Health and Social Care Bill

My Lords, the noble Lord, Lord Clement-Jones, has put his finger exactly on the point here. I absolutely agree that, welcome though the amendments in the Minister’s name are, they do not go far enough. Counting things after the fact will not necessarily provide the kind of protection that is required in this area. Section 44 of the National Health Service Act 2006 currently provides for a limit on the proportion of income that an NHS foundation trust obtains from private charges. I am familiar with this; I had to deal with it in the Health and Social Care Act 2008. That was the point at which my party agreed that there needed to be a review of the private patient cap. That is absolutely the case and we would agree on that. The restriction was introduced to ensure that NHS foundation trusts continued to focus primarily on NHS patients, as the noble Baroness, Lady Williams, explained. However, as we accepted at the time, the way that the cap was based on the financial year cemented in a widely varying range of restrictions, from zero to a little more than 30 per cent, with the average being around 1.5 per cent. The Bill lifts the cap completely. The abolition of the cap on the amount of income that foundation trusts can earn from other sources has the potential to act as an incentive for foundation trusts and could earn them income. However, we believe that it is not right for the Bill to lift that cap unconditionally. I would pray in aid of this many organisations. For example, the Royal College of Nursing said in its response to the October 2010 White Paper: "““the RCN cannot support the removal of the private income cap””," until foundation trusts can credibly demonstrate, "““that private income is not taken at the expense of NHS patients … the current arrangements … should remain in place””." The Royal College of Midwives similarly said that its, "““chief concern is that this could accelerate the development of a two-tier service within foundation trusts, with resources directed towards developing private patient care service at the expense of NHS patients””." The King’s Fund, in the consultation on Liberating the NHS, supported reform to the cap. However, it stated that processes need to be in place to ensure that there is no conflict with or compromising of quality of care for NHS patients or efficient use of taxpayers’ money. The question is: have the Government achieved that? I think that there is still a question mark over it. In its briefing on the Bill’s Second Reading, the BMA said that, "““this could lead to a two-tier health service, as foundation trusts invest more resources in non-NHS facilities””," and could come at the expense of NHS patients’ ability to access facilities. In fact, the Department of Health’s legislative framework of December 2010 acknowledged that concerns were legitimate, but chose to rely on FTs’ ““social ethos and values”” rather than impose proper procedures, accountability, transparency and regulation which would ensure the protection of NHS patients. We oppose the Question that the clause stand part of the Bill in order to have this necessary discussion. I refer briefly to Amendment 299 in the name of my noble friend Lord Beecham, which is a probing amendment. His concern was that the regulator must be satisfied that any application for FT status is able to provide goods and services for the purposes of the National—National—Health Service in England. In parts of the Bill, that is not absolutely clear.