Health and Social Care Bill

My Lords, I am very grateful to the noble Lord, Lord Harris, for his history lesson. Perhaps I should not go on to the Commission for Patient and Public Involvement in Health. Perhaps he remembers that organisation, which never quite worked. I think that it did its best, but it failed to influence the Labour Government of the time. Perhaps it was a bit too strident. Maybe it was not canny enough. Maybe it did not build the relationships that are so critical when one is negotiating a change, especially with a big beast like a Government. Of course, the Labour Government closed that one down very hurriedly. The proposal in the Bill is that HealthWatch England should be a committee of the CQC, as has already been said. There are advantages in that, provided that there are some safeguards in the way that it works. My three amendments seek to achieve those safeguards. There are advantages in being at the top table, knowing what is going on, and building the necessary relationships to influence policy and practice. The CQC will, of course, have the resources to collect and analyse data on a national scale. Provided that it shares that data generously—and it must do so—it will enable HealthWatch England not to have to build its own infrastructure in order to operate effectively. That will also enable HealthWatch England to have a strategic role in shaping the new NHS. It is very important that it should not just be a sounding board for local issues, but should have a strategic vision as well. The CQC will of course learn of the issues that need addressing through the real experiences of patients, through HealthWatch England, which will be at the table. We have to understand what both organisations bring to the party. The CQC is the regulator. Its duty is governed by the statutory standards for healthcare and it has the indicators to measure them, as set out in the Health and Social Care Act 2008. HealthWatch England brings something different: the priorities, the experiences and the views of patients and the public, through local healthwatch organisations. Played right, this combination could be very powerful. It could deliver the accountability that reflects both the priorities of government, derived from the democratic process, which I think of as the theory, and the actual experience of those who depend on health and social services during what may be the most vulnerable time in their lives, which is the reality. If this combined perspective, to be embedded in regulation, is to work well, it is essential that HealthWatch cannot be dictated to or steered by the CQC. It must speak with a clear, strong, independent voice. This requires two things: first, the appropriate balance of membership within HealthWatch England; and, secondly, the appropriate status for its advice within the functions of the CQC. The status of HealthWatch England as a committee of the CQC may be quite pleasing in its value for money and its legislative simplicity, but it does not guarantee that clear, strong and independent voice. This is the voice of the victims who have been so badly let down by the NHS. It is the voice that has been chronicled so meticulously in the first Francis report on the mid-Staffordshire scandal, the Bristol inquiry, and other reports. Therefore, my first amendment, Amendment 307A, ensures that the majority of the members of HealthWatch England are not also members of the CQC. This avoids the advice of HealthWatch England being biased through corporate responsibility with the CQC. My second amendment, Amendment 308A, ensures that the majority of the membership of HealthWatch England is elected from the members of local healthwatch organisations. This permits the introduction through regulation of provisions to ensure that elections cover local healthwatch organisations from across the country, and that representatives are elected through due process for an appropriate term and with appropriate accountability. We know that this works very well. We have seen regional elections to national bodies in the voluntary sector and even outside it, from student unions, to national professional associations, to the National Association of Citizens Advice Bureaux. The National Association of LINks Members recently conducted elections from its regions which were overseen externally and the process proved to be satisfactory. My Amendment 308B places an obligation on the CQC to have due regard to the advice given to it by HealthWatch England in all its functions. This advice will have equal status to that of the CQC's current advisory committee established by the 2008 Act. If HealthWatch England is to have any teeth, it would be illogical for it to have lesser status. Due regard means that the CQC must demonstrate how it has incorporated the advice of HealthWatch England into its conclusions and actions, embedding reality into the way it applies theory. This will open the way for HealthWatch England to comment in its report on whether the CQC has taken note of its advice, as required by new Section 45B. New Section 45A(6) only requires the CQC to respond to advice from HealthWatch England and not take any account of the way it goes about its business of regulating health and social care. This is inadequate and does not incorporate the voice of patients and the public in regulation. Finally, I say that we should learn from past disasters and failures in the NHS. A powerful lesson from the Bristol inquiry was how important it is to involve patients and the public. Recommendation 160 from the inquiry stated: "““The public’s involvement in the NHS should particularly be focused on the development and planning of healthcare services and on the operation and delivery of healthcare services, including the regulation of safety and quality, the competence of healthcare professionals, and the protection of vulnerable groups””." I would not be surprised if the second Francis inquiry states something similar. Of course, I do not know what it will say—this is just a supposition on my part. It would be good for the Government to show that they are ahead on this and that they understand the importance of these issues and are taking action through mending the Bill. If my noble friend Lady Northover is not totally convinced by my amendments—I hope that she will be, but probably she will not—perhaps she will take them away and at least give them serious thought, because I think they have merit. They will give HealthWatch England a sound basis on which to maintain some independence while still being in the tent and therefore in a strong position to influence the CQC and secure continuous improvement in the provision of healthcare.