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Health and Social Care Bill

My Lords, I thank my noble friend for those largely helpful comments. The amendments relate specifically to Clause 41, which concerns the publication of statements of standards relating to healthcare provided and commissioned by primary care trusts. PCTs will need to have reference to standards issued under this clause in discharging their duty of improvement under Clause 134. As we made clear in earlier discussions, it is important to remember that the standards which will be drawn up under Clause 41, unlike the registration requirements on which we have been consulting, are not intended to be requirements that providers of regulated activities must meet in order to be registered with the Care Quality Commission. The registration requirements that we have been consulting on will apply to all registered health or adult social care providers, including providers of non-NHS care. Breaches of those registration requirements will result in sanctions from the Care Quality Commission. Through the Bill, we are seeking to establish a unified framework for the regulation of health and adult social care services. The current consultation proposes registration requirements which the new commission will be able to enforce against any registered provider of care. They have been developed in line with the spirit of the relevant provisions of the European Convention on Human Rights and cover topics including safeguarding people when they are vulnerable; ensuring that people get care and treatment in safe, suitable places which support their independence, privacy and personal dignity; involving people in making informed decisions about their care and treatment; getting people’s ongoing agreement to care and treatment; responding to people’s comments and complaints; and supporting people in being independent. Standards under Clause 41, on the other hand, will not be subject to the Care Quality Commission’s enforcement powers if they are not met. Instead, they will be designed as improvement tools to help to deliver high-quality, publicly funded healthcare. As discussed in Grand Committee, we do not believe that the Secretary of State should be required to issue standards, as envisaged under Amendment No. 28. Standards should be issued only where it is clear from the evidence that they will assist in enabling quality to be improved, and sometimes the evidence does not allow for that. In my view—and I very much support the ambition of clear standards for all areas of healthcare—it is sufficient to give the Secretary of State an enabling power. We also stated in Grand Committee that we do not believe it is necessary to make similar provisions to apply to publicly funded social care, as envisaged by Amendment No. 29. Such related standards are for the Minister for Communities and Local Government to issue under the Local Government Act 1999. If the standards under Clause 41 are to deliver real improvements in care, they must be flexible enough to cope with changes—and indeed with improvements—in services over time and be subject to full public consultation. Consequently, to set them in legislation now, as Amendment No. 31 seeks to do, would begin to remove that flexibility and pre-empt any such consultation and engagement. Nor do I believe that the commission should be required to take certain standards into account in its periodic reviews of English NHS providers under Clause 42, as I understand is the noble Earl’s intention through Amendments Nos. 34A and 34B. I have already made it clear that we intend to delegate to the commission the function of setting indicators for use in periodic reviews of NHS providers. It may well decide to draw on the standards under Clause 41 in determining the indicators and methodology to adopt in those assessments, but that will be for the commission to decide. We can expect to see a great deal about quality and its enforcement under the next-stage review. Of course, under Clause 134, PCTs will already be required to take the standards under Clause 41 into account when exercising their duty to ensure that NHS healthcare continues to improve. The commission will undertake periodic reviews of PCTs to provide an independent assessment of how effective the PCT has been in assessing its local needs and improving outcomes for its local populations. Even if the commission decides that standards need not play a direct role in periodic reviews of NHS providers, it will nevertheless have contributed to the performance of PCTs. I hope that I have been able to set out clearly that it is through the commission’s registration requirement under Clause 16, rather than through the standards in Clause 41, that the important intention behind the amendments will be best met. I hope that with that clarification the noble Baroness will feel able to withdraw the amendment.