Health Bill [HL]

Amendments 74A, 78A and 80A laid by the noble Baroness, Lady Cumberlege, would require the Care Quality Commission to be consulted before a trust special administrator is appointed and in the production of the draft report. Let me begin by making it clear that the CQC will play a vital role within the overall quality framework and in our reform agenda more broadly. The CQC, through its statutory functions, has a key improvement role in terms of demonstrating solid improvement in the safety and quality of care over time. Done well, the CQC’s registration and assurance roles, which demonstrate that providers are getting the essentials right and taking independent enforcement action to bring them back into compliance where they are not, have very real potential to shift the improvement bell curve on a permanent, sustained basis and to drive real local ownership and leadership for quality. Amendment 74A and 78A would add a requirement for the Secretary of State in the case of NHS trusts and Monitor, in the case of foundation trusts, to consult the CQC in advance of the trust special administrator being appointed. The CQC will be aware of any quality issues that result in unsustainability from its ongoing assessment and registration process. In the case of NHS trusts, discussions are currently under way between the Department and the CQC on how registration and assessment can feed directly into the NHS performance regime. The decision to enter an organisation into an unsustainable provider regime is a performance management issue. Any quality assessment made by the CQC is likely to affect that decision, but the decision to trigger the regime is a performance management one. This is why the Secretary of State and Monitor consult only the strategic health authority and relevant commissioners. It is likely to be the last stage in a long stream of interventions, some of which, in terms of quality, may actually have been made by the CQC. It is important to be clear that at the moment of appointment, the trust special administrator makes no decision about the organisation’s future and existing services are all maintained. A decision will not be made until approximately six months later, after the trust special administrator has had an opportunity to research the issues and consult on the proposals, and has made a recommendation to the Secretary of State. The appointment itself has no impact on the provision of services or on quality so there is no need for the CQC to be directly involved before the trust special administrator is appointed. If the CQC has concerns about quality of services at any time, it will be able to raise these with the Secretary of State through powers in the Health and Social Care Act 2008. The provisions do not change this. Therefore, I am happy to offer reassurance that, were the regime to be triggered, my right honourable friend the Secretary of State, in addition to laying a notice in Parliament, would also notify the CQC of this action. Amendment 80A places a requirement on the trust special administrator to consult the CQC when preparing the draft report. I recognise the concerns that have been raised, highlighting that unsustainable organisations are likely to have quality issues, particularly as there is often a link between poor quality and financial problems, but this is not always the case. Indeed, the Healthcare Commission’s annual health check identified several organisations that scored "good" on quality of services and "weak" on the use of resources. This demonstrates that it is possible that some organisations may fall into the unsustainable provider regime for solely financial reasons. In these situations it may not always be appropriate for the trust special administrator to be required to consult the CQC in producing a draft report.