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Health and Social Care Bill

My Lords, I rise broadly to support the Bill and to raise a few concerns about Part 1 on the Care Quality Commission. At the outset, I should declare my interests and confess some of my sins in previous incarnations. I am currently the part-time chairman of the NHS London Provider Agency. I also advise a number of organisations that work in healthcare, all of which are in the Register of Members’ Interests. While I am making a clean breast of things, I should own up to being the Minister who conducted the arm’s-length bodies review which in 2004 recommended that the Healthcare Commission and CSCI should be merged, so it is not my noble friend Lord Darzi who noble Lords should blame. I think that was part of the right policy of the Government to reduce the number of public sector regulators. When listening to the noble Baroness, Lady Cumberlege, who wanted light-touch regulation, it is worth bearing in mind that a smaller number of regulators might be a good start in that direction. It should therefore come as no surprise that I support the unified Care Quality Commission. I understand some of the concerns of those who work in social care that they might be swallowed up by the health leviathan—I have been a director of social services—but having separate inspectorates has hardly produced equality of treatment in terms of attention and financial resources. With an ageing population, health and adult social care are locked into a symbiotic relationship whether they like it or not. As the right reverend Prelate said just now, this kind of change will ultimately benefit service users and make it easier to ensure we provide adequate access to social care expertise. No doubt in Committee we shall get into the issues around how we can safeguard and ensure that social care expertise is available to the new commission, as well as dealing with some of the serious human rights issues in relation to those in social care outside public provision. I recognise that the chairs of the Healthcare Commission and CSCI have reservations about the timing. I have great regard for Sir Ian Kennedy and Dame Denise Platt—who have done fantastic jobs—but there is never going to be a right time for merging these commissions. Once you have announced the decision in principle and have the legislative slot, you inevitably create some uncertainty both among service users and staff. It is important that we move forward as speedily as possible on this, particularly as there are a number of areas which have been outside regulation, in many ways inadequately for so long. We badly need more consistency in this area in Part 2. I am pleased that we are going to make those changes in and around the healthcare professions outside medicine. I note with a great deal of interest the special pleading of the BMA in its briefing on this Bill, but doctors are completely out of line with their own special dispensation of a criminal standard of proof on the facts before a GMC fitness to practice panel. As the GMC now recognises, those panels are not criminal courts; they are there to protect patients when there is evidence that a doctor’s health, conduct or performance calls patients’ safety into question. The GMC, under the skilful leadership of Sir Graeme Catto, has handled well the negotiations and discussions within the profession in this area. I hope that we will support the Government’s approach to this and not spend too long discussing these issues in Committee. I will spend the rest of my time on some of my concerns with Part 1. Let me be frank; it is disappointing that we have reached this stage of the Bill with so much uncertainty around the scope and regulatory requirements under Part 1. I am pleased that we have at least now the Government’s consultation document on the framework for the registration of health and social care providers. I have not had time today to study in detail this 100-page, complex document, but from a quick flip through it I am still left in doubt about the definitions affecting scope in Clauses 4 and 5. I welcome the fact that in this new document the Government are moving towards including GPs and primary care in the new regulatory framework. Yet the issue should not still be in doubt. Some 85 per cent of the public’s contact with the NHS is through GPs and primary care. If we are to have a risk-based regulatory system, as the Government rightly want, there can be no doubt about the inclusion of this sector in the regulatory framework. Where do we stand on some other areas, particularly preventive health activities and commissioning of services? The new consultation document seems to be all about providers of care and not about commissioners. The latter can do more damage to a population’s health through their lack of competence than any provider can. In the diagrams in the original 2006 consultation document, and in the Secretary of State’s response in November 2007, the integrated regulator still had a significant role in respect of commissioners. It was certainly always my view as a Minister that the regulator should be able to intervene when a PCT commissioner was consistently failing the local population and the SHA’s response was inadequate. It would be helpful to know where health Ministers stand on this issue now. I do not have time to go over in great detail some of the issues around regulatory requirements and their relationship to standards, but it is an area we need to explore carefully in Committee. I am particularly concerned that we do not rush to abandon the standards for better health which came out of the 2003 Act. I am pleased to see the noble Earl, Lord Howe, in his place because he and I laboured long in the vineyards on that Act and he will be participating in this Bill. I need to mention briefly three other areas. First, on the status of the chairman of the new commission, advertising the post at a salary of less than half that paid to the current chairmen of CSCI and the Healthcare Commission gives, if I may put it in the most understated way, the wrong signals. I commend to my noble friend and his ministerial colleagues a quick look at the salaries paid in the Financial Services Authority, Ofcom and Monitor, to name but a few. Secondly, a significant failure of performance over time often involves both the use of resources and quality standards. It is important that the new regulator should have the authority, comparable to that of Monitor in relation to foundation trusts, to intervene when there are continuing problems over both finance and quality of care issues. There is a strong relationship between trusts that get into financial difficulties and the quality of care. They often take incompetent decisions on quality of care as a result of financial difficulties. Lastly, there is the important issue of the position of patients, service users and carers in the role and work of the new commission. Given the volume of briefing that we have all had on this, we will need to spend some time on it in Committee. There are a number of issues. One is whether there should be something on the face of the Bill; another is how to define the duty of the commission; and a third relates to the membership of the commission and some of its committees. These are complex issues but we need to give a stronger signal in the legislation about the duties of the regulator to patients, service users and carers, who do not get much of a look-in in this legislation. I commend the Bill to the House, but I believe that we will need to spend some time on Part 1 in Committee.