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Towards the end of the Minister’s remarks, I thought that she might be leading up to giving me some comfort, but that turned out not to be the case. She gave some comfort to the noble Baroness, Lady Meacher, who spoke to Amendment No. 93, suggesting that a sub-committee for mental issues might be on the cards, but she offered no encouragement of the kind that I asked for; that is, for the commission to set up a sub-committee on social care. Without that encouragement to set up a sub-committee, the fears that have rebounded around the Committee that this is a downgrading of social care will not be dispelled, however many ministerial warm words are poured over us.
That is enough for tonight, but not enough for our full consideration of the Bill. We will return to the issue. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
On Question, Whether Clause 2 shall stand part of the Bill?
Earl Howe: There are all kinds of areas that we could cover in debating clause stand part, but we have already spent a great deal of time on this clause and I do not intend to delay the Committee. However, I should like to take a minute or two to bring us back to first principles and to look once more at the proposed functions of the new commission.
I take my cue from the remarks of the noble Lord, Lord Ramsbotham, in our debate on 21 April, when he said,
- “I am extremely concerned at what has happened to CSCI, which has been split in two. Half is going under education, as the noble Baroness mentioned, and is in danger of being submerged there under the style of an inspection or audit carried out by Ofsted, while the elderly will remain with the Department of Health together with mental health, which is yet another different
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The noble Lord’s question was a fundamental one, to which we did not receive a proper answer. What is the rationale for splitting CSCI into two and dividing its expertise, as the Government now intend? What makes the Government confident that that split of CSCI’s functions will not result in a net dilution of regulatory expertise and the loss of professional cohesion—the cohesion created precisely because the work of CSCI, before the hiving off of children's services, embraced the whole field of social care, not just one part of it? If the Government intend to bring the regulation of health and social care closer together on the basis that each will gain from the other by being better integrated, why, at the same time, destroy what is—or was—a successfully integrated organisation?
One has to ask what expertise Ofsted has in children’s social care and exactly why Ministers think that Ofsted will add value to social care regulation. To me, the answer is not self-evident. There are already signs of strain in Ofsted in meeting the health and mental health care needs of children in care. The Children, Schools and Families Select Committee in another place has just been hearing evidence from the NSPCC and the British Association for Adoption and Fostering to that effect. Perhaps we need to remind ourselves that health and mental health represent new territory for the DCSF, the department to which Ofsted reports.
It may be thought that I am raising matters of principle unnecessarily; I do not think that I am. Sparing his blushes, while he is not in his place, I should like to cite part of the speech of the noble Lord, Lord Warner, at Second Reading. He said:
- “I should own up to being the Minister who conducted the arm’s-length bodies review which in 2004 recommended that the Healthcare Commission and CSCI should be merged, so it is not my noble friend Lord Darzi who noble Lords should blame”.—[Official Report, 25/3/08; col. 478.]
I always hesitate before correcting the noble Lord, Lord Warner, but I am sorry to say that on this occasion, unusually, his memory has let him down. The document published by the Department of Health on 22 July 2004 entitled Reconfiguring the Department of Health’s Arms Length Bodies contains no such proposal. There was no proposal in that document to merge CSCI with anything. Still less was there a proposal to split CSCI in two. The document proposed a merger of the Healthcare Commission with the Mental Health Act Commission. The splitting of CSCI was nowhere even hinted at. On the contrary, it was explicitly stated that social care would remain CSCI’s responsibility. I shall quote briefly from the document:
“The Commission for Social Care Inspection will continue to perform a parallel role in social care to that of the Healthcare Commission in health ... any merger with the Healthcare Commission at this time would be a distraction from the heavy agenda of both sides and would impact on the ability of both to regulate providers and thereby protect patients and service users”.
The transfer of functions to Ofsted had nothing to do with the arm’s-length review and had nothing to do with any failure on CSCI’s part. Noble Lords may remember that it had its genesis in the then Chancellor’s
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To be as charitable as I can be to the Government, I am the first to recognise that in the space of three or four years circumstances can change in a way that leads Ministers to take different decisions from the ones they first announced, but we need to be told why. We need to be told what the particular circumstances are underlying the decision to split CSCI into two and the reasons why such a split will not run the risk of weakening adult and children’s social services and, in the process, achieving the very thing that many noble Lords have said they fear—namely, the weakening of the voice that social care has at the board table of the CQC.
7.30 pm
Baroness Thornton: As usual, the noble Earl was admirably brief and to the point. As he will know, the transfer of responsibilities for children’s social care to Ofsted has already happened in the Education and Inspections Act 2006, in which I think we were both engaged. We were very concerned to ensure that the regulator who was created would concentrate on all aspects of children’s services. Indeed, that is in line with the overall policy objectives and the recent reorganisation of departments to reflect the Government’s wish to concentrate on children’s services and education in a coherent way. At the time, that seemed to be the right way to go in that, if you put together children’s services and education coherently, it made sense for their regulation to be in the same place.
Therefore, the key purpose of this Bill is to integrate the regulation of health and social care, reflecting the integration of the services locally and supporting innovation in joined-up service delivery. Noble Lords have, over a long period, advocated that, and indeed this was the way that health and social care was progressing. The proposal underlying the creation of the new commission is that it will build on CSCI’s good work. The Bill broadly comes from CSCI’s existing legal function and will be able to build on that.
Baroness Howarth of Breckland: I am sorry to intervene but I find doing so irresistible. During the passage of the legislation that integrated the regulators, I raised substantial concerns about the method of Ofsted’s regulation. In fact, I was sent by the noble Lord, Lord Adonis, to see the chief inspector to be reassured that the inspection would meet all needs.
What I say next I say simply because it illustrates the concern that we should all have. The regulation of services and delivery of services are different things. It is all to do with methodology. The methodology of Ofsted is very different from that of CSCI. I have found—I say this as a service provider; we have two schools that have been inspected by Ofsted and I have
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I say this now in order to endorse what the noble Earl, Lord Howe, is saying: that very different forms of regulation are being put together here. I think that is what the noble Baroness, Lady Meacher, was trying to illustrate, and I now understand that some bits of regulation are different from others. I say this so that it is on the record: I am not convinced, despite all I have seen, that the integration of the inspectorate—which was for a good reason, at the end of the day—has been successful in Ofsted. We therefore need to be incredibly careful in ensuring that the methodology of inspection, not the methodology of the combination of the services, is clear and related to the service being inspected rather than to a particular way of doing things that has worked in another area. What worked in schools with regard to education will not work in children’s homes.
Baroness Thornton: The noble Baroness is right. Regulation and the delivery of services are completely different. The point I was seeking to make, although children’s services are not part of my brief, is that bringing together children’s services and education and then introducing regulation of the two was the way that the Government moved ahead. That is what we are seeking to do here. We recognise that the delivery of services has evolved, is evolving and is becoming integrated on the ground. It therefore makes sense that the regulation moves together in a coherent and integrated fashion.
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I have said today, and it has been said by Ministers in the other place and by my noble friend the Minister at Second Reading, that that does not mean it is not recognised that none of the three services should overwhelm the others. The Bill allows that recognition. Various alternatives will need to be developed for how the regulation moves forward. That is not an easy task, and no one is suggesting it is. That is why we are going through it in such detail: because the service delivery is evolving, the regulation needs to evolve at the same time.
Earl Howe: This has been a helpful short debate. I thank in particular the noble Baroness, Lady Howarth, for her contribution. I recall for the Committee’s benefit her wonderful line at Second Reading that rationalised regulation is not necessarily rational regulation—a line I wish I had thought of and used myself. There is a superficial logic and a congruence in bringing children’s services all under the same umbrella—I would not argue with that—but we are beginning to learn that, if we are not careful, it can conceal some huge misalignments. The noble Baroness, Lady Howarth, was quite right in all that she said about methodologies. The key to getting the new body working as it should is that the methodologies should be distinct where they need to be.
I thank the Minister for her reply. At this hour, it is appropriate that we move on.
[Amendments Nos. 27 and 28 not moved.]
Baroness Thornton: This may be a convenient moment for the Committee to adjourn until Tuesday 6 May at 3.30 pm. To those noble Lords who are dressed formally, I hope that they have a pleasant evening.
- The Committee adjourned at 7.39 pm.
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