NHS: Clinical Commissioning Groups

Lord Mawhinney Excerpts

Wednesday 16th January 2013 Lords Chamber

[Earl Howe]

Yes, my Lords. As I have indicated, as regards the NHS allocations, the board is clear that the model needs to be reviewed. That does not necessarily mean that it will need to change; the board will have to keep an open mind about that. Clearly, the board was not happy that the formula as currently constructed best met future needs. As regards public health, I think that we are in a better place. As my noble friend will know, the allocations were announced recently and they provide for considerable real-terms increases everywhere around the country.

[Lord Mawhinney]

My Lords, if the Commissioning Board decides to change the present formula, will the new proposal be subject to public consultation before it is implemented?

[Earl Howe]

My Lords, ACRA, the independent committee, will take advice from all relevant quarters. I am sure that the advice it receives will be taken on board. I do not think that there will be a public consultation as such but, if I am wrong about that, I will write to my noble friend.

Department of Health: Budget

Lord Mawhinney Excerpts

Thursday 6th December 2012 Lords Chamber

[Earl Howe]

My Lords, the deficit is not rising. The Government are putting £12.5 billion extra into the NHS over the course of the spending review. The noble Lord, Lord Hunt, will know from his ministerial experience that government departments have an absolute requirement to manage expenditure within the financial controls that are set by Her Majesty’s Treasury and voted on by Parliament. For the Department of Health that means that the net expenditure outturn, which incidentally stems from around 400 organisations, all of whose accounts have to be consolidated, must be contained within the revenue and capital expenditure limits. Given those circumstances, it is sensible to plan for a modest underspend to mitigate against unexpected cost pressures.

[Lord Mawhinney]

My Lords, why does my noble friend believe that he will be able to tell your Lordships’ House that all the PFI hospital projects undertaken under the previous Administration, some of which are in a serious financial mess, will be deemed to be financially sustainable? How many of them are likely to require extra expenditure from his budget to achieve that desired end?

[Earl Howe]

My noble friend raises a very important issue. The analysis that we have done on hospitals financed by private finance initiative has indicated that there are seven trusts that are basically unsustainable as a result of their PFI commitments. The Department of Health has therefore undertaken to support those trusts to enable them to make up the shortfall which is beyond their control. It would be wrong to suggest that PFI was a solution that did not deliver benefits. Clearly it did, but I am afraid that some of the sums that were done initially were sadly wanting.

Health Transition Risk Register

Lord Mawhinney Excerpts

Thursday 10th May 2012 Lords Chamber

[Earl Howe]

My Lords, the law governing the release of government documents is the Freedom of Information Act 2000. The Act specifically recognises that the Government are entitled to consider all aspects of policy formulation in private. It provides an exemption to allow that, but it also allows Ministers to exercise a veto on the release of information if they have reasonable grounds for doing so. We believe that we do have reasonable grounds for doing so.

[Lord Mawhinney]

My Lords, will my noble friend accept that, in trying to find a balance between disclosure and transparency on the one hand and long-term good governance on the other, he has made the right judgment? Will he accept that good governance cannot be traduced or undermined in any way because it is at the very heart of the legitimacy and credibility of what happens here and in another place? Will he accept, finally, from a noble friend, who was occasionally—only occasionally—a constructively critical friend during the passage of the Health and Social Care Bill that the openness with which he handled that Bill will add credence to the judgment that he has announced today?

[Earl Howe]

I can do little but thank my noble friend for his kind remarks. Indeed, if I may say so, during the passage of the Health and Social Care Bill, I always attempted to be as open as I possibly could with the House on all the matters that we debated. I think that that resulted in a much better Bill. I hesitate to do this, but it is instructive to look at the evidence given to the Justice Select Committee in another place last month by Jack Straw. He put the case that we are making in very graphic terms with which I agree. He said:

“If you talk generally about risk registers, it has to be possible for officials to say to Ministers that there are these risks without these going public. Given the assiduity of the British press, if you publish a raw risk register without any more information, you will set all sorts of hares running, but the document was not designed or prepared in that way. You have to say, ‘We think that we could be at risk here. We think we could be at risk there. Have you thought about this?’ In my view, that sort of information must be protected”.

I could not have put it better.

Health and Social Care Act 2012

Lord Mawhinney Excerpts

Wednesday 25th April 2012 Lords Chamber

[Earl Howe]

My Lords, my understanding is that formal post-legislative scrutiny is a relatively new invention. It came in under the previous Administration in, I think, 2008. So until now there have been very few if any—there may have been one or two, a handful—formal post-legislative scrutiny processes. But we will, of course, see this as a more regular feature going forward.

[Lord Mawhinney]

My Lords, my noble friend has just reconfirmed that post-legislative scrutiny will take place in three years—that puts it in 2015. Can he tell your Lordships’ House whether the Government have a policy to have that scrutiny before or after the general election which is alleged to be taking place that year?

[Earl Howe]

My Lords, the plan is to conduct the post-legislative scrutiny three years from Royal Assent, so it will no doubt fall immediately prior to what one assumes will be the date of the next general election.

Health and Social Care Bill

Lord Mawhinney Excerpts

Wednesday 29th February 2012 Lords Chamber

[Baroness Williams of Crosby]

In replying to the last group of amendments the Minister referred to the fact that concern was expressed in many parts of the House about those issues. I am pleased to say that exactly the same is true of this group. Voices from the Cross Benches and from Labour as well as from the Conservative Party have been raised to address the need to ensure that CCGs always cover every resident individual so that we can ensure that the services of clinical commissioning groups are available to all the residents of the United Kingdom—or more precisely of England, although one could extend it to the United Kingdom.

One concern which has been expressed in the House on several occasions is whether, for example, people who are homeless or belong to Travelling groups, such as Gypsies or Didicois, would strictly be covered by the clinical commissioning groups given that there is not total coterminosity as there was in the old National Health Service. The purpose of Amendment 75, in particular, and the related Amendment 94 is specifically to ensure that nobody resident in the United Kingdom is simply left out of the new machinery. It is very important that this should be so as the people likely to be left out tend to be the most vulnerable members of society—the ones who slip through the cracks, if I can use that phrase. I am delighted to see that the noble Lord, Lord Laming, seems to share that view.

[Lord Mawhinney]

Can the noble Baroness tell us whether this amendment would also encompass illegal immigrants?

[Baroness Williams of Crosby]

The phrase used, which I think is also used in other parts of the Bill, is “resident in England”. It is not for me but for others, particularly the immigration tribunal, to judge whether somebody who is an immigrant to this country counts as a resident, but I would assume that if he was an illegal immigrant he would not be. If he or she were here except as an asylum seeker then clearly they would be covered by the amendment, which does not purport to set out a new set of immigration regulations. It would be inappropriate for the health service to do that. Therefore, let me turn back for a moment to Amendment 94 as well.

Health and Social Care Bill

Lord Mawhinney Excerpts

Monday 27th February 2012 Lords Chamber

[Baroness Pitkeathley]

My Lords, I, too, will speak strongly in support of these amendments, to which I have added my name. In spite of my major misgivings about the content of the Bill when it was originally published, I remember being delighted by its title because it had “social care” up there with “health”. Did this mean, I thought to myself, that at long last health and social care were to be given equal status? At long last, was there to be a proper recognition that the patient experience of being ill, disabled or in need of care is an integrated one? The Bill was supposed to be about making the patient experience better—less confusing, and more effective and efficient from the point of view of the patient—so I was hopeful.

In more than 40 years of working at the margins of health and social care, I have seen two experiences constantly repeated. The first is of patients always being surprised, distressed and horrified by the lack of integration between health and social care. Since they cannot put their own needs into two separate boxes, they are surprised that the services seem to be provided in separate boxes. They are further distressed by having constantly to give their details and history to different people, having to undergo unnecessary repeat tests and yet still being left alone or reliant on their families to negotiate between the NHS, social care agencies and local authorities, not to mention voluntary and private sector providers.

The second experience which has been constant in my life is the seeming commitment of all those who work in the system to how important integration is to the delivery of proper patient-centred care. Indeed has anyone in your Lordships’ House or anywhere else ever heard any professional say that there are benefits to care which is not integrated? Yet that is what we continue to deliver and there seems little hope of the Bill in its current form rectifying and ensuring a joined-up approach. Indeed, I fear for the practice manager or the social worker who has to interpret the new diagrams of the system to an elderly and confused patient or client.

My noble friend quoted the Health Select Committee, which said:

“Although the Government has ‘signed up’ to the idea of integration, little action has taken place to date. The Committee does not believe the proposals in the Health and Social Care Bill will simplify the process”.

The committee further said that the reforms in the Bill were built on the hope that GPs, hospitals and local authorities will respond to payments for working together. These amendments are about more than hoping for the best. They make practical proposals, first, about defining integration which, as the Law Commission found, is not easy. It will surely not be difficult to agree, as the Law Commission did, around contributing to or promoting the well-being of the individual. That would cover not only health and social care but housing too. That separation, as your Lordships are well aware, has always been a problem.

The proposals about annual reporting and business planning to check progress are also very practical and taking into account the levels of integration in setting tariffs is also very important. It is of the utmost importance that we take the opportunity given by the Bill to move the reality of integration forward in a way which will make a radical difference. The benefits to the patient, the client and the carer are obvious but there are benefits to the community and society which are similarly significant, since integration clearly delivers more effective and efficient care. There is lots of research evidence about this. For example, Turning Point identified that for every £1 spent on integrating health, housing and social care, £2.65 was saved. This is not only better for patients but provides better value for money. What is not to like in these amendments? I hope the Government will accept them.

[Lord Mawhinney]

My Lords, it would be very courageous for anyone in your Lordships’ House to argue that there was no benefit to the patient in trying to have as integrated a service as possible. I am not that courageous. It is a good place to start. Having said that, I do not believe that these amendments are the answer or that they move forward the argument for integration. I searched through these proposed new clauses and I find no mention of any legal responsibility on the local authority, the social care agencies or anyone else. They are entirely directed to health bodies. That imbalance struck me as being a pretty poor starting point if you are genuinely interested in trying to produce integrated services.

Your Lordships will know that, even before the introduction of the Bill, there were various attempts to integrate services in various parts of the country. I happen to be a reasonably well-informed individual in respect of one of those attempts. It is one thing to say to the PCT, the cluster, or whatever is the latest development in that area that it has responsibilities to integrate with the local authority, just as it will be a different thing to say that a local commissioning group has to integrate with the local authority if some attempt is being made legally to define the role of the health component but there is no commensurate attempt to deal with the legal framework with regard to the providers of social care. I know of one example of attempted integration in this country that is foundering because the health component is seeking to shift its deficit on to the local authority. Sometimes the quality of those who serve in one is so different from the quality of those who serve in the other that no right-minded person who was dealing with his or her own money would invest in a partnership that was as skewed as those that exist up and down the country.

I started where I did because I do not wish to be interpreted as being against useful, appropriate and constructive forms of integrated provision. I have taken a view throughout the Bill that it ought to be for the benefit of the patient. It would be courageous to suggest that some appropriate form of integration would not be of benefit to the patient. However, these skewed and flawed amendments are not helpful and certainly do not beat a path to the future for the benefit of patients.

[Baroness Young of Old Scone]

My Lords, I rise to support Amendment 38C and to disagree violently with the noble Lord, Lord Mawhinney. I think that the importance of integration applies not just between health and social care but also within health services. We have to start somewhere, and the Bill before us gives us the opportunity—now, today—to start with the important new bodies that will come into existence on the health service side of the partnership. It is fundamental and vital that they are properly tasked with responsibility for integration. Let me explain why.

I hope that many noble Lords listened last week to the interesting and powerful “File on 4” programme on the dreadful condition, in terms of lack of integration, of our diabetes services. Diabetes is a long-term condition and those who have it require each year that about 15 essential and different services are clustered around them in an integrated way; otherwise they run a high risk of suffering premature death or horrific and expensive complications. I emphasise the word expensive because those complications can include kidney failure, blindness and amputation, which are hugely expensive for the National Health Service to treat and could, at the current rate of increase in diabetes, financially wreck the NHS. I hope that at least some noble Lords heard that programme because it demonstrated that integration between health and social care and within healthcare is vital for long-term conditions—not just for diabetes but for other long-term conditions as well.

This is a disputed figure, but it is thought that long-term conditions now take up somewhere between 60 and 70 per cent of the NHS budget. If the Bill is about the future provision of healthcare in this country and how healthcare needs to be joined up internally and with social care, it will have to address that 60 or 70 per cent of NHS expenditure that relates to long-term conditions. Therefore, it is pretty important that the new institutions of the NHS Commissioning Board, the clinical commissioning groups and Monitor are clearly now tasked—while we have the opportunity to influence them—with incorporating integration into their annual plans and with reporting annually on how they have got on with fulfilling this obligation and important duty. I do not think it is too much to ask; I think it is pretty important. I hope the Minister will agree.

Monitor will also have a crucial role in the development of tariffs. At the moment we have tariffs which, unless properly constructed, get in the way of integration: they form a barrier to putting together sensible packages of services. In a competitive environment, that will be even more so. It is fundamental that tariffs are constructed in a way that supports the important integration—and I am not going to apologise for repeating this—which if not delivered results in premature deaths and horrific complications. I hope that the Minister will take this point and support the amendment.

Health and Social Care Bill

Lord Mawhinney Excerpts

Monday 13th February 2012 Lords Chamber

[Lord Turnberg]

My Lords, my name is also attached to Amendment 13. The case has been very well made by the noble Lord, Lord Patel, so I have very little to add, except that it is obvious that education and training are a key part of any service provision. For a service under pressure, looking after the patients always comes first, and it is very difficult in some circumstances to provide the time that education and training need. It takes a bit longer in an outpatient clinic to teach a young medical graduate; it takes longer in the operating theatre, I suspect, to show how it should be done. It takes time to allow junior trainees to go on education courses and rotations. The pressure on a service is always to concentrate on caring for the patients, and education and training can easily be given a back seat. This amendment helps straighten that balance.

[Lord Mawhinney]

My Lords, I spoke in favour of training and education at an earlier stage of the Bill, so I have no inherent antagonistic thoughts about the amendment moved by the noble Lord, Lord Patel. However, listening to him and to the noble Baroness, Lady Finlay, and the noble Lord, Lord Turnberg, it was quite clear that there is a financial cost attached to this amendment. They did not spell it out and I wish that the noble Lord, Lord Patel, had. My noble friend the Minister has already responded to the House’s concern about health training. Whether he is minded to accept or reject the amendment, can he tell us his estimate of its cost?

[Lord Walton of Detchant]

I support the amendment and will make a point about costs. As I said last week in a debate on education and training, since the health service began, the actual financial consequences of training specialists in all branches of medicine—surgeons, physicians, psychiatrists and all other specialists—have been the responsibility of the National Health Service. Many of us will remember the days of SIFT—the service increment for teaching—a financial increment that was given to hospitals and other organisations that provided postgraduate training at the same time as training undergraduate students. I have, I believe, an assurance from the Minister that that process is going to continue, which is extremely welcome. So I am not speaking primarily about finance.

However, I want to raise a point with the Minister that was touched on only superficially in the very helpful debate we had last week where the Minister tabled a series of very important and constructive government amendments and gave a number of very crucial assurances. I particularly want to raise the interrelationship between the health education authority and the regulatory authorities, which has not yet been clarified. The Explanatory Notes mention the importance of Health Education England working with professional regulators. I shall refer to the General Medical Council as an example because I was its president from 1982 to 1989, and before that, for seven years, chairman of its education committee. The fundamental point is that under the Medical Act, the General Medical Council’s education committee has the responsibility of ensuring,

“high standards of medical education and co-ordinating all stages of medical education”.

It is the regulator. If a new medical school is created, it has the authority to inspect it and consider whether its curriculum is sufficient. It has the authority to inspect the qualifying examinations of the medical schools in order to make certain that they are achieving an appropriate standard.

The fundamental point is that the GMC and the other regulators are not just stakeholder groups. Their statutory powers,

“provide independent assurance to patients, the professions and the service that national standards apply across the UK both in terms of the quality of medical training and the outcomes it produces”.

Of course, the important difference here is that Health Education England applies only to England, whereas the GMC and the other regulators are responsible for the oversight of education across the entire United Kingdom. What I seek from the Minister—formally, if I may—is an assurance that the activities of Health Education England will not usurp or attempt to usurp any of the statutory responsibilities of the regulatory authorities, which are already enshrined in law.

Health and Social Care Bill

Lord Mawhinney Excerpts

Wednesday 8th February 2012 Lords Chamber

[Lord Owen]

My Lords, I shall not detain your Lordships, but the noble Lord, Lord Hennessy, has asked me to speak on his behalf. I find no reason to disagree with anything that has been said, particularly by the noble Baroness, Lady Jay.

The Minister and I are going to disagree on substantial parts of the Bill—and a profound disagreement it is—but right from the moment when the noble Lord, Lord Hennessy, and I negotiated with him, he always accepted that this was an important constitutional and parliamentary point. He expressed readiness to enter into a novel arrangement, which we very nearly reached, but instead it has come around by another mechanism. At all stages, he has treated all of us, Peers and the House itself, with the greatest respect, courtesy and diligence. For that, I thank him on behalf of everyone.

[Lord Mawhinney]

My Lords, having taken up your Lordships’ time both at Second Reading and in Committee, I want to chip in at this significant point in this particularly significant clause. The noble Baroness, Lady Jay of Paddington, dealt beautifully, succinctly and with clarity with the constitutional importance and relevance of the amendment. I pay tribute to the work that she and her colleagues have done and the clarity with which she was able to persuade us in her contribution.

Colleagues will recall that I did not take the constitutional high ground in my concerns about what was originally expressed. I started from the other end of the spectrum. Whatever we may say constitutionally and whatever the professorial advice, my former constituents did not believe a word of it. They expected the Secretary of State and Ministers to be responsible. That was the argument from the grass roots that I tried to deploy to persuade the Minister to look at this again. I think that I was maybe the first—I was certainly one of the first—to suggest that all this should be taken away from Committee, we should not be tempted into a vote and we should think further about it.

I am delighted with the outcome on behalf of all my former constituents and indeed everyone else in the country, because we are now all on the same page. We are all now saying the same thing. Some of us have arrived there by high constitutional means, others from the grubby reality of the streets. The Secretary of State is the boss and is held accountable. He gets some credit for the successes and all the blame for the failures. That is how it has always been and, thanks to this amendment, it is how it will continue to be. Everyone will think that this is a great outbreak of success and common sense.

I pay tribute to the Minister. My noble friend Lord Newton has just said that the Minister’s colleagues will also have had to have been persuaded to this point. I hope that I will not diminish the sense of satisfaction in the House if I say that perhaps the Minister will have had a more important part to play in that process than the debates in this House.

Whether or not this is your Lordships’ House at its best, I do not care to judge. However, I will tell those of your Lordships who have not had the privilege of serving in the other place that this could never have happened there—never have happened. That is because the other place is infected with a degree of party political commitment that is frequently, though not always, spared at this end of the Corridor. Incidentally, for those who do not share my view and would like to see an elected Chamber, I gently point out that if what I am saying is true, this amendment today would never have been possible in the new, so-called “modernised” Chamber that is envisaged.

I refer to the introduction of the noble Baroness, Lady Thornton, to the previous set of amendments. I pray in aid the fact that she said that she would take responses in this debate rather than in the previous debate. She mentioned me by name and I thank her for that. She reflected accurately what I have just explained at some length. However, I will give her something else that she can quote accurately in the future. I congratulate my noble friend the Minister. He has done an excellent job, not for the benefit of the party, the Government or even the health service, but for the country. I am among those who feel indebted to him for what he has done and the spirit that he has adopted. I hope that, on reflection, the noble Baroness will realise that her introductory three minutes of an extremely party political nature were seriously out of sync with the consensus mood of the House at this time.

Health and Social Care Bill

Lord Mawhinney Excerpts

Wednesday 21st December 2011 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, perhaps I could begin by addressing briefly the matter of the risk register. Arising from earlier debates on this subject, I have discussed the timetable for the appeal with my officials, and I say again that I recognise fully the strength of feeling on this issue and the desire for speedy resolution. As noble Lords are aware, the timetable for matters of this kind is a matter for the Information Commissioner and the legal process. In view of the noble Baroness’s very courteous suggestion that I should write to her and to the noble Baroness, Lady Thornton, about this, I undertake to do so straightaway. I will copy in my noble friend at the same time. In that letter, I undertake to give as much information as I can at the moment about what we see as the likely timetable for the process.

[Lord Mawhinney]

Before my noble friend leaves that, can he tell the Committee whether the Government have already made representations about speeding up this process?

[Earl Howe]

Yes, my Lords; I have personally done so, as I undertook to the Committee that I would do. Perhaps I may include my noble friend in the letter that I send out so that he is fully aware of what I have done and what my department has done.

I turn next to the matter raised by the noble Lord, Lord Owen. To answer his direct question: yes, I was aware that the department was writing to the noble Lord in the terms that he outlined. I would not wish him to think me guilty of discourtesy or bad faith, because after he asked me to look into this matter I did so. I received very firm and clear legal advice that the information he has asked for falls into the category of professional, legally privileged advice given to the Government. It has not been the practice of successive Governments, including the previous Government, to waive privilege on information of this kind. However, as this matter is ongoing, I hope the noble Lord will forgive me if I limit what I say at this point. He has asked me to look at this further, and of course I shall do so.

--- Later in debate ---

Debate on whether Clause 247 should stand part of the Bill.

[Lord Mawhinney]

My Lords, at the risk of irritating my noble friend, I should like to make a brief comment about this matter. I assure him that it does not fall into the category of wishing to irritate him. If there is any virtue, it is a virtue of consistency on my part.

Clause 247 again deals with the interplay between the Secretary of State and the NHS board. We have already clearly established in this Committee that the Government wish to give the board a freedom from the overall influence of the Secretary of State that would mark a fundamental change in the way that the NHS has been conducting its business over many years.

Subsection (1) of the clause gives powers to both the Secretary of State and the board, and either can exercise them. I look down to subsections (3) and (4) and see that both the Secretary of State and the board can exercise powers in relation to the provision of health services. I wondered whether this was a belated recognition regarding the board for those of us who have been encouraging our noble friend to give primacy to the Secretary of State and maybe a stepping stone towards returning to the traditional position. On the other hand, if it is a stepping stone, and given the fact that until we hear from my noble friend there is not a lot of clarity as to what is intended here, these provisions may simply confuse the matter, not clarify it.

I am old-fashioned, as my noble friend knows, and I think that the Minister is ultimately responsible for the area for which Her Majesty has called him or her to be responsible. The Secretary of State could delegate powers to the board, but that is not the way that the Government have chosen to interpret this. All of us are grateful to my noble friend for the fact that he has been so willing to review this whole issue and to come back with new proposals on Report. I cannot be the only Member of your Lordships' House who looks forward to seeing what those proposals contain and measure them against the views that have been expressed on this subject over some months now.

However, since we moved away from the first few clauses, there have been examples of this ambiguity and potential conflict between the Secretary of State and the board running right through the Bill. I have tested my noble friend’s patience on a number of occasions by drawing his attention to various examples of that as we have gone through the Bill. I draw his attention to what is but another example of the importance of getting this relationship right—and my noble friend knows what I believe is right and I know what he believes is right. We are both grateful for the opportunity to review that before Report. I should therefore be interested to hear what my noble friend thinks is actually meant, or intended to be meant, by this clause.

Finally, because we have already established that the risk register is legitimate to discuss under Clause 247, I share the view that it would be very helpful to the Committee to have a definitive decision before Report gets under way. In keeping with what my noble friend Lord Newton of Braintree just said, were the Government to lose and to decide to pursue the matter to the next stage, I hope that the Minister will not think that such a decision would be without friends in this House. I cannot be the only former Minister who has conducted examination of potential legislation on the basis of “What if?”.

[Baroness Williams of Crosby]

I underline the point made by the noble Lord, Lord Mawhinney, because the whole area of information is a crucial aspect of the constitutional issues about accountability. In particular, the clauses we are discussing are expressed in complicated ways that are difficult to understand. For example, I find it hard to be clear that personal and identifiable data will not fall within the terms of the clauses, because the phrases “other persons”, “other bodies”, and so forth are scattered throughout the clauses. That disturbs me. Perhaps the Minister could add a little on data protection legislation and address the important point raised by the noble Lord, Lord Mawhinney, about this aspect of the Bill, which of course relates to several others besides.

Health and Social Care Bill

Lord Mawhinney Excerpts

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.