Health Bill [HL]

My Lords, I rise to speak Commons Amendment 1 and Amendment 1A tabled by the noble Earl, Lord Howe. I should say straightaway that I have sort of jettisoned my speech after counting lines 99 to 153 of the government amendment again and thinking further about the noble Earl’s amendment. For the benefit of one or two noble Lords, I ought to remind the House about Monitor and what it does. I should also declare an interest as a member of the board. As such, I should say straightaway that I have been party to the negotiations held outside this Chamber with the Government about the amendment, and after many weeks the board declared itself to be content because we felt that we had pushed it as far as we could. But, as the code of conduct reminds us, none of us sits in this House as the representative of an organisation, and I am wholly won over by the amendment of the noble Earl, Lord Howe. A Member of this House who is in the Chamber today asked me who on earth Monitor is as if its members were a small group of aliens parachuted in from outer space. We were created by the Government in 2003 to regulate independently foundation trust hospitals and the mental health services that come under that grouping. The organisation is accountable to Parliament and does not float in administrative space. We produce an annual report on which questions can be raised. Its membership is appointed by the Appointments Commission in exactly the same way as are the boards of NHS trusts, so we are not a peculiar bunch of independent-minded folk who do not think carefully about the impact of our decisions on public sector organisations; we are of the public sector. I can think of several good reasons why a trust may be returned to the Secretary of State. We already have provisions in the Bill for those which fail financially, and I can see that there could be times when quality issues require powers of intervention beyond those held by Monitor. It has draconian powers in terms of appointments to and removals from boards, for example, and together with the Care Quality Commission, can intervene and prevent services from running if they are failing dramatically. But what strategic health authorities as links in the Department of Health’s chain of command, and through them the primary care trusts, can do is occasionally recontract a service or change a sector economy to ensure that a service is acting effectively in concert with other services. They can do some of the restructuring that might enable a service to reinvigorate the quality of its care. These are very rare occurrences, but I can see that it could happen. It has not happened yet, I might say, but I can see that it might. As we go into a time when money is going to be very tight and the temptations at the centre will be to implement mechanisms of restraint—which it has been tempted to implement before and they have usually been disastrous in the NHS—it will be very tempting for the department and for Ministers, under certain circumstances, to try to intervene more than would probably be in the best interests of local services. It is also important to remember that there is a group of people at the back of these foundation trusts called governors and members—a million of them—who have a part to play and local powers to intervene. We do not wish to do anything which cuts across those powers of influence. That is why the governors and members were created and why this Government were so keen that there should be some local accountability which would enable powers to be given to local people to intervene under these circumstances. I can see that there could be occasions when it would be necessary for Monitor to request the Secretary of State to rethink the system of accountability and that it should go back to NHS trusts. This is not because we believe that the Department of Health has any greater history of improving services than Monitor; as we have said, the history is worse. I think that, on balance, the powers in the Commons amendment go too far. They enable the Secretary of State to push when under pressure from the media and elsewhere to do so. I am entirely won over by the amendment of the noble Earl, Lord Howe, which still leaves the basic requirements for the deauthorisation of trusts in place but allows for a more sensible provision. There is one point which remains unsatisfactory in the Commons amendment and that relates to the period of time which Monitor is given to respond to the Secretary of State’s request to deauthorise a foundation trust. The proposals require a response from Monitor within 14 days, with flexibility for the Secretary of State to set longer deadlines if appropriate. I seek reassurance from the Minister that, if Amendment 1 is adopted, an appropriate timetable for consideration of any request will be agreed with Monitor on a case-by-case basis. It is clear from our dealings with hospitals that it is likely to require more than 14 days, and a timetable should be set accordingly. I seek reassurance on that. Overall, I am very attracted to the amendment of the noble Earl, Lord Howe, and will give it my support.