It is not for Ministers to do that. I say that with great respect to the noble Lord. In saying that, however, I also highlight the ability of the CQC to flex its inspection frequency in accordance with information received. The noble Lord will know that organisations such as local Healthwatch, and indeed local authorities themselves, are able to alert the necessary authorities through Healthwatch England, which, as noble Lords know, is an integral part of the CQC, to any problems that may be flagged up. The CQC will be consulting in future on its proposals for care home inspections, and I do not doubt that a difference of view will emerge about the frequency of those inspections. I am the first to say how important it is that the inspections take place, and I totally take the point that those assessments should not be allowed to drift in any way. However, for better or worse we have an independent body known as the CQC, which should be allowed to act accordingly. The noble Lord, Lord Campbell-Savours, took us back to the 2008 Act. I would say to him that, in agreeing with the noble Baroness, Lady Howarth, Robert Francis was clear in his report that the system should not be significantly reorganised.
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I fully agree with the point raised by several noble Lords that the CQC under new leadership should be given the time that it needs, both to improve the performance of its current functions, such as registration, and to embed the new functions, such as ratings. The noble Lord, Lord Hunt, asked whether Ministers had put pressure on the CQC. No, absolutely not. We are clear—I am looking at the noble Lord, Lord Sutherland —that the chief inspector should be an independent post in itself. The chief inspectors are appointed by the CQC, not by the Government or the Department of Health, and we think that this is appropriate.
The noble Lord, Lord Campbell-Savours, asked why the CQC does not have a complaints remit. Again, going back to earlier debates under the previous Government, all organisations in healthcare were aware that the Healthcare Commission—as it then was—provided independent review of individual complaints cases. This seemed to act as a perverse incentive not to investigate thoroughly at a local level. In other words, it is arguable that providing an independent stage through a separate organisation had actually worked against effective local resolution of complaints, because NHS organisations were aware that the Healthcare Commission would ultimately undertake the work.
So there was less willingness to take ownership of the problem at the source of that problem. A lot of duplication also emerged from that, with the Healthcare Commission tending to carry out investigations even where the work had been done at local level. That was not a good use of public money. I remember that the Parliamentary and Health Service Ombudsman and the Local Government Ombudsman fully supported the decision to remove handling individual complaints from the regulatory body.
As for the evolution of these ratings, the Government do not expect the CQC to have fully developed ratings for hospitals by the end of this year. That would be unrealistic. The initial ratings will not be a final product. They will instead represent the first stage in an ongoing development process. The Government expect that CQC will improve its methodology over time, and one of the most robust ways to do that is to continually test the methodology in the field. The new Chief Inspector of Hospitals will spearhead the new approach to assessing hospitals, using his clinical expertise to develop an effective approach for rating. I direct noble Lords to the CQC’s consultation document A New Start, which sets out all these plans in some detail.
CQC plans to commence rating providers of acute care from December, with the aim that all these providers receive a rating before the end of 2015. It will begin to develop ratings for mental health trusts during 2014, and for other NHS trusts, such as community healthcare and ambulance trusts, during 2015-16. Why do we not specify in the Bill who will be assessed? The answer in the first instance is that this Bill consolidates the existing regulation power in Section 49 of the Health and Social Care Act 2008, to allow the CQC to have the flexibility to focus on providers of most interest to the public. That is important in defining the scope of the new performance-assessment system through regulations. We are giving the CQC increased flexibility to focus its assessment on those providers and services that are of most interest and concern. We must avoid overloading it with the task of assessing the entire system. We wanted to focus, first, on services where an assessment and subsequent rating are likely to provide the most benefit to everybody.
The noble Lord, Lord Hunt, asked about the commissioning responsibilities of local authorities, and whether they would be a priority for the CQC when it conducts its ratings. The CQC has a duty under the Health and Social Care Act 2008 to carry out reviews of local authority commissioning, but the policy position agreed with the Department of Health is that, for the time being, local authority commissioning performance and assessment will be led by councils as part of wider moves to devolve responsibility for improvement in the sector, underpinned by strengthened transparency and accountability to local people. The policy position is still under consideration. Therefore, the clause gives the Secretary of State the power to define in regulations the scope of the performance-assessment system. Until it is agreed to what extent there will be a need for reviews of local authority commissioning, the policy will be kept out of scope in the regulations.
I hope that I have answered most if not all the questions. Naturally, I shall reply in writing to any noble Lords whose question I omitted.