Health Policy InsightEditor's blog Thursday 24 March 2011: If consortia are just PCTs, why didn't the Bill just say so?
Cats are wriggling their way out of badly-drafted bags.
The uncorrected Hansard of Tuesday's health select committee session with Our Saviour And Liberator Andrew Lansley and DH colleagues is now online.
Dame Barbara Hakin told the committee, "the consortia will be an NHS body very similar in constitution to a PCT - not in the way it operates but in its overall constitution".
Eh? You mean consortia are just revamped, shrunk PCTs?
OK, let's spot the differences.
PCT boards have to meet in public.
Consortia boards don't have to meet in public. (Or in the words of committee chair Stephen Dorrell to Our Saviour And Liberator, "it is slightly odd, isn’t it, to have the commissioning authority in the hands of the consortium without an obligation to meet in public?")
PCTs are accountable to the NHS chief executive and accounting officer, NHS Supreme Soviet Chair Comrade Sir David Nicholson, who is accountable to Parliament.
Consortia will be accountable to the NHS Commissioning Board chief executive NHS Supreme Soviet Chair Comrade Sir David Nicholson, who ... hang on ... do you see what they did there?
So consortia are basically just less accountable PCTs (which is in itself quite a feat).
Except there are more of them.
Without the previous resources (as NHS management spend is being cut by 45% by 2014-15, remember).
Working at more variable, non-LA-coterminous scale.
And they're new organisations.
In addition to which, as new CHKS research for Health Service Journal suggests, PCTs may be really starting to improve demand management - not before time, but you take what you can get.
That's the same PCTs being abolished.
I mean, what could possibly go wrong with that?
To EU or not to EU? Open government alert!
Read this exchange:
Valerie Vaz: Secretary of State, that might be correct but, to clarify, have you taken legal advice on the compatibility of the Bill and EU competition law? It is just a simple question.
Mr Lansley: You will forgive me for saying that those who have been responsible for the production of legislation will realise that all legislation is drafted and progressed on the basis of legal advice. Of course it is.
Valerie Vaz: What does that advice say?
Mr Lansley: That’s not the point. The point is-
Valerie Vaz: No. What does the advice say?
Mr Lansley: Minsters, here and in Committee, have set out very clearly to the Public Bill Committee-and I am telling you now-what the legal position is.
Valerie Vaz: Which is?
Mr Lansley: That the Bill does not-
Valerie Vaz: Is it compatible or not?
Mr Lansley: The Bill does not change the extent or application of either public procurement rules or EU and domestic competition legislation. It is simply-
Valerie Vaz: Is it compatible with EU competition law?
Mr Lansley: That is not a meaningful question. Since EU competition law has direct effect, it cannot not be because EU competition law simply applies.
Valerie Vaz: I just asked the question. I don’t expect you to put me down. I am asking a simple question. Is it compatible with EU competition law, and could you publish the legal advice?
Mr Lansley: It’s a meaningless question.
Valerie Vaz: It is not a difficult question.
Mr Lansley: EU competition law applies now and the issue of the extent to which it applies is a question you would have to ask the EU competition authorities. The point is that, literally, our legislation cannot affect the extent of EU competition law. It can’t do it.
Valerie Vaz: Could you publish the legal advice?
Mr Lansley: It can’t do it because the EU itself determines the extent of EU competition law.
Valerie Vaz: Then could you publish the legal advice?
Mr Lansley: There is no need to do so because I have just explained it.
Valerie Vaz: Why? Do I have to make an FOI request?
Mr Lansley: No. There is no need to because, actually, that is it. That is it.
Valerie Vaz: Is it not in the public interest to publish the advice?
Mr Lansley: You are making a-
And then this one:
Valerie Vaz: On the Ipsos MORI poll, which apparently hasn’t been published by the Department, that was out in the autumn of last year, is it possible to put that on the website instead of the 2007 one?
Mr Lansley: You mean-
Valerie Vaz: The levels of satisfaction with the Health Service.
Chair: This is a Sunday newspaper story that apparently you have suppressed a piece of good news.
Mr Lansley: You mean I didn’t publish it in circumstances-
Valerie Vaz: We don’t always believe what is in the papers, do we?
Mr Lansley: -where my predecessors didn’t publish it either? It is that sort of allegation.
Valerie Vaz: There was an election in May, wasn’t there?
Mr Lansley: As I understand it, it is a piece of work which has been done on a regular basis for Ministers. As it was not published by my predecessors, it is not my intention to publish it.
Valerie Vaz: It was only out in autumn 2010, I understand, but I do not know.
Mr Lansley: Did you say "out"?
Valerie Vaz: I don’t know. That is the question I am asking. I don’t know what goes on in the Department. That is why you are here and that is why we are asking you the questions.
Mr Lansley: It is part of the process of development of policy advice to Ministers. It was not published by my predecessors when it was done in previous years, 2009 and 2008, and it is not my current intention to publish it. If you want to know what Ipsos MORI have done, I point you to work they did for the Nuffield Trust and which was published just a week or so ago.
I would say that was defensiveness. Wouldn't you?
I wouldn't say it's open government, with a presumption to transparency. Would you?