Earl Howe
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(9 years, 12 months ago)
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“NHS foundation trusts and NHS trusts: acquisitions and dissolutions etc
(1) The National Health Service Act 2006 is amended as follows.
(2) In section 56A (acquisitions), after subsection (4) insert—
“(4A) Where the regulator proposes to grant the application, it may by order make provision for the transfer of employees of B to A on the grant of the application.”
(3) After section 56A (acquisitions) insert—
“56AA Acquisitions under section 56A: supplementary
(1) On the grant of an application under section 56A—
(a) any order made by the regulator under section 56A(4A) takes effect,(b) the property and liabilities of the acquired NHS foundation trust or NHS trust are transferred to the acquiring NHS foundation trust (other than rights and liabilities which may be dealt with by order under section 56A(4A)),(c) the acquired NHS foundation trust or NHS trust is dissolved, and(d) where the acquired trust is an NHS trust, the NHS trust order establishing it is revoked.(2) So far as may be necessary for the purposes of subsection (1)(b)—
(a) anything done before the grant of the application by or in relation to the acquired trust is to be treated (on and after the grant) as having been done by or in relation to the acquiring trust;(b) any reference in a document to the acquired trust is to be read as a reference to the acquiring trust.(3) Anything (including legal proceedings) that, immediately before the grant of the application, is in the process of being done by or in relation to the acquired trust may continue to be done afterwards by or in relation to the acquiring trust.
(4) In subsection (1)—
(a) “liabilities” includes criminal liabilities;(b) “property” includes trust property.”(4) In section 57 (sections 56 to 56B: supplementary), after subsection (3) insert—
“(3A) The order may include provision for the transfer of employees of the trust or trusts dissolved by the order.”
(5) In section 64 (orders and regulations under this Chapter)—
(a) in subsection (4), before paragraph (c) insert—“(ba) section 56A(4A),”;(b) in subsection (4A), after “section” insert “56A(4A),”.(6) In section 65LA (trusts to be dissolved), in subsection (3)(b), for the words following “trust” to the end substitute “—
(i) to an NHS body; (ii) to the Secretary of State;(iii) between more than one NHS body or between one or more NHS bodies and the Secretary of State.”(7) In that section, in subsection (5), for “to an NHS foundation trust” substitute “to an NHS body”.”
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, this clause makes amendments to Sections 56A, 57 and 65LA of the National Health Service Act 2006. These provisions are all concerned with the transfer of property liabilities and staff between NHS bodies. The changes proposed in the amendment simply clarify the provisions in the existing legislation to ensure that it can be used in a seamless and efficient way. They do not create new policy.
The clause is needed to remove the current uncertainty over the powers of an NHS foundation trust in Section 56A to acquire another NHS foundation trust or NHS trust, and to correct the omission of key powers with respect to the transfer of staff and criminal liabilities in this provision. It would also explicitly extend Monitor’s power in Section 65LA to transfer the property and liabilities, including criminal liabilities, of an NHS foundation trust dissolved following special administration.
I am sure that it would help the Committee if I expand on those initial comments. The existing Section 56A provisions are uncertain and open to interpretation. Critically, there is no express explanation in the provision of what happens to the acquired trust’s property and liabilities, or third party rights and obligations. As a consequence of this uncertainty, NHS foundation trusts are unlikely to utilise the current provision for fear of legal challenges. We are keen to ensure that where acquisitions are deemed to be in the best interests of patient care, legislation supports this approach. Accordingly, paragraph 1(3) of the clause inserts new Section 56AA to provide for a direct transfer of property and liabilities by operation of law. The grant of application would also be conclusive proof that the acquired trust is dissolved, and in the case of an acquired NHS trust the establishment order revoked.
The Government are committed to ensuring that staff involved in transfers from one public body to another are treated fairly and consistently, and that their rights are respected. The amendment to Section 56A would give Monitor an additional discretionary power to make an order for the transfer of staff from the acquired to the acquiring trust. This would ensure that in cases where TUPE does not apply, or where it is unclear whether it does, Monitor can set out a clear mechanism of transfer that specifies which of the staff are transferring and the implications of transfer. The amendment would also apply to orders made under Section 57 in respect of mergers and separations.
It is established Department of Health policy that criminal liabilities must be preserved on dissolution and transfer of an NHS trust or NHS foundation trust, so that organisational change does not prevent the initiation or continuation of criminal proceedings. New Section 56AA creates a statutory authority for the criminal liabilities of an acquired NHS trust or an NHS foundation trust to transfer to the acquiring trust. Amending Section 65LA will enable Monitor to implement the recommendations of a trust special administrator. Property and liabilities, including criminal liabilities of a failed NHS foundation trust, may need to transfer to more than one NHS body. Currently, Monitor can only transfer to a single NHS foundation trust, and this is not adequate.
As stated earlier, these changes simply clarify the provisions in existing legislation that already support the NHS in taking the decisions necessary on how to continue to deliver high-quality patient care. I beg to move.
Lord Hunt of Kings Heath
My Lords, like the noble Earl, I make a happy, though unexpected intervention in the proceedings of this Grand Committee. I thank him for giving me advance warning that he intended to move an amendment on the question of trust mergers. I certainly would not oppose the amendment, but I should like to put some points to him. As this is being introduced at such a late stage, perhaps I could ask him about the Department of Health’s approach to deregulation, because it is entirely relevant to the amendment.
The noble Earl will know that a later clause in the Bill introduces a new duty for non-economic regulators to have regard to the desirability of promoting economic growth while exercising their regulatory functions. From the list that we have been given by the Government, we understand that the Care Quality Commission is encompassed in the list of organisations to which the new provisions may apply. The Opposition have asked the CQC for its views on the clause, but we have been informed that the Department of Health has told the CQC that it was not appropriate for the CQC to respond to our query, given that it is an arm’s-length body of government. I am surprised by that. As the noble Earl has frequently said to us, the CQC is an independent body. I am surprised that the CQC even approached the DoH for advice, and I am shocked that the DoH should prevent CQC from giving its advice to parliamentarians on the Bill. I do not expect the noble Earl to respond to this point today, because I doubt that he could, but I ask him to respond to me in due course.
What is the Department of Health’s approach to deregulation? My understanding is that it is in favour, and recently told the Health Select Committee that, unless issues of public safety are concerned, it is not in favour of extending statutory regulation to other professions within the health service, which is entirely consistent with what Ministers are saying in the Bill.
The noble Earl will not be surprised that I then want to ask why the department is still attempting to require non-doctor public health specialists to be statutorily registered. I recently asked a Written Question about that. I cannot for the life of me see that public health non-doctors pose any risk to public safety. That conviction has been reinforced by the evidence that the Professional Standards Authority for Health and Social Care, which is the overarching regulator, has now given to the Government, in which it confirms my view that minimal risks are posed by public health specialists. There is a very limited number of them. Whether they are statutorily regulated or not is not a major issue. The problem is that, by so doing, the Government are threatening the viability of a voluntary register, the UK Public Health Practitioner Register, because it depends on the fees of those non-doctor specialists for its viability. I should have thought that a voluntary register accredited by the Professional Standards Authority is just what a deregulatory approach would lend itself to.
Again, I do not expect the noble Earl to give me a response today, but I wanted to raise with him that there is considerable puzzlement that a Government who brought forward this deregulatory Bill is hell-bent—for some reason that no one can understand—on forcing a statutory approach to non-doctor public health specialists, which will put at risk a voluntary register that is entirely consistent with the deregulatory approach that the Government are taking within the Bill.
I will ask three or four questions about the noble Earl’s amendment. It arises from the issue in Staffordshire. Essentially, the services that were being run by the Mid Staffordshire foundation trust are being transferred to two other trusts: North Staffordshire and the Royal Wolverhampton, one a foundation trust and one an NHS trust. The technical amendment that the noble Earl has brought forward seems eminently reasonable in that context, but I wonder whether he would care to reflect on the process by which that has occurred. He will know of the trust’s special administrators, who were appointed to deal with the problems at Mid Staffordshire. I was very surprised that the estimated cost of that process has been between £12 million and £15 million. Can the noble Earl confirm that and say whether he really thinks that we got value for money from that process?
The second question is whether he can assure me that this new amendment will not make it easier to force through mergers without proper public consultation. Staffordshire health service has a bit of form recently. He will know that the clinical commissioning groups have made some very controversial decisions, including—I think this was announced yesterday—the outsourcing of much of their commissioning responsibility. It is notable that the CCGs are very reluctant to debate or discuss those proposals in public. We have debated Lewisham hospital in south London, which is in a special administration process, and we have had some discussion about how services in Staffordshire are to be reorganised. I have been to a number of meetings in Staffordshire and there is real concern that a lot of these major changes are taking place without adequate public consultation. For instance, in relation to services in Mid Staffordshire, assurances were given—it was called the double-lock assurance—by the Secretary of State that there would, as I understood it, be proper public involvement and support for the changes. I am not entirely sure that that has happened.
I would just like to make two further comments. As I understand it, by statute, mergers have to be approved by Monitor, the economic regulator for NHS foundation trusts—and presumably, for non-foundation trusts, by the NHS Trust Development Authority, acting on behalf of the Secretary of State. In the light of experience, does the noble Earl not think that the Secretary of State should have to give their approval to mergers even if they involve foundation trusts? I realise that this amendment is based on parent legislation that goes back further than 2006—perhaps to 2003—and that we now have a much more fragmented system than we had then.
A trust merger is not a business arrangement; essentially, what usually happens is that one trust has fallen into a great deal of trouble and has to be rescued. That will often have a dynamic impact on the services to be provided; Mid Staffordshire is a good case in point. Given that, should the Secretary of State, because of his direct accountability to Parliament, not have to sign off that merger? The noble Earl may know of Clive Efford’s Private Member’s Bill, which I think is being debated in the Commons on Friday. There is a clause in the Bill which actually says that the merger of NHS trusts or foundation trusts should require the consent of the Secretary of State, so I am sure that this is a matter to which the department will be giving consideration.
My final point is about the impact of the amendment on PFI schemes. The noble Earl has already explained about the transfer of criminal liabilities, which makes eminent sense, but let us say trust A is being acquired by trust B. As I understand it, trust B takes on the liabilities of trust A. But what happens to the indemnity that the Secretary of State has made in respect of a PFI scheme entered into by trust B? When trust A takes on trust B’s liabilities, including possibly a PFI scheme, does the Secretary of State’s indemnity also now apply to trust A? I understand that the Department of Health has said that it does not and I would be grateful for some clarity on that.
Lord Rooker
I did not want to interrupt the noble Earl but perhaps I may intervene as he has raised that point at the beginning of his speech. I know that it will take time to write to my noble friend but in two days’ time this Committee will be discussing the growth duty. It would be useful to have a response before we start that debate because there are a couple of amendments relevant to the growth duty. The Joint Committee fully supported the Government’s response on the growth duty in January, but the committee received representations from certain regulators. I do not recall whether the CQC was one of them—I do not think that it was—but there was an open discussion when we were taking evidence about this. Therefore, it would be quite useful to have an answer by Thursday to the specific question raised by my noble friend because there would still be time to table an amendment. Sometimes it takes a few days or even weeks to get a letter, even with the best intentions of the Minister.
Earl Howe
I note the request from the noble Lord, Lord Rooker, and I can only undertake to do my best on that front. If I can get an answer to the noble Lord, Lord Hunt, by tomorrow, I will. I cannot promise that but I shall use my best endeavours to get an answer to him as quickly as I can.
The noble Lord referred to the administration process at Mid Staffordshire. He is right that the cost of administration has been significant. I cannot confirm the precise cost at this stage but it is substantial and I think that that serves to illustrate that the administration process is not one that any Government, or indeed Monitor, should give the green light to wantonly or ill advisedly. It is a last-resort solution and should always remain so. Clearly, in a challenged health economy, as that has been and still is, it is not surprising that the net result of the exercise is not just a substantial bill in terms of the trust special administration but a very substantial capital commitment by the Department of Health to augment the facilities in the trusts concerned to ensure that the quality of care is as we would all wish it to be. From memory, that net investment will be about £0.25 billion. Therefore, the people of that area should feel satisfied that this process has led to a result that will give them significantly enhanced facilities.
As for the noble Lord’s question about public consultation, this amendment has nothing to do with the process by which a decision is reached on a trust in administration or the consultation requirements that go with it. It merely streamlines the process that takes place after that final decision is taken so that it is not cumbersome.
The noble Lord asked me about the indemnity associated with PFI agreements in relation to a trust that has been taken over. My understanding is that the indemnity does transfer. That is the advice that I have received, but if I need to qualify it in any way, I will correct it immediately after Committee.
As regards the Secretary of State’s approval for trust mergers, it is important to point out that Section 56A provides for the acquisition by an NHS foundation trust of another FT or an NHS trust, and it confers on the sector regulator, Monitor, the power to grant an application for an acquisition. The section was intended to enable acquisitions to take place expeditiously with a minimum level of bureaucracy. The decision to undertake an acquisition, if it is between two foundation trusts, is taken by the FTs themselves with Monitor undertaking a minimal administrative function to implement the decision as long as the set legal process has been followed.