---

Health and Social Care Bill

I add my strong support to Amendment No. 1, to which I have added my name. Clear objectives are probably more important for this body than for almost any other one can think of. As the noble Baroness, Lady Barker, said, the CQC will have to regulate tens of thousands of little businesses, along with very large hospitals. I do not think that we underestimate the enormous challenge that this will present to the organisation. Inevitably, the CQC will prioritise its work. It will probably focus very strongly, initially, on certain areas of work, but it is crucial that neither the CQC nor Parliament ever loses sight of the full breadth of the work that it needs to do. Will the Minister confirm the Government’s support for all the objectives set out in the amendment? There is the objective of promoting public interest and the interests of users and carers and for users’ choice. I recognise the point made by the noble Baroness, Lady Finlay, that inevitably there are types of treatment where choice is impossible. If somebody needs a top security place in Broadmoor, one obviously cannot offer them the choice of going to the hospital down the road. The objective of choice is fundamentally important, although I am not sure whether it really needs to be adjusted to allow for that. Then there are the objectives of promoting children’s health, of safety, high-quality care, dignity, welfare, independence, the rights of detained patients, social care and public health. I do not believe that any of us could disagree with any one of them, but for the CQC to deliver all of them will be a massive challenge—there is no question about that. For Parliament to keep an eye on all those objectives, it needs to have them in the Bill. I hear rumours that the Government want the CQC to concentrate on the most basic safety and care standards to have a single set of standards that can be met by the multitude of independent and voluntary sector provisions and the little, tiny homes, as already referred to. That is a very long way from the excellent work being done by Monitor and the Healthcare Commission with trusts to achieve a gold standard of care. Are the Government committed to ensuring that the CQC works with Monitor to take the gold standard agenda forward along with all its other responsibilities? One could lose all that so easily. That is a very alarming thought for people on the front line, as it would be for patients and service users if they were aware of that danger. It would be an appalling catastrophe for the health service. We need to know whether the Government are committed to this gold standard agenda or whether the rumours are correct. Is the Government’s primary concern to go along at this low level, achieving a basic standard across the very wide area of provision in social care and healthcare? It is not clear to me that in that case the CQC would have any relevance to most health trusts or any NHS trust and certainly not to foundation trusts, because most of them are way above that level of care and safety. In fact, I am sure that the Government will want the CQC to be ambitious in raising standards. If that is so, I am sure that the Minister will agree with the words of Sir David Clementi which have already been quoted by the noble Baroness, Lady Barker, in relation to the Legal Services Board. As we heard, he underlined the absolute primacy of objectives in setting out to establish a regulatory body. Not surprisingly, many other regulatory bodies have sets of objectives defined in statute: Ofsted, the Food Standards Agency, the Financial Services Authority and Ofcom. Having the objectives in the Bill lets us all know the modus operandi of the organisation. It is clear and transparent but most importantly it enables Parliament to monitor and care for the delivery of those objectives and ensure their fulfilment. The alternative approach in Amendment No. 4 in the name of the noble Earl, Lord Howe, provides, as I understand it, a single focus on the interests of service users and their families and carers. There is of course much to commend in that clarity. However, in view of the considerable risk—I emphasise that it is considerable—that areas of work will be lost by this huge organisation, there is great merit in a fuller statement of regulatory objectives in this context. I hope that the Minister will recognise the strength of the arguments in this case.