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29 Apr 2008 : Column GC1

Grand Committee

Tuesday, 29 April 2008.

The Committee met at half-past three.

[The Deputy Chairman of Committees (Lord Faulkner of Worcester) in the Chair.]

Health and Social Care Bill

(Second Day)

The Deputy Chairman of Committees (Lord Faulkner of Worcester): First, I must make an announcement that if there is a Division during this Sitting, the Committee will adjourn as soon as the Division Bells are rung and will resume after 10 minutes. I should also announce that at a convenient point about two hours into our consideration of the Bill, it is expected that the Committee will be adjourned for 10 minutes.

Schedule 1 [The Care Quality Commission]:

Lord Lipsey moved Amendment No. 7:

The noble Lord said: I need not detain the Committee long on this amendment because from the moment the issue of pay was raised with Ministers, it was clear that they were already on the case. Indeed, a strong rumour, on which I could not comment, says that they have their man—or woman—for the job. They certainly would not have done that if they had not persuaded themselves that something had to be done on the pay front. As I say, I expect that the Minister will be forthcoming and I shall not detain the Committee long.

The pay issue matters not just because of the pounds, shillings and pence in someone's pocket, which they may or may not need, but because it is a symbol of the importance of the job and the amount of responsibility that goes with the job. Thank God, I will not have to do it. I think it would have been seriously misunderstood in the sector if a good fight had not been put up for decent pay to go with the job. I do not believe that I need to say any more until the Committee has had a chance to hear the Minister.

Baroness Howarth of Breckland: If that rumour is so, I raise rather a serious issue. Irrespective of any personalities or any individual job, if a job is to be paid at a much higher rate than that at which it has already been advertised, I understand that under the Government’s own rules—certainly those rules that they supply to charities which receive grants from them—that job would have to be readvertised. I hope that that will be looked at. If someone has already been selected and will be paid more without the job being readvertised, some quite serious questions could be asked.



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Lord Lipsey: I may have misled the Committee. I meant to say that they had the right man or woman in their sights, rather than that they had got them.

Baroness Howarth of Breckland: I was just raising the question.

Lord Lipsey: I take the point. I beg to move.

Lord Warner: Perhaps I may follow up the point made by the Baroness, Lady Howarth. I have some concerns as someone who has, from time to time, been rung up by headhunters and been approached by a number of other people who have asked, “Would I be wise to get involved in this job?”. My response has usually been, “Not at that rate of pay, if you have any sense”. If someone has been lined up and if this is to be done without further advertising, how do the Government know what they have missed? I can assure the Minister that there are a number of people who have not come forward because of the way in which that job was advertised originally and at the salary at which it was advertised. It was not just a matter of money but the status that was implied by the job description and salary.

There are some issues for the Government. No one wants to delay unnecessarily the appointment of a new chair, but if the Government do finger someone—I know that Governments of all parties have been known from time to time to finger people for these difficult tasks and encourage them to apply for particular jobs—or that has been done, there is a process issue to which the Government ought to give some thought.

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): I would like to update the Committee on the progress of the recruitment exercise for the shadow chair of the Care Quality Commission. At Second Reading, I promised that I would look at this as many noble Lords expressed concern. I can confirm that the Appointments Commission has conducted an independent recruitment exercise based on the advert that the noble Lord referred to and made a recommendation to the Secretary of State. As the Secretary of State announced in January, he intends to invite the Health Select Committee to hold a hearing to enable pre-appointment scrutiny of the Government’s preferred candidate before making his final decision. I expect an announcement to be made tomorrow lunchtime on this next stage of the appointments process. I will write to noble Lords at the time of the announcement.

I would also like to clarify a point made during our previous day in Committee about the advert for the shadow chair which appeared in the Guardian newspaper and on its website on 13 February 2008. I would like to make clear that the Appointments Commission has acknowledged and apologised for the inappropriate placements in the newspaper and on the website. As part of the current recruitment process, the Appointments Commission arranged for the advert to be rerun the following week in more suitable positions in print and online.



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Turning to the amendment, there is no doubt in my mind that the senior leadership of the Care Quality Commission needs to be of a sufficiently high calibre to ensure that it can deliver its statutory functions effectively. The commission will be a powerful new independent organisation responsible for regulating services across the health and adult social care sectors.

Baroness Tonge: Can the Minister explain to me, a relative novice, how it is possible to advertise a job that has not yet been approved by Parliament for a body that has not yet been approved by Parliament? It could be overturned, or at least delayed for a year, by the House of Lords if we do not satisfy ourselves that we want this legislation. I ask in all innocence as I do not understand why the Government have jumped the gun.

Lord Darzi of Denham: We are appointing a shadow chair, not the chair of the CQC. As many noble Lords highlighted at Second Reading, continuity is one of the most important functions of the CQC as it takes its role in due course when the Bill is enacted after having gone through all its stages. I remind the Committee that we are appointing a shadow chair. The post was advertised through the independent Appointments Commission.

Baroness Tonge: I am sorry to intervene once again, but I need to be clear on this issue. If it is a shadow chair, does that mean that the advertisement will be reinserted in the press, the shadow chair will not automatically become the chair of the commission and there will be a proper competition for that post?

Lord Darzi of Denham: We are appointing a shadow chair with the intention of appointing the chair of the CQC, but I will be more than happy to look into this and get the noble Baroness a more detailed legal answer in relation to the appointment if she wishes.

Baroness Barker: I wish to add one thing and I do so happy in the knowledge that I have no interest to declare and will not have in the foreseeable future. One of the principal concerns that I raised at our last Sitting was not the level of remuneration for this post but the requirements of the job, particularly for the chair, which paid no attention whatever to the fact that this person had to have an understanding and experience of local government and social care. I am an avid reader of Wednesday’s Guardian and I have been looking deeply into the far more interesting post of chief executive of the CQC, which was advertised a week or so ago. In that advert, it is clear that the Government have paid some attention to points raised by noble Lords, although not enough in my view. It mentions the need for the person to have an understanding of local government and to know what a comprehensive area assessment is. However, nothing the Minister has said has allayed my fears that this recruitment process, as it has been outlined, is heavily

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biased towards health—almost exclusively. The fact that the Health Select Committee will go through the pre-appointment process offers scant hope that that in itself will be rectified. I hope that when the Minister responds more fully he will pick up that point which, for some of us, is by far the most important.

Lord Low of Dalston: I put my name to these amendments and I am moved to get to my feet because I have not yet heard anything to suggest that the Minister has fully taken their force with regard to the salary at which the position is to be remunerated. As things stand, the post looks as if it has been downgraded when compared with current arrangements for the remuneration of the chairs of CSCI and the Healthcare Commission. I have a raft of statistics relating to the different rates at which chairs of public sector bodies are paid, but it would be otiose to weary the Committee with them. Suffice it to say that there seems to be neither rhyme nor reason to them. There is no discernible pattern. Some seem to be paid at one rate and others at another, although they may have lesser budgetary responsibilities.

It is difficult to discern a pattern, but one thing is discernible. This post of shadow chair—as we are now to call it—of the CQC is, according to the advertisement, to be remunerated at a rate markedly below the level at which either the CSCI chair or the chair of the Healthcare Commission is remunerated. That looks like a downgrading in my book. I understand that the Minister is to make an announcement tomorrow, but it would reassure the Committee if he were able in responding to give some indication that he has taken on board the concerns raised by the Committee about the level of remuneration for this very important position.

Lord Warner: As a Minister when the present incumbents were taking up posts, it might help if I share with the Committee the benchmark in setting the pay of the chair of the Healthcare Commission. As I recall, that benchmark was the pay of a High Court judge. That was the level of seriousness with which that post was equated. Then there was a comparability issue for the chairman of CSCI.

I say that not because I necessarily think that was the right benchmark, but it gives an indication of the way in which only a few years ago this type of job was viewed by this Government. There is an issue. It is not the Minister’s fault that we are in this situation. It is not too late for the Government to reflect a bit further on consistency in the term of office of this Government and on why we have made this rather dramatic change in five years. Nothing that I have read about the new job suggests that it is in any way not comparable at least with what the present chairman of the Healthcare Commission is paid and with what the present chairman of CSCI is paid. I encourage my noble friend to say to his colleagues, however far down the track they are with particular individuals, that they really need to reflect on how this is seen and they need to think about consistency of action within the term of office of a Government.



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3.45 pm

Lord Darzi of Denham: First, let me address the point made by the noble Baroness, Lady Barker, about the scrutiny process. I cannot think of a better scrutiny than parliamentary scrutiny, and the Health Select Committee as it stands covers social care and the whole activity of the Department of Health. The shadow chair will be confirmed only once the legislation has passed. That was made clear to the candidate who applied for the post as advertised.

There is no doubt in my mind that the senior leadership of the Care Quality Commission needs to be of a sufficiently high calibre to ensure that it can deliver its statutory functions effectively. The commission will be a powerful new independent organisation responsible for regulating services across the health and social care sectors. It will have significantly greater powers than the current regulators, which it will replace, and it will seek to assure people who use the service and patients that all the services they receive are fair, personal, effective and safe.

We do not believe that the advertised range of the chair’s salary will adversely affect the capability of the new organisation. Let me put the figures into context. The post, which is a part-time, non-executive role, was advertised at the rate of £60,780 for a time commitment of up to three days per week. The advert also made very clear that more was available for an exceptional candidate. The remuneration offered is at the top end of the current Department of Health arm’s-length body pay scales and compares favourably with the salary paid to some other publicly appointed non-executive chairs of regulatory bodies.

A chair’s pay in any organisation must be seen in the context of the planned balance of responsibility between non-executive and executive appointments in the organisation. We expect the new commission to appoint the highest calibre chief executive and other senior executives jointly to realise the vision that the commission creates. I am sure that noble Lords would agree that it is important that we are sensitive to public perception and to general trends in public sector pay with respect to the salary of the new chair. However, we recognise that there is a balance to be struck to attract the right calibre of candidate for the post, and I believe that the advertised salary does exactly that. I therefore ask my noble friend to withdraw the amendment.

Lord Lipsey: I had rather hoped for more from the Minister. There is a sort of ambiguity about what he said, because he said what the advertised range was, and then he said that more was available to an exceptional candidate, but he did not say whether a good deal more was going to be paid. I hope that this paragon of a candidate, who will be announced tomorrow, will be such that it must be much more, but we will have to wait and see.

Although I do not wish to persist with the amendment today, we will want to see the colour of the money that the Government are providing for the preferred candidate, and it is within the power of Parliament at a subsequent stage of the Bill to act in line with the amendments proposed by the noble Lord, Lord Low, and me, to up

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that package if we think that the Government are so frightened of the public complaining that they are providing an inadequate salary to advertise the importance of the job.

I must admit to another concern that has arisen out of the Minister’s statement; I make no bones about it. This House has not yet agreed that a new regulator should start in office, as proposed by the Government, with the powers set out in the Bill. I moved an amendment the other day—which I withdrew because we do not vote in Grand Committee—to say that it should not happen before 2013. I believe that the noble Earl, Lord Howe, is this afternoon proposing that Clause 2 does not stand part of the Bill. I have been in this House a while and we are flexible, reasonable people. The one thing I have found about noble Lords is that they do not like being taken for granted. The Government are announcing this appointment tomorrow, when noble Lords have not yet had a chance to come to a stern and settled view as to whether it should be going ahead. Members of the Committee will want to consider carefully whether the obvious needs for due dispatch in proceeding with this, if the Bill goes through, have been rightly balanced with noble Lords’ concerns that these matters should be fully debated and decided by the House before the Government go ahead.

In withdrawing this amendment, I say that those two concerns must be met before we come back to this on Report, at Third Reading and even, perhaps, beyond. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 8 and 9 not moved.]

Baroness Finlay of Llandaff moved Amendment No. 10:

The noble Baroness said: I shall speak also to Amendment No. 11, to which I have added my name, on behalf of my noble friend Lady Campbell, who sends her apologies for absence because of a prior commitment.

Amendment No. 10 is supported by the National Consumer Council, the Picker Institute and Which?. It aims to put users at the heart of the regulatory process by bringing them into the commission’s governance structures to influence the development of plans, programmes, methodologies and approaches at a formative stage through insider engagement. It is intended to bring patients, users and carers into the formative processes of the commission’s workings.

Current consultation with service users is usually over specific projects or established work patterns when plans or decisions are already well formed, and involves users in inspections or reviews the methodology and approach which have previously

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been formed elsewhere. In other words, users are usually involved relatively late in the day and can seem almost tokenistic.

The amendment would require the commission to set up a panel to oversee the work of the regulator, reaching out to and feeding back from a wide range of user and public views and experiences. It would focus on helping the regulator to carry out its functions, including setting themes and priorities for review, and shaping regulatory processes. The panel should not be dominated by professionals from charities or lobby groups but must ensure strong representation of service users themselves, particularly those who are vulnerable or seldom heard.

What would the amendment achieve? The model for the service user panel is partly informed by the success of Ofcom's consumer panel. A service user panel would be a critical friend to the board and executive. It could comment on the extent to which the interests of service users, families and carers are properly built into the commission's work streams, and influence board planning and strategic direction. It could ensure that methodology development for inspection and review is appropriate to the patient and the user population of the service to be scrutinised, and enable external organisations such as local involvement networks cost effectively to feed their views into the commission.

The Government have said that service users’ interests should have a high-level voice in the commission's board and executive, and the advisory committee required by Schedule 1, paragraph 6, is welcome but does not go far enough as it does not ensure that users' voices, rather than those of pressure groups, are heard. This advisory committee seems to be a general committee of all relevant stakeholders with the optional inclusion of service users. The nature, membership, objectives and functions of this committee need to be defined, otherwise the user voice will be only one among many. All the research and experience suggests that when patients’ voices are made to compete with other interest groups, they become effectively disempowered. The Government suggested that the proposed advisory committee could, through the way it works, help to make the user voice effective; for example, by enabling sub-committees or establishing meetings between the board and that part of the committee representing other interests.

However, that is not stated in the Bill and, therefore, there are no guarantees that the commission would establish a sub-committee of service users per se. There are precedents. The Mental Health Act Commission has already developed an empowered service user reference panel. The National Institute for Health and Clinical Excellence, NICE, has established a citizens’ council which can cross-examine witnesses and make recommendations which NICE must consider and respond to. The Children’s Plan from the recently formed Department for Children, Schools and Families sets out proposals for parent councils to ensure that their voices are heard within the school.



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The Communications Act 2003 required Ofcom to establish a consumer panel, to which I referred earlier. The Act specified 13 separate subject areas on which the panel should be able to advise Ofcom, including,

The Ofcom consumer panel has had significant influence. It is able to request involvement in, and explanation of, Ofcom work plans at the conceptual stage, and to begin providing critical feedback. It is skilled at identifying the consumer impact of Ofcom initiatives and at advising the regulator on how to make them explicit in work. The proposals in both these amendments fit the policy agenda for engaging users in the design and delivery of public services, including a requirement for regulators to engage with service users and the public at large.


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