Clause 82 - Imposition of licence conditions on NHS foundation trusts

Care Bill [Lords] – in a Public Bill Committee am 9:30 am ar 28 Ionawr 2014.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Question proposed, That the clause stand part of the Bill.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health)

The clause facilitates the imposition of licence conditions on NHS foundation trusts and extends Monitor’s powers to impose additional licence conditions on a foundation trust, which the Opposition welcome. My major concern, which we will consider more fully later, relates to the speed at which Monitor will work. We are all keen to ensure that speedy and appropriate  action is taken, but we surely want to guard against a process that could lead to a forced rush in introducing the trust special administrator, and we can do that by focusing downstream. Clearly, the imposition of licence conditions is intended to be a pre-TSA warning system, but how much of an early-warning system is that? What are the time scales between the imposition of licence conditions and either the lifting of those, or the beginning of the TSA process, and where is that made explicit? Do the Government intend to produce guidance on that and, if so, will that happen before Report?

If 20 or more trusts are in serious financial difficulties, with the possibility of that number increasing as demand increases and supply fails to catch up, and if trust special administration is truly to be a regulation of last resort, the process that leads towards the imposition of licence conditions needs to be crystal clear, not just for effective and expedient regulation, but to maintain care standards. Will the Minister therefore make explicit in guidance the warning signs leading up to the imposition of licence conditions, and the time scale over which those conditions may be satisfied and then lifted, extended, or failed?

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health 9:45, 28 Ionawr 2014

I will address directly the points raised rather than speak to the clause, which we largely covered in the previous debate.

If the CQC recognises that a trust requires significant improvement, it will issue a warning notice, given that, in some trusts, failings of care are so extreme or severe, and thus potentially damaging or dangerous to patients and patient care, that prompt action needs to be taken. The hon. Gentleman talked about the method of last resort, and the warning notice will also indicate that the trust special administration process could be used, if required, which will make trusts sit up much more quickly and take on board the concerns raised by the CQC. One of the concerns highlighted by the Francis inquiry was that trusts have not always taken the CQC as seriously as they need to. This measure will be used as a recognition that significant improvement is required and that trust special administration could ultimately be put in place, meaning that improvements need to be made.

The first step towards those improvements will be achieved through a trust working, as at present, with local commissioners to address care quality issues. Monitor or the TDA will oversee that process for the trust or foundation trusts. Following that process, the CQC will reinspect to see whether improvements have been made broadly in line with what was outlined in the warning notice. It may well be the case that if there were still fundamental concerns, the trust special administration process would need to be triggered. Alternatively, it could be that more time would be required. It will be for the CQC to set time limits that are appropriate to what it finds and what issues have been raised in the warning notice. That is a matter of clinical judgment, so it would be very difficult for hon. Members or Whitehall to be prescriptive about that.

The hon. Gentleman asked about the timetable for setting out the framework for how the process will work, Monitor will update its guidance for health care providers on licensing regimes in the light of the Bill.  There is no set timetable for that at the moment, but once the Bill has been passed, the framework will be laid out. As I outlined when speaking to the previous group of amendments, a process is being lined up for Monitor, the TDA and the CQC to work out joint guidance for trusts and foundation trusts, so I hope that the hon. Gentleman finds that reassuring.

Question put and agreed to.

Clause 82 accordingly ordered to stand part of the Bill.