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Health and Social Care Bill

My Lords, I have listened very carefully to the concerns of the noble Lord, Lord Lipsey, and his proposals in Amendment No. 1 in regard to a further review before the establishment of the Care Quality Commission. Because of the timetable for establishment, such a review would ensure a delay in the establishment of the commission beyond April 2009. Of course I recognise that the establishment of any new body as large as this one is a significant exercise. As pointed out by the noble Baroness, Lady Barker, the contributions to date by noble Lords will undoubtedly make the commission a more effective organisation. However, there is an overwhelming reason why we should press ahead with the current timetable. Accepting the amendment would mean that Parliament would have to consider an independent review of the benefits of establishing the commission before agreeing to it by affirmative resolution. Although the timescale set out in the amendment suggests a rapid review, it is appropriate to remind your Lordships’ House of the general support for the principle of bringing together health and social care regulation. As Anne Williams, president of the Association of Directors of Adult Social Services, said when giving evidence on the Bill: "““so much provision is currently integrated and more and more will be … The public want to be assured that one body is responsible, and that it does not duplicate or focus on different things””.—[Official Report, Commons, Health and Social Care Bill, 8/1/08; col. 79.]" As my noble friend Lord Warner also pointed out, we have already had extensive consultation on these proposals. Central to that ongoing process was the 2006 consultation, The Future Regulation of Health and Adult Social Care in England. That document sets out the benefits of bringing together the regulation of health and social care, such as enabling greater consistency of standards, inspection arrangements and performance assessment. The consultation showed that there was general support for the move to an integrated regulator. In particular, consumer organisations, which represent those people who use the services, see the case for having a single regulator because it will also provide a clear focus for the public, who often find the boundaries between health and social care artificial. We have been working very closely throughout the process with the existing commissions on transitional planning and workforce strategy to ensure that uncertainty is kept to a minimum. As Members of this House have already said, delay now would lead to increased uncertainty. My noble friend Lord Patel of Bradford pointed out in Committee that we risk losing the valuable expertise that we must maintain in the new commission if we do not now get on with the show. The same sentiment was expressed by the National Consumer Council, the Picker Institute and Which? in their letter to noble Lords: "““It is crucial that the transition towards CQC is well managed and sticks to the agreed timetable. We need to ensure that current good practice around engagement, together with the expertise and skills of the current regulators, is not lost by a prolonged transition process; this would not benefit anyone, least of all those who use health and social care services and carers.””" My noble friend Lord Patel also said that what is crucial now is that the shadow chair, "““shows some leadership by saying where we are going and how we are going to get there””.—[Official Report, 30/4/08; col. GC97.]" I am delighted that we have been able to secure a first-class shadow chair in the noble Baroness, Lady Young. I am sure she will provide the strong leadership that will ensure that there is a smooth handover next April. Fundamentally, the commission will help deliver safer and better quality care services for people who use them. We do not want to have to say to those same people that it will take the Government another period of delay and uncertainty to get to this point. The regulatory framework that has enjoyed such excellent scrutiny in your Lordships’ House will support the kind of integrated, personalised services that we all want to see continue to develop, and I want to encourage that in my next-stage review. The noble Baroness, Lady Howarth, has pointed out that some were inclined to support delay, not because they opposed the principle but because they felt that the timing was wrong or that the Bill as drafted would not give the new regulator the best possible starting point, particularly in relation to social care. We have listened to those concerns and brought forward many changes and amendments to the Bill: to introduce clearer objectives, to give the commission an explicit duty to involve and engage with service users and to give it the freedom to determine when and how it conducts reviews of services. I am delighted that the three current commissions have each welcomed those government amendments. We will explore these issues in more detail later on, but they should help reassure noble Lords that the framework is now in place to allow the establishment of the regulator to proceed. There is no good reason to reconsider the case for the integration of health and social care regulation and the creation of the Care Quality Commission. Nor is there a case for subjecting the establishment of the commission to any further delay. I am therefore grateful to the noble Lord, Lord Lipsey, for highlighting that he will withdraw his amendment.