Health and Social Care (Safety and Quality) Bill

Baroness Laing of Elderslie Excerpts

Friday 9th January 2015 Commons Chamber

[Sir William Cash (Stone) (Con)]

I beg to move, That the clause be read a Second time.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

With this it will be convenient to consider:

New clause 3—Care and Quality Commission annual State of Care Report—

‘(1) Section 83 of the Health and Social Care Act 2008 (health and adult social services: reports for each financial year etc.) is amended as follows.

(2) After subsection (2) insert—

“(2AA) The reports under subsection 1(b), (c), and (d) must, in particular, cover the safety of health and adult social care services in England.”’

[Sir William Cash]

Before I make my remarks on the proposals, I pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), my neighbour, with whom I have worked for the past five years with great enthusiasm, because he has dedicated himself to all matters in his constituency, but specifically to dealing with the problems that came out of the Mid Staffordshire public inquiry—I campaigned vigorously to get that public inquiry. I also pay tribute to Ken Lownds, whom I regard as a hero of that inquiry in many respects. I pay tribute to his work on zero harm and the Bill. I do not in any way want to leave the Minister out of the tributes because he has done a great job, as has the Secretary of State for Health. I wanted to put that on the record. We are reaching the climax of the Bill and this is the moment to pay tribute to those who so richly deserve it.

The object of new clause 2 is to amend section 46 of the Health and Social Care Act 2008. The section deals with health and adult social care services reviews and performance assessments. It comes under the rubric of reviews and investigations under chapter 3 of the Act on health care standards.

Section 46, “Periodic reviews”, provides that:

“In respect of each Primary Care Trust the Commission”—

the Care Quality Commission—

“must…conduct reviews of the provision of health care provided or commissioned by the Trust…assess the Trust’s performance following each such review, and…publish a report of its assessment.”

It also makes special provision with respect to each English national health service provider. Subsection (3) states:

“In respect of each English local authority the Commission must…conduct reviews of the provision of adult social services provided or commissioned by the authority…assess the authority’s performance following each such review, and…publish a report of its assessment.”

In the light of experience, and to improve the 2008 Act, particularly section 46, the new clause would substitute for subsection (3) the following:

“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”

The purpose of that is to require the CQC to ensure that the indicators used to assess ratings cover the safety of care, which goes back to the question of harm-free provision. Basically, the argument goes like this: the object is to stress that the CQC can be an effective regulator only if it is free of undue influence from Ministers. The measure is a good indicator of whether the Government are prepared to say that they want the CQC to be able to exert influence and carry out its functions irrespective of undue influence from Ministers. In other words, are they prepared to step back and allow the CQC to do its job properly?

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. On many occasions, I have discussed with Ken Lownds over dinner and otherwise the origins of much of his thinking on the subject, some of which I had difficulty understanding—apparently some of it comes from aviation safety, but I will leave that to the experts.

Under the leadership of the three chief inspectors, the CQC has put in place specialist inspection teams able to scrutinise the quality and safety of care more rigorously. Inspections no longer simply consider whether providers are meeting the registration requirements, but 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.

The CQC’s tougher, people-centred, expert-led and more rigorous inspections are seeing some outstanding care, and the CQC has already rated many good services. That new approach has also exposed poor care and variations in care, making the level of quality transparent in a way it has never been before.

I have to say that my experience of what happened after Mid Staffordshire—this was before my hon. Friend the Member for Stafford came into the House, and I pay tribute to what he has done to help me since—was itself a matter of the gravest concern. Having witnessed what went on there, I then had to engage in a campaign, and I tried, unsuccessfully, to push the Government of the time into having a public inquiry, but Ministers, including two Secretaries of State, refused point-blank to hold one.

Furthermore, I had to nudge—if I can use that word—those on my own party’s Front Bench quite vigorously. I think that would be the appropriate description. That included our then shadow Secretary of State and the now Prime Minister, who responded magnificently, making an inquiry a manifesto commitment. One of the very first things the Government did when they came into power under the present Prime Minister was to say, “We will have this Mid Staffordshire public inquiry under the Inquiries Act 2005.” As a result of that and of the work of Ken Lownds, my hon. Friend and others of us who have been involved in this issue, including the sponsors of the Bill—I should also refer to them—we now have this new Bill in my hon. Friend’s name, which will make quality transparent in a way it never has been.

We are already confident of the great strides the CQC is making to be an effective regulator of health and social care providers. I hope that the Minister will accept that new clause 2 is exploratory, but I tabled it in the fervent belief that he will respond satisfactorily to my request, because this is a matter of grave concern.

If it is convenient, Madam Deputy Speaker, I will move on to the next new clause, unless my hon. Friend the Member for Stafford would like to respond to my points now. Would that be appropriate?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

At this point, we are considering new clause 2 and new clause 3, so it would be appropriate for the hon. Gentleman to address new clause 3, if he so wishes.

[Sir William Cash]

That is very good. I just wondered whether my hon. Friend wanted to respond on new clause 2 before I move on to new clause 3.

New clause 3 proposes to amend section 83 of the 2008 Act, which deals with health and adult social services and with reports for each financial year. The new clause would insert proposed new subsection (2AA), which says:

“The reports under subsection 1(b), (c), and (d) must, in particular, cover the safety of health and adult social care services in England.”

To put that into ordinary language, the purpose is to require the Care Quality Commission to cover safety of care in the annual state of care report. That is hugely important, because it is the narrative to which people will be able to refer in identifying progress on these incredibly important provisions.