Health and Social Care Bill

My Lords, my name is on Amendment 96. I feel we might be running the risk of missing the important point in a rush to say whether this amendment should be tested. I would very much like the Minister to accept that there is an issue to be addressed here: it is on how the commissioning would be carried out for patients with less common conditions and rare diseases. The Bill is not clear, hence this debate and the amendments put forward by my noble friend Lady Finlay, previously in relation to commissioning boards and now in relation to commissioning groups. This amendment alludes to the duties of the commissioning group, "““to ensure the provision of services for patients with less common conditions””." Small commissioning groups may not be able to ensure the provision and may well have to co-operate with other commissioning groups. The direction may well actually have to come from the national Commissioning Board. The noble Lord, Lord Walton of Detchant, referred to the funding issue. There has to be some pool funding from the national funding pool because the commissioning group may not be able to afford the large amount of money required for treating those people. I am familiar with that, because I was involved in setting up the process for handling it in Scotland. I ask the Minister to accept that there is a lacuna here of how commissioning for rare diseases would be done. He needs to reassure us that it will be robustly done, with clear leadership and responsibility. I hope that he will be able to do that. I also tabled Amendment 119 in this group. I hope and have no doubt that the noble Earl will deal with it very swiftly. The amendment relates to quality payments. New Section 223K(6) states: "““Regulations may make provision as to how payments under subsection (1) may be spent (which may include provision as to circumstances in which the whole or part of any such payments may be distributed to members of the clinical commissioning group)””." These are quality payments. As I understand it, members of clinical commissioning groups are individual providers of primary care—mainly GPs—so I am puzzled at how the quality payments will be handled. The Bill states that they will be given to individual primary care providers as merit awards or bonus payments—personal gains. My amendment states that they should be given not to individual providers but to commissioning groups, which should use them to improve services. That seems to be more appropriate. I look forward to the Minister's comments.