Health and Social Care Bill (Programme) (No. 4)

I congratulate my noble Friends Baroness Jolly, Baroness Barker, Lord Marks, Baroness Williams, Baroness Tyler and Baroness Northover on putting in a tremendous amount of work during the Bill's various stages to negotiate and table amendments to advance the arguments that my Liberal Democrat Friends and I have expressed concern about. I have already put on record the fact that, although some of those amendments represent important strides towards making the Bill less bad, the changes still do not satisfy me to the extent that I feel that the Bill should be entitled to go forward from this, the elected House, as a piece of legislation. Unfortunately, that is not an argument that I am going to win, but I wanted to put the point on record. Lords amendment 31 represents an important step forward, but it will merely provide a sticking plaster in what will be a fundamentally challenging scenario. The clinical commissioning groups represent a crumbling pillar in the edifice of the legislation. The big weakness at the centre of the CCGs is the fact that their members will, collectively and individually, be conflicted in almost all circumstances, and they will be unable to escape from that. The Minister emphasised that point further when he told the House why he could not accept the amendment tabled by those on the Labour Front Bench. He told us that members of a CCG should not take part in certain discussions and decisions, even though they had declared an interest, because the groups would, on occasion, be commissioning to all their members. In those circumstances, a CCG would be incapable of making a decision because none of its board members or general members could be brought in to help because they would all be conflicted. That demonstrates a fundamental weakness in the legislation. My noble Friend Baroness Barker has tabled an excellently drafted amendment to deal with that problem, but she was working within very limited parameters. The amendment would simply provide a sticking plaster for a crumbling edifice that will be unable to hold up this policy. I have a fundamental concern about the way in which the legislation will work in this regard. The solution would be to go back to the coalition agreement. I have advanced that argument before. Although no such amendment is before us today, I suggest that we revert to the idea of a much more wide-ranging commissioning body, perhaps based on the infrastructure of the old—or, in some cases, existing—primary care trusts. In so doing, we could get rid of the Government-placed people who come through the Appointments Commission, and instead graft in clinical representatives. The Government are absolutely right to ensure that clinicians play a central role in providing good clinical advice on the decision making and the awarding of contracts. Such a structure would also ensure that the voices of the community, the local authority and patients' representatives would be heard. Unfortunately, we do not have such a pillar in place, and we are now trying to achieve iterations that, I am sorry to say, will not go far enough in addressing the fact that clinical commissioning groups will be fundamentally, endemically conflicted, and there will be no escape from that.