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Baroness Carnegy of Lour: My Lords, the whole idea of the star rating system is to act as an incentive for the raising of standards. On the face of it, that is one way to do these things. However, there is nothing worse when you are actually working in the system than feeling that the system for rating your achievement—in this case the star rating system—is unfair. There is a widespread feeling—I believe that the noble Lord, Lord Turnberg, identified it on a previous occasion, as did others—that the star rating system is unfair because it is too blunt an instrument. It needs to be much more subtle, much more accurate and therefore much fairer. It has to be accepted as a good means of assessment so that if the hospital next door—or whatever part of the health service is being assessed—does better than you, you feel that that is right; otherwise, it acts as a disincentive. So far as I can make out, a good deal of disgruntlement in the health service is brought about by the feeling that this system is unfair.

Lord Warner: My Lords, I am grateful for the thoughtful remarks of my noble friend Lord Turnberg. I say to the noble Earl, Lord Howe, that even in my visually challenged state if I put the telescope up to either eye and I look at targets, I can still see that they have done rather more for patient access to services than some of the measures that were taken in previous times. I acknowledge all the limitations of targets, but they have changed people's ability to get access to services when they really need them both in outpatient and inpatient departments. We should not lose sight of that in our rush to vilify targets and to review them. No one is arguing that the system cannot be improved but we should not lose sight of the benefits that targets have brought to patients.

Amendments Nos. 297 and 338 would allow both CHAI and CSCI the freedom to determine the form that performance ratings may take. Of course it is up to both commissions, as independent commentators, to determine expressly how the performance ratings will look and feel. This has always been our intention and I therefore feel that, given the reassurances I have placed on record, these amendments are unnecessary.

Amendments Nos. 298, 317, 339 and 349 propose to remove the duties on both commissions to seek the approval of the Secretary of State, and in the case of CHAI the Assembly, before issuing relevant criteria under Clauses 49, 59, 79 and 83 of the Bill. I shall not go over the ground again but I have already said on numerous occasions in our deliberation of the Bill that we are giving Ministers the role of approving such criteria proposed by the two commissions in order to

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ensure that the statements of criteria reflect and are consistent with the national standards set by the Secretary of State under Clause 45. After all, the Secretary of State remains accountable to Parliament for the delivery of health and social care provision. These clauses as drafted seek to avoid situations in which CHAI or CSCI's criteria might inadvertently create an additional alternative set of priorities for NHS bodies or social care providers.

However, as I have already made clear, although Ministers will have ultimate responsibility for approving inspection criteria, both CHAI and CSCI will be responsible for drawing them up. This will allow both commissions plenty of opportunities to listen to the concerns expressed in this House and elsewhere and to use their expertise to ensure that the criteria against which health and social care providers are inspected are fair and reflective of the needs of service users. I am sure that both commissions will have in the forefront of their minds the needs of patients. I suggest that it would be a brave Minister who did not listen carefully to Sir Ian Kennedy and his colleagues regarding the criteria and methodologies that they propose.

Amendment No. 344 would prevent CSCI using the lowest level of rating as a measure of poor performance for advising the Secretary of State on the action to be taken to improve such services. The lowest level of rating is given only to authorities who are clearly failing to provide a satisfactory level of social services to their local community generally or where either children's or adults' services are of an unacceptable standard. CSCI, in making these assessments, will use a mixture of data that it has from its general reviews and investigations, statistical data, performance data it receives from the authority and any information available from local inspectors. These decisions are not made on the basis of snap judgments but on the basis of regular liaison with local authorities. Changing from this position to one where action can be taken only where there is significant cause for concern would not be in the best interests of service users. It could be seen to suggest that action might be taken only where serious harm had already been done to the welfare of children or vulnerable adults and that is not acceptable to the Government.

Clause 79(3) already imposes on CSCI an obligation to report to the Secretary of State where any social services authority is failing to discharge any of its functions to an acceptable standard. Therefore the star rating given to the local authority is not the only trigger for such a report to be made. We consider it right that there should be two bases for reports to be made to the Secretary of State, one where its overall level of service is such that it receives the lowest star rating, and a second where any particular service is below an acceptable standard. That two-part test is right, and the proposed additional test would not add anything.

7 p.m.

Earl Howe: My Lords, I thank the Minister for that full and helpful reply. I shall reflect further on what he

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said as regards Amendments Nos. 344 and 349 in particular. I am grateful to him for confirming something that I am not sure emerged from our earlier debates, which is that CHAI and CSCI will themselves be tasked with responsibility for the performance-rating system. That is good news, and I am sure that it is the right way to go. I shall certainly not dwell on the amendments any further, other than to express my pleasure at the Minister's answer.

I still do not understand why, on the question of criteria, it is necessary for the Secretary of State to have a role in approving whatever CHAI and CSCI propose. Again, I shall think carefully about what the Minister said. His case seemed a little thin, but he took a good deal of trouble in answering the points, so the least that I can do is consider what he said fairly and fully. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 298 not moved.]

Lord Warner moved Amendment No. 299:

    Page 18, line 10, at end insert—

"( ) The Secretary of State may, after consulting the CHAI, by regulations make provision as to the procedure to be followed in respect of the making of representations to the CHAI before the award of a performance rating under this section."

The noble Lord said: My Lords, I want to dwell briefly on the opposition amendments in this group, in order to explain my points on the government amendments. I am not in any way trying to inhibit other debate. The opposition amendments are the same as those tabled in Committee. They require CHAI and CSCI to give NHS bodies and local authorities the chance to comment on the contents of reports before they are published or shown to the Secretary of State. I argued in Committee that such amendments were unnecessary because it was already good practice to share copies of reports with the inspected bodies prior to publication. We are still confident that CHAI and CSCI will continue that practice.

However, I said that I would consider further the principle behind the amendments. Having given that further thought, I consider that it would be appropriate to include a provision in the Bill to formalise what will happen in any case through good practice. The government amendments tabled place a series of regulation-making powers in the Bill that will enable the Secretary of State to make provision for the procedure to be followed in respect of the making of representations to CHAI or CSCI before the award of a performance rating or publication of a report.

It is more appropriate that such matters should be dealt with in regulations than by having an explicit duty in the Bill, in order to allow for the flexibility required. We envisage that a regulation-making power which would specify in some detail differing numbers of days that NHS bodies and local authorities would have to respond to reports by CHAI and CSCI in different circumstances is the right way forward. For example, where a body was deemed by CHAI and CSCI to be failing, or they were concerned that the

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safety and welfare of patients or service users was put at risk, we could specify that a lesser number of days should be given than was generally the case. That would ensure that CHAI, CSCI and the Secretary of State were still able to act quickly to protect patients and service users. As I said in Committee, one of our principal concerns with the opposition amendment was that it might hinder them from doing so.

The government amendments require consultation with CHAI and CSCI before any regulations are made. We would of course also carry out a full public consultation on those regulations, to ensure that the particular timescales specified for different circumstances are entirely appropriate. I should make it clear to the House, however, that due to the fact that the regulation-making powers are being added only at this stage, it is unlikely to be possible to carry out such consultation and have the regulations in place by 1st April 2004, although we will aim to do so as soon as possible thereafter. I beg to move.

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