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Health and Social Care Bill

My Lords, I have added my name to the first of these amendments, which is of a slightly different order from the other more prescriptive amendments in the group. I think it right that not only the Secretary of State but future Secretaries of State should be reminded of the three different spheres, as described by my noble friend. In his customary way he has fashioned an amendment which would sit very comfortably in the Bill as it proposes using review, assessment, investigations and the Mental Health Act as prompts when appointing to the commission people with knowledge and experience in the three component parts that will form this new body. I agree with the noble Lord, Lord Warner, who stated on the previous amendment that parliamentarians are not appropriate people to micro-manage. Throughout the Bill’s passage I have tried to ensure the independence of the Care Quality Commission and that it has as much room to manoeuvre as possible. I share the view of other noble Lords that we have an experienced and formidable shadow chair appointed, which I welcome. I thank her for her letter of 12 June in which she let Members of this House know the way in which she plans to recruit members of the commission. She has clearly taken on board the views expressed by your Lordships in Grand Committee and will relay them to the Appointments Commission. So far, so good, but, of course, memories fade and Secretaries of State and chairs of commissions move on. It is tempting to try to secure the future with prescription but I do not think that is right, especially when it comes to management structures. We do not know what the future holds and so often Parliament lags behind trends. We are in a situation of catch-up. We are already seeing a coalescence of health, both mental and physical, with social care. We are seeing joint chief executive appointments covering health and social care, new professions emerging, patient pathways being more clearly defined and modern technology encouraging very different ways of working both clinically and managerially. Increasingly, healthcare will not be provided in institutions but at home. Individual purchasers will commission healthcare and social care and definitions will change. Therefore, I am very reluctant to enshrine a management model, a straitjacket within which the CQC will have to work. Management should be dynamic, should reflect changing social and economic trends and encourage vision within the organisation. It should not constrain but liberate. Above all, it should be designed to do the business efficiently and with care and not be encumbered with an outdated management structure enshrined in law. So, reluctantly, I do not support the more prescriptive amendments but think that the first one would act as a useful prompt to ensure that the Secretary of State is reminded of the comprehensive remit and duties of the CQC when recruiting members.