Health and Social Care Bill

moved Amendment No. 40: 40: Clause 13, page 6, line 4, at end insert— ““( ) on the ground of persistent failure to adequately improve services following adverse periodic or special reviews under section 42 or section 44;”” The noble Lord said: This amendment is very much linked to the larger group of amendments on commissioning that we discussed earlier—especially Amendment No. 29, which was not received quite as happily as I hoped it might be. In essence, it provides for the commission to take action when confronted with persistent failure by a PCT commissioner to remedy its shortcomings and the inability of the strategic health authority to effect the necessary change. The amendment would give the final say on failure to the commission, which, after due notice, would be able to deregister a PCT as a commissioner. It assumes that commissioning can become a regulated activity, which I still hope will be the position that we end up with in this legislation. At that point, it would be for the SHA and the Secretary of State to find a new commissioner for the area concerned. This could mean bringing in an effective commissioner from outside the area to do the job. It would not be the responsibility of the Care Quality Commission to find a new commissioner but only to say, in effect, that enough was enough regarding the old commissioner. I do not move this amendment lightly. I know that it would be unpopular in many parts of NHS senior management, and I am not totally convinced that it would go down terribly well in some parts of the Department of Health, which regards it as the job of the strategic health authorities and Department of Health Ministers to administer the red card based on the information provided by the commission. However, even if we accept that position, the commission has to be able to intervene sufficiently in commissioning to provide the evidence for the red card to be administered by someone else. Therefore, some issues arise here about how effective the commission could be in providing the information to enable that action to be taken by the Secretary of State. Equally, I know how difficult it is for both strategic health authorities and Ministers to administer the coup de grace to a failing health authority, whether it is a PCT or a hospital trust. In the real world, the local politics can make this extremely difficult, especially when heartrending stories are told about the inadequate funding provided and there is a string of hard-luck stories. I have heard some of those stories and have heard some of the reasons why it is impossible to take action in a particular area. Therefore, I sympathise with many colleagues who end up sitting in the ministerial seats. As I said, I have been around long enough to hear those stories myself. I also know that Ministers are often frustrated by the seeming inability of the NHS to tackle local failure adequately. That is not a new phenomenon; it has been the case under successive Governments. My amendment would make it easier for Ministers to act dispassionately because the red card would have been administered by an independent commission and therefore the decision would have been taken outside politics. If the commission could act for the providers of services in this way, that would be extremely welcome. In this amendment, I am simply providing for equality of treatment between providers and commissioners of services, as I would have done if I had still been responsible as a Minister. Looking at my drafting afresh, I can see that it could be improved—I am not proud of the wording—and that it could possibly be located elsewhere in the Bill. However, as I think I said earlier, I strongly believe that it should be up to the commission, rather than SHAs, to administer what I am calling the red card when, after persistent failure, a PCT is shown to be not up to the job. I beg to move.