Clause 222

Health and Social Care Bill – in a Public Bill Committee at 7:00 pm on 29th March 2011.

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Question proposed, That the clause stand part of the Bill.

Photo of Derek Twigg Derek Twigg Shadow Minister (Health)

We are concerned that the clause does not set out much detail of the appeals procedure. We all know that this is a particularly significant aspect of the Bill in relation to NICE, because NICE has so many important recommendations to make. Some of those recommendations are controversial and some less so, but they can all have a massive impact on treatment, drugs and services. It is important, therefore, that we have a chance to discuss the issue.

Unfortunately, there are only two lines of explanatory notes, and they basically say what we already know from reading the Bill. That is a classic example of there being no detail in the Bill on areas vital to our decision making. It is all very well to say what we did and did not do, but the fact is that the Government were told that they were rushing the Bill and that many areas were not covered. This is another example of that happening.

The Bill refers to

“(a) the types of recommendations in relation to which an appeal may be brought,

(b) the persons who may bring an appeal,

(c) the grounds on which an appeal may be brought, and

(d) the persons by whom an appeal is to be heard.”

Those are significant areas. It would have been useful to have some information so that we could make a decision on the clause. I do not know how the Minister will respond and we will obviously wait for that.

We have already discussed how NICE is expanding its role in social care. An important point is made in paragraph E37 on page 119 of the impact assessment about the benefits of the policy justifying the costs:

“The total budget spent on social care, and which NICE’s guidance might be expected to influence, is £16 billion.”

That is a massive figure by anybody’s estimation. Yet the number of appeals that may take place in relation not just to this current responsibility but to social care may be more or less than under the current system. I just do not know. It would be useful to get some detail about what the process will involve.

There is no mention of the process by which an appeal is to be heard, only the persons by whom it is to be heard. We have no idea who that may be. We also have no idea what Monitor’s role or influence will be here. What will the national commissioning board’s role be here? There is an awful lot that we do not know. The impact of NICE’s recommendations is profound for many people yet we have no detail at all. We come back to the old phrase that regulations “may make provision” about appeals against the recommendations made by NICE. Will that be by affirmative resolution by the House? I do not know what the problem is. It is a reasonable question to ask about an important matter. Does the Minister have any time scale in mind for when the House will first get a chance to see the details here, and is there anything else he can tell us that will enable us to consider the clause?

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

The reason my face showed some surprise was that the hon. Gentleman’s argument seems to rest on a desire for detail. He is right that we should have as much detail as possible and that is what we have tried to provide throughout the passage of the Bill both in our responses to points made by hon. Members and in the letters that we have provided. I find it odd that he is so interested in detail when he refers to what happened in the past.

The detail that was set out in the direction that currently gives effect to the work of NICE on appeal arrangements runs to four lines. It says:

“The Secretary of State directs the Institute to make arrangements for holding appeals, on the application of persons aggrieved by recommendations made by the Institute under paragraph 2(l)(a), on the grounds that the Institute has failed to act fairly, has exceeded its powers or has formulated guidance which cannot reasonably be justified.”

That is what it currently says. The clause therefore contains more detail than the hon. Gentleman’s Government set out in their direction. The difference between a direction and the proposals in the Bill is that they are before a Committee of the House and can be amended and debated. A direction cannot.

On so many counts the Bill demonstrates a change of view between the previous Government and this Government. We believe first that we should put more detail in legislation and secondly that we should make it  more accountable to Parliament. Those are big differences which those who follow our proceedings might wish to take into account.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

In a moment. I want to make sure that I have answered the hon. Gentleman’s questions. He has asked some questions and he should get some answers. He asked what procedure will be used in respect of regulations. It will be the negative procedure, and it will be in time for the implementation of the Bill in April 2012.

As for pace, we published a White Paper in July and a Command Paper in December, and the Bill was published in January. The Bill sets out in far greater detail how the different parts of the NHS will relate to one another than was done during the last Parliament and the two before that. I hope that my colleagues will allow the clause to stand part of the Bill. As NICE takes forward its work, it will build on existing practices, and we see no particular reason for that to change. I am sure that the hon. Gentleman’s questions will be answered.

Photo of Derek Twigg Derek Twigg Shadow Minister (Health)

It is a bit rich for the Minister to suggest that these few lines in the Bill are somewhat better than what we produced. However, it is rather academic. The Government talk about making regulations, but that lack of detail is typical of the Bill, with regulations being made under the affirmative resolution procedure. The question is what those regulations will do. Again, I received hardly any answers to my questions. We accept that there has to be an appeals procedure, but we expected a little more detail about what the Government propose.

Question put and agreed to.

Clause 222 accordingly ordered to stand part of the Bill.