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Health and Social Care Bill

moved Amendment No. 15: 15: Clause 4, page 3, line 4, leave out paragraph (b) The noble Earl said: My Lords, I felt it right, following our debates in Grand Committee on whether Clause 2 should stand part of the Bill, to bring us back to an issue of fundamental principle regarding what the remit of the new commission should be. I am extremely worried that the decision taken in 2005 to split CSCI and to hive off the regulation of children’s social care to Ofsted was a mistake. It was a mistake that originated from two causes—a determination by the current Prime Minister, then Chancellor of the Exchequer, to slash the headline costs of regulation by merging regulators; and a conviction that was allowed to take hold in the minds of Ministers and officials that, because Ofsted concerned itself with schools and children, a takeover by Ofsted of the regulation of children’s social services would somehow be a natural fit. Neither consideration was a sound basis on which to dismember CSCI as the body regulating social care across the piece. We need to remind ourselves that the Department of Health’s review of arm’s-length bodies, published in July 2004, contained no proposal to split CSCI or to merge it with anything else. Indeed, the review explicitly set its face against such a course. It stated that any merger with the Healthcare Commission at this time would be, "““a distraction from the heavy agenda of both sides and would impact on the ability of both to regulate providers and thereby protect patients and service users””." That sensible conclusion was overridden the next year in the then Chancellor’s Budget speech. The legislation integrating children’s social services with Ofsted was taken through Parliament despite the misgivings of many who have a close knowledge of social care matters, such as the noble Baroness, Lady Howarth. We are seeing now the fruits of that policy. The Children, Schools and Families Select Committee in another place heard evidence a few weeks ago from the NSPCC and the British Association for Adoption and Fostering. They individually voiced their views that Ofsted is straining to meet the health and mental health care needs of children in care. It is not just the wisdom of hindsight that prompts me to say that this could have been predicted. At the heart of Ofsted is a mismatch. The methodology of Ofsted and the methodology of CSCI are completely different. One relies heavily on a tick-box approach, scoring schools on the basis of facts and statistics. The other depends critically on human interaction: physically inspecting premises, talking to staff and to service users and making value judgments about the quality of the service being delivered. In the end, an assessment of social care focuses on the competence and personal qualities of staff and the happiness of those whom they look after. I have absolutely no doubt that the senior management of Ofsted has undertaken its enlarged responsibilities with seriousness and assiduousness, but the task of assessing the quality of a school is 10 leagues removed from the task of assessing the well-being of vulnerable and sometimes damaged children in a care setting, where mental health needs and physical health needs must always be a concern. The merger of CSCI with the Healthcare Commission, which this Bill will bring about, would have provided a much sounder basis for the regulation of children’s services than the merger which actually occurred. There are, potentially, excellent synergies between the regulation of children’s services and the regulation of healthcare and care delivered under the Mental Health Act, but those synergies are now out of reach unless, somehow, it is possible for the Government to take stock of the situation which they have created and think again about it. Let us forget, for the time being, about the rationale cited for the dismemberment of CSCI in 2005 and concentrate on what is happening now. Is Ofsted succeeding in delivering the kind of regulation of children’s services needed to give us all confidence that standards are being properly maintained? We need an honest appraisal of that question. If the answer indicates that it would be desirable to reintegrate the regulation of children’s social care with that of adult social care under the umbrella of the CQC then, despite all the criticism I have ever voiced about repeated organisations of regulators, we on this side of the House would not stand in the way of such a change. I beg to move.