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Health and Social Care Bill

This portmanteau Bill is incredibly wide ranging in content and it leaves vast amounts to secondary legislation—both things cause concern to the House in terms of proper parliamentary scrutiny. We have debated only a fraction of the outstanding issues this afternoon, and no doubt further clarification will be sought on a number of points in another place. However, as the Minister rightly observed, the broad thrust of the Bill is right, even if it is not necessarily timely. That makes getting the detail correct even more important. We have sought many improvements, and we will no doubt seek more as the Bill goes on its way. We were grateful for the 12 sittings in Committee, which included some long sittings in order to bring proceedings to a close. We were able to time that almost to the minute so that both sides felt that the Committee had offered adequate consideration. That was the first time that I have been involved in a Committee of which that could be said. It was disappointing that the Government did not accept our full witness list for oral evidence, but both sides of the House will agree that that was a useful procedure for the Committee. I dare say that the model will be looked at further—it is yet to be perfected. It is important that the witness list is not just a list of the Government's bidding—it was not in our case. I pay tribute to my colleagues in the Committee, and not only to those on the Front Bench. My hon. Friend the Member for Guildford (Anne Milton) guided us through many parts of the Bill during the Committee. Those on the Benches behind me, including my hon. Friend the Member for Tiverton and Honiton (Angela Browning)—[Hon. Members: ““Where are they?””] My hon. Friends might not have expected Third Reading to begin at this hour and are not yet in their places, but they have certainly been in evidence for a great deal of the debate and have added a great deal of thought and sensitivity to our deliberations. It was important to have the presence of my hon. Friend the Member for Preseli Pembrokeshire (Mr. Crabb) in Committee. Despite the Bill's significant ramifications for the devolved Administrations, he was the only MP in the Committee whose seat is in a devolved Administration. I also pay tribute to the way in which the Committee was chaired and to all the Clerks. We have won two important Government concessions. We are grateful for the fact that the Minister has if not bowed, then at least nodded to the force of our arguments on, first, the inclusion of a strong patient voice in the CQC. Despite our best efforts, the Government will not include LINks—local involvement networks—in the Bill. No doubt such efforts will continue in another place, and we urge the Government to reconsider. We are also glad that there is now scope for legally qualified chairs and that they will be piloted. However, we remain concerned, particularly given the application of the civil standard of proof, that their role should be universal. Again, I am sure that that debate will be continued in another place. We have not been able to change the Government's mind on a number of issues. Obviously those issues will be pursued, particularly those that I raised earlier on Report in relation to HealthWatch. A clear function is required for the CQC, particularly given the concerns about its proposed governance structure. That is not merely a cosmetic legislative issue. The House has an opportunity—indeed, I think that it has an obligation—to send a very clear message to the new commission about what the House expects it to achieve, particularly given, as was agreed, the achievements of the bodies that it will succeed and especially as they were just getting into their stride in a way that was adding value. Independence and the complaints process remain concerns, as do the reviews and the general ability to give opinions on the basis of the evidence that has been gained and on the basis that visits must be properly maintained, particularly in relation to those who are detained under the mental health Acts. We have had useful debates on the extent to which human rights and a rights-based approach should be at the core of health and social care in particular. Again, such debates will continue, as will the discussion of malnutrition and the extent of professional regulation, which we have only just discussed. Public health measures have not featured in today's discussions, although they have been scrutinised with care and determination by my hon. Friend the Member for Guildford. That needs to be placed on record. Although we broadly welcome such measures towards appropriate legislation to deal with modern-day contingencies, we and others, including the organisation Liberty, remain concerned about the length and reporting of detention under such powers. We hope that the Government will introduce in another place the relevant draft regulations and examples of instances where such legislation might be necessary and that there will be an opportunity to discuss the amendments that we were unable to touch on today. The Government may well want to reflect on those issues, and we might need to consider them again if they come back as Lords amendments, even Government Lords amendments. The health in pregnancy grant is another area that we have not touched on today. It is therefore appropriate to use Third Reading to highlight the grant, which was discussed at length in Committee. It is an important part of the Bill. Indeed, the Government have made much of what they are seeking to do with the health in pregnancy grant. Unfortunately, although we used an extensive series of arguments, backed by evidence, we never managed to get the Government to accept that there was a better way to approach the benefits that are sought with the grant. Ours is a different way from that proposed by the Government. I encourage hon. Members to read column 455 of the report of the proceedings in Committee. Quite rightly, it would be inappropriate to repeat those arguments now, but the Government need to put more thought into the grant, because the evidence base does not support what the Prime Minister and the Government are pursuing. Most telling was the Minister's admission that the nutritional benefits of a cash payment are better in early pregnancy—we entirely agree with that, of course—although the Prime Minister, then the Chancellor, announced at the outset that support was needed in the last months of pregnancy, on the basis that nutrition is most important then. Not only was the Prime Minister wrong, but answers to parliamentary questions suggest that the Minister was initially wrong as well. The change made during the proceedings in Committee was a fair reflection of the evidence. All of us who have looked at the issue carefully—particularly women, who are the ones most affected by such issues—recognise that, when focused on the health of the to-be-born child, the most important time for nutrition to be right is both pre-conception and in the early weeks and months of pregnancy, more than in the last weeks, as the Prime Minister suggested. The Bill includes a huge number of miscellaneous provisions and refers to much secondary legislation. However, it has received worthwhile scrutiny, and Parliament has done the job that it must do by seeking to improve the Bill and to elucidate what lies behind it so that the right pointers are given on how further scrutiny can take place with the wisdom that those in another place can bring to bear. I hope that many of our debates will flag up the areas on which those preparing for such scrutiny will need to focus their attention. I also hope that the arguments that we have tried to make will help their deliberations. I thank those who served on the Public Bill Committee, especially my Conservative colleagues and my hon. Friend the Member for Guildford. Although this is not very usual, I pay tribute to those in our research offices who do a lot of work in the background and are often unsung. It is important that we in opposition are supported, given that we must contend with the fact that the Minister is rightly supported by a full Department. I thus pay tribute to the researcher who has helped my hon. Friend and to Sam Barker, who has been a tremendous help to me during the passage of the Bill.