Health and Social Care Bill

My Lords, as we come to our final group tonight, I shall be brief. This amendment relates to payments to clinical commissioning groups in respect of quality. Noble Lords may speak to other amendments in the group which focus on payments for improving health outcomes and the use of payments made to clinical commissioning groups. It would be helpful if the Minister could briefly explain the rationale for the payments, the potential size of the payments and the factors that will be taken into account. Can he provide reassurance that the payments will be used by clinical commissioning groups for commissioning services and not to make payments to general practitioners that they can then treat as personal income? Will the Minister also comment on the potential for perverse incentives? The factors in new Section 22K(2) are very broadly defined. Could they be used in relation to a scheme to discourage patients from being treated? We know that the architecture of the Bill is built round the supposition that, as GPs are responsible for so much expenditure, if you give them the budget they will have an incentive to contain that expenditure, and I understand that. However, that might lead to commissioning groups seeking inappropriately to lessen the availability of treatment because of budgetary considerations. If there are quality incentives that could be interpreted as ““demand management””—which is the term used in the health service—that is entirely understandable, but there could be concerns vis-à-vis the GP-patient relationship if patients felt that their GP was receiving personal payments in order to discourage treatment, and that that was inappropriate. We have not yet discussed the impact on the doctor-patient relationship of these arrangements. This could be quite damaging and unless there are very strict safeguards about these quality payments there may be a lot of suspicion that essentially GPs are being given money to put in their own pockets in order to reduce availability of services to patients. Some clarification on this would be appreciated. I beg to move.