Health and Social Care Act 2008 (Registration of Regulated Activities) Regulations 2009

First, perhaps I may apologise to the Minister for being slightly late. I shall of course read the opening sentences of her speech, those that I missed, in Hansard. I thank her for introducing these regulations, but because of the helpful briefing session that she was kind enough to organise a couple of weeks ago, I have only a very few comments and questions. The CQC’s task of registering all providers of health and social care is a very considerable one, so it is not surprising that the Government have allowed it to be tackled in two stages. The regulations we are looking at provide only for the registration of NHS providers, and then only in relation to a single set of requirements, namely those covering healthcare-acquired infections. It is understood that further registration requirements will be introduced for these NHS bodies next year and that adult social care providers and the independent healthcare sector will also be brought within the scope of the new regime in 2010. If we focus on this initial round of registrations, the first question that arises is whether there is a performance threshold below which the CQC will simply refuse to register a provider and, if so, what that threshold is. Those may sound like odd things to ask, but if these requirements are to mean anything, surely it is essential that every NHS body should have to demonstrate a minimum acceptable standard of cleanliness and hygiene and an acceptable recent track record in rates of healthcare-acquired infections if they are to qualify for a registration certificate. But what is that standard? The Healthcare Commission in general has done a good job in driving improvements in this area, but we know that a number of NHS trusts have been found seriously wanting in their recent performance on HCAIs. In those cases, what action has the CQC insisted be taken, or what improvements has it insisted on seeing before agreeing to issue a registration certificate? Rather like a game at a fairground where everyone is a winner, are we in practice looking at a 100 per cent success rate in the NHS bodies up for registration? Are any conditional registrations being agreed? It is important to understand how strict and how stern the CQC is being with providers with a poor track record. We know from the Government’s own figures that MRSA affected around 6,000 people in 2006-07 and C. difficile about 56,000. The numbers may be falling, but they are still very high. Indeed, we would all say that they are unacceptable. It would be helpful to hear from the Minister whether the CQC is simply focusing on the existence of systems within provider trusts, or are they also looking at the quality of those systems in terms of the results actually being achieved? The second question relates to an issue that is strictly outside the scope of the regulations but which bears closely on them. As I mentioned a moment ago, the registration process for independent sector healthcare providers is being tackled more gradually and the aim is to accomplish that by 2010, at which point those bodies would cease to be subject to regulation under the Care Standards Act 2000. What enforcement powers will the CQC have during that transition period in relation to independent sector healthcare providers and, for that matter, providers of adult social care? Legally speaking, is the CQC fully able to monitor and regulate those bodies during the next 12 months as tightly as we would wish it to do, and does it have the resources to do so? The CQC has said that it will not hesitate to use the range of enforcement powers at its disposal if it needs to do so. Can the Minister assure the Committee that if in the last resort a provider of healthcare has its registration removed and thereby loses its right to be a provider, safeguards will be in place to protect the quality of patient care during the transition to a new provider? Although the power to issue fines as a penalty for poor service and poor infection control is undoubtedly a strong deterrent, there is in practice a downside to such fines. When NHS bodies are called on to pay fines, they will need to divert money from elsewhere in their budget to do so. In certain circumstances, one could imagine money being diverted from frontline patient care, which is the very opposite of what patients deserve in a situation where, if anything, they need enhanced protection. Will the Minister comment on that and will the CQC bear in mind that, in some situations, the imposition of a fine would run counter to the interests of the NHS organisation and of patients? Finally, how often will the proposed register of persons providing services be updated and verified? Does the Minister agree that regular and thorough vetting of the list will be important?