Health Bill [HL]

I support Amendments 35 and 47. My noble friend Lady Murphy has outlined their purpose very eloquently, as she always does, but I hope that I can speak from a provider perspective. I declare an interest, of which most noble Lords are well aware, in that I have a paid post in a provider trust, the East London NHS Foundation Trust, which provides mental health services. We would be directly affected, albeit only administratively, by the amendments. Let me say at the outset that I, too, very much welcome the idea of quality accounts. I would not want to dilute them in any way. I listened with great interest to the Minister’s explanation of how they will be put together, although I confess that I am not entirely clear even now. As I understand it, information will come from a lot of sources, and somehow there will have to be some rather succinct conclusions out of them so that the regulator and others can assess the performance of the trust against these three critical measures: clinical effectiveness, safety and the patient experience. On the point about the patient experience, I will clarify what I meant by patient surveys in our trust and, I hope, in every other trust across the country. Not only do we have the national patient survey, we also have our own patient survey, which looks at the quality of service according to the patient’s experience by ward and, indeed, by consultant. Therefore, if we have some indication that consultants are not always explaining in detail the side effects of treatment and so on, we know which consultants on which wards are failing and we can pick that up in the normal course of the work of the trust. That was an aside, and the point I want to make is that, with respect to foundation trusts, Clause 8 does not take account of the normal reporting and accountability framework for foundation trusts; that is, we report to Parliament, to Monitor and to our boards of governors, which are often called members’ councils. Since the noble Baroness, Lady Murphy, has focused on the Parliament and Monitor angles, I shall focus in particular on our local accountability arrangements and how I hope that the regime for quality accounts will dovetail into them. Local accountability arrangements are one of the most exciting developments introduced at the time of the establishment of the foundation trust model in 2002-03. Unlike NHS non-foundation trusts, we have boards of governors, and the majority of governors are elected by members of the public and key stakeholders from the community. The majority of our governors, and I am sure this is quite normal, are users of services and are patients or carers of patients. There is no better person to assess and be concerned about the quality of services than a user or a carer. For example, one of our governors recently spent time in one of our inpatient wards. She had a hell of a lot to report to us about her experience, and not all of it was good. That feedback from somebody who spent—I cannot go into detail. That feedback is far more valuable for us in assessing how we are doing, what we are doing wrong and what we urgently need to put right than even an unannounced visit from a regulator or an inspectorate, and much more valuable than an announced visit. I can tell you that we work jolly hard before an announced visit. If somebody is sitting in your ward or experiencing your services for weeks or months, they know every detail, including the state of the lavatories and exactly how things are going. More formally, we also report to our board of governors or members’ council on our annual plan and our annual assessment. Our self-assessment declaration goes to the board of governors for its comments and those comments go to the Healthcare Commission. We are coming into a new system, but local accountability is now very strong. I listen to chairmen up and down the country, and they are quite frightened of these boards of governors because they know exactly what is going on. That is the whole point. The proposed new clause would, by implication, require every foundation trust to present its quality accounts alongside its financial accounts to the board of governors at an annual general meeting. This brings quality accounts into the regular accountability framework of foundation trusts. If the Minister agrees with the principle that we are elucidating in this amendment, I hope that the Government will come forward with a government amendment that would incorporate these principles in the Bill. I understand that the Care Quality Commission will be responsible for setting basic standards for the registration of some 27,000 health and social care organisations, but that in future there will be two sets of quality standards. The second one will be some sort of standards or guidance established by NICE, encouraging a general improvement in the quality of care and trying to raise standards above the basic registration level. That is what I understand, but the Minister will correct me if I have that wrong. Boards of governors will be pressing for information about these higher level standards or guidance that the trust should be attempting to meet. I would be grateful to know whether these NICE-developed higher standards will be incorporated into the quality accounts in some way, or evidence against those NICE standards will be incorporated into the quality accounts. An important aspect of the proposed new clause, as the noble Baroness, Lady Murphy, indicated, is that the strategic health authority would have no role in relation to the accuracy of the quality accounts for foundation trusts. The strategic health authority has a clear responsibility for the performance of non-foundation trusts. There is no quarrel about that, and the Bill relates perfectly coherently to the reporting arrangements for non-foundation trusts. In a non-foundation trust, the chairman is appointed by the strategic health authority, and the chief executive officer of a provider trust reports to the strategic health authority as well as to the chairman. All that stops as soon as a trust becomes a foundation trust. There is no reporting line to the strategic health authority. I feel that it is somewhat illogical and confusing for foundation trusts to be sending material to the strategic health authority on quality accounts but on nothing else. There would be no context for that work. I hope the Minister will agree to clarify in the Bill the accountability framework for foundation trusts. I understand that some consideration is being given to dealing with these issues in regulations. My concern is that the primary legislation is over and above any regulations, and therefore strategic health authorities may feel that they should receive the quality accounts to check accuracy, if it is indicated in the Bill. I like clarity and simplicity, and it would be helpful to have a separate clause to set out the accountability framework for foundation trusts. As a provider foundation trust chair, I strongly applaud the accountability framework that we have. It is not that we have any old accountability framework, so we might as well fit into it; rather this accountability framework, with Parliament, Monitor and our boards of governors, has provided not only a simpler but a more robust framework within which we have to work. When people are coming from your wards and your community services and they are sitting in front of you and saying, ““But it is not like that. I have been there and I have experienced it, and it is not good enough. What are you going to do about it?””, the fact is that you get on and do something about it, if you have the money to do so.