---

Health and Social Care Bill

I, too, support the amendment. Indeed, the noble Lord, Lord Lipsey, gave me advance warning that he might have to duck out of the debate prematurely and he asked me whether I would listen carefully to what the Minister had to say and respond afterwards. I shall do that. As I imagine that he will probably have left before I sit down, I join everyone else in wishing him many happy returns. I hope that he has a good party this evening. As I suspect is the case with the noble Lord, Lord Ramsbotham, who has just spoken, I am against this merger, as I made clear at Second Reading. I do not think that a merger of these commissions makes very much sense and most of the arguments suggest that it should not proceed. For example, bringing services together does not necessarily mean that you should bring the regulators together. As has often been said, the sectors being regulated are very different and different models of regulation from one to the other may well be appropriate. The merger will be very costly and the savings looked for have largely been made already—fully by the Healthcare Commission, and CSCI is well on the way to achieving the savings that the Treasury has asked of it. The arguments that have often been deployed suggest that we should not go ahead with the merger. No doubt these arguments will feature again as the Committee goes further through the Bill. However, at the moment we are talking about postponing the merger and I shall confine myself to considerations that suggest it should be delayed, which is what the amendment seeks. Both CSCI and the Healthcare Commission say that from their point of view the merger is premature. If that is the case and that point is taken, the very least one should seek to do is to delay the implementation of the merger, which has all kinds of undesirable features. I would deploy three arguments for a postponement of the kind sought by the amendment. First, as has been pointed out by other noble Lords, this is the third shake-up of social care inspection since 2002. Inevitably this will be disruptive and undermine continuity in the regulation of these sectors. As Sir Ian Kennedy said in the statement that he issued to the Public Bill Committee in another place: "““We will see a period of flux. Senior staff will need to be recruited and then appoint others. Managers will be organising awaydays and be locked in meetings over organisational design and conditions of employment instead of meeting the accelerating demands and expectation of patients. Morale in existing organisations will be increasingly hard to sustain. Good members of staff are already leaving, taking with them knowledge that it has taken three years to develop. This huge distraction from the central mission of the regulator to encourage improvement in care, with particular emphasis on quality and safety, is likely to continue for some time. Academic research on structural reform and our own experience in establishing the Healthcare Commission suggest that it will take at least two years for the new organisation to become operationally effective. This loss of momentum will be even more exacerbated if the new organisation, for reasons which are understandable, decides to return to first principles in designing its regulatory approach””." Someone else described returning to first principles as reinventing the wheel. All that sits uncomfortably, says Sir Ian, with an urgent desire for stronger regulation and safer healthcare, as expressed in a number of speeches by the Prime Minister and the Secretary of State for Health. It seems more likely that the policy will, at a critical moment, set back the development of the culture of safety. My second reason for seeking a postponement is that other models to achieve the desirable end of bringing together the regulation of health and social care while avoiding the cost and distraction of new legislation have been advanced but have not been adequately explored. For example, the health and social care sectors are significantly different, so different models of regulation may very well remain appropriate, despite the new legislation. None of that seems to me to have been gone into adequately. At Second Reading, I referred to the National Audit Office guidance on mergers of public sector bodies. I then asked the Minister whether any of the injunctions which the National Audit Office has given to those undertaking such mergers have been complied with in promoting such measures. For instance, have the Government followed the recommendations of the National Audit Office when considering the merger of regulators? Have they undertaken due diligence, cost-benefit or risk analysis, and have they established measurable success criteria for the merger? It would be very reassuring to have the Minister's assurance on those points. Finally, in February 2005, a Department of Health review concluded that the health and social care inspectorate fledgling organisations needed time to establish themselves independently. Indeed, the review of the noble Lord, Lord Darzi, is proceeding at the moment. It seems that every other health reform except this one has been put on hold pending the conclusion of his review. Why the exception in this case? In summary, merger at this time will be very disruptive when the current inspection regimes are still bedding in. They need more time to establish themselves.