Health and Care Bill

Debate between Baroness Brinton and Lord Lansley

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Lansley (Con)]

My Lords, the purpose of Clause 26 is to introduce a process by which the Care Quality Commission inspects integrated care systems. The structure of this is the subject of my Amendments 162A and 164A. Those two amendments go together—they are not separate, but entirely linked. The purpose of Amendment 162A is to remove the process by which the Secretary of State sets objectives and priorities for the Care Quality Commission in undertaking such inspections of integrated care systems; Amendment 164A then seeks to insert a process by which the Secretary of State, and indeed others, are consulted by the Care Quality Commission over the quality indicators that it would use to assess the quality and performance of integrated care systems.

A bit of background would be helpful for noble Lords in this respect. Think back to what the Care Quality Commission’s existing statutory arrangements are in relation to reviews and performance assessments of existing bodies in the National Health Service. The structure is very straightforward. The commission is asked to set quality indicators, to consult on those and then to review against them and produce reports. I know from personal experience that the Secretary of State cannot direct the Care Quality Commission to undertake a particular review, but they can certainly make a request, and their role as steward of the whole healthcare system has certainly led Secretaries of State to do that from time to time. But the legislation does not permit the Secretary of State to direct the Care Quality Commission in how it does its job; it is an independent body corporate. There is intrinsic merit in the Care Quality Commission, as an inspectorate, operating independently. The structure of this clause in this Bill is at odds with the way in which the existing legislation is structured in the 2008 NHS Act as amended. The effect of these two amendments would be to restore the independence of the Care Quality Commission in undertaking its activities and in the way in which it goes about its job.

The Government’s drafting of the legislation is wrong anyway. There are references to objectives and priorities. The priorities are referred to in new subsection (3), inserted by Clause 26(2), which says that they

“must include priorities relating to leadership, the integration of services and the quality and safety of services.”

I have to say that this is teaching grandmothers to suck eggs. There is no way in which the Care Quality Commission is not going to incorporate such indicators of quality. We know that from the generic nature of the quality indicators that it uses generally for existing NHS bodies. The reference to setting objectives is not only novel but completely undefined. The Secretary of State can set whatever objectives they wish to; we do not know what they are and there is no indication of what they might be. Taking out references to objectives and priorities seems to me to be a very good thing.

As it happens—I declare my own role in this—in the 2012 legislation there was previously a process by which the Secretary of State set standards for the Care Quality Commission in determining what the quality indicators should look like. We actually took that out of the 2012 legislation, precisely on these grounds: that the Care Quality Commission is, and should be, as independent as possible.

I think this clause proceeds from the mistaken apprehension that the Care Quality Commission is a part of the management process of the NHS. It is not. If the Secretary of State wishes integrated care systems to proceed in any particular way, the Secretary of State has the means to do so available via the mandate; the Government plan to add specific powers of direction; and NHS England has duties that go in exactly the same direction. The Care Quality Commission is not part of the management process for integrated care systems; it is an inspectorate. If—and this is a risk we must avoid—the Secretary of State were directly intervening to set objectives for integrated care systems to be inspected subsequently by the Care Quality Commission, whereas NHS England is itself setting objectives for integrated care systems through its responsibilities and duties, those two may come into conflict.

For all those reasons, the Government would be well advised to accept these two amendments and put the Care Quality Commission into the independent role in relation to ICSs that it, and people working in the National Health Service, would recognise as being its role. I beg to move.

[Baroness Brinton (LD) [V]]

My Lords, the noble Lord, Lord Lansley, has set out the tensions underlying the Bill about returning to the Secretary of State powers over independent, arms-length bodies; specifically, in this amendment, the inspections carried out by the Care Quality Commission in its role as a regulatory body. He rightly reminded us of the current arrangements, which give the CQC the ability to set its indicators and which, frankly, work well. I will not repeat his arguments, except to say in a slightly wider context that almost every piece of legislation brought to Parliament by this Government has given Ministers more powers—including, as in Clause 26, the power to intervene and to change remits.

The noble Lord’s amendments maintain the independence that the CQC—and other regulatory bodies—need to be able to inspect and make rulings without fear of favour or influence from politicians, while ensuring that the CQC must consult the Secretary of State when it revises indicators of quality for the purposes of assessment. That seems to me to provide the requirement for the CQC and the Secretary of State to engage in dialogue, but without the political intervention outlined in Clause 26(2) and (5).

Can the Minister explain why the Government feel the need to remove the independence of the CQC—whether this is an issue of management, as the noble Lord, Lord Lansley, said—and how giving the Secretary of State these powers can maintain the independence of a regulatory body?

Public Health England (Dissolution) (Consequential Amendments) Regulations 2021

Debate between Baroness Brinton and Lord Lansley

Tuesday 9th November 2021 Lords Chamber

[Lord Lansley (Con)]

My Lords, it was not my intention to speak in this debate—I wanted to come and listen to it—but I am prompted by a number of contributions just to say one or two things in response to the debate and before my noble friend has a chance to reply. I share with my noble friend Lord Cormack his support for my noble friend in taking on these responsibilities, and nothing I have to say reflects on his role in this. Indeed, I think it has been handed on to the Secretary of State as well, so in a sense we have a new team and I hope they will think about things sometimes in new ways.

I want to make a few, very simple points. The noble Lord, Lord Hunt of Kings Heath, is absolutely right: Public Health England was an executive agency. It worked for the department. In so far as it had operational autonomy, that was not in the legislation; it was a choice made by Ministers. At any stage, as was the case during the Covid crisis, Ministers had all the powers they required in relation both to Public Health England and to the NHS under the emergency legislation.

Let us remember that this House went through the 2012 Act in scrupulous—I might almost say excruciating —detail. It arrived at a conclusion that NHS England should be independent and Public Health England an executive agency. Notwithstanding certain measures put into the legislation to make sure that Public Health England would be more transparent and accountable, that balance was struck not least because I and my colleagues on behalf of the Government said, “We want the NHS to be seen to be independent. We want Ministers to take personal responsibility for public health.”

The noble Lord, Lord Howarth of Newport, referred to one or two things that happened afterwards. I want to share in thanking Duncan Selbie for what he achieved. I want to make it absolutely clear that I understand that Ministers subsequent to the establishment of Public Health England did not give to public health the resources, either for PHE itself or for local government with its responsibilities, that were intended back in 2010-12 under the coalition Government. That did not happen.

Let us remember that, at the beginning of 2020, the King’s Fund produced a report saying that it thought that the public health reforms had worked but they had not been sufficiently funded. Internationally, Public Health England was regarded as being as prepared for a pandemic as virtually any other country in the world. That things fell down needs to be thoroughly examined by an inquiry. An inquiry has not even begun, yet we are already at the point where people have made judgments, reached conclusions and found scapegoats. Heads and deputy heads have rolled.

We are not going about this in the right way. I want Ministers in due course to think again in the light of the report of that inquiry about what constitutes the right mechanism for managing their public health responsibilities. They need an organisation that understands public health in its entirety. How many of us think that the pandemic was unrelated to the extent of non-communicable diseases in this country, to the extent of disparities in this country and to extent of the obesity epidemic that we suffered?

We have so many interconnections between inequalities and public health problems, and our resilience against communicable diseases, that we should never think of managing public health in separate, siloed organisations again, but that is exactly what the Government are doing, without, frankly, having thoroughly understood what happened in in 2020 and 2021. I hope that they will go back and say, “Prevention is not the job of the NHS. Prevention is the job of the Government.” Public Health England was the organisation whose job it was to do that. If it was not strong enough in 2020 to do it, Ministers might look at what they did in the preceding years that might have undermined that role and think carefully about how they should take on the responsibility of building an integrated and fully functioning public health organisation for this country in the future, certainly not simply fragment it.

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association.

From the Liberal Democrat Benches, we support the Motion of Regret in the name of the noble Baroness, Lady Merron, and the noble Lord, Lord Cormack and the noble Viscount, Lord Stansgate, are absolutely correct that this House does not like the fact that once again the Government have chosen to use secondary legislation to make major changes to the way the Government manage their business—in this case, public health.

The noble Baroness, Lady Merron, has set out the chaos of a series of announcements from August last year, followed by a variety of procedures and changes when the Government kept getting things wrong. I absolutely support her concerns, and, as have many other speakers, I start from the position that major reorganisations during a global pandemic are unsound and unhelpful, not just to dealing with the pandemic but to the performance of any successor bodies, including the UK Health Security Agency and the Office for Health Promotion and Disparities, with disparity work continuing in NHS England. I echo the comments of the noble Lord, Lord Howarth, and others on the work of all the PHE staff, and Duncan Selbie in particular.