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Health and Social Care Bill

My Lords, I am grateful to my noble friend Lord Warner for his considered comments and for taking us through Amendment No. 38. He is right when it comes to the history of commissioning, which is why I made the point that we need to remind ourselves that most PCTs are barely 18 months old. We need to give them maturity in establishing their commissioning competencies. Historically, one way of dealing with poor commissioning was restructuring, but we have made a commitment that there will be no further restructuring. However, I agree with noble Lords who made the point that we should build up competencies of commissioning. There is the publication of the Department of Health on the assurance system, to which I referred earlier, but also a failure regime for commissioning, details on the rules and how we set the bar in measuring the quality of commissioning. The noble Earl, Lord Howe, raised the issue of the balance between provision and commissioning. Reviews of PCTs will look at commissioning functions as closely as at the provider function. Some aspects of the commissioning functions that will be part of these reviews are: value for money in commissioned care, in other words whether the PCT has made good use of the resources available to it; quality of commissioning, for example whether the care commissioned by the PCT is of high quality and achieving good health outcomes for individuals using it; the availability of commissioning, in other words whether the PCT has purchased enough healthcare to meet the needs of its population and whether waiting times are within the national standard of 18 weeks; and finally—I feel this will probably be more important in the future—overall health outcomes, in other words whether the PCT has succeeded in improving the overall health of its population by reaching out to those in most need. Those are the type of competencies that a mature PCT in the future will have responsibility for, and, more importantly, through the assurance regime it will be assessed on whether it is meeting those needs. The answer to the noble Baroness, Lady Barker, is yes. I am delighted that, having considered our amendments, in particular Amendments Nos. 36 and 37, my noble friend Lord Warner has agreed that we are striking the right balance of responsibilities between the commission and the Secretary of State and that he will withdraw his amendment. On Question, amendment agreed to. [Amendment No. 33 not moved.]