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Health and Social Care Bill

My Lords, I rise briefly to oppose, uncharacteristically, an amendment tabled by the noble Lord, Lord Lipsey, with whom over the years I have usually been in common accord. I do so as the then Minister who, in the way of the pantomime villain, actually proposed the merger of these three bodies. However, it is worth bearing in mind that that was as long ago as 2004, so the idea that this comes as a great surprise to everyone is a bit of a myth. The change was proposed for a number of reasons. It is fair to say, and with all due respect to the noble Lord, Lord Ramsbotham, that the work in the area of regulation and inspection that was done when I was a Minister revealed discernible mission creep in many of the bodies, as they say in the trade. They grew their functions and their budgets, and indeed many were rather skilful at doing do. There was a need to do a bit of horticultural pruning, and data collection was a good example. But to be fair to the health and social care organisations and some of the other arm’s-length health bodies, they got together in order to reduce the huge diversity and increase the commonality of data collection. There have been improvements, although more could be made. Two areas with particular scope for improvement were commonality of approach and learning best practice in inspection and performance review from each other. The Healthcare Commission has done a great deal of work in this area, relying more on a risk-based approach and self-audit. CSCI could certainly learn a great deal from this. It is unfashionable to say, in any way, that any past body is less than perfect in every characteristic, but the truth is that bodies can learn from each other and improve their performance. Merging would here help to break down what Frank Dobson rather graphically called the Berlin Wall between health and social care. Merging the regulators is likely to help in that area. I recall, when the 2003 Act was going through, standing in the same position as the Minister and being rather chastised from the Benches opposite about the need to move towards a merger of these bodies in due course. Around 2003 there was a degree of enthusiasm—particularly from the Liberal Democrat Benches, as I recall—for moving towards merging these bodies. We have come a long way since then and there is now a good case for merging. It has not been sprung on everybody. I totally agree with my noble friend Lord Harris: my experience of managing change is not so much that people rush off to get other jobs; they rest on their oars, wondering when the change will come and what they need to do, rather than knuckling down to make it. That makes managing those changes very difficult. Finally, it is not for Parliament to micromanage change. This is the job of the Executive, once the decision has been taken to merge these bodies and the legislation has been passed. Parliament is not terribly well equipped to start determining the precise way to execute that change. By all means, criticise the Government if it is not done well, but for Parliament to intervene in that process is unlikely to be an effective way of securing good change.