My Lords, I thank my noble friend for raising this issue. I hope in the spirit of collaboration and compromise I am able to provide him with some further clarity and reassurance, even if I am not able to support his amendments.
Flourishing systems are critical to the success of integration and many of the proposals in the Bill. In that context it is right that the Secretary of State, who is accountable to Parliament, can set the overall strategic direction of reviews of integrated care systems through setting objectives and priorities for the CQC in relation to those assessments. However, it will be the CQC as the independent regulator and expert which will develop and carry out those reviews.
In Committee, noble Lords across this House raised several matters that these reviews should or could look at—from children to rare conditions—and it is right that the Secretary of State should be able to set objectives to explain the intent that lies behind high-level priorities such as leadership, integration quality and safety. These objectives will aid the CQC in its development of the review methodology and quality indicators and lay out where specific focuses should be given. The current clause allows the Secretary of State to make these distinctions and be more nuanced, just as is permitted for CQC reviews of local authority functions relating to adult social care set out in Clause 152. To remove the Secretary of State’s ability to set objectives is to remove nuance, which in turn could dilute the focus of these reviews on particular patient pathways or integration arrangements.
Furthermore, the Secretary of State must be able to ensure that the CQC’s role is complementary to other assessments, such as NHS England’s oversight of ICBs. This is achieved in part through the Secretary of State’s role in approving and directing to revise the indicators of quality, methods and approach. Removing the Secretary of State’s ability to direct the CQC to revise indicators risks the Secretary of State being locked in after approving the methodology. This could prevent the Government being able to respond to shifting developments in health and care, thus undermining the review’s relevance as time progresses.
I further reassure my noble friend and other noble Lords that we expect the power to direct to revise to be used infrequently, so as not to disrupt CQC reviews. The Government fully respect the independence of the CQC, and these powers are designed to ensure that its reviews of the integrated care systems are effective without undermining that independence.
It is for these reasons that I hope my noble friend feels able to withdraw his amendment and not move his further amendments when they are reached.