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Health and Social Care Bill

The best I can say to my right hon. Friend is that I would like to think so. I recall saying at the outset of the Committee that as we were aiming for as much consensus as possible on health and social care—not areas that are normally given to the playing of the party political game—I hoped that the Minister would avoid being tribal or having pride of authorship in the Bill. It was clear to us during the course of the Committee that accepting any Opposition amendments would cause the Minister physically to wince, so he did not accept one. Now we are back, mainly to implement the Conservative amendments, conceded in another place, that we presented in Committee. In answer to my right hon. Friend, there is a genuine question about what the price of saving face, or the price of not thinking quickly enough on one's feet, is. As so much parliamentary time could have been saved had the amendments been accepted when they were first proposed, it is fair to ask precisely what has changed the Minister's mind in the interim. There are indeed some questions about the new clause. A number of hon. Members, and their lordships, have expressed concerns about the picture of the Care Quality Commission painted by the report ““Developing the NHS Performance Regime””, recently published under the aegis of the NHS chief executive. Paragraph 150 states:"““The main responsibilities of the CQC are to: register health and social care providers; carry out a periodic assessment of all NHS…patient pathways or into other areas of concern or risk in terms of patient safety; carry out investigations into specific organisations where CQC believes that user safety is seriously at risk; and gatekeeping and proportionate regulation.””" The report continues:"““However, the principal role of the CQC will be to register health and adult social care providers.””" Paragraph 153 states:"““The registration system will be a key function of the CQC. In operating this, the regulator will register, monitor compliance and take action in relation to healthcare providers' adherence to the registration scheme.””" Furthermore, paragraph 100 states that"““the CQC's approach to assessing the performance of NHS organisations includes their assessment of quality and of financial performance. Our expectation is that the CQC will continue to work closely with the Audit Commission on the latter””." However, what is the expectation for the former—assessment of quality? The document not only flies in the face of the amendment, which does not mention registration, but drives a massive wedge between the CQC's social care and health care responsibilities. The NHS chief executive wants the health care side to be divested of performance monitoring, but presumably such monitoring will be built into the social care side. The chief executive reveals his hand in paragraph 100, which says:"““we cannot have the same organisation being identified as 'weak' by the CQC and not identified as 'underperforming' by SHAs as performance managers””." Could that be construed as the chief executive wanting to keep the dirty laundry in-house instead of supporting the quasi-independent CQC? It remains clear that our model of separate independent regulation of quality and finances, which, sadly, was rejected in Committee, is much more transparent, effective and likely to support world-class patient care. I hope that the Minister will take the opportunity to explain the contradictory messages that the Bill and the Department are conveying. I welcome most of Lords amendment No. 3. Again, I pay tribute to the Conservative Front-Bench team in another place, whose amendments in Grand Committee inspired it. I am especially glad that Local Involvement Networks have finally made it on to the face of the Bill. I know that hon. Members in other parties will also welcome that. I welcome Lords amendment No. 72, which is in the next group, and adds the commission to the list of those to whom Local Involvement Networks must send copies of their annual reports. Again—I do not want to cause too much controversy—the Minister was strident in his opposition to the inclusion of LINks. He told me in Committee:"““I do not think that the amendment requiring a statutory relationship with LINks is the right way to go about the matter… I am not sure that singling out LINks for special treatment in the form of a statutory relationship…is the right way of going about it.””—[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 152.]" On Report, he said:"““we do not believe that it is appropriate to dictate to those statutory and independent bodies the way in which they should involve LINks in inspections or consultations.””—[Official Report, 18 February 2008; Vol. 472. c. 88.]" What has changed? Of course, a late concession is better than none, but the Minister should have been prepared to change his mind when we discussed those matters in Committee, rather than waiting until such a late stage and taking up the House's time. I welcome proposed new subsection (1)(d) in Lords amendment No. 3, which recognises that the commission has a responsibility"““to protect and promote the rights of people who use health…care services””" and I remind the House that we debated that matter in Committee, and again the Minister was unwavering about it. The Government previously extended the provision only to children and vulnerable adults. Conservative Members believed that the CQC should promote the rights of all people, including those groups, but not excluding others. I am glad that the Government saw reason in another place. Again, I regret that the Minister did not see it sooner. I regret that the Government have retained clause 2(4) in proposed new subsection (2) of Lords amendment No. 3. As the provision is drafted, the CQC must still"““have regard to such aspects of Government policy as the Secretary of State may direct.””" That makes nonsense of the idea of independence. I accept that the Minister has made several concessions to the independence of the bodies that the Bill creates or modifies—but those leave the provision that I have just cited looking rather out of place. Through it, the Secretary of State retains significant control over the CQC. In addition, clause 42 provides that the Secretary of State"““may direct the Commission to devise indicators””" of quality. That is a retention of politically motivated targets, and the Bill is peppered with similar phrases. Dame Denise Platt stated in her powerful evidence:"““We think that the independence should be clear. The body should have the opportunity to think, initiate and comment and to be accountable to parliament for what it does””—[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 14, Q18.]" I am not sure that the Bill provides for that sort of independence. It contains many phrases along the lines of ““with the agreement of the Secretary of State””. Speaking about clause 41, the Healthcare Commission stated in its submission:"““there is a risk of conflict with the independence that the Bill envisages for the regulator””." It added:"““We do not think that the Government should determine operational priorities for an independent regulator.””" The independence of the regulator is key to freeing our NHS from political meddling. It is sad that the Government have not taken the opportunity to work towards that. The regulator will have the full confidence of the patients and front-line staff only when quality is its sole driver, not the political desires of the Government of the time. I am glad that we have won that and other concessions, but until the Secretary of State's power as set out is removed from the Bill, it does not go far enough. As for LINks, I welcome Lords amendment No. 4 and its focus on service users, which has yet again been underpinned by amendments from the Conservative Front Bench in another place and a new clause proposed by me in Committee. I welcome the fact that, through Lords amendments Nos. 24 and 25, the CQC will be required to report on user involvement. The Minister rejected our proposals in Committee on the grounds that the advisory committee that the commission must establish under schedule 1 could allow such involvement. I am glad that he has changed his mind, but I would be grateful to know why.