Health and Social Care Bill

My Lords, Amendment 7, tabled by the noble Lords, Lord Beecham and Lord Hunt, and the noble Baroness, Lady Thornton, seeks to set out a new definition of the health service in England as, "““those services provided under section 3””," of the 2006 Act. While I know that the noble Lord has the best interests of the NHS at heart, I fear that this amendment might achieve the opposite of what he intends because its effect would be to narrow the definition of the health service. Section 3 of the NHS Act 2006, as amended, will set out the services that clinical commissioning groups will be required to commission, including, for example, maternity services, hospital accommodation and, in answer to the noble Earl, Lord Listowel, "““such other services or facilities for the care of pregnant women, women who are breastfeeding and young children as he considers are appropriate as part of the health service””." Defining the health service as meaning only those services set out in this section would limit the application of the provisions of the Act, excluding other vital parts of the health service that are not defined in Section 3. For example, that definition would exclude primary care and specialised services, which would be commissioned by the NHS Commissioning Board, and public health services, which would be provided or commissioned by the Secretary of State or local authorities. Clause 1(1) of the current Bill retains the Secretary of State’s duty to promote a, "““comprehensive health service designed to secure improvement … in the physical and mental health of the people of England, and … in the prevention, diagnosis and treatment of illness””." This clearly sets out what the health service must do. Any attempt to define it more precisely might have the perverse effect of leading to an NHS which delivered fewer services. I can assure the noble Lord that services commissioned by clinical commissioning groups will be covered by the wording of the unamended clause, and thus these services will be covered by the Secretary of State’s duty to promote the comprehensive health service. As part of the health service, those services must remain free of charge. Clinical commissioning groups will be responsible for commissioning the services listed in Section 3 of the 2006 Act such as hospital services and maternity services. They must arrange those services, although as with primary care trusts at present, Section 3 will permit them discretion to determine precisely what services are necessary to meet the reasonable requirements of their local population. The Commissioning Board will issue commissioning guidelines and monitor the commissioning activity of CCGs with a view to ensuring that no essential services go uncommissioned in any given locality. I say again to the noble Earl, Lord Listowel, that we will consider mental health issues in a later amendment tabled by the noble Baroness, Lady Hollins, and I will be happy to cover the issues around the parent/child relationship then. However, I agree very strongly with the point the noble Earl made about the importance of the parent/child relationship. In a nutshell, our reforms are aimed at empowering patients, including their families and carers, and the Bill provides a strong footing for that relationship to be strengthened. I can assure the noble Lord, Lord Beecham, that this is not the Secretary of State washing his hands of the NHS. The Secretary of State will retain—at the risk of reopening the previous debate—ultimate accountability for promoting the comprehensive health service. The Bill gives the Secretary of State extensive powers of oversight and stewardship of the NHS. His powers include the power to prescribe, in the standing rules regulations under proposed new Section 6E of the 2006 Act, inserted by Clause 17, that CCGs must commission specified services. I think the noble Lord suggested that the 2006 Act was clearer about what the health service was and that this Bill makes it less clear. The Bill does not reduce the clarity of the 2006 Act in terms of a description of the services which must be provided as part of the health service. Section 3 and Schedule 1 remain in place so far as the services covered are concerned; it is simply the identity of the body responsible for arranging them which will change. The noble Lord asked what was wrong with an illustrative list. There is already an illustrative list in Section 3 of the NHS Act 2006 which, as I have said, sets out the services the CCGs will be required to provide. However, attempts to define that list more precisely will inevitably lead to the problems that I have outlined. I hope that reassures the noble Lord that the existing definition is satisfactory and that he will withdraw his amendment.