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Health and Social Care Bill

moved Amendment No. 15: 15: Clause 2, page 2, line 8, leave out paragraphs (a) and (b) and insert— ““(a) the need to engage with service users and members of the public through appropriate mechanisms and channels, about activities to which the functions relate, (b) the views and experiences of service users and members of the public in relation to such activities,”” The noble Baroness said: This afternoon we will debate groups of amendments that follow a theme. The theme for this amendment was to some extent set in the previous debate. My understanding was that in the previous group of amendments the Committee was considering the role of users in the governance of the commission. I believe that is important. Governance is about setting strategy and direction, not about management. However, the amendments in this group and in subsequent groups are about operational matters, which are also important. I live in a part of London where there are two large hospitals that people who need acute care go to. For some services, probably for most services, people can elect to go to one or the other. As we all know, probably the most elective of elective services is maternity services. I live in an area where there are women who will not set foot in one hospital and swear by the other one, but on the other side of where I live there are women who make the reverse judgment. I have no doubt that if one goes to the mothers and toddlers groups round where I live there are raging debates about the benefits or otherwise of those two hospitals, the basis of which is probably highly subjective. What members of the general public who are not engaged and have no need of those services think is probably based on nothing more than the opinion of the person to whom they last spoke. However, the opinions of users are very different and are formed on a wholly different basis. When we look at the wording of the Bill, it is important to state quite frankly that the Government are way behind the times. By not putting the views of users first, at the heart and above and beyond the views of the general public, they are way behind the thinking, particularly in the field of social care. Why is that? It is, at least in part, because of a point that I referred to at Second Reading, which is that people who need social care have very few rights in law. I suspect that by the time we are through with this legislation the only right that they will be left with will be the right to have information. They are certainly not going to have a right to have services. Particularly in the field of social care, the right of people to be involved at a very high level in decision-making about their personal care and about the management and strategy of services overall has gone on apace, and social care is way in advance of what happens in health. While what is in the Bill at the moment may be a giant leap forward for the NHS, it represents a massive leap backwards for social care. I am afraid that that is not acceptable. Why is this important? Apart from anything else, the diversity of users is important. People who use mental health services have vastly different experiences and needs from people who intermittently use some low-level social care services. Their views are wholly different from people who go through major acute trauma and receive high-level surgical services. There is also a distinction to be drawn between the needs of people with learning disabilities and, for example, older people. That is not a fashionable thing to say at the moment, not least because much of the underlying policy on development of social care services comes from the learning disability field. There is a range of different views to be taken into account. It is important that we should not be prescriptive in this legislation about how the commission should go about the business of user involvement. Indeed, I suspect that it would be misguided if we thought that if we were prescriptive about the involvement of any particular body the legislation we ended up writing would be relevant for more than two years—that is the average length of NHS and social care reorganisation. That is why my amendments are in some ways quite unspecific. They do not make suggestions about involving specific bodies, but simply say that there must be mechanisms that ensure that there is engagement with users and the public. In Amendment No. 108, I again pick the point made by myself and the noble Baroness, Lady Howarth, in our discussions last week about the fact that we remain convinced that a director of adult services must work within the commission to ensure that adult social care has the proper prominence it will need. That is why we have suggested in Amendment No. 108 that it is a duty to have that part of the commission’s work included in its annual report. If I were in the shoes of the noble Lord, Lord Darzi, I imagine that I would say that this is otiose. It has taken 40 years for user involvement to become an expectation in social care in any meaningful sense. However, it is not easy and certainly not cheap; it is a deliberate and expensive process. There remains a fear among many that, if it is not backed up in statute, it may simply become a passing phase and, when times get hard, become a luxury which hard-pressed professionals can simply dump. That is why it needs to be in legislation—although I accept that, in stating that it needs to happen, we cannot be overly prescriptive about how it happens. That is the basis of my amendment. I beg to move.