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

Let me begin by paying tribute to my colleagues in the House of Lords, who have improved the Bill significantly. I want to raise two issues relating to conflicts of interest. Subsection (1) of the new section proposed in the amendment tabled by Baroness Barker states:"““Each clinical commissioning group must maintain one or more registers of the interests of—""(a) the members of the group,""(b) the members of its governing body,""(c) the members of its committees or sub-committees or of committees or sub-committees of its governing body, and""(d) its employees.””" I looked in vain for a paragraph (e) specifying ““parties with which it is contracted for commissioning support””. I think that that is a live issue. There will be commissioning support organisations—some of which will be private institutions, and some of which will be allied with organisations that provide the clinical services that are commissioned—and there may be occasions when those advising the commissioners make recommendations that benefit some parties with which they are contracted. That model, involving the influence of the executive, will be fairly familiar to those who have been members of local authorities. Councillors, like doctors, are often very busy. They rely heavily on expert advice provided by officers, and they generally follow it. The issue was raised in the House of Lords—I believe that it was raised by Lady Barker—but, when I read the report of that debate, I could not help feeling that it had been glossed over. I should welcome any enlightenment from the Minister on how such a quandary can be dealt with. Clearly it must be dealt with, because otherwise it will create general anxiety about how commissioning will proceed. The second issue is a bigger one. I think that it is of particular interest to us all, because it affects the general position of the commissioning consortia themselves. There is a view that PCTs are more or less in the same legal boat as GP or clinical commissioning consortia would be. I disagree with what the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said about that. The PCT, as a unit, is not built around general practices, which, as we have said several times in this place, are small businesses. It is possible to view a clinical commissioning consortium as an association of undertakings, which creates serious issues as to how it is able to use public money. If it used public money to benefit itself, that would obviously become a big issue immediately.