Duty of providers to publish information

I beg to move amendment 92, in clause 9, page 6, line 4, after first ‘State’, insert

‘and simultaneously laid before Parliament’.

The amendment provides for greater parliamentary scrutiny of quality accounts by ensuring that they are laid before Parliament at the same time as they are submitted to the Secretary of State. That is an important principle for all parliamentarians, and one to which the Minister should give consideration. It is clear that if quality accounts are to be successful, widespread engagement with them is needed, including by parliamentarians, especially if we are to represent our constituencies correctly.

The amendment would place a responsibility on the Department of Health to lay copies of quality accounts before Parliament. That is clearly not for the purpose of public accountability, as copies will be publicly available locally from the provider, and nationally when we publish them on the NHS Choices website. Public accountability is there. It is open to any Member of the House to access any of the documents that are on the NHS Choices website, so Members will be able to find out what is in the quality accounts.

I cannot emphasise enough the production process that we envisage. Our testing and engagement process has shown that the NHS wants to ensure that quality accounts are a success. The final version of quality  accounts has already been subject to local scrutiny by patients and the public. What will be sent to the Secretary of State will therefore be the best account that can be given.

It is certainly open to any Member of Parliament to request that a particular quality account be placed in the Library of the House. I am not sure that having large numbers of quality accounts from, in due course, every dentist, doctor and health organisation in the country piled up on the table in the Chamber is what is needed. If anyone wants access to a document, it will be easily accessible to Members of Parliament and members of the public, so the level of accountability is actually considerably greater than almost anything else that is available to MPs.

I do not think that it is necessary for the accounts to be laid formally before the House. There will be so many of them that I do not think that that would be the appropriate way to proceed.

In support of my hon. Friend the Member for Hemel Hempstead, the amendment is probably informed by the fact that those of us who share the privilege of being shadow Health Ministers find that much of the difficulty of furnishing ourselves, as would be expected, with the information that helps us to scrutinise and hold the Government to account arises from the fact that so much information is held not at ministerial level or even departmental level, but at SHA and trust level. Very often, we have found that asking written parliamentary questions has not enabled us to elicit that information, particularly on all the various accounts that relate to the wide panoply of trusts. As a result, freedom of information requests have tended to be the methodology used and, as the Minister is well aware, that is a very time-consuming and burdensome operation. What lies behind the amendment is the desire to short-circuit some of the hard slog that is needed just to make the information available, as any proper Opposition should be doing to hold any Government to account.

I am hurt by the suggestion that asking parliamentary questions does not elicit all the information required.

Not always. It is unreliable.

I am also aware that it is in everybody’s interests that Opposition Members, particularly shadow Health spokesmen, are able to do their work. Certainly, we want to ensure that that is the case in future.

I am glad I raised the subject.

Let me take the point on board and consider, with the Secretary of State, whether we can talk to the Library and see whether it would be prepared to take all the documents. They have the information in the sense that it is on the internet, so they have easy access to it. I am sure that the Library would be able to print off from the internet any document and any quality account that is required.

It might not be suitable for the Library to be doing that. The Vote Office, which has publishing facilities and capacity in the House to print off the relevant forms should a Member require that, is probably the logical way forward.

The Secretary of State will have a copy of the quality accounts and we will look at ways to ensure that Members have easy enough access to them. I think that there is easy enough access anyway through NHS Choices. I doubt that there is a need to publish or print them internally in the House, given that they are so easily available, but I will consider what the hon. Gentleman has said.

Is the Minister saying that all of the information will be in one place on NHS Choices? That is fine, because the problem now is that it is held in all the different trusts and collating information is usually very difficult.

NHS Choices will need to have all the reports and make them all available. They will be accessible via the website, so if the hon. Lady wants a report on a trust, the website is the route that I envisage her using. I am not sure whether that deals with her point, but the information should be easily accessible on NHS Choices.

The point is that all the quality accounts information should be in one finite place, rather than listed separately under each trust, which makes it far more difficult to collate and compare.

That is a fair point, and I will take it back to the Department. The hon. Lady seems to be suggesting that not only should the reports be available in relation to other data on particular trusts and other organisations, but that they should be identified separately on the website, so that it is possible to access just quality accounts. That is a reasonable suggestion, and I will talk to NHS Choices about whether that can be arranged.

I thank the Minister for listening to the arguments. The purpose of the amendment was to extrapolate what we have extrapolated. It is crucial to have accessibility to documents in one place, whether in the Library or on NHS Choices, so that we can cross-assess trusts. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

I beg to move amendment 158, in clause 9, page 6, line 6, at end insert—

‘( ) A document (whether in whole or in part and whether alone or jointly with others) made available to the public by the Secretary of State must be accompanied by such information as may be recommended to the Secretary of State by the National Institute for Health and Clinical Excellence with a view to enabling the public to assess the document’s contents by reference to relevant and meaningful standards of comparison.’.

For the first time in the two days that I have sat on this Committee, an amendment refers to NICE and its role in providing better information. The amendment, which was tabled in the other place by my noble Friend Earl Howe, makes a simple proposal. If NICE has relevant information that would be suitable, necessary  and perhaps informative to individual trust users, it should be placed in or alongside the quality accounts, so that the quality improvement focus that NICE may want to recommend would allow the public to understand better the facilities that they receive.

Amendment 158 would impose on NICE a role in helping people to understand providers’ quality accounts by providing further information to allow a comparison between accounts and to oblige the Secretary of State to publish NICE’s guidance. Our view is that NICE is not best placed to provide the comparability tool. That is not its role. NICE provides standards. It does not measure against them subsequently. It sets them.

Having said that, we are looking closely at how to facilitate comparison in other ways. We have given a commitment that quality accounts should be published on the NHS Choices website specifically to allow for informed and meaningful comparisons to be made. We are also considering providing more explanatory material to the public and a toolkit for publishers of quality accounts to draw on to ensure that their documents are reader friendly and to enable comparability by the public. We intend to do that by guidance rather than prescriptive regulation.

One factor in the production process for the toolkit is evaluation of the current quality accounts testing process being led by NHS East of England and Monitor. We expect to have the final report within the next eight weeks. That will help us to identify any problems, and thus solutions, in aiding public understanding of the meaning and import of the information used in quality accounts. That will then inform our consultation on draft regulations and guidance later in the year. We believe that the role proposed in the amendment would not be welcomed by NICE and would not fit easily with its current role in the NHS.

I have listened carefully to the Minister, and although he will not accept the amendment in its present form, it sounds as though work is being done on what NICE could do to help to inform NHS users. With that in mind, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

I beg to move amendment 163, in clause 9, page 6, line 6, at end insert—

‘(4A) A document (whether in whole or in part and whether alone or jointly with others) made available to the public by the Secretary of State shall contain information about the choice of services available to patients.’.

This amendment gives additional provisions for quality accounts and would put the principle of patient choice on the face of the Bill. This is mentioned in the impact assessment, but is not explicit in the Bill due to the emphasis on powers by regulation.

I am sure that the Minister has had time to read the work that the King’s Fund has done on the Bill. They have put forward four suggestions to help us address the points raised in the impact assessment. These are, first, patients and carers should make choices based on better information; secondly, providers and commissioners should determine priorities for improvement; thirdly, the boards  of NHS trusts and non-NHS equivalents should place quality at the heart of their procedures for planning and delivery; and, fourthly, clinicians and clinical teams should evaluate and compare their performance.

Eminent authorities and think-tanks, such as the King’s Fund, would like to see such processes on the face of the Bill. The impact assessment indicated that they would be there, but they are not. Could the Minister assure me that such processes will be addressed even if they are not on the face of the Bill.

Patient choice is important and we want to ensure that it is at the heart of a number of the initiatives that we are taking. The NHS Choices website is the core way in which that data is made available to members of the public. The website has information well in excess of what will be provided in quality accounts. When making a choice of where to have an operation or what medical service to use, NHS Choices is the source for that information. Quality accounts would only be a fraction, a part, a component of the wider information that is provided by NHS Choices. They can look at quality accounts on the NHS Choices website, but we do not envisage that that would be the basis on which all choices would be made.

We need to make clear the limitations of quality accounts as well as their purpose. Quality accounts will help to shape services on offer from each provider and make each provider account for the quality of those services. That is linked to patient choice, but choice is just one of the ways in which providers will be held to account. There has to be broader support for quality accounts coming from our engagement and I am concerned that using them for a purpose for which, of themselves, they were not intended could detract from the objective of improving quality in the NHS. Choice is important, but there are other ways of delivering it. Quality accounts will be a component of the choice equation, but only a part of it.

Perhaps I could clarify a point that I raised in my earlier remarks. I indicated that the four points were from the King’s Fund. I misread it, they actually came from the impact assessment. Even though the Minister seems to disagree with his own impact assessment, I should clarify that point. The King’s Fund was concerned about the passive and limited method for increasing public accountability within the publication. I have listened to what the Minister has said and with that in mind I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

I beg to move amendment 119, in clause 9, page 6, line 10, at end insert—

‘(aa) as to the information technology that trusts will require to measure and report on quality in the quality accounts;’.

We all know that the Government’s national programme for IT is now four years behind schedule and there is little to show for its £12 billion budget. The Lorenzo patient administration system is in use by only three trusts and the Cerner Millennium system is live in four trusts, three of which are using only the first phase of the software. If 96 per cent. of acute trusts are without  a patient administration system, arguably the most fundamental of the national programme for IT projects, one questions how many trusts possess the IT capacity to provide an accurate portrait of the quality of their services. Without the ability to track a patient’s progress through various NHS services and record the outcome of their treatment, trusts will not be able to present accurate information on the overall quality of the services that they provide.

The impact assessment for quality accounts stated that

“any data mandated for inclusion in the accounts is likely already to be collected for other purposes, so no further data collection costs are anticipated.”

However, given the woeful inadequacy of IT provision in the NHS and the recent report from the Audit Commission on the lack of quality in NHS data sets—the report noted an error rate in NHS data of up to 52 per cent.—I wonder if the Government are overestimating the capacity for trusts to measure quality from existing data systems. I am also concerned that the Government’s estimate that there will be no extra costs is, frankly, a little optimistic. Either the integrity of the quality accounts will be—

The hon. Gentleman makes an interesting point and I share his concern. In some fields, it is being made fairly clear that a lack of a consistent data sets means that it becomes almost impossible to compare trusts. Although we had reassurances earlier from the Minister that there will be some flexibility about the way that trusts collate data, any comparison will be meaningless if the data sets are not similar. So there is a bit of a conflict here with what we are doing, which the hon. Gentleman has rightly highlighted.

I am grateful to the hon. Lady, because she raises the horizontal comparison, which is very important. To some degree, what I am about to say slightly goes against my own instinct to have a top-down approach and I dare say that the Minister was revving up to make that rather easy point. However, regarding the horizontal comparison there is a question, as is the case with all IT implementation, notwithstanding our criticism of the current Government project on IT and indeed our own views on how that project can be improved, which will be made public later in the year. One must recognise that there are great advantages in having some standard setting and some protocols, because it is too easy to argue that it is purely a case of rubbish in, rubbish out. That is the vertical comparison.

However, with the horizontal comparison, we are going to need really useful data sets that will drive this process. The Government use the words about this issue occasionally, but I regard it as being fundamentally more central to improving patient healthcare outcomes. That is to use much more of an upward-spiralling motivating benchmark process, which is owned by the internal clinicians. That would be very helpful, but it absolutely requires a fundamentally well-applied, locally-owned IT approach, while at the same time having protocols across certain standards, so that we can get the horizontal data. So the hon. Lady makes a valid point in complimenting the approach that I was trying to raise with the Government.

As I was saying, either the integrity of the quality accounts will be undermined by a lack of reliable data, or the cost of the accounts will far exceed the cost that is outlined in the impact assessment. Hopefully the Minister will take the opportunity to clarify which one of those rather tense scenarios is closest to the truth.

I shall move on to outcomes, which, as I indicated, are surely the most objective indicator of quality. Again, we return to the issue of costs. In March, I asked the Secretary of State for information on the outcomes that are being measured for surgical operations. The Secretary of State for Culture, Media and Sport, who was then a Health Minister, replied that the clinical audit outcomes data for surgery was “limited” and was collected for only six types of cancer surgery and for heart disease. When information on outcomes is so sparse and the technology to collect it is barely present, I fail to see how quality accounts can play a role in improving the quality of NHS patient care without there being further investment in systems to measure outcomes.

The Government have failed to create a framework of technology and data collection that will support trusts in the measurement of quality. Trusts are expected to produce annual quality accounts without having been given the technological and statistical toolkit to do so. It is important that it is a toolkit; it is not an imposition, but a question of making available the right tools to be able to deliver on the job. That situation will lead only to what the impact assessment calls “perverse incentives” to publish an unreliable or misleading document to meet the annual deadline.

I noted in an earlier intervention that the publication date of the quality accounts of April next year raises questions about the trusts’ preparedness for the initiative, not least because they should already be collecting data from 1 April this year, before the Bill has been considered fully and before trusts can assume that they have to. The Minister said on the last amendment group that people tend engage once they know that the law is coming into effect, so they may not be engaging and therefore not preparing for what is already the year of account. I am concerned that this measure is jumping the gun, which the Minister accused me of on Tuesday on the NHS boards. There is a certain reciprocity of argument.

I hope that the Secretary of State will clarify the baseline data from which trusts are expected to analyse the quality of their services for the first year of the scheme. For instance, if trusts are using mortality as an indicator of quality, they will need to compare the mortality rates this year with those of another, as yet unspecified, period. It is unclear how trusts will go about benchmarking services in terms of quality in 2010 when the terms by which the Government define quality were not available to trusts in previous years to benchmark against. It makes sense to delay the publication date of the first round of quality accounts until 2011 when the trusts can compare data from two successive years.

I hope that those points have been heard and that there is recognition that the Government are behind the curve in making the means by which they want to achieve their aspirations come about.

Let us be clear about what is being proposed: regulations should be made to make provision

“as to the information technology that trusts will require to measure and report on quality in the quality accounts”.

If that is not top-down micro-management, I do not know what is. The Opposition have constantly said that they want to give trusts and NHS organisations greater freedom. They are not even in Government yet—if they ever will be—so should not try to get Whitehall and this House to dictate the information technology that trusts require to report quality accounts. They will use various kinds of information technology.

We need to ensure the good quality of the data provided. I agree with some points made by hon. Member for Eddisbury. The CQC will need to ensure that it can use its data for assessing the quality of what particular trusts provide. The hon. Gentleman says that some trusts are not providing the data now, but we have clearly said that we will use the data that are already provided by trusts to the CQC. Trusts are preparing for quality accounts, as they are already providing data to CQC, which is of precisely the kind that we envisage being used for the first set of quality accounts.

In a sense, we are not behind the curve, but well ahead of it. Therefore, there does not need to be any delay in the way in which quality accounts will develop in the course of the coming year. The data are broadly available. We know what we want to do, but we want to consult on the detail of how we will present it, how we will set out the regulations and the extent to which we want core data to be provided to the CQC and in quality accounts. That core data is one of the key issues—how much is core and how much is local? It is important that we get the balance right. I hope that the hon. Gentleman will accept that there is no need for that level of top-down micro-management, as proposed by the Conservative party. I am somewhat surprised that it has gone down that route. I did not expect it to, and I very much hope that, on reflection, it can think again about its top-down micro-management.

As I anticipated, when we reached the substance of the Minister’s remarks, putting to one side the well-rehearsed attempt at a little political banter, he said that he broadly agreed with what I was seeking to do, and I am grateful to him for that. Even the Bill states:

“Regulations under subsection (1) or (3) of section 8 may”— not “must”—

“in particular make provision”.

The Government have a fundamental misunderstanding of how IT projects work. Simply stating an aspiration and then seeking to impose it in a “one size fits all”, does not make happen, as the NHS IT programme has demonstrated. Far from our seeking to dictate anything, as the Minister said, somewhat pejoratively, on the contrary we recognise that IT is a tool that helps to facilitate and enable processes that improve patient health care and social care outcomes.

Indeed, as highlighted by the hon. Member for Romsey, part of what is required, even when going down the quality route of IT applications, is to make available the information and the expectation required so that people can procure the right type of IT to make sure that it is interoperable with all the other aspects of communication channels necessary to build data sets to interrogate and collate and, thus, be useful in policy and, above all, quality audit. There is also the motivational and quality  enhancement process that comes through sensibly applied benchmarking, the horizontal reference to which hon. Lady referred.

I saw that work extraordinarily well in my pre-political career in the manufacturing industry for more than a decade. Through good benchmarking techniques and the provision of sensible IT standardisation without imposing from the top down, quality can really be spiralled up and people engaged in such a process can be motivated rather than achieving that result by means of imposition, in my case from head office, or in this case from Government. I strongly urge them to consider matters with genuine seriousness and make little less of an attempt to deal with such matters on a political point scoring basis.

The matter will be more broadly in context with a number of things. I shall not press the amendment to a Division. That would just be a gesture. More importantly, I have put my argument and I hope that the Government will think more about it. If they really want to make sure that we get some quality accounts, our point must be taken somewhat seriously. I hope that we can revisit the matter, but now I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

With this it will be convenient to discuss the following: new clause 2—Report to parliament on impact of quality accounts—

‘(1) The Secretary of State shall report to Parliament no later than 4 years after the coming into force of Part 1 on the impact of quality accounts.

(2) The report shall examine the methods and technologies employed by trusts to measure the quality of services and collect data for inclusion in their quality accounts.’.

New clause 5—Notification to Parliament of the impact of quality accounts—

‘(1) The Secretary of State shall make a statement to Parliament no later than 3 years after the coming into force of this Part regarding the impact of quality accounts.

(2) This statement shall address the demand for quality accounts from patients and members of the public, the improvements that quality accounts have brought about as provider organisations focus on quality improvement, and the way that quality accounts reflect the healthcare needs of patients served by the bodies listed in Clause 8, subsections (2) and (3).’.

New clause 7—Evaluation of quality accounts—

‘(1) The Secretary of State shall make a statement to Parliament no later than 4 years after the coming into force of this Part regarding the impact of quality accounts.

(2) This statement shall examine the way quality accounts reflect the demographic, social, economic and geographical areas served by the bodies listed in Clause 8, subsections (2) and (3).’.

I shall deal with new clause 2, and my hon. Friend the Member for Hemel Hempstead will deal with the other two new clauses. New clause 2 would make the Secretary of State accountable for the consequences of quality accounts four years after their introduction. At present, there is no mechanism for accountability to Parliament under the Bill, which means that the Government could launch a significant initiative on trusts without any intention of reviewing its impact on Parliament later down the line. If quality accounts  descend into the realm of bureaucracy, trusts need to have an assurance from the Government that they will intervene to tackle the problem. However, if, as the Minister is promising, they will have a substantial effect on raising the quality of services, I am sure that the Government would welcome the opportunity to report on that success to the House.

The second part of the new clause would ensure that the Government’s report to Parliament would examine the information technology needs of trusts producing quality accounts, which is very much linked the point that we discovered in respect of the forgoing amendment. My concern lies once again with the capacity for acute trusts to measure outcomes when they do not yet have a patient administration system to allow them to track the progress of each patient through different NHS services.

The Government have produced a prototype for quality accounts as a template on which trusts can base their quality accounts. As we all know, it is rather charmingly called, “The Sunnyview University Hospital Trust quality report 2008-09”. Unfortunately, I fear that if trusts were to follow this document as an example of measuring quality with any kind of sincerity, their hopes of driving up quality would be as utopian and unrealistic as the name “Sunnyview”.

If we turn to priority 1 in the document—I am sure that other members of the Committee have seen it, as it is part of the documentation behind the Bill—which deals with the reduction of stroke mortality rates, we begin to see some of the problems posed by the measurement of quality. Mortality is not a nuanced measure of quality if the circumstances leading up to the death of each patient are not examined. Strokes are caused by a variety of circumstances and conditions, and each stroke patient’s medical history will differ. By setting clinicians a target of reducing stroke mortality without examination of the care pathway of each patient, the trust will not obtain an accurate indication of quality.

I realise that the Sunnyview document is not intended to be replicated to the last word by trusts, and that trusts are expected to ascertain their own priorities for measurement. However, I can easily envisage a tired and stressed chief executive cutting and pasting information into a document in order hastily to meet the annual quality accounts deadline. What precautions has the Minister taken to ensure that that does not become a prevalent practice among trusts?

My worry is that quality accounts will descend into a rebranded version of targets and will detract from the care of individual patients. If trusts were given the IT capacity to measure patient care from start to finish and to record the circumstances surrounding their condition, and if quality were deduced from that and not from amorphous mortality or infection rates, real progress could be made.

Somewhat harking back to the amendment that we have just discussed, which I tabled, if the Government’s national programme for IT had delivered the systems it promised, acute trusts would already have significant capacity to track electronically a patient’s pathway through services and to measure the outcome of their treatment right the way from their first GP consultation to their  final discharge from hospital. However, the programme is four years overdue, and the information and data that trusts possess on outcomes is patchy and limited to individual specialisms or procedures.

We support a strengthened emphasis on quality in the NHS, but we also recognise that trusts will not be able to measure quality accurately if they cannot track the care of patients along the care pathway. Information systems are a key facilitator—that is an important word—in this, which is why I propose to place a duty on the Government to review IT capacity in trusts after four years.

I hope that the Minister listened carefully to the previous conversation. The fact is that this is not intended to impose IT, which he sought as a defence for not accepting the previous amendment, but to recognise that for any kind of information system that is supported by IT, there needs to be analysis of the standardisation. The intention is not to limit the offering of products, but to ensure that there is at least a quality assurance within the IT systems and an interoperability analysis so that the data classes and the measures which will enable these things to happen will be in place.

With that, I beg leave to move new clause 2.

It is not a question of moving new clause 2. If it were to be moved, it would be at a later stage. You will see from the selection list that the debate takes place now. The debate is on clause stand part, and new clause 2 is considered as part of that debate.

On a point of order, Mr. O’Hara. I was intending to speak on new clause 5, not new clause 2.

The hon. Member for Eddisbury spoke to new clause 2. I was explaining that he was not moving it but simply speaking to it. You may now speak to new clause 5.

Thank you, Mr. O’Hara.

New clause 5 would give notification to Parliament of the impact of quality accounts on the NHS. It would give Parliament an opportunity to scrutinise the implementation of quality accounts within three years of their coming into force. The Secretary of State would be required to make a statement, written or oral, to the House or to the excellent Health Committee, on the demand for quality accounts from patients. He will need to make it clear what improvements have taken place in NHS bodies in those three years and what impact the policy objectives of the quality accounts set out in the impact assessment, which has already been published, has had on the NHS. Finally, the Secretary of State will need to show how these documents reflect the health care needs of patients served by these bodies and the NHS.

I am concerned that the hon. Member for Eddisbury was worried about tired chief executives cutting and pasting things. Let me assure him that there will be no dodgy cut-and-paste dossiers from this Government—[Interruption.] I thought I would get that in before another Committee member did.

New clauses 2, 5 and 7 would oblige the Secretary of State to carry out an impact assessment of quality accounts and make a report to Parliament, covering the manner of publication, impact on services and demographic, social, economic and geographical factors. That is a worthy objective, but we do not need primary legislation to obtain it. It is worth emphasising that the quality of the care offered to patients is fundamental to the delivery of health care. High-quality care is better for patients and offers better value for money for the taxpayer. Despite that, historically the quality of health care has not been as high on the agenda as the discussion of the performance and operational efficiency of the NHS. That brings me back to the narrative that I gave of the development of the NHS, moving from dealing with underfunding, the need to get targets in, to the need to restructure it and now the need to move on to a new, higher agenda that is basically about bringing quality into the NHS as the focus of its activities.

Where elements of quality have received significant attention—for example, in respect of health care-acquired infections or reduced waiting times—we have seen significant improvements. Quality accounts enable quality improvement by promoting local accountability and transparency. They should enable clinical teams to open up dialogue with their community, which means that a large element of the quality accounts will be for local determination. That is why I am a little bit concerned about the requirement for overall reviews that would be brought in under the amendment.

The legislation as drafted provides a broad framework with broad principles, with the details to be determined later and set out in regulations and guidance. The current engagement in the testing processes is shaping these products. We will consult on our regulatory proposals later this year. It is clear at this point that the data required for a quality account are simply the existing service quality data that providers already report to Department of Health commissioners or the regulators. The legislation therefore sets out minimum requirements. There is no added burden on the NHS beyond the cost of preparing the document; all other work is or should be happening already.

The ambition is to make quality accounts a vehicle for quality improvement. That is why we are working closely with stakeholders in designing the format. More than 1,000 stakeholders have been consulted so far, including NHS managers, clinicians and patients. We will, of course, be implementing and developing ideas through secondary legislation. The process obliges us to present evidence of the real-world impacts resulting from our policies. So the sorts of data and information that the Opposition are currently seeking will need to be provided to Parliament, in any event, during the course of developing the detail of our policies on the quality accounts agenda.

The current testing process is the key to what we want to achieve. We have already started evaluating it. The first report will be available in the next eight weeks and will enable us to move to the detailed design phase. Thus, by autumn we will have firm proposals, strong evidence of their likely impact and an engaged and informed provider community waiting to implement them.

The consultation process—design, testing, implementation, evaluation and revision—will continue. One by-product  of that process will be an annual impact assessment over the next three to five years, dealing with the impact of the policy against the wider criteria set out in the provisions tabled by the hon. Member for Eddisbury. That will become apparent when we publish our evaluation later this summer. However, I am happy to give a commitment now that I will ensure that we consider all the criteria in our impact assessments. He need not worry about that. We have taken on board some of the concerns that he has raised; indeed, they are concerns that we had before. Some of the information he requires will therefore come forward, and it is our intention to make an annual impact assessment over the next three to five years in any event. I hope that, on that basis, he feels able to withdraw his new clauses.

It is not a matter of withdrawing them as they were not moved. To be clear, should the Opposition wish to press the new clauses, they would be moved formally later, as they have been debated.

Question put and agreed to.

Clause 9 accordingly ordered to stand part of the Bill.