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Earl Howe: I am surprised by that answer. I realise that there is a clear distinction between the role of CHAI and that of the regulator. The regulator is not expected, in the normal course of his duties, to carry out inspections and to supplant CHAI. But I would have thought that he should have a duty to inform CHAI if any matters of concern came to his attention. The duty to co-operate in Clause 54 does not seem explicit enough. If it were, one would have to ask why subsection (1) of Clause 54 was necessary in the other direction. The Government clearly thought it important to give CHAI a specific duty to keep the regulator informed—in other words, it is not enough to rely on the duty to co-operate. We shall have to reflect on the matter. I am not convinced by the Minister's reply, but, for now, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 304 not moved.]

[Amendment No. 304A had been withdrawn from the Marshalled List.]

Clause 54 agreed to.

Clause 55 [Reviews of data]:

On Question, Whether Clause 55 shall stand part of the Bill?

Earl Howe: I ask the Minister to comment on this clause, because the Explanatory Notes are not very illuminating. Subsection (1) states:

    (a) the quality of data obtained by others in relation to the provision of health care".

I am not clear who the "others" are in that context. It is potentially a very wide provision that would appear to allow CHAI to review data sources outside the public sector. If that is a correct interpretation, will the Minister gave an example of what kind of data sources could be reviewed in that way, and why?

Lord Warner: I shall try to help. I appreciate the noble Earl's reasons for raising the issue. Clause 55 will enable CHAI to evaluate studies and research carried out by other bodies. Such bodies might include the Royal Colleges, independent commentators, academic institutions or other organisations concerned with public policy or services.

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It is very important that patients and the public have a clear picture of what is happening in the NHS. As we all know too well, it is understandably the subject of much analysis and commentary, sometimes conflicting and sometimes misleading. But patients and the public deserve to have the facts about the NHS as it is. We therefore wish to ensure that there is a safeguard that, in fulfilling its role as the pre-eminent independent organisation to which patients and the public look for information about the quality of NHS care, CHAI can evaluate and, where appropriate, comment on the quality of studies carried out by other bodies, including the methods used in carrying out those studies. That may be to confirm that the studies have a solid basis in evidence and reach valid conclusions.

The National Health Service Reform and Health Care Professions Act placed a similar function on the Commission for Health Improvement to conduct reviews and issue reports on the quality of data obtained by others relating to the management, provision, quality, access and availability of healthcare for which NHS bodies or service providers are responsible, the validity of conclusions drawn from such data and the methods used in their collection and analysis. This clause gives a similar role to the new CHAI.

Subsection (2) makes clear that CHAI must publish a report. That will enable the public to make informed judgments about the quality of information available and healthcare provision. It will help to provide transparency in CHAI's work.

By contrast, CSCI, under Clause 76, will look at research into social care and determine whether it can improve the quality of social care services. It will look, in particular, at the conclusions of such research and whether they are valid. That is different from the role of the Social Care Institute for Excellence, which gathers and publicises knowledge about how to improve social care services. I have given information on CSCI in the hope that it will be helpful, although the noble Earl did not raise it. I have tried to explain the thinking behind Clause 55.

5.45 p.m.

Earl Howe: That is helpful. I am grateful to the Minister. How is CHAI supposed to get behind data provided by the Royal Colleges or academic institutions to review them? It has no power in the Bill to require a body in the independent sector to co-operate with it or to supply further and better particulars. Merely to review the data as they stand might lead to CHAI producing what none of us wants—a half-baked analysis. I am unsure, given the lack of powers in the clause, whether it will be enough for the purposes that the Government clearly have in mind. Can the Minister shed more light on that?

Lord Warner: CHAI would not fulfil its primary duties if it sat around waiting for reports that it might wish to have a go at, or if it tried to investigate too many. I am sure that we can all remember circumstances where there is controversy and differences of view on an issue. Where possible, CHAI

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might wish to look into those differences of view and to do its best—possibly using its own data, for example—to clarify the situation in the public interest. CHAI could not force people to give it access to their methodology and data. On the other hand, if it raised concerns about the validity of particular views expressed, those espousing those views would wish to put their methodologies in the public arena and make them available for CHAI to examine. That is all that we are trying to do.

Earl Howe: Once again, I am grateful to the Minister. We would all have that hope in those circumstances. There is a risk that CHAI will not be able to get sufficiently behind the methodology to make a balanced and well informed judgment. One must hope that there will be an inclination to co-operate, if not a specific duty.

Clause 55 agreed to.

Clause 56 [Co-ordination of reviews]:

Baroness Noakes moved Amendment No. 305:

    Page 21, line 20, leave out "may" and insert "must"

The noble Baroness said: The effect of this amendment on Clause 56 would be that CHAI "must", rather than "may", co-ordinate reviews of health bodies. It is, in part, a debate along the may/shall lines that our Committees often enjoy.

We support the basic thrust behind Clause 56. For far too long there has been at best patchy co-ordination of reviews of bodies in the NHS. There are many stories of the revolving door syndrome when as soon as one reviewer departs the next arrives. I was recently told that 39 different bodies, including the Royal Colleges, have the right to review an NHS trust. This is hugely wasteful and demoralising for the staff who just want to get on and deliver patient care. It is right to put someone in charge of this and someone must, not may, do that co-ordination.

There is a question, however, about whether CHAI should be doing that. Given the huge tasks that CHAI already has to deliver, we might be overloading it. How much of CHAI's time is estimated to be absorbed in this task? Organising 39 reviewing bodies over hundreds of NHS bodies is not a part-time activity. Will CHAI be resourced to do this? We want CHAI to make a positive impact on the ground and it will not be able to do that unless it is properly resourced and well set up to do the task. What levers will CHAI have to ensure compliance with its co-ordination function? It is all very well to say that CHAI may or must co-ordinate, but it takes two—or possibly 39—to tango. What happens if the other bodies refuse to join in? I beg to move.

Lord Warner: Amendment No. 305 would place an explicit duty on CHAI to promote the effective co-ordination of reviews and assessments carried out by other public bodies or other persons in relation to healthcare provided by English NHS trusts and cross-border special health authorities. It is important that we understand that the use of the word "may" is normal parliamentary language when a general

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function—which is what this is—is being specified rather than a particular duty. That is why the word "may" has been used rather than "must". I am confident that CHAI, the primus inter pares of healthcare inspectors, will want to ensure that it facilitates the sharing of best practice between other bodies that have an interest in the provision of healthcare. Given Professor Sir Ian Kennedy's previous comments on the fragmentation of NHS inspection, I am confident that the commission will want to seize the initiative on relieving the burdens of inspection on frontline NHS staff.

I cannot estimate the time that this function will cause CHAI to invest in terms of resources, but I assure the Committee that we are not setting up CHAI to be inadequately resourced. We want it to have the appropriate resources to enable it to fulfil its functions. That is our approach. I also remind members of the Committee that Sir Ian's document Vision for CHAI clearly indicates the commission's willingness to work in real partnership with others, especially in the area of common data collection. I am not convinced that we need to include the explicit duty proposed in the Bill, but I am willing to look again at the issue raised in the amendment, which I agree with the noble Baroness is an important one, and return to the matter on Report if we think that we can make drafting improvements.

Baroness Carnegy of Lour: Many people will regard that as good news. Will the Minister clarify what is meant by general functions? He said that this was a general function of CHAI rather than a specific duty. When he discusses that matter with his officials perhaps he could clarify what that means, because it is a slightly woolly statement. Is it really an optional rather than a general function? The description is one of so many that he has given that I cannot expect him to be anything but annoyed at my niggle, but I thought that it was rather a woolly answer to say that it was a general function rather than a specific duty.

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