Health Bill [HL]

I thank the noble Baronesses, Lady Murphy and Lady Meacher, for tabling the amendment. I welcome the opportunity to explore in more detail the implications of the quality accounts for foundation trusts. First, I acknowledge the role of Monitor and the CQC in helping the department over the summer to bring a bit of clarity on quality accounts. In fact, some of the outputs from their joint working which most impressed me—they were sent to me in September or October—bring clarity to what we are talking about here. I tried to explain earlier that there are sets of indicators in the quality accounts that are set by the regulator, the CQC, which remain the same and which will continue to be the same. There are sets of indicators that are part of the operating framework to which Monitor holds its FT accountable, and those will continue to be the same. There is also the third part of the quality accounts which I referred to earlier, the purpose of which is quality improvement. That is where the confusion is arising. I see no reason why quality improvement information should not be shared with the regulator. If people want that to be the case, and that is the relationship between the FT and the regulator, that is fine; I am not in any way challenging that. It is also very important to reiterate the purpose of the quality accounts as we have described them and as we have debated them with Monitor and the CQC. As I said, some components of the quality accounts are the vehicles for upward reporting to the regulators, although the Department of Health sees no role in that. It is quite important to put that on to the record, as I have done in the past and will continue to do so. I reassure the noble Baronesses about the purpose of the quality accounts. I sympathise with the intentions behind the amendment, which presents a helpful opportunity to set out how we propose to develop the quality accounts in a way that complements the foundation trust lines of accountability, which is the issue that has come up. Again, I reassure the noble Baronesses that we do not want to cut across the current reporting lines of foundation trusts and their accountability to their local communities or in any way to reduce their independence. This Government created foundation trusts and this Government want to see more NHS providers obtaining foundation trust status. I also reiterate that there is no hidden agenda. I have said that before, and it is quite important that I say it again. I will come back to some of the points that have been raised. The purpose of sending the quality accounts to my right honourable friend the Secretary of State for Health is simply to get that information and to put it on to the NHS Choices website. The noble Earl, Lord Howe, asked how we will share this information nationally. We have made a significant commitment to the NHS Choices website, which is the portal through which we will inform our patients in the future about the quality indicators in the quality accounts. That is its only purpose. We do not see our role as in any way holding these organisations to account on the content of their quality accounts; we are simply using that information to display them on the NHS Choices website. When patients look at NHS Choices, they rarely base their choices on whether a hospital is a foundation trust; they base them on the quality of care that is being displayed. It is irrelevant to them who the regulator is. Most patients do not know what Monitor is. That is the purpose of seeking that information, and I hope that I have reassured the noble Baronesses about that. As for setting this out in regulation, I believe that Monitor is keen to publish the quality accounts alongside the foundation trust annual reports. The regulations and guidance should enable it to do that. It is keen, as I said, that foundation trust boards and members sign off their quality accounts. That is perfectly okay; they have every freedom to go ahead and do so. It is a good practice that might be shared by non-foundation trust organisations. We are trying to set up the framework that allows Monitor to obtain the overview that it needs. As I said earlier, we are working with Monitor on the details of how the arrangements will work in practice, having regard to the role of the CQC in relation to the components of the indicators that are relevant to it. I hope that I have reassured the noble Baronesses. I certainly do not accept the amendments as they are, but if noble Lords feel that the wording in Clause 7 is blurred, my officials are still talking to Monitor’s leadership, and if there is better wording, the Government are always there to see that. I do not accept, however, that the foundation trusts should have a completely different reporting structure. I hope, on that note, that I have reassured the noble Baronesses adequately and that they will not press the amendments.