Health Bill [HL]

Amendments 26 and 28, tabled by the noble Baronesses, Lady Barker and Lady Tonge, propose that the Handbook to the NHS Constitution be reviewed at least every five years, rather than every three years as Clause 4 provides. Amendments 30 and 32 propose that the Secretary of State report on the effect of the NHS Constitution on patients, staff and members of the public at least every five years, rather than every three years as Clause 5 provides. The intention behind the amendments, as I understand it, is to give more time to vet the constitution before reporting on its effect; to provide more time to embed the handbook in the NHS; and perhaps to minimise unnecessary changes to the document. It might be helpful if I outline our objectives for the handbook and explain the thinking behind the current drafting. The constitution, as we previously debated, is designed to be an enduring document. We therefore propose to review it every 10 years. The handbook, on the other hand, is an explanatory guide setting out the current law and policies underlying each right and pledge in the constitution. Our intention is to keep the handbook up to date. As the noble Baroness, Lady Howarth, has just mentioned, it would be useful to keep this up-to-date for patients, the public and staff. For example, if one of the Government’s waiting-time targets or commitments were to change, the handbook could be updated straight away to reflect that. Similarly, the Secretary of State has the power to make minor and technical revisions to the handbook at any time in line with changes in departmental policy or law. Clause 4 provides a duty to review the handbook every three years. This would be a more general review of whether the handbook was still fit for purpose in its current format. We believe that every three years is a sensible interval for a major review, but earlier revisions might be needed. A more frequent review could create an administrative burden; any less often and we might lose the opportunity to ensure that the handbook remains useful and tailored to the needs of its audience. Finally, I should like to stress that the overwhelming response from our extensive consultation process was that every three years was considered the appropriate time to review the handbook. I turn to Amendments 30 and 32. We do not wish the new duty for the Secretary of State to report on the constitution to create an administrative burden on the NHS. Perhaps I can set the noble Baroness’s mind at rest by confirming that we will work to ensure that local feedback and monitoring arrangements are aligned wherever possible with the constitution, working in partnership with others such as strategic health authorities, regulators and other stakeholders. We also agree that the constitution needs to be given time to become embedded before we assess its impact, which is why we have set a minimum of three years for the report. There needs to be a balance between providing an assurance that the constitution is having an effect and giving it time to embed, as the noble Baroness so eloquently described it. We believe that reporting every three years will strike this balance. We need to know sooner than every five years what the effect of the constitution is. Furthermore, it is logical that the timetable of both clauses—to review the handbook and to report on the effect of the constitution—should be the same. It means that the review of whether the handbook is fit for purpose can be set in the wider context of how the constitution has affected patients, staff and members of the public. The noble Baroness, Lady Finlay, asked where the data will come from. These are routinely collected data from, for example, our patient surveys—which I very much hope noble Lords will see, as we talk about the quality accounts, will be much more sophisticated. These are much more sophisticated tools for determining the patient experience. The data will also include staff surveys which we have historically collected. We hope to assess the impact of the constitution using this baseline. I hope I have been able to explain why we think that three years is the right period for a review of both the handbook and the effect of the constitution. I strongly believe that the reviews should be aligned. I would therefore ask the noble Baroness, if I have given enough assurance, to withdraw her amendment.