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I am well aware of the noble and learned Lord’s views about House of Lords reform. The cross-party group has been established in the context of the vote in the other place for an 80 per cent or 100 per cent elected House. We know from our past history that unless there is political consensus, it is very unlikely that any progress will be made—hence the membership of the cross-party working group.
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Baroness Miller of Chilthorne Domer: My Lords, I welcome the Government’s announcement on the repeal of those SOCPA clauses clamping down on protests around Parliament. However, I should like to add that it is slightly unfair of the noble Lord, Lord Kingsland, to claim that the Conservative Benches fought vigorously against them. That tribute has to go to the activists out there with their lone demonstrations—particularly on Wednesdays—showing that the legislation was unreasonable, unworkable and unworthy of this country.
Before I get to my main question, perhaps I may ask the Minister about the people who since 2005 have been given a criminal record for a crime as minor as reading out in front of the Cenotaph the names of those who have lost their lives. What about those whose prosecutions are pending? I come to my main question to the Minister. Are there any examples pre-2005 of access to Parliament being seriously disrupted that the sessional orders did not cope with? It is our understanding that the legislation was introduced to deal with issues of terrorism and not with access to Parliament, the argument which has subsequently been developed.
Lord Hunt of Kings Heath: My Lords, on the substantive question that the noble Baroness raises on sessional orders, there has clearly been a lot of concern about whether some provisions of the SOCPA are necessary and whether they are an inhibitor to legitimate protests and demonstrations outside Parliament. However, there is also concern that if those provisions are simply repealed and problems arise in the future with regard to open and free access to Parliament and issues around noise there will not be sufficient powers to deal with those problems sensibly and effectively. We need to look at sessional orders in relation to the past experience of such orders. We have said that we will look to Parliament to give further advice on those matters and I am happy to take into account the noble Baroness’s comments on that.
Baroness D'Souza: My Lords, I should be grateful if the Minister could say what he means by consensus in the context of the cross-party group on House of Lords reform.
Lord Hunt of Kings Heath: My Lords, the consensus that I talk about is consensus between the political parties on the basis of the votes in the other place. Those votes were for two options: an 80 per cent or a 100 per cent elected House. That is the consensus that we seek. The Government have said that they aim to publish the White Paper, as I have already said, before the Summer Recess. Clearly, it is a government White Paper, but we hope that we shall have as much consensus as possible among the other political parties leading on to the next election, to manifesto commitments and, I hope, to legislation. We seek political consensus.
Lord Grocott: My Lords, I welcome my noble friend’s characteristically clear exposition of the relationship between the two Houses on war powers and treaties and his view, quite rightly, that in these
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Lord Hunt of Kings Heath: My Lords, I am not unaware of my noble friend’s strong views on this matter. He is absolutely right that, of course, war powers or international treaties must be subject to deliberation about a relationship between the two Houses were this House to be substantially or 100 per cent elected. However, I say to my noble friend that there is no reason why one cannot have a substantially elected second Chamber which, none the less, enables the primacy of the Commons to be maintained.
The Lord Bishop of Ripon and Leeds: My Lords, I welcome the comments in the Statement about the senior posts within the Church of England. Will the Minister reaffirm, in the context of the comment on no change to establishment, both the importance of the responsibility of the Church to the nation expressed partly, but by no means wholly, in membership of this House and the importance of some greater independence for the Church of England in making those recommendations to the Crown for senior appointments? There is still a good deal of work to be done with the General Synod in putting together those two important requirements.
Lord Hunt of Kings Heath: Yes, my Lords, the Government would very much welcome further discussion with the General Synod on the practical details of the new appointments procedures. I repeat what I said in the Statement. The Government remain committed to the establishment of the Church of England and greatly value the role played by the Church of England in our national life. The right reverend Prelate will know that Lords reform depends on whether the 80 per cent or 100 per cent elected option is chosen but, of course, we are ever mindful of the contribution that bishops of the Church of England make to your Lordships' House.
Lord Elystan-Morgan: My Lords, in the context of the intention of Her Majesty’s Government to repeal statute law in relation to the protection of Parliament from protests in its environs and precincts, I invite the Minister to study an episode that occurred in the first half of the 19th century. I think it was in the context of the bread riots. A volatile mob had gathered outside the House of Commons and, as Members entered, they were kicked, punched and thrown to the ground. They immediately sought to censure the Speaker, who had ordered a squadron of cavalry to
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Lord Hunt of Kings Heath: My Lords, that is a pertinent point. It emphasises the Government’s decision to seek the views of Parliament itself on whether work needs to be done, particularly on sessional orders. The noble Lord has expressed an important view.
Lord Norton of Louth: My Lords, as my noble and learned friend Lord Howe has indicated, this is very much a pudding without a theme. Therefore, the disparate measures encompassed in it will need extensive scrutiny by Parliament. Some specific proposals are to be welcomed. I very much agree with the proposal to place a statutory duty on the Lord Chancellor to report on Law Commission recommendations. In the Statement, this is separate from the Constitutional Renewal Bill. If it is to be a statutory requirement, would it not make more sense to include it in the Constitutional Renewal Bill?
On Lords reform, the Minister said that the intention of the cross-party group is to work towards getting the parties to put proposals in their election manifestos. In other words, it is a party aim. As such, the proceedings of the group are not covered by any of the exemptions in the Freedom of Information Act. Can we now see the papers, not least because they seem to have been released to the Financial Times?
Lord Hunt of Kings Heath: My Lords, I am grateful to the noble Lord for his comments about the Law Commission. We have already heard from the noble and learned Lord, Lord Howe, about the dangers of covering issues in too comprehensive a way. Clearly, we will need to feel our way forward as to how best to take forward Law Commission proposals. The noble Lord did not mention post-legislative scrutiny; he might have done because that was contained within a statement made by the Leader of the other place last week. The proposal that a law be reviewed by the relevant government department, and then by Parliament, three years after it has been passed, is an important one. I suspect we will debate that in due course.
As for Lords reform, the noble Lord will know that there have been some freedom of information requests, which have not found favour with my department. It really is important that the participants in the cross-party talks can talk freely in seeking the agreement that I have already referred to. I urge noble Lords to ignore leaks and speculation, and to be a little more patient. When the White Paper is out, we will have many happy hours debating it.
Baroness Crawley: My Lords, I am afraid that time is up.
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Health and Social Care Bill
4.54 pm
Second Reading debate resumed.
Lord Patel: My Lords, I am tempted to start by agreeing with the words of the respected noble Baroness, Lady Cumberlege. The words I am referring to are in relation to what she had to say about doctors, but maybe that will not be helpful.
I welcome the Bill and support much of it. However, there are areas, particularly in Part 1, that require greater clarity. My brief comments at this stage will be confined to Parts 1, 2 and 4. Time will not allow me to comment on other parts.
On Part 1, I strongly support the creation of a single regulator—the Care Quality Commission—with power to regulate for public and private providers of care and to impose penalties for breach of regulation. On the whole, the public favour having regulators and wish to see the regulator as independent, working in the best interests of patients and public, and with powers to deal with breaches. The regulator has to be able to demonstrate improvement. While having a regulator may in itself act as a lever to encourage care providers to achieve higher standards, the robustness of the regulatory requirement and threat of penalties will bring about the greatest change for the better.
The Bill appears to give the regulator power of independence and power to impose penalties, but is the scope of the powers wide enough and what will be the outcome indicators by which the regulator’s effectiveness will be judged? The very helpful document from the Department of Health says:
“The role of the regulator is to provide independent information and assurance that systems for safety and quality are in place and working well”.
In my view, when patient safety is compromised often the whole system of the care pathway needs to be examined. For example, the noble Baroness, Lady Neuberger, mentioned the case of Northwick Park where the maternal death inquiry had implications for lessons to be learnt by the trust, the PCT, the strategic health authority and community care.
I am aware that the department has had helpful consultation in this and other areas, and the Committee stage will allow us to consider that consultation and explore further what is in the Bill. We need to be clear about the standards that the healthcare organisations need to meet with regard to patient safety. I declare an interest here—I should have declared many interests past and present both in health and academia—as I am currently the chairman of the Patient Safety Agency in England and Wales. Currently all organisations have some system in place for patient safety, as defined in the current basic standards, but they fall far short of the organisation having to demonstrate that it has effective systems of reporting of patient safety incidents, learning from such incidents, implementing change and demonstrating improvement of care. We need to define the standards that the organisations have to meet.
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Part 2 deals with the regulation of health professionals. I support the proposals but have concerns about one—the appointment of responsible officers for monitoring locally the conduct and performance of doctors. I support the creation of the Office of the Health Professions Adjudicator. My brief experience of sitting on adjudication committees of the GMC makes me certain that this is the right way. If I have any concerns about OHPA, they are about costs and how they will be contained when OHPA itself does not have to raise finances.
Although others will no doubt have concerns about the civil standards of proof in relation to fitness to practice proceedings, I do not. I agree with the civil standards of proof, particularly as they will be applied flexibly. The medical profession, too, seems to be divided in its views—colleges and the GMC on the one hand and the BMA on the other. My concern about the appointment of a responsible officer is how effective that post will be, particularly if it is not properly resourced. It is not a role that can be combined with that of medical director, as proposed by some. I cannot see excellent clinicians rushing to become responsible officers.
I want to comment briefly on a matter that is currently being consulted on, but which is not yet part of the Bill—the current statutory education committee of the GMC becoming part of the GMC. I believe that the proposal is right, particularly as the role of the GMC—more so now than in the past—is moving towards medical education in all its stages from undergraduate to continuing medical education. The current education committee does a fantastic job, particularly given that, in the past, the council of the 120-member GMC was dysfunctional. With the new and expanding role of the GMC in education, it is right that the education committee should become part of it and not separate by statute, particularly as PMETB could also now be part of the GMC. I also believe that it would enhance the GMC’s role in working with universities—another area than needs to be explored. I know that my noble friend Lord Turnberg, who is not in his place, had qualms about that. I would go further: it should also carry out national assessments of undergraduate and early-phase specialist training. Again, it would be important for the education committee to be part of the GMC.
It would be surprising if I did not now comment on Part 4, which relates to the health in pregnancy grant. A grant of £190 will be payable from the 25th week of pregnancy to provide support for general health and well-being in the later stages of pregnancy. The evidence that financial costs leading up to birth are a major concern for women comes from a study by the charity Tommy’s. The grant is payable for a pregnancy, but approximately one in 35 children born is a twin or triplet. The costs for parents of twins are more than doubled; believe me, I know. Mothers carrying twins or triplets also have higher nutritional and other needs. Often, they have to stop work earlier and are at greater risk of complications. Should the grant not be for the number of children and not per pregnancy, and why choose 25 weeks when their nutritional needs start much earlier in pregnancy?
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Time does not allow me to comment on other parts of the Bill. I look forward to examining the Bill’s many proposals in detail in Committee.
5.02 pm
The Lord Bishop of Ripon and Leeds: My Lords, I thank the Minister for his concise introduction to this debate, and to welcome the Bill. I want to do that primarily in terms of how it aspires to draw together the provision of healthcare and of social care. There has long been a regrettable division between the provision of health and social care, particularly for elderly people. I believe that the Bill will be a major contribution to closing that gap.
The Care Quality Commission will have a major task in that area, and my first concerns lie with whether it will be adequately resourced to achieve that. It has a hard act to follow—particularly, perhaps, in social care. The Commission for Social Care Inspection has gained a good reputation in that field, and the new commission needs to build upon the work of CSCI and the other commissions, rather than starting again from scratch. In that respect, I hope that the Bill may be strengthened to make it still clearer that this drawing together of health and social care provision needs to happen at local as well as at national level. I am still made aware, far too often, of situations where one branch of local provision fails to co-ordinate its activities, visits or knowledge with that of another. There is work to be done if we are to provide the co-ordinated service that we crave.
Two particular points would greatly enhance this part of the Bill. First, there needs to be a better and more independent complaints procedure. That omission from the Bill, if I have deduced it rightly, seems eccentric. For there to be, in many cases, no recourse except to an ombudsman means either an expensive bureaucratic nightmare or, effectively, no provision at all. Secondly, and more crucially, I join with those who stress the need to use this opportunity to extend the Human Rights Act to private and voluntary sector care providers. The Minister referred briefly to that in his introductory remarks, and I hope that he will return to it when he sums up. These providers are performing functions of a public nature by any ordinary definition, but the Leonard Cheshire case ruling in 2002 means that elderly people do not have the rights to which they believed they were entitled and to which the Government intended them to be entitled. I applaud the care and love that is provided within the private and voluntary sector in health and care provision. That needs to be in the context of human rights legislation, and I am not reassured by the indication by the Minister in another place that that might be better left to a bill of rights. This is a particular, urgent situation. It needs to be dealt with now.
I note and welcome two further points. First, I support the changes in the professional regulation of clinical governance. The Office of the Health Professions Adjudicator is a major advance, provided that it is properly funded, and I welcome the Government working with the GMC on this issue to increase public accountability and public confidence. Secondly, I follow
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This is a good Bill. With small but crucial amendments, it could become a landmark Bill, particularly in the collaboration of health and social care services. I hope that the Government will respond to those needs, particularly by looking at ways in which that can be emphasised in the local context through the work of the Bill and of the commission.
5.08 pm
Lord Warner: My Lords, I rise broadly to support the Bill and to raise a few concerns about Part 1 on the Care Quality Commission. At the outset, I should declare my interests and confess some of my sins in previous incarnations. I am currently the part-time chairman of the NHS London Provider Agency. I also advise a number of organisations that work in healthcare, all of which are in the Register of Members’ Interests. While I am making a clean breast of things, I should own up to being the Minister who conducted the arm’s-length bodies review which in 2004 recommended that the Healthcare Commission and CSCI should be merged, so it is not my noble friend Lord Darzi who noble Lords should blame. I think that was part of the right policy of the Government to reduce the number of public sector regulators. When listening to the noble Baroness, Lady Cumberlege, who wanted light-touch regulation, it is worth bearing in mind that a smaller number of regulators might be a good start in that direction.
It should therefore come as no surprise that I support the unified Care Quality Commission. I understand some of the concerns of those who work in social care that they might be swallowed up by the health leviathan—I have been a director of social services—but having separate inspectorates has hardly produced equality of treatment in terms of attention and financial resources. With an ageing population, health and adult social care are locked into a symbiotic relationship whether they like it or not. As the right reverend Prelate said just now, this kind of change will ultimately benefit service users and make it easier to ensure we provide adequate access to social care expertise. No doubt in Committee we shall get into the issues around how we can safeguard and ensure that social care expertise is available to the new commission, as well as dealing with some of the serious human rights issues in relation to those in social care outside public provision.
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