Health and Social Care Bill

All of us who have worked with Sir David will know that he is a very fine manager and I am very glad that someone of his calibre is in that position. The worry is that although the national Commissioning Board is going to be one organisation, it will have different layers and at the local level it will be very powerful. If there are, say, 50 local offices of the national Commissioning Board, given the smallness of clinical commissioning groups—the Government have followed us into the trap when we created too many primary care trusts—when it comes to the real issues at local level and the kind of leadership of a system that goes across local authority boundaries and covers populations of around 1 million to 2 million, the clinical commissioning groups are simply not going to be big enough to provide the kind of strategic leadership that is required. Inevitably it is going to fall to the local office of the national Commissioning Board. I worry that there is no accountability because these will be simply the outposts of a national body. However much one might criticise primary care trusts or strategic health authorities, the fact is they had a majority of non-executive directors on their boards, they met in public and they felt some local accountability. The local offices of the national Commissioning Board will have no such feel because their sole accountability will be to the national Commissioning Board at national level. Alongside that, we see from Mr Lansley’s article in the Health Service Journal that he is very keen on the implementation of a market. We know that that will come at a price—in terms of the complexity of contract-making and of legal costs and certainly in the profits that private sector companies will wish to take out of the National Health Service. This is a very complex structure that the Government are introducing. My amendment is a helpful reminder to the Secretary of State that there should be a very clear presumption that the kind of bureaucratic monstrosity that is now being introduced ought not to be introduced. I wish to test the opinion of the House. Division on Amendment 18 Contents 169; Not-Contents 231. Amendment 18 disagreed. Clause 8 : The NHS Commissioning Board Amendment 19 Clause 8 : The NHS Commissioning Board Amendment 19 Moved by