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Health and Social Care Bill

My noble friend and I have amendments in this group, Amendments Nos. 77 to 81, 103ZA and 107, which refer to Clauses 42, 43 and 57. All of them concern periodic reviews and inspections. Reviews have been an important tool for both the Healthcare Commission and CSCI. They have proved to be an effective way of improving standards and quality of services. These two regulators, because of their different remits and markets in which they operate, have fashioned different ways of inspecting and reviewing. The Healthcare Commission has a lot of detailed information, gained through the different reporting mechanisms in the NHS, with which to monitor performance. It not only reviews and publishes but returns to ensure that its recommendations bear fruit. In the foreword to its report, Learning from Investigations, Professor Sir Bruce Keogh wrote: "““I served as a member of the Healthcare Commission for the years covered by this report and know very well the benefit of the powers given to it by Parliament to carry out investigations on behalf of patients. Early interventions and the identification of root causes are the best way to ensure improvement. But the use of an independent and authoritative voice to highlight problems and suggest improvements also means that lessons are learned quickly and on a wide scale, whether they relate to the safety of maternity services, the support and care provided to people with learning disabilities or the management of infection in our hospitals””." Professor Keogh concludes his foreword by saying: "““This report makes clear why it is in the interests of patients and the public to have a strong, independent, regulator—one that is empowered to decide when investigation is needed, undertake its work in a robust and professional manner, and publish its findings and recommendations for improvement””." Sir Bruce is, of course, the medical director for the whole of the NHS. We could n have a more authoritative voice on the necessity for the regulator to be independent. The Government would do well to listen to their own doctor. CSCI’s approach is different from that of the Healthcare Commission, in that it has a paucity of detailed information because it is regulating a wholly different service which is largely privately provided. Its approach has been to theme its reviews. Time to Care? was the first ever comprehensive review of the state of domiciliary care services. It highlighted problems for those receiving care, delivered in just 15-minute slots. A Fair Contract with Older People? brought the nation’s attention to the raw deal experienced by self-funders. State of Social Care in England 2006-07, published in January, highlighted the poor quality of life experienced by people excluded from services by the impact of rising eligibility thresholds set by councils. As a result, the Minister, Ivan Lewis, commissioned CSCI to conduct a review of the eligibility system and its impact on people, and to recommend changes. The review is due by September this year. I am sure that this piece of work will be trusted, because it is being carried out unfettered and independent of the department. One of the core qualities to engender and maintain trust in an organisation is for that organisation to be open, transparent, and honest. The opposition to Part 1 of this Bill and the changes that it proposes is due to the fact that all three regulators have been so successful in engendering trust. Their hallmark has been integrity and honesty. They bring to the attention of the Government and the nation, through independent reviews and inspections, the shortcomings and the concerns in certain services or institutions. They are to be trusted. We want our regulator to keep a watchful eye and, without fear or favour, speak out when matters go awry. If it is known that the Secretary of State is meddling in these affairs, the CQC will simply be seen as a poodle of government; it will not be respected or believed. Before a review is undertaken, the regulator must decide what indicators of quality will be used as the benchmark against which services are to be judged. That is only fair and proper for those being regulated. The indicators are entirely a matter for the regulators. They know the business; after all it is their business, and not the business of the Secretary of State, some erstwhile politician here today and gone tomorrow. I am not being disparaging, but it is a fact well recognised; there is nothing in the present legislation to state that quality indicators are the province of anybody other than the regulator. I am surprised that, through this Bill, by changing what is in current legislation, the Secretary of State should want to interfere and fetter the freedom of the new CQC. Action on Elder Abuse only a day or two ago welcomed CSCI's introduction of quality ratings for care providers. Through this work we are made aware that around 70 per cent of all registered providers have achieved an excellent 3-star or a good 2-star rating. We should rejoice in that. Only 3 per cent of all 24,370 providers fall into the poor category. They clearly need attention. The rest, 24 per cent, are adequate, with the remainder being either new services that have not yet been given a rating, or services that are subject to enforcement action by CSCI. Commenting on the new scheme, Gary FitzGerald, chief executive of Action on Elder Abuse said, "““We very much welcome the introduction of Quality Ratings for Care Providers as a concrete example of empowering older people and their families when making difficult and life changing decisions about care””." He continued: "““We commend CSCI for this initiative. We now expect local authorities to use Quality Ratings to inform their commissioning processes and drive out services that tolerate poor practice and abuse. We will certainly be questioning those local authorities who consistently commission services from poor providers of care. Older people who use and depend on these services deserve nothing less””." So here is an organisation which is going to use CSCI's work to improve standards. It clearly trusts the independent information provided and is being helpful to the Government. We are surely all at one in wanting the highest standards and the greatest love, care, and attention when we and our friends and relations are at our most vulnerable. However, we strongly disagree with the Government on the erosion of trust caused by the Secretary of State in devising the indicators—Clause 42—and, in Clause 43, approving the frequency and period to which reviews relate, preventing the commission revising reviews without the Secretary of State's permission and, worse, giving a power to the Secretary of State to modify reviews. That is meddling—big time. Where is the independence when the Secretary of State modifies a review to suit his needs because the results are uncomfortable, or a general election or a by-election is on the horizon, or the Prime Minister is in personal difficulty? Why should we trust the new regulator if we know that the review has been modified to suit the Government's needs and that a spin has been placed on it? I hope that the Minister will recognise that Clause 42(4) and (8)(a), and Clause 43(1)(b), (3) and (4) do no favours for the Government and that she will agree to our amendments which are simple in the extreme. All that is needed is a little red marker pen to strike a few words out of the Bill, thus giving the CQC the credibility which it will need. Amendment No. 103ZA is slightly different. In Clause 57 the regulations—the Secretary of State, not the CQC—may prescribe the frequency of inspections prior to registration, the manner in which they are to be carried out and the type of person who is authorised to conduct them. Again, this is serious interference and is not in current legislation. Why does the Secretary of State want to be involved in the detailed operation of the day-to-day running of the commission's business? I should have thought he already has enough to do. Is he really going to say who should be undertaking the inspection? Will he decide what professional qualifications are necessary? If so, there is a very real danger that the experts by experience, who are so valuable in the current CSCI system, would be ruled out of order. Earlier, we debated the vulnerability of elderly people in relation to the complaints procedure. It is often the experts by experience who can detect what is wrong and report it on behalf of the individual concerned. If the Government wish to stipulate by whom and how inspections prior to registration should be carried out, there is hardly any need for this Bill. It could be done through a contract with the Department of Health. However, I do not believe that is what the Government want. I believe they want a successful Care Quality Commission that is respected and trusted throughout the land. On this clause, all the Government have to do is to amend subsection (1) to read, ““The Commission shall determine””, rather than the present wording which is, ““Regulations may prescribe””. I hope that the Minister agrees that is a splendid idea and that it fulfils the Government's desire for an independent regulator.