UK Parliament / Open data

Health and Social Care Bill

I appreciate what the noble Baroness says about judicial review, and of course she is right that it is a daunting process for the average citizen. As to her question of what is reasonable, I am sure she knows that that is not a question I can answer in general terms. It will depend on specific circumstances. I can only say that the board will have a duty to perform an annual assessment of how well each CCG has fulfilled its duties in the previous financial year. During the course of a year, matters may be drawn to its attention which it will take a view on, either that the CCG has taken a reasonable stance or an unreasonable one. I would have thought that if a patient insists on having a treatment that NICE has said is not cost-effective, that is not a reasonable request for an NHS patient. However, that is only one example, and it is not one that the noble Baroness cited. I had better write to the noble Baroness to set out further and better particulars of this issue, if that would be helpful to her. We fully recognise the importance to effective commissioning of ensuring that allocations give CCGs the resources to meet the distinctive needs of their local population, and clearly we would expect the board to ensure that their methodology of allocation takes into account local factors, and inequalities would be one of those factors. Our preference, however, is not to place particular weight on one factor or a set of factors, however meritorious they may be, to which the board would be tied, but to give the board a free hand in setting the methodology for its allocations and the scope of its analysis of the needs of a CCG’s population. I am really addressing Amendment 220 in that context. In resisting the proposals that CCGs should be under a duty to agree their commissioning plans with the relevant health and well-being boards or an absolute requirement for plans to address the priorities of the health and well-being strategy, we are actually following the advice of the Future Forum. It said that to give health and well-being boards powers to sign off commissioning plans would create an unworkable dual accountability as boards could oppose decisions by Cogs which would have, after all, the statutory responsibility to arrange services to meet the needs of patients and responsibility for the budgets with which to do this. Commissioning competence will also be assured through the board’s annual performance assessment of each CCG, which I referred to a minute ago and in which the board must have regard to commissioning guidance that it has published under new Section 14Z6. Clearly, the board would be exercising its function of assessment and report only if it provided all relevant information at its disposal. Giving the board the role of determining how it presents this information is a proportionate and appropriate level of responsibility. The Secretary of State may issue advice on annual performance assessments under the provision in new Section 14Z14(5)(a). Amendment 245A places a limit on the general power of the Secretary of State, the NHS Commissioning Board and Cogs to take action to discharge their functions. While the amendment is no doubt well intentioned, it is unnecessary and would have the unintended consequence of preventing the NHS Commissioning Board from using its general power to support it in commissioning pharmaceutical services. The only amendment that I have not specifically addressed is Amendment 176B, from the noble Lord, Lord Hunt of Kings Heath, which is about the NHS constitution. It would expand the duty in new Section 14O to promote the NHS constitution to require Cogs to promote awareness of the constitution among providers of primary medical services. Cogs are already under a duty to promote awareness of the constitution among patients, staff and members of the public, which would not exclude staff in primary care providers. CCG membership would have to be aware of the constitution to promote awareness of it among others. I am conscious that I have not answered the question from the noble Baroness, Lady Whitaker, and I hope that she will allow me to write to her.
Type
Proceeding contribution
Reference
733 c355-6 
Session
2010-12
Chamber / Committee
House of Lords chamber
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