Regulatory Reform

Richard Fuller Excerpts

Tuesday 9th September 2014 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

The draft order makes important changes, so I welcome the fact that we can debate it properly on the Floor of the House. Hon. Members will forgive me if I say that the reason we are here today is to try to clear up yet another problem created by the Government’s NHS reorganisation and by the Health and Social Care Act 2012, which will go down in the annals of parliamentary history as one of the worst pieces of legislation this House has ever seen.

[Richard Fuller (Bedford) (Con)]

Will the hon. Lady give way?

[Liz Kendall]

No. I will make some progress. The hon. Gentleman may want to listen to what the Secretary of State for Health admitted in a letter to the chair of Healthwatch England on 11 August:

“The Health and Social Care Act, when it established CCGs, did not make provision for CCGs to form joint committees and other CCGs. PCTs previously had this provision in legislation and many formed joint committees to progress partnership work.

Health organisations, including CCGs, have expressed concerns about CCGs’ inability to form joint committees that are able to make binding decisions. This inability has brought many practical challenges in working together on issues that cut across boundaries, such as continuing healthcare, patient specific funding requests and service change”

across the country. I do not know whether the Minister wants to explain why the Health and Social Care Act removed that provision, as the Health Secretary admitted in the letter to Healthwatch England. Does he want to stand up? If not, I will make some progress.

The Minister was fortunate not to be on the Committee that looked at the Health and Social Care Bill twice, so he will not know that Opposition Members repeatedly warned during its passage that CCGs would often be too small to secure effective changes to services across wider areas. We have consistently made it clear that the only way we can get the big changes we need to be able to improve care for patients, including by specialising some services in regional centres and shifting others out of hospitals into the community and towards prevention, is by working in partnership across larger areas.

In principle, we support the need for collaboration and for CCGs to come together both with one another and with NHS England, particularly in wanting to commission good services across primary, secondary, community and specialist care. However, serious concerns have been raised about the draft order by local healthwatch organisations, Healthwatch England and some of the organisations that responded to the consultation, and my hon. Friends may want to raise real concerns. I will go through the concerns in some detail.

The Minister has talked about the fact that CCGs will remain autonomous, but many of them are concerned that that is not written into the draft order. Many CCGs feel that they are coming under increasing pressure from NHS England and some of its local offices. They are concerned that the draft order might take away their autonomy, forcing them into committees and decisions that they do not think are in the best interests of local people.

--- Later in debate ---

[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—

[Norman Lamb]

rose—

[Richard Fuller]

I am happy to give way to the Minister iteratively, or he can wait until I have given him the full menu. Which would he prefer?

[Norman Lamb]

The answer to that question is yes, absolutely; I repeat that this is a voluntary act by any CCG. To address one of the concerns raised by the shadow Minister, let me say that there may well be circumstances in which CCGs want the rules of the game established at the start of the joint committee saying that there will be circumstances in which they can withdraw from that committee. So there are no circumstances in which any CCG needs to feel that it will be oppressed in any way by its neighbouring CCGs, NHS England or anyone else.

[Richard Fuller]

I am grateful for that clarification. My second question is on the issue of voting on the joint committees. To be effective, is it a requirement that joint committees should be based on unanimous voting only and that all CCGs would have to agree, or will joint committees be substantially based on majority voting? Is it open to CCGs to create joint committees with majority or unanimity voting depending on how they wish to set those up?

[Norman Lamb]

rose—

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. May I say to the Minister that I know he is trying to be helpful, but he will soon be seeking to answer this debate? We have only one more speaker to go, so to help the flow of the debate perhaps Members could finish their speeches and then he can respond.

[Richard Fuller]

I am grateful for the direction, Madam Deputy Speaker. My third question relates to the legalities and costs, which were mentioned by the Minister and were in the justification for making this change from committees in common to joint committees. I am still a little at a loss as to what those legalities and costs are. What costs are currently incurred or are anticipated to be incurred, and why would the costs be substantially less with joint committees? I am not looking for a generic answer such as, “There are some legal costs here and legal costs there.” I am looking for something specific, because if we are to make a change, we have to demonstrate that a substantial administrative burden has been taken away.

My fourth question relates to the impact of the change on existing committees in common. I think it would be correct to say that the Healthier Together review in Manchester is proceeding as a committee in common, not as a joint committee. Would that be the case if this change is made, or would it be possible, either automatically or by choice, for existing committees in common to be transferred to joint committees with the same decision rights that joint committees would have? I am not too clear as to the position for committees that are already extant.

My fifth question relates to the Minister’s statement that committees in common somehow place a “burden”. I would be grateful for his clarification that he does not believe that the essence of localism, which was a substantial intention behind the reform introduced my right hon. Friend the Member for South Cambridgeshire, is the burden to which reference is being made. Sometimes one fears that there is tension between localism and common advance. If we allow the people who are on joint committees and their decision making to get further and further away from the people, the burden of having to go back to get local approval is lost. I hope that the Minister can clarify that that is not what is meant in the order’s reference material.

Finally, there has been a lot of commentary about the fact that it is up to committees to change their minds later on and to decide whether it is a joint committee or not. But the Minister can be clear that not all the consequences of what a committee will find can be known at the outset. Can he clarify whether it is possible for CCGs that are already signed up to joint decision making on joint committees by majority voting to change their rules, or are they bound by those rules once they have signed up to them? I am very grateful for the opportunity to debate these issues on the Floor of the House, and I look forward to hearing the Minister’s response.