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Health and Social Care Bill

My Lords, I declare a number of health interests, unpaid, save for my company, Cumberlege Connections. I thank the Minister for taking this Bill through your Lordships’ House, and for the clear and concise way in which he introduced it. It is long and it is complicated. With the Minister’s professional background and his responsibility for reviewing the NHS, we could not have a more distinguished or well-informed Minister at our Dispatch Box. We are indeed most fortunate. I also thank all those organisations which have been so diligent in their briefing for this Bill. I enter this debate with trepidation. I am fearful of overregulation. I am distrustful of those legislators whose tidy minds tie up all possibility of innovation and the freedom to act appropriately but differently. Life is untidy. My most recent experience has been working with the Catholic Church on safeguarding children and vulnerable adults—visiting 22 dioceses and meeting the most remarkable people, many of whom are volunteers working with children or visiting the old and infirm. These people are now subjected to CRB checks. The impact has been costly, both financially and—much worse—in the loss of some remarkable people who have been respected and trusted within their parishes for decades. As one middle-aged woman told me, ““I only sharpen the pencils for the children’s liturgy. I loved the children and I think they loved me””. My husband drives for the old people’s day centre. He was out one day when someone rang me, asking, ““Is Paddy there? We have been let down””. I said, ““I’m afraid he isn’t, but I can do it””. ““No, you can’t””, was the reply. I have lived in my village since the age of four. My father was the local doctor, and as a former parish, district and county councillor, I am known to the village. At the moment, I even have a clean driving licence. But there is a presumption that I will mug the old folk because I do not have the right CRB certificate. I am not to be trusted, and they, poor souls, are left languishing in the day centre wanting to get home. Of course, the safety of children and vulnerable adults is of the utmost importance, but we the legislators can get carried away. In Section 59 of the Safeguarding Vulnerable Groups Act 2006, we widened a perfectly sensible definition of a vulnerable adult to, among many other things, a person who receives, "““any form of health care””," including medication and so on, and to a person who has, "““particular needs because of his age””." I suppose that we are a House inhabited largely by vulnerable adults, but it has never felt like that to me. Four years ago legislation was introduced requiring residential homes to comply with such high environmental standards that at a stroke we successfully closed countless small, comfortable places that were truly home to their residents. Later the law was relaxed but the damage was done. I am wary of the overconscientious. For me, less means more. Regulation should have a light touch; it should be proportionate, flexible, fair, and risk-assessed; and, above all, it should allow for judgment. Regulation is only necessary when all else has failed. For me, part of that all else is professionalism. When chairing the task force for the Royal College of Physicians, Doctors in society—Medical professionalism in a changing world, I was struck by the evidence we received from many quarters, but particularly from Harry Cayton—then the patient tsar and now a regulator—who told us, ““Opinion polls suggest that doctors are among the most trusted people in society … My own observation is that leaders of medical colleges and organisations are resolutely and seriously self-critical in a way that no other group of employers, experts, workers or advisers have shown themselves to be””. We carried out a survey of 2,000 trainees, 98 per cent of whom thought medicine was a profession; 80 per cent thought it a vocation; and that altruism was essential as was humility. I understand that the world is increasingly complicated. We have international mobility, new emerging professions, an evolving health and social care market and an emphasis on human rights in a demanding but ageing consumerist society. Human beings are frail. We can err and stray, but society requires standards to be set and kept. Surely as legislators it behoves us to simplify and clarify legislation to make it understandable to those who are protected and to those who are to be regulated. The Bill does not do that. The regulation of three distinct parts of health, social welfare and mental health are being scrambled into a single pot. Those three very different entities have three different cultures, and deal with three different markets. There could be a case for bringing these regulators together—but not now, for, unlike the Minister, I believe that the timing is all wrong. In the short time that these regulators have existed, they have shown themselves to be effective and respected. They have driven up quality standards and, above all, are modest enough to insist that they still have a lot to learn. Yet again, however, it is all change. On the whim of the Chancellor who is now the Prime Minister, disruption is the order of the day. We will seek to do our best on these Benches, of course, to ensure that the Bill respects the progress made and does nothing to jeopardise the future. There is much in the Bill that we will support, but we will seek to ensure that the principles and objectives are on the face of the Bill, that it protects the independence of the Care Quality Commission, strengthens the involvement of patients, carers and service users, dismisses the idea that independent reviews should be held in abeyance until after the next general election, clarifies the impact of appeals to the ombudsman and studies the consequences of a new registration system. We will, no doubt, have debates on the standard of proof and the role of the office of the health professions adjudicator, although the GMC has, to a large extent, already gazumped the Government on that initiative. We will examine the responsibilities of the responsible officer; tease out the territory between Monitor, the new Care Quality Commission and the trusts; consider the future implications of the competition panel to be established in the autumn; examine the impact of this Bill on public health; ensure the public accountability of commissioners; and, as we are all guardians of the public purse, scrutinise the additional resources required to enact the Bill and the opportunity costs of more disruption. Later, my noble friend Lord Howe will add detail to these themes in his usual exemplary manner. In conclusion, I foresee long, happy hours in Committee—days, weeks, or even months. Who knows, before this Bill is enacted we might have grown so old that we, too, will qualify as being vulnerable adults.