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Health and Social Care Bill

My Lords, prior to the first day of Report, the noble Lord, Lord Warner, tabled a number of amendments about commissioning, to which I asked that my name be added, only to discover that he had withdrawn them. I was rather sorry about that. Despite the amendments in this group in the name of the Minister, to whom I have listened carefully and whom I thank for his consideration of the points raised in Committee, the amendments originally tabled by the noble Lord, Lord Warner, would have achieved something materially and importantly different from those we are invited to approve. Clause 42, as the Government now wish to amend it, will state that the commission will be given the duty to, "““conduct reviews of the provision of health care””—" and adult social care— "““provided or commissioned by the Trust””—" or— "““provided or commissioned by the authority””." The clause is still focused on the provider end of care rather than also on the commissioning activity, notwithstanding the insertion of the words ““commissioned by””. I hope that the Minister will not mind if I press him, but the legal interpretation of the clause as amended will definitely enable the CQC to review and assess the quality of commissioners and their commissioning as opposed to just the services commissioned. There is a difference, which Amendment No. 54 seems to confirm. It states: "““Any reference in this Part to health care commissioned by a Primary Care Trust is a reference to health care provided by other persons pursuant to arrangements made by the Trust””." If we received a commitment that, "““arrangements made by the Trust””," would also be subject to review by the CQC, I would be happy. Following our debates in Grand Committee, I welcome Amendment No. 36 in particular as it provides useful clarity. However, I do not think that it takes us quite as far as we need to go, which is why I have added my support to Amendment No. 38 and why I agree very much with the remarks made by the noble Baroness, Lady Murphy. Amendment No. 38 captures the very important and specific issue of the interrelationship between the CQC and strategic health authorities. It acknowledges explicitly that the responsibility for performance management of PCTs as commissioners, while vested in strategic health authorities, is one in which the CQC will be able to assist and support in its reviewing role. Shortcomings in commissioning may not always be apparent to a strategic health authority through its standard performance management processes, so I am sure that this is an area of the CQC’s work that the noble Lord, Lord Warner, is right to highlight and which the Minister perhaps ought to take away and consider again.