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Health and Social Care Bill

My Lords, I declare an interest as leader of a local council, and I shall try to reflect those perspectives in my remarks today. I apologise to my noble friend; he must be feeling that with friends like these, who needs enemies? There are lots of things in the Bill that we support but we ought to concentrate on our concerns. I have four, and I am not sure whether they are fully consistent with other areas of government policy. I agree with my noble friend and many other noble Lords about the need for a supervised seamless service between social services and health. Whether that needs the same regulation because of the differences in culture, I am not sure. Many noble Lords have explored the differences, but one factor has not been accounted for, and I hope that my noble friend will reflect on it. Local government is about to be subjected to a totally new and different inspection regime—a radical change. A comprehensive area assessment will measure how local authorities respond with partners to the local needs of their communities. That is a far cry from the traditional top-down, tick-box inspections, and will involve inspectors working closely with local authorities in identifying needs as well as monitoring performance. Will the Care Quality Commission, following the reorganisation, with all the potential problems to which noble Lords have referred, be able to support local authorities in this radical change? I hope that it will, but it is possible that it will not. In the debates in another place, the Secretary of State for Health recognised the need for parity with social care, but I hope that we can have something stronger than that statement when the Bill leaves this House. We need to ensure that the new commission is independent, has clear objectives and has a board that reflects its work in its entirety, not just one element. Part 3 deals with a new approach to public health. We all welcome the modernisation in the Bill, but I am confused about the relationship between this Bill and the Civil Contingencies Act. Clause 1 of that Act refers to any event or situation which threatens serious damage to human welfare in a place in the United Kingdom. Any serious public health issue would come under the scope of the Civil Contingencies Act, but the processes described in that Act are radically different from that prescribed in this Bill. There is no involvement of a justice of the peace. Local authorities with emergency and health partners can go ahead and do what is necessary under the Civil Contingencies Act. I hope that my noble friend can end this confusion. If there is a serious occurrence affecting an area’s public health, which Act do local authorities turn to—the Civil Contingencies Act or public health legislation? The procedures are quite different. I remind your Lordships that the Civil Contingencies Act was brought in because of the inadequacies of public services in dealing with foot and mouth or other emergency matters. We need to end that confusion. I will now do what other noble Lords have done and refer to things close to my heart. Clause 133, in Part 5, places a duty on PCTs ““to secure continuous improvement””. I have two concerns about that. First, that clause goes on to say that it is subject to the standards laid down by the Secretary of State. I am never really convinced that improvements in public services are produced by a command and control method. If we want to change the culture of an organisation, we have to encourage innovation, focus on individual needs and encourage localities to respond to their individual circumstances—rather than simply following the lead of the Secretary of State, which by its nature is bound to be generalised. Secondly, reflecting in the 1950s on his creation of the Health Service, Aneurin Bevan admitted that one of his mistakes was in removing the role of local authorities in health provision. I hope that my noble friend will have the opportunity to correct one of Nye Bevan’s mistakes by asking the Care Quality Commission to encourage pilots that will allow commissioning by a single, local agency—the local authority—rather than assuming that we need the duplication of PCTs and local authorities in all areas, which is a waste of resources. Finally, I remind noble Lords that in July last year, the Government produced the subnational review, which looked at developing a single, regional strategy for parts of England and improving the scrutiny of regional bodies. I think that while that review left it unsaid, Members of Parliament have assumed that health should be included in that scrutiny. Clearly, health has a major part to play in developing a strategy for a UK region. Its contribution to the economy and social welfare of its area means that it should be a major player in developing such a strategy. Can my noble friend give some encouragement that strategic health authorities could be involved with other regional bodies to develop that regional strategy and be subject to the scrutiny that Members of Parliament will wish to see applied to regional bodies? The Bill has missed an opportunity there. Given the time of night, I have tried to summarise what I was going to say. My noble friend needs to be in listening mode, not just during Second Reading but at the next stage of the Bill. We can improve this Bill to make something that will stand the test of time.