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Duncan Hames says LibDems seek cap in health Bill on private work in NHS hospitals

Duncan Hames, LibDem MP for Chippenham, has told Marlborough News Online that the LibDems are working hard to write into the Health Bill a cap on the amount of private work carried out in NHS hospital trusts.  If this demand does not crystalise during this week’s debate in the Commons, they will pursue it in the Lords.

Hames told Marlborough News Online: “The area about which most people have written to me is ensuring some kind of cap on the amount of private health care within NHS hospital trusts.  We’re seeking to have some safeguards to achieve that cap.  We shall be interested to see what attention is given to that [in the Commons debate.]”

He emphasised that LibDem MPs and Peers were working closely together on the Bill and would be pressing their case for a cap when the Bill reaches the Lords.  However he is clear that LibDem MPs will be voting for the Bill:
“We got a lot of changes to the Bill over the summer.  We need to support the government amendments to achieve the third reading.”  The vote on the third reading is today (September 7).

We wanted to ask Mr Hames for his views on the Bill because the new Clinical Commissioning Group (CCG – replacing the Primary Care Trust or PCT) covering the Marlborough area stretches from Ramsbury to Corsham and so includes much of his Chippenham constituency.  And, of course, the LibDems have been instrumental in changing the Bill.

One of the LibDems' main beefs about the NHS has been its lack of democratic accountability and they were successful in getting into the coalition agreement their policy of having elected members on PCTs.  That was in May 2010.  By July 2010, when Mr Lansley’s White paper came out, the abolition of the PCTs was set in stone and any shred of democratic legitimacy lost.

Duncan Hames believes that democratic accountability will now come via the new Health and Wellbeing Boards (HWB) which will be based with local authorities - in our case Wiltshire Council.  The boards’ role has been strengthened following the re-think on the Bill.

“The form of democratic accountability is through elected members on the HWBs. … They will oversee strategy, making critical decisions in setting out what we’re going to provide for the people of Wiltshire.” The elected members will be councillors and Mr Hames says that the greater role given to councils in the provision of health services “is long overdue.”

These boards will have the right to refer back any local commissioning plans that are not in line with the HWB strategy.  This has put another layer of oversight onto the CCGs.  Are doctors happy with this?  “Commissioning services within a budget is never easy, it’s a hefty challenge.  But since the pause, it’s a good thing that clinicians are right at the forefront and the groups are now more broadly based.”

After the ‘pause and re-think’ process, the government decided HWBs should have more members of the public on them.  But it seems that the boards’ only elected members will still be councillors.

Other members will be local authority officers, clinicians from the CCGs and patient representatives – the latter will be from the new Local HealthWatch organisations which are to be run and funded (with non-ring-fenced funding) by local councils.  It is not yet clear how these HWBs will access the sort of expertise and detailed knowledge of local health care needs currently available in the PCTs.

Duncan Hames was successful when the Bill was first considered in ensuring that the new commissioning groups – now run mainly by doctors – would be subject to the Freedom of Information Act.  Will the increasing number of private, commercial firms working for the NHS have the same sort of transparency – and transparency was one of the key elements promised in the White Paper?

It has been alleged by critics of Mr Lansley’s restructuring that commercial confidentiality and competition rules will override transparency.  Mr Hames told Marlborough News Online that as these private providers would be operating “with money coming from the NHS budget we can expect the NHS to demand high standards of transparency.”

Is Mr Hames optimistic that the promised savings on NHS bureaucracy will be achieved? “I am.  The NHS is not having its budget cut: whilst there is a tighter financial regime, there is scope in an organisation of that size to make further efficiency savings.  We are not allowing that to interfere with local democratic accountability.”

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