Clause 3 - Supplementary payments to NHS trusts and Primary Care Trusts
Health and Social Care Bill
5:45 pm
Mr Philip Hammond (Runnymede and Weybridge, Conservative)
I am sure, Mr. Maxton, that you would not want me to elaborate on Conservative education policy, but the difference is that the Secretary of State has a specific power of direction to go behind the health authority, give the money to the trust and require it to be used for a particular purpose. I could launch a partisan discussion here, but I acknowledge that in certain circumstances everyone might agree that it was helpful for the Secretary of State to have that power. However, most right hon. and hon. Members would also agree, if they thought about it for a moment, that real problems of accountability arise in respect of the proper direction of substantial sums in an organisation as large as the NHS.
We cannot endorse a degree of micro-management that would allow the Secretary of State to make discretionary payments to individual PCTs for a specific purpose—£20,000, for example, to hire an extra person of a certain description in a certain PCT in Northumberland. That is a step too far. The Secretary of State should not have such power: in any case, he could not use it effectively. The rationale of devolved authority in an organisation on the scale of the NHS is that the central machinery cannot be sensitive to the needs of local organisations and structures. Parcelling out small sums of money from the centre is highly inefficient because the costs of going through the allocation process are relatively high in proportion to the amount involved.
Those are our main concerns about clause 3. I have aired the issues comprehensively. The amendment is designed not to correct all the deficiencies, which would wreck the Bill, but to add a measure of accountability and scrutiny by requiring the Secretary of State to publish details.