Health and Social Care Bill

My Lords, I shall also speak to Amendment 86. This is very much a probing amendment designed to elicit from the Minister the Government’s intention with regard to high security services. My reading of the Bill is that there is a responsibility on the national Commissioning Board to arrange for the provision of high security psychiatric services but that whoever provides such services is none the less subject to direction by the Secretary of State. Equally the board can also be given directions by the Secretary of State. The noble Earl would be right in thinking that I have no problem whatever about directions by the Secretary of State. I assume that this power of direction is because of the evident importance of sensitivity and risk in relation to high security services. I would be grateful for clarity on that. However, I also want to ask about oversight and scrutiny. If high security services are commissioned by the NHS Commissioning Board, who will have oversight of that? Presumably the Secretary of State will take an interest in how well it is done. That must be implied from the direction duty. Will Monitor or the Care Quality Commission come to this as well? Will the CQC be looking at quality and standards? Will that involve the whole question of whether the NCB is commissioning those services effectively? Those questions might also apply to prison healthcare, which also falls to the NHS Commissioning Board—again with no obvious oversight in relation to that commissioning. Although the issue of mental health services is the subject of my amendment and I was going to ask the noble Earl to clarify, in many ways our earlier debate—many hours ago—on the comprehensive responsibilities for commissioning services by CCGs covered that matter. But if he had a word or two or would write to me about mental health services, I would be grateful. The real issue on mental health services is the GPs’ own approach. There is patchiness in relation to how well GPs are prepared to either treat people with mental health issues or to provide support. The question arises as to whether we are confident that clinical commissioning groups will take mental health services sufficiently seriously. He might want to comment on that. In the main, we need clarity on who monitors the national Commissioning Board when it is commissioning high-security psychiatric services. I beg to move.