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Health and Social Care Bill

We are discussing Government amendment No. 62 and the ensuing ones in the group; again, we have a host of Government amendments. Some are concessions that have arisen from Committee, but the question remains about why they had to appear at this late stage. In amendment No. 62, the Government are making an important concession on patient and public involvement in health. The Government promised a number of times in Committee to revisit the issue on Report. The drafting of the amendment is, to say the least, disappointingly unambitious. I am concerned that the amendment will open the door for any group that claims to speak on behalf of members of the public to harangue the new commission. We will return to the issue when we discuss the next grouping of amendments, but why are the Government fighting so shy of putting LINks—the bodies that they have created—into the Bill? Surely that is not because they have no confidence in the bodies themselves. Is it that, as the hon. Member for Tamworth (Mr. Jenkins) pointed out in Committee, the Government are worried that the bodies will be disbanded in the near future, following hard on the heels of the community health councils and the forums? I hope that the Minister will expand on amendment No. 68; in Committee we had a number of discussions on the withholding of mail from prisoners detained under the Mental Health Act 2007, an issue of specific concern to the current Mental Health Act Commission. Can the Minister guarantee that the status quo will not change? The hon. Member for Romsey (Sandra Gidley) tabled amendment No. 142 to clause 57, which is concerned with regulation. Clause 64 is entitled ““Avoidance of unreasonable burdens in exercise of regulatory powers””. We have proposed that when the CQC increases regulation, an affirmative resolution should be brought before the House. We have found that the Government were most resistant to that idea; as I have placed that on the record, I hope that the matter will be taken up with alacrity and fierce argument in another place. The amendments on the CQC go hardly any way towards addressing the many and deep concerns expressed by the Committee and a number of third-party organisations; the letter published in today's issue of The Guardian testifies to that. It seems to suggest that the Government have lost the confidence of a lot of members of the voluntary sector. There is still no mention of carers among the skeletal functions of the CQC, listed in clause 2. I say ““skeletal””, because for the most part this is skeleton or portmanteau legislation—the body is to be added later, by regulations. That is most noticeable in clause 2, which establishes no overarching function. Indeed, the advertisement for the chair of the commission, already online despite the fact that the Bill has not been passed by either House, states that one of the role's responsibilities will be developing plans for the development of the commission's functions—an interesting job spec if ever there was one. There are still real concerns that social care and the work of the Mental Health Act Commission will be squeezed out in the action of the new commission. To ameliorate the problem, we have sought a separate reference board of commissioners and an executive board to run the commission. Despite the Minister's contention that the CQC is to be free to establish its own direction, the Government have not left space in the legislation for it to establish the most effective system of corporate governance. Furthermore, there are real concerns that the Government are playing politics with the merger, and ultimately with the well-being of patients and service users, through the prevention of special reviews until after 2010—that is, after what will be an increasingly rocky election period for a failing Government and a dithering Prime Minister. We will seek to overturn the issue in another place to prevent that politicking from influencing the important substance of the Bill. Dame Denise Platt of the Commission for Social Care Inspection has expressed concern that many of the commission's functions will become permissive rather than statutory, as they currently are, and that they will therefore be the first to be ditched when the Government put on the financial squeeze. The Government seem unable to get the issue right. What guarantees can the Minister give that they will not scrap this in three years' time? The 1998 White Paper ““Modernising Social Services”” proposed structural change. The Care Standards Act 2000 created a single England-wide National Care Standards Commission, which was launched in 2002—17 days later, the Government announced that it was to be abolished. The Health and Social Care (Community Health and Standards) Act 2003 created the Commission for Social Care Inspection, which was launched in 2004, incorporating the social care responsibilities of the National Care Standards Commission, the work of the Department of Health social services inspectorate and the SSI-Audit Commission joint review team. In 2004, the Government's arm's length body review ruled out a merger with the Healthcare Commission. In his 2005 Budget statement, the then Chancellor announced the merger that we are debating today. Need I say more? Can the Government guarantee that all the work that we are putting in today will not be scrapped within three years? This scandalous provision remains in the Bill. It forces the CQC to have regard to such aspects of Government policy as the Secretary of State may direct; as such, it totally undermines the independence of the body. The Healthcare Commission has put on record its concerns about the timing of the legislation and that the costs will be high and the distraction considerable. It was disappointing therefore that the Government chose not to include the cost of the merger with wind-up costs of £140 million in any risk assessment. The House should also be aware that the merger is saving almost nothing on the efficiency trend that the three commissions themselves have already established just as they were bedding in. Taxpayers are paying £140 million for a merger and rebrand that will probably save them no extra money. Furthermore, parts of the cost savings are due to the commission losing the responsibility for complaints handling. That will be transferred to the ombudsman, but we have had no costings on the increase of her budget in the face of an elevenfold increase in work load. We also have no information on how this will be wound up and transferred. Despite all their amendments, the Government have yet again not got things right. They have not had sufficient ambition when they have sought to address the concerns that have been raised. I hope that the Government have only put down a marker for what will be truly beefed up, made proper and substantive in another place, so that health care needs are met and patient representation and protection are secured.