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Health and Social Care Bill

moved Amendment No. 82: 82: Clause 44, page 21, line 33, leave out subsection (1) and insert— ““(1) The Commission has the function of carrying out special reviews or investigations, and must carry out any specific review or investigation requested by the Secretary of State.”” The noble Baroness said: I shall speak also to Amendments Nos. 83, 87, 89 and 101A. Once more I shall try to convey to the Minister the scope of social care which this new body is going to have to regulate, not just in terms of the number of providers but in terms of the differences between client groups. I refer to the needs of people with learning disabilities, older people and those with mental health problems. This is an enormous, disparate and complex set of objectives to meet. If the legislation goes through, one regulator will have to suffice. In this set of amendments we seek to translate to the new body something which has worked effectively for CSCI, and that is the commissioning and production of special reviews. CSCI plays a uniquely strategic role in social care. It is one of the few bodies that gets to draw comparisons between different providers working in different sectors. I am not sure whether it is possible to convey this to noble Lords, but my sense is that in the NHS, people have a clear understanding of what is going on with other providers of healthcare. That is not the case in social care. Some service providers are very small and have little connection even with other providers in their own locality. Indeed, I have yet to come across a PCT that can produce a totally comprehensive list of the social care provision in its own area, a list that takes into account all the small and voluntary providers operating in the area. What CSCI does in relation to regulated services has been uniquely important to the scope and depth of its reports. These amendments would require the new regulator to carry on with the function of commissioning and conducting special reviews. Special reviews have become a method of addressing issues which, although serious, often go unnoticed. The noble Baroness, Lady Cumberlege, referred to a number of its reports, one of the most effective of which was published earlier this year. It demonstrated what people in social care felt was the case, but often could not prove: by and large, local authorities are commissioning care solely for people who are in acute need. Basically, they are not commissioning for those in any of the other four categories in their access to care services criteria. It was a tremendously important piece of work. Through its special reviews, CSCI has not only set out the scope of what is going on, but has assisted in developing evidence-based social care, which is an extraordinarily difficult thing to do. It requires the establishment of data gathering over long periods, and CSCI has begun to do this work. Under the Bill, the commissioning and production of special reviews is to be reduced to a ““power””: that is, it is something which the commission has the power to do but is not required to do. My amendments, particularly Amendment No. 101A, would change that power into a function. The noble Lord, Lord Darzi, and I had an interesting debate on the first day of our proceedings on the meaning of ““functions”” and ““objectives””, but for the moment I accept that the Bill gives the Care Quality Commission functions as opposed to objectives. Given that, the amendment provides that the production of special reviews should be a function. In addition, the amendments make it clear that whoever is calling the tune on deciding the quality measures for outcomes, the commission will be able to commission its own special reviews and will not be confined solely to matters deemed to be important by the Secretary of State. Moreover, under Amendment No. 83 it will have the resources to enable it to do that. Having commissioned those reviews, it will have the power to make recommendations to the Secretary of State. Whatever one’s view of the preceding group of amendments, the noble Baroness, Lady Howarth, was right to point out that what CSCI knows uniquely in relation to providers should enable it to make recommendations to the Secretary of State. I beg to move.