Health and Social Care Bill

Baroness Pitkeathley Excerpts

Wednesday 12th October 2011 Lords Chamber

[Baroness Pitkeathley]

My Lords, I am going to be in a minority on these Benches by speaking in favour of the Bill, at least of one very small part of it, and that is Clauses 219 to 226 in Part 7 which create the Professional Standards Authority for Health and Social Care. I welcome the changes to the Council for Healthcare Regulatory Excellence, the organisation I currently chair. The changes provided by the Bill will bring in new regulatory options for the health and social care workforce through the accreditation of voluntary registers, new areas of oversight in statutory regulation across social work and new funding arrangements. I support this package of reforms because they keep the interests of patients, service users and the public at the heart of the system regulating healthcare workers in the UK and social workers in England.

These provisions reflect evolving thinking about right-touch regulation and proportionate protection of the public. Giving the Professional Standards Authority the power to accredit organisations which have voluntary registers of health and social care workers but are not statutorily regulated introduces a new, cost-effective and flexible option for improving patient safety and experience. I also support the reforms because they allow for greater integration of health and social care regulation through our oversight function of the renamed Health and Care Professions Council, and of course the CHRE will be renamed the Professional Standards Authority for Health and Social Care to reflect the broader scope of its work. Right-touch regulation promises less but better regulation, and I pay tribute to the nine health regulators and the staff of the General Social Care Council who have embraced the proposed changes, which are not necessarily easy for them to make in a professional and positive manner. That is the limit of my positive approach to this Bill.

I am a passionate devotee of the NHS. I grew up in the Channel Islands, where every visit to a doctor had to be paid for and where good health was, therefore, largely a function of your income. My grandmother was deaf because of neglected ear infections and my grandfather was killed in a road accident because he returned to manual work too soon after being in hospital for surgery, driven by the need to pay the bill. I owe my own life to the NHS through its intervention, pioneering surgery and medical expertise, and my continuing good health to the watchful eye the NHS keeps on me.

In addition, one of the great commitments of my working life has been about social care. It is too easy, as others have said, to overlook the fact that the Bill before us is about health and social care; and about enabling disadvantaged individuals, clients, carers and patients to speak for themselves and to contribute to policy formation. How I judge proposals for changes to health and social care, therefore, is simple: first, whether the new arrangements will lead to services that are more organised around individuals and more focused on patient need; and secondly, whether there will be more integration among the providers of care, whether health services, care services or indeed voluntary and privately provided service.

The emphasis placed on integration and collaboration by the Future Forum report was very welcome but I have yet to be convinced about how its proposals, as interpreted in the Bill, will lead to better integration across health and social care. As the Future Forum report reminded us, the provision of integrated services is rarely dependent on structural change:

“The reality is that the provision of integrated services around the needs of patients occurs when the right values and behaviours are allowed to prevail and there is the will to do something different”.

It is surely not hard to understand that since delivery of co-ordinated services depends on co-ordination between individuals, individuals are less likely to have the will to do something different when they are fearful about their own futures. This is not surprising, since the dedication and commitment of public sector workers is constantly undermined by some in our society and when they are worried about the service they love being dismantled and anxious about a future which seems to offer conflict between different types of vested interests instead of a focus on patient needs.

For the patients themselves, their fear and bewilderment is reflected in the huge number of communications that all your Lordships will have received. Is there anyone who really believes that the mantra of, “No decision about me without me” is going to be facilitated by the changes in the Bill? What patients want—and, I would strongly argue, what patients have a right to expect—are services across health and social care that are easily accessible, free from fears about affordability, and provide dignity, safety and peace of mind as well as treatment or cure. I pity any patient who is seeking those things in the mess the services now find themselves in. Patients always complain about the complexity of systems and about why one bit of the service does not seem to talk to another. The plethora of acronyms and layers with which they now have to contend is hardly going to help; and woe betide any patient who looks at the horrendous flow charts and diagrams of the new system.

I share with others the concerns that have been expressed about the lack of independence for HealthWatch, the potential conflicts of interest for local healthwatch organisations, the lack of proper transition arrangements between LINks and local healthwatch, and also the lack of real power for the health and well-being boards.

In addition, although some progress has been made towards coterminosity between consortia and local authorities, the populations for whom consortia will be responsible will be based on practice lists not geographical boundaries; so there may be all sorts of problems such as we have seen many times before with health and social care professionals trying to work across geographical and administrative boundaries, as the noble Lord, Lord Beecham, has warned us.

However, my principal worry about the patient and public involvement issue—I repeat—is that all my experience shows that structural change does not bring about integration and collaboration, either within a service or across services. It is people and proper communication about the assessment of needs from the point of view of the patient that bring that about. The well intentioned changes that have been made as a result of the Future Forum work have actually led to systems and structures that are more complex and difficult to find your way around—even for the professionals who work in them, let alone the consumers.

We always—not only in these difficult times—have to face a balancing act between quality and affordability. Much mention has been made in this long debate of competition. Some say it drives up quality, and that may be true for some services. I can only say that in a lifetime of working in health and social care, I have seen very few commercial interests competing to provide preventive services or services for those with dementia or with a mental disability. Those have been left to the voluntary and community sector, who will scarcely be able to compete on a level playing field with the giant commercial interests currently circling our NHS. Unlike the voluntary and community sector, which has always subsidised these services, I doubt they would be circling unless there were some prospect of profit.

Anyone who has ever run an organisation knows you have to build a consensus if you want to bring about change—otherwise you spend too much energy fighting the change instead of facilitating it. However pressing the need for change in the NHS—and I have heard no noble Lord in this long debate argue against the need for change—the Government have utterly failed to build that consensus. All the communications we have received, and the large petition that I understand has been received today, are ample evidence of that. For the sake of patients and professionals—and the NHS which is so loved by us all—I hope that the amendment tabled by the noble Lord, Lord Owen, if carried, would give more time for building that vital consensus.