Regulatory Reform

Graham Stringer Excerpts

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.

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

I rise to oppose the order for two primary reasons. I shall attempt to divide the House at the end of the debate.

My first reason relates to the Legislative and Regulatory Reform Act 2006. Right hon. and hon. Members may not be over-familiar with the Act, but its purpose was to allow regulatory burdens to be taken away if it was unlikely that Parliament would find time to debate the issues and if they were not controversial. It provides in the Act—this is why we are debating the order today—that if the Regulatory Reform Committee is not unanimous, there should be a debate on the Floor of the House. If there is a majority against the order, a longer debate in a different form would take place. The Committee did not unanimously support the order—I am not aware why one Member voted against it—and that has provided an opportunity to look at the process governed by the 2006 Act and assess whether the order complies with it.

In the simplest, most common-sense terms, an order would be passed if it would remove a burden and was non-controversial. I think that this order is controversial, and I do not think that it meets the conditions in the Act. Those conditions exist because, effectively, the process and the order concerned will relieve the House of the burden and responsibility of going through three Readings in this House and three Readings in the other place, so we have to be certain that this order is non-controversial.

First, there is the question of the consultation on the order. The report states that the Department consulted the better regulation unit, and was told that, as the order would remove only an administrative burden,

“it would be appropriate to conduct a targeted consultation rather than a full public consultation.”

I do not think that that is appropriate. Almost everything to do with the structure of the health service at the present time is controversial. My constituents and, certainly, Members of Parliament have views and concerns about that, but they were not directly involved or consulted about the process, and I think that that is a mistake in itself.

Then there is the claim that the order will remove an administrative burden. When I questioned the Minister earlier about the administrative burden, I tried to explain that, at present, clinical commissioning groups can organise themselves into committees, and can make decisions if those decisions are unanimous. They do not have to report back to anyone, so there is not an administrative burden there. There are other ways in which they can co-operate: they can reach legal agreements, or, indeed, they can report back, as in the example given by the Minister.

I do not believe that there is an administrative burden to be removed. However, I do think that there is the potential for repression of a clinical commissioning group. While it is voluntary to enter into these arrangements, if clinical commissioning groups entered into them in good faith and then encountered a more controversial issue, it would be difficult for them to move out; and if they could move out, that would return them to exactly the position in which they would have been had they been entering into a voluntary agreement with a committee in common, which means that there is no removal of an administrative burden. If that is the case, we do not need the order. If it is not the case, it is possible for a majority of clinical commissioning groups to overrule the interests of other CCGs.

In my view, the Regulatory Reform Committee and the Department have not followed the rules set down in the Legislative and Regulatory Reform Act 2006, and the House should reject the order on that basis alone.

I am not engaging in a theoretical discussion, and I am not going to ask the Minister to listen to a debate that would be exactly the same as our recent Westminster Hall debate about the proposals in Healthier Together. However, a consultation—a very flawed consultation—is currently taking place in Greater Manchester. The health trust that covers Wigan, Wrightington and Leigh in the west of Greater Manchester, and the one that covers south Manchester and Wythenshawe, fear that the proposals are unreasonable, and feel unable to support them at present. If the proposals were to go ahead, it would be possible for a majority of the 12 clinical commissioning groups that operate in Greater Manchester to make a decision that would impose changes on the hospitals in those clinical commissioning areas which are not wanted by the clinical commissioning groups.

As I said, the consultation is deeply flawed. It involves upgrading some hospitals to specialist hospital status and in effect downgrading other hospitals. Incidentally, three of the hospitals—those in north Manchester, Bury and Tameside—have not been consulted on the proposed changes in those hospitals.

The local healthwatch team said that the way in which our CCGs are operating is outside the law and that this proposal would put them inside the law. We can see the reason why: they want a majority decision, not a decision that would represent the areas of Wigan and south Manchester. I could talk a great deal about the rest of the Healthier Together proposals, but we debated those details in Westminster Hall. I do not think that the proposals are in the interests of the people of Greater Manchester. They try to jump the gun before the general election. It would be better for the decisions to be made by whichever Government are in power after the general election.

The consultation documents omit to mention the financial situation in which Greater Manchester finds itself—a £1 billion deficit is projected in the next two and a half to three years—and make proposals that could lead to the closure of hospitals, while pretending that they are only small decisions. The consultation paper wanders all over the place—through primary, secondary and tertiary care—but at the core of the consultation is the change in status of a number of hospitals in Greater Manchester. I worry that, if the CCGs work together and make majority decisions, the proposals in the Healthier Together consultation will be used as a blank cheque—health authorities in Greater Manchester will have carte blanche to do what they wish, without taking account of the views of the people of Greater Manchester.

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[Richard Fuller (Bedford) (Con)]

It is truly a pleasure to listen to my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) and to follow him in the debate. I am a member of the Regulatory Reform Select Committee and it was my vote that enabled the House as a whole to debate this measure, which might, on paper, seem rather arcane. The hon. Member for Blackley and Broughton (Graham Stringer) asked why we are debating it in this way. We are doing so because the core dilemma in much health reform involves the tension between local decision making and common advance. For many people, there is a tension between the priority to localise decision making and the need, as seen by professionals such as the doctors and clinicians whom we trust, for some decisions to be made on a common basis in order to achieve overall advances in health care. It can be difficult to find the appropriate boundaries as we try to resolve that tension.

I felt that it was important to bring this matter to the House so that other hon. Members could have a chance to talk about the experience in their own localities. The issues in Greater Manchester have already been mentioned, and my hon. Friend the Member for Stafford (Jeremy Lefroy) has mentioned the issues in his own area. I also felt that it was important to herald one of the most important attributes of the reforms that my right hon. Friend the Member for South Cambridgeshire introduced, which was to enable, as far as possible, decision making on these issues to take place locally and to ensure that those local decisions were led not by politicians or bureaucrats but by doctors. A concern has been expressed that this change would somehow draw us away from those reforms.

The shadow Minister, the hon. Member for Leicester West (Liz Kendall), asked some extremely pertinent questions, although she perhaps got off to a bad start by taking the political apparatchik line and suggesting that certain problems were the result of the reforms. This is actually about one of the best parts of those reforms, which allows local people to make decisions. That was reflected in the widely quoted comments made by Anna Bradley, the chair of Healthwatch England. In her note, she said that

“we are concerned that the proposed reforms could create the conditions for CCG decision-making to become disconnected from the transparency and accountability mechanisms put in place by the Government’s health reforms”.

She recognises, as do many hon. Members, the importance of the tension. She also referred to it in a press release, in which she stated:

“We understand the benefits of commissioners working collaboratively but it remains crucial that local people are involved, asked what they want and understand how decisions will affect the way services are delivered in their area.”

In my own area in Bedfordshire, we have been having a collaborative exercise between two clinical commissioning groups, and they have done an extraordinarily good job of communicating and maintaining local decision making.

[Graham Stringer]

The House owes the hon. Gentleman a debt of gratitude for bringing the order before us today. Will he tell us whether, in the example he is giving, the order would help, hinder or be neutral?

[Richard Fuller]

I am not an expert, but in that particular instance I do not think I would fear the joint committee making a different recommendation from the current committee in common, although it has yet to come back with its report. The point is that the hon. Gentleman and others have aired important questions for the Minister to answer. He has answered some of them, and that has been the purpose of the debate today.

Underpinning all this is the fact—whose importance I hope the Minister will emphasise in his response—that people want important health decisions to be taken locally. They can be persuaded of, and they can understand, the issue of common advance, but they want to know that a decision is being taken locally. I think that the Minister dealt with this in his response to the shadow Minister, but I would be grateful if he answered these points quite specifically. First, am I right in thinking that he said that decisions on the part of commissioning groups to go into joint committees were voluntary, rather than compulsory, and that it would therefore remain possible for them to continue to set up committees in common if they so wished? My second question—