With this it will be convenient to discuss the following:
Government amendment No. 301.
Amendment No. 380, in
clause 56, page 20, line 31, at end insert—
'(1A) The CHAI shall undertake studies designed to enable it to prepare reports as to the impact—
(a) of the operation of any particular statutory provision or provisions, or
(b) of any directions or guidance given by a Minister of the Crown (whether pursuant to any such provision or otherwise)
on economy, efficiency and effectiveness in the exercise of any functions of the bodies listed in subsection (1)(a).'.
Government amendment No. 343.
Amendment No. 380 would enable CHAI to undertake studies in relation to particular statutory provisions, or any directions or guidance, in an attempt, I presume, to hold the Government to account for their health policies. The amendment is clearly not necessary because clause 43 already provides for CHAI to give advice to or at the request of the appropriate authority, on any matter connected with the provision of health care. Clause 119 also empowers CHAI to make arrangements with Ministers of the Crown in relation to relevant health schemes.
Government amendments Nos. 299, 301 and 343 are drafting amendments proposed by parliamentary counsel. Amendment No. 299 makes clear CHAI's role of promoting or undertaking comparative studies to improve the economy, efficiency and effectiveness of health care provision, and is a key matter in relation to that general function. Amendment No. 300 makes it clear that CHAI's function of improving the three Es—economy, efficiency and effectiveness—extends to all English NHS bodies, other than special health authorities. We have talked about that.
My point may have been covered earlier, but will the Under-Secretary just quickly rehearse which other body will ensure the economy, efficiency and effectiveness of special health authorities? Is it the National Audit Office, or is it some other body?
It is the National Audit Office.
Reference to the improvement of financial or other management studies is removed by amendment No. 301. CHAI's primary purpose is to improve the quality of health care and it is not appropriate for it to oversee the technical, financial and other management of the NHS, other than where those things have a clear, demonstrable impact on health care provision. The amendment is intended to clarify that. Should the appropriate authority require information on management aspects in relation to quality or the economy, efficiency and effectiveness of a NHS trust, it is at liberty to request CHAI to provide that information under clause 43(3).
Amendment No. 343 amends paragraph 10(6) of schedule 8, which deals with the consequential amendments relating to the Audit Commission Act 1998. The effect is to remove from the Audit Commission a wide-ranging power to undertake or promote powers in relation to the provision of services by a range of NHS bodies. The amendment is proposed for consistency. The intention is that CHAI will undertake such things, rather than the Audit Commission.
Amendment No. 380 is intended to insert after clause 56(1) the same provisions that apply in respect of the Commission for Social Care Inspection under clause 78(2), on page 31. Clause 78(2) allows for CSCI to
''promote or undertake studies designed to enable it to prepare reports as to the impact of—
(a) the operation of any particular statutory provisions, or
(b) any directions or guidance given by a Minister of the Crown''.
In his rebuttal of the amendment, the Under-Secretary cited other general provisions rather than a specific power. The danger is that general provisions do not always allow one to undertake a specific purpose. There are Government amendments—we will not debate them but they will be made—that address defects in previous legislation in terms of relying on a general power to exercise a specific purpose.
Amendment No. 380 would simply put the Commission for Healthcare Audit and Inspection on the same footing as the Commission for Social Care Inspection. I suspect that one argument is that one deals with an independent provider sector and local authorities while the other deals with the national health service. However, given that the rhetoric and some of the substance of Government policy in ''Shifting the Balance of Power'' is to have a more devolved structure for the delivery and commissioning of health care, that argument is becoming increasingly weak. To deny CHAI the ability to undertake studies on the impact of Government directions is a gap that, if not closed now, will have to be closed later in the Bill's passage. I hope that the Under-Secretary will at least take on board some of those points in his response.
I commend the hon. Member for Sutton and Cheam for his amendment, which is a useful contribution. Has the Department examined the impact of statutory provision and regulations on the operation of the health service? Is there an internal
regulatory impact assessment process for health care issues?
On amendment No. 380, the Government have often said that we are on a journey to an ever-closer relationship between the health care and social care inspectorates. We have included the duty for them to work together in the Bill, but we hope to see the possibility of the two organisations coming together.
Before that happens, we must understand the different historical contexts of both inspectorates. As the hon. Member for Sutton and Cheam noted, there is a close relationship between the Audit Commission and local authorities, and he will understand how the Audit Commission does not examine social services just in our local authorities but across the board, giving it proximity to the social service inspectorate. We have tried to replicate and continue that under the CSCI.
That relationship is slightly different for the purposes of CHAI and, in forming the new body, we wanted to ensure that it took on some of the roles of the Audit Commission. We concentrated on the output, which we felt was important at a time when money is going into the NHS, rather than the input, which can be covered by local audit and the Audit Commission. There are two different historical bodies and relationships, but I assure the hon. Member for Sutton and Cheam that the Government are committed in the long term to the direction of travel that I described.
The problem is that even if the Government intend the direction of travel that the Under-Secretary described, we are dealing with primary legislation. The House is unlikely to return to the issue of regulation for some time, as any Government who have made three or four legislative attempts to deal with it in the space of four years are likely to be loth to revisit it in the next two or three years. It will be difficult to include this provision, either in this legislation or through amendments to other legislation, in the future. I am concerned that the provision is not included now. I understand the history, but we are looking to the future.
It is now five minutes to five, and in looking to the future, I note that there are 50 Government amendments that we will not have the opportunity to scrutinise; unless, by some miracle, the procedures of this place are altered to allow for the time taken by votes in the House to be added on to Standing Committee deliberations. I understand that that will not happen, so, much to the joy of some hon. Members, we will not be able to hear the Under-Secretary explain a range of important amendments to the Bill. That is a cause for concern, and I am sure that many outside this place will find it a cause for regret. It is useful to hear the Under-Secretary explain his amendments and to cross-question him so that we can ensure that they can be clearly understood in the future.
Amendment agreed to.
Amendments made: No. 300, in
clause 56, page 20, line 24, leave out from second 'of' to end of line 29 and insert
No. 301, in
clause 56, page 20, line 30, leave out paragraph (b).
No. 442, in
clause 56, page 20, line 33, at end insert—
'( ) For the purposes of this section the CHAI may carry out an inspection of—
(a) any English NHS body other than a Special Health Authority;
(b) any person exercising the functions of such a body.'.—[Mr. Lammy.]
Amendment No. 318 is a minor technical amendment that removes the reference to CHAI and CSCI otherwise making available any recommendations, reports or studies carried out under clauses 56 and 78. There are no circumstances in which we want either of the new inspectorates to make the documents available by publishing them on paper or on the internet. We therefore believe that it will be better to remove ''otherwise make available'' to clarify that the intention is always for CHAI and CSCI to publish such documents as they see fit.
Amendment agreed to.
Amendment made: No. 443, in
clause 56, page 20, line 36, leave out subsection (4).—[Mr. Lammy.]
Clause 56, as amended, ordered to stand part of the Bill.