LORDS AMENDMENT (Hansard, 27 March 2003)

§ Baroness Andrews

My Lords, I beg to move that the House do not insist on their Amendment No. 24, to which the Commons have disagreed for their reason numbered 24A. I will also speak to Amendment No. 25.

Amendments Nos. 24 and 25 would impose a permanent statutory duty on inspection bodies to monitor the impact of the Bill on patients and carers and a permanent statutory duty on the Secretary of State to report on an annual basis to Parliament on the outcomes of patients affected by the Act.

Perhaps I could restate the steps that the Government have taken not only to monitor the effects of policies on the NHS and social care in real time so that action can be taken if there are perverse effects, but also to evaluate policies. In addition, I remind noble Lords about the proposals in the Health and Social Care (Community Health and Standards) 985 Bill to make the new inspectorates much more independent of government. In the light of that, the major problem that we have with the amendments is that it would be inappropriate, having just proposed that the Secretary of State would agree high level priorities only with the new inspectorates, immediately to start a detailed list of inspections that the inspectorates must perform. I hope that noble Lords accept that it would not be right to undermine their independence in that way.

Health and social care already involves a raft of ways of evaluating performance—performance indicators include delayed discharges, emergency readmissions, home care and people helped to live at home. We are also introducing indicators on the speed of service provision. Those indicators will quickly indicate if substantial problems arise, even if they are in only some local areas. The department is also carrying out work at the moment on improving the sensitivity of readmissions data, so that it more accurately reflects whether a patient is readmitted with the same problem as previously. We need to know that. Those mechanisms are robust.

The department's interest in reducing the unhappiness that delayed discharges cause will absolutely not stop when the Bill is implemented. In response to concerns about the impact of the Bill and incentives on behaviour in the NHS and social services and the effect on patients, we will commission an evaluation of the system and of its implementation during the first year of operation. We want to ensure that the system, and the incentives within it, are bringing about positive changes and identify any barriers to successful implementation. In addition, the implementation team, which is led and staffed by practitioners, will be encouraging local partnerships to have "dry-runs" of the system before commencement, which can also be evaluated by a wider reference group and fed back to the implementation team. We want to learn the lessons as early as possible. We will want to intensify that work from October until full implementation in January so that social services and the NHS feel supported when they introduce the new system of notifying each other and acting on those notices. At the same time, the implementation team can offer support to areas having particular difficulties—it will build on what has worked well elsewhere.

I return to the inspectorate. I know that noble Lords were concerned that there was a gap between the difference between collective quantitative information and quantitative information, so that we knew what was happening to the patient and the impact on him or her. I know that the noble Baroness, Lady Noakes, was concerned about that.

The Health and Social Care (Community Health and Standards) Bill proposes the establishment of two new health and social care inspectorates—the Commission for Health Audit and Inspection and the Commission for Social Care Inspection. One of their functions will be to validate performance statistics, but they will also monitor and report on the "whole system" with an emphasis on the experience of the 986 patient and user of the service. We believe that that is a major step forward and one which noble Lords will welcome. The new CHAI inspections will include foundation trusts.

Noble Lords may be interested to know that the current inspectorates and the Audit Commission are already planning a wide-ranging and co-ordinated study of older people's services across health and social care. Field work will begin later this year and it will consider the new structures and report in 2005.

Both the new inspectorates will report annually to Parliament on the provision of NHS and social care. Their independence from the department will mean that instructions from the department about the detail and frequency with which they need to inspect older people's services would not be possible as the relationship between inspectorates and department is currently envisaged.

On that issue, the Commons reasoned that it was neither necessary nor appropriate to impose a permanent specific statutory duty on the inspection bodies to monitor the effects of the Bill or on the Secretary of State to report every year to Parliament specifically on the effect of the Bill. Therefore, I hope that noble Lords will accept that it is preferable to maintain this independence and that the additional evaluation that I have introduced today and the existing very robust mechanisms that we already have in place will meet the reservations raised at previous stages of the Bill.

Moved, That the House do not insist on their Amendment No. 24 to which the Commons have disagreed for their reason numbered 24A. —(Baroness Andrews.)