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Health and Social Care Bill

My Lords, I thank the Minister for his concise introduction to this debate, and to welcome the Bill. I want to do that primarily in terms of how it aspires to draw together the provision of healthcare and of social care. There has long been a regrettable division between the provision of health and social care, particularly for elderly people. I believe that the Bill will be a major contribution to closing that gap. The Care Quality Commission will have a major task in that area, and my first concerns lie with whether it will be adequately resourced to achieve that. It has a hard act to follow—particularly, perhaps, in social care. The Commission for Social Care Inspection has gained a good reputation in that field, and the new commission needs to build upon the work of CSCI and the other commissions, rather than starting again from scratch. In that respect, I hope that the Bill may be strengthened to make it still clearer that this drawing together of health and social care provision needs to happen at local as well as at national level. I am still made aware, far too often, of situations where one branch of local provision fails to co-ordinate its activities, visits or knowledge with that of another. There is work to be done if we are to provide the co-ordinated service that we crave. Two particular points would greatly enhance this part of the Bill. First, there needs to be a better and more independent complaints procedure. That omission from the Bill, if I have deduced it rightly, seems eccentric. For there to be, in many cases, no recourse except to an ombudsman means either an expensive bureaucratic nightmare or, effectively, no provision at all. Secondly, and more crucially, I join with those who stress the need to use this opportunity to extend the Human Rights Act to private and voluntary sector care providers. The Minister referred briefly to that in his introductory remarks, and I hope that he will return to it when he sums up. These providers are performing functions of a public nature by any ordinary definition, but the Leonard Cheshire case ruling in 2002 means that elderly people do not have the rights to which they believed they were entitled and to which the Government intended them to be entitled. I applaud the care and love that is provided within the private and voluntary sector in health and care provision. That needs to be in the context of human rights legislation, and I am not reassured by the indication by the Minister in another place that that might be better left to a bill of rights. This is a particular, urgent situation. It needs to be dealt with now. I note and welcome two further points. First, I support the changes in the professional regulation of clinical governance. The Office of the Health Professions Adjudicator is a major advance, provided that it is properly funded, and I welcome the Government working with the GMC on this issue to increase public accountability and public confidence. Secondly, I follow the noble Lord, Lord Patel, in giving a particular welcome to the health in pregnancy grant. I, too, wanted to make the point that it would be good if it were based on the number of children rather than on the pregnancy itself. I hope that in the long debates that will take place on the Bill there will be no attempt to go back from the commitment to a general and universal grant for health in pregnancy. Pregnancy is a time when many women face or fear particular worries, especially in the light of the current pressure on the midwifery service. Anything we can do to help and support women at that time in their life is very welcome, and this provision will help and encourage that. This is a good Bill. With small but crucial amendments, it could become a landmark Bill, particularly in the collaboration of health and social care services. I hope that the Government will respond to those needs, particularly by looking at ways in which that can be emphasised in the local context through the work of the Bill and of the commission.