Health and Social Care Bill [Ways and Means]

Oral Answers to Questions — Communities and Local Government – in the House of Commons at 3:42 pm on 15 January 2008.

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Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health 3:42, 15 January 2008

I beg to move,

That, for the purposes of any Act resulting from the Health and Social Care Bill, it is expedient to authorise the charging of certain fees by the Office of the Health Professions Adjudicator.

The motion is in the name of my right hon. Friend the Financial Secretary to the Treasury. A Ways and Means resolution has been deemed necessary by the House authorities to allow the office of the health professions adjudicator, the new independent adjudicator created by the Health and Social Care Bill, which is currently in Committee, to charge fees to the regulatory bodies whose fitness to practise cases are to be referred to the office for adjudication. The motion is being moved now because the Bill as introduced did not require a Ways and Means resolution.

The office of the health professions adjudicator will adjudicate on fitness to practise cases involving doctors, those in professions regulated by the Opticians Act 1989 and any other professionals whose regulatory body decides to use its services. At present, the General Medical Council and General Optical Council must meet the costs of the adjudication functions exercisable by their respective committees. The Health and Social Care Bill will transfer those functions to the office of the health professions adjudicator, so those two bodies will no longer have to meet those costs. We have therefore tabled a Government amendment to allow the office of the health professions adjudicator to charge fees to the General Medical Council and General Optical Council. We omitted such a clause from the Bill on its introduction so that we could complete detailed discussions with the General Medical Council about how the new adjudication body should be funded.

Photo of John Bercow John Bercow Conservative, Buckingham

I am not unduly perturbed by what sounds so far like a wonderfully "Sir Humphrey" statement, but I must say—I suspect that other Members entertain similar concerns—that we do not want an entirely open-ended provision. Can the Minister offer the House any indication of the likely scale of the costs that will be incurred, and in what period they will be incurred?

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

I certainly can; I had intended to say something about that in a little while. The hon. Gentleman may like to speak to his spokespeople on the Front Bench, who argued loudly in Committee that the independent adjudicator should be even more independent, and freer to do whatever he or she likes, which caused great concern to the GMC and others in relation to the ability of the House or the Secretary of State to ensure that the fee levels are reasonable.

There are two ways in which the aim will be achieved. First, the new adjudicator will have to consult on the level of any fee that he or she wants to levy. Secondly, those fee levels will have to be approved by regulation and in consultation with the Secretary of State. Given those safeguards, I hope the hon. Gentleman is reassured that the costs of the new adjudicator will be broadly similar to the current costs incurred by the GMC and the GOC.

Photo of John Bercow John Bercow Conservative, Buckingham

I am partly reassured by what the Minister has said. I am grateful to him for his clarification, but as he refers to a prospective order-making power, may I ask the obvious supplementary question—whether the order-making power will be subject to the negative procedure or to its affirmative counterpart? It is rather important to know which.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

My understanding is that it will be the negative procedure. I will write to correct that if I am wrong.

Photo of Humfrey Malins Humfrey Malins Conservative, Woking

I declare an interest as a part-time panellist for the General Medical Council, appointed by the House some time ago. The question of fees troubles me slightly. Can the Minister confirm specifically that the House will have an opportunity to discuss the level of those fees? Can he say who is to set them, roughly how much they will be—the scale involved—and who, ultimately, will pay? It sounds a little like a stealth tax. Will doctors pay? Will the General Medical Council pay? Where does the bill end up?

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

The regulatory bodies such as the GMC, the GOC and possibly others that come under the independent adjudicator's remit will pay the fees, based on the work load of the independent adjudicator in any one year. Individual doctors now pay a levy or a membership fee to the GMC. They will continue to do so, and out of the funds that that raises, the GMC—or the GOC, or other appropriate body—will pay a fee that will be set after consultation with everybody, including Members of Parliament, and approval by the Secretary of State in laid regulations.

We are doing some independent research with the GMC into its current costs. It is rather difficult to disaggregate the cost of the adjudication process from the overall costs that the GMC incurs, but our estimate is about £11.5 million a year. That is the figure that we are working on. That is the current cost, which is met by medical doctors and others who are members of those organisations and pay their annual subscription to those organisations.

The new clause about fees must be authorised by a Ways and Means resolution. The House authorities, I understand, reached this conclusion because the new office of the health professions adjudicator will be for the benefit of the general public, rather than just for the benefit of the professions regulated by the GMC and the GOC. In addition, the fees charged by the OHPA will cover all of the body's costs, rather than costs incurred before a day to be specified in regulations or costs incurred for a purpose specified in regulations. That is the difference between the fee-charging powers of the Healthcare Commission and the future care quality commission. In other words, the fees will be calculated by reference to the total expenditure of the OHPA, rather then to the individual service that it is providing to an individual organisation.

It has always been our intention that the regulatory bodies in receipt of OHPA's adjudication services should pay for the adjudication of their cases. As I said, at present the costs are borne by the health care professional regulators, and we see no reason why that should change. The fee will be charged on an annual basis rather than on a case-by-case basis. As I also said, regulations will be made by the Secretary of State, setting out the process through which the level of the fee is to be determined. I am confident that the funding arrangements set out in the new clause are fair and appropriate.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health) 3:49, 15 January 2008

In speaking to this Ways and Means resolution, I am mindful of the words of my late, great colleague on the Conservative Benches and champion of the rights and duties of this House, the former Member for Bromley and Chislehurst, Mr. Eric Forth. He noted:

"It is always a great pity that these apparently innocuous Ways and Means resolutions attract such relatively little attention from colleagues in the House, because they are, of course, a very important part of what remains of the House's influence on the sort of measures that flow from legislation. I should like to think that in some ways Members would be more interested in Ways and Means resolutions than in many other aspects of the Bills themselves."—[ Hansard, 15 November 2004; Vol. 426, c. 1064.]

I pay tribute to the fact that the Conservative Members who sit on the Committee considering this Bill are present for this Ways and Means resolution debate; apart from the Minister, only the Parliamentary Private Secretary and the Whip are on the Government Benches. That is a shame. Furthermore, it is notable that the Minister chose not to answer the direct questions put to him, quite properly, by my hon. Friends the Members for Buckingham (John Bercow) and for Woking (Mr. Malins); my hon. Friend the Member for Woking brings expertise to this subject from his past.

The Minister has just said that the House authorities deemed it necessary to bring this stand-alone, separate Ways and Means resolution to the Floor of the House today. I remind the House, however, that that would not have been necessary had the Government got their act together sufficiently in advance of publication and the commencement of the Bill's proceeding through the House. They should not have left outstanding a series of open-ended negotiations so that the resolution could not be recognised in the Bill when it was first published.

According to House rules, when the Government table a new clause a Ways and Means resolution is necessary if the new clause would raise a new fee structure or a tax—and I shall argue that new clause 7 does. The Government are responsible for taking up the time of the House on this matter, which is important, given that we are already in Committee and considering the very issues to which it relates.

This debate arises from Government new clause 7. The Committee has not yet debated or voted to amend the Bill through the new clause. It is therefore valid to ask whether we should take up the House's valuable time at this point of the Committee's proceedings.

Photo of Humfrey Malins Humfrey Malins Conservative, Woking

Is my hon. Friend saying that the issue has not yet been fully debated in Committee? That comes as a great surprise, particularly as I understand that many Labour members of the Committee are not here today. Have not Labour and Conservative Committee members already had a full opportunity to debate the new clause and its financial implications? If they have not or are not going to, that is astonishing.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

I am sorry to have to confirm to my hon. Friend that he has to be astonished. We have started the Committee's proceedings and taken the new form of oral evidence, but new clause 7 was tabled at a such a point that it does not even come up for consideration by the Committee for some time.

Photo of John Bercow John Bercow Conservative, Buckingham

Irrespective of whether the programme motion will allow for a debate on that new clause, may I raise with my hon. Friend and, through him, the Minister a wider concern that has been a consistent hobby-horse of mine in recent years? If the matter is to be effectively implemented by regulation—and I do not cavil at that—is it not a good idea, and should not Parliament demand, that we as a House have sight of a draft version of the regulations before the final passage of the Bill? Otherwise, we are voting for a pig in a poke.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

With his usual clarity and unique way with words, my hon. Friend puts his finger right on a point that I shall come to. I hope to confirm that he is spot on.

Notwithstanding the fact that we have not reached the point in Committee where we even know whether new clause 7 will be voted on and passed, I note that had the Government managed to complete their negotiations with the regulatory bodies before Second Reading, so bringing to the House a Bill in much better order—they have already tabled 53 amendments—this matter could have been dealt with on Second Reading. Given the absence of the clause on Second Reading, we are now in the impossible position of being called to vote on fee-charging powers that we have not had the opportunity to discuss. That is somewhat contemptuous and not in line with the Prime Minister's assertion, just a few months ago, that he would hold this place in much higher regard than the Prime Minister whom he succeeded. By the Government's own admission, they found themselves still in late negotiations with the General Medical Council long after the Bill had found its way into the House's calendar. The resolution has either been proposed too early or proposed too late, but it certainly should not be taking up the House's time as it is. However, that is what we are faced with, so we must deal with the facts as we find them.

To understand the context in which the resolution is being considered, I remind the House that the office of the health professions adjudicator is a new body that is being set up under the Bill to take over the adjudication of fitness to practise panels from the GMC and the General Optical Council. It is being established in response to Lady Justice Smith's recommendations in the Shipman inquiry. Under the new procedure, we had the benefit of her being able to give us direct oral evidence, and it was incredibly persuasive and powerful. I dare say that the whole House will join me in agreeing that we, as a legislature, never want a repeat of the appalling Dr. Shipman's atrocities. There is a question mark over the creation of the OHPA. The GMC noted in its written evidence that, by any objective measure, its adjudication track record is extremely good, and that over the past two years, 2006-07, there had been 2,480 hearings regarding doctors' fitness to practise, with all decisions challengeable by reference to the High Court.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

I am grateful to you, Mr. Speaker. Of course, I will do my very best to ensure that I stay within your ruling. I was simply trying to demonstrate that the current body is not doing a bad job at the moment—indeed, only 0.4 per cent. of its rulings have been challenged in the courts. The successor body, with the functions that the Government are seeking to put in place and for which they want a new form of fee charging, is absolutely dependent on the resolution being passed.

Photo of Humfrey Malins Humfrey Malins Conservative, Woking

The more I listen to my hon. Friend, the more I feel we should take the view that the proposal to charge fees through this new body should be scrutinised much more carefully before we proceed any further. I can confirm that the performance of the GMC, in terms of its hearings and so on, has been much more efficient recently. Where, therefore, is the argument that we should be giving the Government carte blanche to charge a whole lot of fees through this new body without the matter having been properly debated—

Photo of Michael Martin Michael Martin Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Chair, Speaker's Committee on the Electoral Commission

Order. Once again, let me say that the bodies concerned can be discussed in Committee, but we have a rather tighter matter before us and we should be debating that.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

I am grateful to you, Mr. Speaker. The fact that we have to vote on this now means that we must raise the issues about where fee charging is dealt with. I recognise that that is the definition of your ruling. Absolutely germane to what my hon. Friend Mr. Malins, with all his experience, rightly says, is the question of whether what two bodies carry out, through two distinct functions, in relation to a matter that was previously dealt with under one body, has a significant bearing on the costs and amounts that may be charged through them as a tax, not necessarily falling on general taxation powers. Perhaps it would have been helpful to have had the benefit of the opinion of the Chairman of the Select Committee on Health; it is a shame that he is not here. [ Interruption. ] Indeed—as he is a GMC member.

Critical to our decision on the resolution is whether we have resolved an issue of serious contention in Committee—whether the new bodies being set up under the Bill, not just this body but other bodies, are truly independent of Government. As an indicator of the Government's intent, if those bodies are truly independent, we would expect them to be able to charge a fee. I have to say that based on all the evidence so far in Committee, it has not yet been established that they are truly independent—far from it—and we have criticised them for that. If they are not independent, we are not considering a fee but a substitution of vicarious taxation of the members of professions covered by the new body for recovery of costs.

We have to consider who might be affected by the passing of this resolution. For the doctors, optometrists, dispensing opticians, student opticians and optical businesses of this country, the fees proposed in the resolution will be garnered from the General Medical Council and the General Optical Council, as the Minister has admitted. That will have a direct impact on the fees charged by those bodies to their membership. The full GMC registration fee on the medical register will rise to £390 per annum with effect from April this year, having been frozen at £290 per annum since 2002. GOC registration stands at £169 per year. My hon. Friend John Bercow, whom I see is still just in the Chamber, raised the essential question of what the costs were, and we heard that there will be a massive increase. According to the Minister, it will be £11.5 million, which, by a quick calculation, means an extra £100 per doctor. It is that sort of detail that my hon. Friend was trying to winkle out of the Minister to find out what extra costs to constituents and the professional community we are truly sanctioning.

I recognise your strictures to stay in order according to the resolution's narrow definition, Mr. Speaker, but the other serious unanswered question is that we have not seen the secondary legislation upon which the resolution depends, even in draft. As my hon. Friend the Member for Buckingham said, that makes it a bit of a pig in a poke. It certainly means that we are flying blind.

The other thing absent from our consideration of the resolution—the final financial point that needs to be addressed—is the question of VAT. Currently, neither the GMC or GOC is registered for VAT, partly because of their charitable status; I hope that that is not news to hon. Members. However, the new office of the health professions adjudicator will immediately slap a 17.5 per cent. uplift on the fees payable to it, irrecoverable against the fees paid to the GMC or the GOC. The Minister should explain fully how the resolution will affect that arrangement. Where will the VAT loss fall, and upon whom?

We have a serious worry about the costs included in the Bill that are, by virtue of this resolution, yet unknown. In addition to what is currently proposed to ensure that a fee is passed on vicariously to the members of the various professions involved—because it is no longer an independent body in our view, we consider this to be a tax-raising power—the Minister told us in Committee on Thursday that the establishment of the care quality commission as a successor body to the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission will cost £7 million, as outlined in the regulatory impact assessment. The transition cost will be £140 million, which includes the costs of redundancies, estate rationalisation and a planned reduction of operating costs. Creating responsible officers will cost between £3.1 million and £16.7 million per year, and extending direct payments will cost £1.5 million to £8 million a year. The social enterprise investment fund will cost £98.1 million and the health in pregnancy grant is a one-off payment.

So, in addition, we have the ways and means resolution, which is the only means whereby the Government can press ahead with insisting that the fees chargeable by the OHPA are recoverable. It effectively constitutes a new tax on members of the professions I have listed. The resolution appears ill prepared and panicky, and has been tabled after the Bill was introduced.

The Bill also presents a significant worry because the money for pregnant women is to be paid at the end of the second trimester. All the evidence that we have established shows that, despite the Prime Minister's assertions, the only benefit to be derived for better diet is before conception and in the early weeks of pregnancy. That contrasts with the Prime Minister's comments. Notwithstanding that we are discussing £175 million in the first year—

Photo of Michael Martin Michael Martin Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Chair, Speaker's Committee on the Electoral Commission

Order. Once again, the hon. Gentleman is going wide of the resolution. He must get back to it—it is very narrow, so it should not be too difficult for him.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

Certainly, Mr. Speaker.

Let me put the resolution in context to understand the way in which it would work. The Government have not yet set out the rationale for establishing the body to which the resolution relates. We have a problem with timing as well as the substantive problem.

Photo of Stephen Crabb Stephen Crabb Conservative, Preseli Pembrokeshire

Is my hon. Friend aware of any genuine consultation on new clause 7 in which the Government have engaged with the professions?

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

I am grateful to my hon. Friend and glad to have the opportunity to point out that, unlike the Government and the Liberal Democrats, despite their assertions, Conservative Members are proud that we have ensured that someone who represents a Welsh constituency will serve in Committee, given that the Bill relates to so many powers that Welsh Ministers exercise in relation to the Mental Health Commission. I am glad to say that my hon. Friend Mr. Crabb will be looking out for his constituents and everyone in Wales in Committee. No other party chose to nominate Welsh Members of Parliament to the Committee.

My hon. Friend's question about consulting the professions is crucial to whether we should pass the resolution and whether we should be called upon at this stage to debate it. Such consultation does not apply only to England but to Wales. Has consultation been properly framed and passed on to Welsh Ministers, who will make decisions that replicate, to some extent, those made in England, to apply to the medical profession in Wales? My hon. Friend asked a germane question and I hope that the Minister will tell us the extent to which consultation has taken place with professional bodies, especially the GMC, to establish whether the resolution is the right way forward and whether the professional bodies are looking forward to being a proxy, vicarious tax collector for the Government to recover fees for the new OHPA, the establishment of which has not yet even been agreed.

I have a final series of questions for the Minister to enable us to make a decision on the resolution and maintain the proper challenge that my former colleague the former right hon. Member for Bromley and Chislehurst issued on such resolutions. Why were matters not sorted out in time for Second Reading? Why is it suitable for the House to table a Ways and Means resolution on an aspect of the OHPA that neither it nor the Committee has had an opportunity to debate? What assurances can the Minister give that the resolution is not a blank cheque, given the OHPA's lack of independence, which we have already observed in Committee by reference to another body—the care quality commission, which is also being set up—the absence of draft regulations on new clause 7 and of cost control measures in the Bill? The Minister did not mention cost measures when he outlined at the outset of our short debate what he believed to be appropriate.

Will the Minister also reassure the House that, in accepting the resolution, we are not creating a huge liability for doctors, optometrists, dispensing opticians, student opticians and optical businesses? How will the resolution operate given the different VAT status of the bodies involved? Why does not the money resolution cover at least part of the resolution that we are discussing?

We have an opportunity to test the Government. Are we to be disappointed or are we in for the parliamentary shock of getting genuine answers to key questions, without which the House should not be contemptuously steamrollered into supporting the resolution?

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health, Liberal Democrat Spokesperson (Health) 4:09, 15 January 2008

I can assure those who are waiting patiently for the next debate that I will be very brief. Participating in my first debate on a Ways and Means resolution, I have to confess that I am left feeling completely confused, particularly after the wide-ranging speech of the Conservative spokesman. However, I share the questions that he put to the Minister, particularly those seeking the justification for why we are in this situation. Despite the Minister's best efforts and what John Bercow said, Sir Humphrey liked to put his case across in a calm and measured way. The situation smacks of chaos and confusion.

The Minister said that the provisions were not dealt with originally because of detailed discussions with the GMC. Is that really the beginning and end of the matter? Did he anticipate that he would be required to come to the House with the resolution in order to satisfy proper procedures? Reference has also been made to the need for the Committee to see the draft resolutions during the Committee stage. Will the Minister ensure that they are available, so that the Committee and the House know exactly what they are voting to permit?

Photo of Angela Browning Angela Browning Deputy Chairman, The Conservative Party 4:11, 15 January 2008

Although it is true that the Committee has not yet dealt with new clause 7, reference has been made to fees and costs in relation to the regulatory impact assessment, which the Minister has made available to the Committee. The figures for the savings from merging the three regulatory bodies into one that the Minister has produced for the Committee are extremely wide ranging—I do not have them with me, although we touched on them in Committee and I am sure that he would admit that. The Minister was asked in Committee whether he could identify how much in those figures represented economy of scale savings from bringing three bodies into one and how much represented contributions from fees earned. At that point, however, the Minister could not clarify what percentage would be contributed by the scale of the fees that he is proposing in this Ways and Means resolution.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

In fairness to him, the Minister offered to send a letter setting out some of the financial parameters. I want to ensure that my hon. Friend thinks that he covered that and that it is adequate for the purposes of passing the resolution that we should not have received those details until after we have challenged the Government on whether it is the appropriate way forward.

Photo of Angela Browning Angela Browning Deputy Chairman, The Conservative Party

My hon. Friend is exactly right. Notwithstanding the promise that the Minister made in Committee to give more clarification on the figures, it is difficult to make head or tail of them if we cannot disaggregate the fee contribution in the calculations that the Minister has offered. When he replies to my contribution, will he be so good as to elaborate on exactly how the fee-bearing side of the regulations will contribute to the broader figures in the regulatory impact assessment?

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health 4:13, 15 January 2008

I am sure that Angela Browning will know that the fees to which she referred are connected to the establishment of the new care quality commission. That is outwith the remit of this resolution, which deals with the independent adjudication of the medical professions. As Mr. O'Brien reminded her, I promised to write to members of the Committee with more details of those costs, and I shall do so, but they are nothing to do with the resolution that we are debating today.

Given the amount of time that we have spent discussing this matter, I do not intend to detain the House further by responding to the many and, I have to say, mainly extraneous and inaccurate points made by the hon. Member for Eddisbury. I shall simply point out to him that we cannot debate them under new clause 7 in Committee until this resolution has been authorised.

Question put:—

The House divided: Ayes 307, Noes 229.

Division number 43 Communities and Local Government — Health and Social Care Bill [Ways and Means]

Aye: 307 MPs

No: 229 MPs

Aye: A-Z by last name


No: A-Z by last name


Question accordingly agreed to.