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Health and Social Care Bill

My Lords, I start with a health warning. I have swollen tonsils, which refuse to disappear, and I hope that I shall not fade out. This Bill is being debated against a background of increasing hardship for many thousands of disabled and older people who are being refused essential health and social care support for independent living. Three-quarters of local authorities in England are restricting their services only to people with critical or substantial needs according to CSCI’s State of Social Care in England report. Meanwhile many of those still eligible for state funding have little choice and control over their lives because we have a system still rooted in notions of welfare and dependency. This Bill gives us the opportunity to create a regulatory system and a legislative framework that is concerned not merely with the quality of care that people receive but also with enabling all those who need state support to live with dignity, to enjoy real autonomy and control over their lives and to contribute to their communities. After all, that is the vision that underpins the Government's recently published Independent Living Strategy and the adult social care concordat. The challenge now is to embed that vision in health and social care law and to support the major culture change that we seek in the delivery of public support services. The remit of the Care Quality Commission needs to reflect and support that government commitment to independent living. However, the current duty set out in Clause 2 to have regard to, "““the need to safeguard and promote the rights and welfare of children and vulnerable adults””" is too weak to enable the CQC to play the role it could and should play in empowering those who use health and social care services to be full and equal citizens, enjoying maximum choice and control over the support that they receive and full respect for their human rights. I agree with other noble Lords that this goal should be elevated to a principal or overarching duty for the new regulator so that all stakeholders have absolute clarity as to its purpose. Moreover, as other noble Lords have said, we should ensure that the CQC is given a strong duty to involve patients, service users and the public, in place of the rather weak duty to have regard to the views of the public. Involvement is the new standard. It is about those who use services participating in policy making as equal partners. Evaluation of involvement programmes—for example, CSCI's Experts by Experience programme which involves service users in inspections—demonstrates that involvement adds value and leads to improved services. Will the Minister ensure that CQC maintains and builds on the involvement of service users in future social care inspections? A fundamental principle of the disability equality duty is that public authorities involve disabled people in setting priorities for action and assessing the impact of policies. Most recently, the Local Government and Public Involvement in Health Act 2007 heralded new measures, including the establishment of local involvement networks and a duty to involve local people in joint strategic needs assessments to ensure that users of health and social care have a much stronger voice in the running of local services. The CQC needs to play a major role in supporting those changes and monitoring their effectiveness. With regard to the new regulatory framework, I hope that the Government will accept the need to ensure that it also reflects current aspirations for promoting equality and human rights. This is the approach adopted in my noble friend Lord Ashley's Disabled Persons (Independent Living) Bill which makes all private and voluntary care homes and agencies subject to the Human Rights Act, with duties on providers to inform service users of their human rights. In the 21st century our expectation must be not simply that we will be cared for and spared indignity should we need support, but that we will all, whether living in the community or in a residential care setting, be able to continue to enjoy time with our families, to make friends and to access leisure and educational opportunities—in other words, to have a life. I hope the Government will want to make progress on this and adopt the amendments suggested by the Joint Committee on Human Rights. In particular, I welcome the Minister’s assurance that the Government are working to resolve the loophole which deprives people in private and voluntary-sector care homes of the protection of the Human Rights Act. Right at the end of the Bill—in Part 5, entitled ““Miscellaneous””—is a welcome, if limited, set of social care reforms. I welcome, in particular, the extension of direct payments to those without capacity. The voluntary organisation Sense, for deafblind people, is particularly concerned that the regulations address some of the difficulties which their members have faced. I shall return to that in Committee. Sadly, other outstanding social care reform commitments are not addressed in the Bill; for example, the commitment in Improving the Life Chances of Disabled People strategy to revise the definition of a disabled person for community care purposes. As noble Lords will know, the current definition under the National Assistance Act 1948 refers to the ““handicapped”” and to ““cripples””. The strategy argued that: "““This definition is out of date, offensive and does not provide a useful starting point for enabling disabled people to fulfil their roles as citizens””." We were promised consultation on a more appropriate definition, followed by a change in the law. Finally, I understand the Government have pledged, in their proposals for modernising complaints Making Your Experience Count, that advocacy should be a right for all across health and social care. I would be grateful if the Minister could give me any information on what progress is being made in that area.