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Health and Social Care Bill

My Lords, I apologise to the Minister for missing the start of his speech. Perhaps my next sentence might explain why I was late. I declare an interest as the paid chief executive of Turning Point, which promotes health and social care and social enterprise and is regulated by the Commission for Social Care Inspection, the Healthcare Commission, the Housing Corporation, the Charity Commission, the Audit Commission, the Housing Inspectorate and the National Treatment Agency. I start by saying that if there is any possibility of regulation that can make sense of my day, I must support it. In supporting the Bill, I point out that all change involves huge risk. If one is too risk-averse to attempt any change, then nothing happens at all. The issue is whether this change is worth the struggle. Is it worth the struggle for those people who are not in this Chamber? I speak with my mother in mind. She has been poorly for some time, she has been seeing a GP, she has been in hospital and she may well need social care. Having done battle with various parts of the NHS and social care system on her behalf, I have to say that it is worth struggling for a joined-up health and social care system. I think that it is worth the struggle to have one phone number instead of 100, and I think that it is worth the struggle in the interests of those people who need a clear route of complaint and of redress. That statement is somewhat visionary and I have listened for some time to a number of noble Lords commenting on this Bill from a position of—how shall I put it?—gentle scepticism about whether the Government are going to achieve that vision. But I believe that we must try. I say that with due regard to the excellent work of the Commission for Social Care Inspection and the Healthcare Commission, with whom I and my organisation work closely. But I see the gaps between those organisations reflected in the unmet needs of many people. I also note the many comments pointing out the risk of social care being rolled over by the huge behemoth of clinical care and the NHS. I have much sympathy with that view and I have often argued with the Minister for social care to have a much greater role in his thinking on NHS reform. The Bill needs a much greater guarantee of that—but this is not a reason for the reforms not to go ahead. It is a reason instead for those who support social care to get their act together and carry on struggling to ensure that it plays its full part in the new arrangements. It is probably worth summarising the concerns that have been expressed so far. I apologise if I do not do justice to everyone’s comments but I think that there are three main concerns. One is that—certainly in relation to Part 1, which is where most of my remarks are focused—we will not keep pace with change, the risk being that the new regulatory framework will take insufficient account of the transformation and change in service provision, patient pathways, customer care, client needs, service user involvement and engagement. That is a real concern, which is not reflected in the Bill. A second concern relates to size, scope and disparity—that is, that the differences in scale, scope, character and accountability within health and social care and mental health will not be reflected in the new regulatory framework. Again, there is much work to be done on the Bill to ensure that those things are integrated within the regulatory framework. The third concern is: where is the benefit to service users clearly expressed in the Bill? People talk about values and principles being set out in the Bill but I prefer to talk about the need to express in the Bill the vision and values of customers or users. It seems to me that those concerns are still valid and it is on those that I base my meagre contribution to the debate. One concern with which I have some sympathy is that the role of commissioning is not mentioned in the Bill. We spend £90-odd billion on health and social care in this country, most of it through the process of commissioning. Commissioning is the means by which you understand the needs of an individual and/or the community in which that individual lives and thus provide the platform for procuring health and social care services. If you do it badly, believe you me, no amount of regulation will help—I have seen it. All those health and social care deserts are not necessarily the result of a lack of funding; they are the result of poor commissioning. Therefore, frankly, I am amazed that commissioning does not form part of the Bill. I am equally amazed at the advertisement for the chair of this new regulatory body. It has been said that a signal is being sent by this advertisement and the salary for the post. Surely a mistake must have been made, in which case the signal is that not enough thought has been given to the Bill and to the leadership that is necessary to put in place Part 1. Alternatively, thought has been given to those matters but they are not considered to be as important as, say, the Audit Commission or the FSA. I, for one, beg to differ. Finally, I support the comments of the noble Lord, Lord Patel of Bradford, regarding mental health. I happen to advise the Minister on delivering the race equality programme and mental health. The impact of mental health on black and minority ethnic groups is disproportionate and severe. It goes unnoticed and is a national disgrace. Despite the concerns and critiques that I have heard, the Bill provides an opportunity to create a truly world-class health and social care regulatory framework. If we lose the opportunity to redress a glaring imbalance in the provision of mental health services, we will rue the day, not just in terms of clinical and social care methods but in terms of social unrest and unease. Therefore, once again, we are at a tipping point between an opportunity and a risk. On the one side, there is the risk of complete and abject failure, because I suspect that the Bill will go through to achieve a vision for my mother and people such as her. On the other side, we have an opportunity to create a world-class beacon of regulation and inspection that will make my daily life easier—I said that I had a self-interest—and, more importantly, to ensure that people not in this Chamber get better care outcomes and better value for money.