Clause 36 - The Commission for Healthcare Audit and Inspection
Health and Social Care
8:55 am
Mr Chris Grayling (Epsom and Ewell, Conservative)
Good morning, Mr. Griffiths. We now move on to the audit and inspection structure that the Government aim to establish—the Commission for Healthcare Audit and Inspection. However, in the amendments that have been selected this morning, we hope to make a small modification by adding the word ''Independent'' at the beginning of the titles of the Commission for Healthcare Audit and Inspection and its counterpart for social services.
The tone of the debate that is likely to follow, not just on this set of amendments—I know that Liberal Democrat Members are minded to go in the same direction—but on a number of other issues that arise on this part of the Bill will show how important it is
that the body established to inspect health care should be independent. If my hon. Friend the Member for West Chelmsford (Mr. Burns) is fortunate enough to catch your eye in this debate, Mr. Griffiths, he wishes to address the same point in relation to the Commission for Social Care Inspection, or the ICSCI, as we hope it will be. The bodies must be truly independent of the Government, truly able to set out standards for health care, to play devil's advocate to the Government and the health care providers and to provide a quality of health care that goes far beyond the rather constrained nature of the present system, driven as it is to far too great an extent by the targets culture established by the Government, which is doing so much damage to the provision of health care.
Too much of this part of the Bill still leaves reference points, controls and influences inappropriately in the Secretary of State's hands. In the run-up to this debate a number of reports in the media, which access the behind-the-scenes discussions taking place in the Government and in health care about the Bill, have called into question the Government's motives for creating the inspectorates, asking whether they are likely to be as independent as the initial rhetoric has made out.
For example, on 7 March the Daily Mail reported:
''Alan Milburn was accused last night of trying to gag a new NHS watchdog before it even starts work. The Health Secretary has insisted that the Commission for Healthcare Audit and Inspection . . . will be independent and have real teeth. But a draft version of the Bill to create the watchdog, which will take over the Audit Commission's role in the NHS next year, reveals that ministers want to keep it on a tight leash.''
The Times reported:
''A senior Whitehall source said . . . that a draft of the legislation showed the Department of Health was seeking to water down previous guarantees of the commission's independence. The source claimed that ministers were seeking 'powers of intervention and initiation' to direct inquiries, while also limiting its right to publish findings without prior departmental clearance.''
Although many of the measures in the Bill establish CHAI as an independent body, members of the Committee will see as we go through the debate a number of areas where that independence is compromised. This symbolic set of amendments at the start of the debate on CHAI is designed to reinforce the organisation's independence.
We are adopting this approach for a number of reasons. The first is the flawed nature of the star rating system, which is perpetuated in the Bill. That system is not a truly independent assessment of the quality of health care. We stress in our amendments that the commission must be independent—independent in its very name through to the way in which it is established, the details of the way in which it works and the parameters within which it works alongside the Government. The star rating system does not reflect an organisation that can provide a true and independent assessment of the quality of health care. The most obvious reason for that is that the star ratings do not reflect clinical outcomes: they are fundamentally about administrative matters. They measure such things as financial management, hospital cleanliness and the length of time that patients wait for treatment, all of which are important, but they do not measure
clinical outcomes; they do not assess whether people get better. What more important measurement could there be of the effectiveness of our health care system than the quality of the clinical outcomes that it delivers?
We believe that a truly independent inspectorate would ensure a much broader reflection of the strengths and weaknesses of hospitals, not simply in the way in which they are run or meet objectives, but through the quality of the health care that they deliver. We want an independent inspectorate to pursue that dimension of its work, and not simply the management framework, as occurs in the current star rating structure. Once again, it is essential that the word ''independent'' be added to strengthen the organisation and set the tone from the start of the debate by saying that these bodies will be free of the Government.
In far too many areas the focus on Government targets is reflected in the way in which the Commission for Health Improvement works. When we debate clause 46 we will see how that clause perpetuates that link and the Government's ability to use their political objectives to shape the inspectorate's work and how that link distorts the work of our health care system.
Too many examples today point to a lack of independence and the fact that CHI—the Commission for Healthcare Audit and Inspection, as it will become—is not independent of government. They show that in too much of its work it is a tool of government. We have seen some clear examples of the way in which the targets culture distorts clinical decision making.