New Clause 16 - Reviews of care trusts
Health and Social Care
3:30 pm

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I beg to move, That the clause be read a Second time. The new clause attempts to write on to the face of the Bill provision for proper review of the operation and effectiveness of care trusts when they are established and the publication of the results of those reviews. It would apply to care trusts established under clause 45 or clause 46 by which the Secretary of State takes powers to set them up by order.

We are prepared to be open-minded about care trusts. We have listened to the arguments for them and we understand the logic of what is being proposed. However, it is a complex matter and, as Ministers have acknowledged, care trusts depend for their success upon people being able to work together to deliver services. On Tuesday, the hon. Member for Isle of Wight (Dr. Brand) referred to the need to merge two different cultures—the local government social services approach and the health service ethos, which is somewhat different. Everyone would acknowledge that there is a fairly tough challenge ahead to make care trusts work.

We know that in some areas social services and health bodies work together extremely well and very closely, and in other areas, frankly, they do not. Given that experience, we all acknowledge that it is possible that the outcomes for care trusts will be different in different cases. There will be lessons to be learned and best practice to be picked up and spread around.

The Government are keen on talking about evidence-based medicine and health care, and that is the right way to proceed. However—the Minister will forgive me if I use the same example again—we are not encouraged by of what happened in respect of NHS Direct. It was a perfectly plausible idea—one that the previous Government piloted in Wiltshire—that may have much to contribute to the future delivery of health care services. We should also work always on the basis that as a scheme is rolled out and pilots are established, they are fully evaluated and costed and properly reviewed and that decisions are taken in the light not of the need for a press announcement or a headline grabber the next morning, but of the evidence available, subject to proper objective evaluation.

In new clause 16 we are telling the Minister that we believe that it is a practical necessity that the operation of care trusts is properly reviewed and that the results of those reviews are published, and that that is essential to building public and professional confidence in the bodies concerned.

I have no doubt whatever that it is the Government's intention to review what happens to the first wave of care trusts. It would be bizarre to imagine that the Government would not be very interested indeed in keeping a close eye on what is happening. However, we do not want to find that the model is being encouraged, or perhaps even a little more than encouraged—people may be under pressure to adopt it—on the ground of supposed benefits that the Government claim to have detected on the basis of some internal review the results of which are not available for scrutiny, and therefore for objective analysis.

I hope that the Minister will accept the new clause as an attempt to ensure that the roll-out of care trusts is based on proper evidence and that best practice is disseminated. If he cannot accept it, I hope that he will be able to give the Committee some clear assurances about the independence of the evaluations that will take place, and an assurance that those evaluations will be published so that other bodies that may be considering making the leap into care trusts will be able to learn from the experience of those who have already gone down that route and make a properly informed decision.

Mr John Hutton (Minister of State, Department of Health; Barrow and Furness, Labour)

The hon. Gentleman is right to say that the Government have a strong interest in ensuring the effectiveness of the new care trusts. He put it very well. We discussed the relevant proposals at length on Tuesday. Of course there is some cynicism, doubt and uncertainty about the value that care trusts will bring. We remain strongly of the view that they will provide an important new opportunity for closer partnership working.

We had a long debate about the merits and principles underlying the proposals. We believe that closer partnership and working between those two very important pillars of our welfare society will enhance the patient and service user experience.

In making his argument, the hon. Gentleman probably dropped into it the seed of its own destruction. The hon. Gentleman's assumption in the new clause is first, that the existing review arrangements are not robust enough, or secondly, that they are somehow not publicly available, or thirdly, that the Government, for reasons that he would probably describe as ideological, would force the new system down the throats of a reluctant health and social care community against the evidence of whether they were working effectively.

We do not want to revisit the old debates about how his party ran the national health service, but that is not how we intend to run it. I will deal with his argument on three levels. Are there sufficient review arrangements and are the robust enough? Yes is the answer to that question.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

That is very good.

Mr John Hutton (Minister of State, Department of Health; Barrow and Furness, Labour)

Yes, it is a persuasive argument. The hon. Gentleman does not have to take my word for it. He needs to look at the breadth and depth of the review arrangements that are in place. I say to him again that they are much more robust and substantial than has previously been the case in respect of our ability to monitor the performance of public services.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I am grateful to the Minister and I would love simply to be able to accept his yes. However, the Minister is a fairly rigorous person. Is he really satisfied with the review process that has been applied to NHS Direct? Does he believe that NHS Direct has been rigorously and independently assessed and that its cost effectiveness has been properly evaluated prior to the announcement of the nationwide roll-out?

Mr John Hutton (Minister of State, Department of Health; Barrow and Furness, Labour)

Yes, I do. The benefits of NHS Direct are becoming clear to patients. In my constituency recently a man and his young family contacted NHS Direct. The young boy was developing meningitis, and if it had not been for that call to NHS Direct there is some doubt as to whether he would have survived.

I am using that as an example of the value of the benefits of NHS Direct, not to confirm the hon. Gentleman's point about the robustness of the review arrangements, but simply to highlight the benefits that NHS Direct undoubtedly has. NHS Direct has saved lives. I should be interested to know how the hon. Gentleman's benefit-cost analysis would put a value on the price of those lives. Perhaps he will tell us what he thinks that might be.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

If I could bring the discussion back to the review of care trusts, will the Minister tell me whether the same arrangements that are so robust in his view will apply to voluntary care trusts as well as imposed care trusts? Last week I asked whether the dissolution of a care trust, which is allowable under Government amendment No. 418, applies only to voluntary care trusts, or whether, after sensible assessment through the robust procedures of which the Minister spoke, is also available to the imposed care trust.

Mr John Hutton (Minister of State, Department of Health; Barrow and Furness, Labour)

Yes. The same review arrangements will apply. I shall list them briefly. Local authorities have a statutory duty to provide best value. NHS trusts are under a statutory duty of quality. The Commission for Health Improvement and the social services inspectorate each have a role. The local authorities have a scrutiny role, and the work of performance management is conducted by the regional office. We now have published data on performance assessment in local authorities and the NHS.

Performance tests and the assessment framework, best value reports, the role of the Commission for Health Improvement and of the social services inspectorate are all in the public domain. I assure the hon. Gentleman that there is no question of the Department of Health somehow cobbling together review arrangements and keeping them secret, thus making local government and the NHS follow the course of conduct that we want them to pursue. We want to put in place properly conducted, robust, independent review arrangements to demonstrate our case for closer partnership working. We have everything to gain from that approach.

The hon. Gentleman may be aware that the Department has a research and evaluation programme that will allow it to take a strategic view of the impact of care trusts. For example, we have commissioned the national primary care research and development centre in Manchester, in conjunction with the King's Fund, to undertake a survey of 72 primary care groups and trusts. That survey is now in its second year. The first report highlighted some of the issues that arise from partnership working, and provided some valuable information. The results of that research will be in the public domain, so that we can establish the benefits of closer partnership working.

The Committee has a simple choice on new clause 16: it must decide whether that material should be included in the Bill. I say that it is not necessary. We have strong arrangements in place to review the performance of care trusts and to allow that information to be in the public domain. If the hon. Gentleman presses the new clause to a Division, I ask my hon. Friends not to vote for it. However, I hope that the hon. Gentleman will feel sufficiently mollified and reassured not to press it.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I cannot say that I feel especially mollified by the Minister's words. He has his emollient days and his less emollient days, but I do not feel particularly mollified. He started by saying that the Government will review the arrangement objectively and rigorously, but went on to assert that they are strongly of the view that care trusts are a positive development. That is exactly my worry: the Government are, in effect, writing the verdict before evaluating the case.

In answer to my intervention on NHS Direct, the Minister cited an example—a good one—of a benefit that NHS Direct has achieved, but he will know, because he is a rigorous thinker, that one example, or even 100 examples, does not prove or disprove a case. He will know also that it was fairly scurrilous of him to ask me if I would tell the Committee what price or value I would put on a life. That was a horrendous question. However, because of the nature of the Department's work, cost benefit analyses have to address such difficult questions, because directing resources into one area necessarily takes them from another. It is a question not of how much value we put on a life, but of how many lives can be saved or enhanced with the available resources. The Minister knows that very well.

I shall look forward to the National Audit Office report on NHS Direct. We shall then discover whether the NAO, an independent and well-respected body, believes that the review process—the assessment of NHS Direct that took place before the announcement of the nationwide roll-out—was indeed a properly rigorous process that addressed objectively the costs and benefits of the service.

I am far from reassured by what the Minister said. I accept entirely that he will want to review the workings of care trusts. I wonder, however, whether the Government will be objective enough to allow that information into the public domain if it does not support their strongly held view, as clearly outlined by the Minister, that care trusts are a positive development. If that review process does not support that view, I would be surprised if Ministers rushed to get the results into the public domain.

Having listened to the Minister, and given that we shall have an opportunity to reconsider these matters next week on Report—perhaps, in the case of review mechanisms, on a slightly broader basis than just care trusts—I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.