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Health and Social Care Bill

My Lords, I welcome the Bill in principle, if it is to provide a seamless, well organised service better to integrate health and social care and to provide substantial improvements in the quality and level of service provided. There is no question that for many individuals and for many public health issues, better outcomes can be achieved by health and local public services working together. The problem at this stage is that the Bill provides a framework for the establishment of the Care Quality Commission, leaving the detailed implementation to regulations that are to follow. However, as others have said, we appreciate the efforts of the Minister and of the department in providing us with adequate briefings. Structural reorganisation is complex and takes time. I fully agree with the Healthcare Commission that the transition to a new regulatory system needs to build on momentum established so far, with a consistency of purpose and of approach. I shall concentrate my remarks on Part 3, so far not discussed, and the widening of public health powers. I shall then talk briefly on the regulations governing registration and standards, the patient and the public, and the health and pregnancy grant. I declare an interest as chair of the Independent Advisory Group on Sexual Health and HIV. My first concern with the widening of the public health powers to include all infections—the all-hazards approach—is that, for the first time, this will include sexually transmitted infections instead of confining the application of public health powers to a list of named infections, such as cholera, plague, smallpox and typhus, as was previously the case. HIV was not subject to these powers. Of course, public health powers are vital to control serious contagious diseases which are spread by everyday contact, and it is understandable that the Government wish to have an extensive set of powers to deal with any future health emergency. It is less clear, however, why such powers should be applied to sexually transmitted infections such as HIV, infections which are not transmissible through everyday contact. Significant human agency from two people is required for the transmission of HIV, and the risk transmission from a single incident is very low. Unfortunately, HIV remains highly stigmatised, and Clauses 123 and 124 of the Bill extend significant coercive powers to include HIV without appropriate justification. I am sure that HIV was not in the Government’s thinking when drafting the Bill but, as it stands, it will have consequences for people living with HIV, as there is no provision to stop the proposed powers being used in relation to such people. In addition, the coercive powers available to JPs in relation to the risk of infection of disease are extended by the Bill. Under the old legislation, a JP could make an order for a medical examination, the removal of someone with a notifiable disease to a hospital or the detention of a person in a hospital. In this Bill, a JP can now additionally quarantine, restrict where an individual goes or with whom they have contact, order disinfection or decontamination, absent them from work and require an individual to attend training or advice sessions on risk reduction. The absence of any reporting and monitoring mechanism will have significant implications for civil liberties, particularly given our obligation under the Human Rights Act. It is crucial that there is the means to ensure that the use of these powers is effective, proportionate and consistent. I understand that officials are in discussion with the National AIDS Trust and I hope that a proper monitoring process can be introduced in the regulations that are to follow. At Second Reading in the other place the Secretary of State said that it is essential that the Bill ensures that the regulatory system can accommodate future patterns of service delivery and that, to do that, the Bill must establish a level playing field for healthcare consumers through registration of all service providers based on common standards. That, for me, raises two questions. First, how will the proposal for a single set of requirements for registration be applied across all regulated activities? Although the compliance criteria supporting the requirements will be specific to the type of service that is being regulated, I still believe that this unified approach to the registration of both social care and health bodies may be difficult to achieve in practice. Only in the most general sense can one relate a large acute hospital to a community contraceptive clinic or a small private care agency. They have differing pathways of care, differing service provision and differing patient requirements. I support the idea that NHS providers should be subject to registration for the first time but a great deal more thought needs to be given to how the registration process will work. Secondly, Clause 41 gives the Secretary of State the power to prepare and publish statements of standards in relation to the provision of healthcare by PCTs and to amend these from time to time. Under Clause 133, PCTs will have a duty to make arrangements to secure continuous improvement in the quality of healthcare provided by them. The standards will be benchmarks of expected behaviour and good practice, and I believe that they should be defined in the Bill. Against that background, can the Minister clarify for me the commission’s role in monitoring and assessing compliance with these centrally determined standards, and can he say whether the appropriate funding will be made available so that the standards can be met and risk reduced? One criticism of the Bill is that it is too provider-focused and does not concentrate sufficiently on the needs of patients and the public. A purpose of the legislation is to provide a truly patient-and-people service, covering all healthcare providers in the public and independent sectors. However, it can fulfil that purpose only if patients and the public have confidence in the work of the regulatory body and in its ability to maintain the public interest and hold professionals to account. The regulator needs to have a stronger duty to involve patients and service users. Currently, the Bill requires the Care Quality Commission only to have regard to the views expressed by, and on behalf of, members of the public. As Which? forcefully expresses in its briefing, there is a crucial distinction between merely ““having regard to”” and proactively going out to engage with users. The advisory committee proposed in the Bill will, in the main, be comprised of providers of services, but they will in no way provide the views and experiences of the patients, their carers and their families. In the words of the noble Baroness, Lady Campbell, that does not go far enough. Allied to that, there has to be an adequate complaints procedure which is clearly defined so that people understand the process. Providers should have a statutory function for dealing with complaints, and that function should be part of the registration requirements. Finally, I wish to say a brief word about Part 4 of the Bill, which provides for the payment of the health and pregnancy grant as a universal benefit. There is clear evidence that universal benefits are likely to reach more women than are grants that have to be applied for. It is encouraging that the financial costs of pregnancy for women and their families have been recognised, possibly for the first time. It is hoped that, with support and advice from health professionals, the grant will encourage pregnant women to lead a healthier life. I had some reservations about the timing of the grant but, having talked to possible recipients, I am persuaded that 25 weeks into pregnancy is about the right time and that it ties in well with other maternity support. There are many issues still to be resolved, whether they relate to the period of transition and the hiatus caused, the inspection and enforcement regime, the powers and sanctions of the commission, funding concerns or the guarantee of independence from government. All those points will be considered in detail in Committee to ensure that the Bill brings about a more integrated approach to health and social care provision to provide a safe and quality service for the people who use it—the patients.