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Health and Social Care Bill

Were the noble Lord, Lord Lipsey, here, I would congratulate him on the excellence of his argument. I congratulate the noble Lord, Lord Low, on his behalf. I thought that he deployed some telling arguments—but then I would, because they are arguments that I have deployed at least twice before, and I think that the noble Earl, Lord Howe, has, too, as we sat through various bits of legislation setting up different health and social care legislators. Having said that, I think that I am in the happy position of being able to anticipate a lot of what the Minister will say to us in response. The arguments about the merger could be made at any time. There will never be a time when there is no change going on in the world of health and social care, so why do I think that those arguments are particularly strong now? I have two reasons. First, I share a feeling with the noble Baroness, Lady Wall, who has now twice expressed her impatience for change. When she does so, my immediate reaction is, ““Yes, but you are representing the acute healthcare sector””. I am sorry but, as someone who comes from the social care sector, that is how I feel and I am one of thousands of people who feel the same. People in social care are fearful that the lack of parity between acute healthcare and social care has not yet been sufficiently addressed. I am sorry to come back to it but that is the reality on the ground. The more telling arguments are not the ones that have already been made about the organisational change for the regulators, but those that say that what the regulator is to regulate is going through a period of unprecedented change. The noble Lord, Lord Darzi, is about to publish his review. I am sure that he will tell us that what the healthcare regulator has to do will not change substantially. That may be so, but immense change is taking place in social care. I shall mention just three things. The first is the implementation of the 2010 procurement directive, which will bring about a necessity for competition in all areas of public funding. That is why even money spent on what is known as Part B, relating to health and social care services, which so far have been exempt, will be open to increasing competition by 2010. If noble Lords care to look, they will find more and more tenders for all sorts of forms of social care. That is having a dramatic effect on providers and that will increasingly be the case for the next two years. The second major area is the extension of individual budgets and self-directed care, which will bring about a massive change in everything to do with care planning and the care workforce. Increasingly, social care will be delivered by informal carers who have been chosen by people given a budget with which to secure their care. Those carers will not have to be registered in any way. That is a massive change. I honestly think that the Government have underestimated the extent and pace of change in social care. The third thing is the Government’s announcement in the summer about long-term care, which, again, will have a huge effect on what happens in social care. Therefore, not only will we go through a period of disruption in the organisation of the regulator and regulation but there will be unprecedented change in the delivery of services. The noble Lord, Lord Lipsey, is not present, but I think that he was quite canny. In the light of those three changes on their own, never mind anything else, I think that it will be early 2013 before we begin to see anything like a settling down of provision. For that reason, I think that the noble Lord, Lord Lipsey, has gone further to the heart of all this than perhaps even he recognised.