Evaluation of Pilot Schemes

Orders of the Day — National Health Service (Primary Care) Bill [Lords] – in the House of Commons at 7:15 pm on 12 March 1997.

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  1. '.—(1) Each pilot scheme must be evaluated and reported upon by the Secretary of State at least once.
  2. (2) Each pilot scheme must be reported upon under this section before the end of the period of three years beginning with the date on which the agreement with the authority is made.
  3. (3) When evaluating each pilot scheme, the Secretary of State must consult—
    1. (a) the authority concerned,
    2. (b) any person providing services under the scheme,
    3. (c) the relevant local representative or local consultative committee (as appropriate),
    4. (d) the relevant community health councils or local health councils (as appropriate),
    5. (e) patients and organisations representative of patients.
    6. (f) the Medical Practices Committee or the Scottish Medical Practices Committee (as appropriate), and
    7. (g) such other persons or bodies as he considers appropriate.
  4. (4) The Secretary of State shall include in this report of the evaluation of each pilot scheme details of the consultations he conducted under subsection (3) above and a statement of what account he took of the views expressed in reaching his conclusions.
  5. (5) The Secretary of State shall make a report on the criteria which he proposes to use in his evaluations of pilot schemes under this section, and before making such a report he shall publish a draft report and give an opportunity to such organisations as he sees fit to comment on his proposed criteria.
  6. (6) Each report made under this section shall be laid before Parliament.'.—[Mr. Chisholm.]

Brought up, and read the First time.

Photo of Malcolm Chisholm Malcolm Chisholm , Edinburgh Leith

I beg to move, That the clause be read a Second time.

Photo of Mr Geoffrey Lofthouse Mr Geoffrey Lofthouse , Pontefract and Castleford

With this, it will be convenient to discuss the following: New clause 7—Local representative and consultative committees—

  1. '.—(1) Section 44 (local representative committees) of the 1977 Act shall be amended, in subsection (1), by inserting—
    1. (a)in paragraph (a), after the word "services" where it occurs for the second time, the words "or services provided under section 28C arrangements"; and
    2. (b)in paragraph (b), after the word "services", the words "or services provided under section 28C arrangements".
  2. (2) Section 9 (local consultative committees) of the 1978 Act shall be amended, in subsection (1), by inserting—
    1. (a)in paragraph (a), after the word "practitioners", the words ", including those providing services under the section 17C arrangements,"; and
    2. (b)in paragraph (b), after the word "practitioners", the words ", including those providing services under section 17C arrangements,".'.

Amendment No. 58, in clause 7, page 6, leave out lines 2 to 13.

Amendment No. 9, in page 6, line 12, at end insert— '(5) Before 31st March in each year, the Secretary of State shall lay before Parliament a summary report of the reviews of pilot schemes conducted in the previous calendar year in—

  1. (a) England,
  2. (b) Scotland, and
  3. (c) Wales,
including an overall summary of the effect, or anticipated effect, of the pilot schemes reviewed (together with other pilot schemes in operation) on the distribution of general practitioners and dental practitioners.'

Photo of Malcolm Chisholm Malcolm Chisholm , Edinburgh Leith

New clause 4 is a substitute for clause 7, which we regard as inadequate. The problem with clause 7 is that it contains nothing about the criteria to be used in evaluating pilot schemes prior to their being adopted as more permanent arrangements. The clause contains nothing about consultation or about a report to Parliament. It could be said that it contains nothing much about evaluation, as it refers to the weaker and more problematic concept of a review.

In Committee, we discussed this matter at great length, and the Minister was resistant to the concept of evaluation. He seemed to wilfully misrepresent or misunderstand our proposal. [Interruption] I should make it clear that he misunderstood our proposal. On 25 February, the Minister said: If one particular matter, for example, evaluation, were included in the Bill, it would be raised to unmerited importance in comparison with a range of other matters that would not be included. He went on to say: Including evaluation in the restrictive imperative way set out in the amendments would not be helpful. Our amendments proposed that criteria should be laid down for assessing the value of any particular pilot scheme. We were merely repeating the suggestion in "Choice and Opportunity" that pilots should be evaluated against the criteria established at the start. The Minister said: there are many other factors, such as the impact of the scheme on other NHS services and other providers. We need thoroughly to consider all possible evaluation criteria before making the rules, instead of picking and choosing issues for inclusion in the Bill."— [Official Report, Standing Committee D, 25 February 1997; c. 88–90.] That is where the misunderstanding comes in. We were not suggesting that the criteria should be detailed in the Bill. The new clause provides precisely the mechanism by which there can be thorough consideration of the evaluation criteria, to which the Minister referred. I hope that he will therefore welcome our new clause.

Once the criteria are established, we propose that there should be an evaluation of each pilot scheme, with the widest possible consultation. New clause 4(2) says that, after that, a report using the criteria should be made within three years, including details of consultation and what account was taken of it, which should also go out to wide consultation. Proper evaluation is at the heart of making a success of the Bill and the innovation in it.

The new clause was drafted a long time before this week, when I received a briefing from the British Dental Association. Since I shall refer mainly to medical rather than dental matters, it might be interesting to quote the BDA's comments, which seem by coincidence to take up exactly the same concerns as those expressed in the new clause. The briefing, which I am sure other hon. Members have received, says: the Secretary of State must consult both nationally and locally with representatives of the profession and consumers on pilot scheme evaluation and account must be taken of their views. The nature of the pilot reviews should be more clearly spelt out: they should be independent, with prior agreement on criteria for quality and service outcomes.there must be opportunity for Parliamentary debate prior to regulations being made for permanent arrangements which may fundamentally change the provision of NHS dental services. The importance of evaluation is very clear when we consider the dogmatic approach to the health reforms that were introduced by the Government at the beginning of the decade. In primary care, the dogmatic approach to GP fundholding is probably what we remember in particular, although my hon. Friend the Member for York (Mr. Bayley) referred in Committee to the way in which the new GP contract was also not properly evaluated. He referred to a report from the Centre for Health Economics at York university, which pointed out how the GP contract had not been evaluated. It said: Without such evaluation, the 'next' reform of the GP contract may be based on hope rather than knowledge. No hopes, however sincere and well meant, can substitute for knowledge in the formulation of health care reforms aimed at using scarce NHS resources more efficiently. My hon. Friend did not say whether he had written the report himself, but it was certainly of high quality.

Photo of Hugh Bayley Hugh Bayley NATO Parliamentary Assembly UK Delegation

I can tell my hon. Friend that I had nothing whatever to do with the report, and had absolutely no interest—commercial or otherwise—in it. It was not a matter of free advertising. I was referring to an independent study, which I felt members of the Committee should bear in mind.

Photo of Malcolm Chisholm Malcolm Chisholm , Edinburgh Leith

I thank my hon. Friend. I found the reference useful, because it illustrated, in the GP contract, a lesser-known example of the Government's failure to pilot and properly evaluate primary care reforms.

The better-known example of such failure is GP fundholding, which was driven through in a dogmatic way, and has still not been properly evaluated. In fact, the evaluation by the Audit Commission was resisted all the way by the Government, which is, of course, not surprising, since the report's conclusions were not favourable. We all know how it pointed out that the costs of GP fundholding far outweighed any benefits.

We are glad that the Government have, at least to some extent, seen the error of their ways in proposing pilot schemes, but we are not satisfied that they have totally seen the error of their ways, because they have not given the required attention to the evaluation. That is why we want it in the Bill. We hear much about evidence-based medicine; what we also want is evidence-based policy making. The Minister can hardly object in principle to setting out criteria in the Bill, because he said in Committee that the criteria for evaluation will be set out by the national consultative group.

We feel that a non-statutory ad hoc committee is not enough. It may well have a role to play in making proposals, but evaluation cannot just be left at that, not least because there is no requirement that the views of that ad hoc committee—I should say committees, since there is one for England and one for Scotland—should be heeded.

Thewords of the Minister are important, because they show that he accepts that criteria for evaluation can be set out. The new clause is asking that the criteria be set out in a report, and that the report be open to public consultation and debate in the House. I cannot see how the Minister could possibly object to that aspect of the new clause.

7.45 pm

Our main concern about the Bill, as we expressed frequently in Committee, is that deregulation could result in further fragmentation of primary care services, with wider variations and possible loss of service. We believe that evaluation is critical to ensure that that does not happen. It does not need to happen; we do not expect it or want it to happen, but it could happen without proper evaluation.

The key issue in evaluation is quality, which is why Opposition Members have started to talk about an effectiveness index for the health service, rather than an efficiency index that measures the quantity of care. At the heart of our health policy is a desire and an intention to lever up quality in primary and secondary care.

Wide discussion of criteria that are adopted to assess any pilot scheme and reach decisions on it must include questions on quality. Has there been an improved quality of care? Is that recognised by patients? Have the outcomes that were set out been achieved? What effect has there been on other providers—not only other doctors but other services and patients? Cost-effectiveness is, of course, part of evaluation.

A further aspect must be evaluation against existing practice. That was perhaps the problem with the absence of evaluation of GP fundholding. When GP fundholders lobby me, they sometimes talk about changes that have been brought about by GP fundholding. I say to them, "Well, other GPs who are not fundholders have developed in that way because there have been developments in primary care. The changes are not dependent on fundholding." Any primary care service must be compared with other services to see whether the developments are intrinsic to one model, or whether they could occur under some different model.

We believe that criteria should not be determined solely by either the Secretary of State or his committees, which is why we want consultation on them. I should say Secretaries of State, since we are talking about two—in fact, three. Criteria must be developed in consultation with the public and professionals.

The emphasis of the new clause is on the importance of consultation as part of any evaluation. Seven groups are listed in subsection (3). Paragraphs (a) and (b) refer to "the authority concerned" and any person providing services under the scheme". Those two groups are the same as the two referred to in clause 7 in relation to the Government review. Paragraph (c) refers to a local representative or local consultative committee". I shall say a little more about that in relation to new clause 7, but in passing I should point out the importance of either of them as watchdogs.

Paragraph (d) refers to the relevant community health councils or local health councils". I referred to that in Committee, pointing out that I was concerned that there did not appear to be any specific reference to community health councils in the Scottish document outlining plans for the pilots. I emphasized: Their input, not to mention their role in conducting consultations and disseminating information, is crucial."—[Official Report, Standing Committee D, 25 February 1997; c. 88–111.] I note that, at column 112, the Minister said that he would examine the matter carefully and, if necessary, write to me. Obviously, it was not necessary, but perhaps he can tell us the results of his examination of that.

Paragraph (e) refers to patients and organisations representative of patients". They must also be consulted with reference to any pilot, because evidence-based health care must take account of patients' views of effectiveness. That must be a key criterion when we are considering evaluation.

Paragraph (f) refers to the Medical Practices Committee or the Scottish Medical Practices Committee". I had better not say too much about that, as my hon. Friend the Member for Cardiff, West (Mr. Morgan) is going to talk about it in the debate on the next new clause. I was going to talk about it, but the new clauses were not grouped in the way that we had imagined, so I have ended up talking about his new clause 7, and he is going to talking about my new clause 5. However, I will say in passing that that relates crucially to the issue of GP distribution, about which he will say more. Paragraph (g) is for anyone else who does not fit into those categories.

Therefore, at the heart of new clause 4 is the importance of consultation as part of evaluation. That is the way in which we want to open out the health service, so that health decisions are made not just by the Secretary of State, or even by GPs, health authorities or health boards, but, crucially, by the public. It is important that they are involved in decisions about the health service. That is embodied in our new clause. Once that full-scale consultation has been carried out as part of the evaluation, we are saying that a report about a particular pilot must be laid before Parliament, because the evaluation must be open to scrutiny.

New clause 7 refers in particular to local medical committees and their role. As currently worded, the Bill does not provide for those committees to be recognised as representative of GPs involved in pilot schemes, as they are of GPs working in the existing system. The new clause would ensure that pilot scheme participants are allowed the same representation and involvement in the local organisation and administration of NHS general practice as their part two colleagues—those involved in traditional GP services.

We believe that it is important that local medical committees are able to represent all GPs, if they are to continue to perform their existing statutory functions effectively, and to fulfil the important role envisaged for them in advising on the establishment of pilot schemes, and developing local work force plans with health authorities.

Local medical committees provide a source of advice to health authorities and boards, which is trusted by GPs and by the authorities. The fact that the committees are representative of all GPs within a health authority or board and carry the confidence of the profession means that they are able to comment authoritatively on a wide range of issues. They provide a means by which health authorities or boards can involve GPs in local planning and give doctors a sense of ownership, which is so important in maintaining the good will of GPs in developing the primary care-led NHS.

Local medical committees provide professional input and expertise to local planning on subjects such as GP-led commissioning, health authority or health board purchasing, the distribution of resources and patient education activities. The committees will not be able to do that so effectively, or continue to have the full confidence of health authorities, boards and GPs if the new category of GP—those working in pilot schemes providing personal medical services—are excluded from the process of consultation and representation.

Examples of the role played by local medical committees include matters concerning the administration of the GP contract and providing the health authority or board with views and advice on a range of matters. They play an important role in NHS complaints and disciplinary procedures, and are also involved in monitoring professional performance. Many of those local medical committee functions will apply equally to GPs working in pilot schemes.

Furthermore, information and advice on professional development, health promotion activities and complaints handling can all be disseminated widely through the local medical committee structure. GPs working in pilot schemes under part I of the Bill should similarly be in a position to receive such advice from a local medical committee.

Labour's plans for primary care centre on the ending of two-tierism, the levering up of quality and the securing of innovation within a coherent strategic framework. The last thing we want is new varieties of fragmentation and two-tierism, either of primary care services or of the primary care work force. To avoid that, it is essential that the new clauses are taken on board.

Photo of Mr Peter Thurnham Mr Peter Thurnham , Bolton North East

Before speaking to amendment No. 9, I should like to add my congratulations to the hon. Member for Wirral, South (Mr. Chapman) on his excellent maiden speech. The Minister may recall that I made my maiden speech on the British Telecom Bill, and shared many hours on Committee with him.

I should like also to endorse the eloquent testimony given by the hon. Member for Birkenhead (Mr. Field) to the late Barry Porter. I remember my shock on learning that he was so ill. I know that he fought his illness bravely up to the last weeks of his death. The sense of loss is shared not only by North-West Members, but, I am sure, by all Members on both sides of the House.

Amendment No. 9, which stands in my name and that of my hon. Friends, is similar to an amendment that we debated in Committee. I hope that the Minister will be able to give a slightly fuller reply than he was able to in Committee to the points I raised. The amendment has been changed to make it, I hope, more acceptable to the Government. It calls for an annual report to Parliament of reviews of the pilot schemes in England, Scotland and Wales, including an overall summary of the pilot schemes' effect on the distribution of both general practitioners and dentists.

The amendment is strongly supported by the Consumers Association. It is a sensible addition to the Bill to see whether it is achieving its aims. One of the Bill's principal purposes is to achieve more even and equitable distribution of primary care. Clause 5(4) ensures that the Secretary of State must have regard to the effect that pilots are likely to have on the distribution of GPs when he approves pilot schemes, so it seems only sensible that Parliament should be given the opportunity to find out whether pilots are being successful in achieving that end. The amendment provides for an annual report to Parliament on the effect of pilot schemes on the distribution of primary care services.

The Minister will, I am sure, recall that, during the debate in Committee, I touched on some of the regional variations of which we are only too well aware in the north-west. In 1980, the Black report highlighted many of the unfavourable variations there. Sadly, many of those variations are still with us.

In Committee, I discussed three examples concerning children's services, renal services and dental health. I could, of course, discuss others, including heart disease. The north-west has the worst record on early heart disease of any district in England.

I remind the Minister of the points that I made in Committee about perinatal mortality rates in Bolton, which are substantially above the national average. The figures for the past five years show that, in Bolton, still births and deaths within one week, which are, of course, tragic events, are 40 per cent. above the national average. There has been no improvement in the past five years, and the national average is deteriorating, so I call on the Government to encourage pilot schemes that would particularly address that issue, and to find out whether we cannot have some improvement in that respect.

On the same subject, there is considerable concern in Bolton about the future of the specialist children's hospitals at Pendlebury and at Booth Hall. I hope that the Minister will say how the Government will come to a decision about the future of the services in those two hospitals. Both face closure proposals. I hope that a decision will be made at an early date to concentrate the services at Hope hospital, for the benefit of my constituents.

The other point I made in the Committee's debate on the Bill was on renal services. I was very shocked to learn that the north-west has the worst renal services in the country. I learned, in a letter to me from the director of the Salford Royal Hospitals NHS trust, that there could be many benefits from an improved service and that, currently, only half the patients who could benefit from life-saving dialysis therapy are on treatment"—

Photo of Mr Geoffrey Lofthouse Mr Geoffrey Lofthouse , Pontefract and Castleford

Order. The hon. Gentleman is straying rather wide of new clause 4 and amendment No. 9.

Photo of Mr Peter Thurnham Mr Peter Thurnham , Bolton North East

The consultation documents mention the proposals' benefits to primary services. I think that it is most important that we have primary services that deal with the concerns of renal patients. The disconnect service, for example, is not available in the north-west, and it would be of great benefit to many people there. Moreover, primary care services require that such services should be located within the reach of constituents. We could have twice-weekly renal clinics, dialysis within the district and a specialist renal physician working closely and often daily with clinicians and other health care professionals in the community and in hospitals.

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I call on the Minister to make an early decision on the future of those services, and to provide them at the Manchester Royal infirmary and at the Hope hospital. I hope that he will tell us in his reply how he will deal with the issue.

We have also been concerned about the north-west's very poor record on dental health. The Minister is aware of my concern on that matter, and he will remember the White Paper "An Oral Health Strategy for England", which contains a map clearly showing that the north-west region is much the worst region for dental health. The figures on the map are supported by tables published by the British Association for the Study of Community Dentistry, which, sadly, show that Bolton is at the bottom of the national league table, with north and central Manchester. It is significant that the bottom 12 areas, all of which are in the north-west, suffer—

Photo of Mr Geoffrey Lofthouse Mr Geoffrey Lofthouse , Pontefract and Castleford

Order. I hesitate to stop the hon. Gentleman again, but new clause 4 deals with pilot schemes. I hope that he will confine his remarks to that matter, and that I do not have to pull him up again.

Photo of Mr Peter Thurnham Mr Peter Thurnham , Bolton North East

Mr. Deputy Speaker, the point on which I wish to press the Minister is that he should encourage the establishment of pilot schemes that will deal with the regional differences that I have mentioned, which are acute in the north-west. My constituents are anxious that there should be improvements in dealing with those differences, and that pilot schemes should be established which deal with the differences.

I ask that the Minister tell us in his reply what can be done with pilot schemes to deal with those severe differences, which have developed not only generally in the north-west but specifically in dental health in Bolton. In Committee, I quoted figures that showed that children's dental health in my area has deteriorated to a point at which it is now the worst in the UK.

I do not wish to press my amendment to a Division, but I hope that the Minister will either accept it or provide a very full explanation of the Government's feelings on the matter.

Photo of Tony Wright Tony Wright , Cannock and Burntwood

From the moment that the Bill first appeared—even before, during its gestation period—everyone who was involved in thinking about it and commenting on it said that the process of evaluating pilot proposals would be the most crucial factor in its success. There could be no objection—indeed, there was wide welcome—that the Government were proceeding to develop primary care on a pilot basis. The important questions, however, were, how were those schemes to be evaluated, against what criteria, who would be involved in the consultation process, and how were reports to be made on the outcome of the projects?

In Committee, those questions were repeatedly asked of the Minister. His answer has always been to trust him to take a view on the matter. He has a committee, and, although it is a splendid little committee, he seems to be saying, "We will make judgments on those matters, and the House need not trouble itself with them." The House must decide whether it is satisfied with that arrangement, or whether it wants to impose framework obligations on the Minister.

It is quite routine in legislation empowering Ministers to require them to report on the discharge of those powers. Scarcely a day passes without the House producing a document—which is avidly read by all hon. Members—requiring Ministers to account for the powers provided by legislation.

It is very strange that at the centre of this legislation are the questions of what type of evaluation will occur, against what criteria, and who will be involved? From the beginning, the Government did not think that it was important to insert that type of criteria into the Bill. I am sure that the Minister will tell us again today that it is not the House's job to specify the criteria or to specify in detail what should be taken into account in evaluating specific pilot projects. I agree with that. However, the House should insist that there is an identified and established process by which pilots will be evaluated, and it should specify who will be involved in them.

I think that the failure to take that action will eventually be regarded as the Bill's major omission. It is important that Ministers did not feel it necessary to correct the omission. Moreover, as I look at the acres of emptiness behind the Minister, I can only remark that the House has not felt itself obliged to remedy it.

Photo of John Heppell John Heppell , Nottingham East

I think that the Minister knows that I am rather keen on passing this legislation, which is why I hope that I can persuade him that it is a good idea to support new clause 4.

I am keen on the Bill because, unlike many hon. Members, I live in an area in which the majority of doctors—in a ratio of 4:1—have not become fundholders. Those non-fundholders, as they call themselves, set up a scheme of their own by which they could be involved in commissioning work. They would have liked to go further with the scheme and achieve total commissioning instead of total fundholding, because it had all the benefits of fundholding without all the bureaucracy. Therefore, this legislation would allow non-fundholders to take their scheme one step further in providing a better services to their patients.

As many of my hon. Friends have said, the Bill's one omission concerns clause 4, because pilot schemes become almost useless without proper evaluation and consultation. If there is no evaluation, how will we know what is the best practice or what has failed? How will we pass on information from good schemes to GPs in other parts of the United Kingdom? Without proper evaluation, pilots become pointless or merely local exercises. They may fail or they may succeed, but they will be concerned with only one area. Even if a scheme is successful, similar schemes may be started from the beginning in other areas, again and again, because information from pilots has not been evaluated and passed on.

People say that the Minister never considered the idea of evaluation criteria at the Bill's inception, but that is not true, because the idea was spelt out clearly in the Government's White Paper "Choice and Opportunity", which expressed a general approach to piloting. The paper contained about seven or eight bullet points, all of which I will not read out. The first was: ideas for pilots will be formulated locally"— and so they continue.

The point that is particularly relevant—it has been mentioned already in the debate—states: pilots will be evaluated against the criteria established at the start and taking account of the views of those involved and affected. That is quite clear, and I thought that it was the Government's intention.

In addition, the White Paper identified safeguards for patients and practitioners. It said that the Secretary of State should be able to make arrangements for the evaluation of a pilot, including approving the criteria and process", requiring health authorities to monitor the quality of the service provided and to provide information locally about the pilot to those affected, particularly on the quality, volume and cost of services to ensure that patients were protected and taxpayers received value for money and on the criteria for evaluation and the process for doing so. Very few of those commitments are on the face of the Bill, which is weakened by their omission. New clause 4 also makes provision for proper consultation with a range of bodies, including community health councils, professional groups and the Medical Practices Committee.

I have made my position clear to the Minister in other discussions, but I should like to draw attention to the provision in new clause 4 to ensure that local medical committees can continue to act as watchdogs. I am confused about why the Minister will not put that on the face of the Bill.

Perhaps the Minister recalls the words of the Chancellor of the Exchequer on a BBC 2 programme "Safe with Us" in respect of previous NHS reforms: I was sure if you isolated a few places as pilots, all the best efforts of the BMA element in the medical profession would be bent to ensure that it failed. That may be part of the problem. The Government treats local medical committees as if they were trade unions. I do not dispute the fact that local medical committees look after the interests of general medical practitioners.

That is part of their role, but they also look after the interests of general practice. There is a difference: they look after the interests of patients as well as doctors.

Local medical committees have been operating since 1911, well before the formation of the national health service. Since 1911, they have been consulted by NHS executive councils, health authorities and, before them, insurance committees. Why should the Minister suddenly decide that local medical committees should no longer have a role in these matters?

My local medical committee represents all the doctors in the area—fundholders and non-fundholders. It speaks for all general practitioners and should be consulted. If local medical committees are not consulted, we shall lose out in terms of the professional advice that general practitioners can offer in medical and administrative matters.

Baroness Cumberlege stated in another place that consultation in the NHS was standard practice. As far as I am concerned, there is no standard practice of consultation at any level in the national health service. Nowadays we have public relations. People produce glossy brochures telling us all the good points of any proposal. It happens at every level—in trusts and health authorities. We never hear the bad news until it is too late. Nor are we told about any proposed changes to the health authority until they are so advanced that we can do nothing about them.

Consultation in the health service has become a farce, with supposedly public meetings packed with health authority and trust staff rather than the general public. If the Minister really believes that the general public are being consulted, he should realise that, if he were not a Minister, he would not find it easy to get information out of certain trusts and health authorities.

The Minister may not know that I have written two letters to the Secretary of State about the fact that neither I nor the general public were consulted about multi-million-pound schemes in my constituency. We knew nothing about schemes that had been in place more than a year. I asked the Secretary of State whether that went against the Government's code of practice on openness for the national health service. He did not reply yes or no, so I wrote to him again asking, "Doesn't this go against your code of practice on openness for the national health service?" Again he wrote back without saying yes or no. So I shall write to him again.

8.15 pm

About a week after I had written my second letter to the Secretary of State, I received a letter from the NHS executive headquarters about the code of practice on openness in the NHS. It was addressed to all Members of Parliament, and it said: Dear Member of Parliament…I enclose a copy of the Code of Practice on Openness in the NHS.A report by the Health Service Commissioner on access to official information in the NHS was recently considered by the Select Committee on the Parliamentary Commissioner for Administration. The Committee were concerned over the Commissioner's findings that there appeared to be a lack of public awareness of the Code of Practice on Openness for the NHS and therefore asked me to arrange for a copy to be sent to each Member of Parliament for information. I have some advice for the NHS executive. It should send out a few more copies to chief executives of NHS trusts, chairmen of health authorities and many others who are not applying the code. I know about the code, but it is fairly obvious that many in the health service do not. That is why it is even more important that we restore some credibility to the health service by ensuring that there is proper evaluation, and, more importantly, proper meaningful consultation with all groups, including local medical committees.

Photo of Mr Gerald Malone Mr Gerald Malone , Winchester

I have listened to the debate on new clause 4 wondering whether I would hear any new or more compelling arguments than we heard in Committee. With respect to hon. Members, who pressed their suits as vigorously as they did in Committee, I have to disappoint them, and say that I did not hear much to persuade me that I should accept the new clause. I shall explain briefly why, but first let me turn to two specific points that were raised by the hon. Member for Bolton, North-East (Mr. Thurnham).

In the context of this evening's debate, I shall not respond to his point about reconfiguration of services in which he has an interest. However, I have noted his comments, and I shall reply to him through other channels and let him know the up-to-date position.

The hon. Gentleman made another point about dental pilots, which could be relevant to the debate in terms of amendment No. 9. I envisage the pilots to which he referred dealing with problems of oral health care in centres of population where oral health is poor. That is the purpose of the Green Paper that preceded the Bill. I can give the hon. Gentleman the assurance he seeks, that the pilots are specifically designed to solve such problems.

As I have said many times, we are committed to evaluating the pilot schemes in a open and consultative manner. I remind the hon. Member for Edinburgh, Leith (Mr. Chisholm) that there is a statutory underpinning for that in that clause 7, which commits us to evaluating each scheme within three years of its beginning to provide services. The question is whether we should set out criteria on the face of the Bill. I have not changed my view, although we have every intention of setting criteria for evaluation.

The hon. Member for Cannock and Burntwood (Dr. Wright) described the national consultative group as a small committee. I was trying to signal to him that a large, wide group will consider criteria that will apply to all schemes.

The universal criteria will be based on the advice of the groups and the local criteria on the work of health authorities and providers. They are likely to cover issues including quality of services, the wider impact on the provision of local general practitioner and dental services—returning to the point made by the hon. Member for Bolton, North-East—administrative efficiency and value for money. With a wide variety of schemes, some of them fairly small, an elaborate system of reports for each would be unnecessary, and out of proportion to other scrutiny arrangements. There is no need for such a requirement.

We believe in using the established mechanisms, well known to the House—Select Committee inquiries, parliamentary questions and debates. From nearly three years' experience as a Minister for Health, I know that some hon. Members are not slow to use such devices to air their concerns. Those are the appropriate ways to deal with such matters, ensuring that information is made available to Parliament and obtained in the form required. The process envisaged in the amendments is likely to be unwieldy and bureaucratic. It may be appropriate for large schemes, but not for the many smallish schemes that we anticipate.

The hon. Member for Leith asked about community health councils. I looked carefully at what I said in Committee, when I answered the point in another way. Community health councils will be consulted in two ways. I expect them to be consulted in the general sense, but I also pointed out in Committee that they have a statutory right to consultation if what is being proposed in a pilot amounts to a major service change. They are reassured by that.

I should like to clarify the Government's position on the issues exposed by new clause 7 on local representative committees. They will play an important role in the development of the new arrangements. Health authorities will need to seek their views on the impact of pilots on existing arrangements and when pilots are evaluated. They will definitely be involved, continuing the long-standing relationship between health authorities and LRCs in the provision of general medical and dental services.

I have an important opportunity this evening to set out my views on the future arrangements and the statutory role of LRCs. The statutory role and funding of LRCs relates to the existing general medical services and general dental services contracts, and various functions performed under them. However, they have also voluntarily undertaken other roles relating to professional matters outside those that are statutory and funded, in which they have been a helpful forum for seeking representative views of GPs and general dental practitioners. That has grown up without the protection of statute.

Health authorities will continue to need to seek representative views on such non-statutory matters that affect all GPs, GDPs and dentists working elsewhere. In doing so, they will need to embrace all those providing primary care services. The mechanisms for securing that should be decided locally by GPs and dentists. I expect LRCs to continue to demonstrate their strength as representative organisations across a spectrum of activity outwith their statutory responsibilities.

In the light of what I have said, I hope that hon. Members will accept that the arrangements in the Bill are the best way forward, showing our strong and genuine commitment to the principle of consultation. I hope that they will not press the amendments.

Photo of Malcolm Chisholm Malcolm Chisholm , Edinburgh Leith

I have two points in response to the Minister. First, he repeated the claim that evaluation was already provided for in clause 7. Leaving aside the issue whether a review is evaluation, the fundamental point is that there is no provision for adequate consultation in the clause. That is our main objection, quite apart from the lack of any mention of criteria.

The Minister persists in repeating his assertion in Committee that we wish to put criteria in the Bill. There is no mention in the amendments that we moved in Committee or in the new clause of putting criteria in the Bill. We are merely asking the Secretaries of State for Health, for Scotland and for Wales to make a report on the criteria. The Minister has conceded that criteria for evaluation will be set out by the national consultative committees. Why cannot that be presented as a report for proper consultation? The Minister has not answered that point, because he has no valid objection to our proposal.

Clause 7(4) says: the procedure on any review is to be determined by the Secretary of State. That reminds us that the best safeguard for the clauses is a new Secretary of State in a new Labour Government. In view of that, I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.