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Health and Social Care Bill

My Lords, I add my thanks and appreciation to the Minister for giving a good deal of clarification of the CQC’s responsibilities in respect of commissioning. On Clause 60, who would have guessed that ““pursuant to arrangements made”” turns out to mean ““commissioned””? That is a great improvement. I shall speak in support of Amendment No. 38, only as an addition to the clarification that we have already had. I am almost persuaded that the problem of giving the CQC intervention powers with commissioners is the difficulty of cutting across the strategic health authorities’ intervention powers as managers. It is a pity that this is the case, because I am rather a nostalgic fan of commissioning, having been the first chief executive of any commissioning health authority back in 1990. I have never really given up hope that commissioning health authorities will be the force that we had originally hoped that they would be but which they have so far singularly failed to become. Although primary care trusts are developing, they have not yet had the influence on the shape of health services in their local communities for individuals and families that we had hoped for, but I have not given up hope that they will have such influence. It would be an important signal to say that they are as important as providers—quite often more so—in shaping how a set of circumstances rolls out and produces disaster for the patient or recipient of a service in the end. The CQC should have the ability to show the red card or the yellow card—I am not sure which colour it should be. It must have the ability to point out that things are going amiss and that strategic health authorities do not always grasp their responsibility to remove or reshape the boards of primary care trusts in the way that they should. It is a pity that there is not some greater pressure that we could exert; this is our one opportunity to do so. I seek reassurance that the changes on commissioning so far will give that possibility to shape failing commissioners so that they make real progress.