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Health and Social Care Bill

As Members of the Committee have so effectively set out, because of its role in regulating both public and independent sector provision across the health and adult social care sector, the commission will be ideally placed to carry out reviews of the quality of care delivery across an entire clinical or care pathway, as my noble friend Lord Harris explained so well. Clause 44 allows for exactly that, and I agree that this is a crucial role for the new commission, hence the clarification in Clause 2(2)(b) that the commission’s functions include its review and investigation functions under Chapter 3 of the Bill. I therefore believe that the provisions in the Bill as drafted already achieve the intention behind Amendment No. 82. Clause 44 also does not limit what special reviews and inspections may relate to. It allows the commission to look at any aspect of NHS or adult social care provision. As such, I believe that reviews or investigations could encompass any of the types of issues that might arise from the commission’s agreed objectives, as proposed by Amendment No. 87. Not only will the Care Quality Commission have the freedom to determine when and how to conduct reviews or investigations under this clause but also it will have greater powers than the Healthcare Commission currently has. The new commission will be able to act directly where a registered provider is not meeting the levels of safety and quality that users are entitled to expect. Where initial action appears to be having no effect, there will nearly always be room to escalate the matter and introduce stronger sanctions to suspend or cancel registration. As discussed, the commission might act following an inspection of an individual provider, or on concerns that arise as a result of a wider periodic or special review. We would of course also expect NHS organisations to take account of broader issues arising from the commission’s reviews and investigations. It should surely be for the NHS bodies to determine the most appropriate action to take, taking account of local needs and priorities. Primary care trusts, as commissioners of local services, and strategic health authorities as performance managers will hold the NHS to account for the quality of provision and whether it meets local needs. Clause 49 already provides the necessary channel for the commission to escalate concerns, or make specific recommendations about the actions that it feels the Secretary of State should take to address those concerns. That could be particularly helpful where the commission has concerns across a health and/or adult social care economy, where the commission cannot already act itself. That is an issue that the Healthcare Commission, in particular, has raised. I realise, however, that Members of the Committee remain unconvinced that the wording of Clause 49 is explicit enough, and I am therefore happy to look again at how we can clarify that the commission is able to make recommendations to the Secretary of State on issues including—