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Health and Social Care Bill

My Lords, I shall speak to Amendments Nos. 3 and 4. One of the skills one learns in social care is group work. Those of us who have worked fairly closely together in the group that has taken this Bill forward have thought through these arguments time and again, and we have been considerably influenced towards the picture that we now see of how social care is moving forward. I want to remind your Lordships forcefully that this is not where we started, and not where the outside world is in its view of the comparative positions of social care and health. We have had reassurances in this House, and I think that we have convinced ourselves that the Bill could give proper emphasis to all the parts. In matters of social care I usually include mental health because my own training included it. That is another issue that I am bound into and it is in close alignment with health and hospitals—the links are all there together. I agree with Members on the opposite side—I say that because of the geography, not because of anything political, she says anxiously—that we have to move forward in different ways. I say that in order to emphasise that outside the walls of this now comfortable group which has come through to this position there is still a great deal of anxiety about where mental health and social care will reside in future. I take heart from the assurances of the noble Baroness, Lady Young of Scone, who has impressed even me by her strength of leadership already in how she has moved all these issues forward. I can hope only that this will continue. However, there are other reasons for being absolutely clear about what prescription might be. The amendment moved by the noble Earl is prescriptive, if not tightly so. We are in the position of decisions being made—or rather, remade or even re-remade when you think how often social care has been discussed in the past five years. It is crucial that we get it right this time, and that having done so, we will not have to be concerned with the issues of disruption outlined by the noble Lord, Lord Harris. Continuity of service and personnel is what really counts in patient-client-people care, but there has been disruption in recent years. I am proposing a dedicated social care commissioner in the amendment, but if I am honest I am not really convinced by my own arguments. As I said in an e-mail to the noble Earl, it is important to reinforce our view. I wish that I had been able to support the noble Lord, Lord Lipsey, earlier. I have been so influenced by the group work in this discussion that we find ourselves at a different place. That is probably what the noble Lord, Lord Warner, was trying to convince us of in his speech. I repeat in all seriousness that we are in a different place, which has to be maintained in the outside world. I have only this week been involved in discussions about the place of social care and nursing services for the elderly, and the worry in some places that nursing homes are becoming more nursing than homes. I know that old people are becoming frailer but they are losing that home environment in their need for medical care as they become increasingly more frail. These are the kind of things that I want us to maintain. That is why it is vital that on the commission there are people who understand that and who have lived through and have the experiences of some of the people on the ground, who, when you visit and talk to them, tell you time after time that they want personal, human care, not a medical centre. That is the crucial difference between these services. Social care is about individualised, often very long-term care, often at home. Medical care may be long term, but usually it is a short experience in hospital or with your doctor. They are crucially different elements. They overlap in places but people need to understand both. I certainly would not say that there should not be someone from healthcare on the commission, but there must someone from social care because it shows where the danger is. On the issue of human rights in Amendment No. 4, it would be useful if a member of staff was appointed to the new commission to fill the statutory position of human rights director. As is the case with social care, the human rights of the people who use social care and health services has been a continuing issue in our debates on this Bill. Having one senior officer specified in the Bill would give that person real authority within the commission to advise it at a senior level on its responsibilities in relation to human rights. This is an amendment I really believe in. It would also act as a strong reassurance for the new commission to place human rights at the centre of its work and activities. The argument against this proposal is simply put. It would be too great an interference with the structure of the new commission to set down specific provisions in the Bill and the commission would be able to get on with its job without interference from Parliament. Once again this proposal has a clear, recent legislative precedent. The Commission for Social Care Inspection, before its responsibilities for children’s social care were taken up by Ofsted, had the statutory position of children’s rights director set out in the Bill. Drawing from that experience, Dame Denise Platt has said that having an officer whose existence was established by Parliament gave that person real clout within CSCI in keeping children’s rights issues at the fore of its policies. On wider human rights issues, it is pleasing that during the passage of the Bill the Government have brought forward amendments partially to close the human rights loophole in relation to publicly funded residents in private and voluntary sector care homes. This group of residents will now have the protection of the Human Rights Act, which is most welcome. But that still leaves the group of self-funders, as we mentioned in Committee.