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Health and Social Care Bill

I should like to think that this amendment or something very like it will commend itself to the Minister and that the arguments ably put forward by all the noble Baronesses will resonate strongly with him. Building a set of overarching objectives into this part of the Bill is, to my mind, tremendously important. There are various ways in which we can do that and there is no doubt that there is a discussion to be had on the precise detail of the objectives, but leaving the first part of the Bill as it is seems to me unacceptable if we want this new body to be a force for public good and to govern its own agenda rather than simply being a tool of the Department of Health or the Ministers of the day. Giving the commission some well defined objectives is part of the buttressing that we need to create to enable it to have independence from Ministers. The less specific the Bill is on what the commission is expected to be and to do, the more scope there is for the sponsoring department to influence its activities. The other key point was well made by the noble Baroness, Lady Barker. This will not just be a body that registers people, reviews what they do and then reports back. If it works as it should, it will be one of the positive influences that we can look to in the system to ensure that standards of care across the piece are maintained and improved in accordance with the kind of values that the amendment articulates. The present improvement duties set out in Clause 2 are quite vague, whereas the duties under which CSCI currently operates are much more specific. CSCI will say that that is helpful, as it enables it to be more focused in what it does and more consistent in the decisions that it takes and to be and feel more legitimate when exercising its powers. If we are clear about what the commission is for, I think that we are being fair to everyone. We are being fair to those on the receiving end of regulation who are in a better position to know what to expect and why; we are being fair to the commission, which will have a better sense of direction from the outset; and we are being fair to ourselves as legislators, because we will be able to hold the commission more accountable than we might otherwise be able to. I understand the point made by the noble Lord, Lord Darzi, at Second Reading—that we want a regulator capable of adapting to changes in the delivery of health and social care over time. We do not want to come back to the Moses Room after five years to invent yet another sort of regulator, merely as a result of having been too prescriptive about this one. But I do not think that we are talking about being prescriptive here. The values set out in the amendment are manifestly enduring. They should apply, whatever the manner in which care is delivered or received, so I do not think that we need to fear that the amendment would create a hostage to fortune in the way that some might suggest. Indeed, if that were so, one would have to ask why other regulators established by primary legislation in recent years have been given this kind of directional underpinning. There are good precedents. Ofcom has been mentioned and has an overarching principle duty, and below that a set of specific statutory objectives that it is required to secure, such as plurality of providers and the protection of the public. In fulfilling its principle duty, Ofcom must have regard to an array of detailed aims—for example, the desirability of promoting competition, encouraging innovation, taking account of the interests and needs of different people, taking account of the needs of the disabled and of other vulnerable members of society, and furthering the interests of consumers, including the need to have regard to choice and quality. While we may think that Ofcom is a different sort of beast from the Care Quality Commission, it operates to a set of aims and values that are directly analogous, if not identical, to the aims and values set out in the amendment. That should give us confidence. Sometimes, when regulators are created by statute, certain Acts of Parliament confer a general duty, not just on the regulator, but on the relevant part of the Bill as a whole. The Climate Change Bill does this, as does the Sustainable Communities Act 2007, which states in Section 1: "““The principal aim of this Act is to promote the sustainability of local communities””." That is the model followed in the amendment, although it takes the precedent of Ofcom and makes the overarching duty more detailed and specific. The thought that lies behind my Amendment No. 4 is similar; it applies a single principal objective to the commission. It is the same idea that was adopted for the Food Standards Agency. If that formulation were adopted, it would be possible to set out below it a series of detailed aims similar to those in Amendment No. 1 and require the commission to adhere to those aims in the fulfilment of its principal objective. Clearly there are various ways in which the end result could be achieved. I am not wedded to any one of them in particular, but we need to agree on one formula or another from the many available options.