Clause 1

Health and Social Care Bill – in a Public Bill Committee at 1:00 pm on 10th January 2008.

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The Care Quality Commission

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

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.

Photo of Angela Browning Angela Browning Deputy Chairman, The Conservative Party 1:15 pm, 10th January 2008

The regulatory impact assessment says, in paragraph 1, that the costs mentioned by my hon. Friend are based on the framework, and that a lot of them will be identified only when the details are known. We are being asked to legislate on something with a set of figures that is extremely broad, and I wonder if my hon. Friend is minded to invite the Minister to provide, during the course of the Committee, more outline detail as to where those costs will fall.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

I am grateful to my hon. Friend. I know that she is very good at working with and using  costs and numbers, and I admire her for that as it is not a skill that is overwhelmingly presented during parliamentary life. It is a serious matter: costs matter, particularly in this case where so much is claimed for the cost benefit of what is taking place. I have already asked how the Minister was able to make his cost estimate, on the basis that it was made only on outline frameworks, without the benefit of the detail, and is still subject to consultation. Unless the consultation is not meant to count for anything, and it is all done and dusted and merely a question of going through the form, we are left having to make assumptions.

That is quite dangerous in the circumstances. If something is to become a successor body to three existing, high-performing bodies in the public arena, certainty is required above all, as there are many vulnerable people for whom this will not be the same as if something is invented, where we have a clean sheet of paper. There will be people with needs that continue today, tomorrow and the day after the organisation is established. If we do not have clarity about the costs, we are in grave danger of making errors as a legislature.

Photo of Angela Browning Angela Browning Deputy Chairman, The Conservative Party

We need to mix into the equation the question of fees that come from sources other than the Government.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

That is an important question. I do not know whether my hon. Friend has had a chance to look at the terms of the money resolution that will be debated on Tuesday on the Floor of the House. As I read them, they are narrowly drafted in relation to the fees that are expected to be paid to the chairmen of the adjudication panels under the new determination procedures for continuing in practice. Apart from anything else, there are serious issues about the fact that the money resolution has come up at this stage, rather than being tagged on to Second Reading as one might have expected. It will look as though there have been subsequent negotiations, perhaps with the General Medical Council and others, which have led to that change at this late stage, and we will have some interesting timetabling issues as a result of that being dealt with on the Floor of the House at the same time as the Committee should be sitting.

My hon. Friend is right to highlight the need to control, as well as understand, the external fees required strategically to deliver the proposals into existence. The fees are highly difficult to quantify but, if sufficient detail has been produced, they should at least enable a realistic estimate rather than a stab in the dark. It is important to put that point on the record.

I am sure that the Minister has listened to the exchange with genuine and sincere concern, and will give a detailed assurance on the matter when he addresses the issues. It is important for him to reconcile the cost differences between the regulatory impact assessment and the Financial Times report, and the point raised by my hon. Friend. He also needs to explain how those costs were reached given that the work of the CQC is yet to be defined.

The Government say that in the long term, the merger will save £60 million per annum. The CSCI is concerned that the CQC will be on a challenging financial footing from the outset—most of us might accept that that is the case with every organisation.  None the less, it will be challenging for the CQC, because the CSCI has already had that experience. I mentioned earlier that it has already demonstrably met its targets to trim costs and it should be publicly congratulated for doing so in a graded way. It is always difficult to pare down running costs, which it has managed to do without standards or the scope of its activities suffering. It is particularly concerning that, as some of the powers for the new commission are permissive rather than mandatory, the CQC may not be able to allocate funds to permissive powers. The Minister has confirmed that the wind-up costs will now amount to about £140 million. Will the Minister confirm those wind-up costs—clearly an important sum to understand—and, most important, tell us when the £60 million of savings will be delivered? What is the projection for that and how will they arise, not least by not impacting on the scope, quality and delivery of services?

I will now provide a final round-up of the amendment. It is with some apologies that I take time over it, but I hope that it sets the scene for an important amendment that would help to encompass so much more of what we are trying to achieve early on in our deliberations. Part of the impact of the amendment would be to mitigate the impact of the upheaval of further change and regulation. The Minister accepted, during the course of his oral evidence this morning, that there is inevitably some disruption when there are changes such as this. He said that we have to weigh up the benefit of going through the process against the inevitable disruption that we have to suffer. We have changes in the social care regulation timeline, and I shall look at how they have progressed.

The 1998 White Paper—“Modernising Social Services”—proposed structural change. The Care Standards Act 2000 created a single England-wide National Care Standards Commission, which was launched in 2002; 17 days later the Government announced that it was to be abolished. The Health and Social Care Act 2003 created the CSCI, which was launched in 2004, incorporating the social care responsibilities of the NCSC, the work of the Department of Health social services inspectorate and the SSI-Audit Commission joint review team. In 2004, the Government’s arm’s length body review ruled out a merger with the Healthcare Commission. In the 2005 Budget statement the Chancellor announced the merger. In his oral evidence, David Rogers of the LGA noted:

“Organisational change always causes some short-term disruption and some loss of focus for a short period.”——[Official Report, Health and Social Care Public Bill Committee, 08 January 2008; c. 82, Q193.]

The Minister was right to point out, in his evidence this morning, that Mr. Rogers thought that the long-term benefits outweighed the disruption, as I indicated earlier. However, Mr. Rogers said that everything must be attempted to minimise the disruption and loss of focus. The amendment would do that, but the Minister, unfortunately, has not yet told us how he would do it, so I hope that he will find our proposal a convenient way to short-circuit the concern that we would otherwise have, and will accept our amendment.

If the Minister wants a list of questions to address, perhaps I could usefully summarise the questions that I hope he will be able to address, as well as giving us  some comments on the general arguments that I have advanced to underpin and substantiate the merits of the amendment. Will the Minister outline what quality inspection functions and duties the new regulator will lose from the sum of its parts? Would it not be better for the current regulators to be brought under one roof and one brand in the legislation, but for their functions to remain unchanged by Parliament at this stage and joint working delivered organically? Does the Minister agree that the constant restructuring of regulation has been disruptive, and will he tell us why the Government will get it right this time, and why the Committee should give them another chance?

Without having information on the scope and content of registration, how did the Minister make the cost estimates that he has made? Will he first reconcile, as I asked earlier, the cost differences between the RIA and the Financial Times report and, secondly, explain how those costs were reached, given the fact that the work of the CQC has yet to be defined? What percentage of the savings is due to organisational costs and what to regulatory costs? That distinction is of key significance, particularly remembering CSCI’s evidence that it has managed to pare to the bone the organisational costs. One must be careful in any walk of life—this certainly compares to my own business life—not to aim to achieve things that are unattainable. If one already asked management to reduce costs to the bone, one does not need to start chipping away at the bone itself. That is a recipe for disaster. When will the £60 million a year savings be achieved?

Does the Minister accept that there has to be some acknowledgement of, and even culpability for, this constant restructuring, which is hardly motivating for all those who so dedicatedly give their lives and careers to the public services that we depend upon? With that set of arguments, I commend the amendment, and I hope that the Minister will feel that the arguments are compelling enough to accept it.

Photo of Jimmy Hood Jimmy Hood Labour, Lanark and Hamilton East 1:30 pm, 10th January 2008

Order. I chose not to intervene when the hon. Gentleman was taking an intervention from his hon. Friend referring to a money resolution in the House next Tuesday. For the record, it is a Ways and Means resolution not a money resolution.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health

I too welcome you to your role, Mr Hood. This may be an appropriate time to declare an interest. I am a fellow of the Royal Pharmaceutical Society and aspects of the Bill directly influence my profession. It is easier to state that at the outset rather than when we get into the specifics.

This is a brief amendment to a brief clause. In some ways we have had a stand part discussion as well, but I will seek clarification on that if necessary. Most of my comments are general but, as this is a 161-clause Bill, I will try to avoid repetition for the sake of it.

Liberal Members have supported the principle behind the merger, but it is right to ask questions: why now, when the existing the existing regulators are  starting to work extremely effectively? Is it worth the upheaval and extra cost——and to achieve what, really? Reorganisations are always costly, not just in money but in staff time. We all suffered the pain of the reorganisation of the primary care trusts, where people were demotivated because they did not know whether they had a job and were unsure of their future role. When our regulatory system is beginning to work so well, there are concerns about putting the brakes on, and some things possibly not going as well as they could. The regulatory impact assessment has been mentioned, mainly in the context of costs. Costs are important and we all want to make maximum use of public money, but I must stress the point raised the hon. Member for Eddisbury.

Photo of Stephen Hesford Stephen Hesford PPS (Vera Baird QC, Solicitor General), Law Officers' Department

As I understand it, there was no vote on the principle of the Bill on Second Reading, so I am at a loss as to where the hon. Lady is going in asking “Why now?”, if the principle of the Bill has already been agreed.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health

If the hon. Gentleman had been listening, he would have heard me say that we agreed in principle, but that I thought that it was pertinent to ask those questions. Just because a principle is agreed, it does not mean that the detail is agreed. We would not be doing our job properly unless we ensured that whatever replaces the current regulators does the job as well, if not better. That is a public responsibility that we all have. We have to make sure that we get the detail right. That, I thought, is why we were on this Committee.

The problem of costs has been raised, and it is not clear what they should be. The biggest problem, as highlighted by the hon. Member for Eddisbury, is that we do not yet know the full scope, breadth or detail of what the new body will do. It would be useful to have more detail when we discuss that.

I also want to echo the concerns raised by the Member for Tiverton and Honiton about costs being passed on to hospitals, nursing homes and other bodies. There has been a drift in that direction to some extent already, but it is robbing Peter to pay Paul, because in some cases those costs are just picked up by a different part of the NHS. Some clarity on that would help.

As well as the costs, the regulatory impact assessment pointed out other risks. It said that the key risks would be

“the Care Quality Commission establishment problems; lack of resources”— but, and this is possibly of more concern to most of us in many ways, there was also

“slipping compliance with minimum quality standards.”

That is on the face of the impact assessment and we are asking these questions because I do not think any member of this Committee wants to see standards fall or to have to deal with the consequence of that.

The regulatory impact assessment states that there is a risk regarding the

“Care Quality Commission having a lack of resources to function properly; or that the Care Quality Commission is unable to properly carry out its functions or does so in a way that is more inefficient than under the current system.”

I hope that the Minister for the South West agrees that those are the very things that we seek to avoid. The hon. Member for Eddisbury raised some pertinent questions and I look forward to hearing the Minister’s response.

Photo of Kelvin Hopkins Kelvin Hopkins Labour, Luton North

It is a pleasure to serve under your chairmanship, Mr Hood. I declare an interest at the outset in that I am a co-chair of the Unison group of MPs——Unison has by far the majority of trade union members in this sector——and I am in receipt of a Unison pension as a former Unison employee.

While I am not in any way speaking in favour of the amendments, I want one or two assurances from my hon. Friend the Minister about costs and budgets. Clearly, there will be some economies of scale that will no doubt reduce costs overall—a figure of 40 per cent. has been mentioned. But there are concerns that this might put budget pressures on the inspection system. I would like my hon. Friend to give assurances that inspection will not be damaged by budget pressures because, particularly as I have mentioned previously, this is largely private sector now, especially long-term care for the elderly. It is important that there is a rigorous inspection system to ensure that care standards are maintained at a high level and nobody in a care home suffers as a result of inadequate performance by the providers because they are not being inspected. Can my hon. Friend could give some assurance on that?

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

May I make two general remarks before moving on to address some of the points made by hon. Members speaking to amendment No. 1? As I said in the evidence-giving session on Tuesday, when a new, independent, flexible and integrated regulator is established there is always tension between the desire to get those elements right, a desire to take as much as possible from the status quo and the desire to be prescriptive about what that new regulator should do in advance of its establishment. I put that tension out there because I suspect that tension is going to run through quite a lot of our discussions this afternoon, not only on this amendment but on others. Hon. Members ranged widely to discuss issues such as cost and transition, so I want to clarify them before speaking directly to the amendment.

The reason we did not go ahead with the integration before was that it was only under this Government, in 1999, that for the first time we had the idea of any kind of independent regulation of the health service and there was still a feeling that that culture and system needed to be given longer to bed down. The hon. Member for Romsey reminded us on Second Reading that her party argued then in favour of integration, although if she has not gone off the principle, she would rather have done it then than three years thence, which is odd. But I leave that there.

There was a discussion about it and we reached the general view that the system we had there needed longer to bed in. There is never an ideal time to integrate regulators, which I accept are working extremely well and have a very good reputation, however good the principles and however much all of us may support the principles of doing so. There are  transitional challenges to deal with. There has been some confusion on cost because many people interpreted the £7 million figure that we included in the regulatory impact assessment as the total figure for all the costed transition. That is only the figure for the cost of establishing the new care quality commission. The much bigger figure of £140 million, which was in the explanatory notes, is our estimate of the transition costs, many of which are already being realised, as the hon. Gentleman recognised in his acknowledgement of the savings that have already been made by the existing regulators, not the set-up costs for the new commission. The £140 million includes the cost of redundancies, estates rationalisation and planned reduction of the operating costs. The savings are the result of the commitment that we have made, which we will realise through this Bill, to reducing the costs of all public service regulation by a third and that will mean £60 million a year. The answer to his question is that within three years, we anticipate that we would more than recoup the overall costs of transition, many of which have already been made, as the existing bodies have already managed to reduce their costs without, I think, reducing their effectiveness in any way.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

It is helpful that the Minister is going through the costs. I think I understood him to say that some of the amounts encompassed within his declared figures, either in the RIA or in other figures, include costs that are already being saved or are being incurred by the existing bodies that will be succeeded by the CQC. Will he confirm that and help the Committee by indicating how much he is talking about as a proportion of what to expect to save or to incur the cost of? That would help us to know where we are on the timeline.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

The hon. Gentleman is right. I am afraid I cannot give him the exact figures, but I can tell him we have been working with the existing commissions to help them achieve those savings and that means, we estimate, that by the time the new commission is established, the Healthcare Commission and the CSCI will be operating within a combined budget of £145 million. We expect the new commission to operate within the same budget. Including the MHAC functions, that will mean a total budget for the new commission of £151 million and that process is already well under way.

My hon. Friend the Member for Luton, North mentioned Unison, with whom I had a very good session just before Christmas in which we went through a lot of its concerns on the Bill in detail. I hope that I managed to reassure it on most of them, but I am happy to write to him, if he would welcome that, in more detail. I think I could even allow him to have a copy of the letter I wrote to Unison after that meeting and the issues we discussed. If he wants to come back to me later in this process and go through that, I would be very happy to do so.

My problem with amendment No. 1 is that we are establishing a new body and the amendment’s practical impact would be to move all the current functions and duties of the existing three bodies lock, stock and barrel on top of the ones we are establishing in the new one. That would be duplicative and create a lot of  confusion. Many of the facets of the new commission’s functions are drawn directly from existing legislation, but there are changes.

For example, the new commission’s registration functions build on provisions for the Healthcare Commission and the Commission for Social Care Inspection under the Care Standards Act 2000, but have been made more flexible to allow for future changes in service provision. For the first time, they cover NHS services, as a result of which those services that have not previously been subject to the registration requirement now will be. In addition, CSCI has said, in particular, that the current regulators do not have sufficient powers to act directly when they find serious failings. We are giving the new independent regulator a range of tougher enforcement powers to enable that to be done.

One of the areas to which the hon. Member for Eddisbury referred that will not be carried forward is complaints. We are not requiring the new body to deal with second-stage complaints. Such issues have already been extremely burdensome for the Healthcare Commission and it is much more important that we improve the quality of complaints handling by health care providers. I think that it was Dame Janet who said in her evidence that that was a real mess at the moment and that it was too slow.

The most important thing is to give powers to the new Care Quality Commission, as we are doing, to ensure that health care providers have proper, decent and satisfactory complaints procedures for patients rather than burdening the independent regulator with a second-stage complaints responsibility. There will still be a second-stage complaint, which will be dealt with by the health ombudsman, but we did not consider it a good idea to burden the new regulator with such matters. We wanted it to concentrate on its core functions of quality and safety.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health) 1:45 pm, 10th January 2008

I am grateful to the Minister, not least for having delayed giving way so that he at last referred to the ombudsman, which is the point of my intervention. He will be aware that it has been said on Second Reading and subsequently that, as a result of this approach, concern has been expressed about whether the ombudsman will have the capacity to deal with the anticipated number of further complaints by way of the final court of appeal coming to him. It would be helpful if the hon. Gentleman would undertake, now or later, to ensure that we have a better handle on such matters because, for the proposal to work well, we must have confidence that the ombudsman is configured with the right capacity to deal with the anticipated increase in the number of cases.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

I should certainly welcome a discussion about that at a later stage. I emphasise the fact that, by making the quality of the complaints procedures of health care providers a priority for the new Care Quality Commission rather than giving them such a responsibility, our aim is that the quality of  complaints procedures becomes much better at provider level. That will mean that fewer complaints will need to go to a second stage.

The ombudsman will be dealing with more complaints than at present, but it is desirable first and foremost that we improve the quality of complaints procedures at provider level. As members of the Committee know, our constituency surgeries are full of people who consider that their complaints have not been dealt with properly. Many times, if the complaints had been dealt with properly by the provider, even if just by way of an apology, matters would often not have escalated and overburdened the Healthcare Commission. If matters are dealt with in that way, they will not overburden the ombudsman.

Photo of Anne Milton Anne Milton Shadow Minister (Health)

I might have missed something, but my understanding of the office of the ombudsman is that it cannot investigate quality of care, but only the process. Will the Minister clarify matters?

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

My understanding is that, if we ask the office of the ombudsman to take sole responsibility for second-stage complaints, it will be able to investigate them and how they had been dealt with. That would involve quality, but I shall clarify matters for the hon. Lady as I am not absolutely certain whether we shall change that or whether it needs to be changed. It is something that I shall happily clarify for her as we progress.

Photo of Angela Browning Angela Browning Deputy Chairman, The Conservative Party

We heard in the oral evidence session that the Healthcare Commission finds it useful to identify emerging trends that might be the subject of a more detailed analysis on its part. Surely that also applies to the complaints procedure. If it is now to be divorced from the complaints procedure, emerging trends that might be a worthy subject for a more detailed analysis and report will be lost to it. If the office of the ombudsman does not initiate its own reports because of emerging trends, who will plug that gap?

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

The Care Quality Commission will still have access to trends and types of complaints, so it will still be able to track them to see whether there are an unusual number of complaints about a particular issue or against a particular provider, but it will not deal with and investigate second-stage complaints itself. It will still have that responsibility and still be able to act on that. In fact, that will be very important. It will remain a very important part of its job. With regard to an area in which I know she has a special interest——learning disabilities in Cornwall——that is exactly how the Healthcare Commission, as it now is, got involved in its investigation there. That will not change. It is just that it will not be burdened by the actual investigation of the individual complaint. That will be the responsibility of the ombudsman, if it has not been dealt with satisfactorily, which we hope it will have been, by the original provider. Did the hon. Member for Guildford want to intervene? We are having an extended debate on the complaints process, Mr. Hood, but I will take your guidance.

Photo of Jimmy Hood Jimmy Hood Labour, Lanark and Hamilton East

If the Minister gives way to the hon. Member, I am sure that it will be in order.

Photo of Anne Milton Anne Milton Shadow Minister (Health)

Thank you for the clarification, Mr. Hood. The reason we are emphasising this is that public confidence in the complaints procedure is crucial, as the Minister said, for his own postbag and for us all. Can he confirm that he will write to us to clarify exactly what remit the ombudsman will have because my understanding is that this will be a significant departure in the role of the ombudsman?

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

The Minister has very rightly said that he will seek to help the Committee in relation to complaints, which bear very much on amendment No. 1 as one of the issues we are concerned about, and whether we will lose stuff through the gaps. He will be aware—and it may be useful when he comes back to the Committee to make sure that he gives a complete response to us and to think the issues through—that about 7,000 complaints a year are dealt with by the Healthcare Commission. Can he confirm the current backlog, for which, I understand, anecdotally, that estimates range between 30,000 and 80,000? Perhaps that will help by giving us a handle on what the capacity issues for the ombudsman are, even taking into account the improved quality of process. What about complaints in relation to privately funded social-care users?

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

I will come back to the hon. Gentleman, as I said, but I think he helps make my point: our prime concern is to improve the quality of complaints-handling at provider-level in order to avoid this burden and to improve patient satisfaction.

Having a good complaints procedure and making senior managers of providers responsible for the quality of that complaints procedure will be a requirement of registration under the new Bill and the new regulator will make sure that that happens.

This direction of travel has been welcomed by patients’ groups, who share our frustration that the current system complaints-processing is not satisfactory, by and large. There are some very good examples of good practice but I am afraid that that does not apply throughout the piece.

I shall turn to some of the other questions raised by the hon. Member for Eddisbury, particularly on visits. He asked about visits both in the context of MHAC and CSCI and I reassure him—this was raised by MHAC in its evidence on Tuesday and on Second Reading—that visiting powers are retained in the Bill as far as the existing visiting powers of MHAC are concerned. Schedule 3(8) proposed new section 120(3) states that it

“must make arrangements...to visit”.

Although I am reluctant to try to put the new regulator in a straitjacket in advance, we envisage that, in areas of particular concern to MHAC, visits would continue with their current regularity.

I return to a question raised by my hon. Friend the Member for Luton, North. On Tuesday, even Sir Ian  Kennedy, in critical mode, said that one of the areas of the Bill that he was prepared to openly support was the idea of modern, precautionary and risk-based regulation. That includes not having a straightjacket where someone has to visit every institution once a year, every six months or even every 18 months, but instead, having a visiting policy that can be based on an assessment of risk. Facilities or institutions that are a greater cause of concern can be visited more regularly than those that have held an exemplary record for a number of years. Spot checks can be made whenever required, and so forth. It is important to allow the new regulator to build on that process, rather than trying to put them in a straightjacket in advance.

Photo of Angela Browning Angela Browning Deputy Chairman, The Conservative Party

On that point, we were given a specific example yesterday with regard to the Mental Health Act Commission implementing the Mental Health Act. For example, when an inspector goes into a secure unit to do a mental health inspection, sometimes they come across things that are happening to patients who are not detained under the Act against their will, but who are there as voluntary patients. The example was given of somebody tied into a chair who, because they were a voluntary patient and not sectioned, the inspectors could do nothing about. Does the Minister intend to amend the Mental Health Act and to extend the scope of that inspection?

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

My official is shaking her head, but I understood that one of the things that MHAC welcomed about the Bill was that its provisions would allow the commission to take action if it came across a similar case. We may not need to amend the Bill.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health

I want to pick up on the risk-based assessments and visits, which I think are a worthy principle. However, we need to take account of situations where a nursing home, which previously has had a good record, has a change of hands. I have seen some dramatic changes after a change of hands.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

I agree. A change of management could be a trigger point for the new regulator to want to carry out an inspection. However, it is not something that we need to prescribe—they will be the experts.

Photo of Kelvin Hopkins Kelvin Hopkins Labour, Luton North

This is a specific comment on my earlier remarks. My point was that, whatever the inspection regime, if there are budget pressures, there is a temptation to reduce the level of front-line work. To take a distant parallel, when water was privatised, many water authorities immediately cut their inspections to save costs—it rained a lot and they did not need to worry about leaks. I do not suggest that there will be immediate cuts, but budget pressures clearly impact upon the level of service that can be provided. There are inherent dangers if that is not specified.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

I am sure that my hon. Friend is as happy as I am that we are not privatising anything under this Bill. I recognise the danger, and I assure him that the last thing that we want to do in setting up a new regulator, is to create the risk that in five or 10 years we will face horrendous headlines of scandals,  which could have been avoided, because of what we have done. The savings that we are talking about—I hope the hon. Member for Eddisbury who asked the question will forgive me, I do not have the specific ratio—will be made, for example, by the amalgamation of back-office functions or a reduction in duplication. Some of the new inspection procedures and policies that existing organisations are undertaking, have already led them to make most of the savings that they needed to, in time for the integration of the three agencies. I suggest that, unless he has evidence to the contrary, as far as I am aware, that has not led to any serious problems in inspection or resulted in a lack of inspection. I hope to reassure my hon. Friend the Member for Luton, North on that.

On the ratings question that the hon. Member for Eddisbury asked, the quality ratings that the CSCI does will be able to continue under the legislation, and we anticipate that they will. Again, that is not something that we are laying down the law about, but that is certainly our expectation.

I want to make the point that I made before about integration. As health and social care provision become increasingly integrated, it may not be obvious, or even meaningful, to the new commission whether it should be following its functions and duties for health as the current Healthcare Commission or Mental Health Care Act Commission, or those for adult social care as the current CSCI. That is why, rather than transferring them lock, stock and barrel in their current legislative form, as the amendment recommends, we are creating integrated functions for the new commission. The amendment, rather than protecting the current provisions, would lead to fragmentation and confusion within the new commission. It would unbalance the coherent provisions that we have set out in the Bill and detract from its purpose. I hope that the hon. Gentleman will agree to withdraw it.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health) 2:00 pm, 10th January 2008

I am grateful that the Minister has sought to take seriously the issues that we have raised. I note, with some enthusiasm, that he has undertaken to burn a bit of midnight oil to let the Committee have more information on some specific areas that we have identified.

I am concerned that it was a long introduction, but it did cover a lot of points. Hon. Members on both sides of the Committee have found it important to raise those important issues about transition, where so many of the questions are arising, as well as some of the more focused points, which no doubt we will come on to in our deliberations.

In light of what the Minister said, it would be false to suggest that I feel either completely assured or satisfied. I dare say that those who observe our proceedings from outside will be concerned that the measure does not necessarily give us more of a handle on how this is all going to happen, or provide the safeguards. I am also concerned that we have not necessarily bottomed out all the costings, which would have helped. The Minister was reintervened upon before he had the chance to say that he had tried to put  in the Library the estimates and the costs. Perhaps some savings have been secured before the CQC comes into existence. That may be information that he would like to share with the Committee. He gave us some assurance on the record, but if there were a possibility of showing us some of the financial information as regards the figures in the regulatory impact assessment, that would help us to understand where the flow of moneys is and what is already being worked on by those, as he rightly says, admirable and high-quality working bodies that will be succeeded by the CQC, which will then be challenged to make further organisational efficiencies without sacrifice to services.

It is with those thoughts that I think that it is appropriate to withdraw the amendment. In addition, I think that a lot of these matters will be reconsidered during the passage of the Bill. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 1 ordered to stand part of the Bill.