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Health and Social Care Bill

It is always a pleasure to follow the hon. Member for Luton, North (Kelvin Hopkins). Nobody can doubt the sincerity and consistency with which he has presented his arguments both on the Bill and over many years, encompassing human rights and his views on the nature of ownership and delivery. I salute him for the consistency of his arguments. I do not intend to take up too much of the House's time. I pay tribute to the work of the hon. Member for Hendon (Mr. Dismore) and the Joint Committee on Human Rights, both in championing the rights of those in care generally and in keeping the Government's feet to the fire on the issue. The Public Bill Committee drew on the JCHR's work, particularly its 18th report of the previous Session entitled ““The Human Rights of Older People in Healthcare””, HC 378. It is important to note that although the Committee was most exercised by the eviction of individuals from care homes, the Government are presiding over a wide range of human rights failings in our health and social care sectors. The Joint Committee report noted that"““many witnesses, including the inspectorates, providers and organisations supporting older people, expressed concern about continuing poor treatment of older people in healthcare.””" The report charted failings under articles 2, 3, 8 and 14 of the European convention on human rights in respect of, among other things: malnutrition and dehydration, which we shall expand on in the next group of amendments; inadequate assessment of a person's needs; abuse, neglect and bullying; lack of privacy in mixed-sex wards, which, as it happens, relates to another of the Government's broken commitments; a lack of dignity, especially for personal care needs; too hasty discharges from hospital; fear of making complaints, an issued that unfortunately has not been selected for debate on Report, despite our best attempts; and age, disability and racial discrimination. On the basis that it is appropriate to the debate, I should like the House to note the importance of the fear of making complaints in relation to the legislation that we are debating today. This is a cross-party concern. It was raised in Committee by us and by the spokespersons for the Liberal Democrats, as well as by the hon. Member for Luton, North, who said:"““A number of my hon. Friends, not necessarily members of the Committee, are concerned about changes in patient representation and procedures for patients making complaints in recent years.””––[Official Report, Health and Social Care Public Bill Committee, 17 January 2008; c. 346.]" The hon. Member for Tamworth (Mr. Jenkins), who I see in his place today, also sought to hold the Government to account for their shortcomings in this area. Furthermore, the hon. Members for Oxford, West and Abingdon (Dr. Harris) and for Hendon are seeking clarification on this issue. The remaining unanswered questions on complaints centre on three issues. The first involves resourcing the ombudsman, who is facing an elevenfold increase in work load, yet none of the costs of that increase have been reflected in the impact assessments for the Bill. The second involves monitoring trends. With the Healthcare Commission losing its complaints function, how can we be sure that the early warning signals will be picked up by the regulator? I dare say that we all remember the tremendous work of the community health councils, which were able to use the collective wisdom of all that they had been able to achieve through their inspections and access to hospitals through programmes such as Bedwatch. That is something that we discussed at length when the Government announced that they were axing the community health councils but then had to postpone their abolition and give them a stay of execution for a year. Those functions now appear to be at risk again. I hope that the Minister will address that point specifically. The third issue involves putting in place a complaints system for privately funded social care. That has just been referred to by the hon. Member for Luton, North. The Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), has said in Westminster Hall that"““it is unacceptable that self-funders should not have the protection that other residents have””.—[Official Report, Westminster Hall, 11 December 2007; Vol. 469, c. 52WH.]" He also told the ““File on Four”” programme in September that he would be achieving his aim through this piece of legislation. That is all on record. That is a promise, however, that the Government now appear to have reneged on. I hope that the Minister will take note that his colleague has put that intention on the record, and I hope that the Minister has now been persuaded that this is the moment to look at this matter. In its submission to the Committee, the Commission for Social Care Inspection said that the new regulator should take a ““strong rights based approach””. In support of that, the Joint Committee said that the Care Quality Commission should adopt a"““human rights framework with the intention that the framework informs all of the inspectorate's work and so makes it more effective in fulfilling its statutory duties.””" The Mental Health Act Commission, which was rightly commended by the Joint Committee for its human rights approach, was particularly concerned in its oral evidence to the Committee that the human rights focus would be lost in the merger. The Government have as yet failed to guarantee that that will not happen. The Commission has called for ““an overarching principle”” of equality and human rights, focusing at all times on the civil, legal and human rights of patients. In Committee, the Minister confirmed that the frequency of visits—a vital point—would be"““a matter entirely for the new commission””.––[Official Report, Health and Social Care Public Bill Committee, 17 January 2008; c. 323.]" The MHAC, however, wants visits to continue with their current six-month regularity. The choice will be truly free only if the Commission is properly resourced to do what it deems important, but the Minister has not as yet given such a guarantee. I hope that we shall be thrilled today by his contribution in that regard. It is disappointing that we have to have these discussions on amendments to a Bill on Report. We looked at these matters extensively in Committee, as the hon. Member for Luton, North has mentioned. He was supported in Committee by the hon. Member for Tamworth. They both raised a number of these issues, but it was felt by the Minister that campaigners on this issue would be pleased to hear his commitment that the Government were"““committed to ensuring that independent sector care homes are covered by the Human Rights Act.””––[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 135.]" He reiterated the Government's line that that would be achieved in the Bill of Rights, but if he has committed to that, we question why he is not prepared to pass the amendments now. Clearly, a cart and horse situation has developed in the Government's mind—that the Bill of Rights is necessary for proper scrutiny in order to arrive at what would be relevant to the application of such human rights to private sector care homes within a Bill of Rights framework. It seems to us that the right place for a thorough going over of that was in Committee, but that was rejected during the course of our deliberations. It is in Committee, Madam Deputy Speaker, that it is appropriate to go through really intense and detailed scrutiny of these provisions, which provide complex material to interweave and interleave into existing legislation. Having an appropriate debate on these amendments now depended on having a proper Committee stage as a matter of principle. In the absence of any such debate and of the bringing forward of the Bill of Rights in advance, our present debate becomes difficult and it is not easy to form a clear opinion of how the provisions will work. I notice that a letter in The Guardian today was signed by 33 different national voluntary sector providers of social care services to disabled people and many others, including all in receipt of social care. They state that the Health and Social Care Bill really must put users at the heart of regulation and argue for the rights-based approach, which was very much the evidence revealed by Dame Denise Platt, the head of the Commission for Social Care Inspection, during Committee hearings. If the new clauses and amendments are pressed to a Division, it would be difficult for us to signal our support, but at the same time we do not intend to vote against them either. We want to register our main point that the Bill of Rights that the Government have prayed in aid absolutely needs to be brought forward fast; otherwise, the Government's commitments will be revealed as hollow. Clearly, there is a major demand to involve human rights principles, not least those articulated by the Joint Committee, but in the absence of discussion of the Bill of Rights, we are in grave danger of trying to legislate for the cart before the horse has been debated. On that basis, our position is clear.