Health and Social Care Bill

My Lords, that was broadly reassuring. There are just two points I would make. First, there are plenty of examples where cost-improvement programmes have taken place and staff on the unit have received a certain percentage of that cost-improvement to spend on better services. I do not think that there has been any inhibition on their part because it has not gone into their personal pocket. I would have thought that most people in the health service, including GPs, would accept that if there were payments to be made, it would be right that they go to improve patient care one way or another. I hope the Minister might look at that again. There is a real risk here. Let us look at outcomes, quality and improvement. I would have thought that an impact on demand management, where the commissioning group GPs were working together to ensure, for example, that there were not inappropriate admissions into hospital, would qualify as a quality improvement. However, we must accept that, for the public, demand management sometimes presents some really tough issues. Even when they instinctively think that they might be better off in hospital, they probably would not be, but in encouraging patients not to go into hospital, GPs may find that the public query their motivation for doing so. Because of that, if there were any financial rewards, it would be much better if they were to go into the commissioning group as opposed to its members’ own pockets. I am genuinely concerned about this impacting adversely on the doctor-patient relationship. The noble Lord has said that this is work in progress. My aim has been to pass on comments to the noble Earl about what he might consider in the future. On that note, I beg leave to withdraw the amendment. Amendment 221 withdrawn. Amendments 222 to 223A not moved. Clause 24 agreed. Clause 25: Requirement for primary medical services provider to belong to clinical commissioning group Clause 25: Requirement for primary medical services provider to belong to clinical commissioning group Amendment 224 not moved. Clause 25 agreed. Amendment 224A not moved. Clause 26 agreed.