Health and Social Care Bill

My Lords, unfortunately the noble Lord, Lord Patel, had to leave before we could get to this amendment so I shall speak on his behalf in moving Amendment 306. The amendment brings us to Clause 178, which is about HealthWatch England. In simple terms, the amendment seeks to make HealthWatch England an independent body and not a sub-committee of the Care Quality Commission. That is its purpose. We have to some extent already touched on this issue and made the arguments in earlier debates about why we think, in terms of public credibility for HealthWatch England, it should not be nestling within, hosted by or whatever else you want to call it the Care Quality Commission. I shall turn to the issue about that particular body in a moment but, as a matter of principle, whether it is the Care Quality Commission or some other body, we take the view that it should be a free-standing body so that it can exercise—and, perhaps just as importantly, be seen to exercise—a very independent role in pursuing the purposes and interests of patients and the public. The whole area of public and patient involvement and them having their say in the running of the NHS, the way it works, its standards and its standards of care has caused difficulty across the political spectrum in getting it right. The Government deserve considerable congratulation on having another go at this. It is not a matter of principle, certainly as far as the noble Lord, Lord Patel, and I am concerned, that we should not have a body called HealthWatch England—we totally favour that—but you might as well go the whole hog if you are going to claim that it is an independent body. Calling it a sub-committee of the Care Quality Commission does damage to the public perception of its role. I know that the noble Earl, Lord Howe, has seen recently the NALM to discuss these issues and I want to quote from some of the briefing that it used in that meeting with him. The NALM made it very clear that they saw collaborative working between HealthWatch England and some of the other bodies as important, but that did not mean to say that it wished it to be hosted in one of those bodies. The briefing is most interesting. It says: "““Our work with the CQC over the past year has given us little confidence that this is the right location for the public’s independent national body concerned with health and social care””." It is concerned that it will not be seen as independent. Whatever arguments the Government may have, we have to take careful note when representatives of the public and patients do not believe that they will be seen as independent if they are placed in the CQC. I do not want to prejudge or make comments on some of the criticisms that have been made about the CQC in recent times. Many of us would say that it has a very heavy load to carry. I played my part in giving it that heavy load, so I own up to that and get my retaliation in first before I am accused of contributing to its heavy load. It is right that we should have that body looking across the NHS and social care, as it is consistent with the enthusiasm for integration of health and social care which has been voiced so eloquently in your Lordships' House. But it has taken on a lot; it has a lot to do. Occasionally, it would be fair to say—and this could be said to be an understatement—it has struggled with the load that it carries. It does not get HealthWatch England off to a good start to place it as a sub-committee of a body which itself is struggling to maintain its public reputation at present. Rightly or wrongly, it is being seen as a body that is struggling to maintain that reputation. That is not to say that it is not an effective body or that it should not carry on in that particular way but, in the present public mood, to put HealthWatch England in the CQC as a sub-committee is at the very least a major presentational mistake. The Government ought to have the courage of their convictions. Having gone along the path of wanting to set up an authoritative body to argue the case for patients and the public, they should make sure that that body is independent. A number of amendments in this group deal with how you select that body. Amendment 306 leaves it to the Secretary of State in effect to make regulations governing how that body is established. I do not have a strong view on how that appointment is made, whether it is made by election from the local level—I can see the case for that—or by some other means. What we care strongly about is that this body is independent not just of the CQC—although particularly of the CQC—but of any other body. If is fine if there are economies to be made by having a memorandum of understanding about back-office services between the CQC or any other body to help HealthWatch England run its affairs in an efficient and effective way. That would not in any way undermine the publicly seen independence of HealthWatch England. In conclusion, I quote again the NALM briefing which was used in the meeting with the Minister. It says: "““HealthWatch England needs to be lean, focused and independent and able to freely criticise the CQC and hold it to account. To place it within a bureaucracy which currently has diminishing public confidence hardly seems wise, bearing in mind the fundamental role of HealthWatch England””." That sums up the case for it being an independent body and being seen to be an independent body. I beg to move.