Mr Chris Grayling (Epsom & Ewell, Conservative)

I beg to move amendment No. 460, in

clause 36, page 13, line 27, after 'the', insert 'Independent'.

Mr Win Griffiths (Bridgend, Labour)

With this it will be convenient to discuss the following amendments: No. 461, in

clause 36, page 13, line 28, leave out 'CHAI' and insert 'ICHAI'.

No. 368, in

clause 36, page 13, line 28, at end insert—

'(1A) Subject to any duty imposed on it by statute, the CHAI shall have complete discretion in the discharge of its functions under this Part.'.

No. 462, in

clause 36, page 13, line 29, leave out 'CHAI' and insert 'ICHAI'.

No. 463, in

clause 37, page 13, line 31, after 'the', insert 'Independent'.

No. 464, in

clause 37, page 13, line 32, leave out 'CSCI' and insert 'ICSCI'.

No. 369, in

clause 37, page 13, line 32, at end insert—

'(1A) Subject to any duty imposed on it by statute, the CSCI shall have complete discretion in the discharge of its functions under this Part.'.

No. 465, in

clause 37, page 13, line 33, leave out 'CSCI' and insert 'ICSCI'.

Mr Chris Grayling (Epsom & Ewell, Conservative)

Good morning, Mr. Griffiths. We now move on to the audit and inspection structure that the Government aim to establish—the Commission for Healthcare Audit and Inspection. However, in the amendments that have been selected this morning, we hope to make a small modification by adding the word ''Independent'' at the beginning of the titles of the Commission for Healthcare Audit and Inspection and its counterpart for social services.

The tone of the debate that is likely to follow, not just on this set of amendments—I know that Liberal Democrat Members are minded to go in the same direction—but on a number of other issues that arise on this part of the Bill will show how important it is

that the body established to inspect health care should be independent. If my hon. Friend the Member for West Chelmsford (Mr. Burns) is fortunate enough to catch your eye in this debate, Mr. Griffiths, he wishes to address the same point in relation to the Commission for Social Care Inspection, or the ICSCI, as we hope it will be. The bodies must be truly independent of the Government, truly able to set out standards for health care, to play devil's advocate to the Government and the health care providers and to provide a quality of health care that goes far beyond the rather constrained nature of the present system, driven as it is to far too great an extent by the targets culture established by the Government, which is doing so much damage to the provision of health care.

Too much of this part of the Bill still leaves reference points, controls and influences inappropriately in the Secretary of State's hands. In the run-up to this debate a number of reports in the media, which access the behind-the-scenes discussions taking place in the Government and in health care about the Bill, have called into question the Government's motives for creating the inspectorates, asking whether they are likely to be as independent as the initial rhetoric has made out.

For example, on 7 March the Daily Mail reported:

''Alan Milburn was accused last night of trying to gag a new NHS watchdog before it even starts work. The Health Secretary has insisted that the Commission for Healthcare Audit and Inspection . . . will be independent and have real teeth. But a draft version of the Bill to create the watchdog, which will take over the Audit Commission's role in the NHS next year, reveals that ministers want to keep it on a tight leash.''

The Times reported:

''A senior Whitehall source said . . . that a draft of the legislation showed the Department of Health was seeking to water down previous guarantees of the commission's independence. The source claimed that ministers were seeking 'powers of intervention and initiation' to direct inquiries, while also limiting its right to publish findings without prior departmental clearance.''

Although many of the measures in the Bill establish CHAI as an independent body, members of the Committee will see as we go through the debate a number of areas where that independence is compromised. This symbolic set of amendments at the start of the debate on CHAI is designed to reinforce the organisation's independence.

We are adopting this approach for a number of reasons. The first is the flawed nature of the star rating system, which is perpetuated in the Bill. That system is not a truly independent assessment of the quality of health care. We stress in our amendments that the commission must be independent—independent in its very name through to the way in which it is established, the details of the way in which it works and the parameters within which it works alongside the Government. The star rating system does not reflect an organisation that can provide a true and independent assessment of the quality of health care. The most obvious reason for that is that the star ratings do not reflect clinical outcomes: they are fundamentally about administrative matters. They measure such things as financial management, hospital cleanliness and the length of time that patients wait for treatment, all of which are important, but they do not measure

clinical outcomes; they do not assess whether people get better. What more important measurement could there be of the effectiveness of our health care system than the quality of the clinical outcomes that it delivers?

We believe that a truly independent inspectorate would ensure a much broader reflection of the strengths and weaknesses of hospitals, not simply in the way in which they are run or meet objectives, but through the quality of the health care that they deliver. We want an independent inspectorate to pursue that dimension of its work, and not simply the management framework, as occurs in the current star rating structure. Once again, it is essential that the word ''independent'' be added to strengthen the organisation and set the tone from the start of the debate by saying that these bodies will be free of the Government.

In far too many areas the focus on Government targets is reflected in the way in which the Commission for Health Improvement works. When we debate clause 46 we will see how that clause perpetuates that link and the Government's ability to use their political objectives to shape the inspectorate's work and how that link distorts the work of our health care system.

Too many examples today point to a lack of independence and the fact that CHI—the Commission for Healthcare Audit and Inspection, as it will become—is not independent of government. They show that in too much of its work it is a tool of government. We have seen some clear examples of the way in which the targets culture distorts clinical decision making.

Mr Win Griffiths (Bridgend, Labour)

Order. I want to clarify a point. The amendments relate to the body's independence, but you have jumped one step ahead. Indeed, you have said that the issue of targets and how the service will respond will come up again. That is not strictly part of this debate. Therefore, while it is fair to refer to it, I do not want an in-depth analysis of it: that can come later.

Mr Chris Grayling (Epsom & Ewell, Conservative)

I am grateful for your clarification, Mr. Griffiths. The point, as I am sure you will appreciate—

Mr Win Griffiths (Bridgend, Labour)

I can see the point that you are making. I do not want a lot of detail on it.

Mr Chris Grayling (Epsom & Ewell, Conservative)

We want to see an inspectorate that is truly independent. My hon. Friend the Member for West Chelmsford will address in the same context the issue of the parallel bodies that the Bill establishes. The Liberal Democrat amendments, with which I have some sympathy, would also strengthen the perceptions and nature of the inspectorate's independence from Government.

As we debate this part of the Bill, we will pursue a system of inspection that is independent, takes a dispassionate view of the quality and delivery of health care in this country and does not allow political priorities to interfere with the decision making, quality and nature of assessment and the reference points that

it uses. We want a system that truly reflects whether our health service is doing a decent job and making us better in a way that minimises the impact of illness on quality of life. Our intention is to set a clear tone for the debate and place on public record where we believe that the organisation should sit, what powers it should have, and how we can ensure a clear and pronounced separation between it and the Government.

The organisation should also monitor the Government. As the Government will continue to play a significant role in the management of health care in this country, why should they be free from the scrutiny of the watchdog? Why should the watchdog not be able to tell the Secretary of State when his Department is not working correctly and impeding clinical work across the NHS? To do that, the watchdog must be independent and have the power to act according its principles. It should have the necessary professional expertise and resources and, ultimately, it must be a free organisation that can make a real difference to health care.

That is what we shall argue for as we debate this part of the Bill, and I hope that the Government will be willing to have a reasoned and sensible debate about how we can strengthen the organisation and give it the teeth that it will need to make a real difference to health care.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

I am pleased to reach part 2 of the Bill on the regulatory framework in which our health and social care system should be conducting its business. In some respects, part 2 constitutes a more important and long-standing change to health and social care in this country than what we have debated so far in Committee, as foundation hospitals will be regulated through the structure that it provides. The whole of the NHS, private health care and social care will be dealt with by part 2. It is an important lever for driving up quality, guaranteeing standards and securing the rights of vulnerable people and patients.

I welcome the debate on how independent the bodies are intended to be from the Government and how much discretion they will have to act in what they believe are the best interests of the groups that I have just described. I subscribe to the points made by the hon. Member for Epsom and Ewell (Chris Grayling) about his amendments and the concerns that he and his colleagues have, and they will form a thread that will run through debates on the Bill until its conclusion in both Houses. If we cannot make progress on the issues in this House, I hope that we can secure some much-needed improvements in the other place.

There are some questions about the Conservative amendments. They would effectively create bodies called ICHAI and ICSCS, and I am not certain that having a body whose name sounds like ''itchy'' would provide the standing that we would want a body that inspects health care in this country to have. The question is whether what is in a name is important, and the hon. Gentleman said that adding the word ''independent'' to the relevant provisions would be a small modification. Indeed, the amendments allow this debate to take place, but our amendments aim to

provide some substance behind that and clearly mark out the ability of the new CHAI and CSCI to act at a distance from the Government and to take their own decisions. When the Secretary of State introduced the paper on the NHS plan to the House last April, he said that CHAI and CSCI would in effect act as the judge and the people would act as the jury, informed by what they did.

The hon. Gentleman rightly asked a question that has been explored during the deliberations of Committees on previous health care legislation: surely these bodies should have within their remit the ability to consider critically and in detail the impact of Government directions, guidance, regulations and other legislation on the way in which the NHS and social care providers go about their activities, and especially on their ability to deliver their services efficiently, effectively and economically. The Bill is deficient on the health care side of inspection in that regard.

The hon. Gentleman also talked about the target culture in the NHS. I shall respect the restrictions that you have placed on the debate, Mr. Griffiths, but I want to refer briefly to the hon. Gentleman's point. The Liberal Democrats are also concerned about the existence of what I would describe as a spreadsheet, tick-box and targets approach to the NHS, which already has the effect of distorting clinical priorities. The Opposition fear that that approach will now inform the work of both commissions. Indeed, it will distort the priorities of CHAI and CSCI. During our debate on the clause, the Liberal Democrats want to talk about how we can ensure that we maximise the independence of CHAI so that its ability to conduct inquiries is not fettered in any way.

Amendments Nos. 368 and 369 stand in my name and those of my hon. Friends. The purpose of clauses 36 and 37 is simply to set out the foundations for the new regulatory bodies. Since the Burden report in 1996, which the previous Conservative Government commissioned, the Health Act 1999, the Care Standards Act 2000 and other subsequent legislation, the Government seem to have been grappling with the problem of how best to organise regulation of health and social care in this country. The amendments offer us the opportunity to probe the Government's intentions regarding the independence of the new bodies. As we proceed with our debate on this part of the Bill, we want to test the Government's willingness to allow CHAI and CSCI to be as genuinely independent as possible.

In the statement of purpose, which I am sure hon. Members on both sides of the Committee will have studied in some detail in preparation for the debate, the Secretary of State set out several ambitions for the body. He said:

''CHAI and CSCI will be the authoritative, independent judges of the quality and efficiency of health and social care in England, and will be the driving force for their continuous improvement.''

He went on to say that it will be inspected, and that the bodies will have independence because an independent body will appoint them. How will the bodies be guaranteed their independence? Schedules 5 and 6 show that the Bill does not provide for members of the

commissions to be appointed by independent bodies, but by the Secretary of State. I hope that we will be able to clarify that point as the debate proceeds.

During the Secretary of State's statement about the NHS plan and its delivery in April 2002, he made several comments about how he saw the body being more independent than the Audit Commission. I want to ask the Minister just how he sees that happening. I hope that he can explain how the two new commissions will be more independent than the Audit Commission. Is it simply that they will be appointed independently, because that is not provided for specifically in the Bill? Is it simply that they will be able to make their own choices about what they inspect, because that of itself is no different from the Audit Commission arrangements? Will they be as independent as the National Audit Office and the Comptroller and Auditor General? Will they have similar powers to report to this place?

This part of the Bill seems to be full of strings that firmly tie both commissions to the Secretary of State. As has been said already, there are powers of intervention and initiation. When one looks at the provisions for the old Commission for Health Improvement—

Mr Win Griffiths (Bridgend, Labour)

Order. This Room's acoustics do not appear to be as good as those elsewhere, or perhaps they are better in the sense that whispers can be heard. If hon. Members need to say anything to each other they must do so in such a soft voice that they might prefer go outside.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

That is very kind of you, Mr. Griffiths.

Mr Win Griffiths (Bridgend, Labour)

I was having difficulty hearing what you were saying.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

And, as a consequence, making sure that I stay in order.

I was about to say that the statutory basis for the Commission for Health Improvement does not stipulate that the Secretary of State can determine precisely how it measures performance within the NHS. There is such a stipulation for CHAI, and that is a clear diminution of the organisation's ability to act independently.

''Delivering the NHS Plan'' goes to the heart of the debate. Chapter 10.8 states:

''New legislation will be needed to establish the Commission. The new Commission will be more independent of Government than the Audit Commission, CHI or the NCSC. Commissioners will be appointed by the Independent Appointments Commission, rather than by Ministers, and in accordance with Nolan rules. The Commissioners, rather than Ministers, will appoint a Chief Inspector of Healthcare.''

How will that be given effect? How will that independence be protected so that a different Minister with a different agenda could not simply choose to make the appointment for himself as the Bill allows? How will CHAI be more independent?

That leads me to the two amendments in my name. They would replicate the independence enjoyed by the National Audit Office. They are modelled on section

1(3) of the National Audit Act 1983 and are intended to strengthen the hand of both commissions in discharging their functions. They basically say that unless there were statutory duties to the contrary the commission would have the discretion to do whatever it believed appropriate to discharge its functions under this part of the Bill.

In ''Delivering the NHS Plan'' the Government acknowledge that the current regulatory arrangements have evolved very rapidly. I said earlier that over the last five years we seem to have been in Standing Committees almost every year tinkering with the regulatory framework yet again. It has been interesting to see how the Government have gradually moved closer to the position that my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) and I pursued during the Committee proceedings on the Health Act 1999 and the Care Standards Act 2000. We argued for greater integration of regulators so that we have a common regulator for health care. At each stage Ministers advanced grave doubts and principled reasons for rejecting both our arguments and our amendments.

The Bill does much of what we sought during Standing Committees in 1999, 2000 and 2001. It means that we will have a more integrated architecture for regulation. However, given that the Government now accept that health and social care are one system, in which over-population with inspectors has led to fragmentation and confusion, why do they not take the next step and create a single, independent commission that regulates the whole of health and social care? Annex B of the regulatory impact assessment for the Bill considered that question and set out four options.

The first option was to do nothing and leave things as they are. The second option was to create two inspectorates, which the Bill does. The third option was to say, ''Well, we'll muddle on. There will be more power, more convergence and co-ordination, and more co-operation and joint working.'' The fourth option was for a single commission and a single inspectorate. The Government made interesting comments about what they felt was the downside of having two separate bodies. On option 2, paragraph 20 states:

''The disadvantages of separate health and social care inspectorates are that it leaves the boundary between health and social care unresolved and does not remove the need for co-operation; different methodologies between health and social care inspections remain.''

That key criticism and concern about how the new arrangements will work over the next few years is shared by many people outside the Committee.

Just for completeness, let me quote what the document says on option 4:

''A single health and social care inspectorate would require significant organisational disruption in creating the new body and a reduction in the effectiveness of inspection and review while the re-organisation takes place; and strong opposition from the bodies themselves. There would be grave doubts as to how effective the focus of such a large body could be.''

That reads to me like an argument that could have been applied to any of the options, but was conveniently deployed to negate the case for a single commission.

Mr Win Griffiths (Bridgend, Labour)

Order. Although the hon. Gentleman is pursuing an interesting line of argument, I cannot see on the amendment paper an amendment that proposes bringing the two bodies together under clause 36. Although he can mention that in passing, we do not need a big debate about whether there should be one or two bodies.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

I was testing your tolerance, Mr. Griffiths, to establish whether the issue might provide the means to have a clause stand part debate now, but I am more than happy to return to these points on clause stand part—[Hon. Members: ''No!''] Some members of the Committee may not want that.

Mr Win Griffiths (Bridgend, Labour)

It would not be in order on clause stand part either.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

So we cannot discuss the principle of the measures. We will find a means of doing so later.

Mr Win Griffiths (Bridgend, Labour)

If the hon. Gentleman had tabled an amendment saying that the two bodies should be one body, we could have debated that, but he did not, so I cannot allow a debate on it.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

I take the point. I am trying not to dig myself deeper into a hole, Mr. Griffiths, but I seek your advice about whether it would be in order on clause stand part—[Hon. Members: ''No!''] Let me finish. I want to clarify whether it would be in order on clause stand part to establish the rationale for the two commissions. That is what I am seeking to do. I am not arguing that there must be a single commission but simply trying to establish, by testing the idea of a single commission, how we have ended up with two bodies, which is what the Bill provides for.

Mr Win Griffiths (Bridgend, Labour)

The Minister is now aware of what the hon. Gentleman has said about the matter and no doubt he will respond.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

Thank you, Mr. Griffiths.

On that basis, the issue of independence is a litmus test for Opposition Members. We hope that the Government find the amendments acceptable, given that they are already established in law in other respects and that they would do what the Government say they want to achieve, which is to ensure that the new bodies are more independent than the Audit Commission and other inspection bodies.

Mr Simon Burns (West Chelmsford, Conservative)

I rise briefly to support the amendments in my name and those of my hon. Friends, and to agree with certain aspects of the Liberal Democrats' amendments, because I, too, believe that it is crucial for the bodies to be, and to be seen to be, effective and totally independent in carrying out their duties in both the health care and social care sectors.

The Government heralded their intention to create the Commission for Social Care Inspection in the publication entitled ''Delivering the NHS Plan'' last April. I agree that there is logic to the creation of that body, which will in effect be the National Care Standards Commission mark II. The original commission fulfilled a badly needed role in improving and enhancing social care. I suspect that whatever their party, hon. Members would not take issue with that intention.

However, there are flaws in the NCSC, whose short life will continue until the Bill comes into force. The rules and regulations that it issued, with the best of intentions, were over-prescriptive and did not hit the right targets to maintain and raise the highest standards of care. That was partly because there was too much interference from the centre; despite repeated warnings, the commission seemed to think it knew better than those on the ground who provide the care. The Government must get the new commissions right at the outset, so that they do not have to come back to the House and relax some of their highly prescriptive measures, as they had to do last summer. The Bill should state that both CHAI and the CSCI will be genuinely independent, so that there is no misunderstanding.

The hon. Member for Sutton and Cheam (Mr. Burstow) made an extremely interesting point, drawing an analogy with the National Audit Office. No one disputes the NAO's independence and integrity, although it was set up in Parliament by the politicised Government of the day. Its integrity was established at the outset, and as a result people respect its reports and views as being independent, unbiased and free from political interference. That is what should be achieved in respect of the two proposed bodies.

The Minister will no doubt tell us that the bodies will be independent; Ministers have made such statements in the past, and I do not question their sincerity. However, I question whether that will happen in reality. Very often, with the best of intentions, the Government interfere to try to rectify a problem within an individual area of a commission's responsibility, and that compromises the body's independence. I hope that the Minister will think again in light of the debate and amend the Bill to ensure that from their commencement the two commissions have integrity, are independent, and are seen to be so.

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

This is a joyous occasion for me. It is my first sojourn in Committee as a Minister, and we are debating a very important Bill. I am grateful for your chairmanship, Mr. Griffiths.

First, I shall put the formation of CHAI and the CSCI in context.

I hope that it is fair to say that all parties have much to be proud of in the achievements of the NHS since its inception in 1948. However, despite the comprehensive and universal care to which the people of this country are entitled, we have not been able to

deal with some of the serious inequalities. It is not controversial to suggest that, as with many British institutions, the NHS may have sometimes seemed elitist, and to have been run in the interests of those who provide the service, rather than in the interests of patients. Certainly, it has seemed that way to my constituents, and no doubt also to those of Chelmsford, Epsom and Ewell, and Sutton and Cheam.

I therefore believe it to be important that, in this new century, we address for the first time the fundamental issue of standards in the NHS. The Government are proud that we set up the Commission for Health Improvement and raised the question of standards in the NHS. It is right that patients throughout the country should be entitled to expect a certain standard of care, not just in NHS hospitals, but in private hospitals. Moreover, in terms of the relationship between the NHS and social care, it is important that the vulnerable in our society, whether they are children in care, or the elderly in our communities, should be able to expect a certain standard of care in the social care arena.

The Bill is important, and our discussions this morning and in the sittings ahead will be fundamental to creating a new NHS. Patients want to be confident that the extra resources that we are investing in the NHS—as hon. Members will know, the 1 per cent. increase in national insurance is directed primarily at the NHS—are being spent well. They will want to draw that confidence not only from the Government, but from an independent health watchdog.

Mr Chris Grayling (Epsom & Ewell, Conservative)

The Minister mentioned standards and deployment of resources. Does he accept the point made by the Opposition that one of the flaws in the current system is that health care outcomes are not measured? The measurement of health care quality by the standard of ''Does the health service make me better?'' is conspicuous by its absence, both from his remarks about the importance of the inspectorate and the way in which the current system operates.

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

No, I do not accept that, because the new independent inspectorate will be able to examine clinical outcomes, and the Commission for Health Improvement, in its relationship with the royal colleges and other organisations, also seeks to examine those areas. I therefore do not believe that that matter is controversial. That is not the best point that the hon. Gentleman has made.

Patients want to know that the institution in which they are receiving their health care is of the highest standard and that it is moving forward. That is being achieved not only by the institutions but by a range of other actions that the Government are taking. For example, one of the most important things that I have done in the past year, within my ministerial portfolio, was to issue the national service framework on diabetes. That sets out a clear template for the care that people suffering from diabetes should expect to receive, wherever they are. That work, taking place alongside that done by the National Institute for Clinical Excellence, the inspectorate and the royal

colleges, should give people confidence in the institutions, their standards of care and the clinical outcomes. I am sure that we will return to the issue that the hon. Gentleman raised.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

Does the Minister believe that the Bill allows for either commission, in reporting publicly, to express reservations about its ability to absorb and comply with the Department's targets and performance measures?

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

The hon. Gentleman should direct that question to those who will head the new organisations if the Bill is passed and they are established.

We had a heated discussion yesterday about waiting times in accident and emergency departments, but it is clear from our success in tackling coronary heart disease that national service frameworks and targets focus people's minds and raise standards. We should applaud that because it directly benefits our constituents.

Mr. Burstow rose—

The Chairman: Order. I do not think that we can explore that issue any further now. The debate on clause 47 would be a good time to do so.

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

I shall concentrate on how CHAI will directly benefit the people of this country. It will effectively become the nation's health watchdog; one that is genuinely independent and in which people can trust. I hope that, over time, its name will become common parlance in the homes of our constituents. By publishing its criteria for inspections and other reviews it will demonstrate the value for money that people want to see in the NHS, given that they are paying for it through general taxation.

Dr Evan Harris (Oxford West & Abingdon, Liberal Democrat)

In making this point, I am also asking you, Mr. Griffiths, if it is in order. My hon. Friend the Member for Sutton and Cheam asked whether, in the Minister's view, not that of people who have yet to be appointed, the clause will, without our amendment, give the bodies sufficient independence to comment on, and perhaps to criticise or even praise, the Department's policy and guidelines. My hon. Friend did not say whether targets are good or bad; he asked a narrow question about the Minister's opinion.

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

I indicated to the hon. Member for Sutton and Cheam that we can, if he wants, ask a series of ''what if?'' questions about the new inspectorate. I am afraid that I cannot read Sir Ian Kennedy's mind and tell the Committee what he thinks about different aspects of Government policy as they develop. I want to explain why CHAI is independent and how it can realise its independence as it takes shape.

The hon. Gentleman will know that this is not a completely blank canvas because we already have the Commission for Health Improvement, which has, in several of its reports, been fairly robust with Ministers about decisions that we have made and targets that we

have set. I am pleased that it has also praised our achievements. The steps that we are discussing take us forward; we are merging bodies to create a more powerful organisation with greater independence. The Bill speaks for itself, as do the individuals involved. I understand the hon. Gentleman's preoccupation with targets, but the clause is about far more than that, and as you indicated, Mr. Griffiths, we will discuss these issues in greater detail as we move on.

It is important to recognise that CHAI will help to identify ways in which the quality of health services can be improved, and it will ensure that appropriate arrangements are in place to promote the health needs of the local population. Hon. Members will know that there are three planks to the Government's policy on the NHS. The first, clearly, is standards, and the second is local delivery. Local outcomes and accountability are important. The third plank is the exciting development of choice in the NHS. It is important that people are able to exercise choice regarding their health care provider, and CHAI will assist in that.

CHAI will also reduce the fragmentation of inspection, helping to ease burdens on front-line staff. It will, for the first time, enable the NHS and private health care providers to have a single rigorous inspectorate, armed with the ability to highlight good practice and expose poor performance. There will be few Members who have not, in their surgeries, had constituents complaining about the proximity of Government to the private health care system, and the merging of the two inspection systems under CHAI is a significant development.

The Government will no longer be the judge and jury for the NHS. CHAI will be the judge, and the people, as they come to trust and believe in that new independent body, will be the jury. Importantly, the provisions have been drafted to enable CHAI to be more independent than the old Commission for Health Improvement and the Audit Commission. CHAI will also report directly to Parliament and the National Assembly for Wales on the state of health care in England and in Wales.

Dr Andrew Murrison (Westbury, Conservative)

I am heartened to hear that the body will be so independent. How refreshing! I remember that the National Institute for Clinical Excellence was meant to be independent. It was independent up to the point at which a new stipulation was put on it that it should consider affordability when it reached its conclusions. Will the Minister reassure the Committee that such as stipulation would not apply to the new bodies?

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

I believe that I said that merging the bodies together in an environment in which more resources go to the NHS provides an environment in which the public can have confidence that the money is being spent well. That is the general direction of travel, and must be so in the public sector. I am not clear about how affordability in the private sector would pertain to standards across the board.

Dr Andrew Murrison (Westbury, Conservative)

The Under-Secretary has failed to answer my question and to give me the assurances that I sought. I am not talking about the private sector, but am suggesting affordability as a political decision. NICE was enjoined to make such political decisions in the extra stipulation placed on it after it was created. In the context of the independence of the new bodies, my worry is that such a thing will happen again.

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

Forgive me; the hon. Gentleman used the word ''affordability.'' I misunderstood the context in which he was using it. In a sense, he is talking about cost-effectiveness. He is right to say that NICE is the body charged with that as the new commission draws up its criteria, which are agreed by the Secretary of State. It can choose to address these issues or not to address them.

Mr Stephen McCabe (Birmingham, Hall Green, Labour)

May I seek an assurance from the Under-Secretary that any body that we establish will have a realistic view of available finances? It must be a new Conservative philosophy that money is no object. I have never heard that one before. I seek an assurance that viability of cost will be part of the consideration. Otherwise, we are living in ''Alice in Wonderland''.

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

Absolutely. My hon. Friend can be assured of that. As I said, in an environment in which are putting more money into the NHS and in which our constituents and the public expect more from the NHS and expect the right standards, it is right that that money is spent appropriately and that our new inspectorate is involved in that discussion as we see the Department of Health's policies take shape.

The hon. Member for Sutton and Cheam raised the independence of the new CHAI in relation to the Audit Commission. In many areas, it is clear that the new CHAI is more independent that the old Audit Commission was. The hon. Gentleman will know that the chairman and the commissioners of the Audit Commission were appointed by the Secretary of State. The chairman and the commissioners of the new CHAI will be appointed by the Appointments Commission under the Nolan principles. That is the same for the chief executive. The tenure of the chairing commissioners for the Audit Commission could be set by the Secretary of State, which is not the case for the new body. The Secretary of State also had a general direction-making power for the Audit Commission to issue directions in the exercise of its functions, but there are no general powers in the Bill to issue directions to CHAI. That demonstrates how the new CHAI is more independent than the Audit Commission.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

I thank the Minister for trying to allay my fears, but will he confirm that the relevant schedules to this part of the Bill stipulate that the Secretary of State makes the appointment? The Secretary of State could then choose to exercise that power through the Special Health Authority, but that is not stipulated in the Bill; a different Secretary of State could choose to make the appointment for himself.

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

It has been the arrangement for some time for the Secretary of State to make appointments across the NHS through the Special Health Authority, which the hon. Gentleman will know is headed up by Sir William Wells. That is the current practice for boards in primary care trusts and strategic health authorities, and it will be for the new CHAI and the new CSCI. We could debate hypothetical views of Parliament in years to come but, under the Bill, the Secretary of State will make the appointment through the Special Health Authority. That is now the established procedure across the NHS, and the hon. Gentleman should have confidence in it.

Mr Chris Grayling (Epsom & Ewell, Conservative)

Does the Minister not accept that there have been many examples in recent years of appointments being made not simply for professional or expertise reasons? We are establishing the watchdog for the future of the national health service, so is it not right to look for the most effective and independent route possible for making such appointments? That is not what he is describing.

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

No, I do not accept that. No one will suggest that the chair designate, Sir Ian Kennedy, who was responsible for the inquiry into the Bristol Royal infirmary, is not independent or that the current CHI is not independent. The practice and behaviour of the NHS Appointments Commission has been exemplary. The hon. Gentleman might remember that some Members were very concerned that they would not have as much leverage on who would become chair or non-executive of their local trust when the Secretary of State decided that such appointments be made by a new commission. If I remember correctly, that issue was hotly debated about the time I was first elected to Parliament.

Several hon. Members rose—

Mr. Lammy: We are straying beyond the point, and I still have not reached the detail of the amendments.

Mr Simon Burns (West Chelmsford, Conservative)

Is the Under-Secretary talking out the Bill?

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

Not at all. I am trying to make progress, as the hon. Gentleman will know. I wanted to provide the context, and I want now to move on.

Dr Evan Harris (Oxford West & Abingdon, Liberal Democrat)

Before the Under-Secretary moves on, I hope he will accept one question. He raised an interesting point about the direction-making powers on this new organisation compared with the Audit Commission. He said that there were fewer powers in respect of CHAI than in respect of the Audit Commission. I do not necessarily dispute that but could he look at clause 58 and explain how that is weaker? It says:

''In exercising its functions under this Chapter the CHAI must have regard to such aspects of government policy as the Secretary of State may direct in writing.''

Perhaps not now, as it a surprise question, but I should be grateful if the Under-Secretary explained how that fits in with what he just said about there being fewer powers of direction over CHAI than over the Audit Commission.

Mr Win Griffiths (Bridgend, Labour)

That could be tackled on a later clause.

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

May I come back to that at a later date?

I turn to amendments Nos. 460 to 464. They would add ''independent'' to the names of the inspectorates. Presumably, the amendments are to test our resolve to ensure that the new inspectorates are autonomous. But, in a sense they are autonomous, and they are independent under the Bill. Inserting the word ''independent'' adds nothing. We made it clear in ''Delivering the NHS Plan'' and subsequently in CHAI and the CSCI's statements of purpose that both inspectorates will be more independent of Government than the bodies that are being merged; namely the old CHI, the Audit Commission and the National Care Standards Commission.

Mr Chris Grayling (Epsom & Ewell, Conservative)

The Under-Secretary has just made our point. These two new bodies will be ''more'' independent of Government, rather than independent of Government. Does he not understand why the Opposition are pressing our amendments?

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

There is a basic philosophical point that I am happy to debate with the hon. Gentleman. As I have said, CHAI and the CSCI are more independent. I suspect that if we go too far along the trajectory towards total independence, we come to a different constitutional arrangement. Ultimately, the Secretary of State must be accountable before Parliament for what goes on within the NHS generally. How the new inspectorate reports to Parliament also relates to that.

There is a balance to be struck. We have struck that balance in making the new inspectorate more independent, more transparent and more accountable than before. I suspect that during our exchanges over the next couple of days the hon. Gentleman will try to test that. I should be interested to hear how he sees any new body still being ultimately accountable to the people of this country.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

Does the Under-Secretary accept that the provisions that the House has made in respect of the National Audit Office and the Comptroller and Auditor General go further than the proposals in the Bill and provide the accountability that he was describing? Does he accept that the NAO is a more independent body than either of these bodies? Would it not be worth following the model offered by the NAO as a way of ensuring their independence?

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

The hon. Gentleman will know that the NAO is a non-ministerial department—not a non-departmental public body like the new CHAI—that reports directly to Parliament. To that extent the NAO's role, which is very limited, relates to the Government and the public sector only. It scrutinises Government expenditure and therefore needs to be more independent. CHAI and the CSCI relate both to the public and independent sectors, and were rightly set up as non-departmental public bodies. They may now become the most independent of NDPBs and could go much further than the Audit Commission or

the old CHI. There is an important political and philosophical difference between the purpose and remit of CHAI and its relationship with the independent and private sectors, and the NAO, which has a specific role related to public expenditure across Government and the public sector.

Returning to the amendment, the Bill provides for the chair and other members of both inspectorates to be appointed by the NHS Appointments Commission, working to Nolan principles. The Bill also gives the chair and the commissioners considerable security of tenure: they can be removed only if they are deemed to be unfit or unable to perform their functions. The chief executives will be appointed by the commission members, and both commissions will make an annual report direct to Parliament on the state of health and social care in England and Wales.

In response to the point raised by the hon. Member for Epsom and Ewell, the Bill gives no general powers to issue directions to either CHAI or CSCI in respect of the discharge of their functions. Ministers will be able to intervene only through a default power, which would be exercised if either body were judged to be significantly failing in the discharge of its functions.

Dr Evan Harris (Oxford West & Abingdon, Liberal Democrat)

Clause 58 states:

''In exercising its functions under this Chapter the CHAI must have regard to such aspects of government policy as the Secretary of State may direct in writing.''

It says nothing about default powers in the case of failure. I accept that that is another clause, and I understand why it has been included. However, how can the Minister say that that is the only general power, when clause 58 provides such a power? Will the Minister address the point now, as it is the second time that he has mentioned the matter?

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

I do not wish to spend too much time discussing that power as we will return to it later, but it will not allow the Government to place detailed restrictions on CHAI as it carries out its functions. It allows the Secretary of State to remind CHAI of its responsibilities as they relate to Government policy and the direction of travel, because it is right that the inspectorate of the NHS should be aware of those issues. Similarly, were the old CHI to be examining standards across the NHS it would be right for it to be aware of Government policy on foundation hospitals. The power concerns the key relationship between the inspectorate, the NHS and the Department of Health. That is not a direction-making power, as such a power in the Bill applies when there are significant failings. ''Significant'' is the operative word.

Dr Evan Harris (Oxford West & Abingdon, Liberal Democrat)

I am grateful to the Minister for that clarification. I accept that CHAI needs to know what is going on in the NHS in respect of Government policy. However, let us suppose that a future Government—obviously not the hon. Gentleman's—had a policy that was damaging to patient care. That is not beyond the realms of possibility, although I will not give

examples now. Under the Bill, would CHAI be able to say, ''That is wrong. It is bad for the quality of patient care. Government take note; the policy is flawed.''?

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

If the hon. Gentleman will forgive me, I shall come to the matter when we discuss clause 58.

Such independence from the centre is necessary to take account of our announcement that the Government will no longer be judge and jury in respect of the NHS and social care. The commission will be the judge and the people will be the jury. We are proud that the Government are making that new arrangement.

Amendments Nos. 368 and 369 arise from a desire to ensure that CHAI and CSCI have complete discretion in discharging their functions and are independent of the Secretary of State. The Government have made it clear before, and I repeat it: we are committed to ensuring that independence. The amendments are inappropriate as the Secretary of State retains parliamentary accountability for both inspectorates and the Bill must allow him limited checks and balances in respect of how both organisations perform their functions. It would be unprecedented for a measure setting up non-departmental public bodies not to include direction-making powers that the Secretary of State could use when an organisation appeared to be failing properly to exercise its functions. It must be right for such powers to be in the Bill.

The Bill ensures that both inspectorates have a wide discretion to exercise their functions as they see fit. The Secretary of State will be able to intervene and issue a direction only when either body is significantly failing. Issuing a general direction to have regard to aspects of Government policy does not prevent either inspectorate from exercising such discretion. For those reasons, I reject the amendments.

Mr Paul Burstow (Sutton & Cheam, Liberal Democrat)

I shall respond briefly to the Minister, particularly to rebut his comments on amendments Nos. 368 and 369. His arguments against the amendments went to the heart of the debate on whether the two new commissions would be independent by virtue of statute or by virtue of the pleasure of the Secretary of State. We learnt today that their independence will be at the pleasure of the Secretary of State rather than at the pleasure of Parliament giving them the necessary statutory basis for their independence.

In responding to the amendments, the Minister specifically and in terms said that they have to retain the means of intervention. He outlined several of those, and we shall explore further under later clauses how the Secretary of States seeks to have powers to approve and determine various matters.

This debate has been useful in illuminating just how far the Government are prepared to travel to achieve a genuinely independent set of commissions. The sad conclusion that I come to is that they are still not prepared to travel as far as they should to allow those bodies to go as far as they should.

The hon. Member for Birmingham, Hall Green (Mr. McCabe) made a useful point about the bodies requiring financial realism when discharging their duties. There point about the lack of financial realism, which some hon. Members expressed, may be fair, but it is important that, in discharging such a responsibility, the bodies can have regard to whether there is an adequate level of resources to allow them to discharge their responsibilities under the standards that will be set by the Secretary of State, whether on social care or health care. I certainly see that as an important role that the bodies should be enabled to play, and I hope that he does, too.

I still feel—perhaps this will be clearer once we read the Hansard record of the debate—that it would be helpful if the Under-Secretary could write to Committee members setting out specifically and in terms how the Bill provides for greater independence than does, for example, the legislation that established the Audit Commission. That would allow us to be absolutely clear that that is the case. I hope that the Under-Secretary will reflect on that and act as I have suggested.

This part of the Bill and the question of the independence of the two commissions must be gone into in great depth now, because we have spent so much time in the last few years realigning the architecture of our arrangements for regulation, and Parliament is unlikely to dwell on that issue in such detail again for some years. We must get the legislation right this time to ensure that we have a robust system that safeguards the interests of the vulnerable and that assures the public that the Government's policies, and the resources that are going in, are delivering the outcomes that we want for our constituents. On that basis, we will not press our amendments, but we will want to return to the issue later.

Mr Chris Grayling (Epsom & Ewell, Conservative)

The Under-Secretary is proud to be in his first Standing Committee, and Opposition Members congratulate him on that in a genuine spirit of friendship across the Floor, but that is about as far as it goes, because he did everything possible in his contribution to justify the line that we have taken in the debate and that we will continue to take in debate on these issues as we proceed. The Under-Secretary said that the Government would not be judge and jury over the health system in future, but other of his comments, and the Bill, give the lie to that. I am thinking of clauses 41, 46, 58 and 59 as examples of areas where it is clear that the Government will retain specific abilities to influence the process.

The Under-Secretary accepted that, because he talked not about a body that was independent of Government, but about a body that was more independent of Government. I agree with the hon. Member for Sutton and Cheam. The Under-Secretary has not explained where the difference lies, and the reality is that, in the crucial areas, the independence is not there. The Under-Secretary was overt about that. He said, ''We are not in the business of total independence.'' He said that the process of independence must not go too far and that the Secretary of State had to be accountable to Parliament

on these issues. Yes, he might have to be, but Parliament needs to be able to draw on genuinely independent information and assessments about the quality of health care.

If the Secretary of State has control over the channels of the creation of that information, over the way in which inspection is carried out and over the way in which the health service is audited, and if the organisation that we are discussing is only more independent of Government, how can Parliament be confident that the information that it receives about the job that the NHS is doing is the right information? That is why is it so important that not only Parliament but the people of this country can see exactly how well the health care system is working for them.

I return to comments that I made earlier. In judging health outcomes, that body should challenge Government policy and say that what the Government are doing is having an adverse effect on patient care. It can do that only if it is independent. The most obvious ways in which independence is constructed are missing from the proposals. Under the Bill, the Secretary of State appoints the chairman and has the right to approve the inspection criteria that the new body will use. CHAI must have regard to Government policy. Those are all ties to Government, not freedoms from it. Whatever the Under-Secretary says, this is in the Bill and is the reality of what will be established.

In a very telling intervention, my hon. Friend the Member for Westbury (Dr. Murrison) asked the Under-Secretary what happens if a new stipulation is placed on the new inspection bodies, as happened with the addition of the affordability dimension to the work of NICE. The goalposts moved. The basis on which the organisation has been working up to that point changes, and does so for political reasons.

With all due respect to the Under-Secretary, he must understand that we do not believe that ''more independent'' is independent enough. As the debate continues, we will actively seek to change the minds of members of the Committee and will seek the Committee's endorsement of several of our amendments that would strengthen the independence of the two bodies. I do not intend to press this amendment to a vote now, but I believe that we have had an enormously valuable debate that has highlighted starkly for the rest of the Committee's proceedings the differences between Government and Opposition Members and the battleground that we will occupy in the hours and days ahead.

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr Simon Burns (West Chelmsford, Conservative)

I beg to move amendment No. 221, in

clause 36, page 13, line 29, at end add—

'(3) No order may be made by the Secretary of State under section 177 for the commencement of section 39(1) until such time as he is satisfied that the CHAI is fully operational.'.

Mr Win Griffiths (Bridgend, Labour)

With this it will be convenient to discuss amendment No. 222, in

clause 37, page 13, line 33, at end add—

'(3) No order may be made by the Secretary of State under section 177 for the commencement of section 39(2) until such time as he is satisfied that the CSCI is fully operational.'.

Mr Simon Burns (West Chelmsford, Conservative)

The amendments relate to clause 36 but are also interrelated with clause 39 on the abolition of the former regulatory bodies from which the two organisations will be taking over. They are simple and straightforward and would ensure that the Secretary of State does not issue any order to start up CSCI and CHAI until he is satisfied that both bodies are fully operational.

The other side of the coin is that the existing bodies—the Commission for Health Improvement and the National Care Standards Commission—should not be abolished under section 39 until the new bodies are up and running and ready to carry out their functions. I suspect that many people would believe that to be a sensible and reasonable proposition. Given the critical nature and the importance of the roles of the two bodies as highlighted by the Under-Secretary in his comments on the previous clause, it is critical that there is no hiatus. Any reasonable person would take the view that that never happens. We know all too sadly, however, that it has happened and is happening.

Several of my right hon. and hon. Friends and others who sat on the Committee that considered a previous Bill will know that the Government abolished the community health councils and replaced them with what they believed at the time, although many other people did not, was a souped-up improvement—patient forums. Time and again, we warned the Government that they should not abolish the CHCs until the patient forums were in place and ready to carry on the duties of representing the users of the health service and protecting them, so that it was a seamless service with no hiatus.

Time and again, we were given assurances—I am sure that the Under-Secretary will give similar assurances when he responds to the debate on the new bodies—that there would be seamless service with no hiatus, and that the patient forums would be ready to take over their duties on the day that the CHCs were abolished. We know that that hope will not be fulfilled. We knew—I choose my tense carefully—that, at the Government's diktat, the community health councils would be abolished on 1 September this year, and the Government have had to admit that the patient forums will not be in place all over the country until 31 December. Therefore, there will be a three-month break in the service and the protection that it gives to patients. We have warned the Government since that announcement that that is a mistake and that there should not be what in effect is a broken promise. We are now warning them that they must not repeat that mistake with the two new bodies.

I want personally to thank the Under-Secretary. If only all Ministers were as efficient and effective as he is. We know, as humble Back Benchers, that written answers and other statements tend to be delayed for as long as possible within the rules. We often receive

holding answers. We now have a new system of written ministerial statements. A survey of such statements since they came into existence at the beginning of January would probably show that they are usually made public around lunchtime. However, between 9.30 and 9.44 this morning, the Under-Secretary kindly, and early, published a written ministerial statement.

I suspect that that statement has a direct bearing on this debate and that it was issued so early and so efficiently not only to benefit our deliberations today, but certainly to benefit the Under-Secretary's deliberations, because he knows what is in it. I suspect that no one else in the Committee Room knows what is in it, except possibly the other two Ministers and, by sheer luck and good fortune, myself. It says:

''The system of patient and public in the National Health Service that will be in place from 1 September provides far greater support for patients''.

It then refers to the merits of this wonderful system, but we all know, because we have been telling the Government for so long and they have admitted it, that it will not be in place on 1 September, although the community health councils will be abolished on 1 September. We know that the statement should read ''will be in place from 31 December'', because in reality that is what will happen.

We then have all the blurb about how wonderful the Government are and how they listen. I would like to thank the Under-Secretary, because he has listened to me. The statement says:

''We have listened to Parliamentarians and other stakeholders''—

it has all the jargon, has it not?—including other bodies. It goes on:

''We have therefore decided to make the position absolutely unassailable''—

that is good spin; this is new Labour-speak—

''by retaining Community Health Councils to continue their monitoring function until 1 December''.

Dr Evan Harris (Oxford West & Abingdon, Liberal Democrat)

I welcome the information that the hon. Gentleman is giving the Committee, but—perhaps he is about to say this—surely the lesson is that the issue needs to be sorted out much earlier. The effect of this failure, this gap and this so-late extension of life on the morale and retention of staff in CHCs will be a lasting legacy, despite the late conversion to what the hon. Gentleman rightly calls reality.

Mr Simon Burns (West Chelmsford, Conservative)

I am extremely grateful to the hon. Gentleman. What he says is true, but I reassure you, Mr. Griffiths, that I shall not go down that path, because I know that it would be out of order. What is in order is the fact that amendments Nos. 221 and 222 are designed to help the Government to learn from their bad experience on community health councils and ensure that a mistake is not repeated in the Bill in regard to what all members of the Committee will agree are two important inspectorates to monitor health and social care.

It has taken the Government many months to admit, in this efficient way, their mistakes, though even then there is a 30-day gap. Of course, there is Christmas, and I do not suppose that people will be

monitoring the performance of the health service on behalf of patients on Christmas day or Boxing day, but there is still a 30-day gap between the two dates. However, that is an improvement on the three months that we were facing.

I want to congratulate the Under-Secretary on one point. With regard to our earlier warnings and debates about CHCs, he has finally listened and sought to rectify a botched job. I am now asking that he does not give us the speech about how the two amendments are unnecessary, there will be a seamless service and the new inspectorate will carry out its functions immediately after the abolition of the Commission for Health Improvement and the National Care Standards Commission. Instead, he should be more cautious and take advice rather than simply relying on the instincts of new Labour.

The Government should either provide in the Bill or give a categorical assurance that the two bodies mentioned in clause 39 will not be abolished until the two bodies mentioned in clauses 36 and 37 are fully established, staffed and prepared to carry out their duties on behalf of those working in and the patients served by the NHS. There must be no avenue for a repetition of the mistakes that we have had with CHCs so that a Minister discussing a future health Bill does not have to slip out the fact, at 9.30 in the morning, unbeknown to the vast majority of the Committee members, that he has had to do a U-turn and that the Government were wrong. To save him from himself, I urge the Under-Secretary to accept the amendments.

Dr Evan Harris (Oxford West & Abingdon, Liberal Democrat)

I rise briefly to say that I support the thinking behind the amendments for precisely the reasons given. The CHC debacle has provided a salutary message. Indeed, one might argue that as the job of CHCs was to help, advise and represent patients and the public, it should have been even more important to preserve their status without an interregnum than it is to preserve the status of an inspection authority, which will have a complex transfer of functions.

The way that the Government handled the transition from CHCs to patient forums presented a problem with not just the gap in time, but the complete dislocation of the service's geography, offices and fundamental structures. There may be good reasons for establishing new office space for the new inspectorates, but the Government must ensure that they justify their moves in advance if they are going to abandon significant parts of the NHS estate, as they did, are doing and are about to do with CHCs. Literally hundreds of offices will, by design, be abandoned because the Government do not want them to continue to operate in the same way. With more than simply the temporal gap, the CHC experience is a salutary lesson in how the Government must not handle the changes.

It is important that we can handle change, as many of the reforms in the quality agenda are necessary, but it is the management of change as much as the policy of change that is important. As far as the CHCs are concerned—that was the example given by the hon.

Member for West Chelmsford in moving the amendment—the Government failed the test. The Liberal Democrats hope that they will not fail again.

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

Amendments Nos. 221 and 222 propose respectively to place the Secretary of State under a duty to ensure that the old CHI will not be abolished until the new CHAI is fully operational, and that the National Care Standards Commission will not be abolished until the new CSCI is fully operational.

We intend to transfer the existing staff of the National Care Standards Commission, and the staff of the old Commission for Health Improvement, to the new bodies. The functions of the existing bodies will either simply transfer to the new bodies, as with the commission's functions for registering care homes, independent hospitals and so on; or they will be superseded by a new version of those functions provided in the Bill. To that extent, the staff of the old CHI—forgive me, but the debate necessitates the use of jargon—will go to the new CHAI.

Mr Simon Burns (West Chelmsford, Conservative)

I accept the logic of what the Under-Secretary says. Can he therefore give us a commitment that no orders will be made to abolish the old bodies until the new bodies have completed that process 100 per cent.?

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

If the hon. Gentleman will let me make progress, I will deal with his point. The new bodies will not be able to operate without staff, and preparations are already under way to develop the smooth transition that the hon. Gentleman is concerned to see. If, in tabling the amendments, he seeks an assurance that the old commissions will be abolished only once the new ones have taken on their equivalent new functions, I am happy to give such an assurance. We intend the abolition of the old commissions to coincide with the transfer of staff and functions to the new commissions.

I cannot accept the amendments, however, because their legal effect is unclear. They might result in us being unable to abolish the old commissions until every clause in part 2 had been implemented, including those that do not relate to the existing functions of the National Care Standards Commission and CHI, such as the power to charge fees. The perverse effect would be that CHI and the standards commission would remain in existence, but with no functions and no staff, awaiting the implementation of other, unrelated parts of the Bill. That would be absurd, and I am sure that it is not the hon. Gentleman's intention. I trust that he is satisfied with my assurance, and that he will withdraw the amendment.

Mr Simon Burns (West Chelmsford, Conservative)

Yes, I am reassured by the Under-Secretary's commitment that the existing bodies will not be abolished until their employees have been used fully to staff the new bodies—and until those new bodies commenced their work, even if they do not undertake some of their responsibilities in certain parts of the Bill. I thank him for that assurance.

I thank the Under-Secretary also for learning lessons from the abolition of CHCs. The Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), who had responsibility for CHCs, is remaining very quiet. [Interruption.] The matter is now the responsibility of the hon. Member for Tottenham (Mr. Lammy), because it was shuffled, but it was the responsibility of the hon. Member for Salford. She had to get her colleague to cave in on something that those with any sense have for months been telling the Government would happen.

Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)

Not at all.

Mr Simon Burns (West Chelmsford, Conservative)

The hon. Gentleman says, ''Not at all'', but his written ministerial statement is living proof to the contrary. However, I am grateful for the assurance that he gave me, and I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The Chairman, being of the opinion that the principle of the clause and any matters arising thereon had been adequately discussed in the course of debate on the amendments proposed thereto, forthwith put the Question, pursuant to Standing Orders Nos. 68 and 89, That the clause stand part of the Bill.

Question agreed to.

Clause 36 ordered to stand part of the Bill.