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Health and Social Care Bill

My hon. Friend touches on an important point—how we benefit from the processes. That has not been particularly well thought through, not least because of the absence of, for instance, the great bed-watch campaigns that the old community health councils could collectively inspire. Indeed, the second of the three areas that I was discussing in relation to amendment No. 8 and our concerns, which remain unaddressed but have been part of the debate that has led us to this point, was monitoring the trends. For a regulator, local or national trends revealed through complaints can be a useful bellwether—precisely the point made by my hon. Friend—in directing its inspection activity. The amendment, however, fails to establish a mechanism for the monitoring of complaints trends at national level—as did the old bedwatch campaign, until it was summarily scrapped. The Minister told the Committee:"““It will be very important that the ombudsman works very closely with the Care Quality Commission if he or she identifies a pattern of complaints that is worthy of closer inspection and investigation.””––[Official Report, Health and Social Care Public Bill Committee, 17 January 2008; c. 347.]" I am disappointed that the Government have not accepted amendments that would have included that in the Bill. As for the third area—the supporting of complaints by social care users—the Bill does nothing to address the disparity in access to such support between publicly and privately funded individuals. The Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), said in Westminster Hall"““it is unacceptable that self-funders should not have the protection that other residents have””.—[Official Report, Westminster Hall, 11 December 2007; Vol. 469, c. 52WH.]" In September, he told the radio programme ““File on 4”” that he would achieve that through legislation. Given the limited scope of the amendment, can the Minister confirm that the Government are reneging on that commitment? If they are not, where is the legislation promised by his equally senior colleague, and when will we see it? We welcome Lords amendment No. 14, which should provide further protection for two groups of people whom I hesitate to bracket together—soldiers and prisoners. Members will be familiar with the countless stories of our brave armed forces personnel being treated alongside the civilian population in what are sometimes unacceptable circumstances. As for prisoners, they have some of the worst health—particularly mental health—in the country, and it is right that they should be protected. I am, however, concerned about the scope for the CQC's powers of entry to be limited"““in the interests of national security””." What assurances do we have that the power will not be used to cover up poor practice or poor Government policy? Surely it is not beyond the wit of man to appoint inspectors who are security-cleared for such circumstances. I appreciate that that may be a problem, but what checks and balances are there on the exercise of executive power? Lords amendment No. 31 defines"““health care commissioned by a Primary Care Trust””" and"““adult social services commissioned by an English local authority””" as"““health care provided by other persons pursuant to arrangements made by the Trust””" and"““adult social services provided by other persons pursuant to arrangements made by the authority””" respectively. Lords amendments Nos. 15 and 16 require the CQC to conduct periodic reviews of health and social care ““provided or commissioned”” by PCTs and local authorities respectively. Can the Minister confirm that that phrasing, which seems to have a certain ambivalence, commits the CQC to periodic reviews of commissioning as well as of commissioned services? I do not understand how ““services commissioned by”” can mean the same as the process of commissioning. One of the aims of amendments tabled by Conservatives in both Houses during the Committee stages was to give the CQC power to inspect commissioning itself, not just commissioned services. Indeed, the Liberal Democrats tabled amendments in almost exactly the same terms and for similar purposes. Anna Walker told the Committee during oral evidence:"““you have to look at a mixture of commissioning and provision; at what the primary care trusts are doing, as well as what the provider is doing. We would like to see that power for the wider review cover commissioning as well as provision.””––[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 17, Q25.]" The Healthcare Commission's annual health check for 2008-09 will assess PCTs on the quality of their commissioning. I remain concerned about the fact that the powers of the CQC seem to be limited to the registration and inspection of health care rather than involving broader health issues. As the Minister will recall, Anna Walker said in her evidence to the Committee, in response to a question from me,"““we are very perturbed that at the moment the administration requirements explicitly exclude catching work on health, as opposed to healthcare ... we believe ... that people's health needs to be looked after as well as their health care … The registration requirements explicitly say that they cannot bite on public health issues, only on healthcare issues.””––[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 12, Q12-13.]" That was in relation to clause 90. Anna Walker raised that issue as far back as September 2007. She told the Health Service Journal:"““People who look after healthcare are really important in looking after health. Although regulation is not the only player in this it is a very useful lever to improve public health.””" I ask the Minister to confirm why the NHS chief executive, who added some evidence in relation to that matter, is content with those proposals, particularly as regards public health. On 2 August last year, the Financial Times stated that "““a battle had broken out””" between David Nicholson, the NHS chief executive, who sees the PCTs as part of his management empire, and Anna Walker, who said that there must be"““a mechanism for holding people publicly accountable””" for the quality of purchasing. During the Committee stage, the Minister said that performance assessment of PCT commissioning ““was provided for”” in the Bill under the special reviews regime, and would not accept our amendments to clause 42. If this provision delivers the power of periodic review of commissioning, I am glad that he has listened to us. Lords amendment No. 17 removes the power of the Secretary of State to modify documents of the commission which set out the frequency of reviews. Those documents would still require the Secretary of State's approval. Again, the amendment comes in response to amendments that we tabled in the Grand Committee, again supported by another party. That is a small victory in the Conservative crusade to have the CQC set up as an independent regulator, rather than one too often at the beck of the Secretary of State. Whether it turns out to be effective in practice, we wait to see. While the Secretary of State will not be able to ““modify””, he will presumably be able to withhold approval until he is happy with the document, amounting to the same thing. Likewise, I welcome Lords amendments Nos. 18 and 19, which give the CQC a new power to refer matters of concern to the Secretary of State, and are the result of points made by my noble Friend Earl Howe in Grand Committee. They give the CQC a further power in its own right, separate from the Secretary of State. I only lament, once more, that the CQC is not independent enough. I welcome Lords amendment No. 23, which again removes the power of the Secretary of State to specify by order when the commission must publish programmes setting out the reviews, investigations and studies that it proposes to conduct. It is a further concession won in another place. Not only is it welcome as a further removal of the Secretary of State's control over the commission, but it is welcome as one less piece of legislation that will use up valuable parliamentary time. The 1950 Parliament put 720 pages of Acts and 2,970 pages of statutory instruments on to the statute book. Last year, the number of pages of new Acts totalled 4,609 and there were 11,868 new pages of statutory instruments. I just could not help referring to that, as it is so shocking. I am also pleased that amendment No. 26 removes the power of the Secretary of State to make regulations prescribing the manner in which the new commission is to make and publish its plans for charging fees. It will be recalled that, although those elements to enhance the independence of the CQC are welcome, the Government have been unable to accept that it was appropriate to reconsider clause 2(4), which now seems rather out of place and which effectively enables there to be a Secretary of State override, as the commission must have regard to what the Secretary of State ““may direct.”” Lords amendment No. 22 enables the Welsh Ministers and the commission to share information to support the efficient and effective discharge of their functions. Representing a constituency which shares a border with Wales, I am glad to see that provision included, because, while there is a political and administrative boundary, people on the ground want to use the service that is most convenient and effective for them: people from Flintshire coming to Chester, and people from the south-west corner of my constituency going to Wrexham Maelor and other such places. I also note that we were the only party with an MP representing a Welsh constituency in the Committee. As the measure applies to Welsh bodies, that was an important point, which we made in selecting those who served on the Committee. I would be grateful if the Minister confirmed whether that amendment would allow me, representing my constituents who use services under the purview of Welsh Ministers, to gain the rights of audience that I should have with those Ministers on behalf of my constituents. It just so happens that a very upsetting constituency case has come across my desk today. Welsh Ministers have today decided to close a special needs children's home, just after an autistic Asperger's syndrome child had spent three months getting familiar with it. Today, with all his furniture moved into his new home, they have announced its closure, and he was due to arrive tomorrow morning. It has been the most desperate decision by Welsh Ministers in that case. I also note the scathing interim report from the Welsh Affairs Committee on cross-border health care. I should be grateful if the Minister confirmed that adequate data protection would be in place for such data sharing, and I hope that Welsh Ministers, English Ministers and the CQC will take seriously the four criteria that have been established: clinical excellence as close to home as possible, border-proofing of policy and practice, cross-border citizen engagement, and transparency and accountable co-operation between localities, regions and Governments. Amendment No. 67 would make a minor amendment to schedule 5 to reflect the fact that the Children and Young Persons Bill, which is referred to in the schedule, is not now expected to receive Royal Assent until after the Health and Social Care Bill does. There is nothing to be said on that amendment other than that it is terribly unfortunate that the Government Whips have failed so monumentally to timetable effectively a Government-sponsored Bill and have therefore got that out of kilter. Amendment No. 68 would allow Welsh Ministers to use any information obtained in exercising specified functions for the purposes of any of their other specified functions. I would be grateful if the Minister confirmed that data passed from English bodies to Welsh Ministers would be handled with the same level of security as they are by English bodies—which, admittedly, is not much under this Government. More important, will English bodies or individuals who are the subject of such data sharing, and their representatives, be given rights of appeal to Welsh bodies as regards that data?