Merged body for health and social care inspection supported by Liberal Democrats

Sandra Gidley speaks at second reading debate on the Health and Social Care Bill

Sandra Gidley, Liberal Democrat Shadow Health Minister, gave a broad welcome to the Bill, although she said a lot of the detail in the proposals needed to be firmed up. She noted that the Bill offered "yet another reorganisation":

"The Healthcare Commission is fairly new, as is the Commission for Social Care Inspection. It would have made more sense to have brought them together three years ago, as the Liberal Democrats suggested at that time. All parties favour a more joined-up approach, but we have to guard against a one-size-fits-all mentality. When we are talking about regulation, we need to remember that what a large acute hospital requires is very different from what might be required when regulating a small domiciliary care agency. Both are important in their own way, but they require different approaches."

She stressed the importance of safeguarding social care inspection in the new body:

"The CSCI has expressed concern that any additional duties for the care quality commission should be adequately and separately funded, such as any duties that might stem from the current focus on hospital-acquired infections, which are also covered in the Bill. Otherwise, it is feared that resources could be squeezed from social care to fund that health agenda. Although we all support money being spent on ensuring that our hospitals are clean and safe, that must not come at the expense of the vulnerable and elderly."

"The Mental Health Act Commission provides for regular unannounced visits to those detained under the Mental Health Act 2007. The frequency of those visits needs to be protected, because it is a crucial tool in ensuring that the rights of the 45,000 people detained each year are protected."

She said that the Bill provided an opportunity to close what she called 'the human rights loophole':

"Nine out of 10 care homes are privately owned or in the charitable sector, and so human rights legislation does not extend to them. Attempts were made during the passage of the Equality Act 2006 to try to introduce some legislation on that matter, but the Government resisted. I hope that they will be more sympathetically disposed on this occasion. Residents of independently run care homes who experience rights abuses cannot challenge their care home provider."

Turning to the parts of the Bill dealing with regulation of health professionals, which have come out of reviews following the conviction of Harold Shipman, Ms Gidley, a pharmacist by profession before she became an MP, said:

"I must declare an interest as a member of the Royal Pharmaceutical Society, which will be no more as a result of the Bill. It is somewhat unusual in that it regulates the pharmacy profession but also acts as a representative body. In the post-Shipman era, we are moving towards councils with a parity between professional and lay members. It is difficult for such a body to represent the profession adequately. The Bill will set up a general pharmaceutical council, which is a move that most in the profession now support. However, there are concerns that the move is being foisted on the profession by the Government. Most of the profession seems to feel that there has been a lack of help in setting up a professional body or something akin to a royal college, as suggested by Lord Carter in the Carter review.

"The balance of any health care regulatory council is important. Instinctively, it would seem right that there should at least be a lay majority. That would help the public to have a greater trust in the regulators. There is a perception, whether it is right or wrong - I think that it is wrong - that the professions look after their own. I contend that the opposite is the case. The vast majority of professionals in any health profession do a good job and they do not want rotten apples in the barrel. The professions are quite hard on themselves. As we are always told that an evidence base is needed for introducing any change in regulation and policy, what evidence is there that a lay majority gives a better outcome for patients? I do not think that there is any. Dame Janet Smith and the Shipman inquiry suggested it, but there is no hard evidence that it is better for patients."

On proposals to reduce the standard of proof for doctors, nurses and midwives and the General Optical Council from the criminal to the civil, she said:

"Most of the noise has been made by the British Medical Association on behalf of doctors. However, the General Medical Council, also on behalf of doctors, planned to introduce such a measure anyway... I understand the concerns of individual practitioners, who must instinctively feel that if they transgress they are at greater risk of losing their livelihood. That must add stress and worry. Other health care regulators, including those in my profession, have managed the civil standard of proof well. It is a serious step to strike a health professional off the register, and it is not done unless there is an overwhelming balance of evidence. It is not done on the balance of probabilities. People have to be sure. We also forget that the people who sit on such committees and listen and decide the outcomes are human too. They apply a standard of fairness in such cases."

She concluded: "Much in the Bill is welcome. Some details obviously need to be firmed up, but on the whole, Liberal Democrats support its broad principles."