I know that Andy Burnham and others have raised concerns about the effect of the regulations and I would like to address them in my response. First, however, I would like to make it absolutely clear that the regulations must be fully in line with the assurances given to the House during the passage of the Health and Social Care Bill. The former Secretary of State, my right hon. Friend Mr Lansley, said to clinical commissioning groups in 2012 that
“commissioners, not the Secretary of State and not the regulators, should decide when and how competition should be used to serve…patients interests”.
That must be the case. I made it clear in Health questions last week that we would review the regulations to ensure that that was the case and that they were not open to any misinterpretation.
The right hon. Member for Leigh himself gave guidance to primary care trusts which made this clear in 2010:
“Where there is only one capable provider for a particular bundle of services or the objective of the procurement is to secure services to meet an immediate interim clinical need there will be a case for Single Tender Action (i.e. uncontested procurement). By definition, an immediate or urgent scenario will be exceptional and likely to only arise on clinical safety grounds or for example, where existing services have been suspended following intervention by the Care Quality Commission.”
The next bit is very important.
“A decision to procure through single tender should always take account of the potential to secure better value by investing in a competitive process, as long as this is justified by the scale and importance of the opportunity (i.e. it has to be worth it).”
[Interruption.] Those were the comments of the right hon. Member for Leigh.
In the Government’s response to the Future Forum report, we committed to ensuring that the regulations would simply continue that approach. However, I fully recognise that the wording of the regulations has inadvertently created confusion and generated significant concerns about their effect. I have therefore listened to people’s concerns and my Department is acting quickly to improve the drafting so that there can be no doubt that the regulations go no further than the set of principles and rules that we inherited from the previous Labour Government. Following our commitment in response to the Future Forum report, the co-operation and competition panel has been transferred to Monitor. That will ensure consistency in the application of the rules.
Concerns have been raised that commissioners would need to tender all services. That is not our intention and we will amend the regulations to remove any doubt and to clarify that the position remains the same as at present and as stated in my right hon. Friend the former Secretary of State’s letter of 2012.
Concerns have been raised that Monitor would use the regulations to force commissioners to tender competitively. However, I recognise that the wording of the regulations has created uncertainty, so we will amend them to put this beyond doubt. Concerns have also been raised that competition would be allowed to trump integration and co-operation. The Future Forum recognised that competition and integration are not mutually exclusive. Competition, as the Government made clear during the passage of the Bill, can only be a means to improve services for patients—not an end in itself. What is important is what is in patients’ best interests. Where there is co-operation and integration, there would be nothing in the regulations to prevent this. Integration is a key tool that commissioners are under a duty to use to improve services for patients. We will amend the regulations to make that point absolutely clear.