Health and Social Care Bill
Simon Burns (The Minister of State, Department of Health; Chelmsford, Conservative)
I will not give way; I am going to deal with questions raised in the debate. The hon. Member for Leicester West raised several, including who was responsible for driving up quality. As I have said, but I will repeat it to her, not one body or person but all parts of the system have a responsibility and will exercise it. It will happen primarily through better commissioning, based on NICE quality standards, and clinicians will have an important and critical role in improving quality. The Bill lets them do that.
The hon. Lady asked whether the duty of quality will apply to providers. I can tell her that providers will be held to account for quality of service through contract commissioners, provider quality accounts, health and well-being boards, HealthWatch and CQC maintaining essential standards. I hope that that deals with her point.
The hon. Lady also asked where responsibility for deaneries will sit within the new system. As the hon. Lady is aware, we are consulting on the future of professional education, because I agree with her that it is absolutely crucial that we have the highest quality education and training to ensure that not only do existing staff within the NHS maintain their professional standards, but that we have the next generation and beyond being trained for a high-class NHS. We are consulting and we will consider the responses before making a decision, which will be taken in the best interests of patients and staff.
We had a fairly long and protracted debate about the question of acting “with a view to” and the meaning of “have regard to”. The duty to act with a view to securing continuous improvement in quality is not weak, nor is it unclear. The Secretary of State would have a statutory duty under the legislation to exercise all his functions in a way that is best calculated to achieve quality. The Secretary of State could be challenged in court by anyone who thought that he was not doing what he could to achieve the objective of improving quality.
On the meaning of “have regard to”, I warn the Committee that I am not a lawyer. Those who are lawyers will understand the full significance and meaning of what I am about to read. A former Lord Chancellor, my noble Friend Lord Mackay of Clashfern, spoke about the term when it was being debated in the context of the NHS constitution. He said:
“It is a very common phrase…and I have been involved in arguing cases and sometimes deciding cases in which it was a crucial phrase. I will not be giving a definitive meaning for it, but I think what, in principle, it means, is that, in making a decision, you take account fully of all the provisions of the document so far as relevant to the issue in hand and you take account of them properly and seriously, not in a dismissive way…It is a compendious phrase with very considerable legal lineage in which it is applied. I do not think there are many cases in which the judges have attempted to say what it means; they know how to apply it.”—[Official Report, House of Lords, 28 April 2009; Vol. 710, c.159-60.]