I thank my hon. Friend the Member for Stone (Sir William Cash) for tabling these new clauses and I commend him on his tireless work in taking forward the interests of his constituents around the terrible events that occurred at Mid Staffordshire NHS Foundation Trust and the subsequent steps he has been involved with all the way through to improve standards of hospital care provided to the people of Stone and the surrounding areas. He is also right to pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), who has worked tirelessly not just on this Bill, but as an advocate for his constituents and local patients. He is a great credit to the people of Stafford and, party politics aside, being a Member of Parliament is about public service, and he embodies the very best of that in the work he has done in bringing forward this Bill and in his advocacy of the needs of his local patients.
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My hon. Friend the Member for Stone was also right to say that we need to learn the lessons of the Francis inquiry and translate some of those terrible learned experiences into improvements in care through this Bill. I believe that is exactly what this Bill will help to achieve when, hopefully, it becomes law.
My hon. Friend has tabled two perceptive amendments that seek to extend the principle behind clause 1 of the Bill to other areas of the CQC’s work. While I applaud the sentiment behind these new clauses, I would like to briefly explain why I do not believe they are necessary.
New clause 2 would require the CQC to include safety of care as an indicator against which providers of health and adult social care services are to be rated. It would require the CQC to consider safety in the ratings of quality that it now produces following every inspection of a hospital, social care provider and GP practice. The question in considering this new clause is not whether safety of care should be considered in the CQC’s performance assessments of providers and reported on. Of course, safety is, and should be, a major consideration in how the CQC carries out its work. Rather, the question is: should this House prescribe the way that the independent regulator conducts its business?
There is a key distinction that needs to be made here. Clause 1 relates to the requirements that are placed on providers of health and adult social care services. Importantly, it does not place an additional requirement on the CQC itself. This new clause is different in that it would have the effect of instructing the CQC in how to carry out its regulatory role. The previous Government established the CQC under the Health and Social Care Act 2008 with the primary objective, under section 3, to protect and promote the health, safety and welfare of people who use health and social care services. This is its core purpose, and we strongly believe that the CQC can be an effective regulator only if it is free from undue influence from Ministers.
The Care Act 2014 underlined this by putting in place a number of measures to enhance the CQC’s independence: the appointment of chief inspectors of hospitals, general practice and adult social care as members of a new unitary board and the removal of nine separate powers
for the Secretary of State to intervene in the day-to-day operation of the CQC. As part of this, the Secretary of State delegated the function of devising the ratings methodology when putting in place the new arrangements for ratings and performance assessments of providers in the Care Act 2014. Devising the indicators against which providers are to be assessed and rated is, therefore, a matter for the CQC to decide, having consulted with the Secretary of State and other appropriate stakeholders.
The CQC has decided to make safety one of the key indicators for the assessment of provider ratings. As a result, safety is a critical component of the CQC’s new inspection regime. Under the leadership of the three chief inspectors, the CQC has put in place specialist inspection teams that are able to scrutinise the quality and safety of care much more rigorously.
These inspections ask five key questions of the services that are inspected: first, are they safe; secondly, are they effective; thirdly, are they caring; fourthly, are they responsive to people’s needs; and, fifthly, are they well led? That is the core of the inspection regime. These inspections no longer simply consider whether providers are meeting the registration requirements, and have moved us away from a tick-box methodology that was in place, sometimes to the detriment of patients, in the past. The inspections now provide a judgment about the quality of care on a scale running from “outstanding” to “inadequate”, offering providers, commissioners and local people fuller information about the quality of care. To date, the CQC has carried out more than 80 inspections and published 48 ratings of acute trusts alone. The CQC’s tougher, people-centred, expert-led and more rigorous inspections are seeing some outstanding care, and it has already rated many services as “good”. This new approach has also exposed some examples of poor care and variations in care, which I am sure we would all agree are unacceptable, and has made quality transparent in a way that it has never been before.
So I am sympathetic to new clause 2, but my sympathy is in part constrained because I am already confident of the great strides the CQC is making to be an effective regulator of health and social care providers. Safety, of course, is one of the key questions the chief inspectors ask when rating the quality of health and adult social care services, and therefore the CQC is already meeting the aim of the new clause. I hope my hon. Friend the Member for Stone will agree that the CQC has made significant improvements, and that safety is already a major feature of its inspection process and ratings of care providers, and will feel able to withdraw his new clause.
My hon. Friend has also tabled new clause 3, which would require the CQC to include its assessment of the safety of health and adult social care services within its annual state of care report. That report is issued under section 83 of the Health and Social Care Act 2008, which requires the CQC to make a report on the provision of NHS care and adult social services and the carrying out of all the CQC regulated activities during the year. Hon. Members will be aware that under the 2008 Act, which established the CQC, the CQC’s main objective in regulating providers of health and adult social is to protect and promote the health, safety and welfare of people who use health care services. As such, safety and the avoidance of harm are already key elements of any CQC assessment of the provision of care by regulated providers.
I entirely agree that the CQC’s annual report should cover safety issues, and indeed the most recent state of care report, published in October, does exactly that. It is difficult to conceive of circumstances in which the CQC’s annual report would not cover the safety of care provided by the organisations it regulates. A report that did not address this important area of safety could amount to a failure by the CQC to discharge it primary functions as set out in the 2008 Act. In extremis, where that is the case, section 82 of the 2008 Act gives the Secretary of State the power to direct the CQC on how to discharge its functions. However, we must be clear that there is a distinction between the power of the Secretary of State to intervene if the CQC fails to perform the primary functions for which it was created and the need for the day-to-day operational independence of the CQC. As my hon. Friend outlined, this Government have rightly ensured that the day-to-day operation of the CQC is free from political interference, and we now have a genuinely independent inspector of health and care. So although I entirely agree with the spirit of the new clause, which seeks to ensure that the state of care report should cover the safety of care, I believe that the current legislative framework strikes the right balance between providing operational independence for the CQC and having a power for Ministers to intervene, in extremis, if the CQC fails to discharge its primary functions—those for which it was set up. Once again, I pay tribute to my hon. Friend’s work in taking forward the interests of his constituents, following the terrible events at Mid Staffordshire, and I hope I have given him sufficient reassurance to allow him not to press his new clauses to a vote.