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Mr. Burstow: Let me respond briefly to the interesting exchange that we have had on this group of amendments. We have sought to raise a number of concerns. We have concentrated on concerns about elder abuse, but other contributors to the debate have broadened the discussion to include the wider context of age discrimination. If the scope of the Bill had permitted it, we would have wanted

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a broader remit for the proposed commissioner, so that the concerns of a number of the relevant charities about age discrimination could be addressed.

1 am

The ageist assumptions still prevalent in our society need to be challenged, as does the taboo about abuse of elders. As a society, we have decided to confront discrimination based on sex and gender, and we have decided to tackle racism. The House has decided also that we should do something about disability, and it is time that we decided to do something about age. The commissioner proposed in the new clause would have achieved that.

However, given the hour of the night and the contents of the debate, the best thing to do seems to be to withdraw the new clause, and return to the matter at a later stage.

I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.

Clause 1

Children's homes

Ms Stuart: I beg to move amendment No. 46, in page 2, leave out from beginning of line 7 to "or" in line 9.

Mr. Deputy Speaker: With this, it will be convenient to discuss the following: Government amendments Nos. 47 to 49.

Amendment No. 33, in clause 2, page 3, line 5, leave out "services are" and insert--

'a substantial part of the services provided are services'.

Amendment No. 34, in page 3, line 11, leave out "any" and insert "a substantial part".

Government amendment No. 50.

Amendment No. 97, in clause 3, page 3, line 41, at end insert--

'; or
'(d) it is a sheltered housing development in which residents live in defined self-contained units and are supplied with nursing or personal care on a variable basis according to their needs'.

Government amendment No. 51.

Amendment No. 98, in clause 4, page 4, line 20, at end insert--

'( ) "Healthcare agency" means, subject to subsection (6), any undertaking which consists of or includes arranging the provision of direct medical services performed by nurses to people in their own homes, or any undertaking which consists of or includes arranging the provision of any personal or medical care performed by occupational therapists, speech therapists or physiotherapists to people in their own homes.'.

Government amendment No. 52.

Amendment No. 99, in page 4, line 42, after second "agency,", insert "a healthcare agency,".

Government amendments Nos. 80, 81 and 85 to 93.

Ms Stuart: I do not intend to detain the House, as these amendments are all tabled in response to concerns raised

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by the hon. Member for Runnymede and Weybridge (Mr. Hammond) in Committee. I shall speak first to amendments No. 46 and Nos. 85 to 93.

In discussion on clause 1 in Committee, I undertook to consider whether it was necessary to exempt homes provided under section 82(5) of the Children Act 1989. That section allows the Secretary of State to arrange for the provision, equipment and maintenance of homes for the accommodation of children in need of particular facilities and services which are, in the opinion of the Secretary of State, unlikely to be available in community homes. This section of the Children Act 1989 replaced section 64 of the Children and Young Persons Act 1969.

The two youth treatment centres--the St. Charles centre in Brentwood, Essex, and Glenthorne in Birmingham--were established in the late 1970s under the 1969 Act. No homes have been established under section 82(5) of the 1989 Act.

In 1995, the St. Charles centre was closed, and Glenthorne will close on 13 July. I have taken the view that local authorities, the health service and specialist facilities in the private sector are better placed to care for the type of children placed in Glenthorne. I have therefore concluded that it is no longer appropriate for my Department to run such a child care facility and that we should withdraw from providing such a service.

Although there is no current intention of using section 82(5) of the 1989 Act to establish any more of these homes, its use cannot be ruled out at some point in the future. In those circumstances, it is my view that these homes should be regulated as children's homes by the National Care Standards Commission, and Government amendment No. 46 amends clause 1 accordingly. Government amendments Nos. 85 to 93 are consequential to bringing these homes within the regulatory framework.

I turn now to Government amendment No. 48. The Bill provides for independent schools that accommodate children for more than 295 days a year to be registered as children's homes. The reason for this dual registration is that, where children do not normally return home to their families during the holidays, they need the added protection that is provided by registration as a children's home.

Government amendment No. 48 will bring all boarding schools--that is, those in the voluntary and state sectors as well as the independent sector--into the dual regulation provision. It is important that children who spend more than 295 days a year in a boarding school, regardless of whether it is independent or not, should receive the added protection of being in a children's home.

In our Committee deliberations, the hon. Member for Runnymede and Weybridge tabled a number of probing amendments to find out exactly how we planned to use the power to except establishments and agencies from the definitions, contained in clauses 1, 3 and 4, of children's homes, care homes, domiciliary care agencies, residential family centres, fostering agencies and nurses agencies.

The hon. Member was concerned that we should not use the powers to exempt individual establishments or agencies from the requirement to register with the commission. I explained in Committee that it was certainly never our intention to exempt individual establishments or agencies from the definitions. We only ever intended to use the powers to except types of

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establishment or agency. However, I am happy to put the matter beyond doubt, and I have therefore tabled these amendments to clauses 1, 3 and 4 today.

On amendments Nos. 49, 50, 80 and 81, there was much debate in Committee on the language used in the Bill to describe people with learning disabilities. It was felt appropriate that mental disorder should be defined in the Bill as an illness. It is quite right that "illness" is defined in what is now clause 120 in such a way as to include mental disorder, and that "mental disorder" is defined as including

which covers learning disabilities.

On reflection, I agree with the hon. Member for Runnymede and Weybridge and other members of the Committee who spoke eloquently on the subject. I have therefore tabled amendment No. 80 to remove mental disorder from the definition of illness in clause 120. I have also tabled consequential amendments to the definition of a hospital in clause 2 and a care home in clause 3. The amendments separate mental disorder from illness and list it separately in its own right.

The last amendment in the group includes mental disorder in the definition of disability in clause 120. At the same time, we have taken the opportunity to update the language in these provisions to provide a more acceptable definition of "disabled".

I am grateful to members of the Committee for drawing our attention to these issues, as I believe that it has helped us improve the Bill in these important respects.

Mr. Hammond: I am grateful to the Minister for going through the list of Government amendments. All of them--unusually, in my experience--are in response to amendments that we tabled or points that we raised in Committee which the Government were prepared to accept in principle while wanting to come back with their own drafting.

I do not wish to do what the Minister has done and read out the purpose of each amendment. However, I have one or two points to make. On amendment No. 46, I am grateful to the Minister for taking our suggestion on board and giving effect to it in the Bill. Similarly, on amendments Nos. 47, 51 and 52, we have always taken the view that it would be iniquitous for Ministers to use these powers to exempt individual establishments or agencies. The Minister of State made it clear that that was not the intention, but the Bill did not make that clear beyond doubt. I am grateful to the Government for agreeing to amend the Bill to make that incontrovertible.

I am also pleased to see amendment No. 48. We tabled a similar amendment in Committee, which the Government rejected. It is good to know that Ministers occasionally go away, think again and then reintroduce the same amendment that they rejected in Committee. We are interested in strengthening the legislation, making sure that it is workable, and in reinforcing and underlining the principle of uniformity in treatment across the different sectors. Therefore, I shall not carp about the fact that it is not my amendment that will be accepted but the Minister's, which is in exactly the same form. I am just glad that we got there in the end.

Amendments Nos. 49, 50, 80 and 81 deal, as the Minister said, with the rather tortuous language in relation to learning disabilities. The Minister of State said in

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Committee, that while he sympathised with the problems, he suspected that there might be some real technical difficulties because of the legacy of the language used in previous legislation and the way in which social care Bills have tended to build on each other. However, I am very pleased that the draftsmen have found a way round this. I think that the Minister was in the Committee when this was discussed, and she will agree that members on both sides felt genuinely uncomfortable that people with a learning disability were being defined as having an illness. In the early part of the 21st century, we should not characterise that condition as an illness. I am grateful to the Minister and her colleagues for addressing the problem.

My hon. Friend the Member for Meriden (Mrs. Spelman) and I tabled amendments Nos. 33 and 34. They address a simple, but potentially important, problem that could arise from clause 2. They would revise the definition of an independent clinic and an independent medical agency. The Bill provides that any establishment or agency that carries out any NHS work will be excluded from the definition "independent medical agency" or "independent clinic".

The problem arises because of the dual system of monitoring--the Commission for Health Improvement in the NHS and the National Care Standards Commission in the private sector, which has rather more teeth because it is able to deregister establishments or agencies when necessary. It cannot be right that, by performing a nominal service in pursuance of the National Health Service Act 1977, an establishment or an agency can move along the spectrum so as to be regulated under a different system.

The measure refers to

The amendment would change the word "any" to "a substantial part". The test would change. That establishment or agency would move from being regulated by the NCSC to regulation by CHIMP only when a substantial part of its services were being provided to the NHS. For example, if an independent medical agency provided out of hours services to a single GP for a small group of NHS patients, it would not be wholly excluded from NCSC control.

It seems common sense to us that the occasional provision of minor services to the NHS, at the margin, should not change the status of an establishment, any more than--as the Minister might argue--a hospital or NHS establishment that provided the occasional paid service to a private patient should be moved from the CHIMP to the NCSC system. Whether or not the Minister is minded to accept the amendments, I hope that she will acknowledge that there is a problem and will tell us whether she sees any other way to address it.

Amendment No. 97 would establish conclusively that the definition of "care home" cannot include units in a sheltered housing development. That issue has been raised again because some doubts, hesitations and concerns remain outside this place as to whether the Bill offers a proper and precise definition.

The issue is relevant because of the way in which the social security system determines the eligibility of individuals for housing benefit. If a sheltered housing development, where people occupied separate and individual units, was classed as part of a care home

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because it was located on a site where services were offered to occupants--perhaps on an ad hoc or a la carte basis--there could be a danger that such people would not be eligible for housing benefit. Organisations outside the House have again raised that issue and I hope that the Minister will tell us whether she will accept this amendment. It would simply make clear in the Bill something that the Minister of State said in Committee was the Government's intention.

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