Written evidence to be reported to the House

Part of Health and Social Care Bill – in a Public Bill Committee at 11:45 am on 8 January 2008.

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Anna Walker: There are three issues that I would like to focus on. The principle behind the first two is our concern that the Bill, as drafted, may be focusing too much on the regulation of providers, whereas the provision of health care is about what care is purchased or commissioned on behalf of the user as well as the provider—that is of course also true for social care. We have concerns about two particular areas. The Bill, as drafted, gives the new regulator the power to carry out wider reviews. That is welcome, because it is under that power that we have looked at learning disabilities, mental health and dignity in care for older people in hospital, so it is a very important power to us. The difficulty is that it is limited to providers only. What we find in health care—I must leave it to others to talk about social care—is that you can say to a provider, “Look, that service simply isn’t good enough”, to which their answer can often be, “But we are not being paid to provide any more than that.”

In order to get the issue right, on behalf of the user and the patient, you have to look at a mixture of commissioning and provision; 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.

There is a second issue to which we attach considerable importance. The Bill, in a very welcome way, has a power to carry out investigations, and we have carried out a number of significant investigations, as the Healthcare Commission. Again, however, in this area the presumption is that the enforcement powers in relation to providers will be sufficient to remedy a problem. However, when we carried out our work—for example, in Cornwall, on learning disabilities; or at Stoke Mandeville and Maidstone and Tunbridge Wells, on infection control—we found that we could not make recommendations solely in relation to the provider. It required work by a significant number of local  organisations: the local strategic health authority, the local PCT, or possibly an independent provider. What we would therefore like to see in the Bill is the power for the new regulator to recommend, as we have at the moment, what are called special measures across the health care grouping as a whole. We notice that in the legislation those powers are given on social care in relation to local authorities, and to Welsh NHS bodies, but not to English NHS bodies, so it is that special power in relation to English NHS bodies. I am sorry; it is complicated, but I hope I have made it clear. When you have something that has gone seriously wrong, you need to go in and say that a range of people have got to do things differently around here.

The final point that I would like to make, very quickly—it is a very different point—is that there is a power in the Bill for the new regulator to carry out certain co-ordination of regulation. This is to ensure that there is not too much duplication of regulation, and we absolutely recognise that that issue exists. It exists particularly in health care, more than in social care. The difficulty is that the Bill as drafted refers only to those with inspection powers. There are many regulators and performance managers who do not have or do not use inspection powers, but do add to the duplication of regulation and assessment. What we are saying in relation to that bit of the Bill is that we think that it needs to be re-addressed to ensure that the co-ordination power has gone sufficiently broadly, and we certainly believe that it needs to go beyond inspection, which is a very small part of regulation as a whole.