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Health and Social Care Bill

I strongly support the purpose behind Amendment No. 106, which was moved so ably by my noble friend Lady Murphy and to which I added my name. It is important to see the amendment as a probing amendment, because I do not think that any of us feels that we necessarily have the words precisely right. I spoke about this at Second Reading very much from my experience on the receiving end of the services of Monitor. I shall not repeat what I said then, but I do want to make a few points. It is significant, and perhaps rather shocking, that the consultation document, the subtitle of which is ““The future regulation of health and adult social care in England””, makes no mention of Monitor, the independent regulator of nearly half the provider health trusts in this country. I checked this with the Bill team and with Monitor, and I think it is true to say—have you found it since, then?—that none of us could find any reference to it. If someone has found a little reference to it, it is obviously very well hidden away. None of us could find it the other day. This lack of attention suggests that the potential confusion and double jeopardy in the future system were not adequately taken into account by those people who planned this legislation. No one anticipated the serious issues which could arise when a failing trust finds itself under scrutiny by two regulators who will be fighting between themselves about whose warnings, and sanctions should be used to bring the trust into line. What a time to have confusion. I understand that the noble Lord, Lord Darzi, fully understands the risks of this double jeopardy and the need to do something to avoid potential problems. But why does this issue give rise to such concern? It is that we risk damaging what in my view is the best regulatory system that the NHS has ever had. That is rather a strong comment to make, but I have been around, in and out of this system, for about 25 years. The system of regulation by Monitor is incredibly effective, in my view, not only in ensuring the financial viability of the trust, as the noble Baroness, Lady Murphy, said, but also in raising standards. I will not repeat the extraordinary impact on my own trust of raising standards—I covered all that on Second Reading. Therefore, for me, this is the first time that the regulatory system enables high-flying managers to get on with the job, to think laterally and to innovate without the dead hand of bureaucracy eliminating all initiative. I have to say that that is how it has felt to me, as a member of boards in the NHS for many years. I cannot overemphasise the importance of that aspect to the quality of services that the NHS is going to provide over the years ahead. It is the more important when foundation trusts will, as we know, become the norm in the NHS as regards providers. If a board underperforms, I am clear that Monitor will micromanage the organisation until the Government’s failures have been put right. But if a board does well, if the financial position is strong and if reports from service users and the Healthcare Commission show that services are good and improving, Monitor will take a careful view, monitoring quarter by quarter how it is doing, and pick up any change. My trust is under obligation to report to Monitor any significant change in it: for instance, a change of chief executive; a change of chair; a difference in our financial systems; and a poor report from the Healthcare Commission on a particular aspect of our service. If it did not report those matters to Monitor, it would be seen to have failed and it would come under very close scrutiny. We are left in no doubt about those things. It is therefore a very robust system when it needs to be, which to me feels right. I want also to emphasise that the relationship between Monitor and the Healthcare Commission appears to work well. From the receiving end, you do not get a sense of confusion in those bodies. But the CQC will have more powers than the Healthcare Commission. I have no objection to that in principle, but the work of Monitor risks being undermined if the powers of the two bodies are not clarified in the legislative framework. It would be a shame if the legislation were to undermine the highly successful regulatory system put in place by our Labour Government. So far, we have suggestions that the CQC will have the power to consult with various organisations. That, in relation to Monitor, would be disastrous. We know that consultation means that you talk and listen to people, but then you can go away and ignore what they have said. I would therefore be most grateful if the Minister would today assure the Committee that either in the Bill or in regulations—one or the other, it is not frantically important, but it would be nice to have it in the Bill—there will be a clear provision to ensure that Monitor’s powers are protected. It should be made clear that the CQC and Monitor are equal and that their powers should be clearly different and complementary.