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Health and Social Care Bill

moved Amendment No. 43: 43: Clause 66, page 32, line 40, at end insert ““, and (c) the Independent Regulator and the Commission must have regard to the need to promote the efficient and effective use of their resources in the exercise of their respective functions.”” The noble Earl said: My Lords, I return without apology to an important set of issues debated in Grand Committee on the potential for conflict in the roles of the CQC and Monitor. The Bill provides the CQC with intervention powers that can be exercised in relation to NHS foundation trusts. In doing that, it will oblige NHS foundation trusts to report to two regulators—the CQC and Monitor—whose powers overlap, and where the statutory underpinning for those powers provides no basis for separating their respective accountabilities. The noble Baroness, Lady Murphy, and others argued powerfully in Grand Committee that this will not do. Effective regulation demands, above all, clarity as to where roles and responsibilities lie. It also demands that one regulator is accountable for performance in a given area. In the case of NHS foundation trusts, having two regulators will achieve the opposite. It is a recipe for duplication and delay. As was argued in Grand Committee, there are strong reasons for Monitor retaining the primary accountability for NHS foundation trusts. In assessing the performance of foundation trusts, Monitor can look across the piece not only at service quality, but also at financial performance. Its powers are wide-ranging; much more so than those proposed for the CQC. Monitor’s compliance regime has, by common consent, already proved effective. There is absolutely no sense in altering it. We all understand that there have to be common standards across all NHS bodies. However, that is not the same thing as arguing that the same body must be responsible for enforcement of standards in all cases. As the noble Baroness said in our earlier debates, the regulatory regimes for foundation trusts and other NHS providers are simply different. What is wrong with respecting that difference? Put another way, what is right about putting foundation trusts at risk of double jeopardy? The Bill requires the CQC and Monitor to co-operate with each other and to share information. I have considered this carefully and simply cannot persuade myself that those provisions are enough. The two bodies can co-operate, but they can still duplicate each other’s roles; they can share information, but still cause confusion and unnecessary burdens for the management of foundation trusts. The noble Baroness, Lady Thornton, argued in Grand Committee that the Bill, "““requires no further amendment to achieve an effective working relationship between Monitor and the Care Quality Commission””.—[Official Report, 14/5/08; col. GC342.]" She said that the two bodies would simply have to work out for themselves what their relationship should be. With great respect, I do not think that that approach is adequate. It is a cop-out. Why is it not possible to define in statute precisely where the respective responsibilities of the CQC and Monitor should begin and end? Why are the Government avoiding clarity in this area and leaving open the possibility that foundation trusts could find themselves subject to duplicated intervention and duplicated enforcement? I make clear that the amendment, as tabled, is not intended as a substitute for proper legal delineation, which clearly needs to be drafted by government lawyers. In my respectful submission, it is merely a means of flagging up some of the adverse consequences of the Bill as drafted. I hope that the Minister will agree to think again about these issues. I beg to move.