National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013

Debate between Lord Hunt of Kings Heath and Baroness Williams of Crosby

Wednesday 24th April 2013 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, I do not understand that. Clearly, if a CCG decides that a potential contract meets the single provider test in regulation 5, for instance, a disappointed provider can go to the courts in any case.

[Baroness Williams of Crosby]

In this particular set of regulations we are giving statutory underpinning to Monitor in a way that will mean, as it did previously, a much greater opportunity to deal with most objections on the spot and not have them carry on into the courts at great expense to the taxpayer and to patients. If we turn it down tonight it will leave us without that structure altogether and we will go back to where we were.

In conclusion, while I have very strong sympathy with the view of the noble Lord, Lord Owen, that the National Health Service of the 1980s was a more true state service than anything today, I am afraid we cannot go back; we are where we are. The best thing we can possibly do is to make patients’ interests the very centre of what the NHS is all about and to recognise that this new route is the way we are going. It could, however, be very exciting and it would lead to a very much more accountable NHS than we have had in recent years.

Health and Social Care Bill

Debate between Lord Hunt of Kings Heath and Baroness Williams of Crosby

Monday 13th February 2012 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, I shall speak also to Amendments 41, 46, 48 and 293.

On a number of occasions, the noble Earl has spoken about the mandate to be issued to the national Commissioning Board. In our debates we have given a great deal of focus to the relationship between the Secretary of State and the national Commissioning Board, and the role of the mandate. When the noble Earl has been pressed to say how the Secretary of State would be able to bring influence to bear in relation to particular issues, he has referred on a number of occasions to the role of the mandate and indeed to standing rules. There is no doubt that the mandate assumes considerable importance. My amendments are seeking to give Parliament a stronger role in scrutiny of the mandate.

I have taken as my reference point the procedure for national policy statements in relation to major infrastructure planning applications. The noble Earl will be aware that the Planning Act 2008 introduced a parliamentary procedure to deal with major infrastructure planning applications. Essentially, it goes back to the issues that have bedevilled infrastructure planning decisions in this country, which mean that very often when there are public inquiries into applications, much of the public inquiry debate has been around the principle of whether a particular infrastructure should be developed in the UK rather than actual local planning matters. The classic for me was the Sizewell B application, where I think there were roughly 300 days of public inquiry, of which only about 10 to 20 were concerned with local issues; the rest were concerned with whether nuclear power should be developed in the UK.

The Planning Act brought in a new procedure where it was accepted that issues to do with nuclear power—or High Speed 2, for instance, if it were not going to go through the hybrid legislation process—would be decided by Ministers because those are national decisions, and the local application would then be decided very much around the impact of an actual planning consent.

What is the connection between this and the mandate? It is the parliamentary scrutiny, because a national policy statement has to be debated in your Lordships’ House in Grand Committee, Members of the House having every opportunity to ask questions, and then brought before your Lordships in the Chamber where it is open for debate. My proposition is that the mandate is of such importance that a similar approach could be taken in your Lordships’ House and in the other place, providing a real process of questioning and debate. Although, ultimately, it is, in my view, a ministerial decision, I argue in Amendment 46 that such a process of parliamentary scrutiny and ministerial consideration followed by an affirmative order to approve the mandate would provide a robust approach that would give much more parliamentary comfort to the nature of the mandate between the Secretary of State and the national Commissioning Board.

I do not believe that the current provisions in the Bill allow for that kind of parliamentary scrutiny and I hope that at the very least the noble Earl might be prepared to take this back to see whether there are ways in which we could beef up parliamentary scrutiny of what all of us acknowledge is probably one of the most important processes between the Minister and the national Commissioning Board. I beg to move.

[Baroness Williams of Crosby]

My Lords, I shall address Amendments 38, 43 and 49 in this group but, given the lateness of the hour, I can reassure the House that I shall not be lengthy on any of them. My comments will follow fairly closely some of the matters raised by the noble Lord, Lord Hunt, and will therefore fit in well with our brief debate.

Amendment 38 in essence is the suggestion that the Secretary of State should issue regulations at least once a year. In addition, those regulations should be shown within an adequate timeframe of about two months to the Select Committee, presumably before they pass through the affirmative or negative procedure. This issue is quite close to the amendment addressed at the beginning of our proceedings by the noble Lord, Lord Hennessy. Members in the Chamber will remember that the noble Lord raised the issue within the context of our discussions on constitutional matters when he suggested that any regulations should be subjected to scrutiny by the Select Committee before proceeding to either the affirmative or the negative procedure.

Quite simply, the reason for this, which I think we all recognise, especially those of us who served for some time in another place, is that the negative procedure is extremely weak. Unless one or two Members of Parliament are particularly concerned about a matter, the regulations pass through with not much more than a nod from the House of Commons. In the case even of the affirmative procedure, unless one can organise a substantial group of people who are deeply concerned about the regulation, debates are not profound. Little scrutiny is offered and very often the procedure is little more than routine.

I am not so concerned about the first part of Amendment 38. I do not think that one should necessarily hold the Secretary of State to having to produce regulations annually, but I am very interested in the second part, which refers to passing it to the Select Committee for scrutiny, presumably of its merits, before it passes on to the fixed procedures. There is of course a fairly close parallel with the Select Committee on the Merits of Statutory Instruments as distinct from the older Select Committee on the vires of statutory instruments.

This is an interesting idea. I am one of those convinced that it is important to strengthen parliamentary accountability, not only on health but across the whole front. Therefore, Amendment 38 is well worth consideration. I hope that the Government will consider it carefully because it would be a substantial and interesting step forward. It would enable the regulation to be looked at carefully instead of in effect just being passed on the nod.

Amendment 43 is about the mandate, to which the noble Lord, Lord Hunt, has already referred. We on these Benches see the mandate as a first-class way for the Secretary of State to indicate his most important priorities for the health service for the coming year or so. As such, we put considerable weight on it. The issue that I should like simply to underline is that the role of the mandate is so important that I hope that in it the Secretary of State would be able to address the known priorities of the Bill, including such issues as the narrowing of inequalities and the proper provision of care for the elderly and those who are chronically sick. The mandate could be a very important instrument for setting before the House, and more widely the public, the goals that the Secretary of State hopes the health system would be able to prioritise.

Finally, Amendment 49 is also in the names of the noble Lords, Lord Warner and Lord Patel, both of whom are unable to be here as late as this. They have asked me to apologise on their behalf. The noble Lord, Lord Warner, is particularly interested in this amendment, which sets out in considerable detail the need for audited accounts and for the careful comparison of those accounts for the levels of performance and for comparison with one another. Given his substantial experience in the field of accountability for health issues, this deserves careful consideration. It would at least enable us to be closely concerned with differential performance in the health service and allow people to make a good judgment of the quality of the care being given. I therefore hope that the Government will look sympathetically at Amendment 49.

Health and Social Care Bill

Debate between Lord Hunt of Kings Heath and Baroness Williams of Crosby

Wednesday 30th November 2011 Lords Chamber

[Baroness Williams of Crosby]

My Lords, I congratulate the noble Lord, Lord Hunt, particularly on Amendment 160A. The idea that patients whose GPs are serving on the Commissioning Board, or are part of a commissioning group which represents that board, should be consulted and we should hear what their own experiences have been, is innovative and interesting. He should be congratulated on putting it forward. It means involving patients as individuals in their own assessment of the service that they have had. Time and again the Bill reflects the demand that that should happen—no decision without me, and so on. This actually makes that real. It gives the words flesh, and I congratulate him on that. It is quite an exciting idea and I hope that it is one that will commend itself to the Government, given the Government’s wish to involve patients.

I am not so happy about Amendment 163B. I fear that the opposition Front Bench has not taken on board as much as I hoped that it might the idea that regulations should not go straight to Parliament, even if they are affirmative, but should go by way of the Health Select Committee. The noble Lord will be familiar with the argument—that the Health Select Committee has a huge range of expertise and knowledge. As a former Minister he will know—as well as I or the noble Baroness, Lady Thornton, knows—that the regime of regulatory scrutiny is not very effective. If there is an individual Member of Parliament in another place who knows a great deal about it and is concerned about it, you can have a real debate and that real debate can affect the outcome with regard to regulation. However, nine times out of 10, there is no great debate. In the case of the negative resolution procedure, there is often no debate at all.

I fear that this is a very weak safeguard for the huge amount of regulation that is built into the Bill. I therefore hope that I might commend to the House, and not least to the opposition Front Bench, the idea of looking again at the proposal, which is also radical and new. It is an idea that really ought to commend itself to those of us who believe strongly in accountability to Parliament and in the need to strengthen Parliament’s power vis-à-vis the Executive across the whole world.

[Lord Hunt of Kings Heath]

My Lords, perhaps I can come back to that. On Amendment 160A, I am grateful to the noble Baroness for her support. I am not even sure that I got it right. I am also trying to get at the fact that so much is happening now without any consultation. The CCGs are essentially being decided by the system and then at some stage there will be a formal application process. I am long enough in the tooth in the health service to know about NHS consultation. Frankly, we all know that the traditional NHS consultations make the decision and then consult. I fear that, with CCGs, this is what is happening. While I welcome the support for the involvement of the public in a formal application, I find it perplexing that so much is now being decided and that the public are not involved at all.

I listened to the noble Earl before supper talking about this being bottom up. That is not what is happening. I do not think that he understands quite how much this is being driven by the centre. It is quite extraordinary. You can call it guidance, but putative CCGs are being given such clear steers about what will be acceptable. I feel that we will reach a situation where, at some point, it will all be a done deal and the consultation will simply not be realistic.

On the noble Baroness’s comments about making the regulations affirmative, I accept that, even if they are affirmative, there is a limit to what parliamentary scrutiny can provide—although that does provide some safeguards. I would be interested in debating the idea of giving the Health Select Committee a role, although excluding your Lordships’ House from it would be a problem. I say to the noble Baroness that I think it a pity that the House did not adopt my suggestion about a mandate for a kind of national policy statement approach. There is an argument for having a more interactive debate, if you like, about some of these matters. I very much take to heart her constructive comments on this and the Select Committee role. It could be a very useful debate for the future.

Health and Social Care Bill

Debate between Lord Hunt of Kings Heath and Baroness Williams of Crosby

Monday 14th November 2011 Lords Chamber

[Baroness Williams of Crosby]

My Lords, if I may, I will pursue what has been raised by the noble Lord, Lord Kakkar, and also, in some ways, by the point made by the most reverend Primate the Archbishop of York. I could not help thinking that perhaps protesters count among the networks and the people responsible for running St Paul’s count as part of the commissioning group. With that in mind, I will pursue also what was said by the noble Lord, Lord Hunt. If you look at his Amendment 224A(6), he helpfully refers to the clinical senate having,

“the function of establishing and maintaining a system of clinical networks”,

in the area. I think that should be applauded. I am very impressed by the way in which networks at their best not only extend information very widely among patients with a chronic condition but bring the patients into the discussions about what should be done in their situation. It becomes a huge educational and, indeed, morale-boosting process. So on subsection (6) I think that the noble Lord, Lord Hunt, has put his finger on something that could be very important and where the clinical senate would give clinical backbone to the deliberations and thoughts of the clinical network. That is almost, I suppose, what we are all trying to achieve.

I am not so clear about subsection (8) of Amendment 224A, where the noble Lord, Lord Hunt, has effectively given the clinical senate something of a veto over the commissioning group. I am not sure that that is wise, as that plays right into what the noble Lords, Lord Patel and Lord Kakkar, were saying about creating yet another layer of bureaucracy. I think that would be unhelpful and might indeed feed into a certain self-importance on the part of people who call themselves senators, whether clinical or merely political.

I would like to ask the Minister, bouncing off the amendment from the noble Lord, Lord Hunt, whether, looking through that amendment, he does not find parts of it that are helpful, useful and constructive. It would make a clinical senator a significant part of the whole structure of the relationship between patients and clinicians. Whether he needs to press ahead with provisions that would bring in the senate as a requirement of the decision-making process of the commission is much more questionable. I am playing a kind of ping-pong, in which the ping of the noble Lord, Lord Hunt, has to go to the pong of the noble Earl, Lord Howe.

[Lord Hunt of Kings Heath]

Can I accept the invitation to come back on this? The reason why I am interested in the other bit of my amendment is that it is essentially about the strategic leadership that needs to be given to reconfiguration issues. When we debated the powers of the Secretary of State, a number of noble Lords complained that Ministers intervened in reconfiguration, which usually means the closure of services, perhaps emergency services, and their concentration around specialist hospitals. They are very contentious. As noble Lords have observed, MPs seek ministerial intervention, which is perfectly normal and democratic. In the new structure, there is no one to really lead this at a semi-national or regional level. The CCGs are far too small; they will not be able to come together to sort out how regional services should be operated, or the number of A&E departments you need within a region. The national Commissioning Board is far too big; it is national. That is why I think that there is room for some regional mechanism. The clinical senates seem the nearest that we can get to that. I do not see them as being like the old-style regional medical advisory committees; I see it as being a rather more dynamic process than that.

[Baroness Williams of Crosby]

I thank the noble Lord for his typically articulate and thoughtful response. The idea of clusters coming together in what one might call semi-regional groupings is a better way forward than bringing regional senates in as a way to resolve the problem that he rightly talks about of bodies being too small or too large.

Academies Bill [HL]

Debate between Lord Hunt of Kings Heath and Baroness Williams of Crosby

Wednesday 7th July 2010 Lords Chamber

[Baroness Williams of Crosby]

My Lords, I shall speak briefly to Amendment 53, which is also part of this grouping. I agree with my noble friend that the proposal that he makes under Amendment 17 would be appropriate.

Owing to the lateness of the hour, I shall keep to my own amendment, the purpose of which is essentially to give Parliament an ultimate level of accountability for what happens in the secondary and primary education system through the process of an annual report repeated every year about the progress of academies, their successes, their failures, their record and so forth.

I shall say clearly, but briefly, why this matters so much. The present structure of accountability is by way of local authorities through to, eventually, their electorates. That system will be largely disappearing by the time that this Bill is passed, certainly for whatever group of schools that apply to be academies. The question then becomes, as my noble friend has said, whether there is any level of accountability, other than directly that of the Secretary of State to Parliament, more precisely related to academies themselves.

It is of the greatest importance that we have a report to Parliament. There will of course be reports to Select Committees, but we all know that Select Committees—although we hope that this situation will be substantially reformed—do not get the public or media coverage that is given to Parliament itself. The idea of a report to Parliament in which all parliamentarians, Members of both Houses, can ask questions is of the first importance. I cannot emphasise enough the crucial nature of accountability in any major democratic reform of this kind. I will simply say that the purpose of Amendment 53 is to arrange for an annual report. That report would clearly be greatly strengthened by the belt-and-braces approach suggested by my noble friend, as we would then know whether academies maintained and ascribed to the agreements and arrangements that were made for them. Even so, the importance of a report to Parliament is central. We have reports to Parliament on a wide range of issues, so why not on a major part of the education of the people of this country?

[Lord Hunt of Kings Heath]

My Lords, we see a bit of a dilemma. In order to give individual schools more authority over their affairs through academy status, the Secretary of State is having to take powers to himself to authorise that. Clearly, that approach has been used before, but with power goes accountability. There is a gap. I agree with the noble Lord, Lord Greaves, that in some way the Secretary of State needs to be more accountable to Parliament for the responsibilities that he will discharge.

In Committee, as the noble Lord, Lord Greaves, said, we debated a number of amendments tabled by Members on this side of the House, which, in retrospect, were probably too detailed and would have required many hundreds of statutory instruments coming to your Lordships’ House and the other place. The noble Lord has come forward with a more sensible approach, which deals with the principles of the granting of academy status and allows Parliament to debate the criteria. As the Secretary of State will be given considerable powers in this area, it is right for Parliament to ask for greater parliamentary scrutiny. I certainly think that the noble Lord has got it right.

How quickly the party opposite has warmed to Executive power. For how many years have we heard noble Lords from both parties opposite ask for more parliamentary scrutiny? I find it surprising that the Government are not able to respond on this matter. Surely what the noble Lord suggests is not too much to ask.

Academies Bill [HL]

Debate between Lord Hunt of Kings Heath and Baroness Williams of Crosby

Monday 28th June 2010 Lords Chamber

[Baroness Williams of Crosby]

My Lords, I will intervene briefly, partly because I was the Minister who introduced the Taylor report, which laid down a requirement that school governors should include representatives of the staff, of the non-teaching staff, of parents and representatives of the local authority, roughly in the order of a quarter each. It was one of the more successful education reforms, for reasons eloquently set out by the noble Baroness, Lady Howe of Idlicote, and also because deep within the sense of the school was a feeling of it being owned by, and part of, the local community. That was where the significance of parent governors came in. The parent governor often shared the same income and problems of living as the community, and spoke for the community in a way that governors appointed by the proprietor or the agency simply could not do.

Secondly, it is vital to have some representatives from the staff on the governing body, so that they speak as part of the entity of the school and not simply as representatives of a staff union or association: they become part of the body and success of the school. As regards non-staff governors, anyone who knows the extraordinary record of teaching assistants—I thank the previous Government for this—will know that, particularly with respect to children with special educational needs, their role has been crucial and can be represented only by a governor who represents the non-academic staff of a school.

It puzzles me—I hope that the Minister will think hard about this—that a Government committed to the idea of decentralisation, of the big society and of involving far more citizens in building and creating that society, should dream of going back to a situation where we have just one elected parent governor in an academy. One reason for this was that it was felt that in the very deprived communities from which the early academies sprang, they would find it difficult to find more than one parent governor, because so many husbands and wives would be working all day long and would find it very difficult to attend governing body meetings. The much more privileged group that we are likely to see now coming into the world of academies of outstanding schools will certainly find it easier to produce governors, but that is no reason to move away from the principle that in every school—whether the community is deprived or not—there should be a clear commitment to the school by the community. I plead with the Government to reconsider the mistaken decision to cut down the governing body and its composition to just one, at a time when we should try to rebuild and strengthen relationships between parents, schools and the community. It is clear from the coalition agreement that the Government are committed to this.

I will leave this hanging in the air: will the Minister consider ways in which we can bring back the community and its parents to the support of, and involvement with, the school? What was said by the noble Baroness, Lady Howe, and by my respected and distinguished noble friend Lady Walmsley, suggests that this is something well worth thinking about.

[Lord Hunt of Kings Heath]

My Lords, I, too, ask the Minister to give this important matter further consideration. One of the great strengths of our education system over the past few years has been the involvement of parents in schools through PTAs, voluntary work in schools or, indeed, helping in classrooms. In my experience and that of many others, strong parent governors can enhance the quality of governance within schools.

The noble Baroness, Lady Williams, made a strong point about why the circumstances that applied to the original academies and those that apply to the situation before us now, whereby many schools are projected to become academies, are quite different. I also remind the Minister that we are talking about academies that are to be established without formal consultation and without the involvement of the local authority. If we take that together with the fact that academies at the very least will not be encouraged to have a large number of parent governors and the fact that decisions by Ministers, who are taking a huge amount of power to themselves, will not be subject to parliamentary scrutiny, then the situation regarding parent governors begins to fit a certain picture.

My concern is that we are seeing the development of almost private institutions without sufficient scrutiny at either local or national level. One way to counterbalance that would be to come back to the Bill, either tonight or at a later stage, with a much greater reassurance about the involvement of parent governors on these governing bodies. I believe that the same argument applies to staff members. My experience is that by and large they add value to the institution and enhance the confidence of staff in the governing body. It is important that there continue to be links between the local authority and individual schools. Again, in my experience, the local authority-appointed governors often bring a breadth of experience to the governing body. It would be very disappointing if that were lost.