Health and Social Care Bill

Debate between Lord Hunt of Kings Heath and Lord Mawhinney

Monday 19th December 2011 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, we come to one of the most important parts of the Bill—the regulation of social workers. Although the Bill is entitled the Health and Social Care Bill, the reality is that most of our debates have been about the National Health Service. It is right that in these latter stages of Committee we give a little attention to social care and specifically the condition of social workers.

I do not think that anyone in your Lordships' House will be in any doubt about the scale of the responsibility placed upon social workers or the pressures that they come under. Although Professor Munro’s review was centred on the child protection system, what she had to say about social workers would apply more generally to the profession. I was particularly struck by the conclusion, which stated:

“While well intentioned, attempts in the recent past to improve the child protection system have not secured the improvements children and young people deserve. Professional practice with vulnerable children and families has been driven too much by compliance with regulation and rules”.

The review found that,

“frontline social workers in particular operate within an over-standardised framework that makes it difficult for them to prioritise time to form relationships with children and to understand their needs. In parallel, it has becomes more difficult to provide the range of help and services to respond to the wide variety of needs and circumstances presented”.

The Government have said that they will,

“oversee a radical reduction in the amount of regulation, working with partners to see a corresponding reduction in locally designed rules and procedures”.

They have also said that they want,

“to improve radically the knowledge, skills, and expertise of social workers from initial training through to continuing professional development”.

The Government said in July that they will,

“work with higher education institutions, employers, the General Social Care Council”,

to ensure that the specific capabilities identified by Professor Munro will,

“explicitly inform social work training, professional development and performance appraisal”.

I am sure that that is welcome and would be generally supported. It is interesting that only five months ago the Government were happy to acknowledge the role of the General Social Care Council. It must surely follow by implication that if the Government are seeking to enhance professional expertise and give social workers more discretion on the front line, it needs to be done in the context of a proportionate, though robust, statutory regulation of social workers. That is what the General Social Care Council exists to do. After a difficult start, which many would acknowledge was difficult, it is performing well. This is not the time to tear the General Social Care Council up by its roots and start again, but that is precisely what the Government propose to do in this Bill, by transferring social worker regulation to the Health Professions Council.

Currently, the council has a register of around 200,000 people, covering 15 health professions. If it takes on social workers, it will have a further 100,000 on the register from a single additional profession. I understand that the reason for which the Government have put forward these proposals is related to cost, not the current performance of the General Social Care Council, which the Government, in the form of the Department of Health, have acknowledged to have improved its performance considerably.

The argument on costs falls away immediately. Registration with the General Social Care Council currently costs £30 per registrant. This is a low figure compared to other regulators, and the Government subsidise the council’s operations to the tune of around £16 million a year. The Government want to get rid of that subsidy and their original aim was to transfer the function to an independent body that it was acknowledged would need to charge higher fees to cover costs. Originally, it was intended to make the General Social Care Council independent and for it to recoup all its costs from its registrants. However, the Government argued that an independent self-financing council would be unaffordable for social workers because registration charges for individuals would be in the region of £200 to £300. This calculation did not take on board the work that the General Social Care Council has done in developing a financial plan for independence. My understanding is that the latest calculation from the GSCC is that the actual cost would be far lower, and not dissimilar to the current HPC charges of £76 per annum. I hope that the noble Baroness will answer that point when she responds and not cite those higher figures for costs. I am clear from the evidence I have received that it would be possible to provide independent regulation in a single body for the kind of figure that the Health Professions Council charges.

Concern has been expressed about the Government’s intentions. First, within the social care sector, the transfer of the General Social Care Council to the HPC, a multiple profession regulator with generic professional standards, threatens to dilute the unique identity of the social work profession at a time when, as we know, the profession has come under considerable pressure. Some critics cite the reduced representation of social workers within the new Health Professions Council and the fact that the name of the regulator will not contain the term “social work”. There are also concerns that a generic, multi-professional regulator will not be well suited to deal with the complexities of social work and the social model, which underpins the practice of the profession.

There are also concerns about changes to the regulation of social work students. Like the General Social Care Council, the HPC does not currently register students of the professions it regulates. I understand that consultation is being or will be undertaken by the HPC on this matter, but it is widely expected that it will conclude that the way in which students are dealt with—in other words, that they are not registered—will continue and that, therefore, social work students will not be registered in future.

That is one problem that we face. I make no criticism of the Health Professions Council, but it has a one-size-fits-all approach to regulation. Its philosophy is that it does not really matter who you register—it could be social workers, clinical psychologists or any profession you like—its model will fit. I am worried about that approach for social workers. That is why I have tabled a number of clause stand part amendments. I think social workers need to have regulation that is geared entirely to the social work profession. My amendments are intended to tease out the Government's approach to how, if social workers come within the Health Professions Council, they are to be given special provision. My Amendments 338B, 338C and 338D are aimed to do that by, first, establishing a statutory committee within the Health Professions Council to oversee the social work regulation, to ensure that the appropriate person will be director of social worker professions’ regulation. That is to ensure that a senior officer is directly responsible for social worker regulation and recognised as such in statute. Next, it is important that there are social workers on the council of the Health Professions Council. I do not understand why the council of the HPC is not being dissolved and a new council formed. The number of social workers coming over to the Health Professions Council suggests that that is what should happen: not simply that the council carries on. There should be specific recognition and social workers should be on the council.

[Lord Mawhinney]

My Lords, a couple of minutes ago, the noble Lord said that he was not going to make any criticism of the HPC. He then sets out amendments which tell the HPC how it is supposed to behave. Is there not a smidgeon of contradiction between those points?

[Lord Hunt of Kings Heath]

I cannot see any contradiction, although I will of course search my mind to see whether I have been guilty of such. I wanted to make it clear that I do not seek to criticise the Health Professions Council as a body. As I set it up, I have a certain feeling of support for it. I am not sure that its approach to generic regulation, which essentially says that it can regulate any profession in the health service and does not in any way need to change how it does it, should apply to social work, which is a different profession to which different matters apply.

[Lord Mawhinney]

But is the noble Lord not in effect saying that he does not trust the HPC properly to discharge its responsibilities, so he has to tell it how it should go about it?

[Lord Hunt of Kings Heath]

If I were to say that I did not trust the Health Professions Council, that might be taken as rather pejorative, and I would not seek to do that. It has done a good job on the health professions it regulates. I simply do not feel that it is right for it to regulate social workers. I do not think that it is prepared for it. Its philosophy is not attuned to it. That is why, if the Government insist on going ahead, some protection needs to be given.

My final amendment relates to the name of the new HPC, the Health and Care Professions Council. I am puzzled why “social worker” is not in the title. Why was it felt that when bringing 100,000 people into this body, it was not thought worth putting “social worker” in the title. I do not think that Health and Care Professions Council can possibly describe a body that will regulate 100,000 social workers.

I hope that the Government will be prepared to consider the matter again. I know that they want to reduce the number of quangos and regulators, although, if the noble Baroness had been here for the Statement on the banking system, she would have discovered that all Governments start by having a bonfire of the quangos and then inevitably they start to grow again. We saw in the past few minutes a good example of the Government starting to grow some new regulators. In this case, I do not think that the issue of money comes into it—the cost of the balance sheet is taken off the public purse, because it will be funded by registering. Because I am satisfied that the General Social Care Council can fund this through fees which would be similar to those of the Health Professions Council, I hope that the Government will give this further consideration.

Health and Social Care Bill

Debate between Lord Hunt of Kings Heath and Lord Mawhinney

Wednesday 30th November 2011 Lords Chamber

[Lord Hunt of Kings Heath]

Perhaps I could try to answer my noble friend. There are two reasons why this is important. First, there is a real risk that the mandate will become so large and extensive to cover the Secretary of State—who wishes to transfer responsibility to the national Commissioning Board—that we will end up with a real fudge about who is actually responsible. Secondly, there are circumstances. Until last week, I do not think that many people knew that once a trust had allowed its waiting times to go beyond 18 weeks, there was a problem with some of them taking their eye off the ball. If a patient missed the target, often he might have to wait for weeks. It is quite possible that even if the mandate is as extensive as I suggest it might be, there will be circumstances in which the Secretary of State may need to intervene. It is not the case of having time to rewrite or edit the mandate, or look at the standing rules. The Secretary of State may need to intervene on the day that an issue arises. All that I want to do—and I suspect the noble Lord, Lord Marks, also wants this—is to make sure that the Secretary of State is able to intervene in circumstances that we cannot necessarily anticipate but, knowing the health service, we suspect will arise from time to time.

[Lord Mawhinney]

My Lords, the contributions of the noble Lords, Lord Marks and Lord Owen, demonstrate again why this Chamber is frequently held in the highest regard for the strength, clarity and coherence of the arguments that are advanced within it. I am not going to repeat what they said because I agreed with both of them. My noble friend Lord Newton and I are in danger of becoming Tweedledum and Tweedledee when it comes to trying to persuade the Government that there is a real world out there with around £130 billion worth of responsibility. Lots and lots of people are doing their best, but human beings have the inescapable ability of getting things wrong from time to time, no matter how good their intentions.

I have to say to the noble Lord, Lord Warner, that one of the interesting things about this Bill is that it talks about a mandate. I think of my time in Richmond House when something had gone seriously wrong and civil servants came in to say, “Well, there’s a mandate, Minister,” and I would say, “Isn’t that fantastic?”.

Let us get down to the reality of what we are going to do about this latest mishap. That is not an argument for not having a mandate, it is an argument for not putting all your eggs in one basket, even if this particular basket is as widely constructed as the noble Lord, Lord Warner, thinks. I have not resiled from what I have previously said in this Committee in that the Secretary of State is responsible. He has to be responsible to Parliament, he has to be responsible in law, and in reality he has to be responsible in the health service. I am relaxed about the Government putting in place arrangements which they believe—it will all have to be tested over the next few years—will provide a more coherent way of delivering a better and more efficient service than we currently enjoy. I do not resile from the fact that when push comes to shove—and it will, because that is one of the characteristics of the Department of Health, more than any other single department in Her Majesty’s Government in my 30-odd years in this building, one end or the other—it must be clear that the Secretary of State can act, and in a way where the people of this country believe he is acting for them and on their behalf.