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Health and Social Care Bill

I rise to speak to Amendment No. 27, which is complementary to Amendments Nos. 10 and 11, but goes a little further in placing a duty on the commission to involve service users, including their families and carers, in exercising its functions. The amendment makes it clear that the term ““involve”” encompasses the need to provide information about the exercise of its functions and to consult and involve service users, families and carers in the inspection of registered service providers. Although I accept the point made by the noble Baroness, Lady Barker, that we should not be too specific in the Bill, there are certain functions of the commission where it is so essential to involve service users that there is a strong case for being specific. The only other point in this amendment is that users should be involved in the process of special reviews. Again, I do not think that that will be done properly unless users are involved. The amendment is supported by the Royal College of Psychiatrists, the National Consumer Council, Which? and the Picker Institute. My motivation in tabling it lies in my experience of working very closely with users, families and carers in East London. The health service has for years paid lip service to user involvement. We had community health councils and PPIs, but I cannot recollect anything really different occurring because of consultation with those bodies. Only very recently have we on the front line taken this seriously. We are finding that the real involvement of service users is the fastest and most efficient way to find out what we are doing wrong and how to put it right. I have never known things coming so clearly through to board level about our problems and what we are doing to put them right as is happening now. At last, this is apparently a part of government thinking across wider areas of government policy and I am delighted to hear that. Things will improve faster than we imagine because of that commitment. Yet the Health and Social Care Bill makes no explicit reference, as I am sure other Members of the Committee will point out, to service users, their families and carers. The most important area as far as this is concerned is that of detaining patients in psychiatric hospitals, which I happen to know little about. The Mental Health Act Commission’s work will now be involved in the CQC. As the noble Earl, Lord Howe, mentioned, these patients have their rights taken away. They have treatment without their consent—about the most unpleasant thing, if you really put your mind to it, that can happen to anybody. They are told, ““You will have this injection. You don't want it but I can't be too concerned about that. You will have it””. Many of them are not allowed to leave the ward. They are de facto prisoners. That is a completely different set-up from the average health or social care person. I will not say any more about the Mental Health Act Commission. The noble Earl, Lord Howe, has spoken eloquently and I know that the noble Lord, Lord Patel, will also speak at length about that, so I simply want to refer to the Healthcare Commission having taken on board itself a degree of patient, service user and carer involvement. How else could it presume to monitor and assess patient focus? I know all too well that that is one of its core standards. I have just been reading our own response to the Healthcare Commission, which is all about patient focus. How can it do that work properly without user involvement? The Government may ask why we need this amendment if current regulators are doing quite a bit of this already. My response is that the Bill as it stands and government statements reveal confusion between listening to the views of the public on the one hand and involving people, users, carers and families in the provision of services on the other. It is a completely different thing. I acknowledge that the Government's response to the pre-legislative consultation in 2007 was encouraging, referring as it did to involving service users. But in response to continuing debate about this issue, the Minister proposed a government amendment producing the following wording in Clause 2: "““In performing its functions the Commission must have regard to—""(a) views expressed by or on behalf of members of the public about activities to which the functions relate””." I think I am right in saying that the words ““or on behalf of”” were added after deliberation on the Bill in the other place. The Minister in the other place then said: "““There will be a wide range of bodies with an interest in a particular issue or representing particular groups, and we want to ensure that the commission hears their views. For that reason, Government amendment No. 62 proposes to make it explicit that a duty to have regard to the views of the public includes views expressed by representative bodies on behalf of members of the public””.—[Official Report, Commons, 18/2/08; col. 77.]" Testing public views through organisations representing patients and service users is helpful, but it is not a substitute for involving the patients, service users and families in the process of regulation as proposed in this amendment. Clause 2(3)(a) simply does not deal with the issue that we are debating here. It goes some way, but it is a long way short. Looking at the history of the health service, I suggest that the Bill as currently drafted details what we have been doing for 40 years. We suggest that we have moved way beyond that, as other Members of the Committee have said. However, the regulator now needs to catch up with what other organisations are doing. I have also tabled Amendment No. 104. This amendment presents a more limited requirement for CQC inspection teams to include lay inspectors—families, carers, users—in their inspections. This is an alternative, more limited amendment and, in my view, it focuses on the crucial bit, which is the inspections. For me, the crucial point about Amendment No. 27 is that it spells out the absolutely key activities—not just one, but a few others—where service users, carers and families really need to be involved if they are to do a good job. I hope that the Minister will agree with the principle proposed here.