Health Bill [HL]

In moving Amendment 38, I shall speak also to Amendment 49. These amendments share the same theme. They attempt to focus on what I see as a critical issue in the area of quality accounts, which is audit and validation. I mentioned in the last but one group of amendments my concern about the absence of any systematic check to ensure that information published by a trust does not mislead the public, either because it contains errors or because, intentionally or not, it conceals information that really matters and that would, if made known, cast a different light on the quality of that trust’s performance. At the moment, all that we seem to have in the Bill is a provision in Clause 7(3) which says that if the CQC or a SHA happen to spot something inaccurate, they can flag it up and get it corrected. That looks like a hit and miss approach, which does not seem to get to the heart of the problem. I am proposing two ideas here. They are not mutually exclusive. One is that the CQC should be given an explicit duty to audit the accuracy and reliability of published quality data, as part of its inspectorial role. That would provide a measure of quality assurance that stemmed from an independent outside check, which I believe would give added reassurance to the public. The other idea is a bit more subtle. It is to suggest that we should try to embed in the NHS a system of quality assurance that relies on the accreditation of providers with professional outside bodies, such as the royal colleges. The attainment of accredited status would act as living proof that the services provided by a trust were of a high quality across the piece, because it would demonstrate that there were standards of training and professional attainment underpinning everything that the trust did. Equally, the quality of the information published by a provider would be shown as having an element of independent validation. In other words, instead of relying completely on an ex post facto audit by the CQC, we should encourage trusts to attain the requisite standards of best practice and to be professionally accredited for doing so. This is what happens in industry. We need the equivalent of an ISO 9000 in the health service. It is the difference between ticking boxes or crossing items off lists and motivating staff and management to up their game and to focus on training and self-improvement. What affects quality adversely is staff errors and staff incompetence. Tick-box systems do not deal adequately with those things. In industry, you do not find tick boxes or lists of things which people have to do. You find that businesses work to accredit themselves with recognised independent bodies, to prove that they actually do what they boast of doing. A system of accreditation in the NHS would avoid the need for the CQC to keep verifying minimum standards in a number of areas and would, I hope, generally make its job a lot more streamlined. I think particularly here of areas such as general practice, which I know is regarded by the CQC as quite a challenge in terms of the resources needed to register and regulate every GP in the country. A system of accreditation with the Royal College of General Practitioners might be an effective way of reducing this burden to a minimum. There are other areas where, even with the best will in the world, the expertise of the CQC may be tested to the limit. I have in mind laboratory medicine. The CQC will be responsible for registering all providers of medical services, including diagnostic services. As regards diagnostics, registration will be based initially, we understand, on self-evaluation against defined standards, including intelligent use of quantitative outcome data. On-site inspections will be carried out according to perception of risk. They will not occur in all circumstances. In any event, registration will require only compliance with ““bare minimum standards””. The CQC is using that phrase. I may be doing it injustice, in which case the noble Baroness, Lady Young, will tell me that I am, but it seems inherently unlikely that the CQC will have the capacity to assess the detail of specialised services such as diagnostics. It has said that it will be delighted to see organisations gain accreditation for the services that it provides, such as CPA accreditation for medical laboratories. Contrary to the recommendation in the recent report by the noble Lord, Lord Carter, on NHS pathology, this accreditation will not be mandatory. I have to say that that concerns me, and one has to wonder how the performance of non-accredited laboratories will be covered by this system. There is a perception, which I believe is quite widely shared, that those responsible for commissioning NHS services have a poor understanding of what represents quality in laboratory medicine. The noble Lord, Lord Carter, has called for better commissioning guidance and model contracts. He is surely right about that. I find it alarming that long-term contracts can currently be agreed for the provision of medical laboratory services without it being a mandatory part of the contract that there should be compliance with accreditation standards. I shall be interested to hear the Minister’s reaction to these ideas. I hope that he will agree that there are two genuine issues to be addressed. One is on auditing the validity of published information; the other is on verifying and validating the quality of a trust’s performance outside the relatively narrow sphere of its published data. Both are of key importance, and neither is dealt with in the Bill. I beg to move.