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Health and Social Care Bill

moved Amendment No. 102: 102: After Clause 51, insert the following new Clause— ““Competition between commissioners or providers of health care (1) Regulations may make provision for the Commission to undertake or promote comparative or other studies designed to enable it to make recommendations— (a) for establishing principles and rules relating to competition between different commissioners or providers of health care; or (b) for promoting transparency and fairness in such competition. (2) Any such regulations may provide for the publication of studies undertaken by the Commission and of recommendations arising from them. (3) Any such regulations must provide for the Secretary of State to have regard to the recommendations of the Commission under this section.”” The noble Baroness said: These are probing amendments. We are seeking to discover the department’s proposals for regulating the emerging NHS market. Amendment No. 102 would introduce a new clause after Clause 51 and is designed to give the regulator powers to manage emerging competition within the NHS. I would be very interested to know whether that is the Government's intention or whether they have a different model and a different regulator in mind. Whatever the model, subsections (1), (2) and (3) of the proposed new clause will be relevant. Subsection (1)(a) seeks to establish the principles and rules relating to competition between different commissioners or providers of healthcare. Subsection (1)(b) seeks to promote transparency and fairness in competition. This is in line with our previous amendments which set out to encourage openness. Subsection (2) would enable the regulator to publish studies and recommendations in the same way as the Healthcare Commission does now, and subsection (3) would ensure that the Secretary of State paid regard to the recommendations of the regulator. It is clearly the Government's intention to have a mixed economy within the NHS—competition between commissioners and providers within the NHS, and competition between the NHS and other providers from the private and independent sectors. Competition is seen as a tool to ratchet up quality standards and efficiency. Experience shows that there is a large body of opinion within the NHS that is ideologically against any quarter being given to the private sector. These people believe that the values of the founding fathers are being betrayed and that however good the private sector may be, it is not to meddle with the Christian socialist ethic that, whether rich, poor, black, white, young or old, healthcare should be provided free at the point of use. The Government, indeed, any Government, have an uphill struggle to change these attitudes and beliefs which are very deep in the British psyche. When United Health Care Europe was selected to provide services in a GP practice in north-east Derbyshire, the PCT was taken to judicial review by the local people. Later the same company was successfully selected to take over another practice in central Derby. The results have been very interesting. The points awarded through the quality and outcomes framework have increased from 80 per cent to 98 per cent and the number of patients using the practice is up by 30 per cent. Neighbouring GPs who previously closed their practice lists have had to reopen them. It is evident that they have had to respond to competition in a way that they would not have done following a diktat from above. Of course markets need to be managed and there is huge merit in the management being undertaken by an independent body, which, acting without fear or favour, will ensure a robust and fair system. It could be argued that the new CQC is well placed to take on this role since it will also control market entry and exit through registration, and has duties to ensure value for public money. I understand that at one time the Government considered giving this task to the CQC but then rowed back, and have now decided to set up their own ““Co-operation and Competition”” panel within the department. The title of the panel alone illustrates the complexities involved. When should co-operation be encouraged regardless of competition? When should competition be stimulated at the expense of co-operation? The two are uncomfortable bedfellows. Understandably, the Government wish to start with a cautious approach and to feel their way, but this does beg the question: how independent is an independent regulator sitting snugly in Whitehall? Will there be pressures from down the Corridor—temptations to favour NHS services in preference to independent providers, especially with the payment by results system in operation? Is it envisaged that the new panel will set prices in the same way as Ofcom and Ofgem do now? In the long term, are the Government planning that their regulator should be an economic regulator? How will it relate to the CQC and Monitor? However these issues are managed, it will always be essential for the regulator to assess each case openly and fairly, and for people to recognise it as a champion of public interest which is independent of the system. The proceedings, reports and findings will need to be published and made widely available. If the Government seriously want to open up the market to competition, I think that their current approach with a departmental panel will be short-lived. There will be mounting pressure to have a freestanding body that is not only independent of government but seen to be independent, and, as we all know, perception is reality. As I have said, this is a probing amendment, and I hope that the Minister will be able to answer my questions. I beg to move.