My Lords, the broad theme of these amendments is to ensure the effectiveness of the commissioning process and the competence of commissioners, which includes the engagement with local authorities, patients and experts to ensure that clinical commissioning meets patient needs. Of course, that theme is entirely to the point.
In support of this, there is an extensive framework in the Bill to encourage CCGs to work with health and wellbeing boards in the exercise of their commissioning functions, and to seek expert advice. To my mind though, it is important that requirements in this regard remain proportionate and do not encumber CCGs with a duty to consult—as, for example, Amendment 197C would require—on the exercise of all of their functions. The health and wellbeing board is the forum for ensuring democratic legitimacy in the commissioning process.
Indeed, the health and wellbeing board is very much a key partner of the CCG, to use the good phrase used in Amendments 216ZAZA and 216ZAZB, but the partnership takes physical form in the jointly agreed health and wellbeing strategy, which is based on the JSNA. It is a joint production, it captures an agreed outlook for commissioning, and it should inform the commissioning decisions of the local authority, and indeed the CCG.
I listened with care to the noble Lord, Lord Patel of Bradford, in this context. He spoke very convincingly about the need for evidence to support commissioning, but also, most importantly, that such evidence is used. We completely agree with him on that, and that is why we have created that link between the JSNA and the joint health and wellbeing strategy. The strategy here will play a key role in shaping service commissioning across the area.
Clause 189 of the Bill specifically refers to the ““partner”” CCGs of the health and wellbeing board. However, the CCG has to retain ultimate responsibility for the commissioning and spending decisions of the commissioning plan. That is important. The health and wellbeing board is not accountable for those decisions, and, of course, it does not have the same statutory responsibilities as CCGs, so we would not want to suggest that the plan is a joint one. It remains the CCG’s plan.
Noble Lords will find quite detailed procedures in the Bill in Sections 14Z9 to 14Z12 in Clause 23, on the process of drafting and revising commissioning plans. These include requirements in relation to consultation.
There are also direct requirements in the Bill in relation to ensuring that CCGs secure appropriate advice. We have also signalled the intention to facilitate the development of clinical senates and networks in order to provide a supportive matrix of expert opinion. However, I would not point to the particular duties or powers within the Bill or to contractual obligations in order to reassure noble Lords, or indeed to reassure the Royal College of Physicians, in relation to Amendment 203B. Rather, I would point to the tremendous potential in the new arrangements for bringing about a cultural change, and above all, to the key principle of clinicians leading the whole process of commissioning, from the assessment of need to the management of contracts. I believe that the system we are aiming to put in place will provide the right elements to stimulate the involvement of clinicians across sectors and organisations, with everything focused on that specific goal of delivering improved outcomes for patients.
The Bill institutes a framework for ensuring that clinicians are fully involved and supportive of commissioning, either as commissioners, or providing expert advice. Again, this is a duty that should not be amended so as to become a burden.
I should like to highlight some of the ways in which we can ensure the competence of commissioners in relation to the amendments tabled by the noble Baroness, Lady Finlay. They aim to ensure the effectiveness of CCGs in commissioning for low-volume specialised conditions. I should like to reassure the noble Baroness that everything these amendments aim to achieve can be done within the existing provisions of the Bill. The board’s guidance on commissioning, which it must produce under new Section 14Z6, can cover commissioning for less common conditions, and the board must be satisfied, before it establishes a CCG, that the area it would cover is appropriate to undertake effective commissioning and that the CCG has appropriate systems in place to do this.
The board possesses, under new Section 14Z19, the ability to intervene in a CCG where it considers that there is a significant risk that the CCG will fail to exercise a function. That would include commissioning effectively to meet the needs of its population. The actions that the board could require would include directing another CCG to undertake a function of a CCG, and CCG commissioning plans could cover arrangements for commissioning for less common conditions, but this should be something which CCGs have the flexibility and autonomy to approach as they see fit. In terms of recourse for the patient in the circumstances that the noble Baroness outlined, the patient could speak to a range of bodies such as the Commissioning Board in an extreme case, or they could go to judicial review. But I think a patient’s first port of call, if they get no joy from the CCG, is the board. I can give a reassurance that CCGs will be under a statutory obligation to arrange for provision of care to meet the reasonable requirements of the people for whom they have responsibility, and the board must oversee that.
Health and Social Care Bill
Proceeding contribution from
Earl Howe
(Conservative)
in the House of Lords on Wednesday, 30 November 2011.
It occurred during Committee of the Whole House (HL)
and
Debate on bills on Health and Social Care Bill.
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Proceeding contribution
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733 c353-5 
Session
2010-12
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2023-12-15 14:21:39 +0000
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