---

Health and Social Care Bill

I find myself in difficulty at this moment. In principle, I would very much like to support Amendment No. 25, but I have some real difficulties with it. I shall take rather more moments than I have been doing to work through why. In my Second Reading speech I said that the rationalisation of regulation is not necessarily rational regulation. I say that again, because we must go back to the first principle that the Bill is deeply flawed in terms of its timing and thinking. However, we have the Bill and, in having it, we must move forward with it. One of the dangers we now face is that, in moving forward, we are trying to maintain the status quo rather than moving forward in a new way. To tackle one or two side issues before going on to where we need to be, I say to my noble friend Lady Murphy—this is a terrible thing, I have done it again. It is my noble friend Lady Meacher. They know that I am mad. I apologise to my noble friend. In her speech she talked about pathways of care, which are terribly important. Those pathways run through whole social strata. Young disabled people and young people with learning difficulties would certainly not consider going through those sorts of pathways of care, because they would consider themselves not sick but in need of other kinds of services. Just as people with mental illness do not see themselves as being in need of the same acute service, there are serious difficulties with some other groups. I therefore do not accept that mental health is unique. All the services have unique positions. Like the noble Lord, Lord Lipsey, and my noble friend Lord Low—and although they both begin with ““L”” I have managed to get it right—I think that we must have movement forward. If you are to look at the governance of this body—that is, good governance—you must be able to set it up in a way that allows it to move forward. The Bill is flawed because we have not had a more fundamental review of services. We have all of us become continually confused in this debate between service delivery and the regulation of services. We are not really talking about service delivery, but regulation. However, regulation must follow service delivery. If we had had that review, we would have been able to regulate for the 21st century. We are currently, to use my noble friend Lord Low’s phrase, going through yesterday’s policy agenda. With that review, we would have been able to look at services as they should be, and the pathways as they should be for all service users, and have them reformed. I have expressed time and again my huge concern that social care will get lost in health services. We have example after example of what is happening in social care now. Only yesterday, I was talking to a provider of large nursing home services who wished to provide those services as a home, a care facility, but perpetually found himself following health-based regulations. He almost felt that he should have a matron in a small hospital rather than a place where people who happened to be frail were being cared for. That is one example of the kind of issue that we will face if we do not ensure that social care has a fairly strong focus. I cannot support the amendment because, in terms of good governance, an organisation must be able to think through the structure that will meet the requirements. If we had clear objectives in the Bill—I go back to that—the governance would therefore follow them and there would be greater clarity in the balance between social care and healthcare. I am therefore deeply sorry that I cannot support the amendments.