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Health and Social Care Bill

I absolutely agree with the noble Baronesses, Lady Murphy and Lady Meacher, that Monitor has done a fantastic job in driving improvements in foundation trusts and that the Care Quality Commission and Monitor need to work closely together to ensure that these closely related but distinct roles can be fulfilled. I reassure the Committee that the Bill already provides for those two organisations to share information and co-ordinate their efforts. The provisions mean that the amendment is unnecessary. The first part of the amendment would require the commission to send a copy of any warning notice it served on a foundation trust to Monitor as well. Clause 35 already provides for this. In addition, Clause 66 requires the commission and Monitor to co-operate to carry out their respective functions. In particular, it states that the two organisations must share information with each other. Together, Clauses 35 and 66 will ensure that Monitor is aware of any concerns that the Commission has in relation to a foundation trust. Clause 66 requires no further amendment to achieve an effective working relationship between Monitor and the Care Quality Commission—which is, after all, what we all want; it is essential. We would like them to work out for themselves what that relationship would look like, in the same way that the Healthcare Commission and Monitor developed their own successful working relationship, although we would expect it to be similar to the arrangements in the future regulation of health and adult social care in England consultation document. Furthermore, what especially concerns me is that the amendment risks confusing the different roles of the commission and Monitor. The commission is being established to ensure that all providers of health and social care services maintain the required levels of safety, service quality and governance. Monitor’s specific role is to ensure that foundation trusts are financially strong and demonstrate the quality of governance to operate autonomously as public benefit corporations. In that context, the amendment significantly weakens the Commission’s enforcement powers. It is vital that the Commission has strong enforcement tools that it can exercise independently and swiftly when necessary to ensure the safety and quality of all services. For example, when the commission responds to a safety or quality failing with a warning notice, the NHS foundation trust will be responsible for delivering the necessary improvements. Monitor will work with the NHS foundation trust to ensure compliance, because it will be concerned about the impact of enforcement action on the NHS foundation trust’s ability to operate. Monitor’s powers of intervention are available and will be used if required. If the provider fails to correct the problem, the commission, taking account of advice from Monitor, may undertake further enforcement action to protect patients using the services. Turning to Amendment No. 212, Monitor is an independent body corporate established under the Health and Social Care Act 2003—consolidated by the NHS Act 2006—to authorise NHS foundation trusts and oversee their operation within the statutory framework for foundation trusts. The amendment would make Monitor a Crown body, changing Monitor’s classification from non-departmental public body to non-ministerial department status. We do not support the amendment; I cannot satisfy the noble Baroness. NDPB status gives Monitor independence within its remit while maintaining strong public accountability to Parliament via the Secretary of State. As an NDPB, Monitor has established a reputation for its independence, competence and rigour that is widely recognised. Its classification has not compromised the way in which it operates. We are not aware of any scrutiny of Monitor’s independence nor has its classification become a matter of public concern. Subject to legislation, the CQC will be established as a non-departmental public body. That is the most appropriate structure for that organisation and we do not think it is appropriate to have differing arrangements for the CQC and Monitor. I therefore ask the noble Baroness to withdraw the amendment.