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Health and Social Care Bill

I support the first amendment and will speak to Amendment No. 3, to which I have added my name. What are the objectives of the Bill? Are they to improve regulation or reduce the number of regulators or are they an attempt to improve services or save money? Perhaps there is an element of all those in the Bill, but there was a lot of confusion at Second Reading, when a number of contributors seemed to believe that by putting the Bill together we would improve services per se. That is not necessarily so. It takes a great deal more to do that, as we have seen in relation to local authority services and the difficulties that occur in providing a continuous service in housing benefits and care services. In its present form, the Bill does not do that. However, if we have a set of objectives in the Bill that give a direction and sense of purpose to the commission, that may help the commission to promote and move forward regulation that enhances services. That is what is behind the amendment: promoting those services might move us forward. I do not want to repeat what has been said, as the noble Earl, Lord Howe, has covered many of the points that I was going to make about comparisons with other organisations. For seven years, I was a member of the Food Standards Agency. Having an overarching principle driving us forward and being independent of government enabled us substantially to change the attitude to food in this country from one of total suspicion to one of acceptance, involvement and understanding. Because social care has many of the same elements, as does healthcare generally, in arousing the suspicion of the general public, we need the same sort of drivers to provide enhancement and promote the public’s understanding of and engagement with those services. The one point that I want to emphasise—it was an issue raised by the noble Baroness, Lady Barker, and others—is the great fear among the consumers of social care services that this will reduce standards in social care and that the health service will devour the currently sparse resources for social care. One has only to look at areas of clinical service in which acute services work alongside community services. Usually it is the acute services that devour the finances and the community services have to make do and mend. As for preventive services, we now have excellent services for the prevention of cancer, with women being screened regularly. However, if you are an old person needing a home help, you have to be in dire circumstances to have any hope of anyone crossing your threshold to assess you, never mind give you a service. There may be a duty to assess but there is no duty to provide the service. That is a very strange anomaly, but there you are. As a clinician, you can be held responsible if you fail to diagnose and treat someone who has crossed your threshold, but the situation is very different in relation to social care, where you can die behind your front door for lack of a service. I can only repeat a point made by the Relatives and Residents Association, because those are the people whose voices should be heard. The association said: "““We are concerned that bringing together health and social care under a single regulatory system will mean that the interests of care homes residents and other users of social care services will be marginalised. We are concerned that lack of detail in the Bill””—" here it links into the two amendments— "““means the new regulatory body, the Care Quality Commission, will be left to determine the details of the regime it will put in place and that social care will be overlooked””." Time and again that concern arises. Why do I feel so strongly about this? During the passage of a previous Children Bill, when the inspectorate for children was amalgamated with Ofsted, I raised the issue of the need to ensure that children’s services and the focus on children were highly maintained. I am sure that in certain areas that has happened, but I have personal experience of Ofsted-type inspections that do not—as with the Commission for Social Care Inspection—look holistically at the whole situation but have a check-list that gives a score. That does not enhance the atmosphere in which people are cared for. I think that is what we are looking for. Sometimes—Denise Platt has been heard to say this—it does not matter how many rooms you have in a home; what matters is what the atmosphere and the care feel like to the residents. That leads me to my last point. Unless we have objectives and principles in the Bill and the power to promote those objectives, the voices of those who are in these services will not be properly heard. My experience is both in the delivery of social care and as a recipient, on behalf of some of my service users and myself, of healthcare. One’s voice in and usage of both services are very different. In healthcare I sometimes get to fill in a questionnaire about what it was like—and I might even be asked by my doctor whether I thought that something that had happened to me was good or bad—but in social care there is an attempt to involve the users fully, to hear their voices and to involve them in inspections. This is to ensure that lay people who have experienced the services can tell about it at first hand. Having these principles in the Bill and the power to pursue the objectives will help in that. I support the amendment.