Regulatory Reform

Lord Lansley Excerpts

Tuesday 9th September 2014 Commons Chamber

[Mr Andrew Lansley (South Cambridgeshire) (Con)]

I did not intend to say much about the regulatory reform order but I am prompted to do so to ask some questions and to respond to one or two points. I will not rise to the bait of the shadow Minister, the hon. Member for Leicester West (Liz Kendall), other than to say that I thought it deeply ironic that, in railing against the Health and Social Care Act 2012, she instanced for most of her speech the views of Healthwatch England, a body representing patients that was created under that Act. It remedies one of the greatest failings of the last Labour Government, who demolished successive efforts to give patients a genuine voice.

I was grateful to my hon. Friend the Member for Stafford (Jeremy Lefroy) for instancing the Act’s requirements on CCGs in relation to patient involvement. “No decision about me without me” is at the heart of the principles of reform. They are set out in the primary legislation. This reform order does not in any way reduce the statutory requirements on CCGs, which must ensure that any joint arrangements they enter into match up to the requirements under the Act.

Under the Act, the essence of CCGs, compared with primary care trusts, is that they are independent statutory bodies. I will not follow the hon. Member for Blackley and Broughton (Graham Stringer) and discuss the process of the regulatory reform order, but he is right: it is not theoretical; it is practical. There is a practical reason why we are in a better place, with CCGs enjoying statutory authority compared with PCTs. Although they were statutory bodies, they did not have the authority that exists presently under statute to deliver and commission services in the interests of the population they serve, without interference or instruction by others. Therefore, as the Minister rightly says, if they wish to enter into these commissioning arrangements, they do so on a voluntary basis. My view is that in the relatively short intervening period under the Act, they have probably underestimated their capacity as statutory bodies to enter into arrangements voluntarily, exercising their statutory authorities as long as they do not improperly delegate their responsibility.

That takes us back to the practical issue. I remember that in 2006, also in Manchester, as it happens—some Members will recall this very well—there was the reorganisation of maternity and children’s services across the city. I suspect that what is being complained of in relation to Healthier Together is exactly the same kind of complaint as was made against that consultation, which had its deficiencies, of which I complained.

Leaving aside whether the consultation was good, bad or indifferent, the point is it did arrive at a position. I can remember talking to the chief executive of the primary care trust in Salford and also, separately, to the chief executive of Salford Royal, and they were told that, as a consequence of the configuration, although the primary care trust wished to commission maternity services and paediatric intensive care services from Salford Royal and the hospital wished to provide them, they were not allowed to do so because the Joint Committee of Primary Care Trusts was preventing them from doing so. In fact, as they were, in effect, in a hierarchy under the strategic health authority, under past legislation they could have been required—forced—to go down that route, and were forced to do so.

That, in my view, is not the position now, and it still will not be the position under these proposals because they are voluntary. If a CCG takes the view that it is in the best interests of its population to deliver some service, it must take a decision consistent with that view. If that means it enters into a voluntary arrangement to deliver that, that is to be supported. If it takes the view that it has to depart from any such arrangement in order to secure the best interests of its population, it must go down that path as well. It would be wrong, under this order or otherwise, for it not to do what is in the best interests of the population it serves.

Finally I have a question, which in this respect is an important one following on from what the shadow Minister asked. In commissioning—quite often when commissioning, for example, out-of-hospital and community services—it is right that one may well need to co-ordinate across CCG services and NHS England’s responsibility for the commissioning of primary care services or, indeed, other services such as dental care and pharmacy services. That being the case, however, it is also important to commission across social care services and some public health aspects of local authorities’ responsibilities. With local authorities having their own statutory authority, and CCGs likewise, it is perfectly possible for them to enter into joint commissioning arrangements, and they do so. I hope the Minister will be able to reassure me that not only are local authorities and the geography of health and wellbeing boards and scrutiny to be respected in terms of the way in which CCGs enter into these kinds of voluntary arrangements, but also that where they enter into joint commissioning arrangements they are able to do so in ways that can mesh together NHS England, CCGs, as necessary, and local authorities.

I urge that at the heart of this is a recognition that CCGs now have statutory authority. That is what is different. They are accountable to their local community, and must set out a commissioning plan and agree it with their health and wellbeing boards. If they try to enter into an arrangement which is contrary to the best interests of their population, as set out in that commissioning plan or by agreement with the health and wellbeing boards, clearly it would be deficient and it should not be able to be pursued.