---

Health and Social Care Bill

My Lords, in Amendments Nos. 34A and 34B, which are grouped here, I turn to an issue that I consider to be of fundamental significance for this part of the Bill and our understanding of what the identity and functions of the Care Quality Commission are. The issue turns on a very basic question: will the CQC be a body that actively promotes the highest standards of care and treatment in health, social care and mental health, or will it merely be a body that seeks to maintain and police a set of minimum standards that are geared to patient safety? The two aims are completely different. It is no exaggeration to say that the very character of the organisation will rest on what the answer to the question is. At the moment, we see the Healthcare Commission making it its business to assess the performance of NHS providers against not only a scale of quality standards but also each other in the way that trusts are ranked. The commission sees itself not just as a promoter of patient safety but also as actively assisting the drive to raise standards of care across the piece. In the same way, CSCI operates a quality rating system, which aims to achieve something very similar with social care providers. What prospect is there of the CQC continuing this kind of corporate mission? I was very struck when I read a few days ago chapter 6 of a document published by the Department of Health called Developing the NHS Performance Regime. The chapter covers independent regulation and says in paragraph 150: "““The main responsibilities of the CQC are to … register health and social care providers … carry out a periodic assessment of all NHS providers and commissioners … carry out special reviews of services, along patient pathways or into other areas of concern or risk in terms of patient safety … carry out investigations into specific organisations where CQC believes that user safety is seriously at risk; and gatekeeping and proportionate regulation … However, the principal role of the CQC will be to register health and adult social care providers””." I do not belittle the importance of patient safety; of course not. However, the message from that to me is quite concerning; it is of a piece with the consultation document issued by the department on the framework for the registration of health and social care providers. That says, in paragraph 2.13: "““The set of registration requirements in this consultation is intended to protect people using services from the risk of harm involved in the provision of health and social care. They do not seek to enforce best practice that other parts of the system will promote””." It continues: "““In moving to a regulatory system which is based on essential safety and quality requirements rather than desirable best practice standards, we propose to put a greater regulatory focus on essential outcomes and on addressing the risks””." Taken together, these statements tell a very clear and, for me, rather depressing story. They tell us that the department is putting the CQC into a tight box marked ““patient safety””. The principal role of the CQC, in the Government's eyes, will be to register health and social care providers and to police and enforce a set of minimum quality standards. The obvious question that springs from this realisation is: what significance should we now attach to the commission’s objectives as set out in Amendment No. 9? What weight should we place on the matters listed in Amendment No. 12 to which the commission must have regard? Those questions may seem surprising after our debates earlier, but if the commission’s main focus is registration and safety, what added value is likely to emanate from active user involvement in the commission’s work—the thing that we were all so keen on, and so glad to see incorporated into the amendment? Of course, these things are of key relevance if we are dealing with a regulator concerned with identifying and promoting best practice in health and social care. But contrary to the hopes of many of us, it does appear that the CQC is going to be that kind of animal. In a real sense, the powers conferred upon the Healthcare Commission and on CSCI are going to be diluted by the Bill now before us. What is the Minister’s answer to this? If the CQC will not be directly promoting improvement and best practice in health and social care, who will be? We have heard some brave and ambitious statements from Ministers. If they are sincere about wanting the CQC to be a force for change in driving up standards, and if the amendment on objectives is really to count for something, we in Parliament ought to send out a clear signal to the commission’s shadow chair. She needs to formulate a mission statement which speaks not only of registering providers and guarding patient safety—activities that set rather unambitious horizons for the organisation—but of inspiring people to do better, celebrating best practice, promulgating it and, in so doing, giving the NHS the means whereby less high-achieving health providers can pull themselves up by the bootstraps, not because they have had a regulatory sword wielded over their heads in a rather threatening manner but because they are genuinely hungry to do so. The same would apply to social care providers. For me, the most telling sentence in the Bill’s Explanatory Notes is the one that comes under Clause 41. At the end of paragraph 192, which covers the quality standards for NHS providers, it says that: "““The Commission has no role in monitoring or assessing compliance with these standards””." Indeed so. That is something which I believe, even at this late stage of our debates, we should reconsider—hence these amendments.