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Health and Social Care Bill

My Lords, I beg to move that this Bill be now read a second time. The Bill contains a number of vital measures to improve and enhance the regulatory arrangements for health and social care. I am pleased by the number of noble Lords who are due to speak today, as that demonstrates the amount of interest in these important issues. The Bill has enjoyed a full debate in the other place, where it benefited particularly from the informed comment during evidence-giving sessions. I know that the Bill will further benefit as it makes its progress through this House from the wealth of knowledge and expertise that so many noble Lords have in this field. The primary concern of the Bill is to improve and enhance the quality and safety of the care that patients and users receive. Its focus is on regulation, both of the health and adult social care system and of health and social care professionals who work within that system. As noble Lords will be aware from the interim report that I published in advance of the next-stage review, I am passionate about the quality of care received by patients and service users. I understand that some concerns have been raised about the timing of the Bill and how this will fit in with my next-stage review. It is my view that this is the right time for the Bill, as it will introduce a framework that focuses on reforming regulation so that it is adaptable to the changing priorities of patients and users. The next-stage review will build on this vital regulatory framework to ensure that quality becomes the connecting thread running through everything that we do. I turn now to the specific provisions in the Bill. Part 1 creates the Care Quality Commission, which brings together the existing Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. The commission will be an independent, responsive and proportionate regulator with safety and quality at its core. I believe that this move is very positive. The creation of the integrated regulator is a necessary step in creating the right legal framework for the development of high-quality health and adult social care services. The existing systems have worked well, and we are building on their achievements, but changes to the way in which health and social care services are delivered through the reform programme mean that a more integrated, flexible regulator is needed. Increasingly, the boundaries between health and adult social care are becoming less defined. A person’s treatment will often require care in a range of settings. Patients want to receive the same protection from the regulatory system wherever they receive that treatment. Bringing the regulation of health and adult social care together will ensure that the same levels of quality and safety can be expected for all users of health and adult social care. It is necessary to stress the importance that the Government place on the role of the Care Quality Commission in dealing with social care matters. There is no question but that social care will be at the very core of the regulator’s functions. The Commission for Social Care Inspection currently regulates around 24,000 services, so the regulation of social care will represent a significant proportion of the work of the new regulator. The Care Quality Commission will be responsible for ensuring that all registered services—whether in health or social care—are safe and of a suitable quality. Equally, I place on record the importance that we attach to the commission carrying out the functions currently carried out by the Mental Health Act Commission—a body chaired by my noble friend Lord Patel of Bradford. Clause 2 states explicitly that the Care Quality Commission’s functions will include those currently carried out by the MHAC. We will work with all three commissions to ensure that the organisational structure, leadership, culture and ways of working that the commission develops are effective in protecting the rights of all vulnerable groups under its remit, including those detained under the Mental Health Act. We will stress how important it is that the skills and expertise required to carry out the MHAC’s statutory functions, including appropriate visiting arrangements, are retained within the new body. Chapter 2 of Part 1 of the Bill introduces a new registration regime, which, for the first time, will include the registration of NHS providers. This is an important step. It is right and proper that NHS services should be subject to the same rigorous registration regime as applies to providers in the social care or independent sector setting. Providers will be able to offer regulated health or social care services only if the regulator assesses them as meeting the registration requirements, giving patients an assurance of safety and quality wherever they choose to be treated across the health and adult social care system. A key component of the registration regime will be the scope of registration which Clause 4 and the registration requirements in Clause 16 provide for. The Government have today published a consultation on the framework for the registration of health and adult social care providers. Noble Lords will be able to draw on this consultation document when considering the registration elements in the Bill and I urge all those who have an interest in this important area to contribute to the consultation. The Bill also gives the commission a wider range of enforcement powers than those available to the existing regulators, giving it greater powers to ensure compliance, as well as being able to cancel registration where absolutely necessary. The regulator will have the freedom to decide how to use its powers of enforcement where services are failing, including for breaches of infection control requirements. The new powers will, for example, allow providers to be fined up to £50,000 for each individual breach of a registration requirement. The Care Quality Commission will also continue to carry out assessments of providers and commissioners. This will provide an independent view of performance and support both patient choice and local decision-making. These powers, set out in Chapter 3 of Part 1, include measures to ensure that periodic reviews are carried out of health and adult social care provision. I also want to touch on an issue that has been raised by the Joint Committee on Human Rights and others in connection with the Care Quality Commission—namely the Human Rights Act and its application to publicly arranged health and adult social care. I can confirm that we are currently considering this issue again, in the context of the Bill, in consultation with key stakeholders, with a view to reporting back as the Bill progresses through its Committee and Report stages. In addition, we intend to use the Bill to ensure that the Care Quality Commission can enforce regulatory requirements which are in line with the spirit of the European convention. Part 2 of the Bill focuses on professional regulation. As a practising clinician, it is appropriate for me to declare an interest at this point. I should also declare that I have an academic interest in the field of the objective technical competency assessment of clinicians, and my clinical department advises the GMC and other bodies on the subject. I remind your Lordships that the Shipman inquiry, under the chairmanship of Lady Justice Smith, found that in the 24 years during which Harold Shipman worked as a doctor, in addition to the 15 patients of whose murder he was convicted, he killed 200 patients. In a further 45 cases, real cause was found to suspect that Shipman might have killed the patient. These shocking facts, along with the findings of the Ayling, Neale, Kerr/Haslam inquiries, seriously questioned the trust that patients have in the system that is there to protect them. I know from my own experience that the vast majority of healthcare professionals are dedicated to the caring of their patients to the very best of their ability, but these measures will help to identify earlier and tackle more robustly that small number of professionals who pose a threat to patient safety. The Government therefore consulted on what changes needed to be made to professional regulation, both in light of the recommendations of the Shipman inquiry and the need to modernise the system more generally across the whole health and social care workforce. The White Paper, Trust, Assurance and Safety, published on 21 February 2007, reflected that consultation. The creation of the Office of the Health Professions Adjudicator responded directly to Lady Justice Smith’s Recommendation 51 of the Shipman inquiry that the adjudication function of the General Medical Council should be undertaken by a body independent of the GMC. The General Optical Council has also indicated its support for this new body. The OHPA will be a statutory body, which will undertake fully independent adjudication of fitness to practise cases initially for doctors, and in due course for opticians and optometrists. Independent adjudication, carried out by the OHPA, will mean that patients and professionals can have confidence in the impartiality and consistency of fitness to practice decisions. Related to fitness to practise cases, the Bill changes the standard of proof to be applied to the finding of facts in fitness to practise proceedings from the criminal standard of ““beyond reasonable doubt”” to the civil standard of ““on the balance of probabilities””. That responds to Recommendation 81 of the Shipman inquiry and reflects the fact that eight out of the 11 existing regulators already use the civil standard of proof. This will build on existing best practice in other sectors such as police complaints and child welfare. Having followed carefully the debate in the other place on this issue, I am aware that certain organisations have suggested that the change to the standard of proof could lead to doctors practising more defensively; that is, to be less likely to choose more risky, but potentially more effective, clinical interventions. I do not believe that this is true. As a clinician who has the privilege of treating patients, I tend to focus only on what is likely to make my patients better. I am sure that it will not affect the way my colleagues do their jobs either. To help to close what has often been called the ““regulatory gap”” between national regulators and local clinical governance arrangements, the Bill seeks to put best practice in clinical governance on a statutory footing by creating the role of responsible officers. Responsible officers will be senior doctors in healthcare organisations responsible for dealing with local professional performance and conduct issues for medical staff, in liaison with the national GMC. The Bill also removes the restriction preventing a Section 60 order of the Health Act 1999 introducing a lay majority for the regulatory body councils. In addition, Part 2 introduces the following important measures: first, it enables the removal of the regulatory functions of the Royal Pharmaceutical Society of Great Britain and the transfer of those functions to the proposed new General Pharmaceutical Council, which creates a much-needed separation of professional leadership and professional regulatory function; secondly, it strengthens the Council for Healthcare Regulatory Excellence to help it become an authoritative voice for patients; and thirdly, it creates a regulation-making power to allow changes to the regulation of social care workers by secondary legislation, which will allow the regulation of social care professionals to keep pace with the regulation of healthcare professionals. In relation to Part 3 of the Bill, the Public Health (Control of Disease) Act 1984 consolidates earlier legislation, much of it dating from the 19th century. Not surprisingly, many of its assumptions, both about risks and about how society operates, are now out of date. It provides for only a limited range of actions when other measures could be more effective in terms of protecting public health, and more convenient and less intrusive for those concerned. In addition, internationally, the World Health Organisation has set out the case for taking an all-hazards approach to dealing with health threats. This is reflected in the new International Health Regulations (2005), which are concerned with infectious disease and with contamination from chemicals or radiation. We consulted widely on updating the 1984 Act. In light of that, the new legislation contained in Part 3 will provide for a comprehensive set of public health measures to help prevent and control the spread of disease caused by infection or contamination which present, or could present, significant harm to human health. This will enable a quick response to new or unknown diseases or threats, such as the ones we have seen in recent times, for example SARS or Polonium 210. Some of the measures proposed could impact on an individual’s human rights. That is why we have provided significant safeguards in the legislation to protect individuals. Human rights require a balance to be struck between the freedom of the individual and the health and safety of other people; we are confident that we have struck the right balance. Part 4 introduces the health in pregnancy grant. This will be a one-off payment of £190, available to all expectant mothers ordinarily resident in the UK, which can be claimed from the 25th week of pregnancy. The grant will be payable per pregnancy, and entitlement will be conditional on mothers receiving maternal health advice from a health professional. We know that women face additional costs during pregnancy and that there are competing financial pressures in the final trimester, which can lead to some difficult spending choices. The grant will provide support to all expectant mothers, in recognition of these extra costs. Linked to the requirement to receive maternal health advice from a health professional, the health in pregnancy grant is designed to help pregnant women to invest in their pregnancy to meet their individual needs, while providing them with flexibility to choose where they spend this money. Part 5 contains a number of smaller miscellaneous issues relating to: the financial arrangements for pharmaceutical services; indemnity schemes in connection with the provision of health services; direct payments in lieu of provision of care services for people lacking in capacity; abolishing the liable relatives rule; the definition of ordinary residence, as applied to the National Assistance Act; payments to social enterprises; the creation of a national information governance board; and the functions of the Health Protection Agency in relation to biological substances. I shall not go into further details here, but I look forward to these issues being discussed in more detail in Committee. The Health and Social Care Bill contains a number of important measures that will enhance the regulatory system to ensure that first-class professionals are able to work in a first-class organisation. By putting safety and quality at the very heart of the agenda, the Bill will be crucial for service users and patients alike. I commend the Bill to the House. Moved, That the Bill be now read a second time.—(Lord Darzi of Denham.)