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Health and Social Care Bill

My Lords, the trouble with having one’s name pulled out of a hat and finding oneself number 33 on the speakers list in a debate of this kind—although I am not sure that it is that scientific—is that most of the points have already been made. If I repeat things which have already been said, please forgive me. I welcome the Bill and the setting up of the Care Quality Commission. It is a clear attempt by Government to improve the health and social care system through a single, regulated body. It also addresses the important role of those who work within the system. The Bill will also do away with many outdated provisions that are currently in place which many within the system would argue are no longer appropriate to meet the needs of both patients and service users. The new Care Quality Commission, to be created by the Bill, will replace the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. As has already been pointed out by the Minister, this rationalisation is a sensible move forward but, by itself, I stress that it is clearly not enough. It is far from clear that the new regulator, as it is spelt out in the Bill, has a clear enough framework by which to judge the effectiveness of the commission in its operation. For instance, will the commission have the specific objective of promoting provision of health and social care services that are safe, high quality and will meet the service user’s needs? One could talk about the protection and promotion of health, safety and well-being of the public, patients and users and so on for some time but a lot of those points have already been stressed in the debate, so I will not go down that path. Having separate systems for health and social care has created confusion, so the fusion of the services working together could be a good thing. Regulation can help the process of delivering what the other services wish to bring about. Although the Bill deals only with the regulation of health and social care, I suggest that we must consider it in the context of other pieces of legislation in this area which have passed thorough both Houses in the past few years. I refer in particular to the legislation that I introduced, namely the Carers and Disabled Children Act 2000, which came into force in April 2001 in England and Wales and which was an important step forward. I was helped enormously before I arrived in this House by my noble friend Lady Pitkeathley, with her wealth of knowledge on the problems carers face within our society. She helped steer the legislation through this House. I will always be grateful to her for that. The Carers and Disabled Children Act 2000 enshrined the right of carers to have their own needs assessed independently of the person they care for, regardless of whether that person had had an assessment themselves. This is an important principle. It ensures that carers are viewed as individuals in their own right, something which carers feel very strongly about, and rightly so. The Act also gave local authorities the power to provide services directly to carers. Councils in England now provide an average of 20,000 holiday breaks to carers each year. My Act was the second of three Private Members’ Bills concerning carers which became Acts of Parliament. The first was the Carers (Recognition and Services) Act 1995, introduced by Malcolm Wicks MP, and my 2000 Act was further strengthened by the Carers (Equal Opportunities) Act 2004, introduced by Hywel Francis MP. It stated, among other things, that local authorities must inform carers about their right to an assessment. As well as assessing and providing services to carers in their own right, councils are starting to do better at recognising the vital contribution that carers make. Most care to elderly and disabled people is provided by carers, not by professionals. We still need to go a long way in truly recognising carers within our society. Although I believe that the Bill has good intentions, I equally believe it needs strengthening. There is a danger that because carers are not mentioned even once, it could mean that the good work being done by the Government—namely, the New Deal for Carers—might be a casualty of the Bill. Perhaps giving local authorities and health services additional requirements on carers outside of the provisions of this Bill might undo some of the good work that has been done by the three carers Acts to which I referred and which are now on the statute book. It is true that in another place Alan Johnson, the Secretary of State in charge of the Bill, inferred that the new commission would have responsibility for involving and listening to carers. I am sure that he was in earnest when he made that statement, but it is not shown on the face of the Bill. The commission must have that pledge written into the Bill for it to have real meaning. I hope that it is not too much to expect that, with all its good intentions, the Bill would be further strengthened by such an inclusion rather than rely on secondary legislation. We cannot take the risk that important priorities of government and Parliament are left out in the confusion of setting up the commission and the onerous task of registering all providers of health and social care services. The commission will have so many other calls on its time and resources, that I am concerned that carers will be forgotten. Of course, the combined budget will be less than that of the existing commission, meaning that finances may be tighter and that anything not specifically included by Parliament will be left out. As the Bill passes through this House, we should consider carefully what exactly we want it to do. Other regulators have a much clearer mandate and the public can therefore see whether they are doing their job properly. In this area, which is crucial to the lives of all our citizens, it is essential that the new body will be held to account. For that to happen, we need to be clear about what it is intended to achieve. I do not believe that is the case with the Bill in its current form and, in my view, it must be improved in Committee.