Health Bill [HL]

The amendment moved by the noble Lord, Lord Patel, would allow my right honourable friend the Secretary of State to direct providers who jointly provide services to publish a quality account that looks at the quality of the service as a whole, regardless of their institutional boundaries. If I have read the noble Lord’s intentions rightly, this would enable us to compel, say, two trusts that regularly treated cancer patients on a single pathway to report jointly on a cancer services theme. I could not agree more. Ultimately, if we are measuring quality through the patients’ eyes, patients do not see these boundaries. This is a challenging area, which is why I felt that we should have quality observatories. This is not just an analytical power. They could also, through that analytical power, see whether they could look at certain indicators in a more joined-up way. We are trying to achieve something similar. This certainly becomes extremely relevant for in-patients with long-term conditions and for in-patients for whom there should be more of a shift towards care in the community rather than in a hospital setting. That in itself is a reflection of quality. The prevention of readmissions and the acute exacerbation of chronic long-term conditions is a good example of that. We need to put significant thinking behind this. The purpose of the amendment is right, and we should do this. I do not feel that the quality accounts should be combined: I feel that we could have certain indicators that measure the whole pathway of care. In other words, we could include primary and secondary care. If we can get that right, I have no doubt that that in itself will align different providers to look at the processes. As we know from a patient’s perspective, 80 per cent of the problems occur because 20 per cent of the processes are wrong. We have demonstrated that on many occasions. The amendment is the right way in which to go, but I am not sure that combining the two quality accounts is the right way. We should first look at indicators that go across pathways and perhaps ask the two providers to report on them in their quality accounts. Some work has been published on so-called aggregated indicators that look at different parameters and come up with what we call a lagging indicator that looks at the whole pathways of care. One of the other purposes of the National Quality Board is to have a sub-committee that is the technical expert committee that will look at the possibility of developing indicators that go across primary and secondary care or even health and social care. The noble Baroness, Lady Murphy, referred to the National Quality Board also having a role in developing the indicators for social care. That is down the line. It is what the report said and is what we want to work. That is why the CQC’s presence and leadership on that board is very important.