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Health and Social Care Bill

My Lords, I thank the Minister for so clearly explaining the Bill. He will know that there has been a great deal of interest outside your Lordships’ House in this very important Bill from organisations concerned with the health and safety of patients and the well-being of clients who can be the most vulnerable people dependent on others. Some members of the public were only just beginning to understand what the Health Care Commission and the Commission for Social Care Inspection were about. Three years is not long for an organisation to get established and for systems to start working well, but now this Bill will merge those two bodies, plus the Mental Health Act Commission, into a new regulatory body to be known as the Care Quality Commission. I hope that the best, most experienced people working in those organisations will not be lost in the reorganisation of the amalgamation. It is hoped that the regulatory body will deal equitably with both the public and independent sectors. There is such variation in the quality of care in care homes. I was once written to by a lady in a home in Leeds. She said that her letters had to be smuggled out otherwise they were read. She was in a room with an alcoholic and her story of the care in that home was deplorable. I contacted somebody I knew who was able to investigate, and sometime later I received a letter from the woman to say she had been moved to a home in Harrogate. She said, ““It had been like leaving hell and going to heaven””. I recently met an elderly nurse who was brought up in Ireland and spoke with a distinctive Irish accent, although she said that she was English. She was working in care homes from an agency in Cambridge. One night a lady with Alzheimer's came out of her room and said she was freezing. The Irish-speaking nurse went to the nurse in charge, who was a Filipino, and asked for another blanket as there was only one on the lady’s bed. The nurse in charge said, ““Don't bother. The English are always moaning. Go and have your break””. The Irish-speaking nurse, who found another blanket and who really cared for the welfare of those unfortunate patients, implored me to bring up the need for better, kinder care in many of the homes she worked in. She said that nobody listens and nobody cares. I hope your Lordships will make the Bill more able to give better protection to thousands of vulnerable people who survive behind closed doors. Many organisations for disabled and elderly people believe that it is unacceptable that disabled and old people living in private or charity care homes have fewer legal rights and freedoms than those living in publicly-run residential homes. They want to see the Human Rights Acts 1998 extended to cover explicitly all disabled and older people living in private or voluntary sector residential care services. A legal loophole currently exists that means that those homes are not legally bound by the Human Rights Act 1998. I hope your Lordships will support an amendment to the Human Rights Act that will close that loophole. Then perhaps some people who feel that nobody listens will feel that your Lordships do. When dealing with mental health issues, specialised skills and knowledge are needed. Will there be the necessary training for members of the Care Quality Commission? Many people believe that the CQC should have a clear mission statement enshrined in legislation making clear its independence of government. That mission statement would set out clear regulatory objectives and place a clear duty on the new body to drive improvements in the health and social care sectors. Do the Government want patient and public involvement? First, they closed down the community health councils and set up health forums, which they have also closed down. They now want to set up LINks, which seem vague and unstructured. Volunteers who have been interested in patients’ well-being have been badly treated and many members of those groups must have lost confidence. They certainly feel let down. It seems that once an organisation gets established, it is closed down. Will the duties of the CQC include monitoring the implementation of nutritional standards in hospitals and care homes and ensuring that standards are driven up, health is promoted and that help with eating and drinking is a top priority? So many modern nurses seem to have lost the basic skills of patient care. Good food that tastes good helps patients to get better quicker and it gives them a morale boost and something to look forward to. The CQC’s responsibilities should include protecting and promoting the interests, health, safety and well-being of the public, patients and users of healthcare and social care services. Many people are concerned by doctors and nurses giving the wrong amounts of drugs and treatments to patients. Recently a nurse working in a hospital in Leeds killed several patients with insulin just because he did not like nursing elderly patients. Patient safety should always come first. There should be a clear statement of purpose in legislation. One message that has got through to the public is that hospitals are dangerous places because of hospital-acquired infections, which are now also in care homes. The Sunday Times Magazine this week had an interesting article on MRSA and Clostridium difficile. The head of medical microbiology at Stavanger in Norway said: "““What works is screening. You test everyone, and you isolate and treat everyone you find with it. In England you can’t do that now because you have too many cases””." This is one of the dilemmas that will face the CQC and now we have the first case of the extremely drug-resistant strain of tuberculosis in the UK. I hope that infection control will be a top priority for the new commission. Unless it has adequate funds it will not be able to achieve all its goals. What is going to be the CQC’s role in the complaints procedure? For years there has been a need for a clear, uncomplicated and quick procedure that people understand. Which? has undertaken research on this issue and found that only half of those with concerns about their hospital care had raised them. Only one in three who felt they had cause for complaint about their healthcare had made a formal complaint. There are many barriers to complaining. Which? is correct in saying that there should be improved communication between providers and patients. This could be achieved by having a panel for service users, patients and the public. This could have a positive impact on regulation. Will providers have effective systems for resolving complaints from patients, service users and carers? Will this be made part of the registration requirements? Will the scope of registration—the range of services and organisations it covers—cover all services posing significant risks to patients? Will the Minister ensure that following an investigation the regulator can tackle failure and has powers to make recommendations to all NHS bodies involved, not just the provider where the problem arose? I hope the Minister agrees that safety and quality of care should come first.