---

Health and Social Care Bill

I agree with the hon. Lady. I also agree with her earlier remarks about the rights-based approach of CSCI. In my opinion, it is important that that should continue into the new commission. The rights of service users and their carers must be at the heart of the development of the new system of registration and inspection. If they are not, there is a real danger that the voices of people who are reluctant to speak up will not be heard. Patients in hospitals have access to the patient advice and liaison service— PALS—that the Government set up. Those patients are in larger establishments, with more people coming in and out and a larger group of trained staff on hand. Care homes are often small, with a small number of staff and often, sadly, very few visitors, and the people living in them can become isolated. In that context, the voice of the user of those services really must be heard. The Bill does not include a requirement for the commission to seek the views of the public. However, two other groups mentioned in the Bill—the office of the health professions adjudicator, in clauses 100 and 101, and the council for healthcare regulatory excellence, in clause 108—are explicitly required to seek public and service user opinions. Perhaps the Government intended the advisory committee to fulfil that role. If that is the case, I would like more information on how the voice of users is to be heard. At the risk of overusing the word ““vulnerable””, I must stress that we are talking about the very vulnerable people who receive these services. I want to mention two groups in particular. Clause 44 will allow the commission to undertake special reviews and investigations. The first group that I want to mention is children with disability. My hon. Friend the Minister might recall that, last year, together with my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), we held a series of parliamentary hearings on the needs of children with disability. One issue that came out clearly from those hearings was the difficulty that many of those children and their families experienced during the transition from children's services to adult services. I hope that the new commission will work closely with Ofsted to see how children's services can be moved forward into adult services in the context of children with disability. The second group involves adults with disability, especially adults with learning disabilities. Sadly, we have had too many instances of inequality of treatment of adults with disabilities, in health care and social care. The hon. Member for Romsey referred to Cornwall Partnership NHS Trust, which was in a truly shocking state in 2005. The trust had three stars in 2004 and it had two stars in 2005. When it was awarded those stars, was anyone looking at the care on offer? When CSCI and the Healthcare Commission went investigated, they described incidents such as"““staff hitting, pushing, shoving, dragging, kicking, secluding, belittling, mocking, and goading people who used the trust's services””." The report described a truly appalling situation. In March this year, Mencap produced a report, ““Death by indifference””, which again detailed cases of institutional discrimination within the health service against people with learning disabilities. We really must ensure that the new inspection regime looks at the quality of the care delivered; it should not be just a tick-box regime, behind which examples of unacceptable practice could be hiding. The commission will look at how local authorities and other organisations deal with complaints, but it is sometimes by listening to complaints that we find out what is happening on the ground. I hope that the Minister will look at the commission's role and ensure that, in reflecting on how local authorities and individual organisations deal with complaints, it will be able to build up a picture and perhaps identify systemic complaints. If the same organisation receives the same complaints time and again, there may well be something seriously wrong, and the commission needs to be able to identify that. About 35 per cent. of people are self-funded in the social care field. They, rather than the local authority, pay for it, so they cannot bring complaints to the local government ombudsman. They have to complain to the person who runs their home. Will they make such complaints if they feel vulnerable within their establishment? If someone else complains on their behalf, how will the new commission find out about it? Again, we are talking about people in isolated settings throughout our communities. A complaints structure provides a good way of building up a profile of when things are going wrong. Finally, I want to say a few words on the social care work force, which the all-party parliamentary group on social care is looking into. The General Social Care Council has raised with me questions about its role on the new commission. The GSCC has already registered social workers, but it is rolling out its registration regime. How will it work with the new commission to ensure that people who work in social care are registered, properly trained and have all the necessary qualities to deliver social care to vulnerable groups of people? As a newly elected MP several years ago, I recall sitting in the Committee scrutinising the Care Standards Bill. That is one of the best Acts that the Labour Government ever introduced because it addressed the delivery of quality care. If the Bill is to succeed, we must ensure that the new care quality commission will pick up all the good points that were embodied in the Care Standards Act 2000 and ensure that vulnerable people—whether they be in a health care setting or a social care setting—are protected, listened to and supported. That will be the test against which the legislation will be judged.