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Local Government and Public Involvement in Health Bill

moved Amendment No. 219ZB: 219ZB: Clause 237, page 169, line 15, at end insert— ““( ) In Chapter 1 of Part 2 of the National Health Service Act 2006 (c. 41) (Strategic Health Authorities), after section 17 insert— ““17A Reports on consultation (1) Each Strategic Health Authority must, at such times as the Secretary of State may direct, prepare a report— (a) on the consultation it has carried out, or proposes to carry out, before making commissioning decisions, and (b) on the influence that the results of consultation have on its commissioning decisions. (2) In subsection (1) ““commissioning decisions””, in relation to a Strategic Health Authority, means (subject to any directions under subsection (5)(e)) decisions as to the carrying-out of functions exercisable by it for the purpose of securing, by arrangement with any person or body, the provision of services as part of the health service. (3) Each Strategic Health Authority must also, at such times as the Secretary of State may direct, prepare a report— (a) on any relevant consultation carried out by the authority, and (b) on the influence that the results of any relevant consultation have had on such matters as may be specified in the direction. (4) In subsection (3) ““relevant consultation”” means consultation in relation to matters specified by the direction under that subsection. (5) The Secretary of State may give directions as to— (a) the periods to be covered by reports under this section; (b) the matters to be dealt with by reports under this section; (c) the form and content of reports under this section; (d) the publication of reports under this section; (e) decisions that are to be treated as being, or that are to be treated as not being, commissioning decisions for the purposes of subsection (1).”””” The noble Baroness said: My Lords, government Amendments Nos. 219ZB and 219ZC amend Clause 237, which currently imposes a duty on PCTs to report on their consultation activity in relation to their commissioning decisions. The noble Earl, Lord Howe, proposed in Committee that this duty should be extended to strategic health authorities. We agree that this is an important addition and, because SHAs have responsibility for the commissioning of specialised services on a national basis, although currently that is carried out by NHS London, it is appropriate for the PCT duty to report on consultations to be mirrored for SHAs. However, in view of the important new duty to involve and consult on the strategic plans for an area, which we discussed earlier, we think that the duty to report should also be extended to reporting on other consultations carried out by an SHA and their outcomes. I am sure that noble Lords will recognise that these amendments are significant. I thank the noble Earl, Lord Howe, again, for identifying these important issues and giving us the opportunity to strengthen the voice of patients and the public in this particular context. Amendment No. 219ZBA, tabled by the noble Earl, seeks to extend the duty to consult to other commissioners. We think that the amendment is based on the misunderstanding that PCTs will be able to contract out their commissioning function either to the pre-approved list of suppliers published as part of the FESC or that this extension could apply to practice-based commissioners. The point we are trying to make is that we do not expect PCTs to be able to contract out their commissioning function in this way. This is not the case, PCTs will remain ultimately accountable and responsible for commissioning, both in terms of practice-based commissioning as well as FESC—I shall put that out in full in a moment—which merely provides PCTs with a pre-approved list of suppliers with specialist expertise to support them in carrying out their commissioning function to supplement their own capacity and capability. The duty is being placed on PCTs because not only do they have responsibility for the vast majority of commissioning decisions, they also hold the vast majority of money in the health service. It is because of these huge responsibilities that this important duty is being imposed—to ensure that PCTs are accountable to local communities in a transparent way. What the amendment seeks to do is rather out of proportion in relation to the PCT duty. While I accept that a small number of services are commissioned by trusts these are certainly exceptions and I do not believe that the duty to report on consultations in relation to those services is proportionate. It is not that the information pertaining to a trust’s consultation in relation to its commissioning activity would be inaccessible to patients and the public. Indeed, a local involvement network could very well request this information from the trust concerned and overview and scrutiny committees could do the same. I am trying to make it clear that it is essential that PCTs report. I appreciate the amendment’s point about the level of delegation that PCTS might make but they cannot delegate this authority or the responsibility to report. Where LINks or overview and scrutiny committees have concerns, they will have access to information and they will be able to hold the PCT to account. I should clarify that FESC is the framework for procuring external support for commissioners. That is about providing the PCT with support; it is not about allowing it to delegate its duties. I beg to move.