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Health and Social Care Bill

I appreciate that that is the point we are discussing. To repeat what I said about the indicators, it is our intention to delegate the function of setting the indicators of quality for English NHS providers to the commission from the outset. We are only delegating to the NHS because local authorities will use the CAA indicators to set their quality indicators. In doing so, we will need to draw on the indicators used to assess commissioner performance so as to align with the outcomes, as I have said. We are therefore unconvinced that Amendments Nos. 75C and 77A, proposed by the noble Baroness, Lady Tonge, and Amendments Nos. 77 and 78, proposed by the noble Earl, are necessary. I am sure that Members of the Committee would agree that it is important that the methods by which the commission will assess performance when carrying out a periodic review are transparent. For this reason, we have included a requirement for the commission to publish its methodologies and indicators used in periodic reviews. We are requiring the method statement and indicators devised by the commission to be approved by the Secretary of State, so that he can maintain oversight and ensure coherence. In particular, these provisions will help the Secretary of State to ensure that the methods proposed do not place an unreasonable burden on those being assessed. Amendments Nos. 77B and 77C are therefore unnecessary. Similarly, I would like to explain the rationale behind the requirement for the Care Quality Commission to seek the Secretary of State’s approval before publishing the frequency of periodic reviews and the period to which they will relate. This is separate from the issue of commencement of special reviews, which we will be coming to later. We agree that the ability for the commission to programme its reviews and studies independently is essential. Under current legislation, the Healthcare Commission and the Commission for Social Care Inspection are required to review NHS bodies and local authorities on an annual basis. We have altered this to allow more flexibility, as I have previously explained, precisely because we believe that the commission itself is best placed to decide on the frequency of periodic reviews. However, there must be effective communication on this matter between the Secretary of State—ultimately responsible for the performance management of the NHS—and the commission. It will surely be beneficial to all concerned if the commission and the Secretary of State agree on the frequency of reviews. For this reason, rather than anticipating that the Secretary of State will interfere, we have included the requirement for approval from the Secretary of State, which Amendments Nos. 79, 80 and 81 seek to remove. Indeed there needs to be a dialogue between the commission and the Secretary of State, and between the commission and other relevant people such as health and social care service providers and other regulatory authorities, on what activity is appropriate and what issues should be seen as priorities. Clause 77 should ensure that service providers are aware of the work programme that the commission will be undertaking. This requirement to consult will be particularly important because there has been some criticism about the burden that may be placed on providers, particularly the NHS, where studies or reviews require new information to be collected. We wish to ensure that the work of the commission does not impose an excessive burden on those being regulated, and therefore has a proper balance. We have discussed these issues with both CSCI and the Healthcare Commission during the preparation of the Bill, and they agree that this is an appropriate arrangement. I therefore cannot agree to Amendment No. 107. Crucially, the Secretary of State is given no power to prevent the commission from undertaking the activity it decides is appropriate. The commission may undertake any investigation, regardless of whether it is in the proposed programme, if it considers there to be a risk to the health, safety or welfare of persons receiving health or social care. I am unable to find where in the Bill there is a power for the Secretary of State to modify the CQC’s reviews and reports, as referred to by the noble Baroness.