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Health and Social Care Bill

My Lords, I rise to support Amendments Nos. 19 and 73 and to speak to Amendment No. 20. My noble friend Lady Finlay has asked me to give her apologies to your Lordships’ House. She has put her name to these amendments, but unfortunately she has an engagement arranged a year ago that she is unable to break. Amendment No. 19 envisages regulations providing for the CQC to ensure the implementation of recommendations coming out of complaints investigations. The noble Earl, Lord Howe, referred to this in relation to care homes. I want to say a few words about its relevance in relation to health trusts as well. I happen to be very well aware that health trusts can be relied on to undertake investigations into complaints; they could not get away with not doing that. But my experience of this is that they are far less reliable in terms of following up the recommendations coming out of those investigations, and yet without doubt it is those lessons which are far more important in fact than the investigations themselves. If you carry out the investigation and do nothing about the lessons, you will have achieved very little. In Committee I mentioned a particular case where a complaint had been made, an investigation undertaken and recommendations issued that a clozapine clinic should be established. In fact, nothing happened after that recommendation, with the net result that the patient contracted diabetes, which of course will affect him for the rest of his life. That is how serious it can be if these recommendations are not followed through with. They—not always, but often—throw up some serious issues. Considerable resources are devoted to these investigations. A lot of professionals’ time is devoted to thinking through the ramifications and the lessons that need to be learnt. It is therefore incredibly cost-ineffective if this is not done. As the noble Earl, Lord Howe, mentioned in speaking to Clause 16, the regulations already make provision for the handling of complaints and disputes. All this amendment does is to make sure that this piece of complaint handling—the following up of recommendations—is not neglected. I find difficult to imagine that Ministers will not be more than happy to incorporate that small adjustment. I speak briefly to Amendment No. 73, which seeks to ensure that self-funders in care homes have access to an independent complaints procedure. The noble Earl, Lord Howe, has, as always, spoken eloquently on this. I make a couple of points. First, in discussing this, a number of us are concerned that we should not establish new bureaucracy, new procedures and elaborate new approaches. The idea of tacking the complaints process for self-funders on to existing local authority procedures is as cost-effective as you can make it. While the noble Earl, Lord Howe, suggested that this may be very expensive, my fear is that it could be rather inexpensive because, even if there is a relatively independent complaints process, such vulnerable self-funders in homes will be disinclined to make complaints, as will their relatives. Only in the most dramatic circumstances will such complaints be made. For that reason, it is important to have this facility. What about somebody who is, as it were, semi-starved? I happened to have a relative in such a situation some years ago. The idea that you cannot do anything about that because you feel so vulnerable, particularly if the complaints process is not independent, is a pretty appalling state of affairs in our society. That is one point: this is about as cost-effective as you can get it. Secondly, if Ministers are willing to accept this point, the regulations will need to make clear who can make such complaints. Tragically, the sort of people we are talking about will probably not be in a position to make the complaints themselves. Some of these people do not have any relatives to complain on their behalf. It may, indeed, be a CQC or LINk representative—or somebody of that kind—who sees something appalling happening and is the only person who can make a complaint on behalf of that resident. I put that concern on record. I go on to speak to Amendment No. 20, which makes provision for regulations to, "““impose requirements as to the need to reduce health inequalities and discrimination on the basis of disability””." It will also ensure that the CQC takes full account of the Disability Discrimination Act 1995. My perspective, as always, tends to be a mental health one, simply because that is where my experience lies. I have no doubt that this amendment has relevance to other groups of people with disabilities. Currently, people with severe mental illness die 10 years younger than the population at large. They are particularly at risk of contracting heart disease, hypertension, diabetes, breast cancer, respiratory problems and bowel cancer. I suggest that health trusts are failing on a massive scale to fulfil their duties under the Disability Discrimination Act. Unwittingly, general practices may also make it quite difficult for this group to receive the services that they need. Many people with severe mental illness require reasonable adjustments in order to gain access to services. For example, on a practical level, people who are taking sedative medication should not be required to telephone at 8 am to get an appointment. This is of some importance. Practices which fail to adapt their policies in this kind of practical way are probably creating health problems rather than helping with them. For example, some people will stop taking medication for their psychiatric disorder in order to ensure that they can get up in the morning and have their physical health dealt with. Why is there apparently so little special provision for people with mental health problems? When you consider that about one person in six experiences mental health problems at some time in their life, it is important to question whether GPs have anything like adequate training in mental health. If GP trainees do not opt for a psychiatry job during their senior house officer years, they can qualify with little or no real exposure to the range of serious mental illnesses from which many of their patients will suffer, or to the minor mental health disorders from which 30 per cent or so of their patients will suffer. In my experience, the physical care of patients in psychiatric hospitals has been badly neglected over the years. Some additional resources are finally now being devoted to this issue; they are certainly well overdue. Insufficient attention is still paid to problems such as obesity despite the fact that a great deal of psychotropic medication leads directly to increased weight unless great care is given to the issue. The health regulator should surely have a remit to require some progress to be made to reduce this gross inequality. In the early stages of the CQC’s life it may have to focus on secondary health services rather than general practice and the proposed amendment allows for development over time. By leaving this issue to the realm of regulations we are avoiding imposing obligations on the Government which may prove impractical in the period immediately following the establishment of the CQC. I hope the Minister will see this as a fairly modest amendment but one of profound importance.