Health and Social Care Bill
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
The hon. Gentleman has read out part of the answer that my right hon. Friend has given him. As he points out, we intend that a commissioning consortium should be able to commission support from an outside provider—a charity, for example, such as the Neurological Alliance—to ensure that access is available to appropriate clinical and patient expertise regarding commissioning activity. That is something that Members on both sides of the Committee have sought to probe and test. There is nothing sinister involved; it is exactly what hon. Members on both sides have sought to achieve, and the Bill will enable it.
Under new section 14O of the National Health Service Act 2006, as detailed in clause 22, the Bill provides that consortia will be under a duty to seek appropriate advice from health experts when they are carrying out their functions. I suspect that the hon. Member for Easington was alluding to that point in his intervention.
In drafting the Bill, we have avoided the temptation to micro-manage. We have not constrained the ability of consortia to seek advice and input from those health professionals who are best placed to give it. By naming particular professional groups in the Bill, we would impose an unhelpful restriction on the ability of consortia to access appropriate clinical advice, which is their duty.
My hon. Friend the Member for Southport has raised some important concerns about the emphasis on GPs, and he has expressed a particular concern about the ability of GPs properly to commission services without access to specialist knowledge. The new model for commissioning is based on the system of registered lists of patients held by GP practices. GPs play a crucial role, as I am sure hon. Members on both sides of the Committee acknowledge, in co-ordinating patient care and committing NHS resources through their daily clinical decisions in primary care. We believe, therefore, that the emphasis on GPs as the foundations for consortia is right.
My hon. Friend makes an important point, however, about the essential contribution of other clinicians. Consortia will find it impossible to secure improving health outcomes without the right advice. Effective commissioning will require the full range of clinical and professional engagement alongside that of local people. Hospital doctors, nurses, allied health professionals and others all have a vital role to play in developing services and improving health outcomes. How a consortium goes about that is rightly a matter for it, and it will be held to account for the outcomes that it achieves. The consortium will set out its approach to discharging its duties in its constitution, which will be scrutinised and approved by the NHS commissioning board at the point of establishment.
My hon. Friend the Member for Stafford considered that that was an essential area that should be included in the criteria that the commissioning board would use to assess consortium establishment applications. New section 14C of the National Health Service Act 2006, as set out in clause 21, contains a regulation-making power that will allow provision to be made regarding the factors that the board must take into account in deciding whether it is satisfied that a consortium has made appropriate arrangements to discharge its functions.
My hon. Friend the Member for Southport also raised concerns, echoed by the right hon. Member for Rother Valley, about GPs acting in a self-interested way when commissioning services, and about the potential instability that might be caused to a consortium if a practice were to fail. That issue is clearly important, and it needs to be aired and properly scrutinised in Committee. The Committee will have the full opportunity to discuss conflicts of interest when it considers amendments 211 and 217 to clause 22. Those are valid points, and we have made provision for them in the Bill.
I will briefly describe what we have done. Without wanting to pre-empt the debate, I should say that consortia must set out in their constitutions the arrangements for making commissioning decisions and managing conflicts of interest. The board will review the constitution and the appropriateness of such arrangements at the point of establishment of a consortium. Clause 63 allows regulations to impose requirements on consortia with regard to good procurement practice and, importantly, the management of conflicts of interest.
I can also reassure the Committee that the failure of individual GP practices will not lead to the failure of a consortium; quite simply, they are two separate legal entities. However, the way in which primary care is delivered contributes to the achievement of consortia objectives in improving health outcomes. It is for that reason that consortia have a duty under new section 14M to support and assist the board in its duty to improve the quality of primary care delivered by their member practices, which we have already considered in this Committee. In the event that the practice loses its primary care contract, the commissioning board has the power under new sections 14Z3 and 14Z4 to assess the impact on commissioning arrangements. The board can then offer assistance and support to the consortium under the powers under new section 14X of the Bill or exercise its intervention powers to ensure that there is no risk whatever to pensions. I hope that that provides the assurance that hon. Members sought in last Thursday’s debate.
I turn to the points raised about public involvement and engagement. New section 14P in clause 22 places a duty on consortia to ensure that people who receive a service are involved in both its planning and development. As with the duty to seek appropriate clinical advice, consortia will have a flexible approach to how they exercise that duty and engage with communities in the ways that make sense locally. That is to ensure the flexibility and freedom specified in new section 14Z: consortia are obliged to hold a public meeting at which their annual report will be presented to members of the public. Consortia may go beyond that minimum level of prescription, and the board will have the power to issue guidance to consortia on the discharge of their public involvement duties to which the consortia must have regard.
Consortia will need to develop effective ways of harnessing the patient and public voice, so that commissioning decisions are increasingly shaped by people’s experiences and aspirations as to what high-quality health services mean to them and whether their express needs are met. I suspect that that is something that all members of this Committee want to see, and it is provided for by this Bill.
Amendment 175 would specify that the accountable officer is to be appointed by the commissioning consortium board. Amendment 176, moved last Thursday, would specify that the board may appoint a person to be an accountable officer for more than one consortium. If the concerns of the hon. Member for Leicester West are that the consortium will have no say in the selection of its accountable officer, I can reassure both her and other hon. Members. Although the Bill does provide for the NHS commissioning board to appoint a consortium’s accountable officer, it will be a matter for the consortium to choose who is put forward. Subsection (3) of new section 14B states that an application to become a commissioning consortium must be accompanied by the name of the person whom the consortium wishes the NHS commissioning board to appoint as its accountable officer.
The role of the board in confirming the appointment is to put a check or balance on the suitability of the proposed accountable officer. That is an important check in the system; in some ways, it is strange that Opposition Members have sought to remove it from the Bill. Schedule 2 also provides in paragraph 9(3) that the NHS commissioning board may appoint a person to be an accountable officer for more than one consortium. Again, it would be for the consortia, if they wished to share an accountable officer, to agree who they wished to take that role and to put that name forward.
I hope that that explanation of the various aspects of the amendments, and why they are in fact more than sufficiently dealt with by the provisions in this Bill, will reassure the hon. Lady and that on that basis she will withdraw the amendments. If I have not managed to persuade her—because this is one of those groups of amendments intended to undermine the Bill, rather than improve it—then I simply say that I urge my hon. Friends to oppose them.