is proposed for the independent panel under this amendment. Amendment 102 would also impose additional accounting requirements on non-statutory providers of NHS services. Statutory providers—for example NHS trusts and foundation trusts—are already subject to the type of accounting requirements set out in this amendment. However, for non-statutory providers operating in a competitive market, such requirements might be commercially prejudicial to their interests. I am afraid that I also think that the imposition of additional, centrally determined accounting and reporting requirements would be expensive and onerous for non-NHS providers or commissioners, many of which are subject to existing Companies Act and charities legislation disclosure requirements in any case. The noble Lord, Lord Hunt, referred to primary medical services. That is where the amendment has another wrinkle, because it might also be deemed to apply to some GP practices; GPs being independent contractors providing NHS services. I have difficulty with the idea that it is equitable or indeed necessary to open up GP partnership accounts to wider public scrutiny in a situation where GP remuneration, fees and allowances are determined nationally. The noble Baroness, Lady Morgan, asked—