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Health and Social Care Bill

My right hon. Friend reaches for the overarching principle that lies behind the mindset that informs Bills of this type. The Government have an opportunity to pick up on the enormous amelioration that we could have, in resettling the basis on which the NHS can deliver, organically and from patient-driven demand, improved health care outcomes, rather than having an input-driven, target-setting approach. That is set out in our autonomy and accountability Bill, which has been drafted by the Opposition and is ready to go. I am grateful to my right hon. Friend for giving me the opportunity to ensure that, if that opportunity had slipped the Government's mind, it is now before them again. We also welcome the explicit mention of carers at the end of Lords amendment No. 4. However, I note the circularity that persists in the Bill, in Lords amendment No. 5, which states that in Chapter 1,"““'health and social care services' has the meaning given by””" clause 3, entitled ““The Commission's objectives””. Clause 3 defines ““health and social care services”” as"““the services to which the Commission's functions relate.””" However, clause 2(1) states:"““The Commission has the functions conferred on it by or under any enactment.””" The Government have failed to investigate not only public health and health inspections, but adequate protection in the areas of cosmetic surgery, needs assessments for care, and health-related assessments for work, as regards the personal capacity assessment and health assessments in custody. Lords amendment No. 66, the final amendment in the group, ensures that the commission includes representatives of health care and social care, and action under the Mental Health Act 1983. I am glad that the amendment has been tabled, because the Minister strongly resisted such a proposal in Committee. We might have progressed through the opening clauses of the Bill much more quickly had the Government made that concession then. I note, for example, that in oral evidence the Mental Health Act Commission made clear the need for"““adequate organisational and personal accountability at board level for the monitoring of and reporting on the needs and rights of detained patients.””––[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 9, Q9.]" The Minister rejected our overtures, saying that our proposals"““specify a great deal more prescriptive detail than we feel happy with…We believe it should be for the commission itself to establish the organisational structures…That should extend to the executive team it chooses to have…Specifying that the commission must have executive officers and committees that lead on different ""client groups could undermine the commission's ability to adopt that integrated approach””.––[Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 134-35.]" I would be interested to know what has changed the Minister's mind, in terms of the content of Lords amendment No. 66, between then and now.