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Health and Social Care Bill

moved Amendment No. 38: 38: After Clause 45, insert the following new Clause— ““Failings by English NHS bodies In the light of evidence of significant shortcomings in the commissioning of health services from reviews under sections 42 or 44 the Commission may— (a) require any relevant Strategic Health Authority to propose and publish appropriate changes to the arrangements for and governance of commissioning of health services in any geographical area to which the evidence relates in order to reduce the risk of harm to that area’s population; and (b) recommend to the Secretary of State that the changes proposed should be implemented.”” The noble Lord said: My Lords, I will not treat noble Lords to the whole speech again. I have not yet withdrawn my amendment, but as we have got to this point in the discussion I think that I can say a few more words. I do not want to get into an historical debate with the Minister, but I used the term ““commissioners””. Commissioners, as I recall, were around before this Government were in office. There was an NHS market from Ken Clarke’s days, and there were commissioners; they were simply not called primary care trusts. There has therefore been a history of commissioning for some time. Many PCTs have been around for five or six years rather than for 18 months, so we have quite a spread of experience of commissioning from which to draw. The harsh reality is that, when push comes to shove with rather powerful acute hospitals, commissioners often back down. They simply do not take the action necessary to balance provision of health services in their area. I in no way disagree with the Minister or with the Government’s position on the performance management role of the strategic health authorities. However, when Alan Johnson published the document about the new regulatory system in October 2007, he very clearly said—I referred to this in Grand Committee—that commissioning was a shared responsibility between strategic health authorities and the commission. The Minister has graciously moved a long way to get commissioning properly established in the Bill. I apologise to the noble Earl, Lord Howe, if I marched him up to the top of the hill and marched him down again by withdrawing my amendments, but I do think that the Government have moved a long way in these areas and I am comfortable with their amendments. However, I still come back to the question of who can take the action to push the SHAs where there is evidence of a failure of commissioning in a particular geographical area. I am still concerned about this. I probably used ““red card”” inappropriately. I bow to the noble Baroness, Lady Murphy, and her superior knowledge of soccer; a yellow card was probably the appropriate analogy. We need to think about this a little more, and as we are at this point in the Bill, I ask the Minister to consider this issue further. In the mean time, I beg leave to withdraw the amendment.