Discussion included the governance and financial responsibilities of the NHS Commissioning Board and the new clinical commissioning groups (CCGs) – which from 2013 will commission and purchase health and care services in local areas in England.
An amendment seeking to ensure ‘sound and open’ assessment of the competence of clinical commissioning groups before they undertake the commissioning of services was defeated.
The amendments debated concerned clauses 21 and 22 of the Bill. Committee stage continues on Monday 5 December.
Lord Warner, former Health Minister (2003-06) and chair of the Social Care Funding Commission, who moved amendment 159 explained: ‘The Bill should make it absolutely clear that a demonstration of competence should be mandatory in submitting an application. If I can put it crudely, we do not want to see people taking a punt. They have to be able to demonstrate that they can actually do the job, otherwise public money and safety will be put at risk.’
Seeking to test the opinion of the House – insist on a vote on the amendment – Lord Warner, said: ‘The problem of healthcare commissioning in this country has actually been the lack of competency. That has been the problem for 10 to 20 years, under successive Governments ... I am interested in having in the Bill that the critical requirement of becoming a clinical commissioning group is competency to do the job, and that the board is required to specify what those competencies are, before people make an application.’
The House of Lords defeated the amendment by 106 votes to 46.
Amendment 327ZB, moved by Baroness Bakewell, to insert a new clause to establish the new role of Commissioner for older people was also debated, together with proposals looking at how effectively NHS services meet the needs of older people.
On Monday 28 November, the Health Minister, Earl Howe, told the House of Lords that the Department of Health would appeal the Information Commissioner's ruling that the Government must release the transition risk register, covering risks relating to the implementation of the NHS reforms under the Bill. Earl Howe was responding to a request for clarification on the Information Commissioner’s decision by Baroness Thornton.
Debate continued to focus on Clause 20, which sets out the mandate of the NHS Commissioning Board – a new independent body that will allocate resources and provide commissioning guidance.
Explaining the decision to appeal the Information Commissioner’s ruling, Earl Howe said that risk registers of this type functioned to allow the freedom ‘to think the unthinkable and record potential risks and mitigations fully, frankly and with absolute candour.’ Publication of the information ‘would be likely, in the future, to undermine the very purpose for which a risk register of this sort is produced, and thus directly threaten the successful implementation of government policy.’
Opposition spokesperson for health, Baroness Thornton, who sought clarification on the Information Commissioner’s ruling during debate on 14 November, expressed disappointment at the decision. Thanking Earl Howe, she said she reserved the right to ‘return to the issues in due course.’
Baroness Williams of Crosby and Baroness Finlay of Llandaff were among Members of the Lords who put questions to the Minister on the decision.
Lord Butler of Brockwell expressed concern about the precedent publication would set for all other risk registers. ‘Once this case is conceded it will nullify the effect of all risk registers across government,’ he said.
Proposals for changes to clause 20, setting out the NHS Commissioning Board’s mandate, discussed included:
- 109A, moved by Lord Butler of Brockwell, which sought to require the publication of guidance on standards for clinical commissioning groups
- 133ZA, moved by Lord Patel, sought to set out duties regarding the education and training of the health care workforce, including the specification of a minimum number of training places.
About the Bill
The Health and Social Care Bill, which aims to modernise the NHS:
- changes how NHS care is commissioned through the greater involvement of clinicians and a new NHS Commissioning Board
- introduces new mechanisms to improve accountability
- empowers patients to increase their voice and involvement in their care
- gives NHS providers new freedoms to improve quality of care
- establishes a provider regulator to promote efficiency.
In addition, the Bill will underpin the creation of Public Health England, a new integrated national public health organisation, which will support the provision of local services and take forward measures to reform health public bodies.
Committee stage: line by line examination
The Bill is scheduled to receive 14 days of committee stage scrutiny in the House of Lords.
Second reading: main debate on the Bill
Two of the largest House of Lords votes for over a decade took place during the second reading – debate on the main principles of the Bill – which took place over two days with 102 Members of the Lords taking part – on 12 and 13 October.
Detailed line by line examination of the separate parts (clauses and schedules) of the Bill takes place during committee stage. Any Member of the Lords can table amendments to make changes to the Bill.
Amendments can allow the House of Lords to make revisions to Government Bills (plans for laws). Members of the Lords, often with specialist knowledge or experience of the subject, submit amendments to explore possible effects of the planned law and the policy that lies behind it.