Health and Social Care Bill

My Lords, noble Lords will recall that in Committee I too highlighted the issue of conflicts of interest. I did so because, like many other noble Lords, I had listened to and read the briefings sent by the professional bodies, many of which raised fears and concerns about conflicts of interest. Like many other noble Lords, I believe it is important not only that members of the public have faith in the integrity of the decisions being made by CCGs but that members of the professions believe in those decision-making processes and feel able to participate in them. They should also have the protection of good governance and good conflict-of-interest policies to enable them to carry out what will be a difficult role. Before we look at the detail of this, it is important to remind ourselves a little of the context. There are conflicts of interest in the National Health Service now. There always have been, as anyone who has ever sat around the table at a joint finance meeting at which every single person has an interest in the discussion will know. It may not be a direct financial interest; it could be about a post, a project or money. Managing conflicts of interest is something that the NHS and PCTs do now. That is not to say that we should not take the opportunity of the Bill to make the principles according to which the NHS should act more overt. They should be the highest of principles. It is for that reason that my colleagues and I raised the matter in Committee. We then drafted a set of amendments that are in this group—Amendments 84, 89, 91, 92, 93 and 116. I am very grateful to several noble Lords, including the noble Lord, Lord Newton of Braintree, who looked at those amendments with the seasoned eye of an ex-Health Minister. His response was, ““Very good but an awful lot of this needs to be in regulation, not in the Bill””. I took his comments to heart, which is why my colleagues and I withdrew those amendments on Friday and noble Lords now have Amendments 79A, 82A, 86A and 86B before them on the Marshalled List. It is also important that noble Lords understand one particular point about the interpretation of the Bill. A great deal of anxiety has been expressed by some of the professional bodies about the role of commissioning support organisations. Noble Lords may recall that I raised that in Committee. I have been in discussion with several members of the professions to try to understand the source of that concern. As far as I can understand, there is a view within some of the professional bodies that commissioning support and the commissioning of services are one and the same thing, whereas the Minister was at great pains in Committee to stress that they are two different processes that go side by side. Noble Lords may have seen a briefing by Professor Allyson Pollock on her interpretation of Schedule 2. Would the noble Earl, Lord Howe, in his response to these amendments, talk particularly about the role of commissioning support? There is a view outside, which is informed by some of those briefings, that people who are not clinicians will have a responsibility for commissioning clinical services. In Committee he was at pains to stress that that was not the case; that it would be members of CCGs only who had that responsibility and that they would be given support to do that only by CSOs. I return to the issue of conflicts of interest. They are extremely difficult things to legislate for because they take a number of different forms. On the ground, a conflict of interest can be financial or non-financial—it is a difficult thing to define in legislation. In our amendments, and particularly Amendment 79A, we state that there must be a register of interests of members of a CCG, the governing body, its sub-committees and its employees. Noble Lords might find it helpful to know that, for the purposes of the legislation, ““employees”” covers people who work as consultants. I do not mean medical consultants, but people who work in a consultancy capacity to the CCG. Under the amendment, they must publish registers of those interests and ensure public access to them; and the registers must be kept up to date, with information being placed on them within 28 days. Why is that important? People's interests change and these organisations will be in the business of giving out contracts to providers. It is therefore important that if someone has a material interest and that interest changes—particularly around the time of the contract being issued—this is brought to public attention quickly. Proposed new subsection (4) in our Amendment 79A states that CCGs, "““must make arrangements for managing conflicts and potential conflicts of interest in such a way as to ensure that they do not, and do not appear to, affect the integrity of the group's decision-making processes””." It is extremely important that these groups not only set out to uphold the highest standards but that they are seen to uphold them.