I defer to you on that point, Mr Deputy Speaker.
New clause 8 would ensure first, that there is an examination of how sector-led improvement is working; secondly, that the concern about rates for care, which we touched on when we debated new clause 15, is looked at, particularly time and task commissioning and procurement; and thirdly, that the way in which resource allocation formula are drafted and how they operate—an issue that came up in my Committee’s inquiry into the Bill—and the fact that they are often very opaque to the public, with regard to what is and is not in them when it comes to determining the level of a personal budget, are absolutely crucial to the quality of the care someone might be able to receive.
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New clause 10 deals with an interesting unintended consequence of some of the changes the Government have made to this part of the Bill. The new clause is intended to bring some clarity to the process whereby the CQC decides that there is an urgent requirement to take regulatory action to protect the safety of patients. The powers it has in that respect are set out in the Health and Social Care Act 2008. The new clause is needed because the Bill establishes a parallel enforcement regime for NHS trusts and foundation trusts, under which the CQC has the power to make a recommendation to the NHS Trust Development Authority or Monitor that a trust be placed in special administration. The CQC therefore has two enforcement regimes at its disposal: first, the one set out in the 2008 Act, which allows it to take enforcement action; and secondly, the one that the Care Bill introduces, which will allow it to request another organisation to take enforcement action instead.
I made a number of points in Committee about the attempt to use the special administration regime on quality grounds. I made three simple arguments. First, special administration is not a particularly suitable process for addressing quality failures, and I suspect that it will
never be used in that way in practice. Secondly, on a related point, the triggers for using the special administration regime on quality grounds are not clear, which introduces an element of uncertainty into the regulatory process. I think that a lack of clarity and consistency in enforcement powers is a hallmark of an ineffective regulation system in the first place. Thirdly, special administration is intended to be used in the Care Bill only for NHS-owned organisations, which introduces a rather odd asymmetry in regulatory powers, which is not underpinned by any evidence that I have seen in arguing for the change.
Whatever the merits of those arguments, however, I believe that the Minister needs to address the extra layer of complexity that is being added to the enforcement regime through the Bill. Where once the CQC alone could take action to address quality failures, now the CQC, Monitor or the NHS Trust Development Authority can take action on NHS organisations. I think that that complexity, which was a cause of concern in the Francis review, needs to be addressed further. I hope that the Minister will be able to address that.
The purpose of new clause 10 is simple: to ensure that in the most serious cases of failure, when the CQC believes that there is a risk to patient safety, it can, should and must ignore all the added complexity created by the measure in the Bill and default to its powers to protect patients as set out in the 2008 Act. I hope that the Minister will be able to confirm that there is a clear order of precedence for how the regulator should act.
Finally, new clause 12 deals with the CQC and integration. It simply seeks to do something that we did not do in the Health and Social Care Act 2012. That Act, largely because of colleagues on the Government Benches and concerns from the Health Committee and others, has built into it duties on every part of the system to integrate wherever possible, with health and wellbeing boards, clinical commissioning groups, NHS England, the National Institute for Health and Clinical Excellence and so on—it is hard-wired into the system. However, because the Bill we were taking through Parliament in 2011 was not really focused on the role of the CQC, we did not add that clarity of purpose on integration into its DNA. I think that is something the CQC wants to do. I know that the Minister has been sympathetic to that in the discussions we had in Committee. This is simply about saying that it is not good enough for a regulator simply to regulate institutions in the interests of patients. The interests of patients are the journeys they have through the system and the quality and experience of the care they receive. That is better defined by the way in which different organisations that they will rely on for that care are collaborating and working together. Therefore, we need to see the creation of more measures along those lines.
I could elaborate further on these points, but I am conscious of the time. I hope that the Minister will be able to give us some further words of reassurance, not least about the discussion that I think he has had with the chair of the CQC since our deliberations in Committee.