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Health and Social Care Bill

My Lords, I forecast that I would put my name to this amendment when we discussed the issue in Committee. I have listened to what has been said by the previous speakers on the question of delay. There are two reasons that worry me deeply about where we are. Neither of them, perhaps, arises straight from the Bill, but they are related to it. The first is the word ““inspection””, recently used by the noble Baroness, Lady Howarth. I reminded noble Lords in Committee that there are three separate functions involved in the role that we are discussing for the commission: regulation, audit and inspection. They are all needed and they are all different. The differences between them include the fact that it is proper for Ministers to be involved closely with both the regulation and audit of the structure and system. Ministers are involved in making the regulation in the first place, and in its performance as well. The audit will probably be of something that is ministerially ordained. However, inspection must be independent and objective if it is to be proper. It must not do anything to damage its objectivity in the eyes both of those being inspected and of the public, to whom reports are made. What worries me about the establishment of the commission is that independence of that kind—the reporting of facts, independently judged—is not something that I see there. That is one reason why I am sorry at another casualty of the Chancellor’s Budget speech of 2005, which first saw the demise of both children’s care and mental health care under Ofsted. Now we have seen the demise of the rest of the independent inspectorate of adults, which has been rolled into another huge commission. My concern is as much about what has happened to the care and mental health support for children, because at the time there was not the same degree of fight about it as we had over the proposed inspectorate for justice, community safety and custody. At least the Government had not appointed a chief executive of that before it came to this House. In the Budget speech of 2005, the Chancellor announced the merger of these public sector inspectorates and described it as a cost-saving exercise. There is no cost saving at all. What has emerged from this Bill is evidence that you must have people in the commission dealing with social care, mental health care and healthcare to make it work. One has to support the noble Baroness, Lady Young—I understand all that she must be going through while this is dissected in front of her. However, this is not going to save anything. My second concern is ““compromise””. Although compromise may look convenient, it inevitably weakens all the parts that are being compromised. In 1996, when I was the Chief Inspector of Prisons, all the chief inspectors involved in the criminal justice system—the chief inspectors of prisons, the Probation Service, the police, court services, magistrates’ courts, and social services—looked at working together to see what things that needed to be reported on could be done together. The first thing we came up with was to ask: what information did each inspectorate need of each other in order to do the job properly; what information was available; what was difficult to get; and what was not available and why? We published this in a report that we put before Ministers saying, ““This is an example of six different organisations coming together to tell you what is needed in order to improve the processes in the areas you are responsible for””. Where is that report? It is sitting on a shelf, because none of the Ministers involved was willing to take responsibility for seeing that all the others worked together. What worries me about this proposal is that we are in the same situation and that the casualty will not be a paper put together on the subject of information, but social care for children and for the elderly. Therefore, while I hear all that has been said about how everyone wants to get on with this without delay and the problems of amalgamation, I beg that before the Government go ahead they are satisfied that all the casualties along the way have been properly catered for so that we do not end up with a compromise of three different systems, that we have not damaged others, and that we and the people we are responsible for providing health and social care to do not end up in a worse state than before the whole exercise started.