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26 Nov 2007 : Column 35

Secondly, we have introduced an ESOL for work programme for more recent migrants. That is paid for, but we think that it will meet the immediate workplace needs. I think—and I suspect that the hon. Gentleman does—that the challenge comes from those long-term residents, often British citizens, who do not have the English language and are therefore excluded from many activities of wider society. I assure him that we shall continue to look closely at the ESOL system and how it operates to see what we can do further to target resources on those people.

Mr. David Clelland (Tyne Bridge) (Lab): Does the Secretary of State agree that transport costs can be an obstacle to those who want to take full advantage of the opportunities available to them? Will he support the north east regional youth assembly in its campaign for concessionary travel for those between the ages of 16 and 19 who want to pursue further education and training across the region?

Mr. Denham: I pay tribute to my hon. Friend’s imaginative initiative in raising an issue that is beyond my departmental responsibilities, in respect of funding for 16 to 18-year-olds and transport policy. I cannot answer directly about any proposals on that particular age group. However, I draw attention to the commitment to which I have already referred a couple of times today: we intend to ensure that long-term unemployed lone parents and those on incapacity benefit are better off in work, even after reasonable transport costs. That will be done by ensuring that long-term benefit claimants moving into work will, for a period, see an increase in their income of at least £25 a week. That applies to workers older than the group to which my hon. Friend referred; we clearly have plans to raise the participation age and so on. I shall draw his question to the attention of my right hon. Friends.

Mr. Charles Walker (Broxbourne) (Con): Hertford regional college in my constituency is undertaking a major new build programme to create a campus in Turnford fit for the 21st century. However, it will have to pay a VAT bill of more than £3 million for that building work. When secondary schools do new build work, they are not subject to VAT. Will the Secretary of State make representations to the Chancellor on behalf of the further education sector to see whether we can end that inequality?

Mr. Denham: Bearing in mind that 10 years ago there was no capital budget for further education colleges at all, I am fortunate to be presiding over a budget of £2.3 billion for FE colleges over the next three years. It is a bit of a cheek to complain about the VAT rules that applied under the previous Conservative Government.

Mr. Walker: It is a genuine question that deserves an answer.

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Mr. Denham: But it is worth making the point that the difference between schools and colleges is that colleges are incorporated as independent institutions, which gives them a different tax treatment. I have not yet met a principal of an FE college who wished to return to local authority control, even if they would be able to reduce their VAT bill as a result.

Mr. David Chaytor (Bury, North) (Lab): I welcome the statement, particularly the great expansion in the number of apprenticeships. Does my right hon. Friend agree that the people at the bottom of the pile in respect of access to jobs and skills are ex-offenders? Although his statement makes reference to offenders who have secured a job before their release being able to benefit from “train to gain”, the majority of offenders are not in that position. Does he agree that providing more advice, guidance, support and assistance for offenders after they leave custody is important both in its own right and as an incentive to reduce reoffending?

Mr. Denham: My hon. Friend is absolutely right to talk about the importance of offender education. I understand that the number of learner hours has increased by 35 per cent. in the past year alone. However, I would not like to lose sight of the significance of today’s announcement. We know that one of the things that most reduces reoffending is an offender’s knowing that they are working towards a guaranteed job when they leave prison. Including such offender learning within “train to gain” means that it will now be possible for an employer who is prepared to take on an offender to get their training paid for once they have left the prison estate. That could make a big difference to future reoffending rates, and it should more than justify the investment involved.

Dr. Roberta Blackman-Woods (City of Durham) (Lab): Does my right hon. Friend agree that unlike the Opposition, who wrote off huge chunks of my constituency with the closure of the mining industry, these proposals will continue to extend people’s opportunities not only to get into work but to undertake vocational training and to upskill, and that that is important not only for individuals and their communities but for the economy as a whole if it is to prosper?

Mr. Denham: My hon. Friend is absolutely right, both about the historical attitude of the Conservatives and in recognising that the statement says that the world has changed and moved on. When we came into power, we had to deal with the backlog of people who had previously been written off and the backlog of a party that had said that mass unemployment was a price worth paying. Today, the issue has changed. Unless we raise skill levels not only for people who are still workless but for millions of people in work, we will not be able to be a prosperous country in the future, nor will we be able to ensure that nobody is left out. The challenges have changed; today’s announcement is about how we will meet those challenges.

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Orders of the Day

Health and Social Care Bill

Order for Second Reading read.

4.29 pm

The Secretary of State for Health (Alan Johnson): I beg to move, That the Bill be now read a Second time.

This is an important Bill introducing improved and integrated regulation of the health and social care system as well as enhancing the regulation of health professionals who work within it. It will help to assure safety and quality of care for all patients and service users. The Bill will also set new regulatory measures where they are necessary, and enhanced regulation where it is appropriate. It will expunge provisions that are out of date and that no longer meet the needs of patients and service users.

Those measures are essential to meet the challenges of 21st century health and social care provision. What was once the single biggest worry for patients—long waiting times—is now far less of a concern. Before we came to power it was common for patients to have to wait 18 months for operations. By the end of next year, patients can expect to wait a maximum of just 18 weeks between being referred by their GP and beginning their treatment. I stress that that will be the maximum waiting time. We expect that most patients will be treated within eight or nine weeks of referral. However, as the spectre of long waiting lists evaporates, patients’ expectations change with the times. Regulation of health and social care must keep pace with new demands, demographic change and medical advances.

This Bill will create a new integrated regulator for health and adult social care in England, the care quality commission, with tough new powers to inspect, investigate and intervene where providers fail to meet safety and quality requirements. Crucially, where infection control and hygiene are poor, the new commission will be able to act quickly and decisively. It will bring together functions from three existing statutory bodies—the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission—and will build on the expertise of those organisations.

Mrs. Joan Humble (Blackpool, North and Fleetwood) (Lab): I thank the Secretary of State for giving way at an early point in his speech. He will be aware that there is some concern in the social care sector that social care should have exactly the same status as health care under the new commission. Sadly, in the past, that partnership has been unequal. Will he assure me that the new commission will treat social care with the same importance as it does health care?

Alan Johnson: My hon. Friend raises the crucial issue with regard to the plan to merge the three current regulators. Social care must have parity in the new commission. That must be reflected on the board of the new commission and in everything that the commission does. I am pleased that she has given me the opportunity to reassert that that is the case, and that it needs to be the case. That point will be emphasised throughout the passage of the Bill.

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I emphasise again that the Bill brings the vital role carried out by the Mental Health Act Commission into the heart of the care quality commission. That will strengthen the monitoring of the Mental Health Act 1983, and offer increased oversight of the treatment of patients subject to compulsory detention. I know that the MHAC places great emphasis on its visiting programme, covering each hospital and each ward that accepts detained patients. I expect the new commission to continue that approach.

The Government recently published their response to the consultation on the future regulation of health and adult social care in England. The consultation highlighted clear support for an independent, integrated regulator with a stronger focus on assuring safety and quality. For the first time, the regulation of the national health service, social care and independent sector providers will be carried out by the same organisation. As services become jointly commissioned and the boundaries between health and adult social care are broken down, it makes sense for our new integrated regulatory framework to work across those boundaries as well.

Mark Pritchard (The Wrekin) (Con): On the issue of joint commissioning, does the Secretary of State recognise that, as is so often the case, there is perhaps inadvertent confusion about whether the local authority or the primary care trust pays for a particular package of care? Within that confusion, it is often the patient—the consumer or end user; the person who needs services—who is subject to extra stress and burden, because they are being written to day after day by someone saying, “It is not our partnership; it is not our problem.” Such people are falling between two stools. Will the Secretary of State give a commitment to the House that the Bill will address those key issues?

Alan Johnson: I accept that things are not perfect. Practice-based commissioning, which is quite new, has still to attract genuine buy-in. Lots of people say that they operate practice-based commissioning, but it is not operating as we would like. The question is not just about the Bill, but about other measures, too. World-class commissioning, which we are working on and will launch shortly, is aimed at ensuring that people do not merely talk the talk on commissioning, but walk the walk.

Mr. Andrew Lansley (South Cambridgeshire) (Con): The Secretary of State talked about the independence of the new care quality commission. If a chairman of the Healthcare Commission were required now, the appointment would be made by the Appointments Commission under the Health Act 2006. In the Bill, the Secretary of State proposes that the chairman and members of the care quality commission should be appointed by the Secretary of State. Why is he reducing the independence in the appointments process?

Alan Johnson: We will need to discuss that point as the Bill goes through the House. With a joint integrated commission, it is the Secretary of State’s role to make that appointment. It is a far more fundamental position, and such an approach is a necessary part of accountability to Parliament.

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The new registration system for providers of health care and adult social care, which will cover both public and independent provision, will set the requirements that every registered organisation will need to meet. They will include requirements relating to infection control. With the creation of a new registration system for all registered activity, patients can rest assured that the care or treatment that they choose will be from providers who have demonstrated compliance with the same key safety and quality requirements, no matter where that treatment is provided.

Rob Marris (Wolverhampton, South-West) (Lab): I think that this is the appropriate point to mention that psychotherapists in the United Kingdom sometimes have a qualification, and sometimes do not. Sometimes that qualification is bogus; sometimes it is not. Sometimes they also have a medical qualification; sometimes they do not. The situation is a mess. Inexpert psychotherapy can be harmful to patients, who may think that they are receiving psychotherapy from someone who is properly trained. Indeed, the patient may think that the individual is a psychiatrist, which is entirely different—although some psychiatrists are psychotherapists, too. Will my right hon. Friend consider introducing regulation for psychotherapy under the auspices of the Bill?

Alan Johnson: Not as part of the Bill, but as a separate exercise, we are seeking to clarify precisely those areas that my hon. Friend has rightly mentioned.

Rob Marris: My right hon. Friend is very accommodating.

Alan Johnson: I do my best.

We expect that the vast majority of providers will continue to demonstrate that they deliver quality services in a safe, clean environment. However, the Bill will introduce a wide range of enforcement powers that the commission will be able to use when registered providers fail to deliver safe, high quality care.

Kelvin Hopkins (Luton, North) (Lab): In the run-up to the Bill, the Government have talked about lightening the burden of regulation for health and social care providers. Is that not worrying? Providers such as one or two that provide elderly persons’ care in my constituency have closed down for failing to meet standards. We should be putting to the fore the safety and welfare of residents, not the burden on providers.

Alan Johnson: My hon. Friend makes a fair point. Of course, the new regime will involve a risk-based assessment, whereas previously providers received the same amount of treatment irrespective of whether they had a good record or even a record that was exemplary year after year. Usually the visits were determined by Government, not the regulators. The point of risk-based assessment is to ensure that organisations that have an excellent track record can experience either light-touch regulation or even no regulation, unless there is a problem. Meanwhile, the regulator can concentrate its attention on providers who have not met those standards. The two things go together. The essential point is that many organisations found themselves being visited by different regulators,
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and one regulator could carry out that function. I believe that that is an important step forward, without in any way compromising the important points raised by my hon. Friend.

Once any activity is registered, the commission can apply specific conditions to respond to specific risks, such as requiring a ward or service to be closed until safety or infection control requirements revert to the expected standard. The current Healthcare Commission can issue infection control improvement notices to NHS trusts only when it considers that the improvement will not be achieved in any other way. The new commission will not be restricted in that way. It will be able to visit trusts more frequently, close down wards and insist on their being thoroughly disinfected before they can be reopened. It could follow that up with more unannounced spot checks. It can also carry out annual infection control inspections of all acute trusts, using teams of specialist inspectors.

More generally, the commission will have the power to issue warning notices and penalty notices or instigate court proceedings to levy fines on any provider breaching registration requirements. When NHS bodies incur fines, the money will be returned to the local commissioners and reinvested to improve services, so that the local population does not lose out. The Bill also provides for the commission to undertake periodic assessments and reviews of care. The new commission will help reduce the burden of regulation on providers from itself and other public inspectorates through gate-keeping powers, which mirror those for other inspectorates, and through targeting activity where it is most needed.

The public expect value for money from their public services. In bringing together the regulation of health and adult social care in one regime, we will streamline regulatory activity and ensure that the commission manages its budget effectively, adopts a more independent and intelligent approach to regulation and provides a sharper focus on safety, quality and cleanliness.

Rob Marris: I thought that I would ask this question before the Opposition asked it, because the streamlining to which my right hon. Friend refers means bringing together the Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection, which are two bodies—I appreciate that a third body is also included—that the Government statutorily established only four years ago. Why the change after only four years?

Alan Johnson: As usual, my hon. Friend asks a pertinent question. If we consider the history, we see that there was no regulation before 1999 apart from that under the Mental Health Act 1983, which was an important development that the previous Government introduced. When the two new regulators were introduced, there was a debate in Government about whether they should be merged immediately—whether we should have one regulator for the health service and for social care, while recognising that a separate regulator already existed for mental health. At the time, it was decided that that would be too much in one go, so the two separate organisations were set up but a process of evolution meant that, almost as soon as the Healthcare Commission was established in 2004, a proposal was made in 2005 to merge the two bodies.
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We are therefore considering a natural evolution. There will be no great change in the organisations’ functions, apart from the important change for which the Bill provides, which is all about integration. Taken together, the provisions will make regulation of providers more efficient and more responsive to people’s concerns. With social care and mental health as vital components, we will have a regulator that reflects the reality of integrated care delivered effectively to all patients, whatever their needs.

The Bill will also improve the regulation of the health professions and social care workers. Let me be clear from the outset that the overwhelming majority of health care professionals show remarkable expertise and exceptional commitment in their dealings with patients. They are as disturbed as we are about the rare occasions when a practitioner falls short of the high standards that they set themselves. That is why, as a society, we hold the professions in such high esteem and place so much trust in individual practitioners.

Earlier this year, the Government published the White Paper “Trust, Assurance and Safety”, which set out wide-ranging reforms to the way in which health professionals are regulated. Those reforms build on the far-reaching recommendations in Lady Janet Smith’s inquiry into Shipman and the report “Good doctors, safer patients” from the chief medical officer. Although the bulk of the legislation to implement the reforms will be effected through secondary legislation, the Bill will enact four key provisions.

Mr. Lansley: I am grateful to the Secretary of State for giving way again. He will know how frequently the hope has been expressed in the House that when we legislate to follow up Dame Janet Smith’s recommendations we will do so not only in respect of health professional regulation, but in respect of coroners and death certification. It was clear in a debate in Westminster Hall back in July that it was the Government’s intention and hope to do that, but there is no coroners Bill in this Session to accompany the Health and Social Care Bill. Why not?

Alan Johnson: That is a matter for the usual channels. I do believe that we listed that Bill, but whether we shall find time for it in this Session is as much to do with the Opposition as it is to do with us. If we get the Health and Social Care Bill through speedily, we shall have more time available.

The Bill will enact four key measures. The first is to ensure that all the professional regulatory bodies use the civil standard of proof, so that the General Medical Council, the General Optical Council and the Nursing and Midwifery Council operate to a method consistent with the other eight health profession regulators. The second measure is to create an independent adjudicator, initially to adjudicate on fitness to practise cases for doctors, to enhance public and professional confidence in the impartiality of the GMC’s judgments. The third measure is to ensure that health care organisations employing or contracting with doctors appoint a responsible officer to identify and handle cases of poor professional performance by doctors, and to make recommendations to the GMC for revalidation. The fourth and final key measure is to pave the way for the creation of a new general pharmaceutical council.

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