Committee (15th Day)
Relevant documents: 19th report from the Delegated Powers Committee, 18th and 22nd report from the Constitution Committee.
My Lords, I return for the last time in 2011 to the issue of the risk register in the Health and Social Care Bill—a sort of Secret Santa for the Minister. During the course of the debate on the Motion to Regret on 7 December, several noble Lords referred to the start point of Report being timed so that the appeal on the Information Commissioner’s report would be complete and the House would know the result. The Minister himself—
My Lords, may I first ask Members to leave quietly so that we may hear from the noble Baroness, Lady Thornton. May we establish on what basis, on what Motion, the noble Baroness is making her point? She has not interrupted the House going into Committee. I believe that perhaps the most appropriate way forward would be for the first amendment to be called. The noble Baroness may then speak as part of her contribution to that amendment, but I believe she would be out of order to continue at this stage.
Clause 247 : Powers to publish information standards
Amendment 345 not moved.
346: Clause 247, page 240, line 7, leave out “may prepare and” and insert “shall”
My Lords, owing to a slight miscommunication, my noble friend Lord Patel and I intended not to move Amendment 345, so we will move to Amendment 346, which is very similar in purpose to Amendment 345. As I informed the Government Whips’ Office earlier this morning, I shall move into this group Amendment 348, which has some similarity to the amendments in this group. I hope that the noble Earl will be able to find his briefing and order it accordingly.
We now reach Part 9, which is concerned with information standards and the Health and Social Care Information Centre. I should declare an interest because, as a Minister, I was a kind of male midwife at the birth of the information centre some years ago. It is an organisation that has had its ups and downs, but it has grown in stature and I support the Government’s wish to put it on to a statutory basis. There is nothing between us on that issue.
I also welcome the idea of an information standard specified in legislation, but I wish to strengthen the provision on this set out in Clause 247(1). Amendment 346 would replace the word “may” with “shall” in Clause 247(1) so that the Secretary of State had to prepare and publish an information standard. Amendment 347 would extend the subsection to define that the standard covers the collection, processing and dissemination of information rather than just processing.
I have not chosen these three terms by accident. It is important that collection is covered so that an eye is kept on avoiding unnecessary data collection requests being imposed on people at the local level. One of the problems that the NHS has faced over the years is a very significant number of—perhaps I may put it this way—slightly random demands for information to be provided and not always even on a comparable basis. The purpose of adding collection is to make sure that we do not go back on some of the progress that has been made in this area.
We also need to ensure that we are clear that the standard covers dissemination. We want to ensure that the information that is collected and processed is disseminated in as useful a way as possible to the NHS and to other users of those data as well as to the public. Again, I think that this has been an issue. One of the more bizarre things that has happened in recent years is that a very effective commercial organisation—I make no criticism of it because I am a great fan—Dr Foster, has had to convert much of the NHS’s data into a format that is useful. That is a significant issue about the way in which, often, public services collect information but do not put it into a useful format for the public and other users of that information. I would hope that the information standard could tackle some of these historical problems. That is why the standard is made a requirement and why, in my view, it should go wider than just processing and cover collection and the dissemination of information.
Amendment 347A goes further by bringing this all together and specifying the purposes to be achieved by the information standard requirement on collection processing and the dissemination of information, and the benefits that the standard is meant to produce in commissioning public health, service provision and public information and choice. It is important that we strengthen the Bill in this way. I am full of admiration for the Government’s good intentions in this area and I hope that we can strengthen it a bit further.
I wonder whether I might also speak to Amendment 348 as part of this group—I had certainly intended to group it with these amendments—rather than in the next group. This amendment is a kind of belt and braces approach based on my own experience of public data collection organisations. Like many quangos, they can have a life of their own and need to be kept under review to ensure that they stick to their purpose, keep their costs under control and remember the demands that they make on those who supply the raw data, at some cost to the providers of those data. The amendment would require an independent audit of the centre’s processes every three years to ensure that they are kept in good working order. I am not too fussed about the period; what is important is the principle that every so often there should be an independent review of those processes.
Finally, perhaps I may make an observation to the Minister. With good reason, the Government have put quite a lot of detail about the workings of the information centre into the Bill. I for one have no quarrel with that and have proposed a bit more detail myself. However, in this Committee, I and others have tried to have more detailed requirements on financial management and performance information put into the Bill, which are areas in which the NHS has often proved to be weak. The Government have resisted putting more detailed requirements of that kind into the Bill. I find that puzzling. Why is it so important to be more prescriptive about the workings of the information centre but not about the weak financial management systems of the NHS, which have contributed so much to previous NHS financial crises and will do so again as the NHS lurches towards the next one? I would welcome the Minister’s observations on this before I prepare amendments on financial management information for Report. I beg to move Amendment 346.
My Lords, I want to speak to Amendment 347B to Clause 247. It teases out the kind of argument made by the noble Lord, Lord Warner, in a more specific form. This probing amendment has the aim of finding out more about the Government’s approach to information provided to patients in accessible forms. Perhaps I have missed something, but I could not find much in the Bill about the provision of information to patients, but given the importance of the principle of “Nothing about me without me”, this would seem to be a serious omission. The provision of information in a form that people can use is a sine qua non of patient empowerment. It allows patients to take control of their situation. Without it, you can hardly get to first base. Maybe the Bill could do with some fleshing out in this regard, and I would certainly welcome the Minister’s views on that.
In the rest of my remarks I want to concentrate on the question of providing information in a form in which people can use it. My particular angle on this is that it should be published in an accessible form so that people with a print disability can handle it, which is what my amendment deals with. It would enable the Secretary of State or the NHS Commissioning Board to publish information standards containing a requirement to record patients’ preferred reading format, whether standard print, large print, audio or Braille. This is an essential precursor to communicating effectively with patients who have print disabilities and giving them proper access to vital information about their health. It will immediately be clear that I have a direct personal interest in this, but I should also declare my interest as a vice-president of the RNIB, the leading charity representing the interests of blind and partially sighted people, for which improving access to information is a major objective of policy and campaigning.
I have raised this issue regularly in the House with cross-party support in debates on local democracy, local transport and other issues, and the matter was dealt with generically in the Equality Act 2010. Ministers have invariably been sympathetic, but I am sorry to say that we still have some way to go in making the provisions of that Act a reality in practice. Article 21 of the recently adopted UN Convention on the Rights of Persons with Disabilities on freedom of expression of opinion and access to information, which the UK has ratified, says that states parties should be,
“providing information intended for the general public to persons with disabilities in accessible formats and technologies appropriate to different kinds of disabilities in a timely manner and without additional cost”.
Yet in the area of health services it is not so long since a survey of blind and partially sighted people in the UK showed that 95 per cent of respondents had never received health advice leaflets or information from their local surgery in their preferred format; 96 per cent had never received letters from their GP, the results of tests or other correspondence in their preferred format; 95 per cent had never received medicines labelled in large print; and the NHS was apparently unable to send out appointment letters in an accessible format.
Research for the RNIB carried out by Dr Foster in 2010 showed that things had improved a bit in recent years but that there was still a considerable way to go. In the Dr Foster survey, 72 per cent of those questioned were given information by their GP in a form in which they could not read it. Similar, even higher figures were uncovered in relation to the rest of the NHS. This included information ranging from appointment letters to confidential test results, which is not the sort of thing that you would necessarily want someone else to read to you.
I recently moved house and joined a new GP practice. I was pleased to be asked on the form that I was required to complete in order to register whether I would like information in Braille. This was as novel as it was gratifying. I do not delude myself that this amendment would be a panacea, but it would take us a long way further forward than the guidance that we have at the moment, which clearly is not working.
My Lords, I shall speak to Amendment 347A, particularly the phrase,
“to exercise informed choice by ensuring maximum transparency of dissemination”.
The House may remember that, at an earlier stage, I raised European Community law and the need to have a great deal more information about this issue. It is all very well for the Government to initiate this rather broad guidance about publishing information and information standards; it gives the impression that they are interested in having a wider debate on transparency. However, I got a letter from the Department of Health only late yesterday telling me that an application that I made under the Freedom of Information Act was being challenged. I started a request on 26 April 2011. I went through all the procedures of internal review on 1 June. I was eventually given a judgment in November, at which point I immediately re-requested the same information. One cannot read this correspondence without getting a sense of obfuscation, of a deliberate refusal to tackle the issues that I have been raising with the department and of a spinning-out of a process during the passage of legislation of the utmost importance to the department.
It is necessary to ask the Minister whether he knows that this letter has come to me following my request on the Floor of the House and his courteous reply that he would look at the question. I am now told that I would normally have to go through another internal review procedure, which would take, no doubt, another month or more, by which time this Bill will have gone through all its stages and probably left the House of Lords. So underneath this is a deeper question.
I also find it slightly objectionable to have received in reply to the request a more definitive statement of the ministry’s attitude. I shall read out one paragraph in particular:
“Furthermore, we agree that information relating to competition in the NHS and the delivery of healthcare services attracts the public interest”.
We can all agree on that. It goes on to say:
“However, there is much information already in the public domain about how competition law does and does not apply”.
But that is open to serious question. Professors on competition law have been writing to me from university departments saying that this is a very cloudy area and that it is difficult to get a lot of the information. The letter goes on to say:
“This includes recently published guidance by the Office of Fair Trading on the application of competition law to public bodies and comment on the case law relating to public purchases, which suggest that these are unlikely to be considered as undertakings and therefore could not be considered under competition law”.
The implication is that the public bodies that have been created in this Bill are unlikely to be considered. That reflects fairly accurately what in broad spirit the Minister has already been saying to the House. This is the problem. This word “unlikely” is not satisfactory when the Bill is in the last stages of its examination and when a perfectly reasonable request has been put through that, under the Freedom of Information Act, the legal advice given to a previous Government—a Labour Government—in 2006 on the application of EU competition law during the process of establishing the co-operation and competition panel should now be released.
I have spoken to the Secretary of State in the previous Government, Andy Burnham, on this question and he is wholly in favour of the release of the documentation. I cannot see any logical case, in the central circumstances of this Bill, for using the word “unlikely” in the rejection of the freedom of information. Therefore there is considerable doubt that we can have this information published as I requested before the House meets on the Bill again, which I gather is likely to be in the last few days of January. The House’s business has been announced and I see that the Bill will not come before it until at least 27 January, although it is reasonable to assume that it will come soon after that. That gives a full month even allowing for Christmas and new year for the matter to be reconsidered.
I ask the Minister yet again. I will not go through internal review procedures after this length of time, and I have written to the Freedom of Information Commissioner again this morning to say that I will not use that avenue. I do not believe that I should be asked to do so since there has also been some evidence of maladministration in the actual definition of what documents we are looking for. I urge the Minister to make sure that there is publication.
I notice that the Minister has called a debate during dinner on 10 January on this very issue. Of course, it would be helpful to the House if that document could be published before the debate takes place. I hope that the Minister will look at this again and reconsider this question and will try to ensure that the department, when there is a matter under consideration and discussion on a Bill, does not close the door without his being able to be consulted. I am quite sure that he has not been consulted because his courtesy is well known to us all. A fresh look must be given to this subject and the document published in early January.
My Lords, in responding to this group I should like first to raise on behalf of my noble friend Lady Thornton the issue of the register of risks on the Health and Social Care Bill. I also apologise on her behalf for not raising the matter at the appropriate time.
In the debate on the Motion of Regret on 7 December several noble Lords referred to the starting point of Report being timed so that the appeal on the Information Commissioner’s report will have been completed and the House will know the result. The Minister himself said:
“I am as keen as anyone to see the matter speedily resolved”.—[Official Report, 7/12/11; col. 736.]
The usual channels are, of course, discussing the next stage of the Bill. We agree with the noble Baroness, Lady Williams, about the risk of this issue not being resolved in time for the next stage. On 7 December, she said:
“I fear that it may hang like a dark shadow over the whole of the Report stage”.—[Official Report, 7/12/11; col. 726.]
In the same debate the noble and learned Lord, Lord Mackay of Clashfern, said:
“I believe the solution proposed by my noble friend”—
the noble Baroness, Lady Williams—
“is the best one … that an expedited decision should be sought from the tribunal”.—[Official Report, 7/11/12; col. 731.]
I have asked my noble friend the opposition Chief Whip, and appeal to the usual channels, not to finalise the arrangements for Report and the timetable until the House has an answer to the question. Our understanding is that a normal timescale, if we are lucky, might mean that we will have a tribunal decision in late February. The Government will then have the option of appealing to the Upper Tribunal. Does the Secretary of State intend to seek expedition of this process? What steps have Ministers taken to ensure that the appeal is heard as early as possible? The Minister can, if he wishes, respond in writing to my noble friend, though obviously he will need to do it as soon as possible.
I shall also speak briefly to this group of amendments generally. I support the amendments tabled by my noble friend Lord Warner and the noble Lord, Lord Patel, all of which seek to strengthen the Secretary of State’s duty to prepare and publish information standards governing the collection, processing and dissemination of information on the provision of NHS health and adult social care. I know that the Minister is in favour of having light-touch definitions in the Bill, but we strongly support being more specific about what the information standard is to be, what it is for and what it should include.
The definition proposed in Amendment 347A underlines that it must include,
“the efficient and effective collection … of information that”—
“benefits the commissioning and provision of health and adult social care services”.
It is equally important to specify that the standard includes the provision of information that will help improve public health and well-being and assist the public’s ability to make informed choices about care and treatment. We also support Amendment 347B, from the noble Lord, Lord Low, which seeks to ensure that the,
“information standard must include a requirement to record patients’ preferred reading format: standard print, large print, audio or Braille”.
We support the general aim of this part of the Bill: to place the current health and social care information centre on a firmer statutory footing, replacing the current special health authority. We have a number of issues to raise, and will do so in the next group.
In view of the reference to me by the noble Baroness, Lady Wheeler, perhaps I may say a few words before the debate proceeds and the Minister replies. The Committee showed good sense—and the noble Baroness, Lady Thornton, was good enough not to press the matter to a vote—over the information tribunal’s decision on the risk register. At the time, it was sensible to undertake to withhold our judgment until there had been an opportunity for the tribunal to consider the Department of Health’s appeal. However, the intervention by the noble and learned Lord, Lord Mackay—as the noble Baroness, Lady Wheeler, indicated—clearly suggests that it would be possible, by a mutual approach from the Government and the Opposition, to speed up the processes under which the appeal was held.
Given that the government Chief Whip agreed that the matter should not come before the House on Report before the end of January, that provided an additional three weeks—a reasonable period of time—to try to persuade the tribunal to act reasonably rapidly. The noble and learned Lord, Lord Mackay of Clashfern, was good enough to say that in some cases which he knew of, the tribunal had been able to deal with an issue in as little as three or four days. That seems very apposite, since it is hard to think of anything much more constitutionally important than the Report stage of a Bill of this kind, and there should be no question of the debate on Report taking place before there is an outcome to the tribunal appeal.
This House recognised that it was proper that the law should take its normal course. We therefore withheld any attempt to try to press it by, for example, insisting on a vote. I think that that was to the credit of the Official Opposition. However, it is quite clear that the decision is very germane to the Report stage. It is highly relevant. All of us accept that if the appeal is upheld then we will be bound by it in a proper course of law, appropriate to all people who come before the tribunal. However, we also all recognise that it lies upon the Government to endeavour to reach a decision as quickly as possible. I am sure that the Opposition, and certainly we on these Benches, would strongly support an approach of that kind.
I would simply plead with the Minister, who has been so reasonable to the House on so many matters, to recognise that there is a real difficulty if the appeal, not having been heard, hangs over Report, and as a result leaves people able to say, “But if the appeal had gone the other way, X and Y would follow”. If the Department of Health—whose record is patchy, to say the least, as the noble Lord, Lord Owen, has rather sharply pointed out—really cares about information being made available, or at the least upholding the law that makes the tribunal make a final decision, it really is crucial that, at the end of this Committee stage, we hear from the Minister whether steps are being taken to accelerate the process as much as possible to enable Report to start properly at the end of January. I would simply urge that attention might also be paid to the further evidence provided by the noble Lord, Lord Owen, which, to say the least, is somewhat disturbing.
May I just make a slight correction? I said that the debate on the impact of the European Union on healthcare in the United Kingdom in the name of the noble Lord, Lord Kakkar, will be held on 10 January. It will actually be held on 11 January, as the dinner-break business. I want to be quite clear about the timing of that important debate, which at the moment is limited to a maximum of one hour.
While I am on my feet, I want to stress that every word that the noble Baroness, Lady Williams, has said is wholly appropriate. This question of risk assessment is central to the judgments which will have to be made at Report. I hope very much that we do not proceed to Report until the tribunal's judgment has been heard.
My Lords, perhaps I could begin by addressing briefly the matter of the risk register. Arising from earlier debates on this subject, I have discussed the timetable for the appeal with my officials, and I say again that I recognise fully the strength of feeling on this issue and the desire for speedy resolution. As noble Lords are aware, the timetable for matters of this kind is a matter for the Information Commissioner and the legal process. In view of the noble Baroness’s very courteous suggestion that I should write to her and to the noble Baroness, Lady Thornton, about this, I undertake to do so straightaway. I will copy in my noble friend at the same time. In that letter, I undertake to give as much information as I can at the moment about what we see as the likely timetable for the process.
Yes, my Lords; I have personally done so, as I undertook to the Committee that I would do. Perhaps I may include my noble friend in the letter that I send out so that he is fully aware of what I have done and what my department has done.
I turn next to the matter raised by the noble Lord, Lord Owen. To answer his direct question: yes, I was aware that the department was writing to the noble Lord in the terms that he outlined. I would not wish him to think me guilty of discourtesy or bad faith, because after he asked me to look into this matter I did so. I received very firm and clear legal advice that the information he has asked for falls into the category of professional, legally privileged advice given to the Government. It has not been the practice of successive Governments, including the previous Government, to waive privilege on information of this kind. However, as this matter is ongoing, I hope the noble Lord will forgive me if I limit what I say at this point. He has asked me to look at this further, and of course I shall do so.
I was the Minister of State responsible for competition policy in the NHS in 2006, when this legal advice was sought by me and, I think, by Patricia Hewitt as the Secretary of State. As I recall, it was at the point when we were considering the whole issue of regulation reform and Monitor becoming an economic regulator. For my part—I cannot speak for Patricia Hewitt—I would be only too happy for that information to be made available to the noble Lord, Lord Owen. If, in a sense, I am the client, I waive my client’s responsibilities in this area, and I am very happy for that information to be shared.
I note the noble Lord’s liberality of spirit in this Christmas season. The problem is that it is not up to him, or indeed me as an individual, to cut across the practice which has been laid down across government. However, I have undertaken to look further into this question and I shall indeed do so.
My Lords, it is of course open to my noble friend to simply seek access to papers that he was given advice on as a Minister. I suggest to my noble friend that perhaps he should ask to see those papers. Having done this myself, I know that you have to see them within the department. Usually you get a cup of coffee from the Permanent Secretary’s office, and you cannot take the papers away, but you can summarise and make notes. If the department is not going to make the papers available, perhaps my noble friend would care to do that.
In the spirit of Christmas, I make myself available to attend the Permanent Secretary’s office. I hope that the coffee in the Department of Health is a bit better than it was when I was there. I would like to take up that offer, which is a very good and constructive suggestion by my noble friend. I hereby deliver the request to the Minister.
Perhaps not quite in the spirit of Christmas, with regard to the important issue which the noble Baroness, Lady Thornton, raised and the noble Baroness, Lady Williams referred to, it is frankly not good enough to say that there will be a letter, which none of us will actually see apart from those particular people over the Christmas period. The major question which hangs over this House is whether the tribunal’s decision will be made available before the Report stage. Could the Minister give a real Christmas present to this House by saying that, whatever happens, the Report stage will not take place until that decision is available?
I cannot give that undertaking, for the reasons that I will set out in the letter. The position—which I shall elaborate on when I write—is that the Information Commissioner has requested more time, and in light of that we have made representations to expedite the process as far as possible. However, the advice I have at the moment is that it is highly unlikely, if not impossible, that the judgment will be delivered before we are due to go into the Report stage of the Bill. This is something that we are dealing with at present, and if I can update my noble friend, as well as other noble Lords, when I write, I shall be happy to do that. I do not wish this to be a closed process. All noble Lords in this Committee who have taken part in these debates are very welcome to be copied in.
My Lords, I intervene briefly and in a way that my noble friend may find somewhat unexpected. Can I just express some concern—although I have a lot of sympathy with many of the things that they say—about the number of ex-Ministers who seek to throw overboard, in a very short space of time and in a particularly short-term context, the policies that have been maintained by successive Governments throughout the whole of my political lifetime? That needs careful thought. On the risk register, for example, it seems entirely possible that the Government collectively may take the view that this is so important that they should appeal onwards, up to the Supreme Court. If so, that would be the proper thing to do if it is thought to be in the best interests of public policy. We need to take care.
I am grateful to my noble friend. I cannot predict what the collective view of the Government would be in a situation in which the decision on appeal went against my department. We have not reached that stage yet but it is potentially the case that the Government as a whole would wish to pursue the matter further in that eventuality.
Perhaps I should now revert to the amendments before us, beginning with Amendment 346. The noble Lord, Lord Warner, is absolutely correct: information standards are important. However, we need to remember, too, that standards have to be appropriate. There can be burdens associated with them as well as benefits. There are a number of different types of information standard that could help to support the health and social care system—for example, standards to ensure the comparability of data or information governance standards to protect patient information. We intend to consider the detail of which standards we would require following the publication of the information strategy. As a result, we think that it is better to create an enabling provision that does not tie the Secretary of State or the Commissioning Board to an obligation to prepare a standard, and gives us an opportunity to consider where we can adopt standards that already exist.
The amendment also seeks to remove the authority for the Secretary of State or the Commissioning Board to prepare an information standard. This means that the Secretary of State or Commissioning Board would have the power to adopt only an information standard designed or prepared by another body. However, in some cases they may need to design a new information standard themselves, rather than rely on one prepared by another organisation. We believe that the Secretary of State and the NHS Commissioning Board would be best placed to develop or commission an information standard if, for example, it became apparent that one had not been prepared by another body or needed to be modified to be appropriate.
Turning to Amendment 347, I should like to reassure the noble Lord that, under the current drafting of the Bill, the collection and dissemination of information would also be subject to information standards. This is because the “processing” of information, as the term is used in this clause, has the same meaning as in the Data Protection Act 1998, which includes collecting and disseminating information. Therefore, the additional wording is unnecessary.
I am sympathetic to the sentiment in Amendment 347A. There are many intended benefits to using information standards, which include those highlighted in the amendment. However, prescribing the anticipated benefits or beneficiaries of the policy in the Bill is not necessary. In fact, it could prevent the development of information standards that do not fit into those categories. I hope that those comments will reassure the noble Lord.
The noble Lord, Lord Warner, asked me why we put so much about information standards in this part of the Bill, compared to what we put in the Bill about accounting standards. Our view is that it is essential that information standards are set at a national level to allow different systems to talk to each other. That is an approach that the noble Lord shares. With accounting standards, the arguments are slightly different. I do not agree that it is appropriate to put accounting standards on the face of the Bill. We need to ensure that the management information collected by local organisations is of use to those organisations; that is, the organisations have the flexibility to determine their management information needs. However, I will write to the noble Lord on this matter before Christmas, and no doubt he and I can have a further conversation about it. I look forward to that.
On Amendment 347B in the name of the noble Lord, Lord Low, we agree that it is vital that people receive information in an appropriate format. This point was clearly made in the responses to our consultation on an information revolution. For example, the RNIB, of which the noble Lord is vice-president, highlighted the importance for health professionals to be made aware of, and respond to, people’s need for information in alternative formats.
We fully recognise the need for people’s communication and information requirements to be recorded—for example, in their care records—and for that information to be shared with professionals along care pathways. I reassure the noble Lord that the department is currently working with stakeholders on the best way to achieve this, which could be through an information standard or through other mechanisms. Further detail will be included in the information strategy, which we plan to publish in April next year.
I realise that I have not covered Amendment 348 in the name of the noble Lord, Lord Warner. This amendment would require the information centre to arrange for and publish an independent audit of its processes every three years. I completely accept that effective oversight and scrutiny of our arm’s-length bodies is important so that the department and the public can be assured that they are performing their functions effectively and are providing value for money. However, we do not believe that this amendment is necessary. I shall briefly explain why. First, as a department, we plan to undertake formal performance and capability reviews of each of our arm’s-length bodies at least every three years, including the re-established information centre. This would consist of reviewing its performance, financial controls and internal governance, and what one might term its “organisational health”, including the centre’s relationships with its key partners in the system.
In addition, the information centre, as a non-departmental public body, would be required to establish an audit committee that would provide independent and objective oversight and assurance of the centre’s systems of internal control, including risk and financial processes. The Bill also requires the information centre to prepare annual accounts each financial year. These would be examined and certified by the Comptroller and Auditor-General and laid before Parliament.
Finally, the Bill makes provision for the re-established information centre to be subject to the Parliamentary Commissioner Act 1967. This means that the Parliamentary and Health Service Ombudsman would be able to investigate complaints that the information centre had not acted properly or fairly or had provided a poor service in the exercise of its functions. With those assurances, I hope that the noble Lord, Lord Warner, will feel able to withdraw the amendment.
My Lords, I am grateful to the Minister for his full reply to my amendments. I will certainly study it very carefully. I think that he and I probably differ on the issue of information standards and accounting standards. I still think that there is an issue in that area given how significant it is for the NHS. Therefore, I will probably return to it.
Before I sit down, I should also mention that in recent days the King’s Fund has produced a report on the very serious situation in London, which is extremely relevant to the consideration of the risk register as it shows that more than 50 per cent of the NHS’s historic deficit is held in London. London is in serious financial difficulty as regards converting many of its trusts, if any, to foundation trust status. The Minister might like to look at that report when considering this whole issue of access to the risk register. In the spirit of Christmas, I say to the noble Earl and to the noble Lord, Lord Low, that I recently bought a case of Chapoutier wine, the labels of which are also printed in Braille. Therefore, I say to the noble Lord that if a French winemaker can do that, the Department of Health ought to be able to do it. I beg leave to withdraw the amendment.
Amendment 346 withdrawn.
Amendments 347 to 347B not moved.
Debate on whether Clause 247 should stand part of the Bill.
My Lords, at the risk of irritating my noble friend, I should like to make a brief comment about this matter. I assure him that it does not fall into the category of wishing to irritate him. If there is any virtue, it is a virtue of consistency on my part.
Clause 247 again deals with the interplay between the Secretary of State and the NHS board. We have already clearly established in this Committee that the Government wish to give the board a freedom from the overall influence of the Secretary of State that would mark a fundamental change in the way that the NHS has been conducting its business over many years.
Subsection (1) of the clause gives powers to both the Secretary of State and the board, and either can exercise them. I look down to subsections (3) and (4) and see that both the Secretary of State and the board can exercise powers in relation to the provision of health services. I wondered whether this was a belated recognition regarding the board for those of us who have been encouraging our noble friend to give primacy to the Secretary of State and maybe a stepping stone towards returning to the traditional position. On the other hand, if it is a stepping stone, and given the fact that until we hear from my noble friend there is not a lot of clarity as to what is intended here, these provisions may simply confuse the matter, not clarify it.
I am old-fashioned, as my noble friend knows, and I think that the Minister is ultimately responsible for the area for which Her Majesty has called him or her to be responsible. The Secretary of State could delegate powers to the board, but that is not the way that the Government have chosen to interpret this. All of us are grateful to my noble friend for the fact that he has been so willing to review this whole issue and to come back with new proposals on Report. I cannot be the only Member of your Lordships' House who looks forward to seeing what those proposals contain and measure them against the views that have been expressed on this subject over some months now.
However, since we moved away from the first few clauses, there have been examples of this ambiguity and potential conflict between the Secretary of State and the board running right through the Bill. I have tested my noble friend’s patience on a number of occasions by drawing his attention to various examples of that as we have gone through the Bill. I draw his attention to what is but another example of the importance of getting this relationship right—and my noble friend knows what I believe is right and I know what he believes is right. We are both grateful for the opportunity to review that before Report. I should therefore be interested to hear what my noble friend thinks is actually meant, or intended to be meant, by this clause.
Finally, because we have already established that the risk register is legitimate to discuss under Clause 247, I share the view that it would be very helpful to the Committee to have a definitive decision before Report gets under way. In keeping with what my noble friend Lord Newton of Braintree just said, were the Government to lose and to decide to pursue the matter to the next stage, I hope that the Minister will not think that such a decision would be without friends in this House. I cannot be the only former Minister who has conducted examination of potential legislation on the basis of “What if?”.
I underline the point made by the noble Lord, Lord Mawhinney, because the whole area of information is a crucial aspect of the constitutional issues about accountability. In particular, the clauses we are discussing are expressed in complicated ways that are difficult to understand. For example, I find it hard to be clear that personal and identifiable data will not fall within the terms of the clauses, because the phrases “other persons”, “other bodies”, and so forth are scattered throughout the clauses. That disturbs me. Perhaps the Minister could add a little on data protection legislation and address the important point raised by the noble Lord, Lord Mawhinney, about this aspect of the Bill, which of course relates to several others besides.
My Lords, I hope that I can satisfy my noble friends on these issues. If my noble friend Lord Mawhinney is old-fashioned, we are all the more fortunate for that. I feel a little old-fashioned myself, so I understand where he is coming from. He will appreciate that the clause provides powers for the Secretary of State and the NHS Commissioning Board to prepare and publish information standards. As we have debated, standards are important for a number of reasons. They can help ensure that information is of high quality, that it is comparable and that confidential information can be stored and transferred safely and securely.
Our aim is for the Secretary of State to set information standards in respect of public health and adult social care services and the board to set standards in respect of NHS services. Indeed, any organisation providing publicly funded health or social care services in England would be required to have regard to those information standards. When the standard is published, there would be accompanying guidance on how to implement it.
As I said, the Bill makes clear that responsibility for preparing and publishing information standards will sit with the Secretary of State or the Commissioning Board. The process that will be followed when the need for a standard is identified is currently being worked through, but we envisage that, in practice, the NHS Commissioning Board will set the standards for the NHS. We are mindful, however, that the Secretary of State is responsible for the health and social care system as a whole. Therefore, it is right that he has the overarching power for both. It could well be that, within the mandate that he sets the board, information standards will feature as something it is tasked to expedite. Of course there is a need to ensure that standards are consistent across the sectors to which they apply.
We are about to move to a group of amendments where I would be happy to address the questions of my noble friend Lady Williams on confidentiality. If she will allow me to do that, I would be happy to follow that course.
Clause 247 agreed.
Clauses 248 and 249 agreed.
Schedule 19 agreed.
Clause 250 : General duties
Amendment 348 not moved.
Clause 250 agreed.
Clause 251 : Powers to direct Information Centre to establish information systems
348ZA: Clause 251, page 242, line 38, at end insert—
“( ) The Information Centre may charge the Board a reasonable fee in respect of the cost of complying with a direction given by the Board under subsection (1).”
My Lords, I shall speak also to the other government amendments in this group, Amendments 348BA, 348BB, 348BC, 348BD, 348BE and 348BF.
The first of these amendments enables the Information Centre to charge the Commissioning Board where the board has directed it to collect information. The next four amendments are drafting amendments to improve and clarify the drafting in Part 9 of the Bill. Government Amendment 348BE is a consequential amendment to ensure that the CQC can continue to be able to require information from the Information Centre to support the CQC’s regulatory functions. Government Amendment 348BF removes a consequential provision from Schedule 20 following a request from the Welsh Assembly Government. I hope that that brief explanation will be enough to persuade noble Lords that these amendments should be accepted and I beg to move.
My Lords, I have Amendment 348C in this group, which relates to the National Information Governance Board being disbanded and a national information governance committee being formed and being part of the CQC. There is concern over the way that that will happen.
The National Information Governance Board currently advises the Secretary of State on access to confidential patient information without patient consent when it is for medical purposes, under the Health Service (Control of Patient Information) Regulations. These are made under Section 251 of the National Health Service Act 2006 and give rise to applications from researchers for access to confidential patient information. The Patient Information Advisory Group, or PIAG, was established and later became the Ethics and Confidentiality Committee of the National Information Governance Board. This provides advice when people who are not the doctors or professionals involved in the care of a patient wish to access information from medical records that are potentially identifiable without the knowledge or consent of those people. It is permitted legally through the exercise of discretionary powers of the Secretary of State. The Ethics and Confidentiality Committee of the National Information Governance Board has an advisory function. It is not a regulator and has no powers to stop disclosure. It helps disclosers of information to know the risks and whether to seek statutory protection. If they are given that protection, they are protected from liability under the common law duty of confidentiality.
Clause 274 abolishes the National Information Governance Board but also omits Sections 250A to 250D of the 2006 Act. In those sections, one of the functions established for the National Information Governance Board is to advise the Secretary of State on particular matters relating to the processing of patient information by any person. This advisory function will not transfer to the Care Quality Commission under Clause 274(3). The Care Quality Commission might be regarded as not being the ideal home for the governance board for reasons concerning its own expertise and current performance.
This is important because there is a need to reconcile two conflicting public goods. The first public good concerns medical purposes and is described in Section 251 of the 2006 Act, which allows access for the purposes of preventive medicine, medical diagnosis, medical research and general care and treatment and also allows the health service to access information to inform individuals, if necessary, about their physical or mental health condition. That conflicts with the other public good, which is maintaining confidentiality. It is in the balancing of those two public goods that the current Ethics and Confidentiality Committee has established expertise. I know that the current chairman, Andrew Harris, has written to the Secretary of State expressing concerns about the transfer. The functions of that committee which involve research will transfer to the Health Research Authority, which seems to be appropriate as we have all been very concerned about the need to process research applications more quickly and to have a streamlined process.
The difficulty is that there are many other times when information is sought. The research decision is in concert with the recommendation of the Academy of Medical Sciences, but there is concern about the remainder of the patient information. That concern relates to applications from the NHS, from the Department of Health and, in particular, from commercial contractors and how the information gained will then be handled, what will happen to it and what will happen to patient confidentiality.
One of the other difficulties is that the process of pseudo-anonymisation, or making data not identifiable in relation to someone, is technologically moving so fast that it becomes quite easy to unscramble pseudo-anonymised data. The gold standard for interpretation of the advice and the processes involved rests with the Information Commissioner's office. There is not a residue of expertise in the Care Quality Commission, which is why there is a suggestion in the wording of the amendment that there should be answerability to the Information Commissioner’s office rather than to the CQC. The fragmentation of the current committee’s function carries risks which would be reconciled by having answerability to the Information Commissioner’s office where the Information Commissioner would then liaise with the research ethics committee functions of the Health Research Authority. Therefore, you would get a read across in the quality of decisions and you would maintain speed for research applications, but you would draw on the expertise of the Information Commissioner’s office.
The Government have a transparency agenda and it is assumed that that will concern only non-identifiable data. The difficulty is that, without investment in the appropriate pseudo-anonymisation technologies, data are potentially identifiable. An independent oversight of the use of disclosures is needed when we do not have consent from individuals for their data to be used. There are extensive provisions in relation to making patient information freely available throughout the NHS and central Department of Health bodies. Those are laid out in Clauses 230 and 253, which provide protection for NICE and for information centre staff from personal liability. I just draw the attention of the House to the contrast between that and the 2006 Act, in respect of the NHS Counter Fraud and Security Management Services, whereby heavy penalties were introduced not only for failure to provide information but also for misuse of the information by their staff.
I return to the need to assess the risks of this change and to balance the two goods that I outlined. I note that the noble Baroness, Lady Williams, expressed some concern over the boundaries of patient confidentiality in her previous intervention. The abolition of the National Information Governance Board is a given, but one has to consider data protection both through the common law duty of confidentiality and the need to be able to access information, and through our responsibilities under EU Directive 95/46/EC, which are currently met through the Data Protection Act. It is through that Act that decisions on research access to confidential patient information must be seen to be consistent.
The new committee could find a natural home in the Information Commissioner’s office and could co-ordinate clearly with the National Research Ethics Service. I ask the Government to consider whether the Bill and the current plans are correct or whether there are better ways both to safeguard patient confidentiality and to encourage and foster the very important research agenda that the Government have given an enormous commitment to and that has been universally welcomed.
My Lords, I broadly welcome these provisions, which deal with the new Health and Social Care Information Centre and put the existing special health authority on a statutory footing. The centre was established in 2005 by the Labour Government to improve information quality, data standards and access to information, to deliver the information required by front-line services and to support commissioning and clinical audit. The centre has had a large measure of success since its establishment, particularly in developing bedrock quality-improvement initiatives in the NHS—for example, indicators for quality improvement and patient-reported outcomes measures. NHS clinical teams have access to more than 200 indicators that are generally accepted as effective measures of high-quality care.
However, while welcoming the broad intent and purpose of this Section, I note that the provisions increase the directions given to the information centre about when it should and should not publish data and how data should be used. It is clear in this context that there are serious concerns that the Government needs to address among noble Lords, patients and doctors' organisations about patient confidentiality, and about whether the Government's proposals go far enough to protect patient data. These concerns were also voiced in response to the Government's statement on UK life sciences industries in the House on 6 December, in which they announced their intention to share much more patient information with the private and independent sectors in anonymised form to aid medical research and development. As we know, under that initiative from December onwards data regarding 250,000 patients will be released online.
I hope that the Minister will recognise these concerns and the need for what the chief executive of Cancer Research UK called,
“strict safeguards that instil public confidence”.
Clause 256 details when information should and should not be published by the information centre, and in particular that it should not publish data that could reveal a person's identity. Amendment 348B, tabled by the noble Lord, Lord Walton, would be the ultimate safeguard, but we recognise the need to find a way through that addresses concerns that doctor and GP-patient confidentiality could be harmed and provides safeguards that are strong enough to protect patients. It is certainly worth acknowledging that, if we are able to get the confidentiality issues right, the UK has a huge opportunity to lead the world in health research.
We support Amendment 348A, tabled by my noble friend Lord Kennedy and other noble Lords. It would create an additional duty that would allow the information centre to request the information required to conduct clinical audits. This requirement would make it explicit that the centre can collect information from organisations identified in the Bill as required to undertake national clinical audits, thereby strengthening its current role of collating such information into a duty to collect clinical audit data from a variety of providers. We welcome this.
Finally, in the debate on the UK life sciences industry Statement, my noble friend Lady Thornton underlined the difficulties with using anonymised data and sought reassurances from the Minister on how confidential patient data will be handled, stored and processed. I think it is right that the Minister repeats those assurances in the context of the provisions in the Bill for the information standards and the centre, and I will be grateful if he will do so.
My Lords, the provisions in Chapter 2 of Part 9 will enable the information centre to become a focal point for health and social care information, linking data together, publishing them anonymously and helping to make information more accessible. I note what the noble Baroness, Lady Wheeler, had to say on Amendment 348, which we dealt with in the previous group of amendments, but I am grateful to her for her comments.
Amendment 348A seeks to provide a specific power in the Bill for the information centre to be able to require information needed for national clinical audits. Clinical audit is an essential mechanism for improving the quality of care patients receive. However, we do not believe that the amendment is necessary. We have mandated participation in national clinical audits within the National Clinical Audit and Patient Outcomes Programme through the NHS standard contract for acute services. This is reinforced in the operating framework for the NHS in England for 2012-13. In addition, there are already sufficient powers in the Bill for the information centre to be able to require information, where appropriate.
Amendment 348B seeks to prevent the information centre being able to collect information that identifies an individual. I am the first to recognise what a sensitive topic this is. Although my noble friend Lady Williams is not in her place, I hope she will allow me to address the question that she put to me earlier on in this connection.
Patients as a whole expect information about their care to flow between the professionals providing their health and social care to ensure that care is safe and effective as well as for other purposes, such as protecting the health of the general public. For example, PCTs currently use information, including patient-identifiable information, for commissioning. Some national clinical audits, such as the National Joint Registry, use patient-identifiable information to improve the quality and safety of patient care.
The noble Baroness, Lady Finlay, asked some extremely important questions about the functions of the information centre. The Bill sets out clear provisions controlling how the information centre can publish information. It would publish aggregated information, which is anonymised, and no information that identifies or could identify individual patients would be disclosed by the information centre, other than by dissemination or pursuant to further legal authority. Since its inception, the information centre has introduced strong security controls, published and implemented security policies and published information about its processing as required for compliance with the Department of Health’s information governance framework. It must at all times comply with the Human Rights Act, the Data Protection Act and any other applicable law. The centre would collect identifiable information within a secure environment but, as I have stressed, it would publish it only in anonymised form. This approach has been strongly recommended by several recent reviews, including the 2008 data-sharing review authored by the then Information Commissioner Richard Thomas and Mark Walport from the Wellcome Trust. That recommendation was reiterated in the Academy of Medical Sciences’ review published in January this year.
I agree with the noble Baroness that it is very important to protect identifiable information appropriately. However, as I hope she will accept, it is also critical that we are able to realise the enormous benefits of securely collecting and linking such information and publishing it in a de-identified form, as we intend the information centre should do. This will help professionals and the public better understand the quality and efficiency of services, enhance accountability, help enable people to exercise choice about the services they use and improve those services. In addition, I would like to highlight the safeguard in Clause 256(2)(b), which prohibits the centre from publishing any information it has collected which identifies or could identify an individual.
As I have said, while we do not believe that this amendment is appropriate, we recognise that there have been some concerns around ensuring that confidential information is appropriately protected. We have had, and continue to have, productive discussions with the BMA on this issue and we plan to bring forward amendments on Report that deal with confidential information in a way that balances patient confidentiality with the need effectively to share information across the system. I hope that those assurances will satisfy the noble Baroness.
Amendment 348C would require the appointment of a chair to the National Information Governance Committee, who would report to the Information Commissioner. The purpose of this committee would be to provide advice and assistance to the CQC in discharging its function to monitor information processing practice of health and social care bodies registered by the CQC from April 2013. The National Information Governance Committee is an advisory committee of the CQC, so it would not be appropriate for the chair of the committee to be accountable to an external body, such as the Information Commissioner. In addition, a reporting arrangement of that kind would be inconsistent with the Information Commissioner’s role as the independent and impartial authority responsible for promoting and enforcing the provisions of the Data Protection Act, the Freedom of Information Act and other legislation.
However, I would like to reassure the noble Baroness that the CQC can involve the Information Commissioner where appropriate and close collaboration between the Information Commissioner and the CQC will be important to support relevant organisations fully to comply with the requirements. I hope that those assurances will enable the noble Baroness to feel able comfortably not to press her amendment.
The noble Baroness asked about the Ethics and Confidentiality Committee of the NIGB, which provides essential support for research and other activities by advising the Secretary of State on whether to approve proposals to process confidential information without the need for patient consent, pursuant to the Health Service (Control of Patient Information) Regulations 2002 under Section 251 of the National Health Service Act 2006. We intend that the approval function will in future move to the following bodies: first, a new health research regulator, the HRA, for research approvals; secondly, the NHS Commissioning Board for service management approvals; and, thirdly, the Secretary of State for public health and social care approvals. Each of those bodies will need to put in place arrangements to secure the advice that they need to exercise their approval functions effectively. These arrangements are still being discussed but it seems likely that a body like the Ethics and Confidentiality Committee will continue to be required and officials are discussing future options with the NIGB. I hope that those comments are informative to noble Lords and that they will not press their amendments.
Amendment 348ZA agreed.
Clause 251, as amended, agreed.
Clauses 252 to 254 agreed.
Clause 255 : Powers to require and request provision of information
Amendments 348A and 348B not moved.
Clause 255 agreed.
Clause 256 : Publication of information
348BA: Clause 256, page 245, line 18, leave out “the following provisions of this section” and insert “subsection (3)”
Amendment 348BA agreed.
Clause 256, as amended, agreed.
Clauses 257 and 258 agreed.
Clause 259 : Advice or guidance
Amendments 348BB and 348BC
348BB: Clause 259, page 247, line 31, leave out “other”
348BC: Clause 259, page 247, line 32, leave out “other”
Amendments 348BB and 348BC agreed.
Clause 259, as amended, agreed.
Clauses 260 to 263 agreed.
Clause 264 : Additional functions
348BD: Clause 264, page 249, line 37, leave out “its functions” and insert “any function it has under or by virtue of any other provision of this or any other Act”
Amendment 348BD agreed.
Clause 264, as amended, agreed.
Clauses 265 to 271 agreed.
Schedule 20 : Part 9: consequential amendments
Amendments 348BE and 348BF
348BE: Schedule 20, page 427, line 16, at end insert—
“Health and Social Care Act 2008 (c.14)In section 64 of the Health and Social Care Act 2008 (power of the Care Quality Commission to require documents and information etc. from certain persons) in subsection (2)—
(a) omit the “or” after paragraph (d), and(b) after paragraph (e) insert “, or(f) the Health and Social Care Information Centre.””
348BF: Schedule 20, page 427, leave out lines 27 to 31
Amendments 348BE and 348BF agreed.
Schedule 20, as amended, agreed.
Clauses 272 and 273 agreed.
Clause 274 : The National Information Governance Board for Health and Social Care
Amendment 348C not moved.
Clause 274 agreed.
Schedule 21 agreed.
Clauses 275 to 277 agreed.
349: Before Clause 278, insert the following new Clause—
“Mental Health Act: members of ParliamentRepeal of section 141 of the Mental Health Act 1983
Section 141 of the Mental Health Act 1983 (members of Parliament suffering from mental illness) is repealed.”
My Lords, Section 141 of the Mental Health Act 1983 provides that where a Member of Parliament is detained under the Act, the Speaker must arrange for two registered medical practitioners—psychiatrists appointed by the president of the Royal College of Psychiatrists—to examine the Member of Parliament and report. Six months later, the Speaker must arrange for a second assessment by psychiatrists, and if in their opinion the Member is still suffering from mental disorder, the Speaker lays a report before the House of Commons and thereupon the seat of that Member shall become vacant. There is no appeal mechanism. This provision also applies to Members of the Scottish Parliament and the Welsh Assembly, but not to the House of Lords. There have been times in this Committee when I have wondered about that.
This clause has never been invoked. In fact, the last use of the preceding section was for the removal of Reverend Charles Leach MP in 1916. It was very interesting to read about his case. He was clearly suffering from what we would call multi-infarct dementia and was not actually refusing to give up his seat, although it is clear to me that he would not now be detained in the way he was in those days. The Victorian legislation was introduced by the Lunacy (Vacating of Seats) Act 1886, a Private Member’s Bill to deal with one particular issue, although it was too late for that and therefore post hoc. The legislation was transferred, word for word and process by process, substituting lunacy commissioners with two psychiatrists in 1959 and again in the 1983 Act, and here we have it still.
We know from a survey conducted by an all-party parliamentary group in 2008 that one in five Members of Parliament admits privately to having had personal experience of mental ill health. That is not significantly different from the general population. The majority of those would be mild forms of mental distress, but some of us are aware of serious breakdowns where Members of Parliament have recovered fully and returned to work with few people being much the wiser. Surprisingly, there is a very inclusive, supportive environment in the Commons for people who have suffered periods of mental ill-health.
There is widespread agreement that this stigmatising and discriminatory legislation is not fit for purpose. None of us would tolerate such discrimination against people with physical ill-health who were away from the Chamber of the Commons for six months or more—for example, with a cancer or following a stroke. I am sure that the Minister will remember his own words along these lines in our debates on the Mental Health Bill in 2007, when the noble Baroness, Lady Wilkins, tabled an amendment similar to this one. Unfortunately, we did not have an opportunity in those 2007 debates to pursue the matter at great length because the previous Government reached the end of their term.
The repeal of this section was recommended by the Speaker’s Conference in January 2010—I think that 68 per cent of those who voted were in favour. In February this year, Deputy Prime Minister Nick Clegg announced that it would be repealed when a suitable vehicle could be found. I pay tribute to him and to the Cabinet Office Minister, Mark Harper, for their continuing commitment to this cause. This Bill is a suitable vehicle. I thank the clerks in the Public Bill Office for finding the right place to include it.
We should get this measure off the statute book and demonstrate the House's commitment to the continuing campaign to reduce the stigma to which the voluntary organisations and the Royal College of Psychiatrists have given so much time and energy to make a success. It is time for change and I hope that the Government will respond positively.
The noble Lord, Lord Stevenson of Coddenham, has introduced in this Chamber an important Bill to repeal four pieces of legislation that discriminate against people with mental health problems, of which this was one. The others refer to jury service, governors of schools and directors of businesses. I am totally supportive of that Bill and hope that it is successful. I understand, however, that it is unlikely to be able to proceed through the Commons this Session and will therefore have to be reintroduced in the new Session. If this amendment were accepted today, it would require a simple revision to that Bill, but the major practical provisions are of much more widespread significance and would, I believe, continue to attract government support.
I had considered withdrawing the amendment and waiting for next Session to get that whole Bill through, but my anxiety is, as Harold Macmillan said, “Events, dear boy, events”. We have an opportunity now to get this right and we do not know for sure whether the opportunity will appear again soon. I would very much like to see the repeal of this section enacted this Session. What a Christmas present for the mental health world that would be. I beg to move.
My Lords, the parallel is that things amazingly go on in this country until they are stopped. The Girls’ Friendly Society long ago lost any reason for existing because the girls with whom it was friendly no longer existed in the situations and houses in which they were, yet it took a good 40 years to decide that it was time for it to go. I remember sitting next to a person who explained to me that the trains from Ipswich did not go to Manchester direct but went down to London because there was a row in about 1850 between the Great Eastern Railway and the Grand Central Railway. No one knew that that was the reason, so the trains still went along that route. It was only on privatisation that people started to look again and discovered why that was.
I really do feel that this is exactly the same kind of situation. We have something that has a murky past anyway. The original history is not one that most of us would like to be associated with. It then proceeds, one Bill after another, even unto devolution, which is an amazing achievement. It really is like the famous story from the Army book. The authors found when they looked carefully that when the gun was being fired one man of the four did nothing at all. They sought the reason for that and discovered from a very old sergeant major that he was the man who held the horses.
This is exactly the same kind of situation. Having someone who does nothing at all because at one time he would have held the horses is not such a terrible thing except that it ties up an extra soldier, but having something on the statute book that makes the distinction between physical and mental illness is deeply unacceptable. It is unacceptable for two reasons. There is already too much unkind, thoughtless and ignorant treatment of the mentally ill nationally and we need to stand against it. It is also another example of unnecessary discrimination.
Of course, your Lordships’ House would not like me to point to the fact that no Catholic may ring a bell, still, because those discriminations still exist under our laws. Every time you try to change them, someone produces a frightfully good reason why Catholics would be ill-advised to ring bells. We must all stand very strongly against these hangovers from a less attractive attitude, both in the religious case and in the case with which the amendment is concerned—mental illness. It is a small thing. I am a great supporter of the Bill of the noble Lord, Lord Stevenson, and we should get rid of this discrimination now.
My Lords, this is a bit like Lords reform. If you deal with the bells question, you then have the Bishops. Is this part of a process of disestablishing the Church of England? I hope not.
We debated this in 2007 during the passage of the Mental Health (Amendment) Act. At the time, on behalf of the Government, I said that it was a matter for the House of Commons and that it was best that the Commons dealt with it. The fact is that the House of Commons has not dealt with it in four years. I hope that the Minister will say that the Government will accept this amendment. I am sure that the noble Baroness will find support on Report if not.
I have been looking at the draft House of Lords Reform Bill and I have quickly skimmed Part 7, which covers the whole range of disqualification of Members. I might have misread it, but I cannot find any reference to disqualification on the grounds of mental illness. Quite clearly, the Government do not think that it is relevant to an elected second Chamber. It certainly should not be relevant to the House of Commons.
My Lords, I remind the Committee that the Government are publicly committed to the repeal of Section 141 of the Mental Health Act 1983. On 3 February 2011, the Government announced that it would be repealed when a suitable legislative vehicle became available. Section 141 sets out a process by which an MP’s seat is vacated if they are authorised to be detained under mental health legislation for a period of six months or more. There is, however, no parallel provision for the automatic disqualification of those who might be hospitalised or on sick leave with physical ailments for six months or more, as the noble Baroness has indicated, even if those people might be equally incapable of fulfilling their duties. The noble Baroness is absolutely right in that regard.
Even those who are imprisoned are not automatically disqualified unless their sentence is more than 12 months. This is an unwarranted discrimination against those with mental illness. With the repeal of Section 141, being detained in hospital for mental health reasons would no longer lead to the automatic loss of a MP’s seat.
However, the Government believe that the most suitable vehicle for this reform would be a stand-alone Bill, allowing both Houses the chance to debate this important issue. There are some outstanding questions on the extent and effect of repealing this provision, which we are still discussing with the devolved legislatures. The Government do not feel it is appropriate to accept this amendment while these questions remain unanswered.
The Private Member’s Bill of the noble Lord, Lord Stevenson, the Mental Health (Discrimination) Bill, had its Second Reading on 25 November 2011. The Bill aims to repeal various pieces of legislation that discriminate against the participation of those with mental health conditions in public life, including Section 141. At its Second Reading, the Government indicated their support for this Bill and we continue to support the Bill as an appropriate means for removing several pieces of discriminatory legislation.
We have already announced our intention to repeal, setting out the Government’s position that this sort of discrimination is not acceptable. While I applaud the noble Baroness’s intention, this important reform should be part of a stand-alone Bill, not inserted here at Committee stage. I am sure that noble Lords will agree that the issue should be given the parliamentary attention it deserves, and I hope that the noble Baroness will be prepared to withdraw her amendment.
Amendment 349 withdrawn.
Clauses 278 to 284 agreed.
Clause 285 : Breaches of duties to co-operate
Amendments 350 and 351 not moved.
Debate on whether Clause 285 should stand part of the Bill.
My Lords, I am grateful to the Committee for allowing this question of whether Clause 285 should stand part of the Bill to be taken today. Previous commitments from the Minister have outlined that the Secretary of State’s annual report is an important mechanism through which he will account for the system, and the Bill sets out extensive powers of intervention in the case of failure, which are essential if Ministers are able to retain ultimate accountability for the health service. However, the Secretary of State’s duty of keeping performance under review applies only to national arm’s-length bodies, although we are also debating—and will be, I am sure, on Report—how it might also refer to the clinical commissioning groups.
The aim of this debate is to explore what will happen if Monitor and the CQC do not co-operate. I am simply seeking some clarification from the Minister in response to certain questions. The Bill sets out a formal duty of co-operation between these two bodies—but what practical actions will be taken if this does not happen? On 7 December, the noble Earl, Lord Howe, stated at the Dispatch Box that the Secretary of State would be able to write formally and publicly to organisations if the duty to co-operate is being breached. How will the Secretary of State monitor how effectively Monitor and the CQC are working together? Will they report on how well they have worked together and where they seek to improve their working relationships in the future? What will trigger the Secretary of State to intervene? Can the Secretary of State take responsibility for any services that have been responsible for triggering a dispute?
The Minister also stated that:
“If the breach is significant, sustained and having a detrimental effect on the NHS, the Secretary of State will have a further ability to lay an order specifying that the organisation should take certain actions only with the approval of another specified body, other than the Secretary of State himself”.—[Official Report, 7/12/11; col. 747.]
Will the Government please give a definition of the meaning of,
“significant, sustained and having a detrimental effect on the NHS”,
and explain what this will mean in practice? In subsection (7) there is mention of arbitration, but who will the arbitrator be in the event of a dispute? Is that the Secretary of State?
There may be examples of work between CQC and Monitor that may not be considered significant breaches of their duty to co-operate but may not be best practice in integrated working. This is a particular risk for complex work such as setting the tariff, especially for care pathways for complex conditions that take into account multiple providers. How will the Government ensure that these two bodies do not meet just bare minimum standards but continue to improve the quality of their integrated working, innovate to find new ways of co-operating and share good practice throughout their organisations, so that integrated working is strategically built in at their every level?
There is a particular concern about the effect on long-term conditions if Monitor and the CQC do not work seamlessly together. We have had debates already about the importance of care being integrated to treat patients with long-term conditions. The Secretary of State must be proactive in ensuring that both Monitor and the CQC themselves work proactively to facilitate such integrated working. I would be grateful for some further elaboration on how this will be achieved. I hope that the Minister will be able to assure the Committee that Monitor and the CQC will be required to report to the Secretary of State on how they have collaborated, including an evaluation of how they have co-operated, and that they will be given goals by the Department of Health on how to improve continuously in such working.
When considering potential failure that is recognised by one party but not the other, who will have the power to intervene? This becomes particularly important as Monitor has powers to intervene in failure but not, as I understand it, at the point when an organisation is at risk of working in a way that may result in failure—in other words, in a pre-failure state. At that point, Monitor does not have powers to intervene. I would be grateful if the Minister were able to answer at least some of my questions today. I realise that I have posed a lot of questions, and that some may come better in writing later.
My Lords, I follow the noble Baroness, Lady Finlay, and very much share her questions—not least about who will be the arbiter in a situation where co-operation cannot be reached between two of the major bodies involved in responsibilities for the health service. I would add just a couple of things. I very much apologise to the Committee for the fact that, when Amendments 350 and 351 were reached—we were already going through at a rattling pace—I was out of the Chamber so did not move those two amendments. I will not refer back to them or move them now; it would obviously be inappropriate to do so. However, I stress the concern that I have about Clause 285.
The trouble is that there is a very long and elaborate procedure under which, if co-operation fails between the board and Monitor, they have then to exchange views with one another and tell each other what their opinions are, and so forth. They and the Secretary of State then have to make statements of their opinions. This seems most unfortunate, because co-operation and integration are at the very heart of what all of us have been saying in Committee are absolutely crucial elements in the attempt to deal with the problems that confront the NHS, and the health service more generally, at the moment. Therefore, to have a procedure which is as elaborate and which has as many stages in it as this one—with, in many ways, the chances to fuel rather than heal any difference between them—seems not to be a sensible clause at all.
Our amendments simply suggested that it would be much better, at a certain point when we were in what the noble Baroness, Lady Finlay, described as the pre-failure period, to allow the Secretary of State to come into the picture. This goes back to what the noble Lord, Lord Mawhinney, was talking about earlier. We are not talking about an immediate intervention. We understand the need to try to get agreement and to decentralise decision-making but in the end, if they cannot agree on how to co-operate and resolve that, either there has to be an arbiter whose voice is such that he or she carries real authority or, since we do not know who that arbiter is, in our view the proper arbiter is indeed the Secretary of State, responsible as he is to Parliament and to the public. Therefore I strongly support the noble Baroness, Lady Finlay. I am very grateful for what she has said. I hope we can hear from the Minister who will be the arbiter, and whether there might be a more rapid and effective way of dealing with a failure of co-operation. I put on record that I think this is absolutely crucial to what this is all about. We need to be able to deal with it reasonably urgently and quickly.
My Lords, I agree with the noble Baroness, Lady Williams. This question brings us right back to the Secretary of State’s powers. I also agree that the procedure in the Bill is complex and I am not sure that it will work. It is not clear at all who will be the arbiter. It seems strange that Monitor has powers to intervene on failure but there does not seem to be the same structure around co-operation and when co-operation fails. This part of the Bill feels like it does not work properly. It is too complex and probably needs another look.
My Lords, I have listened with great interest to the points that have been made. I feel it would be useful if I first set out how this clause would work and the series of events that it would allow. Then I will try to explain why we believe that the powers it provides are an appropriate and constructive lever within the new system.
The method of intervention set out in Clause 285 needs to be considered as one of a range of intervention powers and levers available to the Secretary of State in order to ensure that the system operates in the best interests of patients and that he complies with his duties in relation to the health service. These include the proactive setting of objectives for the health service through the annual mandate to the board and setting requirements through the standing rules. The Secretary of State also will have a duty to keep the effectiveness of arm’s-length bodies under review.
In addition, the Secretary of State will have more extreme intervention powers such as the ability to remove the chair of an organisation, where they have failed adequately to perform their functions, and the ability, under specified circumstances, to give directions to an arm’s-length body where the Secretary of State considers it has failed to discharge those functions, or has failed to discharge them properly. Clause 285 should be viewed as an additional power alongside the others conferred on the Secretary of State by the NHS Act and this Bill. Of course, should the Secretary of State employ his powers as set out in Clause 285 and the problem persists, then where he considers that one of the bodies is failing to discharge its functions properly, he would be able to exercise his powers of direction.
The Bill places new duties to co-operate, in addition to modifying existing duties, so as to ensure that all of the arm’s-length bodies in the system, such as the Commissioning Board and Monitor, are required to co-operate with one another. We wanted to do more to encourage co-operation in the new system, partly out of recognition that the current system would benefit significantly from greater co-operation, but also because the new arrangements will create an even greater need for co-operation given the strongly autonomous and interdependent arm’s-length bodies that will be created.
The clause sets out powers for the Secretary of State to take action in response to a breach of the relevant duties of co-operation. It provides a mechanism for pressing organisations to resolve disputes in the unlikely event—we hope and trust that it will be unlikely—that two or more organisations covered by the clause fail to co-operate. If the Secretary of State believes that the duties of co-operation listed in this clause have been or are being breached, or are at significant risk of being breached, he will have a new ability to write formally and publicly to the organisation in question. If the bodies continue to breach the duty following the notice and the breach is having a detrimental effect on the performance of the health service, as the noble Baroness, Lady Finlay, pointed out, then the Secretary of State will have a further ability to lay an order, specifying that each body could take certain actions only with the approval of the other body. This measure would be subject to affirmative approval by both Houses of Parliament and could last for up to a year. That means that organisations in dispute would be strongly reminded of their interdependence as part of a national system. As a matter of last resort, if agreement could not be reached, either party would be able to invoke independent arbitration under Arbitration Act arrangements. In this way, the organisations in question will be pressed to resolve their difference without recourse to the Secretary of State and the Department of Health.
This is an important element of our policy. We want arm’s-length bodies to focus on the functions conferred on them by Parliament, the objectives set for them by Government and the relationships with other organisations that will help them to achieve their goals. We do not want them placed in a position where they are trying to secure relative advantage in the system by using the Secretary of State as a means of determining the outcome of disputes. The existence of the order-making power will both help to preserve the autonomy of organisations and encourage them to work constructively with one another.
I emphasise that this is a precautionary power and we expect it to be used only in very exceptional circumstances. It is also important to note that the powers and duties described in this clause are about co-operative behaviours. They do not in any way undermine the independence of Monitor or the CQC to make specific regulatory decisions in relation to another arm’s-length body. For example, the Secretary of State could not use the provisions to constrain Monitor from taking action against anticompetitive purchasing by the NHS Commissioning Board.
My Lords, that is the whole point of this clause. The Secretary of State must have levers at his disposal. Even if he does not use them, the fact that he has them will be a clear signal to bodies that they must co-operate in the way that Parliament—if the Bill is approved by Parliament—intends. As I said, we have identified gaps in the current system that need to be resolved because it is important that arm’s-length bodies that have functions directly conferred upon them take those functions seriously and do not resort constantly to arbitration by the Secretary of State or the department.
We expect that the vast majority of differences between organisations will be resolved by the organisations themselves and that this power will be used rarely, if at all. Nevertheless, it is important that the power exists. The fact that failure to co-operate could have public and highly embarrassing consequences will strengthen the incentive for organisations to co-operate effectively in the interests of patients.
We believe that this approach strikes the right balance between the need for the Secretary of State to fulfil his stewardship role within the system, being able to intervene to ensure that disputes are resolved, with the need to ensure that organisations are responsible and accountable for their own decisions and actions. These powers allow the Secretary of State to ensure that solutions to problems are found in a timely manner, without him or her stepping in to specify and micromanage what those solutions should look like.
The noble Baroness, Lady Finlay, asked me a number of specific and detailed questions. I will take up her invitation to write to her on those and copy other noble Lords in. With those assurances, I hope that she will feel able to allow the clause to stand part of the Bill.
Clause 285 agreed.
Clauses 286 to 291 agreed.
Schedule 22 agreed.
Clauses 292 and 293 agreed.
Clause 294 : Transfer schemes
351A: Clause 294, page 264, line 43, leave out “transfer” and insert “occupation”
My Lords, I really am not trying to prevent Christmas starting for Members of this Committee. I feel as though most of today’s amendments have concerned me. These are probing amendments, which relate to NHS capital assets. They are designed to explore what happens to the current offices and clinical premises of an NHS body at the time of transition and afterwards. If these premises are occupied by a clinical commissioning group or a company that is advising a clinical commissioning group on its commissioning, who will become the owner of the property?
This is important because GPs are themselves independent contractors, not NHS employees. For many—not all but a significant number—the premises from which they work are owned by their practice. They, not the NHS, jointly own them, even though the building will usually have been subject to a range of capital improvement schemes from the NHS over many years. Such schemes allow a GP to purchase a practice and invest in it over the years. The capital gained then forms a significant additional pension pot for that GP.
My question for the Government concerns whether the deeds of the property will be transferred to the general practitioners of the clinical commissioning group. Will they be able to sell it for profit that would then be their personal profit? Will the profit revert to the NHS and, if so, to which pot? If property is transferred, will the new owner be liable to put capital gained into the capital part of the commissioning pot to develop service premises and equipment for the health service itself, rather than be able to take whatever capital gain there is on that property? I beg to move.
My Lords, I just wish to add two questions of my own to the list that the noble Baroness asked. Has the Department of Health now resolved the issues around future asset ownership in respect of PCT and SHA estates? Within that, does that include LIFT schemes and PFI?
My Lords, I hope I can answer the question of the noble Baroness very quickly. Clinical commissioning groups will be statutory bodies. They will be legally and operationally separate from GP practices. As such, if a clinical commissioning group occupies property that is under the ownership of that group, it will be under statutory ownership. It will not be open to GPs to sell such property at a cut price, or at any other price, to GP practices to enable such practices to pocket the profits. What the noble Baroness outlined sounded to me very much like embezzlement from the state. It will be no more possible for what she envisages to happen than for a primary care trust to sell a property and have its officers pocket the proceeds. I am a little mystified by the scenario that she has painted.
May I make it clear that I am not suggesting that general practitioners will embezzle funds from the NHS? I am just concerned about who will hold the deeds of such property at the time of transfer. Once the ownership is transferred, the disposal of those assets rests with the new owner. We have seen foundation trusts that have, in rationalising their services, quite rightly sold off sometimes large pieces of estate that have been very valuable and become housing land and so on. That money has then gone back into NHS services. I wanted clarification that the same thing would occur.
My Lords, first of all, the Bill does not provide for PCT property to be transferred to GP practices. The policy on where property may be transferred is still under development but we have powers in the Bill to transfer property to the appropriate body in the new architecture. The noble Baroness will realise that many decisions around this have to be taken locally on a case-by-case basis. We have powers in the Bill to create schemes with enough flexibility to allow this.
If, for the sake of argument, a clinical commissioning group owns property which is surplus to requirements, it will have to go through all the proper processes overseen by its own audit committee and its governing body to ensure that public assets are disposed of for value and in a proper and arm’s-length way. Where a conflict of interest rears its head, the provisions governing conflicts of interest will cut in. It will not be open to the clinicians who have authority within the clinical commissioning group, or, indeed, practices which are members of the clinical commissioning group, to benefit in an improper way. It will have to be done openly. If a GP practice were to wish to acquire property that is owned by the CCG, there will be transparent processes to make sure that this is done in the correct fashion. In these circumstances, the property deeds are transferred to the clinical commissioning group as a corporate entity. They are not transferred to the individual GP members, and once transferred to CCGs, if the governing body wished to dispose of property, that, as I say, has to be done in accordance with the same safeguards that currently apply to PCTs. I hope that that reassures the noble Baroness.
I encourage the Minister to look very carefully at the practicalities of this because I can think of at least two or three examples of health centres in which I have been involved where it did come down to the property, the ownership and the GP—I can think of one now—where one brought together all the practitioners and key community groups to secure development. The person who stopped that development was the GP because of their interests and pension arrangements in the building. Therefore, in my view, it is important to be very careful about these practical arrangements if we want integration to occur.
I suspect that the example the noble Lord has in mind involved GP practice premises rather than property owned by an NHS body such as a primary care trust. I suggest that the two cases are rather different. However, I take the noble Lord’s point that integration of services at a delivery level can often be very advantageous to patient communities. Some of the most successful examples that I have seen are of practices where many facilities are available on site for the patient. We are seeing more and more of these being created around the country. We should encourage that.
I am most grateful to the Minister for that response. This has been a short but very useful debate. I have an anxiety that we may need to refer back to it in the future, although I hope that I am proved wrong. On that note, I beg leave to withdraw the amendment.
Amendment 351A withdrawn.
Amendments 351B to 351E not moved.
Amendments 352 and 353
352: Clause 294, page 265, line 28, after “means” insert “—
353: Clause 294, page 265, line 30, at end insert “, or
(b) a subsidiary of a company which is formed under that section and wholly owned by the Secretary of State.”
Amendments 352 and 353 agreed.
Clause 294, as amended, agreed.
Schedules 23 and 24 agreed.
Clauses 295 to 299 agreed.
Clause 300 : Commencement
Amendments 353ZZA and 353ZA not moved.
Clause 300 agreed.
Clause 301 : Commencement: consultation with Scottish Ministers
Amendments 353A and 353B not moved.
Clause 301 agreed.
354: After Clause 301, insert the following new Clause—
“Review of the operation of the Act
(1) Annually, the Secretary of State shall review the operation of this Act, publish a report on the review and lay the report before Parliament.
(2) If required by a Committee of either House, the Secretary of State must make available to both Houses of Parliament information necessary for the operation of this Act to be scrutinised.”
My Lords, I rise to move the amendment in my name and that of my noble friend Lord Patel, who sends his apologies to the Committee. He is strongly enthusiastic about the amendment but regrettably cannot be here. The amendment would introduce a new clause to provide for a review and scrutiny of the operation of the Act.
The noble Earl, in responding to the Second Reading debate, was kind enough to deal with the matter I had raised regarding post-legislative scrutiny. Your Lordships’ House has determined that careful post-legislative scrutiny should be considered because it is of value and importance for all complex Bills. The detailed Committee stage which has attended the passage of this Bill in your Lordships’ House has clearly shown that there has been considerable anxiety about the potential implications and operation of what will eventually be the Health and Social Care Act. It is only right that a Bill of this complexity should be subjected to post-legislative scrutiny. This can be undertaken only if appropriate information is made available to both Houses of Parliament.
The purpose of exploring the opportunity for the Government to consider the issue at this stage is to determine whether the noble Earl—in addition to confirming the Government’s commitment to scrutiny of the Act, if Parliament decides to pass it—would consider initiating post-legislative scrutiny earlier than the three years which he kindly indicated when answering the Second Reading debate. A range of between three to five years is the normal period in which scrutiny might be considered for an Act once Royal Assent had been received. However, in view of many of the issues that have been raised, it would seem appropriate to attend to the matter of scrutiny earlier.
It might be argued that having scrutiny one or two years after enactment would be a little too early, but many of the new mechanisms and arm’s-length bodies being established to deliver the purpose of the Bill are already available in shadow form. For example, the chief executive-designate of the NHS Commissioning Board has already been appointed. The chairman has been appointed and the board is starting to make other important appointments and to deal with its structure so that when the Act comes into operation the board will be in a position to start its work. It means that, after a year, we should all be able to perform reasonable scrutiny.
With regard to clinical commissioning groups, pathfinder commissioning groups have already been established. They are starting to develop the alliances and relationships in their areas and localities that will allow them to become fully operational at the time that the Bill proposes. Therefore, the period of finding their feet has already been established.
A commitment to both rigorous scrutiny after enactment and early, formal post-legislative scrutiny will allay a lot of anxieties and provide your Lordships and the other place with reassurance that if there were to be unintended consequences associated with the Bill, they may be identified earlier. If other elements of legislation were required to ensure that the Bill’s objectives could be fully achieved, given that the Government are considering a further Bill to deal with matters such as education, research and social care in the next Session, scrutiny of the Bill could inform what legislation might be added to that Bill. I beg to move.
I rise to support the noble Lord. Earlier today, he made a very pertinent point on Lords reform, and this one seems equally pertinent. Before I do so, perhaps I may take this opportunity to say that my noble friend Lady Gould has just vacated the Deputy Speaker’s seat. That was her last session, and I wanted to say to her—I am sure on behalf of the whole House—what a wonderful job she has done. She has accompanied us through many pieces of legislation, often very late at night, always with tolerance and very efficiently, as befitting a former fearsome organiser of the Labour Party, if I may say so.
It would be churlish, then, to spoil the atmosphere by commenting overall on the Bill because, as the noble Lord suggested, it is open to us to have a kind of Second Reading speech, but I will resist—to the benefit of noble Lords opposite, if not my noble friends.
The noble Lord put it very well. The fact is that the reforms are being enacted; they are taking place at this moment. The Government have not waited for legislation. Primary care trusts have effectively been abolished. The new system is coming into being. We have shadow clinical commissioning groups, although they cover much larger areas than originally envisaged, so it would be quite right and proper for early post-legislative scrutiny to take place. Because the changes go to the heart of the National Health Service, I should have thought that it would have been useful to have an annual report and to allow Parliament to debate it.
I invite the noble Lord, Lord Kakkar, to go one step further. He will know that the noble Earl, Lord Howe, has always been fond of sunset clauses. He moved many such amendments when in opposition. I should have thought that the Bill deserves a sunset clause. I would give it two years, because then, if the coalition survives that long, the noble Earl will be back to put right all the problems that he is now enacting.
On that note of Christmas spirit, I invite the noble Earl to accept the noble Lord’s amendment.
My Lords, if the noble Lord, Lord Hunt, is addressing us in the guise of Christmas spirit, it is well disguised from most of us.
However, it may be worth reflecting at this juncture that this is the 41st day that the Bill has been debated on the Floor of this House or that of the other place—a quarter of all sitting days in this calendar year. I thank all parliamentarians, especially noble Lords, who participated in subjecting the Bill to such unprecedented scrutiny. It is a better Bill as a result; the Government are better informed as a result; and I look forward to our further debates in 2012.
I completely agree with the noble Lord, Lord Kakkar, that parliamentary scrutiny of legislation and the actions of government are of paramount importance. The Bill has, as I said, received a huge amount of parliamentary scrutiny during its passage, and I have no expectation that this will stop following Royal Assent—and nor should it. Ministers will continue to provide information to Parliament—for example, in response to Parliamentary Questions and Select Committees. I am sure that we will be providing a lot of information both on the implementation of the Bill and on health and social care more widely in the months and years ahead.
Your Lordships’ House has shown itself more than adequate to the task of scrutiny, using the mechanisms already available to it. However, looking at this amendment, I do not feel that that ability to perform scrutiny would be particularly enhanced by the noble Lord’s proposals. Therefore, I do not think that the amendment is necessary and I shall explain briefly why.
One reason is that Ministers already provide information requested by Select Committees. They already respond to requests for Parliament to provide information on the operation of legislation. In addition, the Bill will be subject to the existing system of post-legislative scrutiny. I can reaffirm the commitment that I made at Second Reading: although five years would normally elapse prior to the Department of Health undertaking post-legislative scrutiny of a Bill, we will bring that forward to three years for this Bill. After one year, were we to imagine such a process, to me it would not be sensible to conduct a review. Substantial elements of the Bill would have yet to be implemented in full at that time. For example, the NHS Commissioning Board and Monitor will take on their full responsibilities only from April 2013. Therefore, as the noble Lord has rightly said, although activity is going on now, I think that he is perhaps straying into a review of policy in general rather than of this legislation. The policy of course is kept under constant review.
The Department of Health will submit a memorandum to the Health Select Committee of the other place when post-legislative scrutiny takes place. This memorandum will include a preliminary assessment of how the Act has worked out in practice, relative to objectives and benchmarks identified during the Bill’s passage. The Select Committee, or indeed any other parliamentary committee, can obviously then decide to conduct further inquiries. Of course, the existence of this process does not stop a Select Committee investigating the implementation of an Act at any time it chooses.
I hope that the spirit of the noble Lord’s proposal is one that the Government have addressed and indeed met, and that I have provided at least some reassurance to him to enable him to withdraw his amendment.
My Lords, I thank the noble Earl for his response, which I think recognises the fact that there will be a need continually to provide reassurance that the purpose of the Bill is not attended by unintended consequences, and an important part of that will be thorough post-legislative scrutiny. However, on the basis of the Minister’s response, I beg leave to withdraw the amendment.
Amendment 354 withdrawn.
My Lords, perhaps I may take this opportunity to thank the noble Earl, Lord Howe, for his remarks about the conduct of the Committee stage of the Bill. I also express my thanks to him and to the noble Baroness, Lady Northover, for the way in which they have responded to the scrutiny debate, and I also thank the Bill team. I fear that Christmas will be cancelled because they are going to be writing so many letters to Members of your Lordships’ House. We look forward to Report.
Clauses 302 and 303 agreed.
Bill reported with amendments.
My Lords, it is my honour and pleasure to put the Motion that the House do now adjourn. It is an everyday matter when the House is in Session in this Chamber but, once a year, it takes on a very special significance. In moving the Motion, I join with the generously expressed remarks of the noble Lord, Lord Hunt of Kings Heath. I would like to pay tribute to the stamina of my noble friend Lord Howe, to all of those on the opposition Front Benches and to all of those around the House who have taken part in the Committee stage of the Health and Social Care Bill. I wish my noble friend the Minister and all others a wholly restful Christmas Recess, despite those letters that the noble Lord, Lord Hunt, pointed out will be written. Of course, I have already offered an early Christmas present in the forthcoming business: the fact that the Report stage of the Bill will not start in at least the first two weeks when we return.
It is customary at this moment for the usual channels, in their broadest sense, to pay tribute on behalf of the whole House to our staff, who have facilitated all the work of this House during the course of the year. It is my privilege to be the first of the four of us who will pay such compliments. The difficulties of the spring of this year are now far behind us. Those difficulties put a burden on our staff, which we all, I know, acknowledge. They managed, as always, with professionalism and patience. This is not always an easy place in which to work: our hours can be long and unpredictable and even with goodwill that can happen. I thank all the staff for their continued flexibility and commitment, which I know is recognised and appreciated by all of us.
I know that my opposite numbers in the other groups will pay tribute to some individual members of staff who have completed or who are shortly about to complete their long service to this House. I would particularly like to pay tribute to Major Mike Charlesworth, who retired in July after 16 years as our staff superintendent. Major Charlesworth joined the House after a long career in the Army, where he served in the Falklands and Bosnia. He was responsible for the day-to-day management of the attendants and housekeepers, both key services, which I know Members of the House greatly appreciate.
One of Major Charlesworth’s first jobs on arriving in the House was to arrange for all Members to be decanted—we are now used to being decanted, are we not?—from the Principal Floor, West Front, in order to install computer cabling, in which we led the way in Parliament, in the disused chimney ducts. Yes, that is where they are hiding. The problem was that that was swiftly followed by a huge rain of soot along the corridor and so his next job was to arrange the clean-up. Major Charlesworth was a key figure in the arrangements for State Opening and state visits. He assisted with the lying in state of the late Queen Elizabeth, the Queen Mother, in 2002, when about 200,000 members of the public came to pay their respects around the clock.
In his spare time, Major Charlesworth was a keen singer in the London Welsh Male Voice Choir, with whom he appeared on “Blue Peter”, earning a much-coveted Blue Peter badge. We hope that he will have time to pursue his interest in retirement. I am sure that all Members of the House will wish to join me in wishing him a long and happy retirement.
Briefly, I would also like to take this opportunity to thank Sir Stephen Laws, who retires next month as first parliamentary counsel. Although not personally known to many Members of this House, his and his colleagues’ work is very familiar to us all. In our scrutiny we often criticise legislation as being badly drafted, when, as ever, what we really mean is that it is badly formulated by the politicians. The error is rarely, if ever, that of the draftsman. Sir Stephen has provided a first-class service to a number of Governments over the years and we wish him the very best in his retirement—the Leader and I in particular because he is our Permanent Secretary.
All that remains is for me to invite my opposite numbers around the House to make their contributions, after which I will formally adjourn the House.
My Lords, it is always difficult following the Government's Chief Whip, but I thank her for her courtesy and generosity of spirit on the closing day of our proceedings this year. I have a number of people to thank. I will start with the staff of the House of Lords in general, who all work incredibly hard to support us and make sure that our deliberations, however long or short, are painless in terms of what goes on behind the scenes. I also pay tribute to my opposite number, the noble Baroness, Lady Anelay, for the way in which she and her office have worked tirelessly over the past year to ensure that our business is conducted in an orderly fashion and manner. Though we might not always agree, I am sure that we agree on one thing: namely, that this House is extraordinarily important, and that the way in which it works is extraordinarily important, too. The usual channels are working well and to an improved standard. That is cause for great congratulation.
I also thank Hansard staff who have tirelessly noted and commented on all our observations on government legislation and beyond. They are here at all hours and are sometimes much overlooked when we conduct our deliberations. The clerks, as ever, are tireless and are there to give us advice and good and wise counsel. They do their job splendidly. I also join the noble Baroness in thanking Sir Stephen Laws. When we were in government we were endlessly reliant on Sir Stephen for good advice and wise drafting. As the noble Baroness observed, it is not often that draftsmen are at fault; it is more often politicians. We would all agree on that.
There is one matter that I should clear up before I pay my tributes: namely, my footwear. There has been a lot of comment on it today. I got up under the mistaken impression that it was national festive footwear day. I apologise, but it is true that I am red from head to toe—and it is in celebration of the fact that we are in the festive season.
I am here as the representative of the Official Opposition to give thanks not just to all the staff of the House—the caterers, the cleaners, the housekeepers and everybody else—but in particular to some of those who are retiring. I pay particular tribute this afternoon to Senior Attendant Bob Jones. We made some inquiries about Mr Jones and found them rather difficult. I was often told that the things which people might like to say about Mr Jones were not repeatable in your Lordships’ Chamber. However, there are one or two salient facts. Bob joined the House in October 1994 after a full career in the Royal Navy. What is not known is whether he served under Admiral West; I am still inviting comment on that.
What is absolutely clear from my observations is that, wherever he has been, Bob Jones has come back with a story to tell—something like the Uncle Albert character in “Only Fools and Horses”. A number of years ago, Black Rod's department decided to have an awayday. I cannot understand why anybody would want a day away from this place, but they did. They chose HMS “Belfast”, apparently because of its age. It was taken out of service a very long time ago, but Bob Jones took great delight in pointing out things on the ship because it was the first ship on which he had served. Of course, now it is Bob who is being taken out of active service.
I am told by other attendants that they have one fear for Bob: namely, that his wife Carol, who is a paragon and incredibly supportive, will become a fishing widow. I am sure that the House would like to record its concern on this matter, and if it were available to me, I would be putting a Motion down because I think that is quite wrong. However, I think everybody will join me in wishing Bob well in his retirement. I certainly enjoyed my discussions with Mr Jones on the odd occasion on my way into the Chamber. He is a very entertaining fellow, and I recommend him to anybody who needs an after-dinner speaker.
Then I turn to Mr Wiggins. Mr Wiggins has been in the building 21 years. He served as a Grenadier Guard. I think he initially worked in the House post office team. If you chance upon Mr Wiggins, there is certainly a bit of the postie about him. I am not quite sure how you determine these things, but he is very good at delivering things. Before that job, he worked as an attendant in the House of Commons and he was a House of Commons doorkeeper, so he has what I am told is described as “end-to-end experience”. I am not quite sure what that means.
My last tribute of thanks goes to Terry Little. Terry Little joined the Pass Office in 1997 after a career in the Metropolitan Police. He worked in the Pass Office until 2001 and for the past 10 years has been a doorkeeper. He and all the other doorkeepers are there to protect us, to ensure that we do not fall over when we might, to ensure that the House is kept in good order and to ensure that when the day is done, we can safely depart the building.
Going back to Mr Wiggins, I am told that he is joining the Commons annunciator team. I had some difficulty with this because the word “annunciator” in my brief is spelt “annunicator”. We do occasionally have problems with the annunciator. I am sure that those problems will be easily abated, but let us make sure that our briefs are word perfect.
I wish everybody in the House a very merry Christmas and a very fulfilling new year. I look forward to our happy return.
My Lords, Christmas time, like some of the other festivals in the year, is of great importance for many reasons, not least the opportunity for us to spend a little bit more time with our families and friends than is usual during the normal period of our work. They also provide markers during the year which remind us and enable us to say a word of thanks to those who work with us and serve us so extraordinarily well in your Lordships' House. We are enormously fortunate in that regard, as we all know.
There are some people who come to us at an early point in their career for a relatively short time—interns and young people who come to work here for a little while who then go off with their knowledge and experience and do other valuable and worthwhile things. Indeed, my noble friend Lady Williams and I were just talking about how pleasant it is to see some of these young people continuing on to do absolutely marvellous things for their community and their country. We have been fortunate that they have started with us. Others, as has already been noted by the noble Lord, Lord Bassam of Brighton, come at a later point in their career, perhaps having served Queen and country in various parts of the world. They come here as doorkeepers, attendants and in other jobs to provide us with order and security, comfort and great courtesy.
However, there are others who come to us through other organisations, and I particularly want to mention those from the Metropolitan Police. It is sadly the case, but it is the case, that we owe our security to them, and it is important for us to acknowledge that that continues and sadly in the upcoming year will undoubtedly continue to be a requirement for us, and we are grateful to them.
There are others who come to us at an early point in their career and spend much of their life working here with us. Some of them are in hospitality, some are in the clerking community and some are in the clerical and administrative community. They provide extraordinary stability for your Lordships' House, and an institutional memory which is itself of enormous importance, although I know that a number of noble Lords also provide some of that. Some stay with us for a very long time, and it is important that we acknowledge them. One in particular, Christine Bolton, has just completed 40 years of service to your Lordships' House. I think that merits particular mention. She is universally and very affectionately known as Chris. She joined your Lordships’ House as a clerical officer on 1 November 1971. For many years, she was on the staff of the Journal Office and was an early user of what in those days was known as new technology—first, using a database on a mainframe computer and then using word-processing software on eight-inch floppy disks. I think that a few of your Lordships still remember those kinds of things.
Chris is now in the Legislation Office where she has become the cornerstone of our procedures for handling private legislation. For myself and our office, when recently one of our colleagues was ill and special arrangements had to be made for a replacement, we should like to acknowledge how helpful, courteous and gracious she was. It was not just a matter of Chris doing the job and doing it properly but she did it with grace and courtesy, which is one of the reasons why she has become so affectionately known throughout your Lordships’ House. She is not alone and many others serve your Lordships’ House in this way but today is an opportunity to pay particular tribute to her.
We will now, I trust, take a break even from some of those letters to which the noble Lord, Lord Hunt of Kings Heath, referred. I trust that all noble Lords will travel safely home to the various parts of our United Kingdom, or to other places if they are fortunate enough to go away, and will have a good rest, relaxation, time with friends and families, and thorough recuperation because I fear that not only the duties within your Lordships’ House but the challenges that come from outside in 2012 may be substantial and significant. We would do well to be ready for them.
My Lords, I think evidence of the effectiveness of the usual channels is that we have reached this point in the calendar at the same time as we have reached the completion of the long Committee stage of the Health and Social Care Bill. This Bill has received the kind of scrutiny for which this House should take great credit. It is in keeping with the function of this House that we scrutinise these Bills with great care. This Bill has certainly received great scrutiny in Committee. I certainly associate myself with the comments of congratulation that have been addressed to the Front Bench and to the others who have played such a big part in the Bill. There is of course much yet to be done.
Mention of one Bill does not exclude in any way the work that has been done on the other Bills that have come before your Lordships’ House. Each of the Bills that we have had, or still have, before us has an enormous importance to our fellow citizens. Potentially, they affect the lives of us all and all citizens of this country. Therefore, it is important that the House continues to fulfil its responsibilities with the care that I certainly admire greatly.
In that process, we are enormously assisted by some outstanding staff. The staff in this House not only help the work to be conducted in a most efficient manner, but they behave always with great commitment, courtesy and support for all that we do. This has been a difficult period because the Bills have been so demanding that it has meant a number of late nights, some of which have become early mornings. As has already been said so well, the House is remarkably well served by its staff. We find it difficult to convey words fully to express our gratitude to them and we are indeed fortunate.
A number of members of the staff of the House work behind the scenes and we never see them, but they are extremely important to all that we do. It falls to me to have the pleasure to refer to two members of staff, Esther Roake and Nelly Parker. Over the years they have been employed to clean the collection of books in the Library. They have done this with great commitment and enthusiasm. They begin their task in the Library, going from shelf to shelf, removing every book and dusting it, cleaning the shelf and then putting the books back, and when they have cleaned all the books in the Library, they move into the collections in the corridors and other byways of the building. Remarkably, at the end of the process they are ready to start again because by the time they reach the end, the books on the Library shelves need to be dusted again. They have done this task for many years with, as I have said, great commitment and enthusiasm and, amazingly, they both claim not once to have opened any of the books. They say the reason for that is that they do not have time to do so, unlike us. They have been very cheerful members of our staff, and Esther always had a generous supply of sweets in her pocket that she would share with those who stopped for a friendly chat along the way. We pay tribute to these two members of staff, who have now retired.
We also offer our warmest thanks to all the staff who work behind the scenes for everything they do. On behalf of the Cross-Bench group, I wish everyone a happy Christmas and offer all good wishes for 2012.
House adjourned at 2.26 pm.