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Health and Social Care Bill

My Lords, I wish to speak on Part 1 of the Bill on the development of the Care Quality Commission. Like many noble Lords who have already spoken, I have grave concerns about the merger of three successful regulators into one, particularly now, and I believe fervently that we should at least wait for the Minister’s review before going forward. I remind the Minister that we are here not because we think it is a good idea to merge health and social care, as he said, but because, as the noble Lord, Lord Warner, pointed out, a regulation rationalisation brought a number of commissions together, and that was part of that rationalisation. I should say that rationalisation of regulators is not necessarily rational regulation. The two are not necessarily the same thing. Structural reorganisation without clear objectives, defined values and an understanding of different cultures, such as is proposed in the Bill, will not bring about the improvements the Government hope for in the delivery of services to some of those most in need of health and social care services in our communities. Indeed, those of us who have lived through reorganisation after reorganisation, and seen through merger after merger know that, while change can bring valuable benefits if introduced with consideration and consultation, it can also, without due involvement of stakeholders or for unclear reasons, simply bring interference and distraction to those involved. I have watched organisation after organisation concentrate on structural change, where the next desk should be, or whose job comes next, rather than the delivery of services, which is what truly concerns us. Both the health and social care regulators have hardly had time to bed down. As my noble friend Lord Low explained, some have not come to the point where they can think through some of the detail. As the noble Baroness, Lady Bottomley, said, the devil is in the detail. I say this with some exasperation, because I was part of the National Care Standards Commission—its vice-chair, indeed—when, 19 days after becoming operational, it was announced that we were to be abolished. It was a miracle that we managed to benchmark every organisation in the country under the National Care Standards Commission’s care and ensure that we did not lose all of our staff despite their being threatened by that reorganisation. The abolition of the Commission for Social Care Inspection was announced some 364 days after it became operational, so, as I said in the debate on the Queen’s Speech, let us hope that if this Bill is passed, the new Care Quality Commission will make it to its first birthday. This new body, regulating a sector with some £105 billion and employing 2.9 million people, will have extraordinary significance for a large swathe of the public sector. My noble friend Lord Walton pointed out the detail and size of the task that this organisation will have. At the moment, however, many of us on different sides of the House are dispirited by the shape in which the Bill has come to us from the other place. I hope that the Government will accept that it is right for this House to fulfil its constitutional functions; that is, to sharply scrutinise, revise and improve this Bill so that it is indeed fit for purpose. Unlike the picture the Minister painted, social care and health are rather different. In the main, health is a universal, publicly provided service and free at the point of need while social care services are means-tested, subject to eligibility criteria and delivered primarily by the private and voluntary sector. We know that they do not mix; in a recent reply to a Question from the Floor of the House it was pointed out that people who had private prescriptions would not necessarily get public health care. Social care services mainly aim to provide a homely environment, or are delivered to people in their own home to support an independent lifestyle. That typically impacts on the quality of people’s lives as a whole, rather than taking place in acute environments or over episodic periods, as much healthcare does. Health and social care services, as many of your Lordships have pointed out, are not cut from the same cloth and the Bill needs to take account of that. Had there been time, I would have referred in detail to the letter published in the Guardian on 18 February from 15 charities representing hundreds of stakeholders. I will simply point out that that joint letter said that the Bill must be improved so that the new commission is mandated to take full account of the perspectives of social care, puts the views and experiences of people who use those services at the centre of its work—as my noble friend Lady Campbell so eloquently said—and takes a proper human rights-based approach to all its activities. The charities concluded by saying, "““Otherwise, as currently drafted, this 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 all those who use such services””." One concern about which many of your Lordships have spoken is the lack of principles in the Bill—criteria against which we can determine the appropriate regulatory action and against which the regulator can be held accountable. Objectives need to be clear to those being regulated, and to other interested parties. There have been several references to the recent National Audit Office guidance on public sector mergers; that also states that strategic objectives are important. What is the reason for such a glaring omission, and is the Minister prepared to look at amendments that put principles and objectives into the Bill? There is a real opportunity to set down some principles in this Bill that should underpin the provision of social care and health services in this country to recognise the core values of dignity, respect and human rights and to give people more control, direction and say over their services. I hope and expect that amendments in this regard will be tabled in Committee; otherwise, the good work undertaken by CSCI in involving people in the delivery of services will be lost. I also wonder whether the Minister would think such involvement appropriate in the delivery of health services. I hope that the House will support these approaches on behalf of those who rely on social care services. They depend upon a regulator who has not only the legal power to stand up for their interests and concerns but the internal culture, means and willingness to do so—and the capacity to speak out without the permission of the Secretary of State.