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Health and Social Care Bill

My Lords, I recognise the need for the right competencies and expertise in particular areas of the commission’s work. I also understand and support the intentions behind most of the amendments. As has been pointed out, last week the shadow chair of the Care Quality Commission—the noble Baroness, Lady Young—wrote to Peers signalling her commitment, working with the Appointments Commission, to ensure that the collective skills, expertise and background experience of the commission’s membership reflects the importance of mental health and social care as well as health and other users’ interests. As the noble Lord, Lord Walton, pointed out, our purpose here is to achieve the right competencies to achieve the right integration. However, the amendments in this group reflect different approaches to ensuring that the Bill reflects that crucial aim. I have some sympathy with Amendments Nos. 2, 5 and 6, proposed by the noble Earl, Lord Howe, and supported by the noble Baronesses, Lady Cumberlege, Lady Murphy and Lady Meacher. They propose flexible mechanisms which seek to ensure that the commission’s chair, members, committees and sub-committees collectively represent the range of the commission’s statutory functions. I will have to reflect on whether the noble Earl’s approach, which focuses on the commission’s vital role in monitoring the use of powers under the Mental Health Act and its review functions specifically under Clauses 42 and 44, really delivers the desired result. However, I applaud his ambition to secure proper representation while maintaining flexibility for the commission itself to decide how best to deliver its statutory functions. I am delighted to have heard that in recent days many noble Lords have acknowledged that it is vital for the commission to maintain that flexibility. I appreciate the intention behind the alternative model proposed by the noble Baroness, Lady Howarth, in her Amendments Nos. 3 and 4, which is to ensure that social care and human rights are properly represented within the commission’s governance. However, I am not sure that the proposed mechanism to achieve that end is through legislation requiring specific posts. Also, although I agree with the intentions of the noble Lord, Lord Lipsey, in his Amendment No. 8, I do not feel that the right way is to create separate sub-commissions to achieve that purpose, each representing one of the current three commissions. There is no doubt that the new commission will build on the expertise of the three existing commissions, while maximising the advantages of integrated regulation. As we said in Grand Committee, we envisage that much of the expertise will transfer from the current commissions. However, rather than creating silos—which we are trying to break here—in the shape of the sub-commissions that the noble Lord proposes, the new commission needs to take the existing differences into account and build on the best of each of the current commissions to release the potential benefits that we all aspire to achieve; for example, the benefits to the provider of both healthcare and social care services, and the benefits to the user of seamless regulation across their care pathway. Once again, I believe that it must be for the commission to decide how best to structure itself and deliver its functions, be that through sub-committees, specific posts or other mechanisms. After all, we are trying to create an independent regulator—something that I know that noble Lords fully support. I remind noble Lords that the Government have sought to reassure all sides through the Bill process that social care and mental health interests will not be lost in the new commission. I hope that the fact that the Commission for Social Care Inspection and the Mental Health Act Commission welcome and support government amendments will provide further reassurance, in particular to the noble Baroness, Lady Howarth, and the noble Lord, Lord Lipsey. There are already further necessary checks on the Care Quality Commission in the Bill. The current drafting explicitly requires that the commission report annually to Parliament and the Government on the provision of adult social care services, on the exercise of its Mental Health Act functions, and on the way in which it has exercised its more general functions. Once again, I stress that I have sympathy with noble Lords’ efforts to ensure, through various approaches, that the commission’s governance structures will reflect the skills, expertise and focus needed to carry out its full range of functions, without the focus of any one of them being at the expense of any other. As I hope I have made clear, while I do not support amendments that would impose inflexibility on the commission in the way that it performs its statutory functions, I support noble Lords’ intentions and am happy to reflect on this debate and seek their thoughts further, prior to bringing this back for Third Reading with amendments that will fulfil their aspirations. With that reassurance, I ask noble Lords not to press their respective amendments.