---

Health and Social Care Bill

I also congratulate my noble friend Lord Lipsey on his 60th birthday, despite his not being here. I hope he will get to his party tonight and will enjoy the evening. Amendment No. 2, as it is written, would delay the Care Quality Commission’s operational start for more than four years. It does not debate whether or not we should have the merger. I have listened carefully to my noble friend’s concerns that the creation of the new regulator is seen as one of a long line of changes. It might be helpful if I talked through the rationale behind those changes. As the Committee knows, we introduced independent assessment of the NHS back in 1999 by creating the Commission for Health Improvement to support the drive to improve quality in the NHS. Although it did that well, it was felt to duplicate or even overlap with aspects of the Audit Commission’s work and, later, the National Care Standards Commission’s regulation of independent healthcare providers. As a result, in 2004—and this brings me to my noble friend’s word ““re-reorganisation””—we created the Healthcare Commission, which enabled more sophisticated assessment of NHS providers and more independent information for patients in the annual health check, as it has been known so far. At that time, however, regulation of the NHS was still new and needed time to bed in, whereas the regulation of social care and independent healthcare was already well established. Improvements since then, such as the better integration of health and adult social care services and, as we have heard today, more choice for patients and service users, mean that the time is now right to bring the regulatory frameworks together for the benefit of those who use the services. We believe that the common framework will remove artificial barriers between the health and social care systems—that is certainly challenging my review at the moment—and will further encourage joint commissioning of health and social care services. Having one single regulator will be simpler for the public too, especially where people are using services from both systems, as is increasingly the case. The noble Baroness, Lady Barker, has eloquently described some of the future challenges in social care and some of the long-term conditions. I strongly believe that the sum of the two commissions is greater than its parts, which is the debate that we have been having today. There is reasonable evidence out there that more integration is better for patients, and a more integrated regulator will probably enhance the quality of integrated service provision. As we will address in detail in response to later amendments on the subject, there are also significant benefits to be gained from bringing the monitoring of functions under the Mental Health Act into a single organisation with health and social care regulation. These include stronger penalties and the fact that the commission will also now be able to take action to intervene where people who may not be subject to compulsory detention under the Mental Health Act are not being cared for appropriately. Given those benefits, let me offer some reassurance about the concerns expressed by my noble friend Lord Lipsey. We do not intend to implement the full registration system until April 2010, in order to ensure that there is sufficient time to establish the new system and for providers and commissioners to familiarise themselves with it. We will not be reinventing the wheel, either. Providers of social care and of private and voluntary health care have been subject to registration for a number of years, and they do it remarkably well. Both the department, in the development of secondary legislation, and the new commission, in developing the criteria, will build on the expertise of the existing commissions and the experience of the social care and private and voluntary healthcare sectors. The system should, and will, build on the Care Standards Act 2000 model to extend to all providers, including the NHS. As part of the transition to the new commission, we are working closely with the existing bodies to ensure business and human resources continuity. Let me address some of the other issues raised. The first is the eloquent contribution of the noble Lord, Lord Low, concerning the quote from Sir Ian Kennedy, who is a colleague for whom I have had tremendous admiration for what he has achieved to date with the Healthcare Commission. At the same time—probably in the same evidence-giving session on 8 January—we heard from Councillor David Rogers of the Local Government Association, who stated: "““Organisational change always causes some short-term disruption and some loss of focus for a short period. If any change is to be made, everything must be attempted to try to minimise that, but I think the long-term benefits outweigh it””." It is strongly emphasised that, as we are going through this change, we need to make it as constructive as possible. That was acknowledged by my noble friend Lady Wall. Earlier, the noble Baroness, Lady Cumberlege, made a point about the Imperial College NHS Trust, an organisation that I have worked in, which has just been through a merger of three separate organisations: two major NHS providers and a university. Ten years ago, you would have said that they were chalk and cheese. That organisation had to merge as quickly as possible in order to have the least disruption to its mission. Those who work in those organisations strongly believe that the sum of the parts is greater than the value of each of them. The noble Lord, Lord Low, also asked whether the Government have followed the National Audit Office guidance. The implementation team is fully versed in the study being carried out by the National Audit Office following the merger of various bodies to form Ofcom, and we are using it to inform work to establish the Care Quality Commission. The noble Lord, Lord Ramsbotham, also raised the issue of inspection and audit. Inspection is embedded in health and social care regulation. The current regulators, whether the Healthcare Commission or CSCI, both audit and carry out inspections. Some noble Lords, to whom I am very grateful, were also concerned about how establishing the new regulator would fit within the next stage review. I should like to make clear that the review will not lead to changes in the organisational structure of the NHS—I made that commitment in the interim report—but is there to build on reform so far and focuses on what should be the purpose of reform over the next decade: quality and safety, two words that we have used regularly today. The regulatory framework in the Bill is designed to be sufficiently flexible to allow that to happen, and I very much hope that the next stage review will be the vehicle by which we can address some of the concerns raised today. Given all the hard work and preparation that has already been done for the new commission, a delay could lead to confusion and an inevitable loss of momentum. It would greatly extend the period of uncertainty for the current commissioners’ staff. Delaying the implementation of the provision would also defer implementation of the enhancement to the function of monitoring of the Mental Health Act achieved by Schedule 3. The long-term benefits of the provision far outweigh the damage that a delay could cause at this stage. I hope that I have provided the Committee with enough reassurance that this is really the right time for my noble friend to feel able to withdraw his amendment.