---

Health and Social Care Bill

I am happy to acknowledge that. Forgive me for shorthanding my presentation. The noble Baroness’s point is obviously correct with regard to mental health, and I warmly embrace it. The Committee can see where I am going: I am arguing for specialisation in the commission. I would take no persuading at all that there needs to be specialisation in the regulation of services for those with mental health problems, and indeed a structure to reflect that. The noble Lord, Lord Lipsey, has acknowledged that in moving the amendment. The points in relation to mental health are going to have to be taken care of as we go through the Bill. Worries have been expressed that social care will be the poor relation of health in the new dispensation that the Bill seeks to set up. There are two grounds for feeling that those worries have some basis. First, there was the specification of the job in the advertisement for the chair that was put out, which no one has sought to deny focused predominantly on health. Then there are the priorities announced for the new body, the Care Quality Commission; the advertisement says that the first priority for the new commission will be dealing with healthcare-acquired infections. I am not seeking to say that that is not important, but saying that it is the first priority has certainly conveyed the impression in the social care world that concerns of social care are being downplayed and deprioritised in the way that the new body is being conceived. Worries have been expressed not just by CSCI but widely across the voluntary sector. Several significant voluntary organisations, including Carers UK, Help the Aged, Age Concern, Mind, Mencap, RADAR and the Alzheimer’s Society, wrote a letter to the Guardian. I cannot think why the RNIB was not there, but then perhaps I would have had to declare an interest. This impressive raft of organisations expressed their serious concern, saying that: "““The new commission must take full account of the particular perspectives of social care in this country, putting human rights values and the views and experiences of people who use these vital public services (all of us, at one time or another) at the centre of its activities. Otherwise, as currently drafted, this bill runs the risk of moving the health and social care sector backwards by setting up a regulator that works to yesterday’s policy agenda, to the detriment of all those who use such services””." Those points were made forcefully in the debates on the Bill in another place that preceded the debates in this House. The Minister of Health acknowledged their force when he said, "““Social care must have parity in the new commission. That must be reflected on the board of the new commission and in everything that the commission does … That point will be emphasised throughout the passage of the Bill””.—[Official Report, Commons, 26/11/2007; col. 37.]" My contention is that it has not been emphasised. The Bill, in relation to the structures that have been put in place to reflect parity between health and social care, has not altered in one particular. Amendment No. 25 seeks to do that. I have no problem whatever in embracing Amendment No. 93, tabled by my noble friend Lady Meacher, as well. These amendments seek to put new structures in place to reflect fully the parity of importance which the Minister himself has acknowledged needs to be given to social care. CSCI is on record as saying that it would like a social care commissioner on the board, but it is a contention of the noble Lord, Lord Lipsey, and myself that that is not enough. We must all have had the experience of being a lone representative of some constituency or other on a board of anywhere between 10 and 20 people. You are a lone voice. It is very difficult to get your point of view across in a mindset which may come from somewhere completely alien, let alone succeed in winning the points that you are trying to make. It is our contention that we need a commission, not just a commissioner. Of course, there should be a social care commissioner on the board and a commissioner with responsibility for mental health as well, no doubt. Commissioners on the board should be able to reflect the views and the expertise of the sub-commissions. If such commissioners on the board are to be able to operate effectively, it is essential that they have the support of their commission. That will give them the added weight that they will need and it will guarantee that the board will have to take account of the perspectives being generated by the sub-commissions. If you are a lone commissioner on a larger body, you can have your say, but it is all too easy for the rest of the commissioners to pass on it. If there is a sub-commission, it will have minutes; it will put papers to the main commission; and account will have to be taken of them—they cannot just be passed over. That is the case for a commission and not just a commissioner. My noble friend Lady Meacher has mentioned the danger of working in silos. That point has been made a number of times in our debates already, but I am not worried about that. Of course, the social care commission would be working in a silo if it did all the work of the regulator in relation to social care, but that is not how I see it functioning at all. The commission would report to the main board, which would have responsibility, not just for taking account of and implementing the views generated by the commission, but for taking an overview and integrating the perspectives of the different sub-commissions. I do not entertain any worry about silos, but the arguments advanced for having a commission, and for saying that a lone commissioner is not enough, are overwhelming. I support the amendment.