Report (5th Day)

Part of Health and Social Care Bill – in the House of Lords at 5:15 pm on 6th March 2012.

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Photo of Baroness Cumberlege Baroness Cumberlege Conservative 5:15 pm, 6th March 2012

My Lords, I, too, tabled an amendment in this group. Before I speak to it, I will say that I very much support what the noble Baroness, Lady Finlay, said. I was interested in an article in the BMJ that she, too, may have seen. It was a report by Nigel Hawkes on how competition works in healthcare and how it can stimulate the provision of better services. He went on to say:

"The report dismisses claims that competition makes integrated care impossible or that the opening of tendering a service to 'any qualified provider' amounts to privatisation of the NHS", and that,

"evidence suggests that competition with regulated prices"- which is what we are proposing-

"can produce higher quality care at the same cost-and without leading to increasing inequity in access to care. Our message is that competition can help the NHS, but proceed with care".

It is "proceed with care" that many of us want. Although I support the idea of competition, the National Health Service is not a free-for-all but a regulated market.

I think we need competition. Looking at the summary scores of the seven nations surveyed on health system performance, which have often been mentioned in earlier debates in this House, we do very well compared with other developed countries, but when it comes to patient-centred care, we come last-seventh. That is really why competition is necessary: to make the health service much more sensitive to the needs of patients.

I appreciate that noble Lords must label me the greatest bore on earth, but I am going to continue to bore because I am going to relate Monitor to the duties for patient and public involvement. This amendment introduces the same definition and scope of involvement for Monitor as Amendment 142, which I moved earlier on Report, on duties for NHS commissioners, including public and private providers.

On 16 February, I received a letter from my noble friend Lord Howe on patient and public involvement, and since then I have had some useful meetings with him. The context of this amendment is that patient and public involvement must be robust as we are moving towards a stronger, more plural market, which I support. Patient and public involvement is an even more indispensable component in a market where the consumer role is split between commissioners, who hold the money, and patients who consume the service. PPI must bridge this gap for the market to work well, as patient choice will never apply to some NHS services.

Given its pivotal role in the reformed NHS, it is vital that Monitor has a PPI duty that is consistent with that of the providers it is regulating. The Bristol Royal Infirmary public inquiry 11 years ago led to the statutory PPI duty and its report specifically mentioned regulators in the list of bodies that should have this duty, so Clause 61(7) is very welcome. However I do not feel that the wording of Clause 61 goes far enough to achieve the Bristol recommendation that regulators,

"must involve the public in their decision-making processes, as they affect the provision of healthcare by the NHS".

On the broader PPI duty, my noble friend helpfully clarified at our meeting that statutory guidance will be used to describe what is reasonable in terms of PPI and that there will be consultation on its content. The intention, as I understand it, is that the guidance will require PPI in monitoring the impact of planning decisions or proposals to require the views of patient representatives and their carers. Perhaps my noble friend will confirm this. We also discussed the role of the NHS Commissioning Board in making sure that clinical commissioning groups enforce the model contract clauses on PPI against private providers. This is important as they do not have the statutory PPI duty that NHS providers have.

I think it is the Government's intention to create a level playing field for patients and the public to influence private providers who are under contract to the NHS in the same way that they can influence NHS providers. Can my noble friend assure me that that is the case? That would be very helpful, particularly as providers may challenge statutory guidance as burdensome under the duty of autonomy in Clause 4 as amended.

In contrast to this clearer PPI framework for providers and commissioners, currently Monitor may decide unilaterally what type and level of involvement, if any, is needed in its decision-making against unspecified criteria. If it decides that no involvement is needed, there are no criteria on which this can be challenged, even by the Secretary of State.

Monitor's primary duty in Clause 61 is,

"to protect and promote the interests of people who use health care services", having regard to the 11 matters listed in the clause, including quality of and access to services. Government Amendments 193 and 194 are very welcome in bringing Monitor's role closer to the patient's interest, including health inequalities and quality of service. However, it seems illogical to recognise that providers and commissioners of services need enforceable statutory guidance on how to involve patients in deciding what is best for them, when they have been trying to do it for 11 years with mixed success, whereas Monitor is expected to become immediately expert and have total discretion without any criteria against which that discretion is to be exercised. Perhaps my noble friend could give me the assurances I seek.