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Health and Social Care Bill

I apologise to the House for the fact that I was not present at the beginning of the debate, but I wrote to the Speaker last week to explain why I would be late. I meant no discourtesy to the House. I have a particular interest in the Bill and I wish to make a brief contribution on Second Reading. When merging the Mental Health Act Commission, the Commission for Social Care Inspection and the Healthcare Commission, I hope the Government will take on board the fact that there is such an overlap of service out there, and rightly so. The service that we should seek to provide, particularly for patients, should be seamless, but despite the Government's best efforts to merge health and social services, we all still come across a great deal of casework in which it is difficult to take matters forward because of the glass walls that seem to exist between areas of responsibility. The care quality commission that the Bill creates will be responsible for inspection and standards and will, we hope, facilitate crossover and ensure the seamless delivery of services. If the system is too compartmentalised, people's conditions and the difficulties that they are encountering will fall down the middle. I am sure the Minister will take that on board. We need to address the matter, not least because, in the context of inspection, there are some groups for which we will have to provide to make sure that the services that are delivered to them and the way in which those services are delivered do not disadvantage them. I shall give two quick examples. Across health and social services, we talk about adolescents, but whether we are talking about physical health, mental health or social services, all too often adolescents find themselves in inappropriate situations because sometimes it is difficult to judge whether children's services or adult services are best for them, for obvious reasons. They are young people going through the transition from childhood to adulthood, and tailoring the services and the quality of the service or care that they are given can be a difficult call for professionals. I hope the Minister will accept that whatever system is put in place when the care quality commission comes into being, it will need to address the particular circumstances of adolescents and ensure that the service meets their needs and that the inspection reflects the issues. Another aspect of the care quality commission that I want to raise with the Minister is the fact that the Government want to take away from the people responsible for inspections the right to look into second stage complaints from individual patients or, occasionally, patients' relatives. Although the Bill does not focus primarily on that, will it give substantial reassurance about the system that is likely to replace that? I know that the Government are going out to consultation, but many of us feel unhappy that something is being taken away before we have a clear idea of what will replace it. I hope the Minister will address that. Another issue that I shall touch on is the extension of direct payments. I declare an interest, as I am responsible for assisting a dependent adult relative who is the recipient of direct payments. I take co-responsibility with him and help him to complete his forms. I have been a great advocate of direct payments so I welcome the extension proposed in the Bill, but I flag up a concern. Apart from my constituency casework, wearing other hats, I get involved in other casework around the country. Some authorities administer direct payments well, and others do not. Some seem to think that that is a cheap option. Some authorities could serve as models of best practice from which others could learn. Will the Minister consider looking at those that perform particular functions well in order to encourage the others to go and learn? For example, I mentioned that I helped with paperwork. In the authority that I deal with—I should tell the Minister that it is not an authority in Devon—the process has been made so simple that it is a joy to undertake. In some authorities, however, where people have been asked to make arrangements to buy in their own services, existing services have been removed and people have been left floundering, trying to find out where they can buy in. The extension that the Government propose deals particularly with extending direct payments to those who lack capacity. They will be least able to shop around without a little guidance, not least to ensure that they are buying from a bona fide provider. We all know the difficulties for those who lack capacity, especially if they are not assisted by an immediate carer. Not all of them have an immediate carer to guide and assist them in buying in their package. Direct payments are a great idea, but one or two details need tidying up in order to improve the service, especially if it is to be extended to that group. I was not in the Chamber earlier, so I shall not dwell on my next point. I flag up to the Minister a concern about clause 145, which deals with electronic records. I am sure that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) on the Front Bench and others raised the matter. In the light of recent events, there is clearly a need to get the provisions spot-on. I hope the Minister will go back to the drawing board to make doubly sure that this part of the Bill will be a new dawn in the collation and management of electronic records. The House has been generous in allowing me to speak, even though I was not present earlier. I have one further point. Across health and social services, there is one group of people who worry us all enormously. In his speech my hon. Friend the Member for Broxbourne (Mr. Walker) touched on the care of the elderly. There are issues such as end-of-life care, of which we have all had experience in our personal lives or in the casework that we have dealt with. The Government should focus on the inspection and delivery of end-of-life care. Very elderly people, often unsupported by immediate family or friends, struggle when they go into hospital or into residential or nursing care, at a time of their life when the service should be a Rolls-Royce service. If we do not give priority to people at the very end of their life, that is an indictment of us as a society and as a country. I hope the Minister will bear that in mind when he brings the Bill to the Committee.