---

Health and Social Care Bill

My Lords, the Bill has clearly attracted considerable attention and with that in mind I shall try to confine my remarks to one or two issues only. I apologise to the House if other noble Lords have already more than adequately dealt with these, but with the number of Bills currently going through the House, and other essential meetings to attend, it has not been possible to be present in the Chamber for as long as one would have wished. It is clear, too, that, as well as the criticism that the House has heard today, there is support for what is seen as the Bill’s potential to deliver a more joined-up approach to health and social care regulation, and to its attempts to remove some existing unfairness; for example, the liable relatives rules. However, even on that issue, the charities and specialist organisations involved remain concerned that some local authorities are not giving the relatives of handicapped or elderly patients the help or the choices of help that they may be entitled to. The proposed new regulator—the Care Quality Commission—while welcomed, is criticised by a number of organisations. We have been beautifully briefed by those organisations—Which?, National Consumer Council and the Picker Institute among others. The main concern, as many noble Lords have said, is that the new regulator is not being provided with a clear set of regulatory objectives. Some progress was apparently made on that point in the other place. However, the phrase ““have regard to”” patients’ views is seen as far too passive and unimaginative an approach. What is needed, it is argued—with considerable justification I, like other noble Lords, would have thought—is for the new commission to be given a duty in the Bill to engage with and involve service users during its regulations and inspections. As my noble friend Lady Masham of Ilton has mentioned, Which? has also argued that the CQC should be required to appoint a separate independent—and I stress independent—advisory committee of service users and members of the public, including carers, which would help the regulator choose themes for reviews and set priorities—perhaps something along the lines of Ofcom’s consumer panel, which does just that. The Picker Institute and a number of other charities, as the noble Lord, Lord Harris, has said, point to the contrast between the Government’s intentions for the CQC and those of the three other new regulators created since 1997, where user interest also required strong protection. Returning to Ofcom as an example, its principal duty is stated at the top of the Act; that is, to further the interests of citizens and consumers. As someone much involved with the Communications Act 2003 and subsequently as a member of the House of Lords Communication Select Committee, I can tell your Lordships that hard-fought-for addition to the Act—and, not least, its acknowledgment of citizens’ and consumers’ somewhat different interests—has had a profound effect on that regulator’s subsequent work and priorities. As Lord Harris also said, it is not just Ofcom. The Financial Services Authority also has its four regulatory objectives printed at the beginning of the Act, which again focuses on end-user interests. Similarly, the Food Standards Agency, set up in 1999 has its main purpose set out at the beginning of the Act, which is, ““to protect”” the public, "““from risks which may arise in connection with the consumption of food … and … to protect the interests of consumers in relation to food””." In light of all this, I hope that the Minister will be able to give the House some encouragement that the Government are undergoing a change of heart, particularly as other Members of your Lordships’ House have mentioned it so many times. The other major issue that I wish to mention and support are the concerns raised by Age Concern, Help the Aged, Radar, the RNID, the RNIB and many other organisations over the Human Rights Act. The fact that this Act currently does not protect the elderly and disabled living in voluntary or privately run homes, which currently cater for some 90 per cent of those needing this kind of care, is, I would have thought, a huge concern. I am sure that, like me, noble Lords will have visited homes that deliver excellent loving care. However, your Lordships will also have read in the press appalling stories of ill treatment and seen the recent disquieting report from the Joint Committee on Human Rights which, I am afraid, highlights that this is far from universal. I hope that the Minister, when he replies, will be able to confirm unequivocally that the commitment given by the Minister, Ben Bradshaw, in another place that all private and voluntary sector providers will be brought securely within the ambit of the Human Rights Act. I think that he has given some indication that he is going to be able to do that at the end of progress on the Bill. I would like to end on a more general note. I confess to not being a totally enthusiastic supporter of what I call the giantism blueprint for regulators of the noble Lord, Lord Carter of Coles, which has been applied by the Government to almost every aspect of public life. He has managed to achieve that by getting the Government to merge existing regulators in a particular field into a single, giant body. Ofcom and the Equality and Human Rights Commission are two good examples. In this case, as we have heard, the Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission are to be merged to form the CQC. There is special concern here because it is the third such proposed change for the national regulation of social care since 2002. Somebody suggested that it was the fourth, which would be even worse. CSCI has done a huge amount of valuable work on the rapidly growing social care side of things, and its view is that another structural change in the regulation of social care and health services is premature; that view may be understandable. However, as was said by my noble friend Lady Murphy, this looks like a done deal. Many involved can see potential benefits from having a closer working relationship between health and social care. However, it is crucial that both be seen as equal partners. Just as those with responsibility for disability rights were reluctant to join the Equality and Human Rights Commission until satisfied of an equal standing with race and sex equality, so this will be crucial for the CQC. Organisations have stressed—I quote Carers UK—that: "““It is essential that the CQC is given sufficient power and resources to maintain a focus on social care and that””," its work is ““not dominated by health””. One further concession is needed from government—apart, of course, from guaranteeing sufficient resources for what will inevitably be the growing social care side of the CQC’s work. It is argued by Carers UK and others that the CQC should have powers to publish independent reviews of its work without first needing to ask for permission from the Secretary of State, but will the Government have the confidence to grant that? I very much look forward to the Minister’s reply.