HC Deb 08 July 2003 vol 408 cc1009-16

'(1) Regulations made by the Secretary of State may provide that, where services of a description specified in the regulations are provided under arrangements under section 31 of the Health Act 1999 (c.8), the CHAI and the CSCI shall jointly—

  1. (a) review the provision by the parties to the arrangements of such services as may be specified in the regulations;
  2. (b) award a performance rating in respect of those services.

(2) The regulations may provide that the CHAI and the CSCI are to exercise their functions under this section—

  1. (a) at such times as may be specified in the regulations;
  2. (b) by reference to criteria determined by the CHAI and the CSCI and approved by the Secretary of State.

(3) The regulations may require the CHAI and the CSCI to publish a report after conducting a review under this section.'—[Dr. Ladyman.]

Brought up, and read the First time.

Dr. Ladyman

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

Madam Deputy Speaker

With this it will be convenient to discuss the following:

New clause 2—Duty of the CHAI to prepare standards guidance relating to health care—

  1. '(1) It shall be the duty of the CHAI to prepare guidance to assist in securing the raising of standards in health care.
  2. (2) In preparing guidance for the purposes of subsection (1), the CHAI shall have regard to performance indicators relating to—
    1. (a) the availability of, and access to, health care;
    2. (b) the quality and effectiveness of the health care provided to patients; and
    3. (c) the financial and other management of the delivery of the health care to patients.
  3. (3) The CHAI must—
    1. (a) lay a copy of any guidance prepared in accordance with the provisions of this section before Parliament, and
    2. (b) once they have done so, send a copy of it to the Secretary of State.'.
New clause 3—Duty of the CSCI to prepare standards guidance relating to social care—

  1. '(1) It shall be the duty of the CSCI to prepare guidance to assist in securing the raising of standards in social care.
  2. (2) In preparing guidance for the purposes of subsection (1), the CSCI shall have regard to performance indicators relating to—
    1. (a) the availability of, and access to, social care services;
    2. (b) the quality and effectiveness of the social care services provided to the public; and
    3. (c) the management of the delivery of the social care services.
  3. (3) The CSCI must—
    1. (a) lay a copy of any guidance prepared in accordance with the provisions of this section before Parliament, and
    2. (b) once they have done so, send a copy of it to the Secretary of State.'.
New clause 4—Duty of the CHAI to prepare standards guidance relating to health care in Wales—

  1. '(1) It shall be the duty of the CHAI to prepare guidance to assist in securing the raising of standards in health care in Wales.
  2. (2) In preparing guidance for the purposes of subsection (1), the CHAI shall have regard to performance indicators relating to—
    1. (a) the availability of, and access to, health care;
    2. (b) the quality and effectiveness of the health care provided to patients; and
    3. (c) the financial and other management of the delivery of the health care to patients.
  3. (3) The CHAI must—
    1. (a) lay a copy of any guidance prepared in accordance with the provisions of this section before Parliament, and
    2. (b) once they have done so, send a copy of it to the Secretary of State and the Assembly.'.
New clause 5—Duty of the CSCI to prepare standards guidance relating to social care in Wales—

  1. '(1) It shall be the duty of the CSCI to prepare guidance to assist in securing the raising of standards in social care in Wales.
  2. (2) In preparing guidance for the purposes of subsection (1), the CSCI shall have regard to performance indicators relating to—
    1. (a) the availability of, and access to, social care services;
    2. (b) the quality and effectiveness of the social care services provided to the public; and
      3. 1011
    3. (c) the management of the delivery of the social care services.
  3. (3) The CSCI must—
    1. (a) lay a copy of any guidance prepared in accordance with the provisions of this section before Parliament, and
    2. (b) once they have done so, send a copy of it to the Secretary of State and the Assembly.'.
Amendment No. 38, in clause 41, page 14, line 23, at end insert— '(lA) The Secretary of State must publish all such statements and must publish a statement of the evidence-base upon which these standards are set'.'. Amendment No. 39, in page 14, line 24, leave out from 'may' to end of line 25 and insert 'amend the standards whenever he considers it appropriate. (2A) The Secretary of State must publish amended statements, and must publish a statement of the evidence-base of the statements.'. Government amendment No. 359.

Amendment No. 1, in clause 45, page 15,1ine 34, leave out from 'must' to end of line and insert 'undertake an assessment of the performance of each such body in relation to the guidance issued under section [duty of the CHAI to prepare standards guidance relating to health care]'. Government amendments Nos. 360 to 370 and 372 to 377.

Amendment No. 226, in clause 70, page 28, line 20, at end insert 'of vulnerable adults and of people with disability'. Government amendments Nos. 379 and 380.

Amendment No. 2, in clause 73, page 29, line 14, leave out from 'must' to end of line and insert 'undertake an assessment of the performance of that authority in relation to the guidance issued under section [duty of the CSCI to prepare standards guidance relating to social care]'. Government amendments Nos. 381 and 382.

Amendment No. 3, in clause 75, page 30, line 24, leave out from 'CSCI' to 'a' and insert 'concludes as a result of an assessment that there is significant cause for concern about the effectiveness of the performance of. Government amendment No. 383.

Amendment No. 23, in clause 88, page 35, line 33, leave out paragraph (b) and insert— '(b) undertake an assessment of the performance of each such body in relation to the guidance issued under section [duty of the CHAI to prepare standards guidance relating to health care in Wales]'. Government amendments Nos. 384 to 386.

Amendment No. 56, in clause 114, page 51, line 5 at end insert—

'(5) Regulations may make further provision—

  1. (a) for prescribed functions of the CSCI to be exercised by CHAI on behalf of the CSCI;
  2. (b) for prescribed functions of the CHAI, so far as exercisable in relation to England, to be exercised by the CSCI on behalf of the CHAI.'.
Government amendments Nos. 387 to 396.

Amendment No. 57, in schedule 5, page 117, line 36, at end insert— '(4) The CHAI must consult and have regard to the advice of the Children's Rights Director under Schedule 6(5)(2) in discharging its functions under section 43(2)(d).'. Amendment No. 58, in page 119, line 14, at end insert 'and is to be responsible to it for the general exercise of its functions'. Amendment No. 59, in page 122, line 12, at end insert 'and is to be responsible to it for the general exercise of its functions'.

Dr. Ladyman

New clause 38 allows CHAI and CSCI to conduct jointly a review of services of a prescribed description provided under section 31 of the Health Act 1999, including reviews of care trusts. The aim of the new clause is to seek maximum flexibility to enable CHAI and CSCI to carry out, where appropriate, a joint review of services provided to the NHS and local authorities in partnership. We recognise and welcome the fact that the number and type of services provided under section 31 partnerships are constantly growing. We wish to allow for the possibility that in future it might be appropriate for CHAI and CSCI to carry out a joint review of certain services provided under a partnership and to award a performance rating in respect of those joint services.

Sir Patrick Cormack

On a point of order, Madam Deputy Speaker. Could we have English spoken in this Chamber, not these extraordinary mnemonics and so on? Can the Minister explain what he is saying?

Madam Deputy Speaker

Order. Perhaps Dr. Ladyman can respond to that point of order.

Dr. Ladyman

I certainly can. The Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection are often referred to as CHAI and CSCI for the sake of speed.

We wish to allow for the growth of organisations where those two services will have joint responsibilities. We want them to have the flexibility to be able to work together. For example, we may choose to provide in regulations that all adult mental health services provided under a section 31 partnership should be subject to a joint performance review under the clause. The Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection would be responsible for drawing up criteria under that section, which might include aspects such as how joined up and seamless was the provision of services under the partnership. The services provided under the partnership would still receive separate performance ratings for their health and social care elements, but we felt that it would be useful to have a separate rating to be able to judge the added value that the partnership had given to the service provision. We will consult all relevant stakeholders closely before drawing up any regulations under the provision and prescribing the services that will be subject to a joint review. I hope that that goes some way towards tackling the anxieties that the hon. Member for Sutton and Cheam (Mr. Burstow) expressed earlier about our determination that both organisations should work closely together.

Government amendment No. 359 has been tabled in response to a commitment that the former Under-Secretary of State for Health, my hon. Friend the Member for Tottenham (Mr. Lammy) made in Committee. That shows the hon. Member for West Chelmsford (Mr. Burns), who has unfortunately left his place, that my hon. Friend listened in Committee and was prepared to respond to good points.

The amendment makes it clear that the Commission for Healthcare Audit and Inspection will be concerned with all the factors in clause 43(2) when it exercises any of its functions that relate to NHS health care, not only the functions to which that provision currently refers.

The list of the Commission for Healthcare Audit and Inspection's functions in clause 43(2) will be extended to include giving advice and information under clauses 49 to 50 to the appropriate authority—my right hon. Friend the Secretary of State, the Assembly or the regulator—reviewing data obtained by others in relation to providing health care and any conclusions drawn from such analysis under clause 51; and promoting the effective co-ordination of reviews or assessments that other bodies undertake under clause 52.

The amendment will therefore ensure that, in discharging those functions, as well as the functions under clauses 44 to 48, the commission will pay particular attention to availability and access; quality and effectiveness; and the economy and efficiency of providing health care. In discharging those functions, the commission, as specified in clause 43(2)(d) and (e), will also concern itself with the need to safeguard and promote the rights and welfare of children and the effectiveness of NHS bodies or persons who provide—or are to provide—health care.

We gave assurances in Committee that we would consider further the application of the clause and I therefore hope that Opposition Members will support amendment No. 359.

Government amendments Nos. 360 and 361 are among the cluster of amendments that we are considering. Amendment No. 360 amends clause 46 to ensure that the Commission for Healthcare Audit and Inspection can undertake a review of the overall provision of health care by and for NHS bodies in England and Wales. We are taking the opportunity to clarify the function because the clause as currently drafted technically enables the commission to review only health care of a specific description. Without the amendment, the commission might carry out a review of cancer services in England and Wales but not of NHS care more generally.

Amendment No. 360 aligns clause 46 with clause 47 when amended by amendment No. 363 expressly to enable the commission to review the overall provision of health care by or for English NHS bodies and cross-border strategic health authorities.

Amendment No. 361 would ensure that my right hon. Friend the Secretary of State could request the commission to undertake such a review, should he consider one necessary. That will enable my right hon. Friend to ensure that the commission undertakes such necessary work so that issues of interest to the public or Parliament will receive the required attention from the inspectorate.

I shall not speak in detail about the other Government amendments, but, if I get the opportunity to do so, I shall happily respond to any points later in the debate.

Chris Grayling

In the few moments available, I want to concentrate on new clause 2 and amendment No. 1. Before I do that, I emphasise that it is a shame that the Government did not see fit to include in new clause 38, which deals with joint annual reviews, provision for joint reviews between England and Wales to avoid the huge duplication that the measure will cause across borders.

New clause 2 gives CHAI the right to participate in the process of setting standards. Under the Bill, it is the duty of the Secretary of State alone to prepare standards for health care. Conservative Members believe that that is unacceptable. That is doubly true when the Bill gives the new Secretary of State, who, by his own admission, has limited knowledge and experience of health care, the power to frame standards. There is no involvement of the Commission for Healthcare Audit and Improvement, which has the job of monitoring and tracking the performance of our health care system and understanding when it is and is not doing well. We believe that CHAI should be formally involved in the process, and new clause 2 would enable that to happen. I intend—with your consent, Madam Deputy Speaker—to press new clause 2 to a vote.

5.45 pm

Amendment No. 1 returns the debate to what is, in our view, one of the big handicaps and impediments confronting the health service: the star-rating system, an ill-judged, ill-thought-out process that sets hospital against hospital, causes confusion in both clinical and management sectors, and throws up extraordinary anomalies.

Let me, in the few minutes available to me, give a clear explanation and a clear example of the problem, with reference to the Audit Commission's recently published report "Achieving the NHS Plan". Three hospitals are cited. Of the first it is said: This Acute Trust performed poorly in relation to NHS Plan targets, and was rated as poor managerially". According to the second case study, This Specialist Acute Trust achieved most NHS Plan targets, and was rated as 'very good' on the majority of measures of financial and performance management". Pretty good, really. As for the third example, This Acute Trust has performed poorly in relation to NHS Plan targets, and the auditor noted significant financial management failings, without identifying any substantial signs of imminent improvement.

What do those three hospitals have in common? The first, which performed poorly in relation to NHS plan targets, was awarded two stars by the Department of Health. The second, which performed well, was awarded two stars. The third, which performed poorly and showed no substantial signs of imminent improvement, was awarded two stars.

The current star-rating system is a disgrace, which is founded on poor statistics and bears no relation to the true clinical performance of hospital trusts. As my hon. Friend the Member for Woodspring (Dr. Fox) said this afternoon, there are good hospitals in this country that are stuck with zero star ratings and all the handicaps that that entails. The star-rating system should go. It should be replaced by a system shaped by CHAI, on the basis of its experience of what is good and what is bad in our health service. CHAI should be given an active role in helping to shape the standards for health care.

I want to press new clause 2 and amendment No. 1 to the vote, because I believe that they would make a real and positive difference to health care, and would help to get the politicians out of the health service.

Mr. Burstow

I want to speak, exceedingly briefly, on amendments Nos. 38, 39, 56 and 59. In all of them the key issues are who decides standards, the process for setting them, and whether that should be entirely within the Secretary of State's remit or the commissions should play a role. That goes to the heart of the question whether the commissions are genuinely independent from the Secretary of State, or independent only at the pleasure of the Secretary of State. At present the Bill is inadequate, because the commissions are beholden to the Secretary of State in regard to much of what they must do.

Amendments Nos. 38 and 39 would require the Secretary of State or indeed the commissions, when publishing standards, to have an evidence base and to refer specifically to the evidence. That strikes me as a sensible proposition, on which a thinking Minister might wish to reflect.

We will support both the amendments that will shortly be put to the vote, not least because we believe that the star-rating system is deeply corrosive of the national health service. It misleads patients, and does not provide an adequate or reliable measure of what NHS performance actually is. It should be swept aside, and replaced by something that is more objective and more independent. We presented that argument in Committee in rather greater detail than I can present it now, but I hope that there will be more time to discuss it in the other place.

Madam Deputy Speaker

Order. Time is up.

Sir Patrick Cormack

On a point of order, Madam Deputy Speaker. May I put on record that the debate has not been concluded, and that two subjects of great importance to your constituents and mine, and everyone else's, have not even been touched on? Will you please report that to Mr. Speaker when you ask him about taking Division time out of programme time?

Mr. Lansley

Further to that point of order, Madam Deputy Speaker. Would it be appropriate also to note that I sought to discuss new clause 22, which stands in my name, in Committee, but it was not reached by virtue of the time limitations imposed in Committee? So this is the second time that it has not been debated.

Madam Deputy Speaker

I am very mindful of what Members have said, but as I am sure that they will appreciate, I am bound by the programme order.

It being more than four and three quarter hours after the commencement of proceedings on the programme motion, MADAM DEPUTY SPEAKER proceeded to put forthwith the Questions necessary for the disposal of the business to be concluded at that hour, pursuant to Order [this day].

Question put and agreed to.

Clause read a Second time, and added to the Bill.

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