Health and Social Care Bill

Public Bill Committee, 31 March 2011.

Mike Hancock (Liberal Democrat, Portsmouth South)

I welcome Members; we are now quorate. This is our last day. I take this opportunity to thank everyone for their co-operation and assistance in making it such a joyful occasion. I am sure that there will be more to say this afternoon.

Derek Twigg (Labour, Halton)

On a point of order, Mr Hancock. You may have picked up on newspaper reports earlier in the week that tell of delays and possible changes to the Bill. You may know of an extensive report in The Times, of which I have a copy, that is headlined “Cameron puts brake on NHS reforms”.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

It is a report.

Derek Twigg (Labour, Halton)

The Minister says that it is a report, but these reports are becoming more and more regular. We keep hearing from the press corps in Westminster that there is increasing concern in No. 10 and elsewhere in Government about these changes to the NHS, and about the position of the Secretary of State. This report is specific about delaying or phasing in the changes in a way that is different from what Ministers have told the Committee and from how things are set out in the Bill. We now hear that the Government are thinking of tabling amendments in the other place to make unpopular changes.

The Opposition have been at the forefront of raising concerns about the Bill, which has been picked up by many in the health sector. Many have greater experience than us and know more about the implications—the impact on the health service, the speed of the changes that are being put in place and the long-term financial viability of the health service.

I ask whether you, Mr Hancock, can do anything to protect the Committee, and to ensure that the Government pay due attention to us. They are talking about amendments. They should say what those amendments are. They should tell us today whether they are about to make changes to the Bill.

Mike Hancock (Liberal Democrat, Portsmouth South)

I suggest to the hon. Gentleman that he should dream on if he thinks that I have any influence over the way in which the Government treat the Committee.

Is it not a point of order for me, but as Chair of the Committee I would be very unhappy if substantial changes were made to the Bill that had not been properly scrutinised by the Committee. I hope that we can all be fair about it. I say to Ministers that if changes are to be made, the place to make them is in Committee, so that we can give them proper scrutiny. I believe that there will be widespread disappointment in the outside world if further changes are not properly scrutinised.

Derek Twigg (Labour, Halton)

Further to that point of order, Mr Hancock. I find your remarks extremely helpful. I spoke of protecting the Committee, and you clearly said that the Committee should have been informed. Ministers can tell us this morning that there will not be changes to the Bill further down the line, or that there will.

Mike Hancock (Liberal Democrat, Portsmouth South)

It is for Ministers to decide how they treat the Committee, but I urge them to treat it with respect and pay proper courtesy to its members, who have devoted a lot of time to the Bill.

Emily Thornberry (Labour, Islington South and Finsbury)

Further to that point of order, Mr Hancock. Will you advise us? If Ministers want a little time to consider the matter, can we put it off until early next week? If fundamental changes are to be made to the Bill, they can then be put before the Committee and scrutinised properly.

Mike Hancock (Liberal Democrat, Portsmouth South)

We cannot do that. We now have to move on, but the record will show the genuine concerns you raised and the point that I made.

Clause 234

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 656, in clause 234, page 196, line 20, at end insert—

‘(4A) An information standard under subsection (1) must state the need for explicit patient consent for the disclosure of patient information, in accordance with the common law duty of confidentiality, unless the information has been anonymised or pseudonymised.’.

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss the following: amendment 659, in clause 238, page 198, line 43, at end add—

‘(7) The powers under this section refer exclusively to data which has been anonymised or pseudonymised or for which explicit consent for its use for these specified purposes has been obtained in accordance with the common law duty of confidentiality.’.

Amendment 651, in clause 242, page 200, line 41, at end insert—

‘(2A) The powers under this section refer exclusively to data which has been anonymised or pseudonymised or for which explicit consent for its use for these specified purposes has been obtained in accordance with the common law duty of confidentiality.’.

Emily Thornberry (Labour, Islington South and Finsbury)

The Opposition want to make a series of amendments to this part of the Bill. For those Members who do not have their copy of the Bill open yet, I should say that this part of the Bill is headed “Health and adult social care services: information” and that the first chapter is headed “Information standards—this is part of what the Government have called their “information revolution”.

We have had conversations with the British Medical Association, and there is considerable concern about the need to protect patient confidentiality. The three amendments amend three different clauses and would protect patient confidentiality. They would ensure that there is no change to the existing requirement that any—[Interruption.]

Mike Hancock (Liberal Democrat, Portsmouth South)

Order. Ministers, I really do want to hear what the hon. Lady is saying, so could you be just a little quieter.

Emily Thornberry (Labour, Islington South and Finsbury)

The purpose of the amendments is to ensure that there is no change to the current requirement that any disclosure, exchange, processing or transmission of confidential information have the consent of the patient or lawful proxy, subject to existing exceptions.

The concerns are that there is a lack of protection for patients’ identifiable data, because no clause makes it explicit that existing standards of confidentiality will be maintained. The amendments would provide assurance to doctors and patients that any data collection will be subject to existing legal and ethical standards of confidentiality.

Obviously, confidentiality plays an essential role in the relationship between health professionals and their patients. We do not want significant damage to be caused to health care as a result of the trust between patients and doctors being eroded. Fears that their data may be shared with others, including central Government, may result in patients withholding important information. That may not only affect their health, but have implications for the wider health service.

Will the Minister clarify how the standards proposed in the clause relate to existing and well established documents that provide guidance and set standards in the NHS? Those documents include the NHS code of practice on confidentiality, the care record guarantee and guidance for health care professionals from their regulatory bodies.

Amendment 659 has the same effect as amendment 656, but refers to clause 238. The clause appears to enable the Secretary of State or the board to authorise the collection of data without reference to any information governance controls or explanation as to why new powers to collect data are necessary.

In addition, data can be collected for an extremely broad purpose—that is, in connection with the provision of health services. The clause appears to run contrary to a number of Data Protection Act 1998 requirements, including the requirements that data should be obtained for a specified purpose and that any disclosure must be lawful in a broader sense and respect other legal restrictions on disclosure—for example, the common duty of confidentiality.

Furthermore, once the data are collected, it is not clear how long they will be retained or whether they will be transferred to third parties. The BMA expressed the view that removing the rights of patients and health care professionals in relation to the control of sensitive information is likely to fall foul of article 8 of the European convention on human rights.

Amendment 651 has the same effect and refers to clause 242. That clause is extremely permissive, which is a worry. It enables the Information Centre to require a health or social care body to provide it with any information without reference to confidentiality.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I take this opportunity to address concerns that come through in a series of amendments that the hon. Lady and other Opposition Members have tabled to this part of the Bill. In a way, the points she has raised touch on the thread of that concern, which the BMA has been aired with the Government and, I suspect, the Opposition. We are certainly listening to these points and we are sensitive to them.

The intention behind the amendments is right. This is about preserving patient and service user confidentiality, which I am sure Members on both sides of the Committee want to continue. We would certainly not want to see the Information Centre breaching confidentiality by publishing information about individual patients or service users. Subsection 243(1), which will be amended later, makes it clear that that is prohibited. Re-establishing the Information Centre in primary legislation presents an opportunity to ensure that the provisions are as strong as they need to be, and that was the basis on which we drafted the clauses.

Benefits can be gained from bringing information together for analysis, and in determining the role of the Information Centre we have carefully considered the safeguards that need to apply. It has for a long time been necessary to collect information that identifies individuals for a range of purposes, including tracking outcomes of care and treatment, medical research and public health analysis. Names and addresses are never needed, but other information such as a unique identifier, date of birth and postcode often are. Without those details, it is not possible to link information about the same individual obtained from different sources or at different times.

Many important purposes are already supported under regulations made under section 251 of the National Health Service Act 2006. They include purposes carried out by the existing Information Centre, and also by many other bodies. Without the powers in the Bill, the Information Centre would have to continue working under the arrangements in the 2006 Act to obtain the Secretary of State’s permission to do as the Secretary of State directed, which is nonsensical. The Government believe that bringing the collection and linking of information together in one place will enable strong controls to be put in place to safeguard information and reduce the number of flows of confidential information around the system, therefore strengthening confidentiality management overall.

In addition to the standards published by the board or the Secretary of State, and the guidance under clause 240 to which the Information Centre must have regard, the centre is required to publish its procedures for requests, and has powers and duties to give advice and guidance. However, given the importance that the Government attach to the issue, we will continue to consider whether the requirements are sufficient to provide the transparency that is needed.

Derek Twigg (Labour, Halton)

The Minister said that the Government are continuing to consider transparency. Does he have a deadline for when they will reach a conclusion on that?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

My point is simply that the Government are and will continue to be responsive to, and listen to, the points that are made to us, and that is why in the correspondence and discussions in which we are engaged with the BMA, we will listen clearly and carefully to its concerns. I hope that today’s considerations will go a long way, if not all the way, to addressing the concerns that people following our proceedings might have. That is why I cannot give you a precise, hard end point at which we will stop listening. It is important that the Government continue to listen throughout the passage of the Bill.

Derek Twigg (Labour, Halton)

No one is saying that the Minister should not continue to listen during the passage of the Bill. From what the Minister says, I understand that the Government have not come to any firm conclusions at this stage, and that they will listen carefully. What are they doing, however, about listening to what has been said today in Committee? The Minister has said that he has read in the papers today about the amendments that will come in the Lords, but what is he doing about listening today to what is being said today?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Later we will debate Government amendments to subsequent clauses in this part of the Bill, and those amendments address the sorts of concerns that have been expressed to the Government. They ensure that the intention of the clauses, which is that patient confidential information should not be released, is covered even more clearly. I want to deal with that important aspect in a moment.

Members will be aware of the report by the Academy of Medical Sciences published in January 2011: “A new pathway for the regulation and governance of health research.” It recommended the establishment of national safe havens or honest brokers be taken forward urgently. The report referred also to the 2008 data-sharing review published by the Information Commissioner and the director of the Wellcome Trust, which had made similar recommendations. The changes we propose for the Information Centre will create such an honest broker role in statute for the first time. The provisions would empower it to collect confidential and identifiable information, and to link information from different sources and over time, but the Information Centre will not be permitted to disclose information that might identify any individual patient or service user without further statutory permission.

Amendment 651 seeks to prevent the Information Centre from collecting anything other than de-identified information without the explicit consent of the individual concerned. Amendment 656 seeks to achieve the same goal by specifying an information standard that would impose the same requirements as the common law in respect of confidentiality. Amendment 659 again seeks to achieve the goal of constraining what the Information Centre collects by limiting what directions the Secretary of State and the NHS commissioning board may provide. As I have explained, the amendments would prevent the Information Centre from having the central role of honest broker in the data collection and linkage, and that strengthens the approach to confidentiality across the system. I stress that this is about strengthening confidentiality across the system. The Bill, as drafted, prohibits the Information Centre from publishing information that identifies individual service users. Indeed, in many cases that information will be confidential and publication would be unlawful.

We will shortly discuss Government amendments to clause 243, and ancillary amendments to clauses 238 and 239. They will further limit the circumstances in which the Information Centre can be directed, or choose to disseminate, any identifiable patient or service user information it collects, with confidentiality restrictions that are stronger and less flexible than those that are currently imposed by common law. Information, if used effectively, can provide enormous public benefits, and the Government are clear that it is essential that we free information from the organisational silos where it currently sits. We also believe, however, that that needs to be more tightly controlled than it has been in the past. For those reasons, and with that explanation and those reassurances, I hope that the hon. Lady will feel able to withdraw her amendments. If she does not, I will urge my colleagues to oppose them.

Emily Thornberry (Labour, Islington South and Finsbury)

In summary, as I understand it, the Minister does not want to amend the Bill today, but he may want to amend the Bill later. He understands that there may be some difficulties, that the Committee is to be satisfied with the answer that we have heard today and that he is not prepared to address the issue properly. It would seem that the Government are not prepared to address the Bill as a whole. In the circumstances, I will withdraw the amendments in the same spirit.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move Government amendment 672, in clause 234, page 196, line 29, at end insert—

‘() any person (other than a public body) who provides health services, or adult social care in England, to which the information standard relates pursuant to arrangements made with a public body exercising functions in connection with the provision of such services or care.’.

I am happy to present this amendment to clause 234. Before I do that, however, I would like to observe that what I believe we are trying to do in debating these clauses is to ensure that the clauses do as the Government claim in their explanatory notes and as I have explained to the Committee. The intention, and the way in which the clauses are drafted, is very clear: common law still applies, the existing data protection law still applies, the Human Rights Act 1998 still applies and the Bill imposes greater controls than have hitherto applied. To suggest, therefore, that there is some tardiness or churlishness in the way in which I have responded is unfortunate.

The purpose of amendment 672 is to make it clear that any information standards set out under clause 234 apply to any organisation providing publicly funded health or social care services, whether commissioned by or on behalf of a public body such as the NHS commissioning board, local authorities, or otherwise.

Clause 235

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 657, in clause 235, page 197, line 19, at end insert ‘including healthcare professionals and have regard to their advice’.

The purpose of the amendment is obvious: to ensure that there is clinical input into decisions taken with regard to information standards. If information standards are to be promoted in the NHS, it is important that there should be clinical input in the process, to ensure that the standards evolve from the best existing practice. Where there are established standards, they should be incorporated rather than replaced.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Clause 235 is all about consultation, so it would be surprising if the intention behind it was not to give effect to what is behind the hon. Lady’s amendment. The clause does exactly what the hon. Lady asks. In that sense, the amendment is unnecessary, and I will explain why.

Amendment 657 seeks to ensure that health professionals are appropriately consulted when information standards are prepared. Hon. Members are right that when appropriate, the Information Centre should consult health professionals. However, the amendment goes too far in suggesting that health professionals should be consulted on all information standards, and that those preparing a standard should have regard to the advice of health professionals, regardless of its relevance to those health professionals. In addition, I was surprised to see no mention of patients in the amendment. Clearly, if the hon. Lady is concerned about whether the consultation powers in clause 235 are sufficient, that aspect should have been tested too. I am more than happy to give the necessary assurances on that as well.

Let us remember that it is the Health and Social Care Information Centre, not just the health information centre. Information standards will come in many shapes and sizes, and will include social care or technical IT standards that are of no interest to health professionals, at least not in most cases. The intention is to consult all those who have an interest, but it is important to remember that health professionals are only one of a number of groups—including patients—that may have an interest, and that it may well be a different group whose voice should be listened to in respect of a particular standard. Clause 235 already places a clear requirement on both the Secretary of State and the NHS commissioning board to consult relevant persons before publishing an information standard.

Emily Thornberry (Labour, Islington South and Finsbury)

It would be helpful if the Minister could give an undertaking that where there are existing, established standards, they should be incorporated rather than replaced.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Earlier, the hon. Lady referred to the Department of Health code of practice, the national information governance care records guarantee and so on. They all consistently set out the confidentiality requirements regarding consent and so on that should be followed. However, all recognise that statutory authority overrides confidentiality when necessary. As the system moves from a non-statutory basis, with the Information Centre, to a statutorily established Information Centre, we should ensure that we do not lose sight of those documents.

I hope the hon. Lady and other hon. Members are reassured that the clause, which is all about consultation, certainly does ensure that health professionals and other relevant persons are properly consulted before the publication of information standards.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to ask leave to withdraw the amendment.

Clause 236

Emily Thornberry (Labour, Islington South and Finsbury)

As the clause concerns the establishment of the Health and Social Care Information Centre, I will take this opportunity to make some general remarks about it. It is right to put on record that we welcome and agree with the Government’s aspirations that people should have greater access to and control of their health and social care records, and more control of their care. We also welcome and agree with the aspirations that patients should have more access to information about treatments and conditions so that they can look after their own and their family’s health and lifestyle, that information should be easy to compare and that greater use should be made of information generated by patients and service users, with the aim of making the NHS and social care systems more responsive. If the proposals mean that a larger and more diverse group of providers must present information to the public, again, we welcome that aspiration.

However, I will be asking questions later about the implications of the proposals for patient confidentiality, as well as about how the data will be used and who will request it. There are concerns about whether funding will be available to bring about the necessary change and fulfil the Government’s aspirations. The Government’s plans pose a huge technical challenge that we believe will entail substantial costs. We would like to know whether they have assessed how much it is likely to cost and where the money is likely to come from. Will the Minister give us more detail on how greater access to patient records will be achieved and how quickly he thinks it will happen?

In light of the Minister’s commitment in the White Paper to move

“away from a culture in which information has been held close and recorded in forms that are difficult to compare, to one characterised by openness, transparency and comparability”,

I seek some clarity on the funding of two important information sources. The first is the general lifestyle survey. It has been carried out every year on behalf of a number of Departments by the Office for National Statistics, which has done a good job but whose funding seems to have been withdrawn by the NHS Information Centre.

The GLS provides information on a wide variety of topics, particularly public health. It is one of the most detailed research exercises of its kind, involving 15,000 households, and has run almost continuously since 1971. It provides data that are comparable year on year, so the information is particularly vital to measuring long-term trends. It has been reported that the NHS Information Centre has decided to axe its contribution of £300,000, meaning that the survey will end. I understand that the head of the UK Statistics Authority, Sir Michael Scholar, has written to the Health Secretary to object. Sir Michael has said publicly:

“The ONS, who, following extensive consultation with the users of their statistics, have just completed their post-budget cuts business plan, have no funds available to make up this shortfall without damaging their own vital economic and social statistics. The decision by the NHS Information Centre will, therefore, result in the immediate discontinuation of long-established National Statistics on smoking, drinking, health conditions and use of health services…The Statistics Authority is concerned that the abrupt discontinuation of a time series on topics as central to public policy as smoking prevalence and alcohol consumption will seriously undermine the UK’s ability to monitor key trends affecting public health.”

That is a concerning statement. Given that we are discussing a policy initiative that is supposed to be in line with the Government’s stated intention to have a culture of openness, transparency and comparability, I wonder how cutting the fund is consistent with that policy objective.

It also emerged this week that the Department of Health intends to withdraw its funding for the health and NHS satisfaction questions in the British social attitudes survey. The BSA survey—[Interruption.] If the Ministers would like me to stop for a moment so they can discuss it, I would have no problem.

Simon Burns (Conservative, Chelmsford)

The hon. Lady might be interested to know that I was telling my hon. Friend the Minister that we had this debate yesterday in Westminster Hall when she gave the winding-up speech for the Opposition. Yesterday afternoon I fully addressed and corrected, though I say so myself, the misconceptions that she is reiterating today.

Emily Thornberry (Labour, Islington South and Finsbury)

The right hon. Gentleman’s contribution yesterday is not forgotten. He will soon find himself quoted by me, because further questions arose from his so-called answers yesterday.

The survey, which the respected National Centre for Social Research has carried out annually since 1983, is perhaps the most important piece of ongoing independent research in its field. It provides comparable year-on-year data from an extensive research base. The cynical might ask, as they did yesterday, what are the Government afraid of from year-on-year extensive research? Are they expecting differences between the service provided by the NHS now and that provided before?

At its best the survey is perhaps the only independent barometer of satisfaction with the NHS, and certainly the only measure that goes back 25 years. The removal of funding looks suspiciously like a deliberate attempt to ensure that there is no way to measure satisfaction with the NHS before and after the Government’s reorganisation. That is a central point, particularly in the light of the reports today in The Times that the Prime Minister is putting the brake on NHS reforms. The Government have said a lot about the need for information to be more widely used and freely available—we agree—so why are they doing this? [Interruption.]

Mike Hancock (Liberal Democrat, Portsmouth South)

Order. It is very difficult to hear what is going on if hon. Members are talking, and it is discourteous to the Member speaking.

Emily Thornberry (Labour, Islington South and Finsbury)

Thank you, Mr. Hancock.

The Government have said a lot about the need for information to be more widely used and freely available to change how the Government and public services function. I applaud the idea, but that cannot happen if information is simply not collected. In yesterday’s Adjournment debate on public satisfaction with the NHS, the Minister denied that a decision had been made on funding for the survey, if he remembers saying that. [Interruption.] The right hon. Gentleman obviously cannot hear what I am saying now because he is speaking to a Back Bencher, which is unfortunate, but he did say it.

Mike Hancock (Liberal Democrat, Portsmouth South)

I think you should repeat it.

Emily Thornberry (Labour, Islington South and Finsbury)

I think that perhaps I should, Mr Hancock. In yesterday’s Adjournment debate on public satisfaction with the NHS, the Minister denied that a decision had been made on funding for the survey.

Mr Burns indicated assent.

Emily Thornberry (Labour, Islington South and Finsbury)

Will he explain why the King’s Fund announced that it will step in to provide the funding in the Government’s place? If the Government have not cut the funding, why does the King’s Fund think that it is taking over the job?

Jeremy Lefroy (Conservative, Stafford)

I want to make one brief point about information, which arises out of the experience of the Mid Staffordshire NHS foundation trust and the ongoing Francis inquiry.

Concern was raised in the evidence to the inquiry, and in particular in the medical press, about standardised mortality ratios, and I want to highlight that as an area that should be looked into. It is not that they are not needed—there is a clear requirement for more accurate information to be produced on such matters—but I ask that, whatever the outcome of the Bill, the Health and Social Care Information Centre makes it a priority to ensure that the sort of statistics produced on mortality ratios are more and more accurate and become leaders in international best practice. I say that because there has been some controversy over the figure originally produced for the Mid Staffordshire trust, which suggested that between 400 and 1,200 excess deaths had occurred. The way that the information was first produced and then reported gave rise to concern. Without the work of Cure the NHS, led by Julie Bailey, the problems would perhaps never have been brought to the public’s attention.

The publication of the standardised mortality ratio launched the initial investigation. Clearly, those statistics play an important role in monitoring the NHS. If they are going to be used, they must be refined more. Is it intended that the Health and Social Care Information Centre will engage in the sort of research that will ensure that we have world-leading statistical indicators that will enable the public and patients to monitor their trusts in future?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I welcome the opportunity to enter into this debate. I have heard no arguments that the clause should not stand part of the Bill—rather than a discussion of its merits or demerits, hon. Members have explored some of the issues that spin from it. I am grateful to the hon. Member for Islington South and Finsbury for listing a host of areas where we share a common aspiration. That is helpful. She is right that we set out those aspirations in the consultation we published last year, “Liberating the NHS: An Information Revolution”. We intend to translate them into practical action. These clauses are part of that.

As the hon. Lady rightly said, for far to long we have had systems that hoard information rather than share it and often that hoarding has not been in the public interest. We are therefore determined to make sure that far more information is freely available for comparison, so that people can make informed judgments about the performance of the NHS as a whole and of adult social care, and can make choices about their own treatment options. That is at the heart of the changes.

The hon. Lady asked about funding for the life science survey and the social attitudes survey. My answer will probably disappoint her, but at this stage no decisions have been made on the funding, and certainly none to withdraw it. It is therefore not entirely clear why the King’s Fund made its announcement, because there has been no decision to withdraw funding. Discussions on the Information Centre’s continued role and funding are ongoing as part of the budget and business planning process. That is not yet settled. We are not into the new financial year. As soon as we are those matters will be clear. They will be published and put into the public domain.

Emily Thornberry (Labour, Islington South and Finsbury)

I have listened with interest to the hon. Gentleman’s comments. I am sure that the King’s Fund will follow them with interest too. Can he tell us when a decision will be made about the funding of the British social attitudes survey?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

All I can tell the hon. Lady today is that the matter is under consideration. We expect to make those decisions in time for the start of the new financial year, which we are nearing, so we are near to the point where those business plans will be finalised. As soon as the information is available, I will be more than happy to ensure that the hon. Lady receives a letter with the answer to that question.

Emily Thornberry (Labour, Islington South and Finsbury)

I do not know whether the Minister is a regular reader of “Health Policy Insight”, but it states that it can exclusively reveal that the Department of Health has terminated its funding of the health and NHS satisfaction survey. That seems to be in the public realm now, but the Minister seems to be the last person to hear about it.

Mike Hancock (Liberal Democrat, Portsmouth South)

Mr Burstow, I do not know where this is taking us, but perhaps you can answer it once and leave it at that.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I think I am being invited to go down another of those paths. I will be honest and say that the magazine to which she refers is not part of my bedside reading—[Hon. Members: “It is a blog.”] I will ensure that I take a closer look at it. It would be wrong to comment on something that I have not seen, so I will decline to do so at this point.

Emily Thornberry (Labour, Islington South and Finsbury)

Will the hon. Gentleman therefore do me the courtesy of writing to me on the subject?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I gave an undertaking to write to the hon. Lady before she intervened. I give her that undertaking again. She also asked about the pace at which we are moving toward greater access to patient records. Work is already taking place from the bottom up to drive that forward, and by setting clear information standards we can ensure that progress is accelerated.

I hope that I have reassured hon. Members. I will write if I have not covered all the points they made.

Clause 237

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 658, in clause 237, page 197, line 34, leave out subsections (b), (c) and (d).

The amendment is clearly probing. We seek to generate a discussion of the nature of the guidance that will be issued. On the face of it, the clause is general—the hint is in the title. It states that

“In exercising its functions the Information Centre must have regard to—

(a) the information standards published by the Secretary of State or the Board under section 234,

(b) such guidance issued by the Secretary of State as the Secretary of State may require,

(c) such guidance issued by the Board as the Board may require, and

(d) the need to promote the effective, efficient and economic use of resources in the provision of health services and of adult social care in England.”

It could not be more general. We would like more information about it and about the Information Centre.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The hon. Lady seeks to probe the clause and craves more information. Given that we are debating clauses that are all about information, I will do my best to provide it.

The amendment is interesting, because it exemplifies the zig-zaggy nature of the amendments that have been tabled during the Committee’s consideration of the Bill, moving from an obsessive desire to see the Secretary of State control everything one moment to an obsessive desire to prevent the Secretary of State from having any influence the next. We have zig-zagged again, because the amendment is more about giving greater freedom to the Information Centre than about the involvement of the Secretary of State.

The amendment seeks to free the Information Centre from having regard to guidance that is issued by the Secretary of State or the NHS commissioning board. It would also remove a duty

“to promote the effective, efficient and economic use of resources in the provision of health services and of adult social care”.

I am surprised that, in probing the nature of the Secretary of State’s guidance, the Opposition consider it appropriate to remove references to delivering such things in effective, efficient and economic ways. That is quite puzzling. Perhaps the hon. Lady will explain.

Emily Thornberry (Labour, Islington South and Finsbury)

As the Minister has some difficulty understanding what Opposition is about, I will explain that our role, as we understand it, is to hold the Government to account and to ask difficult questions. It is not to set out an alternative Bill; unfortunately, we are not in a position to do that. We have simply to probe the legislation that the Minister is trying to pilot through the House, unless and until the Prime Minister puts the brakes on it.

I said at the outset that the amendment was probing. So that the Minister understands, the purpose of a probing amendment is not to press it to a vote. We have tabled it so that the Minister can justify and properly explain the clause. Clearly, we are not against the need to promote effective, efficient and economic use of resources in the provision of health services, but we are concerned that it sounds somewhat bland and we want to know exactly what is meant by it. If he gives us more detail, we will have fulfilled our role as the Opposition.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Having spent 13 years working on the opposite side of Committees, I am grateful for that lesson about how to discharge the functions of Her Majesty’s loyal Opposition. Although the hon. Lady suggests that the Opposition have not been providing an alternative to the Bill, what they have been doing is persistently and consistently painting a narrative that relates to the fantasy Bill—the alternative Bill—not to the real one.

Liz Kendall (Labour, Leicester West)

Will the Minister give way?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

In a moment. The amendment was moved by the hon. Member for Islington South and Finsbury. I would not wish to move on to all sorts of other matters that are not really part of the clause. [ Interruption. ]

Mike Hancock (Liberal Democrat, Portsmouth South)

Order. I, for one, would like to hear what the Minister has to say.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

This is the last sitting of the Committee, and an element of that is coming through. We have all come to enjoy each other’s company so much.

Establishing the Information Centre as a statutory body, no longer subject to the whim of the Secretary of State, puts it on a far firmer footing. It is only by virtue of that step that we are having any of these debates about information governance in the first place. Although I can reassure the hon. Lady and other hon. Members that the Government have no intention of interfering in the centre’s day-to-day work, there will be matters on which it is entirely appropriate for the Secretary of State or the board to issue guidance to which the Information Centre should be obliged to have regard. For example, the Secretary of State remains accountable to this House for the governance of the centre; he will need to issue guidance on corporate governance requirements and have the centre take heed. Similarly, the NHS commissioning board may issue guidance on promoting patient involvement or innovation, to which the centre should also have regard.

Finally, let me draw Members’ attention to the deletion of subsection (1)(d). One of the centre’s key functions, as envisaged in the White Paper, was to reduce the burden of data collections. The hon. Lady asked earlier about the appropriate use of resources and how we make sure that the centre conducts its functions appropriately, and the provisions are part of how we do that. The Information Centre has functions relating to the collection, analysis and publication of information. Giving it a general duty to promote the effective, efficient and economic use of resources in performing those functions seems an eminently sensible step. The language may be bland, but the intention is important for the clause and the Bill. To suggest that the centre’s advice should not have regard to effectiveness, efficiency and economy when it advises those seeking to collect information is surely not the right approach, and I am sure that it is not what the hon. Lady intends.

Owen Smith (Labour, Pontypridd)

What powers will the new Information Centre have to compel different providers in the NHS to gather data and provide them to the centre?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Later clauses relate specifically to the centre’s relationship with the providers of information, to the advice and guidance that it will be able to give and to the circumstances in which it might be able to require information to be provided. I will deal with those matters when we reach the relevant clauses, if I may.

Emily Thornberry (Labour, Islington South and Finsbury)

May I ask the Minister one further question and perhaps give him a moment to catch his breath? I should perhaps have asked him before whether he could provide assurances that the guidance in subsection (1)(b) and (c) in particular will not override the existing standards of confidentiality.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Yes. I can most certainly give that guarantee; there is no doubt about that. That harks back to my remarks on the first group of Opposition amendments we debated today.

Clause 242, which we will debate later, deals with the matters raised by the hon. Member for Pontypridd. Concern has been expressed about whether the Information Centre will be involved in hospital standardised mortality indicators. The centre will have a key role in developing and producing standardised mortality indicators for public inspection. With those answers, I hope that the hon. Lady will withdraw her probing amendment.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to ask leave to withdraw the amendment.

Clause 238

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 675, in clause 238, page 198, line 43, at end insert—

‘( ) A direction under subsection (1) may require the Information Centre to disseminate information (other than by publishing it) only if the Centre is authorised to do so by section 243 or authorised or required to do so by or under any other provision of this or any other Act.’.

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss amendment 676, in clause 239, page 199, line 9, at end insert—

‘( ) A request under subsection (1) may request the Information Centre to disseminate information (other than by publishing it) only if the Centre is authorised to do so by section 243 or authorised or required to do so by or under any other provision of this or any other Act.’.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

These are not minor and technical amendments, but substantive amendments, which reflect the fact that the Government are listening to concerns and, where appropriate, acting on them.

A primary role of the Information Centre is to collect and publish information for everyone to access and use. Information that the Information Centre collects and cannot publish is set out under clause 243 and includes, as I am sure we would all expect, information that might indentify individual patients or service users. Amendments 675 and 676 clarify that directions made under clause 238 and requests made under clause 239 cannot specify that information should be collected and disseminated as an alternative to publication, other than in limited circumstances set out in clause 243. The amendments also clarify that the restrictions on disseminating information imposed under clause 243 should not interfere with the right of any other lawful authority to disseminate under other legislative provisions.

The key point is that the measure is a further tightening of the requirements to protect confidential patient information, which is dealt with in clause 243. The amendments necessarily tighten that in ways I hope will reassure many of those who have raised concerns about this part of the Bill. When we discuss clause 243, we will look at the circumstances where it should be possible for a direction or a request to specify that information might be disseminated and not published, and the circumstances where the Information Centre should have discretion to disseminate non-identifiable information that it cannot publish.

It is worth noting that we are putting the Information Centre on a firmer footing, based in primary legislation, which enables us to discuss these important provisions and set them in legislation that is stronger than common law. It is important to many hon. Members and to those who are following our proceedings to ensure that there are appropriate constraints on how powers are used. I hope that the amendments will receive the Committee’s support.

Emily Thornberry (Labour, Islington South and Finsbury)

I have been interested to hear the Minister’s remarks. I do not know whether I should make my brief comments now, in response to what he said, or on clause stand part. However, as I am on my feet, I shall speak now.

Will the Minister consider putting in the Bill limitations applying to any request to collect information that could be used to identify individual patients, even though collecting such information could be valuable in certain types of analysis? There will be times when using information in a particular way means that an individual patient could be indentified and that would be of some value. However, will the Minister consider including limitations to that request? It is important. I can see from the civil servants that I may be pushing an open door.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

When we come to clause 243, I will draw attention to the fact that that is already in the Bill.

Clause 239

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 660, in clause 239, page 199, line 19, at end insert—

‘(4A) Nothing in this section shall have the effect of rendering lawful any exchange of information currently prohibited under current law.’.

The purpose of the amendment is to ensure that there is no change to the requirement for any disclosure, exchange, processing or transmission of confidential information and that the consent of the patient or lawful proxy is required unless subject to current exceptions. Again, it is an attempt to ensure that the public can be confident that the current laws of confidentiality will continue to apply under the new system that the Government want to introduce under the Bill.

The clause allows any person to request the Information Centre to establish systems for the collection, analysis, publication and dissemination of information. That includes mandatory requests from Monitor, the Care Quality Commission, NICE and any other person specified in subsequent regulations. The clause provides extremely wide powers on information sharing, and concerns have been raised that there is no reference to patient confidentiality or information governance controls on information sharing. The explanatory notes state in paragraph 1356 on page 229 that a request from a private person or body must satisfy existing regulations under section 251 of the National Health Service Act 2006. What is the definition of a “private body or person”, and why does that requirement not apply to all requests made to the Information Centre? Perhaps the Minister will explain that, because it is a potential lacuna, and we are worried about it.

This is a fundamental point regarding the protection of patient confidentiality. Patient information must remain subject to appropriate safeguards to protect confidentiality and to maintain public trust in a confidential health service. The liberal use of identifiable data described in the clause threatens the therapeutic relationship between doctors and patients, and we seek specific reassurance. When read cold, the clause seems very permissive, and is worrying.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Clause 239 enables any person to request the Information Centre to

“establish and operate a system for the collection, analysis and publication or other dissemination of information”

specified. It is worth saying at the start that the Bill does not need to set out new requirements for information governance controls, because they are already required under data protection, human rights and confidentiality law. The Bill includes explicit provisions to set information standards, which will require consultation, and cover information governance. That will become legally binding on health and social care organisations.

Amendment 660 raises issues that are already covered to some degree in clause 234. The amendment would prevent the Information Centre from accepting a request to collect anything when there is a barrier in law, and we accept that that should be the case when there are statutory prohibitions on data sharing—for example, on gender reassignment cases. As I explained, however, that would prevent the Information Centre from having a central role as honest broker for data collection and linkage that strengthens the approach to confidentiality across the system that the Government believe is desirable. It is essential to marry that role with the appropriate safeguards to ensure proper protection of patient confidentiality. I have set out the arrangements in some detail, and we will return to them on later clauses, especially clause 243 which covers specific aspects of that concern. I hope that the hon. Lady is reassured.

The hon. Lady asked specifically about definitions of “private organisations” and how they might be treated differently. I want to ensure that when we come to clause 243 I give her a clear answer to reassure her, but there is no intention that they should be treated more favourably under the clause.

Emily Thornberry (Labour, Islington South and Finsbury)

Many of us are concerned about who will be allowed to get their hands on the information, who can request it, and what controls there will be. Perhaps we can debate the matter when we come to clause 243, because it throws up some important issues. I will be happy if I obtain reassurance then. I beg to ask leave to withdraw the amendment.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 663, in clause 239, page 199, line 23, leave out subsection (6).

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss

Amendment 661, in clause 239, page 199, line 25, at end insert

‘except that all such requests must be in accordance with the Data Protection Act 1998.’.

Emily Thornberry (Labour, Islington South and Finsbury)

Clause 239 covers powers to request the information centre to establish information systems. It provides a list, and subsection (6) allows the Secretary of State to

“direct the Information Centre to comply with a request specified in the direction which was made by a person outside the United Kingdom”

That is a bit strange, particularly given how few resources we think the Information Centre will have. Will there be any restrictions? With which requests made by foreigners from outside the United Kingdom will the Secretary of State direct the Information Centre to comply? The Minister ought to give us a little more detail about that. Will he give us an example of a reasonable request?

On amendment 661, the clause also commits the Secretary of State to direct the Information Centre to comply with a request from a person outside the UK, so will the Minister give assurances that such requests must comply with the Data Protection Act 1998? The Act is clear that personal data must not be transferred outside the European Union without adequate protection for the rights of data subjects equivalent to that provided by the Act.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The amendments relate to some important issues, but I hope I can reassure the hon. Lady and other hon. Members that they are not necessary.

Amendment 661 would ensure that the Data Protection Act applies to any request for information made to the Information Centre from overseas. I confirm that the Data Protection Act has, and will continue to have, full effect, so the amendment is unnecessary.

Amendment 663 would remove the power for the Secretary of State or the NHS commissioning board to direct the Information Centre to comply with requests from outside the UK. The power is essential to ensure the Information Centre will continue with valuable work in collaboration with the World Health Organisation and across the European Union. I reassure the hon. Lady and other hon. Members that no information that could identify individual patients or service users would be released by the Information Centre in response to such requests. Indeed, both our data protection law and our common law make it unlawful for the Secretary of State or the NHS commissioning board to direct or for the Information Centre to comply with a request to disclose information on such a basis.

I hope, therefore, that the hon. Lady is reassured and that she will withdraw her amendment.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to ask leave to withdraw the amendment.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 662, in clause 239, page 199, line 41, leave out paragraph (d).

The amendment would remove the provision to define a “relevant body” as

“such other persons as may be prescribed in regulations.”

It is another very vague statement on which it would be a good idea if we had more understanding. Will the Minister clarify the scope of paragraph (d) and assure the Committee that no regulation will be made to require the information centre to establish information systems in response to a request from non-NHS bodies such as pharmaceutical companies? Will the Minister explain the limitation of the term “system” and confirm that it could not include mandating information collection through any single or limited number of information providers such as software systems?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The amendment would remove the flexibility that is needed to add bodies able to make requests of the information centre for data collections that must be complied with.

Although there are no plans to give such authority to any other body, it is subject to change. Without the flexibility of a regulation-making power, change could only be effected through primary legislation.

At this point, I could say how interesting it is that we have had an information centre for a long time. It is established as a special health authority, so it is very much at the beck and call of the Secretary of State. Removing the flexibility that the clause provides would effectively stitch it into a legislative straitjacket. It is not worth going much further on that point at the moment, but I assure the hon. Lady that it is our intention is to keep that flexibility.

With regard to relevant bodies and the list of organisations that can make mandatory requests, the regulations will be subject to the negative procedure. Even so, such regulations are required to be laid before Parliament for a period of 40 days after being made, during which time they are subject to parliamentary scrutiny and can be debated.

The hon. Lady also expressed concern about whether private organisations would be treated any differently. Clause 240 requires the publication of procedures to be used by the information centre. We are setting it out in primary legislation for the first time. It strengthens the current arrangements, which were based on ministerial directions, and such directions did not have to be signed by Ministers. It is a significant enhancement of parliamentary accountability here, and it starts with this clause.

Emily Thornberry (Labour, Islington South and Finsbury)

I am a little concerned not to have received an answer to my direct question. Will the Minister assure the Committee that regulations will not be made to require the information centre to establish information systems in response to requests from non-NHS bodies such as pharmaceutical companies?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The question is about the scope of regulation, and which bodies will be covered. It is most likely that public bodies or bodies exercising public functions such as NICE, Monitor or the Care Quality Commission will benefit from the provisions of this clause. It is certainly not the Government’s intention to see it being used as the hon. Lady suggests.

Emily Thornberry (Labour, Islington South and Finsbury)

I liked the last half of the Minister’s answer. However, the first half causes me some trouble, especially the weasel words “most likely”. May I ask the question again?

Can we be assured that there will not be regulations put in place to require the information centre to establish information systems in response to requests from non-NHS bodies such as pharmaceutical companies? If the Minister were to have another go at answering without using weasel words, I would appreciate it.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

My words were certainly not as described. I was referring to the bodies most likely to be the beneficiaries of the clause; they are the public bodies that I listed a moment ago. I then went on to say that it is certainly not the Government’s policy intention to do it in the way described by the hon. Lady.

Pharmaceutical companies can request information collections, but the Secretary of State can veto them. There is no direct relationship; a pharmaceutical company could not expect anything to be done by the information centre on its behalf. The safeguards and the enhanced transparency put in place by the Bill mean that any such collections by the information centre will be published in a register. We shall come later to the clauses that deal with the fact that the information centre has to set out all the information collections that it undertakes, even if they are not published. There will be much more information about what it is doing than hitherto.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to ask leave to withdraw the amendment.

Debbie Abrahams (Labour, Oldham East and Saddleworth)

I want to put on record my concerns about this clause and preceding and subsequent clauses, and the unintended consequences that might result. Information is power. We heard from the Minister that data that are collected can sometimes be too abundant, but limitations on the data that we collect, how they are analysed and how they are disseminated can have profound consequences. For example, if data had not been available during the 1980s, publication of the Black report would have been the first time that issues such as health inequalities, socio-economic inequalities and the difference between different groups of the population, especially the north-south health divide, were raised.

Members should consider the effects of limiting the collection, analysis and dissemination of information. Members will also remember how that report was held up and published in quite disgraceful circumstances. I wanted to put that on record and to raise my concern that the Secretary of State and the information centre must have regard to the guidance.

The way in which this Bill has been presented suggests that the Secretary of State is removing political control from the NHS and its business. That is a key way in which he is having a direct influence over the data that will be collected, which, in turn, will affect policy for the NHS and what lies beyond.

Owen Smith (Labour, Pontypridd)

I have a number of questions that follow on from points made by my hon. Friends. The establishment of the Information Centre is an excellent idea in principle and I endorse everything that my hon. Friend the Member for Islington South and Finsbury said earlier on about the intentions behind it. However, what consideration have the Government given to the fact that the work of the Information Centre might be hamstrung as the centre becomes inundated with the requests that will flow as a result of the framing of the clause, which refers to the ability of any person to make a request for information? That suggests that the Government want to be open and transparent about information and allow as many individuals in our society to request information, and, in principle, I support that. None the less, as my hon. Friend the Member for Oldham East and Saddleworth said, information in health care has the power to influence policy, unnecessarily create alarm on occasion and cause decisions to be made at all levels in the NHS that may not necessarily be borne out by further scrutiny.

What consideration have the Government given to the fact that there may be many, many requests for information and the centre, with its limited resources, may not always be able to determine what the impact of providing such information might be? What analysis have the Government undertaken to determine what proportion of the requests they anticipate will come from commercial sources? As someone who has worked in commercial health care in some fashion, I imagine that there will be myriad requests for information from commercial companies and entities. There may be many good reasons for them wanting that information, but there could be some less desirable ones, too.

The Information Centre can charge for such information. Under clause 250, the centre can charge at commercial rates for anything it chooses to provide. What provisions are in the Bill to limit the extent to which the centre is tempted, given its limited resources, to provide information for profit and to subsidise its meagre resources in these straitened economic times, perhaps not giving due consideration to the potential negative consequences of so doing?

My last point is in relation to the remark made by the Minister a moment ago. In response to my hon. Friend the Member for Islington South and Finsbury, he suggested that in the event of an information request from a commercial entity, the backstop by which the Government would stop that information going into the public domain is the Secretary of State. Although at one level it is an excellent backstop to have the ultimate wicket keeper in the Secretary of State, in a world where we have many requests, is it realistic to expect the Secretary of State or even the Department of Health to be able to intervene repeatedly? Is it not more likely that the Information Centre will have to make more of those decisions itself, with the concomitant risks that I have described?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

As the hon. Gentleman has demonstrated, clause 239 requires us to read across other clauses, particularly clauses 244 and 240, to understand what is intended. That would go some way to allay, or even remove completely, the concerns of the hon. Member for Oldham East and Saddleworth about the quality and range of data that we have been collecting.

Both in the information revolution consultation, to which we will be responding shortly, but also through our actions, we have expressed our intention to ensure that much more information is readily comparable across three different domains. We have published our plans for a public health outcomes framework and we will shortly be publishing the first ever outcomes framework for adult social care. Last year, we published the first ever NHS outcomes framework.

Each of those frameworks begins the process of designing new data collections that are more attuned to measuring outcomes in the systems for which the Department of Health is responsible. To deal specifically with the questions put by the hon. Member for Pontypridd, in the first instance, the clause needs to be looked at in the context of clause 244, which requires the publication of a register of all collections that are undertaken. That will provide increased transparency: when collections have not been disseminated in any way, it will be apparent. Members and others following our proceedings will be able to ask why certain information was not released. That is a new enhancement of transparency.

Clause 240, which also relates to clause 39, is where charges for that particular purpose come into play. Clause 240 relates to supplementary matters about the publication of procedures, with regard to when requests can be made under clause 239. By setting out clearly in advance the basis on which such decisions will be made, the provisions deal, in some degree, with the hon. Gentleman’s concern about a deluge of requests and how they will be judged. It will be set out in a transparent way at the outset. There is also provision in this part of the Bill for reasonable charges. Clause 250 covers commercial charges and clause 240 refers to reasonable charges.

I hope that addresses some of the concerns raised. I have a piece of paper that was the inspiration for the question I have already answered, so I will not rehearse that again. These three clauses—we are about to come to the other two—interlock, providing greater transparency and the safeguard of not overloading the system with trivial or inappropriate requests.

Owen Smith (Labour, Pontypridd)

That answers some of the questions I asked. My final question: does the Minister anticipate that the charging regime laid out in the regulations will be designed simply to cover the costs of the provision of that information, or does he anticipate that the Information Centre will at some point make a profit?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The Information Centre will be able to make reasonable profits from charging for its services, but these services are unlikely to include the sale of information. The information that the centre will be able to release will generally be published without charge, so it will not interact with freedom of information or the reuse of public sector information regulations. Instead, services may include advice or guidance, support for data quality improvements and so on. The Information Centre will also be expected to publish procedures that cover charges. Again, therefore, there will be greater transparency from the outset as to how those charges are framed in the first place.

Finally, the hon. Gentleman asked for an estimate of the proportion of information from commercial sources, but there is no estimate at this stage. Because there will be requirements for publishing reports, accounts and so on as time goes forward, that information will be clearly in the public domain. As I have already said, we expect that most requests will come from public bodies involved in health and social care and mostly from the Secretary of State and from the NHS commissioning board.

Owen Smith (Labour, Pontypridd)

Does the Minister anticipate, therefore, that once the Information Centre is set up, the NHS will no longer need to buy in lots of information from other sources, as it has done over recent years from, for example, Dr Foster Intelligence? That has obviously become a profitable business as a result of NHS information. Will the provision obviate the need to employ a body such as, but not necessarily, Dr Foster Intelligence?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am grateful for the invitation to speculate, but I will resist the temptation to answer that speculative, hypothetical question at this stage. The Bill provides for a range of scenarios, but it also sets out considerable safeguards for those scenarios. I will not speculate as to whether commercial sources of data will be used. In some cases, they may be necessary, because that may be the only way to obtain the relevant information.

Mike Hancock (Liberal Democrat, Portsmouth South)

We will be adjourning in three minutes, so for the benefit of hon. Members who have not been on such a Committee previously, this afternoon’s debate will finish at 4 o’clock, but that does not mean that the business will have been concluded by then. There will then be the procedure of moving amendments and clauses that we have not reached, so there may be votes after 4 o’clock. While the debate finishes at 4 o’clock, proceedings could go past 4, because of the wind-up of the rest of the business. I wanted to clarify that position, so that nobody is in the dark.

Clause 241

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 678, in clause 241, page 200, line 31, leave out ‘must’ and insert ‘may’.

The amendment is a technical one to make it clear that provided the Information Centre has come to a decision, information that has been collected, or information derived from such information, no longer needs to be retained and may be destroyed by the Information Centre.

Clause 242

Paul Burstow (Liberal Democrat, Sutton and Cheam)

On a point of order, Mr Hancock, will amendments 683 and 684, which were not moved just then, be dealt with at a later stage?

Mike Hancock (Liberal Democrat, Portsmouth South)

We have to deal with amendment 652 first, and we will then move on to amendment 685 and then amendments 683 and 684. That is the peculiar way in which the system works. We have reached 10.25 am, so unfortunately we must now adjourn.

Mike Hancock (Liberal Democrat, Portsmouth South)

Before we proceed, I will explain one other thing that I meant to explain this morning. There will be Divisions in the House this afternoon, but, unlike in other circumstances, there will be no extra time as a result. If hon. Members want to make points and there are two Divisions, that will be half an hour out of the debating time. I repeat what I said this morning. The debate finishes at 4 o’clock, so please bear that in mind. If you have important points to make and want to get to them, we will have to work together.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 652, in clause 242, page 200, line 41, leave out ‘such period’ and insert ‘a reasonable amount of time’.

I entirely take on board what you have said, Mr Hancock. I shall do my best to go as fast as I can, because I know that hon. Members want to raise a large number of points.

Amendment 652 relates to subsection (2), which requires that health and social care bodies comply with requests for information from the Information Centre in a manner and time period specified by it. The primary role of health and social care bodies must clearly be the provision of care to patients, and the amendment seeks assurance that health care professionals will be protected from unreasonable demands for information that take them away from their clinical duties and expect them to provide information within an unreasonable amount of time. This short, sharp amendment is straight to the point.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I think I can offer the reassurance that the hon. Lady is seeking. The Information Centre is already under a general obligation to behave reasonably when discharging its functions, as are all public bodies. In addition, the Information Centre is required by clause 241 to consult representatives of those bodies from whom information will be collected. Clause 237 imposes a duty on the Information Centre to seek to minimise the burdens that it poses on others. For those reasons, I think that the issue of reasonableness is fully dealt with, and I hope that the hon. Lady will be able to withdraw the amendment.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to ask leave to withdraw the amendment.

Emily Thornberry (Labour, Islington South and Finsbury)

We discussed earlier what this provision means and why there are powers to require and request information. It would seem that the Information Centre can require health and social care bodies to provide information, but it can only request that any other person should provide such information. What would happen if there were a health care body that was not an NHS body? Would the Information Centre have the power to require an independent, private care provider to provide information, or does it have power only over NHS bodies?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The key test is whether a provider is providing NHS services. If it is providing such services, it is covered by the terms of the clause. It does not matter whether it is private, not-for-profit, a charity or a public body, such as a foundation trust. I hope that that answers the question.

Owen Smith (Labour, Pontypridd)

Further to the point raised by my hon. Friend the Member for Islington South and Finsbury, I think that the Minister has explained that, in essence, the provision refers to any private body providing NHS services; I assume that that includes any body providing services to a GP consortium. It would therefore be designated a health or social care body—a public body—and would be obliged to provide the information.

How does that potentially conflict with the right that is enshrined—or at least implied—elsewhere in the Bill that a commercial operation may be able to withstand having to provide that information if it is deemed to be against the commercial or other interests of that private provider? Which duty is pre-eminent in that circumstance? Is there any circumstance in which the Minister can imagine a company that provided NHS services—it would therefore be obliged to provide information to the Information Centre—successfully arguing that to do so would be detrimental to their commercial interests? Would it be allowed to withhold the information?

Finally, if that danger exists, is there then a further, much larger danger? When we have an NHS with many more providers, which is a clear intention of the Bill, it might be more difficult for the NHS, as an aggregate, corporate entity, to get detailed information that is critical in judging whether it is performing well, and whether changes in policy might be required. Is there a danger that in this new world, because so many commercial actors are involved, we might have less well sourced and fewer uniform, mineable data available to Ministers?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I return to what I said to the hon. Member for Islington South and Finsbury. The first point is that where a provider—whether private, a charity or a public body—provides publicly funded services, it will be covered by this clause and the other clauses in this part of the Bill. The scenario that the hon. Gentleman described is important to test, but I can reassure him. As far as we were concerned when drafting the Bill, the clauses, and the powers they give to the Information Centre and other bodies, will enable us to ensure that there is consistency and the ability to compare information in the way that the hon. Gentleman fears we might not.

In addition to that, there is the contracting route, which would be available to reinforce that further, but we are confident that, as drafted, the clauses allow for those requirements to be placed on any provider funded by the taxpayer to provide free NHS care. We drafted the Bill to have that policy effect.

Also, to ensure that we can fulfil those information questions, Government amendments 683, 684 and 685, which I have just moved formally, clarify that the Information Centre will have powers to collect information from publicly funded private organisations providing health services or adult social care under arrangements with public bodies. For example, Monitor, as one of the bodies involved, could request information through the Information Centre in that way. Part of the issue is about having one organisation that is seen as the honest broker and the place where data are held, within a framework that guarantees patient confidentiality. That is the key guiding principle that we have followed in framing the provisions.

If, on reflection and having read Hansard, I feel that I have not covered every point that the hon. Gentleman has raised, I will be sure to write to him.

Owen Smith (Labour, Pontypridd)

I am grateful for that answer. However, it still seems to me that, as it relates to this discussion, clause 242 conflicts slightly with clause 243(1)(a), which essentially says that the information might not be provided if the Information Centre deemed it detrimental to the interests of the provider.

I still think that my question stands. If a commercial company, albeit one normally bound by the same rules in respect of providing services to the NHS, does not want to provide the information because it is damaging to its commercial interests—competition law will obviously apply here, so there will be a slightly different set of parameters—could it withhold that information?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

No.

Clause 243

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 686, in clause 243, page 201, line 15, leave out ‘—’ and insert

‘the information falls within subsection (1A); and, subject to the following provisions of this section, if the information falls within that subsection, the Centre must not publish it.

‘(1A) Information falls within this subsection if—’.

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss the following:

Government amendments 687 to 691.

Amendment 653, in clause 243, page 201, line 24, leave out paragraph (c).

Government amendments 692 to 698.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Replying to a speech before one has heard it makes for an interesting debate. I will first deal with our amendment and then I will discuss amendment 653. We have already discussed the importance of confidentiality and privacy safeguards in respect of information collected by the Information Centre. In particular, we need to ensure that information published by the Information Centre does not lead to individual patients being identified. I would like to reiterate how important an issue that is; we do not take it in any way lightly.

Amendment 686 clarifies that when the information collected by the Information Centre is in a form described in the next subsection, the centre must not publish the information. For example, the amendment makes it clear that the Information Centre is prohibited from publishing information that identifies patients or service users. Amendment 698 corrects an inaccuracy in the definition of “provider” originally proposed in this clause. The original definition did not capture all those whose identities it may be in the public interest for the Information Centre to publish. Amendment 698 provides a more comprehensive definition of those whose identity might be published.

Amendment 692 removes the old definition and amendments 687 to 690 replace the previous term with the new one. Amendment 691 ensures that when the information collected by the Information Centre does not meet published standards, the Information Centre must use its discretion as to whether the public interest is sufficient to warrant publication. The reliability of information is an important consideration for professional statisticians, for the public purse and for those who need to trust the information made available.

I want to make it clear, however, that the Information Centre may not disclose information that identifies any individual patient or service user without specific further statutory authority to do so. In addition, the powers to direct or request the Information Centre to collect information provided by clauses 238 and 239 do not themselves provide such statutory authority.

Amendment 694 sets out the circumstances in which the Information Centre may pass information to one or more bodies whether or not it was obliged to publish that information. It replaces the existing provision, which is removed by amendment 697. The Information Centre may disclose information if it considers that it is in the public interest to do so, when the reason why the information was not published was to protect the identity of a body that provided care or because the information did not meet relevant published standards.

However, we do not feel that the role of the Information Centre is to collect information that cannot be published: that should be the exception rather than the rule. There may be circumstances, however, in which the Secretary of State or the NHS commissioning board would want information that identifies bodies to be published but in which the Information Centre, if it were using its discretion, would choose not to do so.

Amendment 693 makes it clear that the Information Centre does not have discretion where it has been directed to publish such information. We recognise that the Information Centre’s views may be important and should be taken into account. Indeed, clause 245(4) requires the Secretary of State or the NHS commissioning board to have regard to advice that the Information Centre may give. However, we feel that ultimately the Information Centre should not be authorised to disregard a lawful direction.

Amendments 695 and 696 provide the Information Centre with discretion as to how and when, and in what additional forms, it will publish information that it has collected. That discretion is subject to the duty of the Information Centre to have regard to making information easily accessible and to the likely needs of those who may benefit from the information.

Opposition amendment 652 seeks to prevent the Secretary of State or the NHS commissioning board from directing the Information Centre not to publish information that it collects.

Mike Hancock (Liberal Democrat, Portsmouth South)

Order. We are discussing amendment 653, but you can come back if you choose.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I misread my brief. I shall do that.

Emily Thornberry (Labour, Islington South and Finsbury)

I am grateful to the Minister for the opportunity to explain what amendment 653 is about before he decides that he does not want it. However, you never know; after seven weeks, this might be the one—[ Interruption. ] Perhaps we will just have to wait until the Prime Minister steps in.

Clause 243 is about the publication of information. It states that the Information Centre must publish all information that it collects, but there are some exceptions. Those are, first, when

“the information is in a form which identifies any provider”,

which makes sense, and secondly, when

“the information is in a form which identifies any individual”.

The third exception, however, is when

“the information is of a description specified in a direction given to the Centre by the Secretary of State or the Board.”

All information will be published, therefore, apart from the information that the Secretary of State would rather is not, and we wondered what that was. Will the Minister give us an example of what that information would be, particularly in light of the debate that we had on the previous clause?

Bupa, for example, might say to the Minister, “We are happy to provide services to the NHS, but we see no reason why we should be providing all this information to the Information Centre. As far as we are concerned, it should be confidential, because it will embarrass us commercially otherwise.” The Secretary of State might say, “Yes, we understand.” Would the Information Centre not publish information in such circumstances?

The Minister’s response was interesting. I wonder whether he has thought it through and whether there has been real consultation with private providers about the attitude of the Department on publishing all the information on any services provided by the private sector to the national health service. I am interested to know whether I am right, and whether clause 243(1)(c) covers those points.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I do not resile from what I said earlier. I stand by it, and it is on the record.

The Opposition amendment seeks to prevent the Secretary of State or commissioning board from directing the Information Centre not to publish information that it collects when that information would otherwise have been published. I fully sympathise with the desire to ensure that information is not withheld simply because the commissioner of that information does not like what it says. It is for that reason that a number of safeguards have been built into the Bill to ensure that this further amendment is unnecessary.

For example, the Information Centre may provide advice about the publication of information under clause 245, and the Secretary of State and the commissioning board are obliged to have regard to that. The Information Centre is also under an obligation provided by clause 244 to maintain a register that contains a description of the information that it has collected, and I referred to that register in this morning’s sitting. It would therefore be very obvious if an attempt were made to suppress the publication of data collection.

There will, however, be rare occasions when it is entirely appropriate for the Secretary of State to direct that information should be collected, but not published. For example, there might be information about a serious epidemic or a threat to public health. The release of such information will occur, but that needs to be done carefully to prevent unnecessary alarm.

I hope that hon. Members are reassured that the powers are needed and would not be abused, and that they feel able not to press their amendment to a Division.

Clause 245

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I beg to move amendment 699, in clause 245, page 202, line 24, leave out from beginning to ‘about’ in line 26 and insert

‘The Secretary of State must, at least once in any review period, exercise the power under subsection (1)(b) by requesting the Information Centre to give the Secretary of State advice’.

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss Government amendment 700.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The amendments arise from evidence that the Government have heard. We have listened carefully to comments made outside the Committee and will continue to do so.

The NHS Confederation supports the amendments, and its members told us that the overlap and duplication of requirements to provide information can be a problem for NHS organisations. Its report on the burdens of bureaucracy, published in 2007, reflects that view. It told us:

“We are pleased that Ministers have listened to this concern and will create a new requirement for this to be reviewed every three years.”

It continued:

“We would also urge the Government to ensure that the Information Centre or the Department of Health has adequate powers to ensure its findings are put into practice when information is being collected.”

I am pleased to be able to reassure the confederation. Under subsection (4), all health and social care bodies given advice under the section must have regard to that advice. The amendments add a useful provision to ensure that every three years the Information Centre conducts a review of the burdens that data collections might have placed on the system, and they are welcomed outside the Committee.

Emily Thornberry (Labour, Islington South and Finsbury)

I have just been passed a note, but I have not had a chance to read it—[ Interruption. ] It is not from the Prime Minister, so Government Members can stand down. May I have the chance to read it, Mr Hancock because it is relevant to the clause—you might have seen it passed to me about 20 seconds ago? [Hon. Members: “Who is it from?”] It is from the NHS Confederation, and since we have just heard that an amendment has been made as a result of the confederation, I want to make sure that I know what it says before I speak to the clause.

Mike Hancock (Liberal Democrat, Portsmouth South)

Order. Rather than take a moment, I think it would be better if the hon. Lady read it out to everyone.

Emily Thornberry (Labour, Islington South and Finsbury)

I would rather read it first.

Mike Hancock (Liberal Democrat, Portsmouth South)

Order. Then I am in the hand of the Committee. Is it the wish of the Committee that we adjourn for a minute or so to give the hon. Lady time to read the note? I hope that I have given her time to do so by asking that question. The answer is no, so I will not suspend the sitting.

Emily Thornberry (Labour, Islington South and Finsbury)

I was at the Bar for 20 years and during that time I learned a very important lesson: one should never get to one’s feet to speak on something that one does not know about. I have lived by that rule, and when I get to my feet to argue a case, I try to ensure that I understand it. Since I have not had a chance to read my note, I am not in a position to tell the Committee whether the NHS Confederation has any comments on the Government’s amendments.

Mike Hancock (Liberal Democrat, Portsmouth South)

I am sure the hon. Lady has been here long enough to find a chance in the next two and a half hours to introduce whatever the confederation said.

Clause 247

Emily Thornberry (Labour, Islington South and Finsbury)

The clause deals with the power to establish an accreditation scheme. Why does the establishment of an accreditation provider exclude public bodies? Why should a public body—perhaps a shared service function within a major foundation trust—not provide such a service? Why is it limited to private providers?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I shall speak briefly to the clause and answer that question as I do so.

The clause will allow regulations to make provision for a scheme to accredit organisations that act as information intermediaries. Information intermediaries are expected to play a key part in making better use of information to support service improvement and patient choice. An accreditation scheme may be run by the Information Centre or by any other body that is specified in regulations. The regulations would enable the operating body to set the accreditation criteria, to keep the scheme under review and to charge reasonable fees. The scheme will essentially act as a kitemark, indicating that the products of an accredited organisation are of a high quality and enabling those seeking the services of an information intermediary to select one that has demonstrated that it meets quality standards.

I return to the hon. Lady’s question, which suggested that it would not be possible for a public body to deal with that. The matter would be dealt with by regulations, so I do not believe that that is the case—I believe that the regulations could cover a public body discharging this role. If I am incorrect I will certainly write to her to correct that information, but that is my understanding. We do not prescribe that in the Bill; we deal with it through regulations—[Interruption.] I now know that I have given the correct answer.

Clause 249

Jeremy Lefroy (Conservative, Stafford)

I am sorry to delay the Committee, but I have read this clause and the relevant explanatory note and I just wondered what its purpose was.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

This perfectly crafted clause gives support to many of the others in the Bill. It enables the Information Centre to be provided, under regulations, with functions in connection with verification of the identity of GPs who are able to issue prescriptions. The clause is necessary to ensure that the Information Centre can collect such information. The process would involve the Information Centre checking the identity of GPs and issuing numbers that are unique to individual GPs and used in prescribing services. That is needed to ensure that only authorised GPs are able to issue prescriptions, which is a necessary safeguard of the sort that we discussed earlier in the week.

Clause 251

Emily Thornberry (Labour, Islington South and Finsbury)

Clause 251 allows the Information Centre to make arrangements with others to provide services. Would the restrictions that apply to the Information Centre, such as making reasonable charges, also apply to such an arrangement?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

To illuminate the Committee, the clause enables the Information Centre to make arrangements with other bodies to carry out services. That is needed to allow the centre to make decisions on the best way of meeting its obligations. It can act only in the context for which the Bill provides, so the answer to the hon. Lady’s question is no.

Clause 252

Emily Thornberry (Labour, Islington South and Finsbury)

Our consideration of this clause seems an appropriate stage to address the NHS Confederation’s point:

“The Committee should consider placing a responsibility on the Secretary of State to periodically review the level of bureaucracy on NHS commissioners and providers”.

Its members say that there is overlap and duplication of requirements to provide information, which can be a real problem for NHS organisations, as the NHS Confederation highlighted in its report “The bureaucratic burden in the NHS”. It is pleased that Ministers have listened to its concerns and will create a new requirement for this to be reviewed every three years. It also urges the Government to ensure that the Information Centre or the Department of Health has adequate powers to ensure its findings are put into practice when information is being collected.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

It is good to have that on the record twice, because I have just rehearsed those points. I am also pleased to be able to reassure the NHS Confederation and the hon. Lady. Clause 245(4) states:

“A health or social care body to whom advice or guidance is given under this section must have regard to the advice”.

As we have discussed at various points in our proceedings, “have regard” is not a term to be taken lightly. It means that such bodies will have to take the information carefully into consideration. Those issues were raised by the NHS Confederation back in 2007, and the Government have acted on them at the earliest opportunity.

Clause 254

Schedule 18

Clause 258

Kevin Barron (Labour, Rother Valley)

The clause will abolish the Alcohol Education and Research Council, and I want to ask the Minister a few questions about that. The council’s role is to generate and disseminate research-based evidence to inform and influence policy and practice, and to develop the capacity of people and organisations to address alcohol issues.

My understanding is that the council works. It gives good advice to different organisations in the UK about alcohol which, as I am sure all hon. Members realise, is a public health issue that has grown rapidly in the last decade or two in this country. I am concerned about the abolition of this council, even though the explanatory notes say that it will be made into a separate charitable body. I would like to ask the Minister exactly how it will operate and what its new status means.

Hon. Members will know that in recent months the Government have been putting together the responsibility deal. There are numerous areas in which people are trying to influence what we eat and drink and everything else, but the Government’s responsibility deal alcohol network has not been able to agree the way forward, as I am sure that the Minister is well aware. Six organisations in the network have refused to sign up to what the Government are proposing: Alcohol Concern, the British Association for the Study of the Liver, the British Liver Trust, the British Medical Association, the Institute of Alcohol Studies and the Royal College of Physicians, in which I have registered an interest during our Committee proceedings.

Those organisations have refused to sign up because they are not convinced that the Government’s responsibility deal on alcohol will work. Their collective statement says:

“The overall RDA policy objective to ‘foster a culture of responsible drinking’ does not adequately address the need to reduce alcohol-related mortality and morbidity.”

It continues:

“The RDA drinks industry pledges are not specific or measurable and do not state what would be the evidence of success.”

The statement goes on and on, but it also says:

“There has been no commitment made on what alternative actions the Government will take if the RDA pledges do not significantly reduce levels of alcohol-related harm.”

These major charities have been involved for decades in examining alcohol misuse and treating people for alcohol abuse and binge drinking in this country. If they will not sign up to the responsibility deal, it must raise some question marks about the journey that the Government are making. The British Retail Consortium, the members of which have played a major part in the responsibility deal, has also questioned the whole issue.

Nick de Bois (Conservative, Enfield North)

I am sure the right hon. Gentleman is aware that the Alcohol Education and Research Council has said of its future status that it believes:

“The creation of a new, independent charity will bring considerable benefits and open up significant new opportunities for the stakeholders in it.”

The council itself therefore welcomes this opportunity.

Kevin Barron (Labour, Rother Valley)

As I have said, I want the Minister to allay my concern about these changes and how they will affect alcohol policy. Alcohol policy is in a bit of a mess at the moment.

The British Retail Consortium put out a press release saying:

“it has emerged that a number of NGOs have opted to not support the responsibility deal, believing that the pledges do not go far enough, or that Government is too close to industry.”

The Health Committee echoed that in the last Parliament, when I was a member, when one of its reports found that the previous Government were far too close to the industry. The British Retail Consortium also says:

“While this is disappointing, we think this reaction, as well as the process itself, should form part of a review into the Deal, to capture the lessons, before the Government rolls this approach out in other areas of policy.”

There are major issues around alcohol and public health. I am disappointed that we have ended up in such a situation with the responsibility deal, but I would not want Members to think for one minute that I am not in favour of its aims. If we look at what has happened with processed food in the past eight years or more, there has been a massive reduction in salt, for example, and that has happened due to co-operation among the food industry itself, the Food Standards Agency and other organisations.

Let us hear the Minister say that the abolition of the council, or its change to a charitable body, will not affect the work it is has been doing and our uphill struggle against alcohol abuse in this country and its ill effects. Will he confirm that that change to charitable status will not stop the work that the council has been doing in recent years?

Owen Smith (Labour, Pontypridd)

My right hon. Friend has set out many of the points that I was going to make. I am particularly interested in the clause because I know that the Alcohol Education and Research Council has had a particular impact in Wales. It has conducted research into the impact of alcohol misuse on young people and families, which led to the formation of the strengthening families programme—SFP10-14—which operated extremely successfully in south Wales, particularly in the Cardiff area with the drug and alcohol misuse board. Although the clause does not abolish the fund that the council has hitherto administered, can the Minister offer any reassurance that the funding will in no way be jeopardised by the council’s change in status because, as my right hon. Friend said, alcohol misuse is such an enormously important issue?

Debbie Abrahams (Labour, Oldham East and Saddleworth)

Most of my points have been made, but I reiterate that the organisation has contributed significantly to the evidence base around alcohol-related harm. It is a real concern that this will not be able to continue in the way that we would like. There are also concerns about the trend towards the alcohol industry having more sway than such important organisations.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I am happy to respond to the debate and give some of the reassurances that right hon. and hon. Members have sought.

The comments that the right hon. Member for Rother Valley made about the responsibility deal, and particularly about the way in which such engagement with industry can result in greater and more rapid progress, were welcome. That is the responsible way to approach the responsibility deal, too. One of the misconceptions that has been spread around is the belief that the deals are the only game in town when it comes to public health policy. Some of the non-governmental organisations with which we have engaged on the responsibility deal in respect of alcohol have certainly had that misapprehension. They thought that the responsibility deal was the only way in which issues around alcohol harm could be pursued, but that is not true.

In the meetings that we have had with a variety of NGOs, including those to which the right hon. Gentleman referred, the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), and I have made it very clear that the Government also intend to produce a strategy for reduction in alcohol harm. The Government are already moving on a number of fronts, particularly around price and the use of tax policy to make more progress than has perhaps been made up until now. However, the NGOs seemed to want to have a debate with industry, with all the companies in the room, about setting prices and tax policy. It is not possible to have industry in the room collectively agreeing price issues because that breaches competition law, so we were not prepared—or able—to have conversations in that context.

That does not mean that the Government do not want to make progress on those issues. Indeed, the key thing is who sets policy. I am clear that it is the Government who set policy, not industry and not NGOs. As long as we are clear about that, we will listen to both sides and make judgments appropriately. We have seen some marked movements already with the responsibility deal on alcohol, not least from one supermarket that has decided to withdraw all front-of-shop alcohol promotions. Another alcohol purveyor has committed itself to reducing the alcohol content of one of its leading brands. Those are useful nudges—to use a much maligned phrase—to others to act in such a way.

To answer Opposition Members’ questions, the Alcohol Education and Research Council does have a future. It does not have a future as an arm’s length body within statute, but it has a future as a charity. Dave Roberts, the chief executive of the AERC, has said:

“We are very excited by these developments. We believe that the creation of a new, independent charity will bring considerable benefits and open up significant new opportunities for both the organisation and our stakeholders.”

The body is embracing the change and sees an opportunity to be an independent organisation offering the expertise that it has developed over several years.

The fund is secure, and we are not changing the funding arrangements in that regard. We are simply ensuring that the organisation can act independently of the Government as a charity and continue to provide its valuable services. On Wales, which we should not leave out of our considerations, the fund will still be there, and it will still work in Wales in the future. I can also assure the Committee that the Welsh Assembly Government have agreed to the change.

Clause 259

Liz Kendall (Labour, Leicester West)

As hon. Members know, the Appointments Commission, which the clause will abolish, oversees, among others, all primary care trust chair and non-executive director appointments. We learnt from page 3 of The Times today that the Prime Minister is seeking to put a brake on the reforms that the Ministers are so valiantly attempting to defend. The article states:

“Instead of a swift revolution, in which GPs take control of all local healthcare services within two years, Downing Street is considering a slower pace of change”.

Nick de Bois rose—

Mike Hancock (Liberal Democrat, Portsmouth South)

Order. I have to say that, interesting though it is, that article bears little relationship to the business before us today. I have to rule that we discuss what is before us, rather than what is potentially before us. If you are talking about the Appointments Commission, can we stick to that and not to something that might be purely hypothetical?

Liz Kendall (Labour, Leicester West)

My point is absolutely relevant. If the Government are about to make changes to the Bill and say that primary care trusts will not, as we read in The Times—

Mike Hancock (Liberal Democrat, Portsmouth South)

Order. I have to rule that speculation on changes could effectively be made on every clause that we are about to discuss, because the article does not explicitly explain where the Prime Minister might make changes, so we can only speculate. We are not here to speculate; we are here to decide whether clause 259 should remain in the Bill. We cannot make speculative judgments. We must recognise what we are discussing here.

Liz Kendall (Labour, Leicester West)

I bow to your ruling, Mr Hancock.

It is wrong to abolish the Appointments Commission. Opposition Members would argue that if we need to keep primary care trusts to ensure that there is greater stability and financial control in the system, they will have to have chairs and non-executive directors appointed, just as GP commissioning consortia or clinical consortia, or whatever they end up being called, would, I hope, also have such positions appointed in future to give them some kind of governance or accountability. We argue that the commission should be kept, so that appointments can be made, especially if primary care trusts, as nobody is speculating, will be kept in future.

Kevin Barron (Labour, Rother Valley)

I do not want to carry on from where my hon. Friend left off, except to say that, if there are any changes to the Bill coming down the road—particularly anything about the slowing-down of the process—it might be the case that people in situ, who were appointed by the Appointments Commission, may have to be kept on for a length of time.

I have one other question. I have been through the NHS Appointments Commission process—the second time I was appointed a lay member of the General Medical Council. It was very much at a distance from Government, although I was a politician at the time. I see that the power will remain with the Secretary of State if and when the commission is abolished, and I would like some reassurance that, if in any future shape or size it sits in Richmond house, it will be as even handed, no matter who is in government, and professional as when I went through it.

Owen Smith (Labour, Pontypridd)

My point is nothing to do with the story in The Times this morning, however fascinating that was—

Liz Kendall (Labour, Leicester West)

Will my hon. Friend give way?

Mike Hancock (Liberal Democrat, Portsmouth South)

Order. I can understand hon. Members being demob happy this afternoon, but their enthusiasm encourages me to believe they have something to say.

Owen Smith (Labour, Pontypridd)

My question relates more broadly to the decision to abolish the Appointments Commission. The history of the Appointments Commission is quite interesting. It was established in 2001 as a body to appoint people within the NHS—

Simon Burns (Conservative, Chelmsford)

Why?

Mike Hancock (Liberal Democrat, Portsmouth South)

If you wish to intervene, Mr Burns, I suggest you rise to do so. I think that Ministers are here to answer the questions, rather than Opposition Members.

Owen Smith (Labour, Pontypridd)

Thank you Mr Hancock. As I was saying, I will briefly relate the fascinating history of the Appointments Commission. It was established in 2001, within the NHS, to appoint people to trusts and other NHS bodies, but its role has expanded significantly over the last couple of years. In 2003 it was expanded to include appointments to all bodies in the health and social care sector. Then—this is my real point—in 2006, its role was expanded further and its name changed to the Appointments Commission, from its original title, the NHS Appointments Commission. It became a body responsible for providing recruitment and selection services to all Government Departments. It is therefore no longer concerned solely with the NHS, or just health and social care bodies; it is responsible for absolutely everything—all Government Departments. To safeguard its original role in the NHS, a special committee—the health and social care appointments committee—was established internally to carry on the NHS part of the role.

I have three questions. First, if the Government wanted to change the procedures in the NHS and, as the clause suggests, pass all the responsibility for recruiting and selecting for all NHS bodies to the Secretary of State, why not simply abolish that committee within the Appointments Commission?

Secondly, what will be the procedure in future for selecting, recruiting and sourcing people for public bodies within the NHS? The responsibility will pass to the Secretary of State. His responsibilities will be dramatically reduced by the Bill, because he will no longer be directly responsible for promoting universal health care—that will be the responsibility of the NHS commissioning board quango—but I would not have though he will have enough time to recruit and select people for all the various GP consortia and other public health bodies. Is it not likely that we will see Odgers or one of the other headhunting firms, as opposed to a public body, selecting people with the relevant expertise and experience? Is it not more likely that we will see more private recruiting companies employed by the Secretary of State to source, select and appoint these individuals?

Thirdly, what process will apply in other Departments? The decision implemented in the Bill will affect all other Departments. Every year, the Appointments Commission selects more than 1,000 people to leading roles in public bodies in this country. That is a lot of work for other Ministers to undertake. Can the Minister point to where in other Bills those other Ministers will be given the responsibility for taking on the role that previously has been conducted by the Appointments Commission?

Mike Hancock (Liberal Democrat, Portsmouth South)

I do not think it is the Minister’s job to explain what is going to happen in other Departments. His responsibility to this Committee is to explain what is going to happen in the Department of Health. I was a bit nervous for a minute there, Mr Smith. You got very comfortable leaning on the back of your chair. I thought that we were in for a very long speech.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Let me start by being very clear about where responsibility sits once the Appointments Commission is abolished. Yes, it rests with Ministers, but it rests within the context of a framework of existing safeguards that apply to ministerial appointments in other Government Departments. These appointments will be undertaken in accordance with the code of practice issued by the Commissioner for Public Appointments, who is not being abolished and will continue to be subject to that office’s scrutiny. That will help to ensure that the process remains open, transparent and that appointments are made, as they always should be, on the basis of the merits of the candidates.

There was a number of questions about how long the Appointments Commission will continue to work. The Department and the commission are working towards a planned abolition date of 31 March 2012, which leads on to a question about what happens in the interim period between its abolition and the abolition of primary care trusts in 2013. Where necessary re-appointments, or in a more limited number of cases, extensions of appointments, should be made for strategic health authority and PCT chairs and non-executive directors up to the latest abolition date for the body. Otherwise, either a vacancy will be carried, as long as the board can function effectively and is quorate, or a temporary appointment will be made in the context of the code that I just described, which is overseen by the commissioner.

The Department has also amended legislation to allow the flexibility for primary care trust non-executive directors to serve on more than one PCT board, in part to reflect the current clustering. The hon. Member for Pontypridd asked me about the Appointments Commission’s responsibility for other Government Departments. It can make appointments elsewhere, but the vast majority of the appointments it makes are to the NHS. One of the other changes that we have already debated are the changes to the governance arrangements for NHS trusts, with all of them moving to foundation trust status, where they will be responsible for their own appointments. The commission is not sustainable as a non-departmental public body once those NHS appointments are removed from its remit, so other Departments will appoint in the same way as I have described: Ministers will appoint on the basis of merit and subject to the code of practice.

Owen Smith (Labour, Pontypridd)

Does the Minister not accept that it is a retrograde step to reverse the arrangement wherein an arm’s length body administers appointments in the NHS and return to the status quo ante where the Secretary of State does it? Is that not also at odds with the Government’s stated aim to remove the Secretary of State and reduce political interference in the NHS?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

No, no and no. To expand ever so slightly, the number of appointments that would be made in future would be in the tens, not the thousands and because of that and because they are appointments to positions such as the chair of the Care Quality Commission, or to Monitor, or to a limited number of other posts such as on the NHS commissioning board, it will be appropriate for those matters to be discharged by ministerial appointment in the context of the code and the necessary supervision that is provided both to the Department of Health and other Government Departments.

John Pugh (Liberal Democrat, Southport)

I stand to be corrected, and I am obviously a disappointed and bitter person because I have never been on a quango in my life or been a non-executive anything, but presumably appointments will be made to acute trusts which are managed through the appointments process. Is that not the case? Acute trusts will continue to exist and there will presumably be plenty of them. I received an advertisement today about my local acute trust that appeared to come from the Appointments Commission. In the past, a disproportionate number of the candidates who got such posts seemed to be of a favoured political party, depending on who was the Secretary of State at the time. Will the Minister assure me that there will be rigid monitoring, so that when the Secretary of State has this power, appointments will be made in a transparent way and no political bias can be detected?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Yes is the first and straightforward answer to that question. Secondly, in future all acute trusts will be foundation trusts and therefore responsible for their own governance arrangements. There will be accountability and safeguards for that, which we debated last week. Such decisions will not be made by the Secretary of State; they will be made by the members and the governors of the foundation trusts.

Clause 261

Derek Twigg (Labour, Halton)

I want to explore some of the detail of the clause, not least by means of the impact assessment. The clause will abolish the National Patient Safety Agency, which is tasked with promoting and ensuring patient safety, which clearly is of paramount importance. During our deliberations we have heard a lot from the Government about the need to protect patient safety and about what the Bill will not do on that, so it is worth having some debate on the NPSA and the implications of the Government’s proposals.

A number of people and organisations outside the House have raised concerns about the proposals. According to the Royal College of Nursing

“the agency has a critical role in collecting data on patient safety problems, and identifying trends and patterns of avoidable incidents as well as supporting ongoing education and learning.”

Given the numerous incidents in the lifetime of the NHS, collecting data and identifying trends and patterns of avoidable incidents are important. We need to be satisfied that patients are well looked after and that the Government’s changes provide such confidence. I will not go into specific patient safety incidents, but no doubt the hon. Member for Stafford could spend a long time talking about that in the context of the Mid Staffordshire trust and related areas.

The Royal College of Nursing cites the example of the national reporting and learning system, which since its inception has received more than 4 million incident reports from health care staff. We know that most, if not all, staff pay a lot of attention to patient safety and that it is given a great priority throughout the health service, but mistakes are made. Human beings make mistakes: there are mistakes in procedures, mistakes in the provision of treatment and mistakes in the various reporting systems of the various parts of the health service. We cannot overestimate the importance of patient safety. The Royal College of Nursing also believes that as a result of the NPSA’s abolition

“the patient safety function is likely to become considerably smaller”.

It would be useful if the Minister commented specifically on that.

The Royal College of Nursing goes on to state:

“This causes some concern regarding retention of expertise and… quality and safety in the NHS.”

The Royal College of Nursing has built up massive experience and knowledge about patient safety and about the health service. The Minister might want to say where we stand in terms of people leaving the service or staying, and how we safeguard the experience and knowledge that are critical to improving safety in the health service.

In its report, “Smaller Government: Shrinking the Quango State”, the Public Administration Committee concluded that the Government’s current approach to arm’s length bodies

“is not going to deliver significant cost savings or result in greater accountability.”

That is an important consideration, although patient safety is paramount in our present discussion. It goes back to the Government’s whole approach to quangos and arm’s length bodies and whether there are real savings to be made, or whether it is the product of an ideological drive to make changes. I do not want to muddy the waters, but concerns have been raised about that generally. The Royal College of Nursing is concerned that patient safety could be compromised by a much reduced service resulting from the NPSA’s abolition. As I have said, the Public Administration Committee has stated that the Government’s approach to abolishing quangos does not necessarily deliver all that they said it would. I would like to hear the Government’s views on that.

The patient safety division function will become part of the remit of the NHS commissioning board. There was some debate earlier about this, but this is our first chance to discuss it in some detail. The impact assessment states that

“Only the functions relating to the PSD will require primary legislation”.

I am not trying to make a political point, but I would like the Minister to say a bit more about that. The impact assessment goes on to state that

“The work of the PSD relating to reporting and learning from serious patient safety incidents will move to the NHS Commissioning Board as a Patient Safety sub-committee of the Board.”

I understand from the impact assessment that that is supposed to happen by September this year. The Minister may want to say some more about that, because the timing and the scale of the change are clearly important. Given that the new body would be a sub-committee of the board, what assurances can the Minister give us on the priority and focus that the NHS commissioning board will give it?

Again, the impact assessment states that

“The work of the PSD relating to reporting and learning from serious patient safety incidents will move to the NHS Commissioning Board...This is intended to happen by September 2011.”

I have just mentioned that, but it is useful to repeat it. The impact assessment continues:

“The functions for which the sub-committee would be responsible (for overseeing or arranging) would include: Coordinating system-wide patient safety activity in the health service; Improving the safety of NHS care by promoting a culture of reporting and learning from patient safety incidences including adverse events or near misses; Devising, implementing and managing patient safety systems, or arranging for these, including providing for the existing national reporting and learning system (NRLS) and central alerting system (CAS), with a view to informing and disseminating learning; Appraising and analysing information on reported adverse events and near misses, identifying patterns of practice or service provision that appear causally related to unexpected or serious adverse outcomes.”

Those are exceptionally important areas of responsibility. Is the Minister confident that that can all be simply transferred and taken on by the board? As I have stated, according to the impact assessment it is intended that the sub-committee should be up and running by September this year.

The priority that the sub-committee will be given by the NHS commissioning board is important, as is the make-up of the sub-committee. I suspect the Minister will probably say that that is up to the national commissioning board to decide, but I wonder whether in drawing up this legislation the Minister has had discussions with the other Departments or with the health service as a whole about the possible make-up of the sub-committee. Although he could say that that is up to the NHS commissioning board—he might not say that; I might be pre-empting him—it is important that we know the level, calibre and responsibilities of people who could be considered for that sub-committee, in order to give us confidence.

I note with interest paragraph E98 of the impact assessment, the second sentence of which states:

“If the NHS Commissioning Board is set up with outposts, the strategic thinking and leadership on safety could sit at Board level, while support for operational delivery could sit with the outposts.”

That is interesting for a couple of reasons. When we asked whether the national commissioning board would have regional or local offices, we were told that that was completely up to the board to decide, yet the impact assessment suggests that there could be outposts. What is the likely outcome? [Interruption.] The Minister can intervene if he wants.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

It says “if”.

Derek Twigg (Labour, Halton)

In earlier sittings, Ministers refused to discuss whether the national commissioning board would have regional offices—I think you were here for that, Mr Hancock. Whether or not the word used is “if”, the matter is discussed in the impact assessment. It is interesting to see that a regional office is known as an outpost—that might be some indication of how important the regions will be. I am not sure where the terminology comes from. Has the Minister had any more thoughts on whether having regional offices would be a logical extension? I want to repeat the quote for him, because this is important:

“the strategic thinking and leadership on safety could sit at Board level, while support for operational delivery could sit with the outposts.”

Is the Minister able to confirm the costs? Paragraph E103 says that

“the Department anticipates that there will be”—

could be—

“indirect costs, such as a loss in output caused by the underperformance of a disenchanted workforce during the transition period.”

I accept that it is in the impact assessment as a possibility, but it will be useful to hear whether the Government are thinking along those lines. Is there more information on the staff and how they are reacting? What safeguards have been put in place? The paragraph also mentions

“a loss of NPSA stakeholder assurance”,

which is important. Interestingly, the following paragraph says:

“There is a possible risk that bringing the PSD into the NHS Commissioning Board will lead to reduced importance for patient safety”.

I accept what the Minister says about the mitigating measures in that regard.

These are important matters. We are not trying to score political points, but asking crucial questions about patient safety and the changes that the Government are making. Part of our argument, which is very real, is about fragmentation. The whole reorganisation process will take a long time and many people will be involved, and they could take their eyes off the ball—that is in the impact assessment. It is important to get answers to our questions and assurances about the crucial area of patient safety.

Jeremy Lefroy (Conservative, Stafford)

I have three very brief points, and with them three very brief questions.

My first point follows what the hon. Member for Halton said about the importance of patient safety. Clearly, after the Mid Staffordshire experience, patient safety is now taken extremely seriously throughout the NHS—I am sure that it always was in most cases, but it is now at the forefront of NHS services. There are two ways to regard the abolition of the NPSA. Either it indicates that there is less emphasis on patient safety; or—the alternative that I subscribe to and the explanatory notes endorse—it embeds patient safety in the heart of the NHS. In fact:

“The intention is to ensure that patient safety is embedded into the health service through commissioning consortia and the contracts they agree with providers.”

I welcome that.

Derek Twigg (Labour, Halton)

The hon. Gentleman makes an important point. Does he accept that our concern is reasonable? I hear what he says about a lot of emphasis being put on patient safety, and of course there is, but the health service is about to go through the biggest reorganisation in its history. There is a massive amount of work to do, ranging from work on clinical care and commissioning to pricing, accommodation and other reorganisation issues, so there could be a danger that people will take their eye off the ball, because the reorganisation will pull them so much in one direction. That is the point I was trying to make.

Jeremy Lefroy (Conservative, Stafford)

I thank the hon. Gentleman and I would underline his point. I was about to say that it is vital that the ball is not dropped in the transition between the NPSA and the embedding of patient safety in the heart of the NHS and the national commissioning board. Patient safety is of the utmost importance. I would like to hear the Minister’s reaction to that and to get that on the record.

Secondly, I ask the Minister to comment on the likely outcome of the Francis inquiry. I am sure that there will be a lot on patient safety, and I ask him what his reaction will be to any suggestions that might be made. Patient safety has been an important part of that inquiry.

My third point concerns the national research ethics service. It may be a minor part of the NPSA’s remit, but I see the risk of something falling between the gaps when I read the explanatory notes. Research ethics are key if we want to be at the forefront of medical research internationally—indeed, we are at the fore at the moment, and we must not fall behind. How will the Government ensure that there is no hiatus between the present provision under the NPSA and that envisaged in the Bill?

Liz Kendall (Labour, Leicester West)

At the end of his speech the hon. Gentleman the Member for Stafford asked a question I was going to ask. It is clear that the clause abolishes the National Patient Safety Agency and moves responsibility for the national reporting and learning service to the NHS commissioning board, but it does not say what will happen to the national research ethics service, which guarantees or attempts to guarantee the safety and rights of patients involved in research and to promote ethical research; nor is it clear what will happen to the national clinical assessment service, a part of the NPSA which helps practitioners and managers to prevent patient safety incidents from happening.

I have an example of what the National Patient Safety Agency does from my own experience of running the ambulance service network. The NPSA’s work is very important, and I am concerned about its responsibilities moving to the national board. We did a large piece of work with the NPSA where it provided from the ambulance services all the reports of patient incidents where there were real safety concerns. Those incidents often happened during the handover period, when ambulances turn up at hospital or people are leaving hospital. The NPSA gave its initial findings to the network and we met with all our members from the various ambulance services and talked about how to increase reporting rates where appropriate—there were big variations between different ambulance services which did not make sense. We explored the data, saw what was happening, what the impact on patients was and what was going wrong. We held a big event where people could, in a safe environment, say what had really happened and why they thought things had gone wrong. We learned from best practice and from what other people were doing to try to reduce those safety concerns.

That is one small area of patient safety, yet a very important one that had not been looked at before. My worry is that the national commissioning board has so much else on its plate that it will not be able to do that kind of work in detail across a range of different areas. With the big reorganisation that the Government want, I do not think that that sort of work will be at the top of the national commissioning board’s agenda.

It is right that safety is integral to the work of commissioners. However, we know staff have been worried in the past about reporting patient safety incidents, basically in case they got into trouble. Now they are being asked to report incidents not to an independent agency, but to the very board that is responsible for driving the commissioning of their services. Are they likely to say, “We have had some safety problems” to the people who will commission their service? They will not, because they will think, “The board might not commission us if they think we have problems with patient safety.”

I have a practical concern: will the board be able to do what is required of it, with everything else that it has on its plate? I am also worried about a point of principle. Is it likely that services will report such incidents to the body that determines whether their services are commissioned in future? That is why I am concerned that the clause and the abolition of the NPSA have not been thought through.

Mike Hancock (Liberal Democrat, Portsmouth South)

I take this opportunity to remind Members that we are up against a very tight time scale, and 4 o’clock is beckoning.

Owen Smith (Labour, Pontypridd)

In that case, I will not repeat concerns that my hon. Friend has just raised, but I will add one further, important illustration. The National Patient Safety Agency is responsible for both funding and monitoring the national confidential inquiries. Three are undertaken every year; they examine patient outcome and death, maternal and child health care, and suicide and homicide. NCEPOD—the national confidential enquiry into patient outcome and death—is particularly important to the NHS. It is one of the key investigative tools that the NHS has to provide it with meaningful scrutiny of outcomes—the most important outcome, which is whether patients die as a result of NHS treatment.

By way of further illustration, the most recent NCEPOD report, which was about deaths of patients within 30 days of cancer treatment, has been hugely influential in shaping the latest iteration of the national cancer strategy. I cannot imagine that NCEPOD is being abolished, so will its funding and monitoring pass to the national commissioning board? Is the Minister confident that among the commissioning board’s many other priorities, many of which will be administrative, it will have the requisite time and expertise to conduct that work? Is there not a danger that some of the expertise of the NPSA will be lost?

My second point, as ever, relates to Wales. The NPSA is a prime example of a body that touches Wales and England. Its remit covers both countries, and in passing its responsibility wholly to the national commissioning board, there is, as far as I can see, no provision in the Bill for what will happen in Wales henceforth. Which body will be responsible for the activities undertaken hitherto by NPSA? If I am wrong, and the Minister can point me to the place in the Bill where it says what will happen in Wales, I shall be grateful.

My third and final point relates to the national clinical assessment service. The explanatory notes state that it will move to being self-funding, which raises a question in my mind, related to the one I asked on Tuesday about the abolition of the Office of the Health Professions Adjudicator. My concern is that that will lead to less independent scrutiny of clinicians’ fitness to practice. What reassurance can the Minister give that, in becoming somehow self-funding, the important work that the NPSA undertakes in that respect will not become less rigorous? In other words, will people not want to use the service if they have to pay for it in future, which seems an obvious risk? Ditto—will that apply to Wales and England, or will Wales have to fund the service itself in future?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I shall try to work my way through the various questions that I have been asked.

With the opening remarks of the hon. Member for Halton, we returned to a debate on which we spent some happy hours at the beginning of the Committee: whether the NHS commissioning board would have a local or regional presence. As I tried to intimate to the hon. Gentleman, the impact assessment is drafted to indicate that that is an if and remains so. All I would say is that we have indicated that we expect, not least because the NHS commissioning board will have membership of the local health and well-being boards, that it will have some form of local presence. We expect the NHS commissioning board to have the responsibility for defining precisely how that is delivered.

The hon. Member for Halton made a point about the RCN and its view about the important role that is currently discharged by the National Patient Safety Agency. There is no difference between either side of the Committee on the importance that the Government attach to patient safety. We see that as a key priority for all those working in the health service. We cannot allow patient safety to be an add-on, or an afterthought. For that reason, the Bill puts safety at the heart of the NHS and not at arm’s length, which is how it is currently arranged.

Currently, the NPSA’s core function is to improve the safety of the NHS by promoting a culture of reporting and learning from adverse events. It does that primarily through the patient safety division, which runs the national reporting and learning systems. Functions of the organisation, while necessary in the system to support wider quality and safety improvement, do not of themselves need to be reformed at arm’s length from the Department. Safety is a key domain of quality and will therefore be a central priority for the commissioning board. Patients rightly expect that any service provider within the NHS, and funded by the NHS, should be safe.

The hon. Gentleman’s suggestion that somehow this is an example of fragmentation, is really nonsense. Clause 19 inserts new section 13M in the National Health Service Act 2006 to make provision to give the NHS commissioning board responsibility for the functions currently carried out by the NPSA: the collection of information about patient safety incidents, the analysis of that information, and the sharing of the resulting learning with all providers of NHS services—those who contract with commissioning consortia, or directly with the NHS commissioning board. There is a notion that having those functions in a nominally arm’s length body somehow makes them more effective than bringing them right into the core of commissioning activity and leadership within the system, which we think is a far more powerful way of driving a safety agenda through the NHS.

Let me address the question from the hon. Member for Halton about what will happen to the NPSA. We now know of the power the national reporting and learning system has for driving improvements in the safety of services; the NPSA’s national reporting and learning system is the most comprehensive system of its kind in the world, and we will preserve and improve on it. There is no intention for that system to be jettisoned as part of the transition.

The hon. Gentleman also asked about staff at the NPSA. The NPSA is working with its board and the Department of Health to ensure that a robust transition plan is in place to help protect staff. The NPSA has offered various forms of support to its staff, and, in December, embarked on a consultation with staff on the detail of proposals for staff. Indeed, the hon. Gentleman referred to paragraph E104 of the impact assessment. If we read on, it notes:

“Furthermore the transfer of staff to the NHS Commissioning Board will ensure that expertise in patient safety is retained and the commitments outlined above”—

in that clause of the document—

“will ensure that the role of patient safety - and the importance that patients place on safety under the NHS care - are maintained.”

That is an important part of the impact assessment, which it is right to refer to in this part of our proceedings as well.

I was asked when the functions will be transferred. The NHS commissioning board is unlikely to take on NPSA functions until early 2012. Abolition of the NPSA is expected to take place on 31 March 2012. Therefore, the suggestion that it will take place in September 2011 is no longer the case. Following discussions with the shadow chief executive of the NHS commissioning board, it has been decided to make clear, to ensure—

Derek Twigg rose—

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Let me finish. This is a change from what has been said before, which is why I want to make it absolutely clear. The reason for the change is to ensure continuity through all aspects of the transition, and to ensure that moves to the NHS commissioning board are done in an orderly fashion. Let me, therefore, move on to deal with some of the other specific ingredients of that transition, and where things end up.

Derek Twigg (Labour, Halton)

Just to be clear, paragraph E97 states that the transition will happen by September. I accept that these things change. The Minister has just said that it will now happen in 2012. What led those who wrote the document, and the Ministers who approved it, to think that the transition could be made by September 2011?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The thinking was that it was a task that would need to be dealt with at an early stage in the preparations of the NHS commissioning board. We have now taken the view that to maintain continuity in service and to work through the issues of staff transfer, it makes more sense to work on the basis of 31 March 2012 as the point at which the National Patient Safety Agency is abolished.

I was asked some questions about the National Clinical Assessment Service, the patient safety division, the National Research Ethics Service and the national clinical audit and patient outcomes programme. The patient safety division, which both reports on and learns from serious patient instances, should move to the NHS commissioning board as a patient safety sub-committee of that board, covering the whole function from getting evidence to working up evidence-based services. That will provide an opportunity to preserve the synergy between the learning and operational practice that already exist in the system. We are engaging with the National Patient Safety Agency to discuss the transitional arrangements for the patient safety division.

In respect of the questions about the National Clinical Assessment Service that were asked by the hon. Member for Leicester West and my hon. Friend the Member for Stafford, I have to say that the service is widely valued by doctors, dentists and pharmacists. However, there is an expectation that revalidation of the medical profession and other incentives in the system will reduce the need for such a service in the future. The National Clinical Assessment Service will become self-funded, and the Department intends to agree a date with the service for achieving that self-sufficiency.

Reference was made to the National Research Ethics Service, which helps to protect the interests of patients and research participants in clinical trials and facilitates and promotes ethical research. It also recognises and authorises research ethics committees that approve individual research applications. We propose that the future of the National Research Ethics Service is considered as part of the wider Academy of Medical Sciences review of research regulation with a view to moving the function into a single research regulatory body in due course.

The hon. Member for Pontypridd asked about the National Patient Safety Agency’s work in respect of clinical audits and so on. Currently, there are three confidential inquiries to provide learning about what went wrong in adverse health care incidents. In future, the inquiries would sit with the national clinical audit and patient outcomes programme, which consists of 30 individual national clinical audits managed on behalf of the Department by the Healthcare Quality Improvement Partnership.

Finally, let me come back to the over-arching point about patient safety. We are developing outcome measures for patient safety so that everyone can see how the NHS is performing and organisations can be held to account by the people they serve. My hon. Friend the Member for Stafford asked about the inquiry and the Francis report. I reiterate the point that I made to him previously. We are listening to that inquiry.

Owen Smith (Labour, Pontypridd)

Wales?

John Pugh (Liberal Democrat, Southport)

The Minister said at one point that if someone is a whistleblower, it is at least probable that they will want to refer to a commissioning body rather than to an arm’s-length organisation. There is no either/or in this. I was slightly concerned by what he said. I am well aware of a specialist commission in which there are serious accusations of incompetence on the part of surgeons. I am also aware of allegations that these whistleblowers have been treated extraordinarily badly within the organisation.

It is obviously very important that a whistleblower with an honest concern should find it easy to blow the whistle when appropriate. The whistleblower can do one of two things. First, they can blow the whistle and get in trouble with their own provider, which is a tough choice to make, especially if they are not guaranteed anonymity or protection. I can cite a number of whistleblowers who have been offered anonymity but that anonymity has been betrayed by the provider.

Secondly, given the scenario laid out in the Bill, the whistleblower can report to an organisation that directly commissions the particular service. I am not certain whether that will make a whistleblower more or less confident to do the important job of whistleblowing. The Government have made appreciable progress and their rhetoric gives the impression that they genuinely wish to make it easier for whistleblowers to report errors.

I may be asking for too much, but I wonder whether there is sufficient evidence to suggest that people are more comfortable going to a body that provides the wherewithal—the funding or the cash—for their organisation, even if it is one of its sub-committees, or going to a completely independent body. The hon. Member for Leicester West made that point, but it was not quite answered by the Minister, who seemed to suggest that that might be an alternative. However, it need not be an either/or if the net effect is that fewer whistleblowers feel secure in what they endeavour to do.

Owen Smith (Labour, Pontypridd)

I want to come back in, because the Minister did not answer my question about Wales. Other members of the Committee with Welsh interests may not be concerned about having an answer, but I absolutely am. I am very keen to hear who will be responsible for paying for services in Wales that were previously carried out by the National Patient Safety Agency.

Derek Twigg (Labour, Halton)

I welcome some of the things that the Minister said, but we still have serious concerns. The fact that the Government got the date wrong—the change was intended to happen by September 2011—is a serious concern, as we are talking about national patient safety. It is worth repeating, so that we can understand this, that the Government stated:

“The work of the PSD relating to reporting and learning from serious patient safety incidents will move to the NHS Commissioning Board as a Patient Safety sub-committee of the Board. This is intended to happen by September 2011.”

We have now heard that that will not happen until September 2012, and I would not put money on even that being the date. If they can get that wrong in their impact assessment, that is a serious issue that raises more concerns about their going apace with the whole process.

We are told that that is what the Bill is all about, but we have to examine the fragmentation caused by the Bill, the pressure brought about by both the reorganisation and the monetary constraints on people, and the speed at which the Government are trying to take the changes forward. That is why we have had this debate. We have found out only one nugget of information on one or two other interesting issues. I am interested to hear what the Minister has to say on the points that have been made, as we have serious concerns. Unless he can convince us otherwise, we will vote against the clause.

Mike Hancock (Liberal Democrat, Portsmouth South)

For the third and last time, I hope, I call the Minister.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I will be brief, not least because we are expecting one or two Divisions at 3 pm, and there are still 20 clauses and two groups of new clauses to be dealt with. As a result, we may not manage to get to them all.

Patient safety is an important issue, and hon. Members are right to want answers to their questions. The hon. Member for Pontypridd asked about Wales, and I confirm that we have agreed the provisions in the Bill with the Welsh Assembly Government and that we are working closely with colleagues in Wales to ensure that both the transition and future arrangements are adequately managed.

On reporting, health care professionals working in the NHS have not only the right to protection in law, but a fundamental professional duty to raise with their employer any concerns they may have about the quality of patient care. They should feel free to raise legitimate concerns within their organisation and be supported when they do so. The Government have made it clear to NHS organisations that they should have policies and procedures in place to support and encourage staff to raise legitimate concerns, which should be acted on. We want to see a culture in the NHS in which whistleblowers can come forward and raise legitimate concerns without fear of repercussions or reprisals.

Of course, we are not changing the system that people can use to report such concerns; we are merely moving the function back into the heart of the NHS, where it properly belongs. How people access that function and make their reports is not changing. In that sense, people should have no doubt about how they discharge their responsibilities to patients. If my hon. Friend the Member for Southport writes to me about the details of that case, I will be only too happy to follow those matters up with him subsequent to our deliberations.

My final point is on the question asked by the hon. Member for Halton about the change of date. We are in one of those “damned if you do, damned if you don’t” situations, where if we had more detail—

Derek Twigg rose—

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Let me finish the point. If we had more detail, we would be condemned for having rushed it, having far too much detail and prejudging things. However, when we do not have a level of detail and we come to an initial interim timetable, we are condemned for not having enough detail. The Department of Health has received an early business plan from the NPSA—

Derek Twigg rose—

Paul Burstow (Liberal Democrat, Sutton and Cheam)

No, I will not give way until I have finished this point, if the hon. Gentleman will forgive me. The Department of Health has received an early business plan from the NPSA. The proposed transition will be in September 2011. When tested, it was clear that more time was required for the NHS commissioning board to determine how to deliver these functions. Early 2012 was a more appropriate date. In other words, we are ensuring continuity of service during transition. That is the right and proper thing to do with the reorganisation that we are going through.

On the hon. Gentleman’s suggestion about pace, all I would say is this. We published the White Paper last July and consulted extensively. There were 6,000 responses. We had a Command Paper in December and the Bill was published this year. That is not rapid. The hon. Gentleman may want to paint that picture, but it is not a true characterisation at all.

Derek Twigg rose—

Mike Hancock (Liberal Democrat, Portsmouth South)

Very briefly.

Derek Twigg (Labour, Halton)

I was not going to come back in, but now I feel that I must. If more time is needed and if what was done in the beginning in terms of the date will not work out as intended, of course we welcome the fact that the measure has been delayed. We are talking about the Government’s impact assessment, which is supposed to be well thought out. What is the point of an impact assessment, if the Government do not think of the issues that will result from what is being proposed?

The Minister talks about the time scale, but it was not until the details—the Bill and the explanatory notes, whatever they are worth—were produced that people realised what the Government’s changes were about. They wanted to rush the Bill into the House of Commons as soon as they could, but they will not rush it to Report.

Mike Hancock (Liberal Democrat, Portsmouth South)

We have a decision on whether clause 261 should stand part of the Bill.

Clause 262

Derek Twigg (Labour, Halton)

This clause is important. The explanatory notes state that the organisation mentioned in the clause title supports the NHS in analysing its current practices against best practice and implementing changes to achieve better results. What we have been talking about in terms of improving quality is paramount to improving patient safety, about which we have had a long discussion. Obviously, a body that plays an important role in analysing current NHS practices against best practice and bringing about changes to achieve better results is very important. It will be interesting to hear what the Minister has to say about the rationale for the measure.

I refer again to the gold mine of information that is the impact assessment. It states:

“An alternative possibility is that the functions remain provided by, and staff employed by, the social enterprise under a contract to provide the leadership for commissioning improvement services directly to the Commissioning Board. It is possible there might be indirect costs from staff due to underperformance from changes. However, it is believed the changes will be small and negligible in cost terms.”

It would be useful to know the Government’s position, because I cannot underestimate the concern of the Opposition about the impact of the changes in the Bill—obviously on patient safety, but also on quality improvements and commissioning. Those are essential elements throughout the health services in terms of clinical care and patient pathways.

We have some concerns about the provision. We have raised concerns about patient safety under the previous clause, so I will not try your patience, Mr Hancock, by going through all that again. It would be useful, however, to hear from the Minister about the rationale and to have my questions answered.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I agree with the hon. Gentleman that the impact assessment is a gold mine of information, and I urge anyone who is closely following our proceedings to ensure that they do not rely solely on the extracts. When it comes to it, they should source everything directly from the document. If they do, they will sometimes get a fuller picture.

As the Committee has already seen, the Bill provides for the NHS commissioning board to have the functions of the NHS Institute for Innovation and Improvement that will support the board in promoting innovation and leading quality improvement. Clause 19 places a duty on the NHS commissioning board to promote innovation when exercising its functions. We also had a recent debate on the role of NICE in promoting innovation. Innovation could be achieved, for example, through the NHS commissioning board’s developing guidance for commissioning consortia, hosting some clinical commissioning networks, where appropriate, and working to encourage a culture of innovation within commissioning organisations.

Clause 19 also provides for the NHS commissioning board to make payments as prizes in order to promote innovation in the provision of health services. Promoting innovation in this way will support the delivery of quality and productivity improvements across the NHS to help transform health care for patients and the public. With the board’s responsibilities around innovation, the arm’s-length body is no longer necessary and that is why clause 262 provides for its abolition. The issue is about ensuring that patient safety and innovation are not subcontracted or at arm’s length, but rather that they are at the heart of what the NHS is about.

Clause 264

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to move amendment 726, in clause 264, page 209, line 25, at end insert—

‘(3A) Nothing in this section shall have the effect of rendering lawful any exchange of information currently prohibited under existing law.’.

Mike Hancock (Liberal Democrat, Portsmouth South)

With this it will be convenient to discuss the following: amendment 727, in clause 265, page 210, line 9, at end insert—

‘(3A) Nothing in this section shall have the effect of rendering lawful any exchange of information currently prohibited under existing law.’.

Amendment 728, in clause 266, page 211, line 9, at end add—

‘(9) Nothing in this section shall have the effect of rendering lawful any exchange of information currently prohibited under existing law.’.

Emily Thornberry (Labour, Islington South and Finsbury)

This group of amendments takes us back to a theme that arose earlier today—it is important that information should be shared, but that should be within the strict confines of existing law. We want specific reassurance about that. Clause 264 requires Monitor to share information with the Care Quality Commission. Clause 265 requires the Care Quality Commission to share information with Monitor. Clause 264 also obliges Monitor to co-operate with the Care Quality Commission in a more general sense.

It is difficult to envisage any circumstances that would require the economic regulator, Monitor, to use patient information to carry out its functions. Therefore we assume that this does not refer to medical records. Would the Minister consider making that clear in the Bill? Amendment 728 makes the same point. Clause 266 sets out which bodies would be subject to a duty to co-operate with another. Although information sharing is not specified in the Bill, the explanatory notes indicate that this duty could take the form of bodies requesting information from provider organisations. The bodies concerned are the commissioning board, Monitor, the CQC, NICE, the Information Centre and strategic health authorities. That potentially enables very wide information-sharing powers without reference to confidentiality or information governance controls.

Once again, it is a matter of looking at the Bill, seeing that it seems very permissive and being rightly concerned about whether the necessary controls are in place. We all know that confidentiality plays an essential role in the relationship between health professionals and their patients. The requirement for confidentiality allows patients to divulge sensitive information to their doctor without worrying that it will be disclosed to others without their consent. If there was any doubt about that, patients might think twice about divulging such information. So could the Minister provide some reassurance that patient confidentiality will be preserved when all these bodies are under a duty to co-operate with one another?

Simon Burns (Conservative, Chelmsford)

I know that the Committee wants to make progress so I will be as quick as I can and, hopefully, provide the hon. Lady with the reassurances that she seeks.

The primary purpose of the information provisions of clauses 264 and 265 is to ensure that the Care Quality Commission and Monitor work together to operate an effective joint licensing and registration regime in a streamlined way. This regime would present a single, integrated process and interface for providers.

The provisions ensure that both bodies assist each other in the exercise of their functions, by sharing information. For example, given that a provider has to be registered with the CQC to fulfil the requirements for holding a licence issued by Monitor, there would be a need for the commission to share information relating to a provider’s registration status with Monitor. That is important in preventing the two regulators from requesting the same information separately, which will reduce demands placed on health care providers themselves.

These duties are absolutely not designed to enable either body to override current checks on the sharing of confidential information. In particular, patient confidentiality is an important principle and is something that everyone entrusted with sensitive information about patients and service users should recognise. Under the Health and Social Care Act 2008, the CQC is prevented from disclosing confidential personal information except in particular circumstances set out in legislation. For example, disclosure is permitted when the information is necessary to protect the welfare of any individual or for the purpose of criminal proceedings. The Bill does not alter that.

In addition, the 2008 Act places the CQC under a statutory duty to publish a code of practice in relation to how it will obtain, use, handle and disclose confidential personal information. The Commission is required to consult with interested parties, such as user and advisory groups, before publishing the code. That remains unchanged.

As the economic regulator, Monitor will not need to collect or make use of attributable personal information. Consequently, Monitor should not require any such information from the CQC in order to carry out its functions, nor should it have any such information to share. Monitor might collect information only in relation to individual cases, such as the costs of particular care, if it is necessary, for example, to carry out economic analysis or to investigate anti-competitive behaviour. In such cases, the information collected will again be non-attributable.

In carrying out its competition functions, Monitor will also be bound by the restrictions on disclosure of information in part 9 of the Enterprise Act 2002. These restrictions would prohibit the disclosure of information—relating to the affairs of an individual or any business of an undertaking—that was obtained by Monitor when exercising functions under the Competition Act 1998, or in relation to market investigation references, except as expressly permitted.

All the bodies bound by the new duties of co-operation in clauses 264, 265 and 266 will continue to be subject to existing rules protecting confidential information. In particular, they will all be subject to the Data Protection Act 1998. The new duties in these clauses do not allow them to share information outside those legal constraints.

The hon. Lady also wanted specific reassurance on whether Monitor might need to see patient records. There is no reason for Monitor to need or see patient records. I hope that that helps her. Monitor may require only information necessary for the exercise of its functions, and patient records would not be necessary for that purpose. For those reasons I hope that the hon. Lady will withdraw the amendment.

Emily Thornberry (Labour, Islington South and Finsbury)

I beg to ask leave to withdraw the amendment.

Kevin Barron (Labour, Rother Valley)

I have a brief question for the Minister. Subsection (3) says that Monitor would have to, on request, provide the Care Quality Commission with any information relevant to it in relation to Monitor’s concurrent competition functions with the Office of Fair Trading. Could the Minister give us an example of what that means, and how competition relates to the Care Quality Commission in the context of the clause?

Mike Hancock (Liberal Democrat, Portsmouth South)

I call Mr Lefroy.

Kevin Barron (Labour, Rother Valley)

He is not the Minister.

Mike Hancock (Liberal Democrat, Portsmouth South)

Patience, Mr Barron.

Jeremy Lefroy (Conservative, Stafford)

I am still a member of the Committee, I think. I want to welcome this clause and the following one. One of the things we learned from the Mid Staffordshire problems was that—in my view and many others’, including, I believe, Mr Francis in the inquiry—the Care Quality Commission and Monitor were not sharing information enough. I think this duty to co-operate is absolutely vital.

Emily Thornberry (Labour, Islington South and Finsbury)

I should like to address the point that the hon. Gentleman just made. Monitor will be changing its function entirely; it may keep its name, but its role will be completely different in future.

Jeremy Lefroy (Conservative, Stafford)

That is true, but it also retaining its role in respect of foundation trusts for so long as they are there.

Emily Thornberry (Labour, Islington South and Finsbury)

That is a moot point. At this moment we cannot debate what powers Monitor will have in the future and where the centre of its work is likely to be—those were concerns raised by the Opposition.

In looking at the clause, and in particular at Monitor’s duty to co-operate with the Care Quality Commission, I wish to hark back to and tie it into the debate that we had on clause 53, on the power to give Monitor functions relating to adult social care services. Essentially, clause 53 sets up the architecture to allow regulation that will, in the future, allow Monitor potentially to set up designated services in adult social care.

How would that impact on the relationship that Monitor will have with the Care Quality Commission, given the CQC’s particular role in relation to social care? They are supposed to co-operate, yet Monitor may enter the field by making decisions as to which organisations will be designated. Since our debates on clause 53, there have been further developments in relation to the chain of old people’s homes known as Southern Cross. They continue to remind us of the importance of this procedural issue, of the vulnerability of many important services and of the potential need for Monitor to designate a large number of them, particularly given the cold wind that is blowing through social care at the moment; it will continue blowing for the next few years.

Simon Burns (Conservative, Chelmsford)

What cold wind?

Emily Thornberry (Labour, Islington South and Finsbury)

The cold wind that will result in at least a £4 billion shortfall in the funding of social care over the period—

Simon Burns (Conservative, Chelmsford)

Oh, please.

Emily Thornberry (Labour, Islington South and Finsbury)

The Minister asked. He can groan as much as he likes, but according to the Association of Directors of Adult Social Services, that is exactly what will happen to social care. [ Interruption. ] I understand from the heckle, made from a sedentary position—from someone who ought to know better—that that is time wasting. If anyone seriously believes that pointing out that there will be a £4 billion shortfall in the money paid to look after the elderly and most vulnerable is time wasting, what is the purpose of our being here?

Mike Hancock (Liberal Democrat, Portsmouth South)

Let us not go down that route, or we will be here beyond four o’clock.

Simon Burns (Conservative, Chelmsford)

I shall not go down that route, Mr Hancock, but in passing I would say that the hon. Lady’s fantasy figures totally ignore the extra money made available for social care in the Budget.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

It would appear on this occasion that the King’s Fund is not being prayed in aid; it published a report a few weeks ago saying that before taking account of efficiency savings the gap would be only £1 billion by 2014, and that once efficiency savings were taken into account there will be no gap. [ Interruption. ]

Simon Burns (Conservative, Chelmsford)

The hon. Member for Islington South and Finsbury must know that she cannot intervene on an intervention. My hon. Friend the Minister for social care makes a telling point. Whenever the King’s Fund can be prayed in aid, we are jumped on with glee by Opposition Members, but in this case the silence is deafening.

Mike Hancock (Liberal Democrat, Portsmouth South)

Order. Can we just slide round to the debate?

Simon Burns (Conservative, Chelmsford)

Indeed I will, Mr Hancock.

We have had a brief but important debate on clause 264. I shall be brief because we got to the nub of the issue when we discussed the amendments. I thank my hon. Friend the Member for Stafford for his brief contribution and his support for the clause. He was right in his analysis. Given his experience as a constituency MP in Stafford, what he said was relevant. The right hon. Member for Rother Valley asked for an example. I am more than happy to give one. The information could, for example, disclose suspicion of poor quality.

The hon. Member for Islington South and Finsbury mentioned social care. In debates on an earlier clause it was made clear that Monitor’s role will not apply to social care until regulations are made. There will be full consultation before that. If Monitor is given functions in relation to adult social care—before anyone gets hold of the wrong end of the stick, that sentence began with “if”—we would expect it to co-operate fully with the CQC on concerns that might arise in relation to the provision of such care. For those reasons, I ask that the clause stand part of the Bill.

Kevin Barron (Labour, Rother Valley)

The Minister did not answer my question. He was trying to tell the Committee that the Office of Fair Trading will have responsibility for the quality of care in the health service. He will correct me if I am wrong. Am I misreading what he said? I did refer to the Office of Fair Trading.

Mike Hancock (Liberal Democrat, Portsmouth South)

The Minister does not have to answer. Does he want to?

Simon Burns (Conservative, Chelmsford)

The right hon. Gentleman asked for an example. I gave an example, which I thought he would be happy about, but if he would like me to repeat it—

Mr Barron indicated dissent.

Simon Burns (Conservative, Chelmsford)

The right hon. Gentleman is clearly unhappy. I am saddened, so I will try again to enlighten his afternoon. For example, providing services below cost in abuse of dominant position could provide evidence of a reduction in quality. That has broadened my original answer, and I hope it satisfies the right hon. Gentleman. Does it?

Mike Hancock (Liberal Democrat, Portsmouth South)

Do not invite him.

The rest of the debate is in Hansard.