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Health and Social Care Bill

My Lords, we have had a number of useful debates about what requirements should be set under Clause 16. In Amendments Nos. 19, 20 and 73, the noble Earl, Lord Howe, the noble Baroness, Lady Meacher, and the noble Lord, Lord Low, have raised two issues that have attracted considerable debate: complaints, particularly the need for adequate arrangements for those who arrange their own care; and the importance of reducing health inequalities and discrimination. Perhaps I may respond first to Amendment No. 73. As the noble Earl, Lord Howe has made clear, the amendment is intended to fill a gap that exists when those who do not qualify for state support make a complaint about a service and feel that it has not been addressed appropriately. I remind noble Lords that anyone who has their care arranged by a local authority, even if they pay the full cost of that care, can refer a complaint to the Local Government Ombudsman. However, as I hope I made clear in Committee, we recognise that the fairness of current arrangements for those who arrange their own social care is an issue. We are talking to key stakeholders to agree a solution. We recognise the concern of the noble Earl, Lord Howe, and the noble Baroness, Lady Barker, who also raised the matter. However, I am afraid that I am not able to say anything more in detail about that, other than that we expect to be able to put forward proposals soon. I hope to be able to make a statement regarding independent adjudication within the timescale of the Bill. The noble Baroness, Lady Barker, was correct that this is a complex issue. Therefore I should perhaps also say that, given the complexity of the ongoing discussions, we would not be able to bring legislative changes forward in the scope of this Bill. I hope that, given that assurance that we take the issue very seriously, the noble Earl will feel able to withdraw this amendment. When we debated these matters in Committee, I believe that we all agreed that it is as important that action is taken to follow up and learn from complaints as it is that they are dealt with properly. Amendment No. 19 would ensure that regulations under Clause 16 included requirements about how recommendations following a complaint were taken on board. I described to the Committee requirement 10 in the registration requirements, on which we have consulted. It would require providers to ensure that there were simple, clear arrangements for handling complaints and disputes, and that complaints were investigated and resolved promptly and effectively. Crucially in light of our debate now, it would also require providers to ensure that learning from complaints was reflected in risk management, quality assurance, clinical governance and training and development arrangements. Learning would be informed by a variety of sources, but we would expect recommendations from the ombudsman and other key sources to play a vital role. The commission will be able to use the full range of its enforcement powers to take action where people fail to meet those requirements. I believe that we are in the same place here. However, I recognise concern that there should be a clearer indication in the Bill of the importance we place on this issue. I therefore undertake to consider Amendment No. 19 with a view to bringing back an amendment at Third Reading. I turn to Amendment No. 20. The noble Baroness was absolutely right about the need to tackle health inequalities, on which she spoke with her usual great eloquence, and to ensure that services provide comprehensive healthcare to people even when they have particular needs that require specialist support. As I said in Committee, we have been consulting on registration requirements which are particularly relevant. However, every requirement is relevant, which is why it will be important that the commission enforces them all with equal rigour. Amendment No. 20 seeks to address discrimination. I appreciate that it is driving at the ability of the commission to act in relation to a failure to implement the Disability Discrimination Act. The Bill already provides the commission with precisely such a power. It will be able to take action against a registered provider in relation not only to the requirements in this Bill but to those in other relevant legislation. I agree with the intention of the amendment, but there is no need to duplicate requirements that already exist in legislation. What we must provide for, as the Bill already requires, is that the commission is mindful of those requirements when it monitors services. In light of this, and my commitment to look again at Amendment No. 19, I hope that the noble Earl and the noble Baroness will agree not to press their amendments.