Health and Social Care Bill

John Pugh Excerpts

Tuesday 20th March 2012 Commons Chamber

[Nicky Morgan (Loughborough) (Con)]

I will speak very briefly. Let me begin by pointing out to the hon. Member for Leicester West (Liz Kendall), who said that we did not have enough time to consider all the amendments, that if we had not spent an hour and a half discussing the risk register yet again, we would have had more time to discuss the amendments.

I congratulate the Government on accepting Lords amendment 1, which relates to parity of esteem between physical and mental health. As the Minister said, genuine parity cannot be laid down in legislation, and the mental health framework will be very important to the achievement of it. However, research findings published by the Centre for Mental Health, which I mentioned to the Minister during health questions recently, show the link between physical and mental health conditions. As I am sure we all know from our constituency casework, when someone presents with a physical health condition, it may be clear that there is an underlying mental health condition which has been either undiagnosed or untreated, and which is therefore hampering the person’s physical health recovery.

The Minister spoke of the “symbolic significance” of including a reference to mental health. He is right, but I think that on a day when we have seen Her Majesty the Queen address Parliament, we should recognise that there is sometimes a place for symbolism, particularly when it comes to something that is as cherished on the Government Benches as the NHS. I know that the Opposition claim ownership of the NHS, but in fact it is cherished by all of us, and by our constituents.

I also thank the Government for accepting Lords amendments 19, 32 and 33, which concern the duty of commissioners and commissioning groups to provide patient-focused care—the “No decision about me without me” duty. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) rightly spoke of the importance of mental health care in that regard. I have certainly found, when listening to patients in the mental health system, that they want their doctors, consultants and everyone else in the system to ensure that they are involved in their own care. I am glad that the clinical commissioning groups will be given guidance on that, but I do not expect the very best CCGs and GPs to need to follow it. They are likely to know that treatment is more likely to succeed if patients are involved in it.

Having spent 10 weeks on the Public Bill Committee, and having been present during all the debates on the Floor of the House, I am especially pleased to be able to welcome the amendments.

[John Pugh (Southport) (LD)]

Let me begin by paying tribute to my colleagues in the House of Lords, who have improved the Bill significantly.

I want to raise two issues relating to conflicts of interest. Subsection (1) of the new section proposed in the amendment tabled by Baroness Barker states:

“Each clinical commissioning group must maintain one or more registers of the interests of—

(a) the members of the group,

(b) the members of its governing body,

(c) the members of its committees or sub-committees or of committees or sub-committees of its governing body, and

(d) its employees.”

I looked in vain for a paragraph (e) specifying “parties with which it is contracted for commissioning support”. I think that that is a live issue. There will be commissioning support organisations—some of which will be private institutions, and some of which will be allied with organisations that provide the clinical services that are commissioned—and there may be occasions when those advising the commissioners make recommendations that benefit some parties with which they are contracted. That model, involving the influence of the executive, will be fairly familiar to those who have been members of local authorities. Councillors, like doctors, are often very busy. They rely heavily on expert advice provided by officers, and they generally follow it.

The issue was raised in the House of Lords—I believe that it was raised by Lady Barker—but, when I read the report of that debate, I could not help feeling that it had been glossed over. I should welcome any enlightenment from the Minister on how such a quandary can be dealt with. Clearly it must be dealt with, because otherwise it will create general anxiety about how commissioning will proceed.

The second issue is a bigger one. I think that it is of particular interest to us all, because it affects the general position of the commissioning consortia themselves. There is a view that PCTs are more or less in the same legal boat as GP or clinical commissioning consortia would be. I disagree with what the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said about that. The PCT, as a unit, is not built around general practices, which, as we have said several times in this place, are small businesses. It is possible to view a clinical commissioning consortium as an association of undertakings, which creates serious issues as to how it is able to use public money. If it used public money to benefit itself, that would obviously become a big issue immediately.

[Mr Simon Burns]

No.

[John Pugh]

The Minister says “No”, but I tabled a question recently in which I asked him whether he had taken advice from the European Commission. He told me that he had not. [Interruption.] We are talking about European law—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. This is not just a conversation between the Government Front Bench and its supporters and the hon. Gentleman. If Members want to intervene to disagree with the hon. Gentleman, they should do so, rather than shouting at him while he is speaking.

[John Pugh]

The Minister could undoubtedly answer my query and deal with my anxiety. A significant regulatory issue is involved in the provision of regulations that will work for commissioners in the Department of Health, and he knows that that is the case. It is not a question of what we intend to do; it is a question of what those in the European legal system will make of the function and the nature of what we have set up. If they interpret it as an association of undertakings, that is exactly how they will treat it, regardless of what the Bill says or of what the Minister says at the Dispatch Box. This is a matter of concern that has been raised by people who are more knowledgeable about such matters than I am, and it genuinely needs to be addressed.

Lords amendment agreed to.

Lords amendments 2 to 10 and 13 to 30 agreed to, with Commons financial privileges waived in respect of Lords amendments 7 and 21.

Amendment (a) proposed to Lords amendment 3(1)—(Andy Burnham).

Question put, That the amendment be made.