Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2011

My Lords, the regulations before the Committee today relate to the registration of providers of NHS primary medical services with the Care Quality Commission. The effect of the regulations is straightforward. It defers the registration of most providers of NHS primary medical services by 12 months, until April 2013. The registration of a small number of out-of-hours providers of such services will still go ahead in April next year, and the commission has started the process of registering these providers. As the independent regulator, the Care Quality Commission has a key role in assuring the public and people who use services that health and social care providers of ““regulated activities”” meet certain requirements. In order to be registered, providers must meet a series of essential safety and quality requirements on an ongoing basis. Where a registered provider fails to meet these requirements, the CQC has a range of enforcement powers that it can use to bring a provider back into compliance. In the case of the most serious failings, the CQC is able to cancel a provider's registration, which would result in the provider's closure. The Committee will be familiar with some of the criticisms that have been levelled recently at the CQC, in particular that the number of inspections of providers that it carries out has fallen to unacceptably low levels and that it failed to respond appropriately to serious service failings, most notably in the case of the appalling abuse of residents at Winterbourne View, a hospital for people with learning disabilities. The Government attach the highest importance to the role of the regulator in carrying out its statutory functions in an efficient and effective manner. The regulations before us are part of the process of how we and the CQC respond to these issues. Deferring the registration of around 9,000 providers of NHS primary medical services will give CQC additional time both to improve the registration process for this tranche of registrants and to increase the compliance activity of providers that are already registered with it. Implementing the new registration system has required the Care Quality Commission to register around 21,000 providers already, bringing in, first, NHS providers; then independent sector healthcare providers and adult social care providers; and then independent ambulance and primary dental care providers. This has been a major programme of work for the CQC, which it has carried out well. However, given the scale of the task, it is perhaps not surprising that the number of compliance inspections carried out by the regulator fell. The current timetable set in regulations brings providers of NHS primary medical services into the registration system in April 2012. This would bring in around 9,000 additional providers and includes GP practices, out-of-hours primary medical care providers and some NHS walk-in centres. Although we remain committed to the registration of providers with the CQC and are confident that this will provide effective levers to tackle providers who deliver sub-standard care to patients, we have reconsidered the timing of registering the majority of these providers in the light of the challenges that the CQC has faced. Following a consultation that came to an end in July, and engagement with key stakeholder representatives, we have decided that providers of NHS primary medical services who provide out-of-hours care to patients who are not registered at their practice will be required to register with the CQC as planned from April 2012. Out-of-hours services tend to treat unfamiliar patients in unfamiliar surroundings and see a higher proportion of vulnerable patients with urgent care needs that are often more complex than those generally found in daytime general practice. As such, there is a more pressing need to register these services than other NHS primary medical services, which is why we are forging ahead with the registration of this group of providers. All other providers of NHS primary medical services will now be required to register in April 2013. The regulations before us amend the regulated activities regulations in order to achieve this delay. In parallel with our consultation on the proposed changes, the CQC has reviewed its registration process, looked at streamlining its registration systems, and is increasing its scrutiny of providers that it already registers. Consultation responses made clear that a streamlined process would be welcomed. I am pleased to assure the Committee that the commission is taking steps in this direction. On the registration process for primary medical services, I am informed that the CQC is overhauling its online application process so that providers will be able to start completing the application sooner than in previous application rounds. The website will contain full information on the registration process and will provide updates on the progress of an application and how long it is anticipated that it will take for key decisions to be made. The CQC will also put in place a central team to handle applications, avoiding the risk of the registration of NHS primary medical care providers impacting on the CQC’s ability to monitor the compliance of other registered providers. Noble Lords may recall that there were delays in registering dental practices earlier this year due to the volume of Criminal Records Bureau checks required. The CQC is considering a different approach, which I am assured will go a long way to resolving these problems. The CQC will engage with providers of medical services over the coming months to ensure that they have a clear understanding of what registration will entail and how compliance with the registration requirements will be assessed. The CQC’s compliance inspections have been increasing steadily since the spring. and I am confident that the delays proposed and the arrangements the commission is putting in to handle registration in April 2013 will allow this to continue and be sustained. Looking beyond initial registration, the CQC is also proposing changes to strengthen and simplify its regulatory model. Importantly, the commission is planning to increase the number of inspections that it carries out. These proposals would see all registered providers of hospitals, social care providers and independent healthcare providers being inspected at least once a year, with primary dental care providers inspected at least once every two years. I hope that the Committee will be reassured by the progress that the CQC is already making to improve its registration processes and to increase its focus on compliance and inspection. The delay to the registration of providers of NHS primary medical services that we are considering today will allow the commission the space and time that it needs to move further in this direction more quickly. I commend the regulations to the Committee.