Clause 52 - National reviews
Health and Social Care(Community Health and Standards) Bill
2:45 pm
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
I beg to move amendment No. 436, in
clause 52, page 18, line 19, leave out 'into' and insert 'of'.
Mr Win Griffiths (Bridgend, Labour)
With this it will be convenient to discuss Government amendments Nos. 437, 438, 440, 442, 447 and 445.
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
Amendments Nos. 436, 437, 440 and 445 make subtle drafting changes suggested by parliamentary counsel to clauses 52, 53 and 66. The consequence of amendment No. 438 will make it clear that in discharging its functions CHI will be able to carry out an inspection of any NHS body or any other person who provides, or is to provide, health care. For example, that may enable CHI to assess the suitability of premises and/or other commissioning arrangements that are intended to provide health care before they are put into use.
Amendment No. 442 makes it clear that under its functions of promoting or undertaking comparative or other studies and improving the economy, efficiency and effectiveness of the exercise of any of the functions of a PCT, a strategic health authority or an English NHS trust, CHI may inspect any English NHS body other than a special health authority and/or any person exercising the functions of such a body. Special health authorities are excluded from such inspection as we have decided to avoid overlap with those functions that fall within the remit of the National Audit Office.
Amendment No. 447 was tabled to make it clearer that the clause will enable the Commission for Social Care Inspection to carry out an inspection on any local authority in England when carrying out studies on economy and efficiency in the provision of local authority social services. We always intended that the clause would enable CSCI to do that. Although the Bill would have that effect, the amendment would provide an additional subsection, putting the matter beyond doubt and clarifying it.
Mr Chris Grayling (Epsom and Ewell, Conservative)
I have two questions for the Under-Secretary. First, will the extension of the inspection powers to individuals permit CHAI to inspect complementary practitioners that are used alongside NHS trusts? The Under-Secretary will be aware that, increasingly, complementary medical practitioners, such as osteopaths and chiropractors, are operating in local medical centres and sometimes in hospitals. I should be grateful if the Under-Secretary made it clear whether they come under the umbrella of inspections set out in the changes that he has just outlined.
Secondly, I want to inquire about the inspection regime for the laboratories that were part of the Public Health Laboratory Service until the formation of the Health Protection Agency on 1 April. The Under-Secretary will be aware that, until 1 April, a number of laboratories fell within the ambit of the Public Health Laboratory Service. They were sited in hospitals around the country and provided, in particular, microbiology support to the health service. They were also part of the network monitoring diseases, outbreaks and epidemics nationwide. As of 1 April, those laboratories have almost totally moved to
national health service trusts. They are now sited in, and owned and managed by, the trusts in whose premises they formally sat.
The Under-Secretary has made the point that the special health authorities—the Health Protection Agency is a special health authority—are exempt from inspection by CHAI. Will he explain the inspection regime for the former Public Health Laboratory Service laboratories? Are they simply covered by the process of CHAI inspecting a trust, or will CHAI carry out some form of inspection of the work of laboratories generally? Will the National Audit Office retain any kind of assessment role of the work that laboratories do and the part that they play in the national work of the Health Protection Agency?
Sir George Young (North West Hampshire, Conservative)
The Under-Secretary began by explaining that some of the amendments are subtle. Can he explain to the Committee the subtlety of deleting ''conduct'' in ''conduct an inspection'' and inserting ''carry out''? What is the difference between those things?
''Review'' and ''investigation'', which appear quite often in clauses 52 and 53, seem to be almost alternative words. The same is true of the word ''inspection''. Those three words are used almost interchangeably. Will the Under-Secretary explain the difference between a CHAI review, investigation and inspection?
Dr Andrew Murrison (Westbury, Conservative)
I seek clarification on the role of others who might inspect or survey health bodies; in particular, the Audit Commission. How will it interact with CHAI to ensure that there is no overlap between what the organisations do? I cannot find anything in the Bill to make me confident that there will not be an overlap. It is in the interests of both organisations to co-operate closely.
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
If care is provided for an NHS body, complementary practitioners will be within CHAI's scope, to answer the question of the hon. Member for Epsom and Ewell (Chris Grayling). I just want to make it clear that ''persons'' can also mean the legal identity of a person and, therefore, the independent sector.
Public laboratories within NHS trusts are also covered by CHAI if they are no longer run by the special health authority, but the hon. Gentleman will also know that there is a duty of co-operation between CHAI and other inspectorates. They could liaise and produce a joint piece of work if they so wished. We are not seeking to prescribe that endeavour.
Dr Andrew Murrison (Westbury, Conservative)
The Under-Secretary will know that the Public Health Laboratory Service will form part of the Health Protection Agency. I wonder whether what he has just said will still apply when the HPA is inaugurated.
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
I thought that I had said that the inspectorate of special health authorities is the NAO, but there is a duty of co-operation. For public authorities that fall within particular trusts, CHAI has a nexus. That is an arrangement where one would expect the inspectorates to talk to one another and
formulate protocol on the way that they wish to proceed. I am advised that ''carry out'' rather than ''conduct'' is used for consistency purposes in the Bill. The Bill draws on several pieces of legislation in bringing the inspectorates together.
Sir George Young (North West Hampshire, Conservative)
If that is the case, why does subsection (6) refer to conducting a review or investigation instead of carrying one out?
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
We are attempting to tidy up the document to make it clear. If the right hon. Gentleman has found other areas where we may need to make that change, I shall get back to him on that. I am grateful for his contribution. Inspection, review and investigation are part of the same attempt to ensure that it is clear when, for example, CHAI is conducting a review into the performance of diagnostic treatment centres in the NHS and wants to review that service of facility. There may have been an investigation where there was an element of controversy or where CHAI had been requested to carry out that investigation by some party. An inspection as a general term can mean the whole process. The right hon. Gentleman will know that there can be some flexibility within which the terms are used, but the Government are genuinely attempting to tidy up the Bill and bring some clarity to those general points.
Dr Andrew Murrison (Westbury, Conservative)
I am now more confused than I was on the issue of the Public Health Laboratory Service, which I assume is subject to inspections by the Commission for Health Improvement. I should be grateful if the Under-Secretary clarified that, and confirm that when the PHLS becomes part of the Health Protection Agency it will not be directly subject to CHAI but to the National Audit Office. I think that was the thrust of what he said.
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
Yes, it was. On the first point, I said that where public laboratories are within trusts, they come under the auspices of CHAI.
Amendment agreed to.
Amendments made: No. 290, in
clause 52, page 18, line 21, leave out
'other than NHS foundation trusts'.
No. 291, in
clause 52, page 18, line 23, leave out
'other than NHS foundation trusts'.—[Mr. Lammy.]
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
I beg to move amendment No. 292, in
clause 52, page 18, line 24, at end insert—
'(1A) If the Secretary of State so requests, the CHAI must conduct—
(a) a review under subsection (1)(a) of the overall provision of a kind of health care specified in the request; or
(b) a review under subsection (1)(b) of the provision of health care, or health care of a kind specified in the request, by or for NHS bodies of a description so specified.
(1B) The Secretary of State must consult the Assembly before making a request under subsection (1A).'.
Mr Win Griffiths (Bridgend, Labour)
With this it will be convenient to discuss the following:
Government amendment No. 315.
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
Following the removal of the exception of NHS foundation trusts from CHAI's
national review function, amendments Nos. 292 and 293 insert new subsections to place a duty on CHAI to conduct national reviews of particular types of health care as specified by the Secretary of State. The combined effect of the amendments enable CHAI to conduct national reviews of care provided by and for all NHS bodies and of particular types of health care as it and the Secretary of State may request.
Amendment No. 292 places the Secretary of State under a duty to consult the National Assembly for Wales before making any such request in undertaking any national review. In conducting such a review, CHAI will be placed under a duty to take into account the appropriate statement of standards as provided by clauses 41 and 42.
Amendment No. 315 redrafts clause 76(3) to clarify that the Secretary of State may request the CSCI to conduct both national and local studies of a particular service or user group. As currently drafted, it could be argued that subsection (3) allows the Secretary of State to request reviews only of particular local authorities, which was not our intention. The Secretary of State may want to ask the CSCI to conduct a national review of child protection services, and the amendment makes it explicit that it could be a national review of a particular service or service user group.
Mr Chris Grayling (Epsom and Ewell, Conservative)
I have a couple of points for the Minister.
It makes clear sense to have some ability to take a national view of the provision of health care services. Amendment No. 292 requires the Secretary of State to consult the Welsh Assembly, but what would happen if we were dealing with the provision of a specialist service of which there is only one facility in the country? Great Ormond street hospital is an obvious example, as it is Britain's premier children's hospital. It is the sole provider of a number of services in the United Kingdom, and it brings together for treatment children from all parts of the United Kingdom.
Therefore, with the proviso that I recognise the potential difficulties with the structure of devolution legislation, is it not logical for such reviews to be able to cover health care provision and requirements across the UK, including Scotland and Northern Ireland, particularly as Northern Ireland is not currently governed by the Assembly? Even if it were governed by the devolved Assembly, would it not sometimes be necessary to take a UK-wide view? For example, we may need to check whether we have adequate or too much provision in one area or whether we need to refocus resources. We may have to ask whether we need the Department of Health and the three devolved assemblies to work together on a particular issue; perhaps the need to establish a specialist burns or cancer centre for the UK.
Mr Win Griffiths (Bridgend, Labour)
Order. The Bill is not about the whole of the United Kingdom. This clause deals with England and Wales, so the hon. Gentleman's views on how it should be extended to the whole of the UK are irrelevant to the debate on these amendments.
Mr Chris Grayling (Epsom and Ewell, Conservative)
You will correct me if I am wrong to ask this question, Mr. Griffiths, but why would the Bill limit such a review to England and Wales? Does the Under-Secretary believe that a review covering England and Wales would reflect nationwide priorities in specialist aspects of our health service?
Mr Win Griffiths (Bridgend, Labour)
Order. Whatever feelings the hon. Gentleman has about the United Kingdom, I have heard this debate before. Those views need not and should not be made in the context of the two amendments.
Mr Chris Grayling (Epsom and Ewell, Conservative)
I am happy to accept your guidance, Mr. Griffiths.
When the Secretary of State has secured a joint review for England and Wales with the consent of the Assembly, what powers will he have? I shall give the Under-Secretary the specific example—we have discussed it on a few occasions in Committee—of a cross-border acute trust providing services from one side of the border to the other. Let us suppose that a significant devolution of services to community-based facilities on one side of the border had not been replicated on the other side of the border. An investigation would be carried out under clause 52(1)(b), which provides for an investigation of
''the provision of health care, or a particular kind of health care, by and for NHS bodies, other than NHS foundation trusts, of a particular description.''
The example involves a specific investigation at the request of the Secretary of State into the provision of community-based services to support an acute centre in a cross-border area. If the review says, ''The problems we have in this area are being caused by the fact that all the community facilities are on one side of the border and not on the other'', does he have the power to secure a solution or is he solely at the whim of a decision taken at the Assembly? Is his only option returning to the Assembly to ask for its help? I should be grateful if the Under-Secretary clarified what happens after the review. What powers does the Secretary of State have to act after the review?
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
I have the sense that the hon. Gentleman is trying to rehash last week's argument about the Welsh Assembly. I said to him then that we cannot return in Committee to the discussions that we had in this place about devolution. I was not a Member of Parliament at the time, but I know that the discussion was heated in 1999 and that a settlement was made. A national review—this is why it is called a ''national'' review—examines a particular service, and the Secretary of State shares the information with his colleagues in Wales, in the understanding that there will be a Welsh response to the review's outcome. It is not the case—the hon. Gentleman would like this—that the Secretary of State in England tells his colleagues in Wales how they should or should not behave.
Following the elections a few weeks ago, Conservative Members will be disappointed to hear some of the hon. Gentleman's arguments in Committee and will be interested to read Hansard tomorrow. The settlement was established in 1999 and,
in a sense, the Bill corresponds to it and extends it. Like all the Ministers in the Department of Health, the Secretary of State is engaged in constant dialogue with his colleagues in Wales, who seek to bear down on specifically Welsh issues.
Mr Chris Grayling (Epsom and Ewell, Conservative)
Given all that the Under-Secretary says about the Secretary of State's inability to intervene in a devolved matter, I am grappling with the idea of a national review. If a national review of children's services concludes that a new specialist children's hospital is required to meet a particular health care need, will the English NHS build it for the Welsh or will it be a joint venture? I am grappling with the purpose of a national review if there is no ability to follow it through with specific action.
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
I am rather confused. I believe that I was here this morning and last week, and I believe that the hon. Gentleman was here as well. If I am right, and this is not some ''Dallas''-type Bobby Ewing dream, we discussed the standards that my right hon. Friend the Secretary of State is charged with applying to the NHS and that the National Assembly for Wales is charged with applying to the health services in Wales. Those standards are informed by several considerations, including national reviews. It is patently obvious that action would result from an important review into, for example, child protection services or something of that manner.
Amendment agreed to.
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
I beg to move amendment No. 293, in
clause 52, page 18, line 24, at end insert—
'(1C) In conducting a review under this section in relation to any health care the CHAI must take into account—
(a) the standards set out in statements published under section 41, where the health care is provided by or for an English NHS body or cross-border SHA;
(b) the standards set out in statements published under section 42, where the health care is provided by or for a Welsh NHS body.'.
Amendment No. 293 would ensure that CHAI acted consistently when performing its functions. Clauses 46, 51 and 53 already require CHAI to take the statements of standards into account when performing annual reviews of NHS foundation trusts and other NHS bodies and when performing other reviews and investigations. Indeed, that is what I was just saying. The amendment would insert a new subsection that placed a duty on CHAI to take into account the standards set by my right hon. Friend the Secretary of State and by the National Assembly when undertaking its national reviews.
Mr Chris Grayling (Epsom and Ewell, Conservative)
This point may belong to another part of the debate. The amendment refers in subparagraph (a) to
''the standards set out in statements published under section 41, where the health care is provided by or for an English NHS body or cross-border SHA''—
''cross-border'' is the word that concerns me—and then in subparagraph (b) to
''the standards set out in statements published under section 42, where the health care is provided by or for a Welsh NHS body.''
Will the Under-Secretary clarify whether services that are provided on the Welsh side of the border in a
cross-border SHA will be subject to English standards? What will happen in the case of a practitioner who serves patients in the cross-border SHA area and in the adjoining Welsh SHA area? I should be grateful if he clarified those points.
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
My hon. Friend the Member for Cardiff, Central effectively raised the point about the relationship and proximity that CHAI would have to English patients receiving care on the Welsh side of the border. When that came up last time, I said that CHAI has a nexus to deal with services in such areas. Clearly, in looking at those standards, CHAI will be minded to be aware of the Welsh standards.
I said that we would not tie CHAI, or HIUW, the health inspection unit for Wales, in the National Assembly. We would expect them to work together, draw up protocols and do joint reviews, or to come to determinations about the way in which they wished to take those cross-border issues forward. But, yes, a cross-border special health authority is subject to English standards, whether it is operating in England or in Wales. However, the only cross-border special health authority that I can think of is the UK transplant service.
Mr Chris Grayling (Epsom and Ewell, Conservative)
I am grateful to the Under-Secretary for that point of clarification, but I want to press him on one point. In relation to a cross-border SHA—which, therefore, would be subject to English standards—would CHAI have to measure a clinical practitioner, or whoever it may be, against two different sets of standards in the same place doing the same job, in Wales? There is a risk that even greater confusion will arise than our discussions have revealed, because a clinic established on the Welsh side of the border that is providing a specific service within a cross-border SHA is subject to CHAI investigations. However, because it operates in Wales, it is also subject to Welsh standards. Therefore, on the English side of the border, not only do we risk having two sets of standards working at the same time, but CHAI might make a rare foray into Wales, armed with two sets of standards to carry out the inspection. Is that right?
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
I do not know about the hon. Gentleman, but many people on the English side of the border make forays into Wales on a regular basis; I know that I do. In a sense he confuses the special health authority, because in his earlier example he referred to an individual receiving particular care on the Welsh side.
The Bill refers to a special health authority, and I can think of no special health authorities that provide services to individuals. However, if there are any, or if some should come about, we would expect CHAI to talk to the National Assembly for Wales and establish appropriate protocols.
Amendment agreed to.
Amendments made: No. 437, in
clause 52, page 18, line 25, leave out
'subject to this Part, conduct'
and insert 'carry out'.
No. 294, in
clause 52, page 18, line 28, leave out
'other than an NHS foundation trust'.
No. 438, in
clause 52, page 18, line 29, at end insert 'or is to be'.—[Mr. Lammy.]
Mr Paul Burstow (Sutton and Cheam, Liberal Democrat)
I beg to move amendment No. 364, in
clause 52, page 18, line 32, at end insert
'and shall send a copy of any such report to the Comptroller and Auditor General.'.
Mr Win Griffiths (Bridgend, Labour)
With this it will be convenient to discuss the following:
Government amendment No. 439
Amendment No. 365, in
clause 53, page 19, line 16, at end insert
'and shall send a copy of any such report to the Comptroller and Auditor General.'.
Government amendment No. 441
Amendment No. 403, in
clause 53, page 19, line 23, at end add—
'(10) The Comptroller and Auditor General shall from time to time lay before the House of Commons a report of any matter which, in his opinion, arises out of report or studies of the CHAI under this Part and ought to be drawn to the attention of that House.'.
Amendment No. 366, in
clause 56, page 20, line 35, at end insert
'and shall send a copy of any such summary to the Comptroller and Auditor General.'.
Amendment No. 34, in
clause 56, page 20, line 36, leave out subsections (4) to (6).
Government amendment No. 443
Amendment No. 373, in
clause 117, page 51, line 7, at end insert—
'(5A) Where a review or study is conducted under this section the CSCI and CHAI shall send a copy of any such joint report to the Comptroller and Auditor General.
(5B) The CSCI and CHAI must, on request, provide the Comptroller and Auditor General with all material relevant to a review or investigation under this section.'.
Government new clause 5—Provision of material.
Mr Paul Burstow (Sutton and Cheam, Liberal Democrat)
This group of amendments is one of two that address the reporting relationship between the Commission for Healthcare Audit and Inspection and the National Audit Office, or the Comptroller and Auditor General. The amendments would insert into the Bill the provisions of the Audit Commission Act 1998. Although we are glad that many parts of the Bill stipulate that the Comptroller and Auditor General can seek from the commission relevant and background material arising out of inquiries and studies that it has conducted, it does not stipulate that the commission should send a copy of the report to the National Audit Office in the first place.
That may seem blindingly obvious, but it would be better to state it in the Bill, as parliamentary counsel seemed to think was appropriate when they drafted what became the Audit Commission Act 1998. I want to know what changed in administrative practice in
law that led parliamentary counsel to come to a different conclusion in this case.
Why does the Bill not require the commission to send a copy of its report to the NAO and the Auditor General? That is why the amendments were tabled. I hope that they will be regarded merely as tidying-up amendments to ensure that we have a law that is consistent with past law and that the NAO has the benefit of the reports—and the ability to know that those reports exist—and can, as a consequence, seek detailed information from the commission if it sees fit to do so to facilitate any reports that it might choose to produce.
Mr Chris Grayling (Epsom and Ewell, Conservative)
Amendment No. 34 is a probing amendment, designed purely to extract from the Under-Secretary an explanation of the provision. In fact, the amendment jumps ahead to clause 56. How does he envisage the relationship between CHAI and the Audit Commission? Clearly, an important relationship is established under the Bill. The Government envisage the Audit Commission carrying out a number of functions on behalf of CHAI. The amendment is designed to secure information as to what sort of work the Under-Secretary expects that to be, and on what occasions he expects CHAI to subcontract its work to the Audit Commission.
Most particularly, we seek assurances that the Government are not creating a multiple inspection structure. The Under-Secretary will be aware that any participation by the NHS in a review—whether it is a review of a particular area of the NHS or a comparative study as referred to in clause 56(1)—involves a huge investment of time by NHS professionals and management teams, which takes them away from their core function of running the service for which they are responsible.
Given that a second body is being put into the equation, we want to understand how the relationship will work between the bodies and how the Government will ensure that there is no unnecessary duplication of effort, that we do not expose NHS management teams to endless periods of inspection unnecessarily and that we do not write into the Bill an extension of the inspection bureaucracy in an undesirable way. I should be grateful if the Under-Secretary explained the three subsections to which the amendment refers, and set out precisely how he sees the role of the Audit Commission in its work alongside CHAI.
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
This group of amendments deals with the relationship between CHAI and the Comptroller and Auditor General. On the face of it, many of the amendments are moving in opposite directions, but in fact that is not the case. Both Government and Opposition are moving down the same road. The question may be about how far down that road we choose to go.
Opposition amendments Nos. 364 to 366 would require CHAI to send to the CAG a copy of any report that it made when it carried out a national review under clause 52, other reviews and investigations
under clause 53 or value-for-money studies under clause 56. The hon. Member for Sutton and Cheam (Mr. Burstow) raised that point. I sympathise with the aim of the amendment, but it would mean that CHAI was not required to send a copy of its published reports on these functions to one group.
I have no doubt that the Comptroller and Auditor General will receive the reports in the natural course of CHAI's business. It is also more important for the Comptroller and Auditor General to have the relevant material behind the reports than to have the reports themselves. The proposal would restrict that to the reports themselves, and Government new clause 5 deals with that.
The hon. Member for Sutton and Cheam talked about consistency. The amendments are consistent with section 33(5) of the 1998 Act, which states:
''The Commission shall . . . on request, provide the Comptroller and Auditor General with all material relevant to the studies.''
In answer to a question from the hon. Member for Epsom and Ewell, Audit Commission expertise can assist CHAI in early-years building. We would expect that, which is why there is the duty to work together. We expect CHAI to rely on Audit Commission expertise in financial matters if that is important for a study. As an inspectorate, however, CHAI is more concerned with outcomes such as cost-effectiveness and efficiency than with the inputs and the expertise that we would usually expect from the Audit Commission and the local auditors, although they may be used in a particular instance.
Mr Chris Grayling (Epsom and Ewell, Conservative)
The Under-Secretary talks about CHAI's focus on cost-effectiveness. Surely the point of the comparative studies mentioned in clause 56 is to judge whether there is cost-effectiveness and whether we are receiving value for money for a particular service? Is there a dividing line between CHAI's involvement in financial assessment and the Audit Commission's involvement in it?
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
There is a dividing line to the extent that CHAI's focus will be on the outcome; namely, on the result of the care or of a particular exercise. Therefore, its concentration is on the cost-effectiveness of care and the value-for-money exercise at the end of the process. The input—financial management, fiscal responsibility and other requirements—are naturally in the ambit of the Audit Commission. In the early days, we expect the Audit Commission and CHAI to work closely together. However, Audit Commission staff are on secondment with the new CHAI and so they are working together in that sense. The relationship that I mentioned exists in staffing arrangements.
Mr Chris Grayling (Epsom and Ewell, Conservative)
The Under-Secretary refers to Audit Commission staff being on secondment with the new CHAI. Interestingly, however, I have just had from the old CHI a request for information for a major research exercise that it is carrying out. Will he clarify the status of the old CHI and the new CHAI?
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
Forgive me. I am not sure if I understood the hon. Gentleman's question.
Mr Chris Grayling (Epsom and Ewell, Conservative)
The Under-Secretary has just said that Audit Commission staff are seconded to the new CHAI, by which I understand that the new CHAI is already up and running, at least in developmental form, yet the old CHI is carrying out detailed research work with patients and opinion formers. I just want to understand the status of the old CHI and the new CHAI.
Mr David Lammy (Parliamentary Secretary, Department of Health; Tottenham, Labour)
I thought that this issue had already been raised and clarified. The hon. Gentleman will know that Ian Kennedy is on the shadow board. The aim of an amendment tabled to an earlier clause was to ensure a smooth transition, which the hon. Member for West Chelmsford (Mr. Burns) had mentioned. I explained the shadow arrangements and that the bodies are working together. Until the Bill completes its passage through Parliament, there is no new CHAI, as the hon. Gentleman will know. Under the auspices of the old CHAI and the new shadow board in development, we are working towards the establishment of the new CHAI some time next year, subject to Royal Assent. We will then move into the new arrangements.
Mr Paul Burstow (Sutton and Cheam, Liberal Democrat)
The Under-Secretary's comments about the relationship between the Comptroller and Auditor General and the commission are useful, but the concern I still have is that when the Under-Secretary referred to section 33(5) of the Audit Commission Act 1998, he did not go on to refer to the fact that subsection (6) of that section specifically stipulates that the Audit Commission, in undertaking studies as to the economy, efficiency and effectiveness of health bodies has to consult with the Comptroller and Auditor General. In other words, it has prior knowledge of the fact that such studies are being undertaken.
The way in which the Bill is framed does not provide for similar consultation. The Comptroller does not have prior knowledge that a study is taking place. It is perfectly reasonable for the Under-Secretary to advance the idea that in a reasonable world reports will go to the Auditor General as a matter of course, so we do not need to specify that in the Bill. However, the question he did not answer was why parliamentary counsel, in conceiving the 1998 Act, thought it necessary to stipulate that such reports should go to the Auditor General. That seems to be an important clarification; I hope that the Under-Secretary will discuss that with his officials so we can be clear about what has changed between the passing of the 1998 Act and now.
Although I think that the amendments are important, I shall give the Under-Secretary the opportunity to consult on them further so that we may return to them at a later stage. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Amendment made: No. 439, in
clause 52, page 18, line 33, leave out subsection (4).—[Mr. Lammy.]
Clause 52, as amended, ordered to stand part of the Bill.