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Health and Social Care Bill

I do not know what the current status of the hon. Member for Wolverhampton, South-West (Rob Marris) is in the law. I hope to develop this point a little later, but it is interesting that the proposals are not clear about whether somebody subject to the adjudication process has rights of representation. They might need to avail themselves of legal aid, irrespective of the hon. Gentleman's point. I have not seen whether there is a legal aid impact assessment, but the fact that I did not see one on my first reading did not surprise me. I should like to highlight the point made by my hon. Friend the Member for Tiverton and Honiton (Angela Browning) on the direct payment extensions. There is unquestionably a lot to be done to iron them out so that they are smooth-running. However, there is no question but that as a matter of principle they are the right way to go when they fit the circumstances of both the cared-for person and the person who assists. Most importantly—and this point cross-refers to other elements of the Bill—my hon. Friend was absolutely right to highlight the fact that the Government have not put forward proposals for benchmarking and the transfer of best practice. That proposal was extremely constructive. I hope that we may have the benefit of hearing more about it if my hon. Friend is lucky enough to be considered to serve on the Committee. In his authoritative and all-encompassing speech, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) made clear our position on the care quality commission. [Interruption.] I did have to say that—because my hon. Friend's speech was considerably more impressive than the Secretary of State's. The Government are moving in the right direction, but they have not gone far enough, as I have said. In the simplest analysis, the CQC will not be independent of Ministers, despite the Secretary of State's claim. As the hon. Member for Wyre Forest (Dr. Taylor) observed, the legislation fails to set out the commission's core duties and responsibilities beyond the most anodyne of statements coupled with a crude fining system. At this point, we should note the genuine demand for the seamlessness mentioned by my hon. Friend the Member for Tiverton and Honiton. I hope that the Minister will take the opportunity to answer the question put by my hon. Friend the Member for South Cambridgeshire. It was about the Appointments Commission, which is currently responsible for the appointment of the chairs of the Healthcare Commission and the Commission for Social Care Inspection. In his answer, the Secretary of State said that that would not be the case for the CQC because the job was so important that it could not be left to the Appointments Commission. That answer was most surprising, and I dare say he may reconsider it. Until our proposals for an NHS autonomous of ministerial meddling, with separate and independent quality and independent regulators to support it, are delivered, the Bill will do little more than bring about an amalgam of existing bodies, with their existing constraints. Furthermore, without a strong national patient voice, that regulator will lack the necessary checks and balances to operate most effectively . We hope that the Bill provides the opportunity for us to seek to strengthen LINks to provide that. The hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) rightly advocated listening to the voice of the user. The hon. Member for North-West Leicestershire (David Taylor) advocated the use of citizens councils; that idea might go a little further than most of us would wish. However, I hope that his point is at least explored in Committee so that we can discuss its merits and demerits. Another question was raised that remains unanswered; perhaps the Minister will take the opportunity to answer it when he winds up. In the development of the new institutions, the complaints system is effectively being taken back fully in-house. There is a big question mark about the absence of true independence; a question was raised about whether the health service ombudsman has the capacity to deal with the anticipated higher incidence of complaints that will find their way to his desk. That point, too, was emphasised by the hon. Member for Wyre Forest. I hope that the Minister will clarify the issue. Many organisations have expressed concern that the experience built up by the Mental Health Act Commission, the Commission for Social Care Inspection and the Healthcare Commission will be lost. We shall seek assurances from the Government that the establishment of the CQC will not mark yet another year zero, particularly given the continual upheaval that the Government have brought to social care regulation. My hon. Friend the Member for Broxbourne (Mr. Walker) made a serious and passionate speech in which he made clear that we also need to make sure that the Government give assurances that the social care and mental health responsibilities of the CQC will not be squeezed out by its Healthcare Commission-type functions. For example, have the Government made allowances for the impact of community treatment orders on the work of the MHAC? What work will the CQC do in prison health care? That point has not been raised. We should consider the point, raised by my hon. Friend the Member for Worthing, West (Peter Bottomley) in his excellent and comprehensive speech, about the appropriate use and deployment of magistrates under the Bill. My hon. Friends have deplored the Government's failure to combat health care-associated infections effectively. That the Government are embarrassed by that is clear from the fact that the relevant provisions are buried deep in the Bill. However, we guarantee—as will others from across the House, I am sure—to make sure that Ministers are engaged in a frank and open debate as we go through the Bill's parliamentary stages. As for professional regulation, we want proportional regulation that protects patients and the public, as well as innocent doctors. My hon. Friend the Member for South Cambridgeshire flagged up our debates on the role of the office of the health professions adjudicator. If Ministers believe in self-regulation, as we do, why is the OHPA required? We must leave that question hanging for them to answer, today or in Committee. It was interesting to hear from the right hon. Member for Rother Valley (Mr. Barron) about his experience of serving on the General Medical Council, which raised the question of why it is necessary to have another body in addition to developing the role of the GMC. His speech was restricted to that subject, but I hope that as Chairman of the Health Committee he will devote some time to, and take equally seriously, the social care aspects of the Bill.