Lords quality accounts fight may cause an unpleasant sensation

This time they are fighting for control of quality accounts. The Health Bill introduced by the government says the accounts will be sent to the health secretary. Monitor has countered that this would compromise foundation trusts' independence. An amendment from cross bench peer and Monitor non-executive director Elaine Murphy calls for them to be sent to the regulator and Parliament instead, as are financial accounts.

Just a few weeks ago Baroness Murphy owned up to being behind a 1970s hoax, when the medical world was led to believe there was a painful condition afflicting male musicians called cello scrotum. There have been several occasions when Monitor executive chair Bill Moyes has had a similar effect on senior DH figures, and this looks like being another one.

Although regulators may occasionally arrange the tabling of parliamentary amendments to tidy up legislation, it is curious behaviour for one to confront its departmental ministers over a matter of principle in this way.

Lord Darzi's defence of the government's position - that the quality drive is about much more than regulation - holds water. While the accounts should not become a mechanism for central control, it would surely be hard to convince the average taxpayer that the minister accountable for health should not have direct access to a record of the quality of the service being provided.

This latest locking of horns again highlights the need for a debate on the relationship between foundation trusts and the DH.

It is in the interests of foundation trusts for that to happen sooner rather than later. It is the differentiation between foundations and non-foundations that brings the issue of freedoms into focus; once almost everyone achieves foundation status they will no longer be part of an elite, and government will find it far easier to circumscribe their powers.