Health and Social Care Bill

I am saying that the Secretary of State will not have the ability to micromanage the health service as he does at the moment. Whether the examples cited by the noble Baroness constitute micromanagement, if my right honourable friend is just expressing a view, I rather question. The autonomy duty is a necessary part of the Bill because it places a duty on the Secretary of State to consider the expertise of those in the health service while recognising that there will be circumstances in which they must be able to step in to protect the interests of health service patients. That is the balance that we are trying to strike. The noble Baroness, Lady Finlay, asked whether the autonomy duty would allow a clinical commissioning group to justify not commissioning the full range of services. The autonomy duty does not apply to CCGs; it is a requirement on the board and the Secretary of State. If a CCG chooses not to commission services and the board considers that this is not consistent with the interests of the health service, the board can intervene to direct a CCG. If the board fails to intervene when necessary, the Secretary of State has power to intervene. Finally, the Secretary of State can set out services which CCGs must commission, and he can do that in the standing rules if he considers it necessary. The CCG’s key duty is to arrange services as it considers necessary to meet all reasonable requirements of the population that it is responsible for, and the amendments do not change that in the slightest. It might be helpful to say a little more about Amendment 34. I rather skirted over it in my introductory remarks, although my noble friend Lord Marks spoke to it very eloquently. We have tabled Amendment 34 to make clear the link between what CCGs do and what the Secretary of State does in the exercise of his functions. CCGs will be required to act consistently with the discharge by the Secretary of State of his duty under Section 1(1) of the National Health Service Act when exercising their duty to commission services under Section 3. Our amendment goes even further by requiring CCGs to act consistently with two additional things: first, the discharge by the board of its duty to promote a comprehensive health service; and, secondly, the objectives and requirements of the Secretary of State’s mandate to the board. This addresses concerns raised by several noble Lords, including my noble friend Lord Marks, who rightly said that there should be a clear link between CCGs and the mandate. The amendment also applies this duty to the powers of clinical commissioning groups to commission services under Section 3A, as well as their duty under Section 3, so that it covers all the NHS services that they commission. The amendment does not mean that it is for an individual clinical commissioning group to determine how best to promote the comprehensive health service and then act consistently with that view. On the contrary, the Secretary of State remains responsible for determining how best to discharge his duty to promote—in part through the mandate to the board but also through the exercise of his other functions. The clinical commissioning group must then act consistently with how the Secretary of State performs that duty. When making decisions about the commissioning of services—for example, when deciding whether to withdraw that service—a clinical commissioning group would have to bear the Secretary of State’s duty in mind and act consistently with how he is performing that duty. To take a practical example, it would not be consistent for a clinical commissioning group to withdraw a service if the Secretary of State had indicated that the service was a vital part of the NHS that should be available to all patients throughout England. The noble Baroness suggested that the duty of autonomy threatens care pathways. I simply cannot agree with her. As I have set out extensively on previous occasions, both integration and competition are tools at the disposal of commissioners to deliver high-quality care to patients. The autonomy duty would not alter that in the slightest. The noble Lord, Lord Warner, asked whether what we are doing here would somehow inhibit CCGs from bringing in new players. No: where commissioners believe that new providers would serve the interests of patients, they will have the ability to bring in such new providers. Nor does it interfere in the slightest with the ability of the board to support CCGs in the event of distress. I hope I have covered the questions that have been asked. I thank noble Lords for their valuable contribution to this debate. Once again, I thank the noble Baroness, Lady Jay, for her good offices in bringing us to this point. I hope that my remarks and the amendments tabled will reassure noble Lords that the interests of the health service are and always will be at the heart of the Bill.