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Health and Social Care Bill

I shall speak to Amendment No. 93 in this group which requires the Care Quality Commission to establish a sub-committee known as the mental health sub-committee. This sub-committee would be responsible for advising the commission about the exercise of the commission’s functions with respect to mental health services. Why do we need to single out mental health in this way? First, patients detained under the Mental Health Act or the Mental Capacity Act who are subject to community treatment orders are likely to be less able to defend themselves than, perhaps, any other patients whose services will be the subject of regulation by the CQC. If you do not have your full mental capacities, you really are in a completely different situation from anyone else. I fully recognise that people with a range of disabilities and problems have their own vulnerabilities, but this is different. Secondly, these patients are likely to be less able to understand whether or not services are being properly provided to them and, if not, to what extent. They may not even realise what is going on. Thirdly, these patients are not at liberty to change their service provider or opt out of the patient role. As I said previously in relation to another amendment, in a real sense they are prisoners in their environment in a quite different way from most other patients, although I recognise that some other patients may feel somewhat imprisoned. If we take three examples the point can be readily illustrated. For example, how can a dementia patient who is not being adequately fed or cared for in a nursing home deal with that situation proactively? The same can be asked about an acutely ill psychotic patient on a locked ward who has an adverse reaction to medication and can hardly remain conscious; and about an acutely depressed service user under a community treatment order whose medication is so ineffective that they become suicidal. None of those people would be in a position to pursue concerns in a proactive way, as they would need to do with a normal regulatory regime. The Mental Health Act Commission rightly operates entirely differently from the other two inspectorates. It relies in a unique way upon visits to individual detained patients to check that services are being properly provided under the law. But the new regulator will also need to consider safeguarding those patients who, from 1 October 2008, will be subject to community treatment orders. There is a whole raft of new challenges that have not been faced previously. Also the new provisions of the Mental Capacity Act are another raft of new requirements and demands. How on earth are the interests and needs of these different groups of very vulnerable people to be assessed alongside all the other regulatory responsibilities of health and social care providers? They will need to be dealt with in an entirely different way. The Healthcare Commission adopted an efficient self-assessment system with visits limited to trusts that are not coming up to scratch and a number of others chosen on a random basis. But this process simply will not be suitable for mental health. One of the benefits of the unified CQC regulator will be the streamlining of the work of the three organisations, as appropriate, and the reduction of bureaucracy. As Members of the Committee know, I am one of those who feels that, in relation to health, the weight of all these regulators, plus that of about 50 others, has been pretty disastrous and incredibly time and resource-wasting. There will be potential for streamlining in health and social care. For any individual patients, health and social care are increasingly intertwined, certainly in my world. People move all the time between health and social care and back again, and at any one time they can be using both. An important role for the new regulator will be the monitoring and inspection of care pathways across and between health and social care. That is one of the reasons why in the future there will be a great potential benefit in bringing these areas together. That is the main reason why I do not support Amendment No. 25. There will be a value in bringing these areas together. You do not want to create silos where the potential benefits of the regulator will not be experienced. I am not arguing that all three parts of the new body should simply carry on as before; that would make nonsense of the reform. Equally, though, it will be important to be sensitive to the fact that the three existing bodies are dealing with very different issues and very different people, as well as different environments, from hospitals to domestic homes to individuals in the community. Only through something like an expert mental health sub-committee will the new body find the right balance between the integration of functions and adequate protection for people with severe and enduring mental health problems whether they are in the community or in hospitals. The expert committee could make skilled judgments about the extent to which it would be reasonable to adopt a more selective approach to visiting detained patients, those in the community and those under the Mental Capacity Act. It would be dangerous for those sorts of decisions to be made by a general commission comprised of people with very different kinds of experience but not a depth of professional knowledge about mental health. It is worth reiterating that we have a precedent for this approach in the Equality Act 2006, which included provision for a disability committee within the Commission for Equality and Human Rights. The committee was included in the Bill to ensure that the EHRT was able to respond effectively to the distinctiveness of disability without that specific perspective affecting its ability to deliver other strands of its remit. I hope that the Minister will recognise that there is a similar case for a mental health sub-committee within the new Care Quality Commission.