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Lord Warner: I am sure that Sir Ian Kennedy and his colleagues would not look favourably on any suggestion that they should be recommending cruel and unusual punishments. They may recommend special measures that they feel, given CHAI's expertise and first-hand account of the situation, should be taken to rectify the failings it has identified. In doing
We do not think that it is right to prescribe the detail of this in legislation. CHAI will consist of people with expertise who will go to a specific body. It will find out what may or may not be wrong and my expectation is that it will tailor its recommendations to putting things right as speedily as possible in that particular set of circumstances. Those are the special measures that we are talking about.
Should CHAI wish to recommend measures which are not specified in regulations there would in my view be an unacceptable delay while the regulations had to be mended. That could be an effect of the amendment. It would be unworkable for both parties to have their hands tied in such a way, especially given the unpredictable nature of some of the things that may be discovered by an inspectorate when reviewing a body. That is best left to the judgment of CHAI; we are sure that in order to have credibility with the NHS, the special measures that it recommends will be fit for purpose given the circumstances that it has inspected.
Baroness Noakes: This is one of the rare occasions on which the government are prepared to trust CHAI's judgment, so I suppose that one should not be ungrateful for having identified one such small area. However, because this is such an important issue for the NHS bodies affected by the provision, it is right that the Bill shouldwhether directly or indirectly by regulationspecify what are the boundaries within which recommendations may be made for special measures.
That is such a vague term. It has no recognised meaning in the NHS and there are no principles by which to decide what it can and cannot do. For the sake of clarity for the NHS, it is important to ask the Government to set out what sort of things CHAI or CSCI could recommend. If, over time, those things became insufficient, that could be amended by further regulations, but clarity would again be important.
Although the Minister's response was good on the basis that he trusts CHAI, it was unhelpful because it did not provide important clarity to the NHS. We may want to return to the matter on Report. I beg leave to withdraw the amendment.
The noble Baroness said: I shall speak also to Amendments Nos. 304 and 339. The amendments provide for CHAI and CSCI to make regular reports to the public. Amendment No. 302 relates to making public reports, alongside keeping the Secretary of
Baroness Howarth of Breckland: I would support the noble Baroness, Lady Noakes, except that I believe that the provision is contained in Section 7 of the previous Actcertainly for CSCI's responsibility. However, the amendment also relates to my previous comment, which is that such public reports will overall be reflected in government policy, so the noble Baroness should take heart from that.
Lord Warner: I have some sympathy with the intent behind the amendments, but I must resist them none the less. Of course we are all keen to improve public information about performance of public services, and the Government are doing so. If I may say so, that is why we favour performance ratings, but there seem to be different views about that.
The Bill already contains provisions designed to ensure that the commissions' expertise and understanding of services are made available to the public. That may help the noble Baroness, Lady Masham. Clauses 51 and 57 for CHAI and Clauses 78 and 80 for CSCI provide that following an inspection, the commissions must publish reports of their findings. Most fundamentally, the "Reports and Information" clauses for CHAI and CSCIClauses 63 and 85 respectivelyplace a duty on them to send out copies of reports to those who request them. The commissions are also required to produce an annual report to Parliament that will also be available to the public.
So there are substantial provisions in the Bill to ensure that those reports are in the public arena. To place a wide-ranging general duty on the commissions to keep the public informed about services, as the amendments are framed, could give rise to important
Baroness Noakes: I am grateful to the Minister for his responsein particular, for his agreement to take the matter away to reconsider it. There is a difference between the information provisions that he mentioned, which are scattered throughout the Bill, and those referred to in the amendments. It is that information that we are trying to ensure will be in the public domain and will not be subject to a decision, which might in future not be open and transparent, about whether to keep the public informed. I beg leave to withdraw the amendment.
The Deputy Chairman of Committees (Lord Murton of Lindisfarne): Before calling Amendment No. 303, I must tell the Committee that if it were agreed to, I should be unable to call Amendment No. 304 because of pre-emption.
I am here thinking especially of any notable example of good practice in a foundation trustbearing in mind that in Clause 47(1) the general function of CHAI, before all others, is that of encouraging improvement in the provision of NHS healthcare. But it is also possible to imagine the regulator being made aware of an area that merits possible investigation by CHAInot only in the foundation trust concerned but in the NHS more widely. An example might be a deterioration in the delivery of cancer services by a foundation trust within a cancer network or plans by a foundation trust to reconfigure one of its services in a way that may have a knock-on effect on other NHS bodies. In those and other such circumstances, the regulator should have a duty to communicate any concerns to CHAI. That ought to be a specific duty. I beg to move.
Lord Warner: The regulator and CHAI will be under a duty to co-operate with each other under Clause 54(3). That duty will ensure that the regulator keeps CHAI informed of any other information relevant to the exercise of CHAI's functions. However, the regulator does not have a function of reviewing healthcare provision of NHS foundation trusts. It is not therefore sensible to require him to keep CHAI informed about such provision. The distinction that we make is not to place a duty on the regulator, as the noble Earl proposes, but to use the duty to co-operate in Clause 54(3) to ensure that the regulator makes available to CHAI information relevant to the exercise of its functions.
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