---

Health and Social Care Bill

There are all kinds of areas that we could cover in debating clause stand part, but we have already spent a great deal of time on this clause and I do not intend to delay the Committee. However, I should like to take a minute or two to bring us back to first principles and to look once more at the proposed functions of the new commission. I take my cue from the remarks of the noble Lord, Lord Ramsbotham, in our debate on 21 April, when he said, "““I am extremely concerned at what has happened to CSCI, which has been split in two. Half is going under education, as the noble Baroness mentioned, and is in danger of being submerged there under the style of an inspection or audit carried out by Ofsted, while the elderly will remain with the Department of Health together with mental health, which is yet another different ""function. The loser in all this is social care—the care of children and the elderly, both of whom have mental health needs quite apart from any other needs””.—[Official Report, 21/4/08; cols. GC 223-4.]" The noble Lord’s question was a fundamental one, to which we did not receive a proper answer. What is the rationale for splitting CSCI into two and dividing its expertise, as the Government now intend? What makes the Government confident that that split of CSCI’s functions will not result in a net dilution of regulatory expertise and the loss of professional cohesion—the cohesion created precisely because the work of CSCI, before the hiving off of children's services, embraced the whole field of social care, not just one part of it? If the Government intend to bring the regulation of health and social care closer together on the basis that each will gain from the other by being better integrated, why, at the same time, destroy what is—or was—a successfully integrated organisation? One has to ask what expertise Ofsted has in children’s social care and exactly why Ministers think that Ofsted will add value to social care regulation. To me, the answer is not self-evident. There are already signs of strain in Ofsted in meeting the health and mental health care needs of children in care. The Children, Schools and Families Select Committee in another place has just been hearing evidence from the NSPCC and the British Association for Adoption and Fostering to that effect. Perhaps we need to remind ourselves that health and mental health represent new territory for the DCSF, the department to which Ofsted reports. It may be thought that I am raising matters of principle unnecessarily; I do not think that I am. Sparing his blushes, while he is not in his place, I should like to cite part of the speech of the noble Lord, Lord Warner, at Second Reading. He said: "““I should own up to being the Minister who conducted the arm’s-length bodies review which in 2004 recommended that the Healthcare Commission and CSCI should be merged, so it is not my noble friend Lord Darzi who noble Lords should blame””.—[Official Report, 25/3/08; col. 478.]" I always hesitate before correcting the noble Lord, Lord Warner, but I am sorry to say that on this occasion, unusually, his memory has let him down. The document published by the Department of Health on 22 July 2004 entitled Reconfiguring the Department of Health’s Arms Length Bodies contains no such proposal. There was no proposal in that document to merge CSCI with anything. Still less was there a proposal to split CSCI in two. The document proposed a merger of the Healthcare Commission with the Mental Health Act Commission. The splitting of CSCI was nowhere even hinted at. On the contrary, it was explicitly stated that social care would remain CSCI’s responsibility. I shall quote briefly from the document: "““The Commission for Social Care Inspection will continue to perform a parallel role in social care to that of the Healthcare Commission in health ... any merger with the Healthcare Commission at this time would be a distraction from the heavy agenda of both sides and would impact on the ability of both to regulate providers and thereby protect patients and service users””." The transfer of functions to Ofsted had nothing to do with the arm’s length review and had nothing to do with any failure on CSCI’s part. Noble Lords may remember that it had its genesis in the then Chancellor’s 2005 Budget speech, in which he announced the merger of 11 public service inspectorates into three: one for criminal justice, the proposal for which was defeated in this House; one for education; and one for health. In other words, we are considering drastic action affecting some of the most vulnerable people in the country not for efficiency reasons but, in the first instance, to cut costs. To be as charitable as I can be to the Government, I am the first to recognise that in the space of three or four years circumstances can change in a way that leads Ministers to take different decisions from the ones they first announced, but we need to be told why. We need to be told what the particular circumstances are underlying the decision to split CSCI into two and the reasons why such a split will not run the risk of weakening adult and children’s social services and, in the process, achieving the very thing that many noble Lords have said they fear—namely, the weakening of the voice that social care has at the board table of the CQC.