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Health and Social Care Bill

With the amendment, the noble Lord, Lord Lipsey, has taken us to the heart of an issue which was never far below the surface of our debates at Second Reading—the issue of timing. I believe, as does my party, that there are sound practical and policy reasons for wanting to bring the regulation of health and social care closer together and that a combined regulator makes sense as a matter of principle. I can see that not all noble Lords are necessarily signed up to the principle but, if the principle is accepted, the next question has to be about the practicalities. It is on that issue that we have not yet had a convincing set of answers from the Government. The purpose of having a regulator of health and social care is, above all, to protect patients and service users from harm. There are all kinds of other good and worthy reasons but it is as quality watchdogs that the Healthcare Commission and CSCI ultimately justify their existence. Abolishing two regulators that are already up and running and creating a new regulator in their place is inevitably a recipe for disruption in the way that services are monitored. You can plan to implement the new set-up in the smoothest way imaginable, but with staff recruitment, organisational design and general setting up, some hiatus between one regime and the next is unavoidable. With that hiatus comes an enhanced risk to patients and service users because managers and employees, as the noble Lord, Lord Lipsey, rightly said, will have their minds on matters other than their core tasks. That is the dilemma faced by Ministers in rolling out the policy they have embarked upon. Or at least it should have been. Like the noble Baroness, Lady Howarth, I am not aware that the practical implications of accomplishing this merger have ever assumed much salience in ministerial in-trays, and certainly not in ministerial public pronouncements. Any sensible person must agree that the merger needs to be carried out in a way that is least risky and least disruptive to those concerned. Fixing next April as the date when the CQC begins its operational life presents, in my opinion, a hugely ambitious timescale and a hugely risky one. If you talk to the Healthcare Commission and CSCI, they will both tell you the same thing—that they are young organisations and that it is only now that the new systems of regulation that they have put in place are beginning to bite and have real effect. Both bodies have restructured themselves and have made substantial budgetary savings in the process. CSCI is even now in the middle of further rationalisation involving staff cuts and closure of offices, quite independently of the coming merger. CSCI has modernised its way of working and put in place an estates and IT strategy fit to carry it into the future. Of course, that restructuring has not been without pain; staff numbers will be 38 per cent lower in March 2009 than they were two years ago. So it is not surprising that the prospect of making significant financial savings, which is one of the supposed benefits of merging the two regulators, is hardly now a factor, as the noble Lord, Lord Low, said. CSCI has identified a merger dividend of only £5.25 million a year, which, set against the estimated costs of the merger—about £140 million—is not large. Another reason for the merger cited by Ministers is the need to have a regulator with stronger powers. If you talk to the Healthcare Commission or CSCI, neither of them would say that they need stronger powers. What they need is to be able to maintain the momentum that they have so successfully generated. That prospect is apparently to be denied them. For a period of two years, we will lose the benefit of the Healthcare Commission’s work on areas such as maternity services, the care of those with learning disabilities and infection control—to cite the examples given by Sir Ian Kennedy. We have heard much of what Sir Ian said already, but in giving evidence in another place he went so far as to say that the rationale of the Bill remained ““at best unclear””. Coming from him, that statement should set alarm bells ringing. If the noble Lord, Lord Lipsey, were to press me, I would have to express some hesitation about going quite as far as his amendment goes in postponing implementation by four years. He perhaps needs to go a little further to demonstrate why four years would be an appropriate delay. However, I might well join him on Report if he proposed a slightly shorter delay—a period sufficient for both the Healthcare Commission and CSCI to work together more closely than they do at the moment and sufficient for them to be confident of handing over their respective going concerns in a shape that could be taken forward more coherently than they can now. This is one of the most important questions that we will need to decide, and I only hope that the Minister is in listening mode.