Health and Social Care (Re-committed) Bill

John Bercow Excerpts

Wednesday 7th September 2011 Commons Chamber

[Nadine Dorries (Mid Bedfordshire) (Con)]

I beg to move amendment 1, page 6, line 8, at end insert—

‘(c) after paragraph (f) insert a new paragraph as follows—

“(g) independent information, advice and counselling services for women requesting termination of pregnancy to the extent that the clinical commissioning group considers they will choose to use them.”.’.

[Mr Speaker]

With this it will be convenient to discuss the following:

Amendment 2, page 6, line 8, at end insert—

‘(2A) After subsection (1) insert a new subsection as follows—

(1A) In this section, information, advice and counselling is independent where it is provided by either—

(i) a private body that does not itself provide for the termination of pregnancies; or

(ii) a statutory body.”.’.

Amendment 1221, in clause 14, page 9, line 37, at end insert—

‘( ) After paragraph 8 insert—

“Provision of independent information, advice and counselling services for women requesting a termination of pregnancy

8A (1) A local authority must make available to women requesting termination of pregnancy from any clinical commissioning group the option of receiving independent information, advice and counselling.

(2) In this paragraph, information, advice and counselling are independent where they are provided by either—

(a) a private body that does not itself refer, provide or have any financial interest in providing for the termination of pregnancies; or

(b) a statutory body.’.

Amendment 1252, page 9, line 37, at end insert—

‘( ) After paragraph 8 insert—

“Provision of advice relating to unplanned pregnancy

8A The Secretary of State must ensure that all organisations offering information or advice in relation to unplanned pregnancy choices must follow current evidence-based guidance produced by a professional medical organisation specified by the Secretary of State.”.’.

Amendment 1180, in clause 240, page 226, line 31, at end insert—

‘(1) Regulations must require NICE to make recommendations with regard to the care of women seeking an induced termination of pregnancy, including the option of receiving independent information, advice and counselling about the procedure, its potential health implications and alternatives, including adoption.

(2) The regulations must require health or social care bodies or any private body that provides for the termination of pregnancies to comply with the recommendations made by NICE under subsection (1).’.

--- Later in debate ---

[Mark Pritchard]

Soubry, zip it! [Interruption.] Sorry, Mr Speaker.

[Mr Speaker]

Order. The hon. Gentleman should withdraw that remark.

[Mark Pritchard]

I withdraw it, Mr Speaker.

[Mr Speaker]

I am grateful to the hon. Gentleman. Let us try to maintain proceedings on an even keel. The hon. Gentleman has said that he is sorry, and that is fine.

[Nadine Dorries]

As I said, I do not want to look as if I am knocking abortion providers. As a nurse, I assisted with many terminations. I do not want to look as if I feel that there is no place for abortion provision. I am pro-choice and do not want to return to those other days.

--- Later in debate ---

[Mr Umunna]

rose—

[Mr Speaker]

Order. It is important that the hon. Lady makes it clear to whom she is giving way.

[Nadine Dorries]

I give way to the hon. Member for Streatham (Mr Umunna).

--- Later in debate ---

[Nadine Dorries]

I will not give way. The right hon. Gentleman may be interested to know—

[Mr Speaker]

Order. I apologise for interrupting the hon. Lady, but there is so much noise in the House that it is sometimes difficult to know whether somebody is seeking to intervene or standing for another purpose. Point of order, Mr Martin Horwood.

[Martin Horwood]

On a point of order, Mr Speaker. Is it in order for an hon. Member to accuse a former hon. Member of blackmail in the course of their speech? That is an accusation of a criminal offence.

[Mr Speaker]

I am grateful to the hon. Gentleman. My understanding at present is that there has been no breach of order. However, I would say to the hon. Member for Mid Bedfordshire (Nadine Dorries) and to the House that temperate language, moderation and good humour are the essential features referred to in “Erskine May”, and it is best if they inform our debates.

--- Later in debate ---

[The Minister of State, Department of Health (Paul Burstow)]

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

New clause 10—Requirements as to transparency—

‘(1) Regulations may impose requirements on the National Health Service Commissioning Board and clinical commissioning groups for the purpose of ensuring that they are open and transparent in their decisions in commissioning health services for the purpose of the NHS.

(2) Regulations under this section may in particular impose requirements relating to—

(a) the imposition of minimum waiting times for patients,

(b) the imposition of clinical thresholds that a patient must reach before being eligible for treatment.

(3) The regulations may provide for the requirements imposed, or such of them as are prescribed, not to apply in relation to arrangements of a prescribed description.’.

New clause 11—Financial duties on clinical commissioning groups: administrative costs—

‘After section 223K of the National Health Service Act 2006 insert—

“223L Financial duties on clinical commissioning groups: administrative costs

(1) The Board must direct clinical commissioning groups to ensure that their expenditure on administrative costs does not exceed a prescribed percentage of their resource.

(2) The Board must ensure that the total national limit on clinical commissioning groups expenditure on administrative costs in any year from April 2014 does not exceed 55 per cent. of the total spent on administrative costs by primary care trusts in the financial year 2009-10.”’.

New clause 12—Secretary of State’s duty as to education and training—

‘After section 1F of the National Health Service Act 2006 insert—

“1G Secretary of State’s duty as to education and training

For the purposes of improving the quality of patient care, the Secretary of State has a duty to maintain a comprehensive, multi-professional education and training system for health professionals and to ensure the continued professional development of all staff delivering NHS services.”’.

New clause 13—Providers’ duty as to education and training—

‘For the purposes of improving the quality of patient care, all providers of services for the purposes of the health service have a duty to contribute towards the maintenance of a comprehensive, multi-professional education and training system for health professionals and to ensure the continued professional development of all their staff delivering health services.’.

New clause 14—Duties of clinical commissioning groups as to persons for whom they are responsible—

‘After section 3B of the National Health Service Act 2006 insert—

“3C Duties of clinical commissioning groups as to persons for whom they are responsible

(1) A clinical commissioning group has responsibility for persons who usually reside in the clinical commissioning group’s area.

(2) Regulations may provide that for the purposes of this section a clinical commissioning group also has responsibility (whether generally or in relation to a prescribed service or facility) for persons who—

(a) were provided with primary medical services by a person who is or was a member of the clinical commissioning group,

(b) have a prescribed connection with the clinical commissioning group’s area, or

(c) are provided with primary medical services by a member of the clinical commissioning group.

(3) The power conferred by section 3(1B)(b) must be exercised so as to provide that, in relation to the provision of services or facilities for emergency care, a clinical commissioning group has responsibility for every person present in its area.

(4) Regulations may provide that section 3(1A) does not apply—

(a) in relation to persons of a prescribed description (which may include a description framed by reference to the primary medical services with which the persons are provided);

(b) in prescribed circumstances.

(5) The duty in subsection (1) does not apply in relation to a service or facility if the Board has a duty to arrange for its provision.”.’.

New clause 16—Distribution of health service functions—

‘(1) The Secretary of State may direct the NHS Commissioning Board, or a clinical commissioning group, to exercise any of his functions relating to the health service which are specified in the directions.

(2) The functions which may be specified in directions include functions under enactments relating to mental health and care homes.’.

New clause 17—Secretary of State’s directions to health service bodies—

‘(1) The Secretary of State may give directions to any of the bodies mentioned in subsection (2) about its exercise of any functions.

(2) The bodies are—

(a) the NHS Commissioning Board; and

(b) clinical commissioning groups.

(3) Nothing in provisions made by or under this or any other Act affects the generality of subsection (1).’.

New clause 18—Care Quality Commission: duty as regards stability of existing NHS services—

‘The Care Quality Commission, in exercising its functions, must have regard to the need to avoid existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research or case-load, becoming viable or unstable due to an unplanned reduction in income or caseload.’.

New clause 20—Clinical commissioning group commissioning work: public function—

‘The Secretary of State must issue directions to clinical commissioning groups which will ensure that commissioning work is predominantly retained as a function by staff directly employed by the clinical commissioning group.’.

New clause 23—Chief environmental health officer for England—

‘(1) The Secretary of State shall appoint a Chief Environmental Health Officer for England.

(2) The Chief Environmental Health Officer for England shall give advice to and report to the Chief Medical Officer for England on all such aspects of environmental and public health as are relevant to the public health functions referred to in section 2A of the National Health Service 2006 Act and the duties referred to in section 2B of that Act.

(3) The Secretary of State shall report to Parliament annually on the work of the Chief Environmental Health Officer for England.’.

Amendment 1222, in clause 1, page 2, line 2, leave out ‘promote’ and insert ‘provide or secure a’.

Amendment 1223, page 2, line 3, leave out from ‘must’ to ‘improvement’ in line 4 and insert ‘provide or secure a comprehensive Health Service designed to promote’.

Amendment 1239, page 2, line 4, after ‘improvement’, insert ‘and to ensure improvement’.

Amendment 1176, page 2, line 7, leave out subsection (2) and insert—

‘(2) The Secretary of State must for that purpose provide or secure the provision of services in accordance with this Act.’.

Amendment 1224, page 2, line 8, leave out ‘secure that services are provided’ and insert ‘provide or secure, either directly or indirectly, services’.

Amendment 48, page 2, Leave out lines 10 to 12 and insert—

‘(3) The services so provided must be free of charge.’.

Amendment 1174, page 2, line 10, after ‘services’, insert ‘so’.

Amendment 1175, page 2, line 10, leave out ‘as part of the health service in England’.

Amendment 1177, page 2, line 12, at end insert—

‘(4) For the purposes of this Act “the health service in England” is defined as those services provided under section 3 of this Act.’.

Amendment 1240, in clause 2, page 2, line 17, leave out ‘with a view to securing’ and insert ‘so as to ensure’.

Amendment 1241, page 2, line 23, leave out ‘with a view to securing’ and insert ‘so as to ensure’.

Amendment 1212, page 2, line 33, at end insert—

‘(5) In discharging the duty under subsection (1) the Secretary of State retains the power to create a new NHS trust or provider organisation.’.

Amendment 1169, in clause 3, page 2, line 38, leave out from ‘State’ to end of line 40 and insert ‘, so far as is consistent with the interests of the health service, must exercise the functions conferred by this Act so as to secure—

(a) that inequalities between the people of England with respect to the benefits that they can obtain from the Health service are reduced, and

(b) a continuous reduction of inequalities between the people of England with respect to the outcomes achieved for them.

‘(2) The Secretary of State must publish and lay before Parliament an annual report detailing the progress which has been achieved in discharging this duty, and the means by which the Secretary of State intends to fulfil this function in the following year.’.

Amendment 1183, page 2, line 38, leave out ‘have regard to the need to reduce’ and insert ‘act with a view to reducing’.

Amendment 1197, page 3, line 1, leave out Clause 4.

Amendment 1194, in clause 5, page 3, line 16, leave out ‘have regard to the need to’.

Amendment 1242, in clause 9, page 5, line 32, at end insert—

‘(h) promoting co-operation between each of the authority’s relevant partners.’.

Amendment 1243, page 5, line 35, at end insert—

‘(4A) For the purposes of this section each of the following is a relevant partner of a local authority—

(a) where the authority is a county council for an area for which there is also a district council, the district council;

(b) the police authority and the chief officer of police for a police area any part of which falls within the area of the local authority;

(c) a local probation board for an area any part of which falls within the area of the local authority;

(d) a youth offending team for an area any part of which falls within the area of the local authority;

(e) a clinical commissioning group for an area any part of which falls within the area of the local authority.

(4B) The relevant partners of a local authority must co-operate with the local authority in the making of arrangements under this section.’.

Amendment 5, page 5, line 43, leave out Clause 10.

Amendment 1178, in clause 11, page 7, line 15, leave out from ‘Subsections’ to ‘apply’ and insert ‘(1), (3) and (4) of section 3C’.

Government amendment 49.

Amendment 1172,  in clause 14, page 9, line 35, after ‘blood’, insert ‘, haematopoietic stem cells’.

Amendment 1173, page 9, line 37, after ‘tissue’, insert ‘, haematopoietic stem cell’.

Government amendments 50, 51 and 54.

Amendment 42, in clause 20, page 16, line 34, at end insert—

13DA Duty of the Board as to commissioning of services

In carrying out its duties in respect of the commissioning of services the Board must in the exercise of its functions have regard to the interdependency of services and the impact that the arrangements for the provision for one service may have on the financial and clinical sustainability of other services.’.

Amendment 1198, page 17, leave out lines 12 to 19.

Amendment 1184, page 17, line 21, leave out ‘have regard to the need to reduce’ and insert ‘act with a view to’.

Amendment 1185, page 17, line 23, leave out ‘reduce’ and insert ‘reducing’.

Amendment 1186, page 17, line 25, leave out ‘reduce’ and insert ‘reducing’.

Amendment 1187, page 17, line 36, leave out ‘act with a view to enabling’ and insert ‘have regard to the need to enable’.

Amendment 1188, page 18, line 4, after ‘functions’, insert ‘have regard to the need to’.

Amendment 1195, page 18, line 17, leave out ‘have regard to the need to’.

Government amendment 60.

Amendment 1203, page 19, line 28, at end insert—

13OA Duty as regards stability of existing NHS services

The Board must not exercise its functions, in particular in respect of section 13I (Duty as to patient choice) or 13K (Duty to promote innovation) in a way which could lead to existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research, becoming unviable or unstable due to an unplanned reduction in income or case-load.’.

Amendment 46, page 22, line 12, at end insert—

‘(1A) The Secretary of State must publish guidance to the Board, to which the Board must have regard, about the exercise of its powers under subsection (1).’.

Amendment 1167, page 24, line 16, at end insert—

‘Duty to reduce bureaucracy

132ZA Duty to reduce bureaucracy

‘(1) The Board must exercise its powers so as to reduce administrative costs in the NHS.

(2) For that purpose the Board must exercise its duties under 14A and 14C to ensure that at no time there exist more clinical commissioning groups than there were primary care trusts on 1 April 2011.’.

Government amendments 67 and 68.

Amendment 1206, page 26, line 41, at end insert—

223E1 Financial duties of the Board: needs-based allotments

(1) The Board must make allotments to clinical commissioning groups based solely on the need of the population served by each commissioning group.

(2) The Secretary of State may give directions as to how the needs set within subsection (1) are determined.’.

Amendment 1218, in clause 22, page 27, line 17, at end insert ‘provided that the members of a clinical commissioning group cannot consist entirely or mainly of persons who are providers of primary medical services under section 83(2).’.

Amendment 1211, page 27, line 22, at end insert—

‘(c) shall be co-terminus with the social services local authority, unless it is notified by the relevant health and wellbeing board, and the local authority, that they approve an area which is not co-terminus.’.

Government amendments 70 and 71.

Amendment 43, in clause 23, page 34, line 20, at end insert—

14PA Duty of clinical commissioning groups as to commissioning of services

In carrying out its duties in respect of the commissioning of services each clinical commissioning group must in the exercise of its functions have regard to the interdependency of services and the impact that the arrangements for the provision for one service may have on the financial and clinical sustainability of other services.’.

Amendment 1189, page 35, line 2, leave out ‘have regard to the need to reduce’ and insert ‘act with a view to’.

Amendment 1190, page 35, line 3, leave out ‘reduce’ and insert ‘reducing’.

Amendment 1191, page 35, line 5, leave out ‘reduce’ and insert ‘reducing’.

Amendment 1192, page 35, line 22, leave out ‘act with a view to enabling’ and insert ‘have regard to the need to enable’.

Amendment 1193, page 35, line 36, after ‘functions’, insert ‘have regard to the need to’.

Amendment 1196, in clause 20, page 36, line 3, leave out ‘have regard to the need to’.

Amendment 1230, in clause 23, page 36, line 7, leave out from ‘consortium’ to ‘that’ in line 8 and insert ‘has a duty to secure’.

Amendment 1231, page 36, line 16, leave out from ‘consortium’ to ‘that’ in line 17 and insert ‘has a duty to secure’.

Amendment 37, page 36, line 36, at end insert—

14YA Duty as to conflicts of interest

(1) Each clinical commissioning group must exercise its functions so as to ensure that any conflicts of interest, and personal and prejudicial interests are dealt with.

(2) The Secretary of State must issue guidance on how conflicts of interest and personal and prejudicial interests should be dealt with by clinical commissioning groups as part of their decision making.’.

Amendment 1204, page 36, line 36, at end insert—

14YA Duty as regards stability of existing NHS services

Each clinical commissioning group must not exercise its functions, in respect of section 14U (Duty as to patient choice) or 14W (Duty to promote innovation) in a way which could lead to existing NHS services, including but not restricted to, emergency care, intensive care, chronic and complex care, teaching, training and research, becoming unviable or unstable due to an unplanned reduction in income or case-load.’.

Amendment 41, page 36, line 43, leave out from second ‘are’ to end of line 44 and insert ‘fully consulted—’.

Amendment 45, page 38, line 22, at end insert—

‘(1A) The Secretary of State must publish guidance to commissioning consortia about its exercise of powers under subsection (1), to which each commissioning consortia must have regard.’.

Amendment 1181, page 38, line 26, at end insert—

‘(3) For the avoidance of doubt it is hereby declared that nothing in this section authorises a clinical commissioning group—

(a) to disregard any enactment or rule of law, including but not limited to section 1(3), or to override any person’s contractual or proprietary rights; or

(b) to charge for anything the group does in the exercise of its powers under this section which relates to any accommodation, service or facility of a type to which section 3(1) applies; or

(c) to charge for anything in relation to the exercise of its functions under section 3 or 3A.

(4) A clinical commissioning group shall exercise the powers specified in section 7(2)(f) only after consulting (to the extent that it appears to it to be practical) any person who appears to it to have an interest through its own previous research in the ideas or intellectual property in question as to whether it should exercise them and, if so, as to any financial arrangements.

(5) A clinical commissioning group shall demonstrate in its annual report under section 14Z3 how the exercise of its power conferred by subsection (1) has not interfered to a significant extent with the performance by the group of its functions.

(6) Income raised by a clinical commissioning group as a result of the exercise of powers under this section shall be specified in its annual accounts, referred to in its annual report under section 14Z13, and paid annually to the Secretary of State.’.

Amendment 1250, page 41, line 38, at end insert—

‘(6A) If the opinion of a Health and Wellbeing Board given to the clinical commissioning group under subsection (5) is that the Health and Wellbeing Board does not consider that the draft takes proper account of each joint health and wellbeing strategy referred to in that subsection, and if the clinical commissioning group does not so consider it, the group shall inform the Health and Wellbeing Board, whereupon it may report to the Secretary of State that it does not consider that such a plan takes proper account of any such strategy and the Secretary of State may require the clinical commissioning group to carry out such further consultation with the Health and Wellbeing Board as he considers appropriate, or may make a final decision on the plan and require the Commissioning Board or the clinical commissioning group to take such action, or desist from taking such action, as he may direct.’.

Amendment 1171, page 42, line 23, at end insert—

‘(3) If in the Board’s opinion, having considered any opinion submitted to it by a Health and Wellbeing Board under 14Z12(1)(a), the plan published by the clinical commissioning group does not take proper account of each joint health and wellbeing strategy published by the Health and Wellbeing Board which relates to the period (or any part of the period) to which the plan relates, the Board must instruct the clinical commissioning group to revise its plans under 14Z10(1).’.

Amendment 1202, page 42, line 23, at end insert—

14Z12A Power of Referral of Commissioning plans to the Secretary of State

(1) If the Health and Well-being Board is of the opinion under section 14Z12(1) that a plan published by the CCG under section 14Z9(6) or 14Z10(2) and which is submitted to it in accordance with section 14Z9(6) and 14Z10(3) or 14Z11(4) or (8), does not take proper account of any relevant joint health and wellbeing strategy it may refer the matter to the Secretary of State for a decision.

(2) Regulations under this section may provide for the mechanism by which such referrals are made.’.

Amendment 38, page 43, line 9, at end insert—

‘(ab) section 14YA’.

Amendment 1199, in clause 24, page 49, line 35, leave out from beginning to end of line 37 on page 50.

Amendment 1213, page 50, line 27, at end insert ‘and must consult with local Health and Wellbeing Boards prior to any decision on this matter with a view to securing their agreement.’.

Amendment 1255, in clause 27, page 53, line 5, leave out ‘the Secretary of State’ and insert ‘Public Health England’.

Amendment 1256, page 53, line 6, leave out ‘an’ and insert ‘a suitably qualified’.

Amendment 1257, page 53, line 20, after ‘authority’, insert ‘, reporting to the Chief Executive of that authority,’.

Amendment 1253, page 53, line 21, at end insert ‘, and will be accountable to—

(a) the local authority, and

(b) the Secretary of State for Health.’.

Amendment 1258, page 53, line 21, at end insert—

‘(2A) The individual so appointed is to be employed by Public Health England, which shall have responsibility for their professional qualification and development.’.

Amendment 1259, page 53, line 30, after ‘authority’, insert ‘or Public Health England’.

Amendment 1254, page 53, line 42, leave out ‘consult’ and insert ‘obtain the agreement of’.

Amendment 1260, page 53, line 42, leave out ‘the Secretary of State’ and insert ‘Public Health England’.

Amendment 7, in clause 29, page 54, line 30, at end insert—

‘(3) This section comes into force on a date to be specified by order by the Secretary of State.

(4) The time specified in subsection (3) must be after such time as the Secretary of State is satisfied that the workforce education and training functions of strategic health authorities are being fulfilled by another body.’.

Amendment 1237, page 256, line 31, leave out Clause 299.

Amendment 1238, page 257, line 29, leave out Clause 300.

Amendment 47, in clause 304, page 261, line 19, at end insert—

‘(1A) Section 29 comes into force in accordance with sections 29(3) and (4).’.

Amendment 1245, in schedule 2, page 269, line 21, leave out from ‘consortium’ to end of line 24.

Amendment 1244, page 269, leave out lines 25 to 29 and insert—

‘(3) The arrangement must include provision for the functions of the clinical commissioning group to be exercised by, and only by, its employees on its behalf.’.

Amendment 1249, page 269, leave out line 29.

Amendment 1234, page 269, line 29, at end insert—

‘(4) Nothing in paragraph (3) shall authorise the inclusion of any provision for any of such functions to be exercised by—

(a) any of the clinical commissioning group’s members who hold or benefit from contracts to provide primary medical services under section 83(2); or

(b) individuals who have been employees of such members; or

(c) by a governing body, committee or sub-committee which consists entirely or mainly of such members.’.

Government amendments 292 to 299.

Amendment 1170, in schedule 4, page 278, leave out lines 35 and 36 and insert—

‘(a) omit “Strategic Health Authorities” and insert after “(a)”— “the National Health Service Commissioning Board”, and

(b) omit “Primary Care Trusts” and insert after “(b)” — “Clinical Commissioning Groups”.’.

Amendment 1247, page 281, line 10, at end insert—

‘(2A) Regulations made under this section must specify that—

(a) direct payments can not be made in respect of the whole or part of a course of private health care or in respect of insurance premiums which have the purpose of providing healthcare, and

(b) direct payments can only be made in respect of services which NICE has specified are services that can be provided by the health service, having particular regard to safety, efficacy and cost-effectiveness.’.

Amendment 1248, page 281, line 23, at end insert—

11A In section 12C (Direct payments pilot schemes) omit subsection (8).’.

Amendment 31, in schedule 23, page 417, leave out lines 18 to 21.

Amendment 32, page 418, line 34, leave out lines 5 to 8.