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Health and Social Care Bill

I thank all noble Lords for an interesting discussion. I should say to the noble Baroness, Lady Barker, that we have said several times already that we will take things away and look at them. Indeed, according to my notes, we will be doing that a few more times, so it is not a question of the Government not being prepared to listen. I have listened to the arguments in support of this amendment and I shall explain why we do not want to accept it, but we need also to consider what my noble friend Lord Warner has said. I shall set out why we do not want to change this part of the Bill, but we know that other parts relevant to the issue may need to be looked at. As the noble Earl said, Amendment No. 22 would remove the power for the Secretary of State to issue directions requiring the commission to have regard to particular aspects of government policy. I say at the outset that we are committed to creating a commission that is no less independent than any of its predecessors. Clause 2(4) carries forward the same wording as the legislation that created the Healthcare Commission and CSCI. I refer to Sections 130 and 131 of the 2003 Act respectively, with which my noble friend is probably very familiar. I think that we would all agree that the current bodies have been independent and do not seem to feel any less independent as a result of the legislation that established them. Moreover, I would say that that applies particularly to Dame Denise Platt. Like its predecessors, the Care Quality Commission will be an important player in the broader regulatory framework. If that framework is to have a positive impact on the health and social care that the public receive, the commission will need to work effectively with all the parts of it. Perhaps noble Lords will allow me to explain that. Both the NHS and local government social services are public services with significant political and policy input. In requiring the commission to have regard to aspects of government policy, all that we are indicating is the expectation, with which noble Lords have generally agreed, that the commission will respect the broad direction that government policy is driving towards. In the fullness of time, the commission almost certainly will be critical of aspects of that policy—indeed, that is exactly what it should be—but it is entirely reasonable that, in monitoring and assessing statutory services, we should expect the commission to take account of government strategy and the policy objectives that those services are expected to meet. We need to look at this in the context of the agreement made by the Government yesterday to examine the earlier part of this clause in order to establish the right balance. The relationship is reflected in the detail of the Bill. The Secretary of State will set the registration requirements approved by Parliament and the commission will then produce detailed guidance on what different services should do to comply with those. Similarly, for the commission’s periodic reviews, the Secretary of State will set the overall indicators that statutory services will be assessed against, but the commission will determine the methodology by which it conducts those assessments. Its new enforcement powers will apply to NHS providers for the first time and, although registration requirements will be set out in regulations, the CQC will develop its own criteria and methodology for its judgments. Therefore, we would expect the new commission to take account of government policy without the need for directions to be issued. However, if it did not, I suggest that that would result in inconsistency and confusion for the public, commissioners and providers of health and social care; indeed, it could undermine the credibility of the Care Quality Commission. I do not think that any of us anticipate that that is what will happen. I hope that I have explained where we are. It is unlikely that we would be prepared to amend this part of the Bill, but I ask noble Lords to see what the balance looks like when we have looked at the earlier parts of this clause and then put that in the context of the rest of the Bill.