Regulatory Reform

Debate between Graham Stringer and Norman Lamb

Tuesday 9th September 2014 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I beg to move,

That the draft Legislative Reform (Clinical Commissioning Groups) order 2014, which was laid before this House on 13 March 2014, in the last Session of Parliament, be approved.

The draft legislative reform order seeks to amend the National Health Service Act 2006 in two ways. First, it will allow clinical commissioning groups to form a joint committee when exercising their commissioning functions jointly. The 2006 Act already allows two or more CCGs to exercise their commissioning functions jointly, but makes no provision for them to do so via a joint committee. Secondly, it will allow CCGs to exercise their commissioning functions jointly with NHS England and to form a joint committee when doing so. The Act already allows NHS England and CCGs jointly to exercise an NHS England function and to do so by way of a joint committee, but it makes no provision for them jointly to exercise a CCG function.

This draft order has already been scrutinised by the Regulatory Reform Committee, and I was pleased with its recommendation that it be approved under the affirmative resolution procedure.

I should say from the outset that the proposed arrangements are voluntary. One party cannot impose the arrangements on another. This allows CCGs to retain their autonomy and to continue to make decisions that are in the best interests of their local populations. They can decide whether to enter a joint committee arrangement with other CCGs. At the moment, the lack of provision for CCGs to form joint committees is placing a burden on CCGs and preventing them from working in the most effective and efficient way. Without the power to form joint committees, CCGs have had to find other means of reaching joint decisions that are binding. That means that they often end up seeking legal advice to ensure that they are on a firm footing, and that adds to cost and complexity without a proper process in place.

As an interim measure, therefore, some CCGs are forming committees in common whereby a number of CCGs may each appoint a representative to such a committee. Those representatives then meet, and any decisions reached are taken back to their respective CCGs for ratification. This leads to additional costs in terms of people’s time in sitting on multiple committees, administrative resources, and extra financial cost. Clearly, such arrangements are burdensome, particularly when compared with the simplicity of a joint committee. Primary care trusts, the predecessors of CCGs, were able to form joint committees at which all participating PCTs were bound by the decisions reached, subject to the terms of reference of that committee.

[Graham Stringer (Blackley and Broughton) (Lab)]

The Minister’s advice that all the members of a committee acting in common have to report back is at odds with the letter from the Department of Health to a committee dated 8 April 2014, where part of its case is that decisions have to be taken unanimously. That is quite different from having to report back, and it undermines his case about the administrative burden.

Healthier Together Programme (Greater Manchester)

Debate between Graham Stringer and Norman Lamb

Tuesday 22nd July 2014 Westminster Hall

[Norman Lamb]

To be fair, when I indicated earlier that the issue is about process, the hon. Lady came back at me—as is her right—to say that it is not just about process but about the model of separating specialisms from general hospitals. I therefore quoted what the shadow Secretary of State for Health had said in that regard.

I turn to the specific case raised by the hon. Member for Blackley and Broughton in this debate. Healthier Together was launched by the NHS in Manchester in February 2012 and is part of the Greater Manchester programme for health and social care reform, which seeks to improve outcomes for all Greater Manchester residents. The scheme is substantial, involving 12 CCGs and 12 hospital sites across Greater Manchester. As the consultation sets out, the case for change aims to improve access to integrated care and primary care, community-based care and in-hospital care services, including urgent and emergency care, acute medicine, general surgery and children’s and women’s services.

The House should appreciate that although those are the services being looked at, there are interdependencies with the core in-hospital services, including anaesthetics, critical care, neonatal services and clinical support such as diagnostic services. Changes in one area might have consequential effects elsewhere, as hon. Members have pointed out, and those effects have to be fully understood.

I should also repeat that the proposed changes are not a top-down restructuring. They are led by local clinicians who know the needs of their patients better than anyone. They believe that the clinical case for change—

[Graham Stringer]

Will the Minister give way?

[Norman Lamb]

I am conscious that I have only three minutes left. I have tried to be generous.

Local clinicians estimate that across Greater Manchester around 1,500 lives could be saved over five years as a result of implementing the proposed changes; that is not my assessment, but that of local clinicians. That would be an impressive improvement in health care, touching and affecting the lives of thousands of ordinary people—not only the individuals concerned, but their families and friends. It is because of the area’s current performance: if all trusts in Greater Manchester achieved the lowest mortality rates in the country, the CCGs believe that the number of deaths in Manchester could reduce by some 300 per year, equating to saving 1,500 lives over five years. That is an objective that we should all sign up to.

I am sure hon. Members will agree that it is not an unrealistic aim for hospitals in Greater Manchester to want to be the very best in the country. I am also sure all hon. Members want the very best for their constituents. Greater Manchester has some of the best hospitals in the country. However, not all patients experience the best care all of the time. In particular, the consultation sets out evidence that suggests that for the sickest patients who need emergency general surgery, the risk of dying at some Greater Manchester hospitals might be twice that at the best hospitals. That is simply not acceptable.

There is a shortage of the most experienced doctors in services such as A and E and general surgery, leaving some hospitals without enough staff. Only a third of Greater Manchester hospitals can ensure a consultant surgeon operates on the sickest patients every time; similarly, only a third can ensure a consultant is present in A and E 16 hours a day, seven days a week.

Healthier Together aims to ensure that all patients receive reliable and effective care every time. The programme is endorsed by the independent National Clinical Advisory Team, which offered strong support for the programme’s ambition, vision and scope, as well as its impressive public and clinician engagement. The NCAT felt that the programme’s approach was an exemplar of how the NHS should try to improve safety, value and sustainability.

I have not had time to say everything that I wanted to. I am conscious that hon. Members raised specific issues that I should respond to and am happy to write to all Members who have taken part in the debate. I hope my remarks have been of some help.

Oral Answers to Questions

Debate between Graham Stringer and Norman Lamb

Tuesday 27th November 2012 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I thank my hon. Friend for that question. The NHS outcomes framework includes an indicator on the quality of end-of-life care as it is experienced by patients and carers, which is based on the VOICES survey of bereaved relatives. The proposals for reform to the NHS constitution include a right for patients and families to be involved fully in discussions, including at the end of life.

[Graham Stringer (Blackley and Broughton) (Lab)]

T3. What action does the Minister intend to take to reduce the number of unplanned emergency admissions to hospital by sufferers of muscular dystrophy and other neuromuscular conditions?