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Health and Social Care Bill

My Lords, I thank my noble friend for setting out so clearly the aims of this Bill and I hope to be able broadly to support its passage through your Lordships’ House, provided we use the time here to address some of the significant concerns I have about it. I want to say at the outset that, along with others, I believe that we are considering this Bill at the wrong time. I share the views of CSCI that we are creating a single regulator prematurely. However desirable it is in the long term to have a single regulator, it would have been better not to create the unavoidable turbulence created by such proposals at this particular time. The current system has been in place for too short a time and was set up as the result of great turbulence and change only four years ago. Doing things too quickly does not normally lead to good regulation; and mergers, as those of us who have been involved in them in public and voluntary sectors know only too well, carry their own disruption and inevitably lead to lack of focus on the issues and too much focus on structures and positioning. In addition, the Bill was somewhat rushed through the other place with insufficient time for proper debate. Certain other actions—notably the inadequate and ill-considered advertisement for CQC officials—leads one to think that there is a hurried and ill-thought-out air about the Bill. However, we are where we are and I am a pragmatist, so I am confident that the Bill will emerge from this House more fit for purpose than I consider it to be at present. In that regard, I am delighted that it is to be committed to a Grand Committee, which allows for productive and helpful exchanges, and I am delighted that Ministers have expressed willingness to accept changes for improvement. I accept that the current framework for regulating adult health and social care is fragmented and that it may be unsuitable for the pace of change that we are seeing in these services. We are seeing more and more care provided across boundaries of health and social care. I welcome the fact that social care is finally emerging from the shadows and being seen as less of a poor relation of, and more an equal partner with, healthcare. The Government have taken a lead on this, promoting debate and confronting the policy challenges of providing social care to an ageing population in which living with major disability is more common. In matters such as human rights, tightening eligibility criteria, the position of carers in our society and independence for people who use these services, the Government have shown a real willingness to listen. But they must now ensure that these lessons are carried forward where the regulation of social care services is concerned. We can do this in two ways—by championing and driving improvement in social care and by ensuring that the voices of users and carers are as strong as possible. The CQC, when established, must drive the improvement of social care. It should have a clear mission statement enshrined in legislation, which makes clear its independence from government. This mission statement would set out clear regulatory objectives and a clear duty on the new body to drive improvement in the health and social care sectors. The Healthcare Commission and CSCI currently have such a duty; under the Bill, the CQC would not have such a remit, but instead would focus on the narrower objectives of registration and inspection. It is all very well to have a lighter regulatory touch, but we do not want to throw babies out with the bathwater. In producing its reports such as The State of Social Care in England, CSCI has provided real direction to the sector and has highlighted areas where implementation of policy has not been successful, as well as providing concrete evidence about the performance of services. For example, this year’s report highlighted the problems caused by eligibility criteria for social care services and recognised the heavy strains that this places on families and carers. CSCI’s expertise and the way it involves services users and carers in its activities is well respected across the sector, as colleagues have said. The Care Quality Commission should not be a passive observer of the way that services are delivered but should have a proactive role in supporting the reform of social care and demonstrating excellence. This work should include the publication of independent reviews, which the CQC should be able to issue as soon as it is established without the permission of the Secretary of State. It is essential that the CQC is given sufficient power and resources to maintain a focus on social care that is not dominated by health—building on the valuable expertise developed by the CSCI. This could be achieved by creating specific posts with responsibility for social care on the board and in the senior management team of the CQC. Although Ministers have stated on several occasions that social care should have parity in the new commission, none of the amendments that would help to achieve that were accepted in the Commons stages of the Bill. I turn now to issues involving users and carers. The Minister of State for Health said on Report in the other place that, "““the Government believe that involving and listening to users, patients, their carers and the public will be a central responsibility for the new commission””.—[Official Report, Commons, 18/2/08; col. 77.]" However, Carers UK, in which I declare an interest as its vice-president, is concerned that measures to achieve this vision are not present in the Bill in its current form. Carers should be recognised in the Bill as key stakeholders in the provision and regulation of health and social care services, and the CQC should be given duties to consult and involve them alongside patients, users and the public. At the moment the Bill does not mention carers once. It is essential that we change this, given that the health and social care system relies to a huge extent on the unpaid care provided by families, friends and neighbours. There are more carers than there are health and social care professionals, and the replacement cost of the unpaid care is £87 billion a year. The fact that I give that statistic endlessly does not make it any less important, because it is equivalent to the entire budget of the NHS in England. Carers are more likely to have a thorough knowledge of the quality of services through their role as an advocates and negotiators for the person for whom they care. I remind your Lordships that often carers are responsible for funding care on behalf of a family member. The Putting People First concordat, published by the Government in December 2007, which sets the direction of policy for social care, recognised the responsibility of service providers in treating carers as experts and partners in care. The Bill should reflect this and other policy developments, not least the forthcoming national strategy for carers to be published in June of this year, which will recognise carers’ places at the heart of the health and social care system. The new commission must take full account of particular perspectives of social care in this country, putting human rights values and the views and experiences of people who use these vital public services at the centre of its activities. Otherwise, as currently drafted, the Bill runs the risk of moving the health and social care sector backwards by setting up a regulator that works to yesterday’s policy agenda, to the detriment of those who use such services. These are big issues to be confronted, but we can and must confront them as the Bill passes though your Lordships’ House.