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Health and Social Care Bill

moved Amendment No. 5: 5: After Clause 1, insert the following new Clause— ““The Commission’s duty to report to Parliament on its proposed activities etc. (1) Before the start of each financial year the Commission must lay a report before Parliament on its proposed activities for that year, which must in particular report on the following matters— (a) the extent of the resources which it intends to commit to its functions in relation to the regulation of adult social care under this Act; (b) the extent of the resources which it intends to commit to its functions in relation to the regulation of healthcare under this Act; (c) the extent of the resources which it intends to commit to its functions in relation to people detained under the Mental Health Act 1983 (c. 20); (d) its general programme of activities; (e) the extent to which, in relation to its activities, it intends to involve and consult people who use health and adult social care services, their families and carers; and (f) the objectives which it intends to meet in— (i) the regulation of healthcare and adult social care; and (ii) the performance of its functions in relation to people detained under the Mental Health Act 1983. (2) Nothing in this section shall prevent the Commission, following its report to Parliament, from making such adjustments as it considers reasonable to the balance of its resources expended in each area of activity or to its general programme, consultation activities or in-year objectives as set out in sub-section (1). (3) But any adjustment made to a matter referred to in subsection (2) which the Commission considers to be substantial should be reported by it, with a reasoned explanation, to Parliament within one month of the adjustment being made.”” The noble Earl said: A consistent theme of our Second Reading debate, reprised several times today, was the fear that one area of the commission’s regulatory activities would assume an undue ascendancy over one or both of the others. In particular, the fear was that social care matters could in certain circumstances become the poor relation to healthcare within the commission’s programme of work. The underlying thought here is that the commission will be an organisation whose success in the public mind will be judged largely by reference to those areas of its remit which tend to assume a high public profile—in other words, health—and that, almost inevitably, resources will be sucked into that area of its work at the expense of others. There are various ways in which one could set about forestalling that possibility in the Bill. We will shortly debate an amendment designed to ensure that adult social care is properly represented on the board of commissioners. I happen to have great sympathy with that idea, not least because it is common sense. Later, we will debate an amendment in the name of the noble Lord, Lord Lipsey, which would create sub-commissions within the commission—one for health and mental health and the other for social care. I can see where the noble Lord is coming from in that amendment, although I am not sure that I shall be able to support him, as setting up sub-commissions would seem to me to encourage the commission to work in silos. That would not be particularly helpful in bringing the regulation of health and social care closer together, which is what many of us want to do. Setting that objection aside, neither of those ideas will necessarily ensure that the risk of the poor relation syndrome is diminished. By itself, having a commissioner with extensive previous experience of adult social care, sensible though that would be, would not prevent resources being sucked away from social care regulation and into health care regulation. In the end, what will matter is the spotlight of public accountability. The more transparent the workings of the commission, the more likely it will be that no area of its work will be unduly advantaged at the expense of another. The amendment proposes that accountability to Parliament would be a way in which to achieve this end—a system of reporting to Parliament not after the year end but before the year begins. At an appropriate moment, a Select Committee would receive the commission’s business plan for the coming year and within that plan the commission would set out exactly how it proposed to allocate its budget between its various activity streams. It would have to stand ready to justify that allocation. Public scrutiny would therefore become the main safeguard against the unfair skewing of resources that some fear. Adopting this idea would also provide a means whereby the influence exercised by the department and Ministers over the commission’s work programme would be healthily counterbalanced. The Minister may not be all that drawn to that idea. No doubt he will tell me that there will be a line of accountability between the commission and the Department of Health as the sponsoring department and that Ministers and officials are capable of keeping an eye on such concerns. I understand that argument but, again, I do not see departmental scrutiny in the same light as I do parliamentary scrutiny. Departmental scrutiny takes place behind closed doors and is not a process that exposes a public body to the transparent public questioning that is necessary if we are to avoid the kind of pitfalls that many fear. I hope that the Minister will understand the motivation behind the amendment; it is a genuine attempt to tackle the widely held concerns that have been expressed without being too prescriptive about how the commission structures itself or sets about its business. I beg to move.