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

No, I am going to make some progress and then I will be more than happy to give way. [Interruption.] I am sure there will be more opportunities and I will give way in a moment. On how Monitor exercises its powers, the Government have supported amendments made in the House of Lords, which were tabled by my noble Friend Baroness Williams, providing that the Secretary of State can give Monitor guidance to help ensure it exercises its functions in a manner consistent with the Secretary of State's duty to promote a comprehensive health service. The amendments also help to ensure that the Secretary of State can discharge effectively his responsibility for the health service in England and to ensure that Monitor carries out its functions to that end. I therefore commend the amendments to the House. Both this House and the Lords have stressed the need for Monitor to use its powers to support integrated services and co-operation between providers. The Government therefore tabled amendments in the other place to provide express powers for Monitor to set and enforce licence conditions that would enable integration and co-operation between providers. On the detail of Monitor's specific regulatory powers, Monitor would have powers to intervene proactively to support commissioners in ensuring continued access to NHS services if a provider became unsustainable. Amendments tabled by the Labour peer Lord Warner, which we agreed in the other place, provide that Monitor will have to identify and publish evidence where it identifies risk that it considers arises from unsustainable service configurations. Those amendments would require commissioners to act on that information where necessary. Hence, they make clear the expectation that commissioners will address problems proactively and ensure that patients continue to have sustainable access to the services they need. These are sensible provisions that had support from all parts of the House of Lords and I hope that this House will also agree to them. I want to say a bit more about the powers and responsibilities of Monitor, which relate to further amendments made in the other place. The extent of the various matters that Monitor would have to take into account was the subject of considerable debate in this House and the other place. I want to be absolutely clear about where we are regarding the overarching duty that Monitor has to take into account. Monitor will have a single, unequivocal duty—to protect and promote the interests of patients by promoting provision of NHS services that is economic, efficient and effective and that maintains or improves the quality of services. Beyond that overarching duty there is no hierarchy. No preference is given to competition or integration because integration is clearly a responsibility that sits with commissioners and Monitor's role is to support it. Peers also raised concerns about proposals for the Competition Commission to undertake seven-yearly reviews of competition in the provision of NHS services. The Government were sympathetic to the arguments and were concerned that it might be taken to suggest that competition was being given a higher status than the interests of patients. In order to avoid that, we accepted an amendment tabled by my noble Friend Lord Clement-Jones that removed the provision in the Bill for Competition Commission reviews. We also supported other amendments tabled by my noble Friend Lord Clement-Jones requiring the Office of Fair Trading to seek advice from Monitor whenever it considers mergers or potential mergers involving foundation trusts. The amendments will help to ensure that benefits to patients are evaluated on an informed basis by a sector-specific regulator giving its expert advice to the OFT in the discharge of its responsibilities and as a paramount consideration.