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I am not in any doubt, having been the person who moved the foundation trust legislation in this House back in 2003, that, at the end of the day, the right person to take action on removing authority to continue to provide services is Monitor. The licensing system has worked well. There have been good working relationships between the Healthcare Commission and Monitor. They know where they stand. I hope we can continue that kind of relationship, but I think it will require action on the part of Department of Health Ministers to set the expectations on how those regulators might behave.

Lord Darzi of Denham: My Lords, I fully support the intention behind this amendment, which is to encourage the independent regulators of NHS foundation trusts, Monitor and the Care Quality Commission to co-operate with one another on the efficient and effective use of resources. We of course want to ensure that public money is put to best use and the work of the two regulators, both of which have roles in healthcare, is co-ordinated. This co-ordination will not only make the most of the resources but, more importantly, it will help to ensure that there is no duplication in the actions each body takes with respect to foundation trusts.

Your Lordships have debated two issues. The first is the clarity of the purpose of the two regulators and the second is if there is any duplication in their function. With regard to clarity of purpose, I remind noble Lords what was said in Committee and also in response to the consultation document which was published in October 2007. We said that we expect the CQC and Monitor to work closely together especially when imposing sanctions or taking enforcement actions. For example,

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when the Care Quality Commission responds to a safety or a quality failing within a foundation trust with a warning notice, the Care Quality Commission will notify Monitor to ensure that it is aware of its concerns. While the foundation trust will be responsible for delivering the necessary improvements, Monitor will work with the NHS foundation trust to ensure compliance because it will be concerned about the impact of the enforcement action on the NHS foundation trust’s ability to operate.

It is unfair to compare what the Healthcare Commission does now and what the CQC will do in the future. The CQC will have an enforcement function and we are trying to find the adequate framework in which Monitor and the CQC will work together.

We believe that the duty to co-operate in Clause 66 will lead to the commission and Monitor establishing a good working relationship. I should like to set out other aspects of the legislation that support the intention behind this amendment. First, under Clause 63, the commission is required to,

This provision is intended to ensure that the commission works with other public bodies, such as Monitor, when planning reviews and assessments, in order to avoid duplication and ensure that resources are used effectively and efficiently. Monitor is already required to exercise its functions effectively, efficiently and economically under paragraph 16 of Schedule 8 to the National Health Service Act 2006.

Schedule 4 provides for the commission's interactions with other authorities. It can act jointly with other public bodies and provide advice and assistance to other public authorities. Furthermore, the Secretary of State may specify public bodies in addition to the inspection authorities that the commission must co-operate with for the efficient and effective exercise of its functions. Therefore, if the Secretary of State considered it necessary, he could make an order specifying Monitor. However, we do not consider that that will be necessary given the provision in Clause 66.

The noble Baroness, Lady Meacher, asked what the Government would do about the computers. I am always amazed when people think that each organisation that provides health and social care will have two computers, one for CQC and one for Monitor. The whole purpose of the provision is to create intelligent information that will be available to all sorts of public bodies involved in regulation, regardless of whether it is financial regulation or regulation of the quality of care provided. However, Clause 64, which was a government amendment in the other place, is intended to avoid the duplication of information collection alluded to earlier.

Both Monitor and CQC have to produce annual accounts and a report on how they have exercised their functions. These reports must be laid before Parliament, and there is an independent scrutiny of the accounts by the Comptroller and Auditor-General, who must also lay his report before Parliament.

I therefore believe that the Bill contains adequate provision to ensure the effective and efficient use of resources by these two bodies. However, if noble Lords feel that we can do better, I will be more than happy to listen between now and the next stage.

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Baroness Meacher: My Lords, before the Minister sits down, perhaps I may respond quickly to his response to my brief remarks. The whole point of the duplication of information is not that identical bits of information are requested; if they were, they could be interchangeable. He would be amazed at how requests for information can be defined slightly differently, with slightly different assumptions, so that the exercises have to be done completely separately and the same information cannot be provided to two or more organisations.

Lord Darzi of Denham: My Lords, I agree; it is a relevant point. I am sure that one day this information will be publicly available for anyone to analyse. On that note, I ask the noble Earl to withdraw the amendment.

Earl Howe: My Lords, the Minister's reply was particularly helpful, and I am grateful to him for setting out in considerable detail how the Government view this problem. It was never my intention to press this amendment, but I am very glad that I encouraged myself to press the Minister on the central point at issue because it drew from noble Lords opposite some pertinent points, notably from the noble Baroness, Lady Meacher, and the noble Lord, Lord Ramsbotham. I am particularly grateful to the noble Lord, Lord Warner, for his helpful comments.

The concluding point made by the noble Lord, Lord Warner, was that there was scope for the department to set its own expectations on how the two bodies should fulfil their respective roles. That point was borne out by the last exchange between the noble Baroness, Lady Meacher, and the Minister. There is clearly scope to examine, not so much precisely where the two bodies may interact and duplicate each another, but where the burdens placed on one of the bodies may be unnecessary because the other is doing an approximately similar area of work.

Perhaps the Minister could look at that. I repeat that I found his reply particularly enlightening and feel comfortable, on that basis, in withdrawing the amendment. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

4.45 pm

Clause 77 [Publication of programme of reviews etc.]:

Lord Darzi of Denham moved Amendment No. 44:

On Question, amendment agreed to.

Clause 79 [Reports for each financial year etc.]:

Lord Darzi of Denham moved Amendments Nos. 45 and 46:

(e) the steps taken by it during the year to implement the proposals in its statement under section (Statement on user involvement) (statement on user involvement).”

On Question, amendments agreed to.

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Clause 81 [Fees]:

Lord Darzi of Denham moved Amendment No. 47:

On Question, amendment agreed to.

Lord Darzi of Denham moved Amendment No. 48:

(a) does not require regulations made under section 4 to be made so as to apply to activities carried on by or on behalf of the Crown, and(b) is to be read as if section 38(3) of the Crown Proceedings Act 1947 (c. 44) (references to Her Majesty in her private capacity) were contained in this Act. (a) should not be exercisable in relation to any premises which are used by or on behalf of the Crown and are specified in the certificate, or(b) should not be exercisable in relation to any premises which are so used and are specified in the certificate, except in circumstances specified in the certificate,those powers are not exercisable in relation to those premises or (as the case may be) are not exercisable in relation to those premises except in those circumstances.”

On Question, amendment agreed to.

Schedule 5 [Further amendments relating to Part 1]:

Lord Darzi of Denham moved Amendment No. 49:

“Local Government and Public Involvement in Health Act 2007 (c. 28)“(ca) the Care Quality Commission;”.”

On Question, amendment agreed to.

Clause 92 [General interpretation of Part 1]:

Lord Darzi of Denham moved Amendments Nos. 50 to 52:

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On Question, amendments agreed to.

[Amendment No. 53 not moved.]

Lord Darzi of Denham moved Amendment No. 54:

On Question, amendment agreed to.

Clause 95 [Fitness to practise panels]:

Earl Howe moved Amendment No. 54A:

The noble Earl said: My Lords, this straightforward amendment has arisen directly from our debates in Grand Committee. It concerns the composition of fitness-to-practise panels in the OHPA. Clause 95 says that a fitness-to-practise panel must consist of a chair, a lay member, a professionally qualified member and,

My only problem is that it leaves open the question of equality of representation. As the wording stands, the OHPA could assemble a panel comprising a majority either of doctors or of lay people. There may currently be no intention to do that, but I question whether it is appropriate to leave this issue to be decided by the rules of the OHPA.

In creating the OHPA we are surely attempting to establish a body which commands the confidence of the public, as well as the confidence and respect of doctors. For me, at least, that objective of necessity requires a balance of lay and professional members. To unbalance the make-up of the panel in either direction would risk jeopardising the public standing of the OHPA. This is not likely to change over time. Either the balance of confidence is important or it is not. If it is, there is scope for the Government, with the benefit of advice from the GMC, to reconsider the wisdom of this provision. I beg to move.

Lord Walton of Detchant: My Lords, I support the principle underlying the amendment. I declare an interest: from 1982 to 1989 I was president of the General Medical Council and, under the rules then obtaining, I regularly chaired fitness-to-practise panels in the old disciplinary committee. Almost invariably there was an unequal number of professional and lay members. Professional members were in the majority, but almost invariably they took a much harsher view of the problems of which the respondent doctor was accused, whereas the lay people nearly always tended towards lenience.

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However, that is, of course, old history. The Minister may now say that this issue is not to be enshrined in primary legislation but governed by rules. In those days, rules made by the General Medical Council had to be approved by the Privy Council. Those were the days when the medical profession and its regulatory authority cherished their independence from government, regarding the Privy Council as a crucial barrier between them and Big Brother in the Department of Health.

Now the rules are to be made by the OHPA. Will the Minister clarify whether they are simply rules it can make without reference to any other body, or whether they must be approved by the Department of Health? Also, the crucial principle of parity between lay and professional members on fitness-to-practise panels will mean a great deal to members of the medical profession; the clause also applies to the optical profession.

I therefore support the principle underlying the amendment, believing that parity between professionals and lay people is essential. Lay people must be included, following the decisions of Dame Janet Smith in her report and the change in regulation now embodied in the Bill. However, it is also crucial that there should be adequate professional representation on these panels, to ensure an ability to advise on specifically medical or optical issues. I hope that the Minister can clarify these important points.

Baroness Gardner of Parkes: My Lords, my Amendment No. 56 is in this group. I am sorry that I did not speak before the noble Lord, Lord Walton, as I had hoped that he would also support my amendment. As we are on Report, this is the only time we will debate it; perhaps he can intervene before I sit down.

I apologise; I had thought that it would be a long time before we reached these amendments. My Amendment No. 56 does not cut across the amendment of my noble friend Lord Howe at all. I strongly support having equal numbers of lay and professional people. My history of doing so goes back nearly 50 years, when I supported equal numbers on the Inner London Executive Council, which ran the National Health Service for London. I was a professional member, of whom there were too many. The numbers were not equal, and I did not think that that was a good or healthy thing. It is far better to have equal numbers, so I support the amendment of my noble friend Lord Howe.

My amendment is quite different. I would like to see retention of at least two elected professional members. The profession has ownership of its council if it can elect some of its own members. A fully appointed body is not as good. I have quoted various bodies that make appointments; professionals do not feel that they are in touch with that process at all. I therefore propose that at least two professional people should be elected by members of their own profession. In my experience on the General Dental Council—sadly not comparable with the General Medical Council—most of the original thoughts came from the elected members. They were people in ordinary practice who seemed to know what was going on in the everyday life of their profession.

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Lord Walton of Detchant: My Lords, could the Clerk clarify the rules at Report stage? It is my belief and understanding that you can speak only once on Report. You can speak again, but to a different amendment.

Baroness Thornton: My Lords, the noble Baroness was speaking to her amendment, not moving it. The rules state that you can speak only once on Report unless you choose to intervene.

Baroness Golding: My Lords, I thank my noble friend for that clarification. I wish to speak to Amendment No. 54A, moved by the noble Earl, Lord Howe. This amendment is linked to a question that I raised in Committee regarding American doctors practising in this country. I asked whether they would be covered by the rules under which they practised in the United States or whether they would be subject only to the jurisdiction and rules of the General Medical Council. Since then, I have received a letter from my noble friend Lady Thornton, for which I thank her. It states:

I believe that this could cause a problem for American doctors practising here.

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