UK Parliament / Open data

National Health Service (NHS Payment Scheme—Consultation) (No. 2) Regulations 2022

I thank noble Lords for their contributions to the debate. A number of issues were raised which, as ever, shows the diligence of noble Lords, particularly as I believe none were raised in the other place—so good for us. Let me try to address them.

Most of the comments were around whether 66% is the right threshold. My understanding is that it was kept at 66% because that is what historically the number has been, so it was decided to continue with that for reasons of continuity. At the same time, I accept the point that the consequences now in terms of it no longer being a Competition and Markets Authority review are not so high. To my mind, the real question is: what circumstances have we seen where it has fallen between 50% and 66%? Clearly, no one would ever say we should have a threshold of less than 50%, but should it be somewhere between those figures?

I think I need to give the disaggregated figures to be able to give a specific answer. I have aggregated the responses where generally there were much larger

majorities. Looking at the last three years, for instance, in 2019-20, the figure for those responding positively was 66%, so right on the threshold; it was 78% in 2021 and 77% in 2021-22. So those figures are fairly high. However, if I may, I will come back with the disaggregated figures, because it is only those that give the real data.

The noble Lord is correct that the idea behind having the ICSs involved in these is very much to try to set them around local needs, to make sure that they are understanding that and reflecting some of the inequalities that might exist in their local area.

To address to some extent the point about ministerial or political input, obviously having those thresholds set does not stop Ministers being involved in the decision and seeing that, even if it is a lower threshold, the point raised about particular local circumstances can mean that something needs to be overruled. Funnily enough, it was something we have been talking about in terms of Ministers today. The Secretary of State was saying that with the procurement function, while it is seen by a lot of people as a bit dry and boring, you actually have tremendous buying power and can move the needle very significantly, whether in getting economies of scale in terms of purchasing and purchasing power, incentivising innovation or buying British—which is exactly the point that the noble Baroness, Lady Merron, made. I know that is very much understood by the current ministerial team. I cannot speak historically, but that is very much on our agenda at the moment.

On reviewing this legislation going forward, to look at how well it has worked, I am happy to commit to making sure that we have a further opportunity to reflect on the findings. We would probably need to give it at least a year, maybe more, but we can then have an opportunity to see whether the system has worked in the way we hoped. By definition, that works only if there is then some sort of transparency in terms of the feedback, so that noble Lords can see it and reflect on it. I am happy to take that on; I think it is a wise way forward.

With that in mind, and if I can come back with the detail on those percentages, I will welcome my new year’s gift—may those gifts keep flowing, but I suspect maybe they will not. I appreciate the input from noble Lords today. I hope that we will feel that we have struck the right balance going forward and, crucially, that we are getting the local input we need to set the right process going forward.

About this proceeding contribution

Reference

826 cc266-7GC 

Session

2022-23

Chamber / Committee

House of Lords Grand Committee
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