Health and Social Care Bill

We of course expect the CQC to consider taking enforcement action where providers fail to improve to meet safety and quality requirements that are currently the subject of our consultation. It will have a range of powers at its disposal, including the cancellation or suspension of the registration of a provider or registered manager if necessary. The review function is additional to the registration and enforcement system, reporting on the quality of services and looking into specific or general matters in relation to statutory health and adult social care services. Of course, if the commission uncovers significant safety or quality issues when carrying out a periodic or special review of a registered provider and the matters are covered by the registration requirements, the commission will, as a last resort, be able to cancel registration. Amendment No. 40 is intended to ensure that. That is not, however, the only way that problems uncovered in reviews can be addressed. The comparative information that the commission will publish as part of its review function will not only help the public, patients and users of social care services to make informed choices about who should provide their care; it will also prompt local authorities and PCTs to address poor provider performance through their contracting arrangements. Where a body is found to be failing in its role of commissioning care, the Care Quality Commission will of course publish those findings and be able to give advice to the Secretary of State. In England, the performance management of NHS bodies is the responsibility of strategic health authorities, while the Care Quality Commission can recommend special measures in relation to local authorities. Those are important roles in the system and will play an important part in driving forward quality improvements. Rather than necessarily cancelling a registration outright, there will be occasions when it is more appropriate for the Care Quality Commission to suspend the registration of a manager or a service provider in respect of a regulated activity for a specified period, so that a breach of a specified requirement can be resolved. Two routes to suspension are set out in Clause 14. Under the first route, the Care Quality Commission will have to give the provider or manager a notice in writing of its intention to suspend the service. The provider then has the right to make representations before the commission decides whether to continue with its proposal. If it continues with suspension, the provider will have the right to appeal to the tribunal before the suspension takes place. The noble Earl is right to say that there will be time implications there. Should the breach that led to the suspension remain unresolved at the end of the suspension period and the associated risk continue, Clause 14 allows the commission to extend suspension for a further fixed period. We anticipate that the non-urgent route of suspension will be most appropriate where the provider and the commission agree to a period of suspension—especially as it is preferable to cancellation of registration. Therefore, there would not be appeals to the Care Standards Tribunal. That should be the standard procedure; it allows the provider a chance to make representations before action is taken. That should both encourage issues to be resolved before costly enforcement action is taken and protect the provider’s rights by giving them access to due process. The Bill also allows for an urgent suspension procedure under Clause 27. The commission will be able to use that expedited route when it has reasonable cause to believe that unless it acts, people may be exposed to the risk of harm. The CQC will use that when a provider is not only failing to act within the registration requirements but is exposing people to the immediate risk of harm. Suspension is different from de-registration in that a suspended provider or manager will remain registered with the new commission. That is to ensure that once a suspension has been lifted the person will not need to re-apply for registration. That will avoid unnecessary delays for service users and for the provider. Clause 2 means that the CQC must balance the risks of its actions against the risks of allowing dangerous services to continue. I hope that my noble friend and the noble Baroness, Lady Murphy, are now reassured that Amendment No. 40 is not required for the Bill to achieve their intention. I hope that I have also been able to explain clearly the purpose behind Clause 14.