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Health and Social Care Bill

My Lords, I, too, congratulate the Minister on introducing the Bill, and I thank the many organisations for their excellent briefings. The Health and Social Care Bill seeks to improve the regulation of health and social care by building on the experience of the current regulatory systems in practice. At the same time, the Minister is conducting a review of the NHS. Disraeli once said that change is constant in a developing country. That is never more so than in the NHS. However, there is another constant; there are always patients and users requiring a quality care of some sort, but necessarily in the traditional patterns of care. The Bill sets out a framework, but, having read briefings from various organisations and from my own observations and experience in the NHS, I suggest that it requires considerable strengthening to ensure that high-quality care is delivered within a rapidly changing health and social care sector that is designed to meet the needs of individuals, including involving people in planning and managing their own care, and ensuring that there is a seamless service crossing the pathways of various organisations. As noble Lords have already said, the Bill requires very detailed scrutiny to support such an agenda. The briefing papers of several organisations refer to the need for a clear statement of the regulatory objectives. Clause 2(3) sets out the need to involve patients and services so that their views are central to an assessment of healthcare needs. But the regulator needs to have an explicit statement of appropriate mechanisms and channels through which the commissioners can communicate with the public and service users. While appreciating that the Government do not wish to be too prescriptive, there is a need to communicate the commissioners’ independence and means of engagement. In Clause 2(5), I question the description of the function of the commission. Just to ““encourage”” the improvement of activities is a rather weak description of its purpose. I hope that the Government will consider strengthening the function to ““promoting”” improvement, especially with regard to safety and quality of care. I, like the Minister, have a passion for improving patient care. Clause 16 allows for the scope of registration to be set by regulation. That is a fundamental step so that public expectations on the appropriate scope of the regulations are clear. They need to be clear, for example, on the risks to patients and service users. The Department of Health’s set of core standards are not optional. Parliament needs to be reassured that this section of the Bill will provide a level of assurance to patients, at least as high as the minimum core standards. These minimum core standards need to be of a high quality, emphasising the requirement for safe and effective care. Again, it is important that there is a ““care line”” of management of the service as well as a ““service line””. Those two lines—““care line”” and ““service line””—are needed for the rigorous monitoring of effective care. Past experience of the Healthcare Commission has shown that a deficit of sound systems in place and deficient checks and balances often leads to the eye being taken off the ball, and disaster follows. Like the right reverend Prelate the Bishop of Ripon and Leeds, I believe that removing the functions of receiving and dealing with complaints from the regulator to improve the local handling complaints is a retrograde step. Experience over many years demonstrates to me that despite every endeavour to deal satisfactorily with complaints, there will be occasions where a complainant is genuinely not satisfied. The suggested referral to the ombudsman is the only route of appeal in the Bill. The commissioners will be well placed to adjudicate on whether there is substance in the complaint—usually pointing to a level below that of minimum core standards—to explore quickly and to avoid a spread of poor practice. I hope that the Minister will reconsider removing the right of the commissioner to investigate complaints that involve a level below the minimum core standards. Under Clause 42, the regulator of healthcare needs to be able to take a joined-up view of performance covering commissioning, provision, quality and value of health care. How the pathway of care operates across organisations, GPs, hospitals and social care is concerning to patients. Under Clause 42, as well as suggesting periodic reviews, the commissioner is able to investigate specific incidents that put the health and safety of patients at risk. That will include looking into the decisions that have led to the situation arising, such as the commissioning. The standards set by the Secretary of State in Clause 41 have no regulatory back-up. Implementation is dependant on commissioning as a lever. The standards should be linked to the periodic reviews undertaken by the regulator. So that the performance of healthcare organisations against those standards is clear to the public and patients, this should be linked with the regulators duty to promote improvement. Clauses 44 and 46 need to be strengthened to deal with the identified failure in the system, not just by the provider. When problems arise, experience has shown that the issues are usually complex and that all parts of the health economy—including the strategic health authorities, Monitor, PCTs as well as providers—need to take action. The regulator needs powers to act in such circumstances. The performance manager is responsible for rectifying the issues and not the regulator. The regulator needs powers to make recommendations to all bodies. The regulator needs to be able to move quickly to protect patients and clients where there are significant concerns. Clause 107, on the standard of proof in the fitness to practice, amends the Health Act 1999 by imposing a civil standard of proof for all regulatory bodies and the Office of the Health Professions Adjudicator. The Royal College of Nursing and UNISON are suggesting that where the facts of the alleged misconduct point to a criminal case, a criminal standard should be applied. My experience as a chairman of the UKCC Professional Conduct Committee and as a lay member of the GMC means that I am inclined to agree with that, although I am open to suggestion. So many Peers have already said that the civil standard should go forward that I am willing to be persuaded. I look forward to taking part in the passage of the Bill. I am sure that this is going to be a long and interesting debate. I apologise to Members of the House for leaving before the conclusion of the debate. The Minister is aware of my early departure—I am going to be experiencing, I hope, a high quality of care.