Clause 100 - Advice

Care Bill [Lords] – in a Public Bill Committee am 4:45 pm ar 28 Ionawr 2014.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Jamie Reed Jamie Reed Shadow Minister (Health) 4:45, 28 Ionawr 2014

I beg to move amendment 166, in clause 100, page 89, line 6, at end insert—

‘(g) professional bodies;

(h) royal colleges;

(i) trade unions;

(j) commissioners;

(k) patients’ groups.’.

Photo of Andrew Rosindell Andrew Rosindell Ceidwadwyr, Romford

With this it will be convenient to discuss amendment 167, in clause 104, page 92, line 7, leave out subsection (b) and insert—

‘(b) relevant commissioners.’.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health)

The amendments aim to make the process for consultation clearer under clause 100, which amendment 166 would alter, and clause 104, to which amendment 167 applies.

The aim of the Bill, as we have said time and again, is to improve patient care. I will continue to say that everything we do must be driven by the principle, and seen through the prism, of improving outcomes for those who rely on our health services, which includes us all. It is not enough simply to want it; we must match our ambitions with what we do in Committee. A political consensus is developing alongside support from professionals, patients’ groups and others that the way to achieve better outcomes is through better integration and better co-operation. As I have argued consistently, the only path to better integration is through better co-operation, and the only path to that is to ensure that strong relationships are facilitated through effective consultation at all stages.

Good consultation is the foundation for all integrated practices; in fact, it is absolutely essential for all services to work effectively together. They need to buy in to what they jointly would like to achieve and to have ownership of the services within their locality, yet the way in which the Bill lays out the framework and guidance for consultation could and should be improved.

Clause 100 deals with advice. Subsection (2), to which the amendment would apply, puts a duty on Health Education England to

“seek to ensure that it receives representations” from various groups in respect of fulfilling its duties under subsection (1). Those groups are simply those it must consult and seek advice from when exercising its functions.

Amendment 166 would make essential additions to the groups that must be consulted. Subsection (2) sets out in general terms who should be consulted, but does not give Health Education England any freedom to consult others. Amendment 166 would add to the statutory consultees professional bodies, Royal Colleges, trade unions representing health care workers, relevant commissioners and patients’ groups.

I am sure we all agree that those bodies contain a significant amount of expertise. There is a danger that the existing drafting of the clause could exclude those groups from giving advice to HEE to assist it in performing its considerable functions under the Bill. I tabled the amendment to seek assurances from the Minister that the groups it specifies will be included. There are assurances in the explanatory notes, but it is not clear that the Bill’s wording matches that intention.

According to the explanatory notes:

“This clause stipulates that HEE must make arrangements for obtaining advice from persons who are involved in, or have an interest in, the provision of education and training. The education and training landscape is multi-faceted, and many organisations have an interest in the development of health professionals, ranging from local employers in the NHS through to national organisations such as the professional regulators like the General Medical Council and professional bodies such as the medical Royal Colleges.”

However, the vagueness of the drafting of subsections (2) and (3) could mean that those groups are excluded. I understand that subsection (3) makes it clear that representative groups can be consulted, but the worry is that HEE would be under no obligation to speak to them. Subsection (3) states that Health Education England may fulfil its obligations under subsection (2) by consulting representative groups, but there is no duty to ensure that that happens.

Will the Minister assure us that, in all cases, professional representative bodies will be fully consulted? Will he explain why that omission has occurred and why there is a difference in the application of subsections (2) and (3)? Why is there no duty on Health Education England to seek representations from representative groups? The amendment is designed to ensure that the intention behind the clause is fully realised, so if the Minister can give us those assurances or undertake to write to the Committee to provide greater clarity, I will see no reason to test the Committee’s opinion on the amendment.

I turn to amendment 167, which has the same underpinning principle as amendment 166. The amendment relates to clause 104(4)(b), which places a duty on a local education and training board to involve the providers that it represents in the preparation of its education and training plans, along with commissioners of health services, health and wellbeing boards and any other organisations that it or Health Education England consider to be appropriate. The explanatory notes state:

“It is important that education and training plans are informed by the local needs of the health and public health system.”

That is a sentiment with which I agree entirely. The amendment was tabled with that in mind, and I thank the Royal College of Physicians for its assistance in bringing the amendment forward. The RCP expressed concerns that subsection (4)(b) refers only to local commissioners. It fears that that may impede regional and national planning, which require input from NHS England and clinical commissioning groups outside the geographical remit of the local education and training boards. Amending the subsection to read “relevant commissioners” would place a duty on local education and training boards to ensure that all commissioners’ plans in their area are co-ordinated and reflect relevant national commissioning plans.

That, in a similar way to amendment 166, would ensure effective consultation could take place with those who need to have input. Subsection (4)(b) currently prevents commissioners outside the area of an LETB from being involved in consultation over the preparation of its education and training plans, which is wrong. I understand that subsection (4)(b) makes provision for a local education and training board to consult other persons it considers to be appropriate, but why not ensure that relevant commissioners are enumerated earlier in the section to make certain that they are involved in the consultation process? I appreciate that I rattled through that, but it was necessary to do so. I hope the Minister can assure us that relevant commissioners will be able to take part in relevant consultation processes, because the better integration of services relies on that.

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health 5:00, 28 Ionawr 2014

I rise briefly to respond, and I hope I can quickly give the hon. Gentleman the assurances that he seeks. Amendment 166 is designed to require HEE to ensure that it receives representations from specific bodies and groups. Clause 100 requires HEE to

“make arrangements for obtaining advice on the exercise of its functions from persons who are involved in, or who HEE thinks otherwise have an interest in, the provision of education and training for health care workers.”

The clause sets out particular groups from which HEE must ensure that it receives representations, specifically:

“(a) persons who provide health services;

(b) persons to whom health services are provided;

(c) carers for persons to whom health services are provided;

(d) health care workers;

(e) bodies which regulate health care workers;

(f) persons who provide, or contribute to the provision of, education and training for health care workers.”

The additional groups proposed in the amendment are already covered by clause 100(2) in the criteria that I have just outlined. Professional bodies and royal colleges are covered by (2)(f). Trade unions are covered under subsection (2)(b), and patient groups by subsections (2)(b) and (2)(c). Subsection (2)(e) makes it clear that HEE may seek the views of representative groups or organisations when seeking advice on its functions.

The hon. Gentleman mentioned commissioners, and clause 99(1)(d), (e) and (f) make it clear that HEE must have regard to the priorities set by commissioners and Ministers across the NHS and public health system when carrying out its functions. In addition, LETBs must ensure that they involve commissioners in the preparation of LETB education and training plans, as set out in clause 104(4)(b). Under HEE, special health authority advisory groups have already been established for professional groups covering medicine, dentistry, nursing and midwifery, the allied health professions, pharmacy and healthcare science. These bring together partners from the professional bodies, professional regulators and trade unions to look at issues related to work force planning, education and training for the professions. HEE also has a patient forum. At a local level, LETBs have established their own networks and partnership arrangements to inform their planning and education commissioning. I hope that hon. Members will feel reassured by this and will feel able to withdraw their amendments.

Amendment 167 seeks to amend the nature of commissioners of health services with whom the LETB must consult from all those in the LETB’s area to those deemed “relevant”. It is important that local partners across the health and care system have the ability to be involved in the development of education and training plans. That is why we made provision under clause 104(4) for providers of health services, commissioners of health services and health and wellbeing boards to be involved in their development. That is part of helping to deliver an integrated approach to healthcare and health and care education, which is so important, given the challenges we face in delivering more care in the community and in people’s homes.

I should also point out that the Bill allows LETBs to involve such other persons as the LETB itself considers appropriate and enables HEE to direct LETBs to involve other persons in the development of its plans. In addition, the Bill is very clear, in clause 104(3), that LETBs must have regard for the priorities of local health care providers, the priorities of commissioners of health services in the area, any assessment of relevant needs relating to the LETB’s area prepared under section 116 of the Local Government and Public Involvement in Health Act 2007 and any joint health and well-being strategy related to the LETB’s area.

Clause 102 makes it clear that the criteria that the HEE special health authority has used to appoint LETBs requires them to demonstrate meaningful and effective engagement with a much wider range of partners across health, public health, social care and the education and research sector. This includes patient groups, students and trainees and the range of professional bodies and professional regulators with an interest in education and training.

Finally, I should also point out that HEE has a clear duty in clause 99 to have regard for the needs of national commissioners, such as NHS England, and any priorities set by Public Health England in the exercise of its education and training functions. I hope that hon. Members will feel reassured by this and that the amendments are unnecessary as the duties and the purposes of those amendments are already fulfilled in the Bill as it stands.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health)

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 100 ordered to stand part of the Bill.

Clause 101 ordered to stand part of the Bill.