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Health and Social Care Bill

My Lords, I do not think that this amendment is the right way forward, but the points made by the noble Earl, Lord Howe, and the noble Baroness, Lady Meacher, are worthy of further consideration by the Government. We have already gone down the path of history once this afternoon; I would like to take us there again. Sometimes the collective memory of that great and august organisation, the Department of Health, is less good than it might be, so it is worth dwelling on this issue. In some ways, it was the forerunner of the move to merge the three regulators. Way back in 2003, there was great concern across the political spectrum at the demands being made on the NHS in relation to information from regulators of various kinds, including central government. I brought together all these various characters, including the medical royal colleges which were also making quite a lot of demands both in their inspection and data collection. A concordat was agreed in which people would co-operate a bit more about the collection of data and to reduce the Piccadilly Circus effect of one inspector following another inspector—as one went out of one door, another would come in through the front door. That is a real issue for an organisation like the NHS. The second point is what I think I said at an earlier stage—the tendency of regulators to mission creep. This is bad news for people delivering operational services. There are issues about who has precedence and whose information is used by whom in the area between the Care Quality Commission and Monitor. I am not sure that legislation is the way to deal with that: indeed, I suspect that it is not. The reason I am standing up here, however, is to try to get the message across to my noble friends on the Front Bench that there is an issue for the department to grapple with in terms of the expectations that it sets for the two regulators. I am not in any doubt, having been the person who moved the foundation trust legislation in this House back in 2003, that, at the end of the day, the right person to take action on removing authority to continue to provide services is Monitor. The licensing system has worked well. There have been good working relationships between the Healthcare Commission and Monitor. They know where they stand. I hope we can continue that kind of relationship, but I think it will require action on the part of Department of Health Ministers to set the expectations on how those regulators might behave.