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The inclusion of objectives is helpful in reinforcing the social care aspects of the commission. I was also delighted to see that the commission must now have regard to
“the efficient and effective use of resources in the provision of health and social care services.”
We tried to raise the issue of commissioning quite a bit in Committee, but the Minister resisted our various attempts to include a provision in the Bill, despite the fact that Anna Walker made a powerful case for one during the Committee’s evidence sessions.
It is probably fair to say, however, that those changes were not resisted as strongly as were the attempts to include LINks, and I am delighted that LINks are now included. Interestingly, I have picked out the same quote as the hon. Member for Eddisbury did from the Committee proceedings, when the Minister clearly said that he did not think including LINks was the right way to go, although he added that he would come back with clearer thinking on the issue. On Report, however, he repeated his earlier sentiment; indeed, we divided the House, and Government Back Benchers, almost to a man and woman, although not quite—there were a few honourable exceptions—agreed with him. I am almost tempted to find a way to divide the House now, to see whether Labour Members, as one body, have changed their minds, but that would be churlish, and we have to welcome what we have.
It is all very well including LINks, but some of us have grave concerns about how they will work in practice. They will be very different. They are supposed to respond to local needs. There is no formally prescribed set-up. LINks will have a different make-up in different parts of the country. I welcome the Minister’s mention of the fact that there will be a broader basis and a broader consultation, and it would be helpful if he could outline how that will be achieved.
I have a couple of specific questions for the Minister. Lords amendment No. 3 deals with
“Matters to which the Commission must have regard”.
It is right that it must now have regard to
“the rights of people who use health and social care services”,
which means the rights of everybody, not just specific groups. However, the use of the word “rights” got me thinking. At various stages in our consideration of the Bill, we have attempted to introduce a human rights-based
approach. It is relatively easy to define human rights, and although it is not always easy to enshrine them in new legislation, such legislation does help us to define them. It would be helpful if the Minister could clarify whether the word “rights” is intended to include human rights, whether it is intended to be broader, and what is meant by rights. I do not think that the term has particular legal meaning, so a broader outline of the Minister’s thinking would be helpful.
I also have a question about Lords amendment No. 4. Although I am delighted to see a focus on user involvement, the proposed new clause strikes me as potentially tokenistic. Although the commission has to publish a statement describing how it proposes to involve users and carers, it is not clear when that is supposed to happen. The proposed new clause mentions periodic reviews that must be consulted on, but it does not say by when we should have the statement. Again, it would be helpful to have some clarification from the Minister when he sums up.
Finally, I welcome Lords amendment No. 66, which would make it clear in the Bill that a full range of knowledge must be represented on the commission, and that is clearly important. The chair of the commission has now been appointed, and in her evidence to the Select Committee she was very open about the fact that she knew little about social care. Knowledge has to be taken into account, so it would be useful to have further clarification of the depth of knowledge expected, of whether one board member will be enough, and of whether there will be attempts to create a balance. Although there has to be a full range of knowledge, the balance could still be tilted if the composition of the board changed over time and this principle were not kept at the forefront of thinking.
Mr. Bradshaw: I share the slight disappointment of the hon. Member for Romsey (Sandra Gidley) at the ungracious tone adopted by the hon. Member for Eddisbury (Mr. O'Brien). We made it clear throughout Committee that we were in listening mode, and open to constructive suggestions as to how to improve the Bill further. The hon. Gentleman referred to the contribution of his noble Friend Earl Howe when the Bill passed through the other place—and Earl Howe described the Government amendments as diamonds and gems. If the hon. Member for Eddisbury wants me to outline the exact differences between these amendments and those that he proposed in Committee, I shall be happy to do so, but let me say that his amendments were closer in form to stones and pebbles than to diamonds and gems. That is why we tabled our own amendments; if we had not, he would have criticised us for not listening and not improving the Bill. Thanks to the contributions of noble Lords from the Conservative, Liberal Democrat and Labour parties, as well as Cross Benchers in the other place, the Bill has been considerably improved, and I had hoped that the hon. Gentleman would have found it in himself to welcome that.
The hon. Member for Romsey asked about rights. The answer to her question is that the rights include human rights, but are not exclusively about them.
Lords amendments Nos. 2 to 5 agreed to.
Mr. Bradshaw: I beg to move, That this House agrees with the Lords in the said amendment.
Mr. Speaker: With this it will be convenient to discuss Lords amendments Nos. 7 to 23, 26 to 31, 53, 54, 67 to 72 and 84.
Mr. Bradshaw: This group consists of concessions, where we have listened and responded carefully to debate, and some minor technical amendments. Amendments Nos. 15, 16, 18 to 21 and 28 to 31 make it explicit that, as has always been our stated intention, the new regulator must conduct periodic reviews of care commissioned by primary care trusts or local authorities. Amendments Nos. 18 and 19 mean that, following a special review or investigation, the regulator must consider whether the report raises issues on which it should advise the Secretary of State.
Tabled in response to discussions on the independence of the new commission, amendments Nos. 17, 23 and 26 would moderate certain powers that the Secretary of State will have. We have also put on the record the fact that the commission can decide for itself when it begins its special reviews.
Finally, amendments Nos. 8 and 72 make even more explicit the need for providers to learn from complaints, and require LINks to send their annual reports to the commission. Amendments Nos. 53 and 54 result from recommendations of the Delegated Powers and Regulatory Reform Committee, while the remaining amendments are simply technical and are intended to improve the Bill. I hope that the House will support them.
Mr. Stephen O'Brien: I shall use precisely the same words as I used in my opening remarks on the previous group of amendments. I welcome—the Minister and the hon. Member for Romsey (Sandra Gidley) both seemed to miss my saying that—the majority of the amendments, which again pick up on points made by Conservatives in both Houses. It does not matter how much the Minister and the hon. Lady wish to deny that they were Conservative initiatives, they were indeed proposed by us in both Houses. I am pleased to say that some of them were supported by other Opposition parties.
I am glad that the complaints function is addressed in regulations, although I fear that there are unresolved issues for patients, particularly for self-funders in social care. I am glad of greater scrutiny for prison and defence health care, although I retain some concerns about the powers of the Executive over that. I am glad of the amendments that limit the powers of the Secretary of State, but I am disappointed that no substantive amendments were achieved on malnutrition, given the powerful debates on that both in Committee and on Report.
Amendments Nos. 6, 7, 9 and 11 are not controversial. Amendment No. 8, however, merits a bit of discussion. In addition to the handling of complaints and disputes, it enables regulations to make provision for the application of lessons learned from them. I am pleased to see the
amendment on the amendment paper. It recognises that an effective complaints process includes a performance management output, so that mistakes are not repeated and loopholes are closed. I again pay tribute to my noble Friend Earl Howe for championing the amendment in another place, and I am pleased that the Government made the concession. However, it comes nowhere close to addressing the serious concerns that remain about the complaints arrangements both within registered providers and on a national scale through, inter alia, the parliamentary and health service ombudsman. I draw the House’s attention to cross-party concern on that.
The hon. Member for Luton, North (Kelvin Hopkins) made a number of powerful speeches on the subject in Committee, saying:
“A number of my hon. Friends, not necessarily members of the Committee, are concerned about changes in patient representation and procedures for patients making complaints in recent years.” —[ Official Report, Health and Social Care Public Bill Committee, 17 January 2008; c. 346.]
He was supported by the hon. Member for Tamworth (Mr. Jenkins) in holding the Government to account for their failure in that respect. The amendment fails to address three issues—resourcing the ombudsman, monitoring trends, and supporting complaints by social care users.
If you remember, Mr. Speaker, the Committee had three evidence-taking sessions before it considered the Bill in detail. In the ombudsman’s written evidence, she said:
“I have already explored with the Treasury the additional funding I am likely to require”.
However, no figure has been put on that. This is a serious issue, as the saving made by the Care Quality Commission will no doubt be reported as a gross saving by the Department, but could be a net loss to the taxpayer.
I must remind the Minister that at column 348 of our Committee proceedings he promised to write to me with “the exact figure”—a promise that his letter MS (H) 103035 failed to deliver on, dealing with the issue only in the broadest terms. It is disappointing that the Bill has reached its final stages, with this amendment, without that information coming before the House. I complained about that on Third Reading, but have had no response from the Minister.
Looking at the complaints that the Healthcare Commission has received, the ombudsman faces a potential elevenfold increase in her work load. How much will that cost? We need to know whether the cost is admitted by the Treasury, or is it in denial of the costs of its very own legislation? Has the ombudsman been given the assurances and budgets requested and required? If not, why not? If the Minister does not know the answer, then after all this time, why not? If he does, but will not give it, surely we are right to place the question on the record.
Angela Browning (Tiverton and Honiton) (Con): Associated with my hon. Friend’s comments is the fact that I am still unclear—I wonder whether he or, eventually, the Minister can clarify this—how some of the lessons learned and how the complaints procedure generally, whether it is through the Care Quality Commission or the ombudsman, will translate into changes of policy in either health or social care?
Mr. O'Brien: 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 bed-watch campaign, until it was summarily scrapped.
4.30 pm
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”
“adult social services commissioned by an English local authority”
“health care provided by other persons pursuant to arrangements made by the Trust”
“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
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