My Lords, I support my noble friend’s amendment. My noble friend Lord Hunt cannot be with us this afternoon, so I shall expand on the issues around the CQC which he raised in Grand Committee last time. He asked for an explanation of why the CQC would not respond to a request that sought its views on this matter. We asked it for its views on the clause and were informed by the Department of Health that it had told that CQC that it was not appropriate for it to respond to our inquiry. Indeed, my noble friend forwarded to me a copy of the letter that he received from the department as a result of his exchange with the noble Earl, Lord Howe. The letter says:
“CQC sought views from the Department of Health and Cabinet Office before responding to the request. The CQC is a non-departmental public body, and is part of the Government landscape”—
whatever that means. It goes on,
“As such, it was not considered appropriate for the organisation to give its views to the Opposition on a piece of legislation. This is in line with the civil service code. I understand that the CQC replied to confirm it would not be appropriate for them to
comment and suggested that the Office of the Leader of the Opposition contact the Department directly should there be any further queries”.
So we might take that one up anyway.
This letter raises more questions and concerns than it answers. Given that today marks the publication of guidance for NHS organisations on the duty of candour and the fit and proper persons requirement, it seems rather ironic that a press release from the CQC says:
“One week to go before new NHS regulations to improve openness and transparency”.
Well, yes.
I shall ask the Minister for some further points of clarification in this context. If the CQC cannot answer the questions directly that we want to put, I would like to know what we should do. These are the questions that we think that it would be legitimate to ask. I quote from the CQC’s website on the principles of that body. It says:
“Throughout everything we do, we always … put people who use services at the heart of our work … have an open and accessible culture … are independent, rigorous, fair and consistent … work in partnership across the health and social care system … are committed to being a high-performing organisation … promote equality, diversity and human rights”.
As those of us who were involved in the legislation two or three years ago know, the CQC is accountable to the public, Parliament and the Secretary of State for Health for the regulation of most of England’s healthcare provision, including hospitals, both NHS and private, GPs, dentists, care homes and other institutions. It does a very important job. Surely we have to be confident of the CQC’s independence and that it will have only patients’ interests in mind in all the work that it does. How will this work alongside the duty to consider economic growth? I really do not expect to hear soothing sounds from the Minister about this because the House needs to know that this has been tested in some way and that questions have been asked and hypothetical cases have been put, such as a care home whose business interests are at risk because of the work of the CQC, with a loss of jobs, meaning that economic growth is therefore in jeopardy. Those are totally legitimate questions to put about the duty being imposed on the CQC. Those are the unintended consequences that my noble friend referred to in his opening remarks. We need to know whether the CQC would find itself in a policy clash situation. Does the Minister accept that any danger that the economic growth regulation might have a chilling effect is actually disastrous when talking about the country’s foremost health regulator? It is completely legitimate that the Committee should want to know the answers to these questions before the CQC is included in this legislation.
I was not at all comforted by reading the draft guidance. Point 5 on page 7 says:
“The impact that regulators can have on sector-level economic growth will depend on the context and/or sector(s) within which they operate. In order to understand sector level impacts, where possible regulators should consider how their actions impact on indicators such as consumer confidence and fair competition”.
In the context of the health service, where competition is being put at the heart of service delivery by the Government, that seems to be an extremely important point and raises questions about the problems that the
CQC might face. We know that the health service—which we face having to save yet again after the general election—is already a lawyers’ playground. How much more of a lawyer’s playground will it be if these issues are not resolved?
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