Health and Social Care Bill

Debate between Lord Kakkar and Lord Rea

Monday 14th November 2011 Lords Chamber

[Lord Rea]

My Lords, following the noble Baroness, Lady Finlay, I raised this issue briefly on the second day of Committee. I felt, however, that the Minister only gave a partial answer. CCGs must have an “area” as set out in their constitution, but there seems to be nothing in the Bill which defines the limit of this area or its basis other than that CCGs will cover the registered practice population of the GPs sitting on the CCG. This will result in very untidy boundaries which will interdigitate with a variable number of other CCGs.

However, proposed new subsection (1A) in Clause 10(3) says that a clinical commissioning group has responsibility for other people resident in its area but not registered with a GP—homeless people, rough sleepers, asylum seekers, et cetera. A geographical boundary for those people is therefore implied. Can the Minister say how this boundary is to be delineated? Will it coincide, as my noble friend has suggested, with the local authority, or with the former PCT—which in fact in 85 per cent of cases will be the same as the local authority boundary—or will it have some other basis? There is a strong case for—sorry about this word again—coterminosity with local authorities. They provide many of the services on which GPs depend. In fact, they are an integral part of primary care, such as social services and community health services, and public health, including maternal and child welfare services. They are especially important as, under the Bill, local authorities will all have their own director of public health. There are a number of services which were formerly provided by PCTs on a geographical basis: for example, ambulance and emergency services, genito-urinary medicine clinics, and drug and alcohol services. These are by no means all the services which CCGs will have to commission or co-operate with. What arrangements will be made for the area that these services will have to provide for?

[Lord Kakkar]

My Lords, Amendment 60 is in my name and that of the noble Lord, Lord Patel. It proposes to deal with the anxieties over real and perceived conflicts of interest that might exist in the functioning of clinical commissioning groups. The amendment proposes that:

“The Secretary of State must publish, and may from time to time revise, a code of conduct for all clinical commissioning groups … The code must, in particular, incorporate the Nolan principles …‘The Nolan principles’ means the seven general principles of public life set out in the First Report of the Committee on Standards in Public Life”.

It is important to take the opportunity to explore the issues around potential conflicts of interest and the anxieties that these raise. The reason is very simple. Clinical commissioning groups will be new public bodies. They will have by large measure a large number of primary care practitioners as their membership. Primary care practitioners, GPs, will have responsibility for delivering care and have very special and cherished relationships with their patients in terms of promoting and guarding the interests of their patients. Moving forward, they will have new responsibilities for the commissioning of services. A potential anxiety exists under those circumstances.

For many other statutory bodies in the public sector involved in healthcare, we have dealt with the problem of potential conflicts of interest by ensuring that those organisations and those who serve in those organisations are obliged to conduct themselves in a way consistent with the seven principles of the standards in public life: selflessness, integrity, objectivity, accountability, openness, honesty and leadership. Those seven principles are very powerful indeed.

On 14 April I put a supplementary question to the Minister at Oral Questions about whether clinical commissioning groups would be obliged to follow the Nolan principles. The Minister stated that, since they were going to be public bodies, they would be obliged to do that. As they are new public bodies, many of those that are going to serve in important capacities in clinical commissioning groups will have little experience of public life. Yet they will have very important responsibilities and have to deal with the sensitivities and anxieties of patients, because they will both serve in capacities on clinical commissioning groups and continue to serve as patients’ principal caregivers and primary medical practitioners. We need to find a way of ensuring that those anxieties are overcome.

In many other situations, we have dealt with that through these seven basic principles. Indeed, the Parliamentary Standards Act 2009 was designed to ensure that anxieties over the conduct of Parliament could be dealt with in such a way as to satisfy the public more generally that there was transparency, and that those serving in public life in this Parliament had no doubts about their obligations and responsibilities. The Parliamentary Standards Act 2009 includes a commitment and requirement to adhere to the standards in public life defined in the Nolan principles. I therefore believe it might be an important opportunity to overcome the anxieties that attend the question of potential conflicts of interest in terms of the conduct of clinical commissioning groups for the same approach to be taken with regard to this Bill, and to include a specific reference to the Nolan principles in terms of the conduct of clinical commissioning groups.