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Health and Social Care Bill

My Lords, I fully support the intention behind this amendment, which is to encourage the independent regulators of NHS foundation trusts, Monitor and the Care Quality Commission to co-operate with one another on the efficient and effective use of resources. We of course want to ensure that public money is put to best use and the work of the two regulators, both of which have roles in healthcare, is co-ordinated. This co-ordination will not only make the most of the resources but, more importantly, it will help to ensure that there is no duplication in the actions each body takes with respect to foundation trusts. Your Lordships have debated two issues. The first is the clarity of the purpose of the two regulators and the second is if there is any duplication in their function. With regard to clarity of purpose, I remind noble Lords what was said in Committee and also in response to the consultation document which was published in October 2007. We said that we expect the CQC and Monitor to work closely together especially when imposing sanctions or taking enforcement actions. For example, when the Care Quality Commission responds to a safety or a quality failing within a foundation trust with a warning notice, the Care Quality Commission will notify Monitor to ensure that it is aware of its concerns. While the foundation trust will be responsible for delivering the necessary improvements, Monitor will work with the NHS foundation trust to ensure compliance because it will be concerned about the impact of the enforcement action on the NHS foundation trust’s ability to operate. It is unfair to compare what the Healthcare Commission does now and what the CQC will do in the future. The CQC will have an enforcement function and we are trying to find the adequate framework in which Monitor and the CQC will work together. We believe that the duty to co-operate in Clause 66 will lead to the commission and Monitor establishing a good working relationship. I should like to set out other aspects of the legislation that support the intention behind this amendment. First, under Clause 63, the commission is required to, "““promote the effective co-ordination of reviews or assessments””." This provision is intended to ensure that the commission works with other public bodies, such as Monitor, when planning reviews and assessments, in order to avoid duplication and ensure that resources are used effectively and efficiently. Monitor is already required to exercise its functions effectively, efficiently and economically under paragraph 16 of Schedule 8 to the National Health Service Act 2006. Schedule 4 provides for the commission's interactions with other authorities. It can act jointly with other public bodies and provide advice and assistance to other public authorities. Furthermore, the Secretary of State may specify public bodies in addition to the inspection authorities that the commission must co-operate with for the efficient and effective exercise of its functions. Therefore, if the Secretary of State considered it necessary, he could make an order specifying Monitor. However, we do not consider that that will be necessary given the provision in Clause 66. The noble Baroness, Lady Meacher, asked what the Government would do about the computers. I am always amazed when people think that each organisation that provides health and social care will have two computers, one for CQC and one for Monitor. The whole purpose of the provision is to create intelligent information that will be available to all sorts of public bodies involved in regulation, regardless of whether it is financial regulation or regulation of the quality of care provided. However, Clause 64, which was a government amendment in the other place, is intended to avoid the duplication of information collection alluded to earlier. Both Monitor and CQC have to produce annual accounts and a report on how they have exercised their functions. These reports must be laid before Parliament, and there is an independent scrutiny of the accounts by the Comptroller and Auditor-General, who must also lay his report before Parliament. I therefore believe that the Bill contains adequate provision to ensure the effective and efficient use of resources by these two bodies. However, if noble Lords feel that we can do better, I will be more than happy to listen between now and the next stage.