---

Health and Social Care Bill

My Lords, in my spare time I am a social historian. One of my topics of interest is 19th and 20th century health and social care regulatory bodies from the Madhouses Act 1828. It is fascinating to discover that parliamentary discussions were just about the same then as they are now in regard to these crucial issues. How boundless are the hopes that successive Governments have for the power of regulation, and how quickly hopes are dissipated, often brought about by Governments’ own meddling and reorganisation. The truth is that no regulator can substitute for good management and professional education and we should not have false hopes that the new Care Quality Commission can. As we have heard, the new commission follows hot on the heels of the barely toddler-aged Healthcare Commission and CSCI, both organisations having made significant strides in establishing themselves as effective businesslike organisations. Of course we can all find admirable reasons why processes across the health and social care spectrum are sensibly examined together along care pathways, and why some of the new provisions improve the inspectorial work of the Mental Health Act Commission, but whether this justifies abandoning the good work of these three bodies and starting all over again so soon, I am not so sure. Although I am not a betting person, I would like to offer the House a wager that within three years further debates will be about the reorganisation of this commission because it does not cover the entire spectrum of provision and functions, including financial functions. There is yet a great deal to do. I realise there is little appetite for opposing the overall thrust of the legislation—let us face it, it seems to be a done deal—but somehow we must ensure that what emerges has the chance of being something other than a new version of the NHS-focused Healthcare Commission. We have debated in this House many times—it has been eloquently expressed again today—the inverse care law, if you like: the hierarchy of socially desirable diseases that places acute medicine and hospital care at the top, social care for older people way down underneath, and lurking even further underneath the social care of seriously mentally ill people and people with learning disabilities. I was very concerned to see that it has already been decreed that the new CQC will focus on hospital-acquired infection as a number one priority in its first year. That does not suggest to me that the priorities for those most at risk of care failures are going to be considered in that first year. Is that not of serious concern to those interested in the 25,000 units providing social care to the most dependent individuals in our society? Will such patients get a look in? It is a very poor statement of intent for the first year. Turning to a few specifics—I declare an interest as I was for seven years vice-chairman of the Mental Health Act Commission—I am as concerned as the noble Lord, Lord Patel, to ensure that the Bill affords detained mental health patients at least as good protection for their human rights as the current arrangements, if not better, and I will be supporting amendments brought forward to that end. At the moment, of course, it is all just not clear. Secondly, I am a board member of Monitor, the NHS foundation trust regulator, which does not figure much in the legislation but plays a crucial role in the regulatory framework of the NHS now that almost half of NHS trusts are foundation trusts. We therefore have a keen interest in ensuring the effectiveness, cost efficiency and total clarity of the regulatory regime. I shall be seeking reassurances about the way the system will work in practice. I am a keen supporter of the Government’s healthcare reforms and I believe a system of devolved, autonomous and competitive providers from a mixed economy can flourish only where there is clear, strong but light-touch regulation. But any lack of clarity in this respect will be disastrous. Like many people in the House today, I was delighted to hear that the Government are exploring the introduction of amendments to the Bill to recognise the Human Rights Act in relation to residents of private care homes placed there by the public purse. I hope they will also recognise the Human Rights Act in relation to those paying for themselves. As a geriatric psychiatrist I know of numerous instances where older people have been evicted, quite callously, from their places of residence in the face of increasing disability. This flies in the face of the Human Rights Act and has to stop. I hope we will find an opportunity to solve the problem this time round. I understand the seduction of a universal registration system but in some other countries it has established a lowest common denominator of standards and has not raised the game. I want to be reassured that it will be different here. We need reassurance that registration standards will build on the care standards and the minimum standards currently used by the three commissions. Surely we are not going to register organisations of lesser quality which could not meet these standards. We must build on the improvements that these standards have brought about. I wish to comment briefly on the fines to be imposed for offences. Even the highest possible fine—£50,000—will have a negligible financial impact on NHS trusts or many private healthcare companies. Can the Minister tell the House how shovelling public money around the system will do the slightest good? I am trying to think how the financially beleaguered Maidstone and Tunbridge Wells NHS Trust would have better addressed its C. difficile problem by being fined £50,000. I cannot see it myself. It was already preoccupied with that problem; it was too busy looking at its financial balance and not busy enough looking at its patients. One or two other issues complete the picture. I strongly support the Government’s intention that all healthcare professional regulatory bodies use the civil rather than criminal standard of proof, including the GMC, and the proposals for organisations to appoint a responsible officer in cases of fitness to practise. I declare an interest as being registered with the GMC. It would have made my life much easier as an NHS manager in dealing with some of the most difficult cases. The GMC failed to deal adequately with them because of its criminal standard to proof. I shall probably make myself deeply unpopular with many people in the House, but I question whether it is wise to give extra money to women in the 25th week of pregnancy. I know that it is a popular procedure, but it is a small proportion of people who fail to attend antenatal care. We do not usually bribe patients to take health measures. Given the Healthcare Commission’s recent report on maternity services, I wonder whether it is the best way to spend public money when so much more money is needed to provide continuity of care in midwifery. I would like us to be absolutely sure that the powers of intervention in private lives for the sake of public health will be used wisely, and that we have adequate safeguards, appeal mechanisms and independent review for the new powers. I look forward to working on this interesting Bill through its Committee stage.