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Health and Social Care Bill

This is exactly the sort of debate that we need to have. In order to access the grant, the woman will have to seek advice. I hope that that same woman will seek advice at an early stage in her pregnancy, as indeed most women do. They either go to the doctor to confirm that they are pregnant or go to the doctor once they have confirmed that personally. I remind the hon. Gentleman that the grant should be seen in the context of other initiatives from the Government, such as Sure Start projects and the expansion of children's centres. Women would have to sit at home and not read a single newspaper, not watch any television and not leave their houses in order to avoid all the advice that they are now given not only about their pre-pregnancy diet and diet once they are pregnant, but about having a healthy lifestyle in general. I welcome the grant and I am sure that it will be appreciated by the overwhelming majority of pregnant women. A second aspect of the Bill that I welcome is the removal of the liable relative rule. It is clearly unjust to require a husband or wife to pay for the cost of the care of their spouse in a care home over and above the resident's contribution. Indeed, the overwhelming majority of local authorities do not enforce the rule, so I welcome the fact that we are going to remove it. I also welcome the new public health measures to help to prevent and control the spread of serious disease. The extension of direct payments to those who lack capacity, by allowing payments to be made to a suitable person who will manage it on their behalf, is a welcome move, especially for families who have severely disabled children. Those children can access direct payments, which are usually made through their parents. When that child becomes 18, they cannot continue with direct payments, because they will then be an adult lacking capacity, but under the proposed extension they will be able to do so. Other groups will also be able to access direct payments for the first time, including people with dementia, people with learning disabilities and people who may have a fluctuating capacity. Will my hon. Friend the Minister offer an assurance that vulnerable people who lack capacity will be protected? The Mental Capacity Act 2005 sets out a functional test for capacity. An individual might lack the capacity to make certain decisions, such as complex financial decisions, but might well be capable of making decisions about their personal care. In the context of direct payments, an individual with learning disabilities might not be capable of managing their finances, for example, but whoever is doing so should ask them what sort of care they want, in order to determine whether they can talk about the care that they feel they should have. Let us not think that the extension of direct payments means removing all decision making from an individual, because the same individual could, within the terms of the 2005 Act, be more than capable of making some decisions, while being incapable of making complex financial decisions. I also welcome the transfer of the pharmaceutical global sum to PCTs. PCTs should already be working with pharmacists. Reference has been made in this debate to the new pharmacy contract. I visited my local pharmacy, near where I live in Blackpool, after the new contract was introduced. My local pharmacist had set aside an area for private discussion and consultation. He was looking forward to engaging with his customers and offering them advice. Pharmacists now have a public health role that they should be working to. The transfer of the global sum to PCTs represents an opportunity for them to work much more closely with pharmacies to deliver that important part of the Government's public health agenda, so I welcome it. I welcome the Government's proposal to establish the care quality commission, in order to deliver a seamless package of care between health and social care. There are not two different groups of people, one that receives only health care and another that receives only social care. There is already a mix. Sadly, however, some people find it difficult to get a seamless progression of services through health and social care. I was at a meeting with Blackpool PCT on Friday, at which I discussed that very issue. I was pleased to hear that Blackpool PCT is already developing integrated care packages for patients, so that it can look at what an individual needs, from an ambulance to take them to hospital and the acute care that they will receive to the after care that they will need, thereby treating the individual as a whole person, not as a care episode, a health episode, then another care episode and probably another health episode after that. If by introducing the care quality commission the Bill helps PCTs to deliver that sort of integrated package of care, it will be very much welcomed. As I mentioned in my earlier intervention on the Secretary of State, there are concerns in the social care sector that social care will be a second-level partner. It must not be, not only because of the individuals receiving that care, but equally because we cannot afford to lose the excellent work that the Commission for Social Care Inspection has done over recent years. Dame Denise Platt has offered leadership to CSCI, which has raised standards in social care, increased the profile of social care and undertaken important research. Above all, CSCI has listened to care users and their carers. I read CSCI's annual report with interest. It is not often that I read annual reports with interest, but every hon. Member should read CSCI's annual report, because it outlines what social care is provided, how it has changed and how it will continue to change. I strongly believe that the hard work that CSCI has done needs to be taken forward and put at the centre of developments for the new care quality commission. My question for the Minister is: how is it going to do that? How will the new commission deal with the fact that 24,000 of the 30,000 registered health and social care providers are in social care? The new commission will be dealing on the one hand with NHS facilities and any health facilities that are large and, on the other, with a multiplicity of social care providers, the majority of which will be small independent providers in the private sector—often, small and medium-sized businesses. Bringing together the Healthcare Commission, CSCI and the Mental Health Commission in this new organisation will therefore require changes of practice to address the different forms of facility that the new body will register and inspect. It goes beyond that, however. I am talking not only about the nature of the facilities but about the differences, which the commission will address, in policy background in health and social care. Health and social care often start from different perspectives. Heath care usually works on the precautionary principle: we see an illness, respond to it, write a prescription or perform an operation. Social care, however, has traditionally been in the risk business. It involves seeing how far someone can cope on their own, and giving them a bit of support while leaving them in their own home in the community. We are going to have to bring together those two very different ways of working, while maintaining the proper roles of the health care and social care professionals. Interestingly, the all-party parliamentary group on social care, which I chair, is undertaking an inquiry into the changing role of the social care profession. That role is changing, but social care professionals want to hang on to what makes their role special. It will be an important job of work for the commission to ensure that it acknowledges that, and that it acknowledges the differences between health care, social care and mental health care, now that they are all within the same remit. The commission will have to acknowledge very real differences in another area as well. The NHS is free at the point of delivery, but social care customers pay. They are at the very least assessed to see whether they should pay for most of the services that they receive, and large numbers of them do pay for day care, domiciliary care or residential care. Those paying customers will want their voices to be heard. Concern has already been expressed about how the voice of the user will be listened to by the new commission. There is a tension between the Government's understandable desire for light-touch regulation and the need to safeguard vulnerable individuals in health or social care. Sadly, having policies in place is sometimes not enough, because those policies are delivered by fallible individuals. Inspection to see how individuals are applying the policies that we determine is therefore vital. As I understand it, the new commission will have a less frequent inspection regime. Indeed, some social care providers might not see an inspector more than once every three years. I listened with interest to an answer that the Secretary of State gave following an intervention on this point. He quite rightly asked why, if someone was doing their job well, we should go round and inspect them every other week. Of course we do not need to do that. However, many social care establishments have a high turnover of staff. I do not have the statistics on health care. A snapshot visit on day one might reveal an excellent care team delivering high quality services, but that does not mean that that same high quality team will still be in place a month, six months or a year later. I wonder how the new commission will be able properly to monitor the huge number of social care establishments that experience a high staff turnover. There is a particular danger involved when senior staff leave, whether the manager of an establishment or a member of the senior team. Those people set the tone for an establishment. They make sure that new staff are trained to work with vulnerable individuals. I hope that the Minister will be able to reassure me that the new commission will look at an appropriate inspection regime for that multiplicity of social care establishments. The Bill requires the commission to establish an advisory committee to ensure that it takes into account the views, advice and information coming from people such as providers and users of social care. It should listen to the views of the public on activities within its remit. Again, my question is: how will this work? How will this be achieved in practice?