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Health and Social Care Bill

I am grateful for the opportunity to speak on Second Reading. The Secretary of State says that the Bill is important. I do not dispute that it has important implications, but it seems that its importance was not such that the Prime Minister thought fit to refer to it at all at the start of the Gracious Speech debate. It is customary each year for at least one health Bills to be a flagship Bill, as it were. Unfortunately, this year the health Bill is not so much a flagship as a fleet auxiliary—useful measures grouped together in much less visible form that never acquire the status of a flagship. I am afraid that this Bill in no way represents the changes in overall regulation that are required. After the 2005 election, the Government believed that there should be a wider review of regulation. They commissioned a review by Lord Currie of Marylebone and others, but they then more or less ignored it. They proceeded to publish consultation documents—frankly, inadequate ones—about the regulatory review, which culminated much later than originally intended in the document to which the Secretary of State referred. This Bill implements only one aspect of all that—the part that relates to the Healthcare Commission—but it is perfectly clear that it will not achieve the regulatory changes necessary to provide assurance in the longer term to those providing services to the NHS. If one believed in the long-term role of the independent sector, for example, in supporting the NHS, one would need not only powers of inspection for the commission, but an independent regulator to undertake economic regulation in respect of market entry or market exit. Since 2003, the Government have failed to introduce legislation for the failure regime or for the exercise of powers relating to competition and pricing. None of that is in the Bill: it is not the legislation that we really need to provide either autonomy or proper accountability. We have made it clear that we will introduce the necessary legislation in this Session and we will endeavour to ensure that it complements the aspects of the Bill that we support. In the course of the Bill's passage, we can do certain things to make it more consistent with our long-term structure and vision of health care. Before exploring some of the Government's proposals in more detail, let me isolate one point. What is lacking in the Bill—for example, in respect of the structure of the care quality commission—is any formal structure to give a voice to patients and the users of services. Members—particularly those who are present—will recall that when legislation was introduced during the last parliamentary Session to abolish patients forums and set up local involvement networks, we thought it important for patients to have the national voice that was missing from that legislation. The same applies to social care for care users and, indeed, carers. This Bill provides no such national voice. Although clause 2 enjoins the care quality commission to have regard to the views of patients, no structure is built into the Bill to make that happen. The Secretary of State intends the care quality commission to bear comparison with other regulators, but such structures are explicitly incorporated in many other regulating bodies. The Office of Communications, for instance, has a consumer panel, set up under the statute that inaugurated it, whose purpose is to acquire patients' views. That is one of the reasons why, in the measures that we propose, we will make specific provision for HealthWatch—working alongside the Healthcare Commission, or the care quality commission, as it will become—to represent patients and express their views on the health service to the whole regulatory structure and the Secretary of State. The same could, of course, apply to those using social care. Conservative Members will seek to amend this Bill to bring those principles into effect. Back in 2005, when Lord Currie of Marylebone presented his report to the then Secretary of State, he made it clear that such a national voice for patients was an essential part of a future structure. The hon. Member for Wolverhampton, South-West (Rob Marris) kindly asked part of the question that I had intended to ask the Secretary of State. However, I recall from my membership of the Standing Committee considering what became the Health and Social Care (Community Health and Standards) Act 2003 that at that time we abolished the Commission for Health Improvement, which I think had been around for only about three years, in order to establish the Commission for Healthcare Audit and Inspection, now colloquially known as the Healthcare Commission. It does not seem as though any of those bodies had been entrenched for any length of time before being abolished, and the same is true of the Commission for Social Care Inspection. The National Care Standards Commission was abolished in the 2003 Act, CSCI was established, and no sooner is it up and running than we are to abolish it. I would not wish the House to be in any sense misled. We believe that there has always been a strong case for those bodies to work side by side. We have always supported the proposition that we must try to break down the barriers between health and social care, and institutional divisions in the regulatory structure do not help that to happen. If we are to encourage, for example, the use of individual budgets and personalised care stretching across health and social care, it clearly makes sense for the regulatory bodies to work side by side. On the commissioning side, the current position in Herefordshire, where the primary care trusts and the local authority have effectively merged their activities at executive level, suggests that a single organisation could be helpful. The relationship between Ofsted and CSCI in respect of children's services is a good example. While I am happy with the principle that the two bodies should be merged, the central issue—as the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) rightly said and as the Secretary of State rightly accepted—is that when social care and health care are brought together there is a natural, or perhaps unnatural, tendency constantly to prioritise health care to the exclusion of social care, and to make mental health a Cinderella within health care. There is an inherent danger that bringing everything together under one regulator will cause both the functions currently performed by the Mental Health Act Commission and those performed by CSCI to attract less priority than the current functions of the Healthcare Commission. I have no doubt that the more often we say that during the passage of this Bill, and the more persistent we are in Committee about the nature of the duties—we shall have to spell that out clearly, as the duties are expressed only in the vaguest terms in current legislation—the more likely we will be to ensure that this body delivers what is intended. In my experience, the more independent a regulator needs to be, the more important it is that their duties, including the factors to which they must have regard, are spelled out in legislation; otherwise, that independence will be undermined—or if there is independence, the more likely it will be that the regulator behaves in ways that do not attract the support of the House.