THE HEALTH INSPECTORATE

HC Deb 15 January 2002 vol 378 cc233-44 '(1) There shall be a body corporate known as the Health Inspectorate, which will take effect from 1st April 2004. (2) The Health Inspectorate shall assume at that date the functions undertaken prior to that date by—

1. (i) The National Institute for Clinical Excellence,
2. (ii) The Commission for Health Improvement,
3. (iii) The National Care Standards Commission, and
4. (iv) The Council for the Regulation of Health Care Professionals.

(3) The Secretary of State may by order make such amendments of the legislation relating to the health service in England and Wales as in his opinion facilitate, or are otherwise desirable in connection with subsections (1) and (2) above.'.—[Mr. Heald.]

Brought up, and read the First time.

Mr. Heald

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

Mr. Deputy Speaker

With this it will be convenient to discuss the following: Amendment (a) to the proposed clause, in line 5, leave out— '(i) The National Institute for Clinical Excellence.'. Amendment (b) to the proposed clause, in line 8, leave out— '(iv) The Council for the Regulation of Health Care Professionals.'. New clause 4—Public health functions of the Commission for Health Improvement— 'The Commission for Health Improvement shall have such further functions as may be prescribed relating to the management, coordination, provision or quality of public health services for which prescribed NHS bodies, service providers, local authorities or other bodies have responsibility.'. New clause 10—The Commission for Health Improvement: amendments to section 20 of the Health Act 1999— '(1) Section 20 of the Health Act 1999 is amended as follows:— (2) After paragraph (1) (e) there is inserted— (f) the function of conducting reviews of and making reports on the guidance on priorities for the NHS set out by the Secretary of State, regional directors of the health service, and Strategic Health Authorities (3) After subsection (1) there is inserted— (1A) in carrying out the functions set out in subsections 20(1)(a) to (e) the Commission shall, where appropriate, review, investigate and report on the guidance on priorities for the NHS set out by the Secretary of State, regional directors of the health service, and Strategic Health Authorities. (4) Subsections (3) and (4) are repealed'. Amendment No. 89, in clause 12, page 17, line 15 after "others", insert— '(including but not limited to the National Institute for Clinical Excellence, the relevant royal colleges, regional directors of the Health Service, the NHS Executive and the Secretary of State)'. Amendment No. 88, in page 17, line 29 at end insert— '(1C) The criteria referred to in subsection (1A)(b) shall be agreed between the Commission, the Secretary of State and the relevant royal colleges, which shall take due account of the adequacy of resources available to meet the performance indicators.'. Government amendments Nos. 29 to 32, and 57 and 58.

Mr. Heald

In a world of reform by soundbite, where the answer to every issue is to set up a new commission, a new institute, a new agency or a new committee, surely there comes a time—[Interruption.]

Mr. Deputy Speaker

Order. Hon. Members who are interested in holding private conversations—[Interruption.] Order. That includes the hon. Member for Worsley (Mr. Lewis). Hon. Members who are not interested in listening to the debate would serve their colleagues better by leaving the Chamber.

Mr. Heald

Surely there comes a time to rationalise, and new clauses 3 and 4 would do just that. New clause 3 would combine the functions of the National Institute for Clinical Excellence, the Commission for Health Improvement, the National Care Standards Commission and the Council for the Regulation of Health Care Professionals in one body known as the health inspectorate.

The Government have a piecemeal approach to reform: an issue arises, a committee is set up. That has led to a plethora of commissions, institutes and the like. It has also led to particular issues to do with the National Care Standards Commission and the CHI. The NCSC will monitor and inspect private sector providers. The CHI will inspect the same providers if NHS patients are at their premises. Surely only one body should do that work. We know that Government policy is changing fast. Only last year the Secretary of State was saying that the national health service was "thankfully" a monopoly provider. The right hon. Gentleman said that by and large, we thankfully have one monopoly provider and that is the NHS. As long as a Labour Government are in power, that will remain the position."—[Official Report,26 June 2001; Vol. 370, c. 500.] When the Bill was being prepared, that was indeed the right hon. Gentleman's view; yet by 7 December 2001—six months later—he was saying: Where we need to get to is a position where the NHS is no longer a monopoly provider of care but it does become a monopoly funder of care. In other words, in six months, the Secretary of State went from a monopolist to a non-monopolist.

Having given us the NHS plan in 2000 and the Bill in 2001, the right hon. Gentleman has now come up with another big idea to rescue the day. The reason is that, despite his promises and despite his words, he was wrong. There has been no delivery: all talk, no delivery.

Today we have heard about foundation hospitals. As the changes are made, the case for an all-embracing health inspectorate grows. There would be no demarcation disputes between private sector monitoring and public sector monitoring. There would be less red tape and better co-ordination. There would be fewer burdens on busy clinicians, nurses and other staff. Indeed, if some of the comments are to be believed, the Government will embrace a national health service provided by third parties and will simply act as a regulator. In that case, why do we need this plethora of commissions, inspectorates and the like? Surely it makes sense to rationalise the situation.

Under new clause 4, we would extend the role of the CHI to cover the monitoring, inspection, reporting, co-ordination, management and quality of public health. On 10 January, the chief medical officer announced a new committee—the national infection control and health protection agency—which will assess the threat of new and emerging infections and diseases and implement vaccinations. That is necessary simply because of the Government's lamentable failure in public health.

In a report published in February 2000, the National Audit Office exposed huge discrepancies in performance between hospitals. It found that infections caught while in hospital were killing about 5,000 people a year and infecting about 100,000. The very old, the very young, those undergoing invasive standard procedures and those with suppressed immune systems were particularly susceptible. Hospital staff were not practising basic hygiene. The NAO found that infection rates could be reduced by 15 per cent. by better application of existing knowledge and realistic infection control practices.

The NAO also found that there was insufficient funding, that there was no up-to-date information and that hospital infections were costing the health service £1 billion a year. It said that the NHS could save hundreds of millions of pounds if it tackled infection seriously, and that the high number of patients occupying beds and contributing to the problem could be improved.

Against that background of the Government's failure to take public health and infection seriously, exactly what happens when Labour is in power can be shown by referring to certain diseases. The number of tuberculosis cases has risen enormously in recent years. In September 1999, the Department of Health asked the health authorities to suspend routine immunisation in schools for 10 to 14-year-olds because of a shortage of vaccine, yet that programme has still not been fully reinstated.

The number of BCG vaccinations fell from 518,000 in 1997 to 137,000 in 2001—a decrease of almost 400,000—yet the number of TB cases reached a 15-year high. According to the British Thoracic Society, the number of adults and children with the respiratory disease TB was at record levels. The figure rose by a fifth between 1987 and 1988, and London has become the capital for TB.

The rise in sexually transmitted diseases has been remarkable, too. Between 1999 and 2000, the incidence of syphilis increased by 51 per cent.; gonorrhoea increased by 25 per cent.; and chlamydia by 12 per cent. We have seen a similar picture with other diseases. So there is an epidemic of TB and sexually transmitted diseases are increasing.

Dr. Evan Harris

I am interested in the hon. Gentleman's topic; it used to be my field, but I am little confused—perhaps I am missing some amendments—about its relevance to new clause 3, about which important issues remain to be discussed. He refers to important issues, but they are not necessarily connected with new clause 3.

Mr. Heald

Perhaps I have been so speedy in my remarks that the hon. Gentleman has not noticed that I have moved on to new clause 4, under which we would require the CHI to take an interest in public health services. The reason why that is important is the Government's neglect of very important issues, such as those diseases, and the hon. Gentleman might make common cause with us about that. Certainly, when the Select Committee report on public health was debated recently in Westminster Hall, he and I agreed that the Government have an appalling public health record.

Although the chief medical officer has belatedly set up yet another committee, the hon. Gentleman may agree—certainly his amendments to new clause 3 suggest it—that it would be better to have one effective body than to have committee upon committee upon committee. On 10 January, the chief medical officer reported that he was setting up the national infection control and health protection agency, but the new clause suggests that the Commission for Health Improvement could deal with such issues as well.

8.45 pm

One hopes that the Commission for Health Improvement will give advice to all the health bodies in the country. If it has the role of providing advice and support, it is surely odd to set up yet another new agency to give advice on public health when we already have a body that meets and liaises with all the other bodies and authorities to deal with the issues. We therefore suggest the rational approach of dealing with the matter through one body.

The Government have recently, belatedly, produced a strategy on sexual health. However, there has been great criticism of it. The response from the George House Trust has been to say that the Government are following the "wrong strategy". It states: Much is made by the Government of the need for the joined-up working' … but not so on HIV. It points out that to achieve the long term aims of a reduction of HIV transmission and the best possible quality of life for people with HIV requires a cross-Government approach. It criticises the Government for providing something worse than that, adding: The document almost doesn't deserve the name 'national strategy'. Building on their weakness on this issue, the Government have produced yet another document that is short on the sort of detail that those in the community who have to deal with such illnesses think is necessary.

Mr. Hutton

I understand that the hon. Gentleman's new clauses and amendments deal essentially with the role and responsibilities of the Commission for Health Improvement for what he described as public health areas. He has now moved on to the sexual health strategy and sexual health services, but that is one issue for which the Commission for Health Improvement already has competence and jurisdiction.

Mr. Heald

The point that I am making is that we should join up the functions. If the Minister had attended the debate in Westminster Hall, he would know that public health is a well recognised field. Like the Select Committee on Health, we went through the history of the subject and back to 1850 and the earliest steps taken in public health. We reached the conclusion—and a consensus even with the Minister's colleague who attended the debate—that sexual health was part of public health. It obviously has a medical dimension too.

On haemophilia, the fact that recombinant factor 8 is not available across the whole United Kingdom has been a failure of public health policy. So the public are right to be concerned that the Government do not know what they are doing for public health. The Select Committee on Health has done an important job of highlighting the vital nature of the issue, but I return to my central point. Why do we need yet another new committee? Why not give the Commission for Health Improvement the job of being a combined inspectorate that brings together the four bodies mentioned in new clause 3, while having additional responsibilities for public health?

The British Medical Association has expressed concern that the new arrangements in the Bill may lead to some areas having no public health doctor advising either the PCT or the strategic health authority. Will the Minister address the issue and tell us whether he is satisfied with that? The national tracker survey mentioned in previous debates concluded that most PCGs and PCTs feel they need more public health support". So why not give the job to the people who advise on all the other matters? Why not give it to a unified body or to the Commission for Health Improvement?

Other new clauses and amendments are before the House, and I shall leave it to other Members to describe them. However, I hope that the Minister will, for once, move away from the Government's gimmicky, soundbite approach that we see so often. Every time there is a problem, they set up a committee. Why can we not rationalise and at least bring all the powers together in one body?

On a non-partisan note, when financial controls and checks were disparate and a plethora of bodies dealt with financial regulation, the Chancellor of the Exchequer considered the problem and decided to bring those bodies together with a strong regulator, the Financial Services Authority, to cover all financial regulation. If that is good enough for financial regulation, why is it not good enough for health regulation? Let us bring the bodies together, give them some teeth and have real expertise. I ask the Minister to look on the new clause with the same affection as he showed for our proposals on consultation.

Dr. Evan Harris

Before addressing the new clause and amendments that the Liberal Democrats have tabled, I want to deal with new clause 3, which would amalgamate the functions of the Commission for Health Improvement, the National Care Standards Commission, the National Institute for Clinical Excellence and the Council for the Regulation of Health Care Professionals. I am half with the Conservatives on that. The hon. Gentleman knows that for a long time we have thought that there should be one quality regulator for both the private sector and the NHS. Such an inspectorate would have specialist departments to deal with, for example, the inspection of care homes, on which my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) is an expert. We believe that the nature of the inspectorate should be to consider issues of quality in both sectors, with powers to be discussed and arranged later in our proceedings.

We also believe, however, that NICE and the Council for the Regulation of Health Care Professionals are separate bodies with separate functions. We have made it clear to the Government that we support their quality initiative, even if it means more acronyms. That is the price we have to pay for the previous lack of machinery to deal with quality assurance in the health service. So we accept that two of the bodies could be combined, which is the purpose of amendments (a) and (b) to new clause 3.

Mr. Heald

Does the hon. Gentleman agree that when the Government thought of having two bodies, they favoured a monopoly supply in the NHS, so there would have been little overlap? Now that they are coming forward with changed proposals, it is far more important that one body should deal with such matters; otherwise, more than one body will survey the same premises.

Dr. Harris

The hon. Gentleman is too generous. I do not think that the Government provided a rational reason for the separation, especially with regard to the fact that NHS patients in private hospitals would be subject to Commission for Health Improvement inspection, which means two separate bodies going to similar sectors. It is true that the then Secretary of State took a separatist view of the private sector, but I do not think that that approach was ever rationalised. I do not believe that it can be.

Mr. Hutton

The hon. Gentleman, like the Conservatives, overlooks the implications and consequences of section 9 of the Care Standards Act 2000, which prevents the duplication to which he refers. In the present situation, it offers a sensible way to deal with his reasonable concerns and criticisms.

Dr. Harris

That section might deal with one form of duplication, but it does not address the duplication of structure. I am concerned about the duplication of two bodies that could more easily pool best practice and identify lessons to be learned from each other by being in one inspectorate. I am sure that if we revisited this issue, the Government would accept the establishment of one body, albeit with different specialisations.

New clause 10 is important and touches on matters that we raised in Committee. The Government say that they want the CHI to be more independent. Together with amendments Nos. 88 and 89, the new clause would ensure that they deliver on that and that the body really is independent. Under the cloak of greater independence, the measures would have the commission doing the Government's bidding, because it will be put in charge of measuring hospitals against performance criteria laid down by the Government, but it will have no duty to ensure that those criteria are sensible.

Amendment No. 89 seeks to ensure that those criteria would be discussed and agreed by the commission, the Government and the royal colleges. The commission, rather than simply measuring how well hospitals, trusts and PCTs jump through hoops and how high they jump, should have some input, with the royal colleges, in determining the nature of the hoops.

In the past, there have been ridiculous performance criteria with political objectives. In fact "ridiculous" is a polite description. For example, trusts that put patients ahead of political targets by treating urgent cases quickly, even at the expense of creating a few more long waiters—I accept that in general waiting times are too long—get marked down in performance tables compared with those that deal with long waiters, and have no one waiting over 15 months, by delaying waiting times for urgent operations from one month to three months. Patients come out worse in the second case, but the trust scores higher on the crazy performance criteria.

I accept that there must be some performance monitoring, but let us have sensible criteria. Politicians will do as they do, so it would be sensible to ensure that the commission is able to agree criteria with the Government and the royal colleges. The Government have made efforts to engage the royal colleges in such discussions, but it is clear, as the Minister said in Committee, that the criteria in the Bill will be set by the Government and they will be designed to meet Government targets.

The Government should not be allowed to get away with imposing distortions on the health service unless they are satisfied that they can pass muster with the newly independent commission. New clause 10 would give the commission the power to conduct reviews and draw up reports on the guidance on NHS priorities set out by the Secretary of State and the people to whom he delegates those powers. If priorities and planning guidance emerged that would not inevitably lead to improved quality but merely dealt with subsidiary matters unrelated to patient outcomes, they could be subject to a report by the commission. The Secretary of State could, of course, choose to ignore that report, but at least the information would be out in the open, and the Minister would have subjected the priorities emanating from his Department to the same scrutiny as the conduct of the trusts that seek to meet those criteria will be subjected to.

One amendment seeks to ensure that when setting the criteria some regard would be paid to resources and their effect on the ability of hospitals, trusts and PCTs to meet those criteria. There is nothing more invidious and depressing for trusts than to be named and shamed, as the Government indicate they will do and as they have done through the zero rating, when they fail to meet performance criteria, solely because they do not have the necessary staff or capacity. Delayed discharges, for example, are well beyond the control of even the best public sector or even—dare I say it?—private sector managers. That amendment should not be a threat to the Minister; indeed, he may argue, as I do, that it would be a benefit because it would ensure that trusts get a fair deal. Without performance monitoring that does not have a devastating effect on morale, we will not have the health service that we require.

I hope, Mr. Deputy Speaker, that at the appropriate moment you will allow us to call a vote on new clause 10, if the Government oppose it.

Mr. Hutton

I shall speak to the Government amendments before I turn to those in the names of Opposition Members. Amendments Nos. 29 to 32 are technical amendments that relate to the Commission for Health Improvement. Amendment No. 29 concerns the commission's investigatory role, and the remaining amendments deal with its role under the new system of local health boards to be established in Wales.

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Amendment No. 29 is designed to ensure that confidential information can be disclosed to the Commission for Health Improvement when it is carrying out investigations in relation to special health authorities or other bodies that may in future be prescribed in regulations under section 20(1)(e) of the Health Act 1999, not only when it carries out investigations in relation to health authorities, PCTs and NHS trusts. Whenever we discuss confidential information and its disclosure, it is important that we address the essential safeguards needed to ensure that there are no abuses. Those safeguards have already been built into the existing legislation.

The Commission for Health Improvement may obtain personally identifiable confidential information only in the circumstances specified in 23(2)(d) of the 1999 Act. Broadly, those circumstances are where it is not practicable to disclose the information in an anonymous form; where there is a serious risk to the health or safety of patients; and where the risk and urgency involved mean that the information needs to be disclosed without consent. Those are stringent and necessary safeguards.

Amendments Nos. 30, 31 and 32 are technical drafting mechanisms to address the fact that local health boards will be set up at a future date in Wales. Amendments Nos. 57 and 58 are also technical amendments, consequential on the creation of local health boards. The practical effect of amendment No. 57 would be to ensure that CHI' s functions in relation to local health boards under section 20 of the 1999 Act operate once such boards are established and given responsibility for health care. The practical effect of amendment No. 58 would be to ensure that local health boards are subject to the appropriate provisions of existing legislation.

The principal debate and arguments in relation to this group of amendments has concerned new clauses 3, 4 and 10. New clause 3 seeks to create a new health inspectorate by bringing together a number of current or proposed bodies. In tabling new clauses 3 and 4, the hon. Member for North-East Hertfordshire (Mr. Heald) has, properly and correctly, raised an important issue with which I have a great deal of sympathy. However, I have serious doubts about the drafting and wider effects of the new clauses, which means that I cannot accept them this evening. Clearly, as the hon. Gentleman said—and I agree—there is a strong case for effective co-ordination between various agencies in the field and for ensuring that the NHS is not subject to unnecessary or bureaucratic regulatory inspections. That is a key objective for the Government, which we need to keep under careful and continuous review.

My overall concerns about the new clauses, especially new clause 3, are to do with the mixture of distinct functions and the disruption that that kind of change would inevitably cause at this moment in time, particularly when the National Care Standards Commission has not even begun to discharge its statutory functions and CHI has not taken on its new and expanded role under the Bill. While there is no doubt at all that the sort of collaboration and co-ordination that the hon. Gentleman and I want must continue and be strengthened, the proposed health inspectorate would create a new body with what might be described as an indigestible and confusing mixture of NHS and wider regulation and inspection roles. As I said in an intervention on the hon. Member for Oxford, West and Abingdon (Dr. Harris), we should not lose sight, in our rush to reform, of other ways in which we can facilitate the type of operation that he and I want to see, especially the use of section 9 of the Care Standards Act 2000.

We have already made provision for greater co-ordination between CHI and the Audit Commission in the Bill. Additionally, we have provided powers for the sharing of functions between the National Care Standards Commission and CHI, which has entered into important memorandums of understanding with a range of organisations, such as the royal colleges. We were able to send copies of those memorandums of understanding to members of the Standing Committee; I hope that they found that useful. In the present circumstances, that is the right way to proceed.

I wish to make it clear to the House that we are considering, as part of our response to Professor Kennedy's report on the Bristol royal infirmary inquiry, what further steps might be taken to improve the co-ordination of the activities of those various bodies. As the hon. Member for North-East Hertfordshire, and, I hope, the House, knows, the Government's response to the report will be published in the near future. While I fully understand his arguments and strongly sympathise with them, I am not in a position to support his particular attempt to resolve those problems. As I said, the difficulties can be addressed in the present circumstances in other ways—less bureaucratic ways than the drastic changes and upheavals proposed. That is particularly true in relation to the National Care Standards Commission, which has not yet started its work.

Amendments (a) and (b) tabled by the Liberal Democrats to new clause 3 would mean that the new health inspectorate would perform the functions of the Commission for Health Improvement and the National Care Standards Commission, but not those of the National Institute for Clinical Excellence or the new Council for the Regulation of Health Care Professionals. As I have already indicated, the proposal to establish a single health inspectorate as set out in new clause 3 may have some attractions, but it confuses the very different roles of the bodies concerned and ignores the actual and potential collaboration between them. By reducing the number of bodies involved, the amendments inevitably mitigate the confusion, but do not remove it entirely.

I have tried to explain to the hon. Members for North-East Hertfordshire and for Oxford, West and Abingdon that we are examining the issues closely, but there are genuine difficulties with the new clause. The hon. Member for North-East Hertfordshire may or may not be prepared to accept that, but I assure him and the House that the Government are studying these matters carefully.

New clause 4 would allow CHI to be given new functions in relation to what are described in the new clause as "public health" services. That is not a term defined in the Health Act 1999, which set up the Commission for Health Improvement. The hon. Member for North-East Hertfordshire was right to draw attention to the chief medical officer's report last week, which announced plans for a new national infection control and health protection agency, which is designed to streamline the services involved in the prevention and control of infectious diseases.

The agency would subsume the functions of a number of the bodies of expertise which currently provide health protection services, including the Public Health Laboratory Service, the National Radiological Protection Board, the Centre for Applied Microbiology and Research—CAMAR—and the National Focus for Chemical Incidents.

The establishment of such a new agency would clearly raise important questions about its relationship to the Commission for Health Improvement, to which we are not yet in a position to give a final answer, but which we will consider carefully. I accept that new clause 4 raises an important issue, which requires serious consideration, alongside the issues raised by the hon. Member for North-East Hertfordshire in relation to new clause 3.

There are undoubted arguments in favour of giving recognition to the importance of public health services, as proposed in new clause 4. However, complex issues are involved in clarifying the range of public health services that might appropriately be brought within CHI's remit, the relationships with both the bodies responsible for those services and those responsible for their inspection or regulation now and in future, and the legislative consequences arising.

I therefore propose that the new clause should not be accepted tonight, but I am happy to give an assurance to its proposers and to other right hon. and hon. Members that we are giving serious consideration to ways in which the issues that it raises might best be taken forward. I intend to keep right hon. and hon. Members fully informed of progress on the matter.

The hon. Member for North-East Hertfordshire will not be surprised that I take issue with his general description of the Government's record in relation to public health. That traduces the policies that the Government are taking forward and fundamentally misrepresents them. The Government have a good and strong record in relation to public health issues, which we intend to pursue into the future.

The hon. Member for North-East Hertfordshire raised a version of new clause 10 in Committee—

Mr. Heald

Does the Minister agree that there is a TB epidemic, vaccinations are down, and the sexual health of the nation is worse than it has been for a good deal of time? There are numerous public health issues—the re-use of surgical equipment is another, and all the diseases in hospitals. The Government's record does not look good. How would he defend it?

Mr. Hutton

The hon. Gentleman gives a highly selective account. He did not mention, for example, the enormous success of the introduction of the meningitis vaccine into the NHS. He did not refer to the flu vaccination policy that we have successfully introduced, and which has made a significant impact on dealing with winter pressures across the NHS. He did not mention the introduction of new public health strategies and policies for young people, including the policy to ensure that children at school have access to fresh fruit.

The hon. Gentleman can pick and choose and describe that record as a failure, but that is not an impressive argument. It overlooks the positive achievements. Of course, there is always more to do in the public health arena, but to say that the Government are doing nothing and that the public health of the nation has deteriorated is a travesty of the facts.

In Committee, we had a revealing discussion with the hon. Member for Oxford, West and Abingdon about new clause 10, which would give the Commission for Health Improvement the additional function of reviewing guidance on NHS priorities issued by my right hon. Friend the Secretary of State, directors of health and social care regions and strategic health authorities. It would ensure that the commission reviews, investigates and reports on that guidance in carrying out its other functions. There is genuine disagreement between us about the proper and effective role of the commission and of Ministers and the House in holding the specified people to account. This is an important point to thrash out. He might say that I am presenting a travesty of his argument, but I must put it to the House that the new clause is about transferring responsibility for scrutinising the work of Ministers to the Commission for Health Improvement. That is the wrong thing to do.

Dr. Evan Harris

That is a travesty.

Mr. Hutton

None the less, it is what the hon. Gentleman is trying to do and it is a mistake. It is perfectly legitimate and reasonable for Ministers, including my right hon. Friend the Secretary of State, to set priorities for the national health service. The hon. Gentleman' s election manifesto was full of priorities for the national health service. It dealt with the extra staff that he wanted to recruit and the extra procedures and so on that the Liberal Democrats wanted to introduce in the national health service. It is complete nonsense to suggest that it is inappropriate for Ministers to set priorities for the public services, including national health services, and to be accountable to the House. They should be accountable not to a ministerial or public body set up by the House, but to the House itself. That is the right constitutional balance.

Dr. Evan Harris

I intervene merely to make the same point as I made in Standing Committee. No one is suggesting that these priorities should not be set by Ministers. One can argue about their volume and the frequency with which they are sent out, but the question is whether they will be open to scrutiny in terms of their impact on the quality of patient care. Use of funds is a separate issue.

Mr. Hutton

Again, the hon. Gentleman misunderstands the current arrangements for ensuring the scrutiny that he and others, including me, want. It is not correct to say that the only way of ensuring the scrutiny that he and others want is to give the Commission for Health Improvement the proposed new function. A range of tools and mechanisms is available to aid the process of scrutinising Government policy. We should bear in mind the National Audit Office, the Audit Commission and the role of this place and the Select Committee on Health, which is so ably led by my hon. Friend the Member for Wakefield (Mr. Hinchliffe). A range of effective measures is already in place to ensure that the decisions taken by Ministers are subject to effective scrutiny. It is important that they are subject to such scrutiny. My argument with him is about his choice of the Commission for Health Improvement as the body that should provide additional scrutiny in respect of such decision making. I do not believe that that is the right way forward.

As the hon. Gentleman knows, the Bill strengthens the powers of the Commission for Health Improvement to do a better job throughout the national health service and to report to the House on what it has found out about the state of the health service. If the Liberal Democrats are looking for more effective ways of scrutinising Ministers and more ammunition in that regard, he should be aware that we are providing him with exactly that sort of ammunition. It is up to them to use it, but it is incorrect to suggest either that the current arrangements are defective and therefore justify new clause 10 or that Ministers are fighting shy of giving the Commission for Health Improvement a range of effective powers to deal with the issues that he and others have raised.

I have tried to set out my arguments clearly. I hope that the House will support the Government amendments and not seek to press the new clause.

Mr. Heald

The Minister's approach to new clauses 3 and 4 was constructive. We do not agree about the Government's record on public health, which we think is lamentable. None the less, he considered the new clauses and explained the complexity of the issues and made some points that I would like to consider further. I am not promising that the issues will not be raised again in the other place, but I shall not press the new clause. I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.