Health and Social Care Bill

I support this group of amendments. In my view, we come to the absolute nub of the role of the Care Quality Commission and its ability to act as a quality improver of NHS and other service providers. I reiterate what the noble Lord, Lord Warner, said. It seems to me that in the current structure of the National Health Service the commissioners should play a crucial role in demonstrating that they are the champions of the local community and that they are purchasing on its behalf for the improvement of public health. It is true that they are directly responsible to the strategic health authorities for the delivery of that, but they are simply managed by the SHAs. With the Care Quality Commission, we are proposing that there should be independent regulation by people who have no direct interest in how the budget is spent or divvied up across their patch and no direct interest in the support of the providers; we are proposing a body that can monitor independently the quality of what is being provided. I remind the Committee of a good example. The Maidstone and Tunbridge Wells NHS Trust inquiry report clearly demonstrated that the local primary care trusts were—not to put too fine a point on it—fiddling while Rome burned. They were so busy joining themselves up and reorganising themselves from two primary care trusts into one that their functions went to pot and they were not adequately monitoring what they were purchasing in terms of the quality of care being delivered. At a Monitor board meeting this morning—I declare an interest as a board member—I came across a good example of how things can go wrong if you monitor the providers and not the commissioners. We were having a board-to-board meeting with an acute hospital in the Bristol area that wishes to become a foundation trust. We noted that its performance on its MRSA and C. difficile targets looked dodgy last year and that it did not look as though it would be in great shape this year unless something was done about it. The trust pointed out to us that the local Bristol primary care trusts had set it a target for this year with which it could comply because the new contract would include only MRSA that was picked up in the hospital and excluded that which was picked up in the local community, thus at a stroke allowing the local hospital to meet its contractual targets. It seems to me that, from the point of view of the Department of Health, that is perfectly okay—we want local commissioners to make local decisions about the health of their local populations. Under the old system, the strategic health authorities—right up to the Minister—were responsible for the lowering the contractual target. Under the new local commissioning arrangements, it is very directly the responsibility of the primary care trust. However, will the Care Quality Commission pick up where a local area produces more community MRSA and does not improve against its hospital MRSA targets? It will have satisfied its local commissioners but what is delivered to the local community will be of poorer quality. If the NHS reforms are to work and we are to have arm’s-length responsibility in the local commissioning bodies, it is crucial that we have independent regulation of what is purchased by local community primary care trusts. When we talk about commissioners, we ought also to include joint commissioners of health and social care, because they, too, are responsible for what is delivered. The commissioners of services must be held just as accountable when things go wrong. We must make it clear that the whole gamut of the processes that we put in place for the system must be able to deliver and be accountable to the regulator.