Health Bill [HL]

Amendments 4, 5 and 6 tabled by the noble Baronesses, Lady Barker and Lady Tonge, propose that all bodies and persons who must have regard to the NHS Constitution must also have regard to the handbook to the NHS Constitution. Amendment 8, tabled by the noble Earl, Lord Howe, has a similar effect but uses an alternative method through a new clause. I understand the intention behind these amendments, seeking as they do to strengthen the duty on bodies and persons to have regard to the NHS Constitution by extending this duty to the handbook. However, it is important to give some context to the Government’s existing proposals. We propose in Clause 2 that all providers of NHS care in England should have regard to the constitution. As noble Lords will know, the constitution is designed to be an enduring document that will, as I said previously, be updated infrequently and only after full consultation with patients, the public and staff. By contrast, the handbook is the explanatory guide to the NHS Constitution. It explains what the constitution means in practice, by setting out the law and departmental policy that underpin each right and pledge in the constitution. There is no right or pledge in the handbook that is not mentioned in the constitution, and the handbook itself does not create policy or law. Although, of course, we expect those having regard to the constitution to be familiar with the content of the handbook, it is not a document that we intend should be legally taken account of by providers of NHS care. If I use my earlier analogy of the Bill that we are currently debating and the Explanatory Notes that go with it, I hope that that makes the case. Having regard to an explanatory guide is fundamentally different from having regard to the constitution, and I believe that a requirement in that regard may be unduly bureaucratic, given that NHS providers will in any event be familiar with the content of the constitution. In addition, if there were an obligation to have regard to the handbook, there would also be a case for a more formal process for updating it—for example, a requirement to consult on any revisions to the handbook. Furthermore, strengthening the legal status of the handbook in the way that the amendments suggest could, ironically, make it a less useful and accurate guide for patients, the public and staff, because imposing a requirement to consult on any changes to the handbook would make it slow and cumbersome to update, even though most of the changes would be minor and technical. It would undermine our objective of ensuring that the handbook was readily revised and kept up to date. That objective has widespread support. For example, the Constitutional Advisory Forum, which oversaw the consultation, recommended that the handbook should be updated regularly to keep pace with changes in legislation and policy. Although I sympathise with the intention behind the amendments, I believe that they would complicate what we are trying to provide as a simple guide to the constitution for patients and staff in the NHS. I hope that I have made my case and that the noble Baroness, Lady Barker, will feel able to withdraw the amendment.