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Health and Social Care Bill

moved Amendment No. 6: 6: Schedule 1, page 110, line 24, at end insert— ““( ) The Secretary of State must ensure that the Commission includes at least one member appointed under sub-paragraph (1)(b) who has comprehensive experience or knowledge of the provision of adult social care services in England. ( ) The Secretary of State must ensure that all members of the Commission are appointed on a non-executive basis.”” The noble Baroness said: I am sure that the Minister feels like he is facing yet another over of bowling on the same wicket, but in a slightly different style. Amendments Nos. 6 and 9 go back to the issue that we have talked about all afternoon; that is, ensuring appropriate representation of social care in the CQC. In the previous amendment, the noble Earl, Lord Howe, sought to attack the issue in a different way. Amendment No. 6 is predicated on the belief that it is people and the experience that they bring to an organisation, especially in its formative stages, that set the culture and priorities of that body. I return to the matter that I raised earlier: the advert for the chair of the CQC. It was evident from that advert that the social care was certainly not to be included with anything like the same status as healthcare. That has set many fears running throughout the world of social care. It is always difficult for the Opposition during debates on Bills such as this to argue at one and the same time that an organisation should be independent and that it should seek to make lots of representations about how it should be formed and what it should do. I think that it is legitimate to go as far as we do in the amendment, and probably not much further, in determining who ought to be the members of the commission, for the reasons that I have already outlined. It is inconceivable that the CQC could do its job effectively were it not to have in its membership someone with extensive experience of social care, local government and the history of the development of social care up to this point. I remind the Committee that the advert for the chair did not mention the need for the chair to have any experience of local government or the independent sector. There should also be a small governing body that consists of non-executives. It is quite clear from the advert published in March that the model used was that of a strategic health authority, because it took the health service model of having a mixed board of executives and non-executives. That is not standard practice in social care and does not reflect the governance structure of many of the bodies that the CQC will be regulating. Throughout social care, no matter what size the body, it is the norm for there to be a non-executive body—trustees, board members or whatever—to set the strategic direction of an organisation and provide a line of accountability. The body then employs executives to implement that. There are parallels. The Audit Commission, for example, has a board of commissioners. They set standards, strategy and objectives; they set the budget; they monitor performance; they are responsible in law for accountability; and they govern the actions of the body within its statutory remit. That governance model is appropriate to the body that we are setting up which, judging by the advert in last Wednesday’s Guardian, will have a very high-powered chief executive and executive staff below. I anticipate one argument that may be advanced by the Minister in his attempt to resist the amendment: why do we not then say that there ought to be members who represent the different strands of users within social care? That is unnecessary. It is entirely possible for someone who comes from a social care background to understand issues common across all social care groups. I do not believe that all social care needs are the same or that all client groups necessarily have the same priorities. I have worked for most of my life with older people and I understand that issues to do with them are distinct and different from issues to do with adults with physical or learning disabilities, and they are wholly different from those which apply to children. But those distinctions are of a different order from the distinction between healthcare and medical care, which are presaged on a separate basis of need and decision-making. It is therefore possible to have one member who comes from a social care background. Amendment No. 9 proposes that there should be a children and adult rights director. I simply refer the Committee to the earlier speech of the noble Lord, Lord Ramsbotham, in which he made much of my case for me. CSCI has done outstanding work over the past few years on children’s issues, but the majority of what it had to do with children has been taken off to Ofsted. Nevertheless, there remains a whole raft of social care issues relating to children and it is important that in this body there is someone with the expertise, knowledge and understanding to work on children’s issues. People who work in children’s issues have to maintain a separate set of relationships with, for example, schools, CAFCASS and adoption agencies; it is a different world to any other part of social care. The noble Lord, Lord Ramsbotham, made the case effectively when he mentioned the safeguarding of children work that is done by CSCI. To lose that—and there is a huge danger that it could be lost—would be a disaster. It is important that from the very beginning there is someone in this body who understands a rights-based approach to social care and who has the knowledge and the power to stand up to the sometimes powerful and overwhelming cases made by health and, in particular, acute health services for attention. We need people who, as they are in social care, have the experience and the wherewithal to sit within the body and to keep asking the questions which are difficult to answer, not least because they generally have a long lead-in and are difficult to measure within a short space of time. I fully expect members of the Committee to say that this will be too restrictive on the new commission. I do not believe it will be. In many ways the proposal is essential to the body doing its job properly and to it having the right amount of standing within the social care world, which it certainly does not have at the moment. I beg to move.