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Health and Social Care Bill

My Lords, I, too, support Amendments Nos. 2, 5 and 6, to which I added my name. The noble Earl, Lord Howe, clearly articulated the arguments for these amendments. I want to put on record my reasons for having shifted my position since we last debated these issues. In Committee, I pressed for a mental health sub-committee to try to make absolutely sure that the role of the Mental Health Act Commission in relation to detained patients was not lost. Others argued for a social care sub-committee or for specific work strands to be represented on the commission itself. I would like to thank Ministers for our very helpful discussion since the Committee stage on this issue and many others. They are clearly well aware of the concerns, in this House and elsewhere, about the potential for acute health services to dominate the CQC, if only because those services have such enormous public interest and also considerable problems, as we know well. I have become conscious of the need for flexibility within the CQC as, over time, services within the country and the role of the CQC evolve. Even at this stage, the remit of the CQC to regulate services delivered to individuals and small groups and to hospitals and large organisations may require an organisational structure that will not, in fact, fall neatly into health, social care and mental health. For example, taking one possible scenario to illustrate a point, one could envisage a structure with five work strands: individual rights, hospital services, community homes, commissioning, raised by the noble Lord, Lord Warner, and perhaps prison health services. In such a structure the individual rights strand could cover detained patients in psychiatric units, but also individuals whose rights are protected by the Mental Capacity Act, very much in the social care field. However, they have problems very similar to those of detained patients—they are, de facto, detained and they are often given medication without informed consent either because they are not capable of giving that consent or because they are alleged not to be capable. Another group of people who might be covered in that single strand of individual rights could be, for example, people on community treatment orders who have not been covered by the Mental Health Act Commission because those orders do not come into effect until the autumn of this year. Things are changing year by year. I hope that I have said sufficient to explain why I have come to the conclusion that the one thing we must not do in this House at this time—we are not capable of doing it—is to try to be specific about the structure of the commission and sub-committees on the CQC. I therefore strongly support Amendments Nos. 2, 5 and 6. Those amendments take account of that flexibility—it is vital flexibility. I would be concerned about having another jig at this because the incentive for a number of noble Lords is to try to be more specific. That would be unhelpful and would not be in the best interests of patients and service users in future.