Clause 2
Health Bill [Lords]
4:00 pm
Mike O'Brien (Minister of State (Health Services), Department of Health; North Warwickshire, Labour)
Amendment 3 would oblige those bodies that must have regard to the NHS constitution to also have regard to the handbook and the statement of accountability. The hon. Member for Eddisbury has indicated that he wants to know why one is in the Bill and the other is not.
It may help if I set out the purpose and intentions behind the handbook and the statement of accountability. The handbook is an explanatory guide designed for patients, members of the public and members of NHS staff. As the words in the constitution are necessarily at a high level, the handbook outlines in practice what each right, pledge and responsibility in the constitution means. In a sense, it is a description. That intent is clear in the introduction to the handbook, which states:
“this Handbook is designed to give NHS staff and patients all the information they need about the NHS Constitution for England.”
The handbook is not an instruction manual or guidance for the NHS. It does not create any new policy or law; it merely describes what currently exists; and it does not contain guidelines to which people must have regard. The handbook does not ask anything fundamentally different of NHS organisations. It merely sets out policy and law with which organisations should already be familiar.
For those reasons, it would be inappropriate to impose a duty for bodies to have regard to a patient and staff-facing explanatory guide. It is just a document for members of the public to glance at in order to get some idea of what the constitution means in practice, and no more. We would be somewhat concerned if some sort of legal effect were given to a handbook that can be rewritten from time to time.
Furthermore, imposing a duty to have regard to the handbook would create a case for a more formal process for updating it, such as a requirement to consult on any revisions, which might merely reflect current departmental policy or law. Strengthening the legal status of the handbook would make it a much less helpful guide for patients, the public and staff, as the process of making minor or primarily technical amendments to it would become bureaucratic and time-consuming, potentially requiring extensive consultation. Essentially, what we are looking for in the handbook is something that can be amended whenever it needs to be and that will not have any legal force, but will just help the patient or NHS member of staff know what the constitution, to which bodies must have regard, is all about.
The statement of NHS accountability, on the other hand, was published alongside the constitution on 21 January as a response to last year’s consultation, in which we heard that patients and the public would find it helpful to know the system of responsibility and accountability for taking decisions in the NHS. We believe that it is vital that the public know how the NHS is accountable at a local level and how they can get involved. The statement of accountability is also a public-facing document and explains roles, responsibilities and accountability in the NHS. It is a short summary of the current structure and functions of the NHS in England. There would be little value in requiring NHS bodies to have regard to a factual document detailing the structure of the NHS.
For that reason, although it is permissible to refer to the documents in regulation, we do not want them to have any statutory force, be referred to during court cases or add a large amount of documentation to an NHS constitution that we want to be fairly straightforward. People will require some explanation. They will ask, “What does this mean?” or “What does this sentence in the constitution mean?” Therefore, we want to provide a handbook, but we do not want to give it a lot more weight than it needs. Giving it that extra weight would add complications, and the courts might then start to take a keener interest in it than we want them to. It is not for judges or lawyers; it is for patients and members of staff.