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Lord Clement-Jones: I strongly support the amendment of the noble Earl, Lord Howe, and shall speak to our Amendment No. 89.

The noble Earl has put the matter extremely cogently, drawing on the Haskins report and the Government's response. He also referred to the current changing practice among regulators in fields outside of health. As the noble Earl said, Ofcom is a classic example—and there was no controversy about that when the Communications Bill passed through the House. The Competition Commission is another model, as are Ofgem and Ofwat, to which the noble Earl also referred.

I have had dealings with a large number of different regulators over a period of time. The new system recommended by the Haskins report—and accepted in principle by the Government—of having boards comprising the regulator is vastly preferable. As the noble Earl said, there is the danger of the cult of personality. When the water regulator changed as an individual, it had a major impact on investment decisions and whether the water companies could change their pricing. Single individuals can have a huge impact on the bodies, businesses and organisations they regulate. There is a very strong case for the Department of Health to consider best practice outside the health field.

Even among the existing regulators there is something of a cult of the personality. When a new chairman of a regulatory body is appointed, interviews take place with him and he sets his own stamp on the body. I am thinking of the recent changeover of the chair of CHAI. The two chairs were very different in style; there were interviews galore in the Health Service Journal about the different approaches. For the bodies being regulated or audited in those circumstances, that is not particularly helpful, much as one may value both the previous and the current chair of the body concerned. That is a classic example in the health field.

I hope that the Minister will consider this and will agree that adopting best practice in the field is the way forward.

Baroness Finlay of Llandaff: I support this amendment and the spirit behind it. I should like to speak from the perspective of the professions which

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are to deliver the changes. The professions are screaming out for continuity in the backdrop against which they provide services.

The danger of the cult of the personality has been very well explained. I urge the Government, in the name of continuity and consistency over decision-making, to look very carefully at the proposal in this amendment.

Lord Warner: It is hard to deny the force in some of the arguments put by the noble Earl and other noble Lords. We have been listening carefully to the arguments in another place and elsewhere supporting the establishment of the office of the independent regulator with a board structure rather than a single office-holder. We are awaiting the publication of a report by the Better Regulation Task Force examining the role of regulators who have a wide hybrid role, with economic and other functions. That is due to be published shortly.

If the task force recommends that a board structure might be appropriate for this group of regulators, we are minded to accept this and would bring forward suitable amendments to the Bill on Report to take account of those recommendations. I am happy to give the assurance that we would also consider the proposals in these amendments in parallel with any recommendations of the task force in determining which amendments to bring forward on Report. But I do not want to pre-empt the Better Regulation Task Force report by giving any indication today of what the Government might or might not include in any amendments that we bring forward on Report.

Lord Clement-Jones: Could the Minister give an idea of when the Better Regulation Task Force report might be forthcoming? After all, we are galloping through the Bill, and it would be extremely helpful if the report were available at least after the Committee stage and before Report.

Lord Warner: The noble Lord might have been riding on some rather slow horses if he describes this as galloping. That may explain why he may not have won much money on the Grand National.

As for when the report will be available, the best answer I can give is sooner rather than later. It is not for me to give a date. Let me put it this way: I will be quite surprised if we finish the Committee stage before the report is published.

Earl Howe: I take more than a crumb of comfort from what the Minister has said, even though he has not been able to commit himself. I am grateful to other noble Lords who have weighed in behind my amendments. I suppose that, in the time-honoured words, we shall just have to wait and see. If, for any reason, the Government need nudging on this issue, we shall not hesitate to do so on Report. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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Lord Clement-Jones moved Amendment No. 85:


    Page 1, line 11, leave out "officer" and insert "office within the Commission for Healthcare Audit and Inspection,"

The noble Lord said: The motive for wanting the regulator to be under the umbrella of CHAI derives almost entirely from the desire to simplify our current health regulatory system. I was recently at a fringe meeting at my party's conference and made what I thought was the fairly moderate statement that more than 20 bodies are entitled to inspect NHS hospitals. The particular regulator involved said, "No, more than 40 can do that". A phenomenal number of bodies are entitled to inspect NHS hospitals. It is quite interesting to note that a new body seems to be set up whenever there is a problem. Only in very recent times, we have had the National Patient Safety Agency, the National Clinical Assessment Authority and so on.

The Bill sets up a potentially very powerful regulatory body. However, there are many ways in which the role of this regulator conflicts with that of CHAI. If the roles do not conflict, there will certainly be considerable overlap. The noble Lord, Lord Hunt, pointed out earlier that we have all these regulators. He is right. We have too many regulators. The Minister referred to CHAI's duties in terms of the performance and impact of foundation trusts. That was designed to reassure us that all was going to be well and we did not need any further provisions in the Bill. However, that is going to cut across the new independent regulator as set out in the Bill.

I believe that there is a very strong case for simplifying the system. I wish that we could go much further than simply this amendment. There are many reasons for telescoping quite a number of the new bodies, putting them under CHAI and some of the other bodies and consolidating the whole system. At the moment it is vastly over-egged. Consequently, hospital managers spend an awful lot of their time looking at the nature of inspection and audit in a very unhelpful way rather than at how best to deliver the best outcomes for patients. I believe that the burden of regulation is far too great, not because of individual trusts' duties but because of the sheer number of regulators. I beg to move.

Lord Hunt of Kings Heath: I wonder whether the noble Lord, Lord Clement-Jones, could perhaps answer one or two questions about his amendment. He says that he will put the regulator under CHAI, but surely he sees the tremendous risk that the regulator will then engage and indulge himself or herself in all the activities with which CHAI is concerned. There is a real risk here that we will replace micro-management by government department and Minister with micro-management by regulator unless we ensure—and I know that the noble Lord mocks me for saying there should be light-touch regulation—that the regulator limits his intervention to those issues where the public interest clearly suggests that a foundation trust is seriously going off the rails. The last thing we want is for the regulator to intervene in all the minutiae with which a foundation trust is concerned.

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As we know, CHAI's reports already cover a huge amount of activity. The risk must be that that will influence the regulator to intervene rather more than I suspect he would if he were truly independent and outwith the CHAI mechanism. I just wonder whether the noble Lord could perhaps reflect on that.

Lord Clement-Jones: I can certainly reflect on that. There may well be a risk, but the issue is a practical one. The regulator will need quite a lot of the information that CHAI will produce in order to assess what he needs to do in performance of his duties under Clause 3. He will need that information from CHAI. Therefore, duplicating the gathering of that information seems to me entirely unnecessary if the regulator is part of CHAI, as is envisaged.

The question of light touch is a cultural issue. I hope that CHAI, and the regulator as part of CHAI, will adopt a light touch. I do not think that one can legislate for that. Earlier I mentioned the way in which different chairmen of what was CHI adopted a different approach to inspection and audit. I do not envisage the dangers occurring to which the noble Lord, Lord Hunt, referred; the practical arguments still remain.

Baroness Noakes: I hope that the noble Lord, Lord Hunt, will help the Committee by indicating where in the Bill there is reference to light-touch regulation. Where is there any kind of guarantee on that? I am aware that that is what the noble Lord, Lord Hunt, desires but, as I read the Bill, there is nothing in it to stop the regulator acting in a heavy-handed manner. If that is important, perhaps it is another issue that we should consider in more detail.


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