Clause 1
Health and Social Care Bill
1:00 pm
Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)
I beg to move amendment No. 1, in clause 1, page 1, line 9, at end insert
‘with the totality of their quality inspection functions and duties passing to the Care Quality Commission’.
At the beginning of the first amendment, to clause 1, may I formally take this opportunity in our line-by-line sessions to welcome you, Mr. Hood, and your co-Chairman, my hon. Friend the Member for Old Bexley and Sidcup (Derek Conway), to the Chair to deliberate over our proceedings?
As is patently clear to all of us who have been studying the Bill for some time, clause 1 introduces the Care Quality Commission—the body that will take over from the Commission for Healthcare Audit and Inspection, the Commission for Social Care Inspection, and the Mental Health Act Commission. Clause 1(2) states that those three predecessor bodies are to be “dissolved”. We have proposed an amendment that would add after the word “dissolved” the phrase
“with the totality of their quality inspection functions and duties passing to the Care Quality Commission”.
It is vital that I explain why the amendment is important. It is at the beginning of the Bill and will, therefore, be important in relation to many of the other things that we deliberate on. Most importantly, it seeks to ensure that we leave as little doubt as possible for all those who will have to put in place the arrangements contemplated under the Bill—assuming that it has safe passage through the House. I commend the amendment to the Minister and hope that he will regard it as constructive, helpful, positive and not at all partisan, and as something that will help those who have to implement the Bill. I hope that he contemplates accepting it.
The amendment would establish continuity with the previous regulators, thereby smoothing the transition, and clarify the costs involved. We have heard a lot about transition in the last three sittings, during which we heard helpful oral evidence. All the regulators as currently constituted and many third-party groups have expressed concern at the silence of the Bill on their future function, as embodied in the new Care Quality Commission. Both the Commission for Social Care Inspection—CSCI, as I shall abbreviate it for future reference—and MHAC, the Mental Health Act Commission, have expressed concern that their work will be curtailed due to the merger.
CSCI has asked me to alert the Committee to a letter that it has sent, outlining its opposition to the Minister’s principled welcome to the Bill. It might be helpful if we recall that, during the course of CSCI’s evidence to us just a couple of sittings ago, it engaged in a dialogue with the Minister. CSCI is concerned that an impression may have been given about its public position in relation to the merger of the three bodies that it does not feel necessarily fairly reflects its position.
CSCI has written saying that it has now had the opportunity to look again at its statement of 24 October 2007—it was quoted by the Minister—that was prepared following the publication of the Department of Health’s response to the consultation on its wider regulatory review and its decision to proceed with the creation of a new Care Quality Commission, bringing together the functions of this commission and the other two. The letter from CSCI says:
“It did not make reference to the Bill now before your Committee.”
Indeed, the Bill was only published on 24 October and given its First Reading on 15 November. That statement was posted on the commission’s website, but it was not formally issued as a press release. CSCI, which is relevant in respect of the way that amendment No. 1 works, notes that in welcoming the overall policy direction, it also made it clear in the statement that there was a “great deal of detail” yet to be determined in the proposals. It says:
“This commission has always been of the view that a structural change in the regulation of social care and health services at this time is premature, however desirable that end might be in the longer term.”
That is important, because the amendment is intended to ensure that we have some continuity, rather than the pitfalls that might attend to something that is seen, by those who have the greatest experience and expertise in that area, as premature.
CSCI also said:
“The new organisation must have parity between health and social care.”
On Second Reading, the Secretary of State said:
“My hon. Friend”—
he was referring to the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble)—
“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.—[Official Report, 26 November 2007; Vol. 468, c. 37.]
Here is the opportunity for the Minister to ensure that that is given a true manifestation in the Bill.
CSCI also says that if additional functions, such as around hospital cleanliness, are not adequately funded by the Government, it fears that they will be funded out of cuts to social care regulation. Moreover, it has been asserted that CSCI has already
“reduced its recurrent operating costs by 33 per cent. in real terms between 2004 and 2009. The Government has also said that the new body will have to operate on a substantially smaller budget than the combined current budgets of CSCI, the Healthcare Commission”
and MHAC.
That is why putting amendment No. 1 into the Bill after the word “dissolved” would make it absolutely clear that in this case—rather than looking at the quality inspection functions—we are looking particularly at having the duties passed to the Care Quality Commission, without there being a danger that the things that CSCI has, over a relatively short period, worked so hard to establish in the crucial areas of both care and inspection fall through the gaps during what, as the Minister admitted, will inevitably be a disruptive time as one goes through change. Disruption attends upon any change.
In support of this amendment, I am aware that it is always nice to have short and crisp amendments. However, I know that there has been some discussion, through the usual channels, about the first few amendments inevitably being some of the more lengthily debated ones. Much of the ground that will be dealt with later will be covered by this very important first amendment, which would clarify the transition, the inspection functions, duties and costs.
I therefore move to the Mental Health Act Commission’s comments to help us chart our way through this. In its press release on the launch of the Bill, it said:
“The Mental Health Act Commission is concerned that with the merger of its functions into a large regulatory body with a wide variety of functions that monitoring of the operation of the Mental Health Act and the protection of vulnerable patients may not get the priority it needs”.
Chris Heginbotham, the chief executive of the Mental Health Act Commission—whom we all saw the other day when he gave evidence—said:
“Only by visiting detained patients regularly and frequently can abuses be identified and rooted out”.
During the evidence session, MHAC expressed the fear that their focus
“will get lost in a large organisation”——[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 8.]
MHAC submitted that
“There are six functions or sets of functions, and the way in which those functions are performed, that the MHAC considers to be vitally important”
for the CQC. Some are current powers; some are other powers that it would like. Briefly and in short form, those six functions are:
“Visiting and interviewing detained patients in private ... Engaging mental health service users ... Adequate organisational and personal accountability for monitoring and reporting on the needs and rights of detained patients; Statutory notifications of admissions, discharges and deaths of detained patients, and other relevant information; Ensuring adequate and appropriately trained staff”,
and an equality and human rights focus. That last will, of course, be the subject of a number of other discussions as we proceed through the Bill, but of course it matters even at this early stage.
A majority of third-party organisations has also expressed concern about the merger, hence this rather important approach to clarifying the purpose of the merger in the amendment. Age Concern, in its submission on the Bill, was
“very concerned that overall funding for this super-regulator will be far less than existing funding for the regulatory bodies that are being replaced”.
Carers UK argued that CSCI
“has built up valuable expertise on carers’ issues and on social care more broadly”,
and that
“It is essential that the new body is given sufficient power and resources to maintain a focus on social care and that it is not dominated by health.”
Help the Aged said:
“CQC’s budget must be sufficient to maintain frequency and quality of inspection and to ensure that the new Commission builds on the work of existing bodies — doing more, rather than less”,
and that
“Work on social care must be given fair priority and resource allocation within the Commission’s programme ... We are also confused by the fact that Regulatory Impact Assessment for this Bill sets out that the cost benefit of having one regulator rather than three depends on the scope and responsibilities of CQC, which will be set out in secondary legislation. This would seem to suggest that it is, as yet, impossible to tell whether the new Commission will be cheaper...We are seeking assurances from Government that CQC’s budget will be adequate to maintain the quality and frequency of inspections and to build on and develop the work of the previous organisations, rather than reducing its programmes.”
The General Social Care Council believes that
“it is important that the distinctive nature of social care and the values of social care regulation developed by the GSCC and CSCI continue to be recognised in the work of the CQC”.
During an oral evidence session the Association of Directors of Adult Social Services said that any loss of focus in social care would concern them.
The amendment would enable the commission to protect the current regulatory framework and grow organically, rather than legislatively, out of that. It was interesting that Which?, during oral evidence, commented that the Bill does not set out a clear statement of purpose for the CQC. The amendment would give protection against activities falling through the gaps during transition or getting lost in a bigger organisation, let alone defocused, because it is inevitable that priority is lost during the admitted disruption and instability. We are already hearing anecdotally of the inevitable recruitment and retention sclerosis that is bound to attend upon the current proposals and the possible demotivation of the people involved.
We will have many specific questions over the course of the Bill so I will not tack them on to the amendment. However, before the Minister contemplates his response to the amendment, I want to highlight something that came out for all us during the oral sessions—visiting rights. The visiting rights called for by the Mental Health Act Commission could be distinguished from the kind of visiting undertaken by CSCI and the Healthcare Commission. The Minister made clear in his evidence this morning that the Government do not think it right to dictate now who—I interleave the commission—should visit, and how often.
I hope that amendment No. 1 would enable the Minister to underpin the assurance he is seeking to give when addressing the very real concerns about those who are most practised, most knowledgeable and most pragmatic in making sure that—as managements and organisations—they have the continuing capacity to deliver for incredibly important, needy and often vulnerable people in our society.
Another point to highlight is the ratings system. The CSCI is concerned that its quality ratings system will fold—in particular the star-rating system for individual services that it plans to start rolling out during 2008. It is telling that the official questioned this morning noted that it is highly likely that the annual health check for hospitals will remain annual, but that the CQC will not need to do that for all its investigations; so despite Government statements about parity of social care, this morning’s oral evidence left us with the impression that officials may consider that health care regulation is of prime importance. I hope that the Minister can give us some genuine reassurance about that.
The amendment covers the issue of trying to identify the costs of transition, which I am sure are well recognised. It is important that I try to get a handle on that as we introduce the amendment. With regard to the costs of the merger, part of the impact of the amendment would be to mitigate the variables in the costings forecast for the CQC. A number of witnesses made statements on costings during oral evidence. Dame Denise Platt pointed out that this is framework legislation. Anna Walker noted that the commission will need to be resourced to do the job that Parliament sets for it and that the Bill is only a framework for that. The Minister has made available to the Committee a briefing on the registration requirements, which states that he is planning a formal public consultation to inform the scope—that is, which services fall within registration—and the requirements for registration. The question must be put before the Committee, and again I hope the amendment helps us with that. Without that information, how could the Minister make the cost estimates that he has made?
The regulatory impact assessment identifies that the net benefit range from a gain of £129.3 million to a loss of £52.7 million over the next 10 years, with a probable estimated benefit of £52.7 million plus a net gain of £3.3 million on the administration burdens baseline, is at 2005 prices. On 13 December, the Financial Times reported that the Minister had confirmed wind-up costs of £140 million, and there were departmental claims that it would save £60 million per annum. We must try to identify whether the amendment helps us to get a handle on that vital area of cost which, given the claims made for the combination, must be understood. Otherwise, we could be proceeding not only in the dark, but under false assumptions.