I welcome the Governments proposal to establish the care quality commission, in order to deliver a seamless package of care between health and social care. There are not two different groups of people, one that receives only health care and another that receives only social care. There is already a mix. Sadly, however, some people find it difficult to get a seamless progression of services through health and social care. I was at a meeting with Blackpool PCT on Friday, at which I discussed that very issue. I was pleased to hear that Blackpool PCT is already developing integrated care packages for patients, so that it can look at what an individual needs, from an ambulance to take them to hospital and the acute care that they will receive to the after care that they will need, thereby treating the individual as a whole person, not as a care episode, a health episode, then another care episode and probably another
health episode after that. If by introducing the care quality commission the Bill helps PCTs to deliver that sort of integrated package of care, it will be very much welcomed.
As I mentioned in my earlier intervention on the Secretary of State, there are concerns in the social care sector that social care will be a second-level partner. It must not be, not only because of the individuals receiving that care, but equally because we cannot afford to lose the excellent work that the Commission for Social Care Inspection has done over recent years. Dame Denise Platt has offered leadership to CSCI, which has raised standards in social care, increased the profile of social care and undertaken important research. Above all, CSCI has listened to care users and their carers. I read CSCIs annual report with interest. It is not often that I read annual reports with interest, but every hon. Member should read CSCIs annual report, because it outlines what social care is provided, how it has changed and how it will continue to change.
I strongly believe that the hard work that CSCI has done needs to be taken forward and put at the centre of developments for the new care quality commission. My question for the Minister is: how is it going to do that? How will the new commission deal with the fact that 24,000 of the 30,000 registered health and social care providers are in social care? The new commission will be dealing on the one hand with NHS facilities and any health facilities that are large and, on the other, with a multiplicity of social care providers, the majority of which will be small independent providers in the private sectoroften, small and medium-sized businesses. Bringing together the Healthcare Commission, CSCI and the Mental Health Commission in this new organisation will therefore require changes of practice to address the different forms of facility that the new body will register and inspect.
It goes beyond that, however. I am talking not only about the nature of the facilities but about the differences, which the commission will address, in policy background in health and social care. Health and social care often start from different perspectives. Heath care usually works on the precautionary principle: we see an illness, respond to it, write a prescription or perform an operation. Social care, however, has traditionally been in the risk business. It involves seeing how far someone can cope on their own, and giving them a bit of support while leaving them in their own home in the community. We are going to have to bring together those two very different ways of working, while maintaining the proper roles of the health care and social care professionals.
Interestingly, the all-party parliamentary group on social care, which I chair, is undertaking an inquiry into the changing role of the social care profession. That role is changing, but social care professionals want to hang on to what makes their role special. It will be an important job of work for the commission to ensure that it acknowledges that, and that it acknowledges the differences between health care, social care and mental health care, now that they are all within the same remit.
The commission will have to acknowledge very real differences in another area as well. The NHS is free at the point of delivery, but social care customers pay. They are at the very least assessed to see whether they
should pay for most of the services that they receive, and large numbers of them do pay for day care, domiciliary care or residential care. Those paying customers will want their voices to be heard. Concern has already been expressed about how the voice of the user will be listened to by the new commission.
There is a tension between the Governments understandable desire for light-touch regulation and the need to safeguard vulnerable individuals in health or social care. Sadly, having policies in place is sometimes not enough, because those policies are delivered by fallible individuals. Inspection to see how individuals are applying the policies that we determine is therefore vital. As I understand it, the new commission will have a less frequent inspection regime. Indeed, some social care providers might not see an inspector more than once every three years.
I listened with interest to an answer that the Secretary of State gave following an intervention on this point. He quite rightly asked why, if someone was doing their job well, we should go round and inspect them every other week. Of course we do not need to do that. However, many social care establishments have a high turnover of staff. I do not have the statistics on health care. A snapshot visit on day one might reveal an excellent care team delivering high quality services, but that does not mean that that same high quality team will still be in place a month, six months or a year later. I wonder how the new commission will be able properly to monitor the huge number of social care establishments that experience a high staff turnover. There is a particular danger involved when senior staff leave, whether the manager of an establishment or a member of the senior team. Those people set the tone for an establishment. They make sure that new staff are trained to work with vulnerable individuals. I hope that the Minister will be able to reassure me that the new commission will look at an appropriate inspection regime for that multiplicity of social care establishments.
The Bill requires the commission to establish an advisory committee to ensure that it takes into account the views, advice and information coming from people such as providers and users of social care. It should listen to the views of the public on activities within its remit. Again, my question is: how will this work? How will this be achieved in practice?
Sandra Gidley: I am listening with interest to the hon. Lady, and she might be about to raise this point. It is all very well having an overarching group of the great and the goodnamely, patients who are known to the system. Does she agree, however, that the benefit of the way in which CSCI has worked has been to ensure that, when an inspection takes place, local views are taken on board?
I agree with the hon. Lady. I also agree with her earlier remarks about the rights-based approach of CSCI. In my opinion, it is important that that should continue into the new commission. The rights of service users and their carers must be at the heart of the development of the new system of registration and inspection. If they are not, there is a real danger that the voices of people who are reluctant to speak up will not be heard. Patients in hospitals have access to the patient advice and liaison service
PALSthat the Government set up. Those patients are in larger establishments, with more people coming in and out and a larger group of trained staff on hand. Care homes are often small, with a small number of staff and often, sadly, very few visitors, and the people living in them can become isolated. In that context, the voice of the user of those services really must be heard.
The Bill does not include a requirement for the commission to seek the views of the public. However, two other groups mentioned in the Billthe office of the health professions adjudicator, in clauses 100 and 101, and the council for healthcare regulatory excellence, in clause 108are explicitly required to seek public and service user opinions. Perhaps the Government intended the advisory committee to fulfil that role. If that is the case, I would like more information on how the voice of users is to be heard.
At the risk of overusing the word vulnerable, I must stress that we are talking about the very vulnerable people who receive these services. I want to mention two groups in particular. Clause 44 will allow the commission to undertake special reviews and investigations. The first group that I want to mention is children with disability. My hon. Friend the Minister might recall that, last year, together with my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), we held a series of parliamentary hearings on the needs of children with disability. One issue that came out clearly from those hearings was the difficulty that many of those children and their families experienced during the transition from childrens services to adult services. I hope that the new commission will work closely with Ofsted to see how childrens services can be moved forward into adult services in the context of children with disability.
The second group involves adults with disability, especially adults with learning disabilities. Sadly, we have had too many instances of inequality of treatment of adults with disabilities, in health care and social care.
The hon. Member for Romsey referred to Cornwall Partnership NHS Trust, which was in a truly shocking state in 2005. The trust had three stars in 2004 and it had two stars in 2005. When it was awarded those stars, was anyone looking at the care on offer? When CSCI and the Healthcare Commission investigated, they described incidents such as
staff hitting, pushing, shoving, dragging, kicking, secluding, belittling, mocking, and goading people who used the trusts services.
In March this year, Mencap produced a report, Death by indifference, which again detailed cases of institutional discrimination within the health service against people with learning disabilities. We really must ensure that the new inspection regime looks at the quality of the care delivered; it should not be just a tick-box regime, behind which examples of unacceptable practice could be hiding.
The commission will look at how local authorities and other organisations deal with complaints, but it is sometimes by listening to complaints that we find out what is happening on the ground. I hope that the Minister will look at the commissions role and ensure
that, in reflecting on how local authorities and individual organisations deal with complaints, it will be able to build up a picture and perhaps identify systemic complaints. If the same organisation receives the same complaints time and again, there may well be something seriously wrong, and the commission needs to be able to identify that.
About 35 per cent. of people are self-funded in the social care field. They, rather than the local authority, pay for it, so they cannot bring complaints to the local government ombudsman. They have to complain to the person who runs their home. Will they make such complaints if they feel vulnerable within their establishment? If someone else complains on their behalf, how will the new commission find out about it? Again, we are talking about people in isolated settings throughout our communities. A complaints structure provides a good way of building up a profile of when things are going wrong.
Finally, I want to say a few words on the social care work force, which the all-party parliamentary group on social care is looking into. The General Social Care Council has raised with me questions about its role on the new commission. The GSCC has already registered social workers, but it is rolling out its registration regime. How will it work with the new commission to ensure that people who work in social care are registered, properly trained and have all the necessary qualities to deliver social care to vulnerable groups of people?
As a newly elected MP several years ago, I recall sitting in the Committee scrutinising the Care Standards Bill. That is one of the best Acts that the Labour Government ever introduced because it addressed the delivery of quality care. If the Bill is to succeed, we must ensure that the new care quality commission will pick up all the good points that were embodied in the Care Standards Act 2000 and ensure that vulnerable peoplewhether they be in a health care setting or a social care settingare protected, listened to and supported. That will be the test against which the legislation will be judged.
Peter Bottomley (Worthing, West) (Con): I hope that the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) will forgive me if I do not follow up all the points that she has presented to the House.
I start by paying tribute to Peggy and Arthur Wynn. She wrote the first book on family policy in the 1960s. Family policy, or trying to put the family life cycle and family perspective into social and economic policy, has now become a more generally accepted idea. Some people used to think of it as population policy. That is not for us. It can apply to what might be called the private aspects of public health. One of the points that Peggy and Arthur Wynn drew to our attention was the need for pre-conception care, which cannot come from public authorities or commissions.
Whatever the benefits of having child benefit during the later stages of a pregnancy, the health of the mother can be affected when the father smokes, for example. That can affect rates of birth handicap. Some congenital malformation is perfectly normal, but some can be severe. Some of the severe ones can be affected
by the state of the mothers health and the fathers behaviour before conception. I believe that we should pay more attention to those issues. We could then add on the sort of provision that the Government are offering through the Bill. It is getting the culture right that matters.
The French, for example, decidedin the 1960s, I believethat they wanted to deal with difficulties affecting birth and infancy, so they set out a seven-year programme with various targets that they wanted to achieve. They actually achieved the targets within a year and a half of launching the programmelong before the measures that they had introduced had any chance of having an impact. They were raising awareness and consciousness, and getting people to do more of the things that worked and fewer of the things that did not work. I hope that people will view this debate in the context of trying to get people to do things that are more consistent with what they want for themselves and for those whom they love most.
We should try to ensure that the early stages of pregnancy get the right degree of attention. I declare an interest, as a member of my family is involved in early-stage pregnancy. Having heard that the Royal Pharmaceutical Society is likely to lose its regulatory impact, I would also like to say that I am the great grandson of the last personand for all I know, the first personto be president of the Royal Pharmaceutical Society without being a pharmacist. But that is so far in the pastit was 100 years agothat it is not relevant now.
On early-stage pregnancy issues, research will reveal more of what people would want to know, but we already know enough now to be able to say that once someone discovers that they have contributed to conceptionthis applies as much to the father-to-be as to the mother-to-becare and concern matter. We want to get away from what could be characterised, probably falsely, as a bipolar approach to pregnancy: too many of us have our conceptions when we do not intend them, when we are very young, and too many of us delay them far too long. We need to get back to the stage of saying that creating a new child is a perfectly normal and natural thing to do and it should not have to be put off until people can afford to buy a house in their 40sbut it should not be done quite so often and so blindly by people in their teens. In effect, we want more people nowadays to make fewer of the mistakes that we ourselves made in our time.
On the regulation of the professions, I want to declare my general view that it is often easier to make an existing system work better than to have thorough reviews and a thorough all-change. That is not what we are facing. There seems to be reasonably bipartisan agreement that the preparation for the changes in regulation is worth while.
I back up what the Chairman of the Health Committee said about the civil standard of proof. This is not as big a change or contrast as people have thought. The reason why I raise the matter is that when I served on the Standards and Privileges Committee, we were considering possible offencesand certainly some actions by some of our fellow Members of Parliamentand there seemed to be a general view that the worse the implications of finding someone guilty of bad behaviour, the higher should be the standard of proof. It almost reached the stage where
something could not be proved. Just because something cannot be proved, it does not mean that we cannot take action, or that by examining the matter in public at some stage, we cannot get people to understand that someone will say to them, as they would say to me, for example, if I were the person involved, Youve got to do betterget some retraining, or stick to the part of the job youre good at and stay away from the part youre not good at. Only in very rare cases is it found that no one knew what was going wrong.
I remember some years ago being told by a GP in south London, where we then lived, that his job was to go around saying to other GPs, Look, you can fight this out in public if you want, but I want to tell you that many of your colleagues dont think youre good enough at what youre doing in this particular area. Please focus on the things that you are good at, where youre making a great contribution. It is not as if people have no right of appeal, or cannot ask for the matter to be examined in a rather more official fashion. It is the same sort of public service that the Whips provide in the Housein a way.
I also think that we should look for standards of proof of competence, rather than always looking for standards of proof of incompetence. Given the changes that are taking place in, for instance, medicine and sickness care, most people want to demonstrate that they are capable of doing things in a way that has been shown to be better. Obviously an innovative procedure may be challenged. I remember when, 50 or 60 years ago, the wizard of Wigan started to provide hip replacements. First it was said that they would not work, and then it was said that even if they did work, no one would be able to afford them. Now I have constituents who are on their fourth or fifth new hip. That is a normal development: we are used to it in many other parts of medicine, and we should allow for such innovations. Keyhole surgery, for example, became a fashion, until people discovered that in many cases it was not being done very well; now it is being done very well indeed.
I pay tribute to one of my constituentsI suppose that, for reasons of medical confidentiality, I should not name himwho worked on the campaign to save Worthing hospital. Instead of coming to lunch with me today, he had a heart attack yesterday. He was diagnosed and taken to hospital, and had his operation today, with a doctors balloon up an artery. He is now 100 per cent. fighting fitor, at least, happy; it will take some time for him to recover fully. Such cases are a result of innovation and professional standards, and I pay tribute to the doctors, nurses and others who cared for my constituent. Lunch could be postponed but the operation could not, and I am glad that Worthing hospital was still there to provide it
Clause 119 has received no attention so far. Obviously Second Reading is not the time to go into great detail, but Liberty has contributed a useful thought about the provision for a magistrate to exercise major power, suggesting that except in emergencies a magistrates court, rather than just a single magistrate, should be involved. Perhaps the issue could be dealt with in Committee. When a magistrate signs a detention orderwhich is only one of the powers available to himit may be challenged, although on many occasions it will be accepted. If the order is challenged, could it not be put to the magistrates court for confirmation?
Perhaps on Report, when the Committee has had a chance to consider the matter, we could have a fuller debate on whether Libertys point should be followed up, or at least adapted. Clearly the power to detain someone with an infectious condition or for failing to accept treatment, or for some other reason, is necessary, but I do not think that the provision should automatically be passed because of other issues of regulation. If a persons liberty could be at issue, we ought at some stage to engage in a full and open debate on the Floor of the Housefor the protection of the public, if not for that of the person concernedand it would seem appropriate to do so on Report.
Clause 41 states that the Secretary of State must consult before making regulations. The people whom he consults will be chosen by the Secretary of State himself. That raises a point of trust. I think that whoever holds the office of Secretary of Stateand it is a matter of public record that I am married to someone who once held that officewe ought to be able to trust that person and his or her advisers. We should resist the temptation to throw a few jokes around, and say that while Secretaries of State and their advisers may not necessarily be perfect, they ought to be able to run a system allowing open and genuine consultation before the laying of regulations. The public ought to be aware of the points that are made, and the Secretary of State should have to defend the decisions that are eventually made. However, I cannot claim that the system always works.
I end by paying tribute to the Health Committee. I attended its first hearing on Modernising Medical Careers and the medical training application service. The officials who gave evidence made an opening statement that allowed the tone of the meeting to be far more useful than it might have been otherwise. However, we need to know at some stage how so many people became involved, and why the outcome wasI am using very gentle language hereso inappropriate.