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Health and Social Care Bill

My Lords, I am pleased to contribute to today's debate on such an important Bill. Not only have I worked in social care policy and, in a more limited capacity, health service policy, but I declare an interest as a constant user of health and social care services. For too long, health and social care services have been provided in fragmented systems that put process before people. Disabled and older people, who are the main users of these services, often suffer the consequences of divided provision. A single regulatory body for health and care services could be a welcome step in ensuring closer co-operation. When I am going to bed, I need both my ventilator and a personal assistant. The ventilator is healthcare, and the person is social care. Both are equally essential to my life. However, as former chair of the Social Care Institute for Excellence and a founder of the National Centre for Independent Living, I share a little concern that social care may become the junior partner in the new inspectorate. Healthcare has always enjoyed a substantially higher political profile, significantly greater funding and strong public understanding and support. In contrast, frankly, social care has had to work its socks off to gain a fraction of health's economic and political power and public attention. That has always baffled me. Like millions of others, I could not function without social care in exactly the same way as I could not function without healthcare. However, the Bill has inherited the imbalance between the status of health and social care. We will have to think carefully in Committee to combat that and make it work effectively and equally. Today, I will confine my remarks to two areas of concern. First, I question whether the Bill does enough to secure and build on the achievements of the Commission for Social Care Inspection. As it stands, the proposed Care Quality Commission is slightly more concerned with health services, as I said before. I am particularly anxious that the potential imbalance will result in a medical response to society's social care needs; we in the trade call it the medical model. Medicine is generally about curing or easing one's condition, which is important. Social care is much more about removing barriers and providing external support. In social care, there is a long history—much longer than in healthcare—of empowering and involving service users to find solutions to their own problems. When I look at the Bill, I am struck by the lack of a strong duty to involve people who use health and social care services. The Bill requires the Care Quality Commission to ““have regard”” to the views of the public. It also allows for advisory panels to be established. In my long experience in the field, that is simply not enough. One need only look at the work of the Commission for Social Care Inspection’s ““experts by experience”” to see the benefits gained from maximising user involvement. There, CSCI involves service users directly in quality assurance and inspection processes. The Care Quality Commission needs to build on that but go much further. We should expect something more robust in the Bill to ensure that service users are not only partners but coproducers in the work of the Care Quality Commission. Thankfully, we live in an age when patients and service users are no longer passive recipients of professional care services. With the advent of direct payments, and now the personalisation agenda, thousands of people who benefit from social care support have taken control and responsibility for the care they receive. Thousands—nay, millions—more will do so over the coming years. The Expert Patients Programme is also empowering people to manage their conditions. It is, therefore, essential that a modern integrated commission adopts the principle and practice of user involvement in significant and clear ways. The Bill must surely be the place for the principle to be stated. That brings me to the second and last principle that I would like the Bill to underpin. It is the need for a clear and unequivocal commitment to embedding human rights principles throughout the CQC. The Joint Select Committee on Human Rights recently reported on the Health and Social Care Bill. In relation to the new commission it said: "““We recommended that the proposed merged inspectorate for health, social care and mental health should adopt a human rights framework to underpin and inform the new inspectorate's work and make it more effective in fulfilling its statutory duties””." I wholeheartedly endorse that and will be looking for it. During the passage of this Bill in your Lordships’ House I hope that human rights are given adequate attention. I refer, for example, to the urgent need to ensure that residential care homes inspected by the new Care Quality Commission will be subject to the Human Rights Act. As a commissioner at the Equality and Human Rights Commission, I believe that health and social care services must actively uphold the Human Rights Act and the dignity of people using services. To date the Human Rights Act has been undermined in social care. For example, public funds are used to support people in care homes which have no obligation to uphold their residents’ human rights. There are moves afoot to cover residents who are not self-funders but not those who self-fund. Surely this is unacceptable. How can the Care Quality Commission inspect and regulate a care home where of two residents sitting side by side one is found to be protected by human rights law and the other not? There is broader evidence of human rights failures in health and care services. I need not detail the cases of abuse and neglect exposed by the Healthcare Commission and the CSCI at an NHS Trust in Cornwall in 2006 and the Sutton and Merton PCT last year. These cases are relevant to this Bill. The existing pattern of failure will continue if equality and human rights do not underpin the work of this new inspectorate.