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Session 2001- 02
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Standing Committee Debates
NHS Reform & Health Care Professions Bill

NHS Reform & Health Care Professions Bill

Standing Committee A

Thursday 6 December 2001


[Miss Ann Widdecombe in the Chair]

NHS Reform & Health Care Professions Bill


entry and inspection of premises

9.30 am

Dr. Evan Harris (Oxford, West and Abingdon): I beg to move amendment No. 209, in page 21, line 5, leave out 'may' and insert 'shall'.

The Chairman: With this we may discuss the following amendments: No. 210, in page 21, line 14, at end insert—

    '(f) prison service premises where such joint working as is specified in section 21 is taking place.'.

No. 211, in page 21, line 25, at end add—

    '(4) In this section ''premises'' shall have the same meaning as in section 23(6) of the 1999 Act.'.

Dr. Harris: The amendments relate to the powers that the Bill will give to patients forums. Amendment No. 209 seeks to replace the word ''may'' with ''shall'' because entry and inspection is a critical function of any regime through which patients and community representatives carry out their tasks. However well-meaning the Secretary of State's intentions, it seems reasonable to require him to issue regulations on the entry and inspection of premises by patients forums, rather than leaving the matter to his discretion. Heaven forfend, as the Under-Secretary might say, but the current Secretary of State may not hold that post for ever; some might question whether he holds that post now in respect of certain health service functions. Regulations must also be made to clarify the way in which the clause's provisions will be implemented, and the amendment seeks to establish whether the Department will consult all relevant stakeholders when drafting regulations.

Amendment No. 210 concerns the powers of patients forums to inspect delivery of NHS care in prison premises where there are joint working arrangements, as identified in clause 21. In a previous sitting, the Under-Secretary said that we might discuss some of these matters when we considered clause 21, and I am happy to leave that to her discretion. However, it would be useful if she explained now whether the clause as drafted would enable such inspections.

By definition, it is difficult to discover what is going on in prisons. Such isolation has given rise to current concerns about the level of prison health care, although it should be said that those concerns are not necessarily a reflection on prison medical officers. The isolated nature of the delivery of prison health care is a critical factor in terms of quality. Opening up the environment in which NHS care is delivered in prisons would not only improve accountability and openness, but raise quality.

Amendment No. 211, which makes reference to section 23(6) of the Health Act 1999, is a probing amendment that is intended to establish whether privately owned establishments such as nursing homes and others in which NHS care is provided will be open to inspection. Does the Under-Secretary think that the Bill's current definition of the word ''premises'' will enable the widest possible coverage?

Mr. Oliver Heald (North-East Hertfordshire): Patients are now being sent abroad and to other parts of the country for their treatment; we shall hear more about that later. Would the amendment allow a patients forum to inspect the treatment that patients from south-east England receive in France or Germany?

Dr. Harris: That question applies not only to inspections by patients forums, but, importantly, to quality control inspections such as those carried out by the Commission for Health Improvement. We touched on that issue earlier. The Bill was never intended to cover quality assurance and community participation because it was drafted long before the latest panic measure of exporting patients—shortly followed by staff—to Europe. There is no definition to which I can refer that would be wide enough to cover all the options that the Government are currently dreaming up.

None of us wants patients to wait longer than they need to, but the Government must think carefully about the areas in which they want NHS patients treated so that those patients will be adequately covered by quality assurance measures, the reach of civil litigation for negligence and the duty and right of patients forums to inspect those systems and input to them. The Minister described extensively—perhaps even eloquently—her vision of public participation in every area of NHS care. However, the hon. Member for North-East Hertfordshire (Mr. Heald) raised an interesting point about what sort of patient and public involvement there can be in those settings.

I do not want to be distracted from the point, which concerns the definition of premises. Having found the correct part of the Health Act 1999, I recognise that the definition suggested in this amendment—which I stress is a probing amendment—is more limited than the one it seeks to replace. I am unsure how that happened, but it was almost certainly a function of drafting the amendment late at night while examining many different definitions of premises. Will the areas listed in the clause include private health care providers whose premises are covered by the regulations that apply to the Commission for Health Improvement where it has been given the right to inspect premises?

I should have prefaced my comments by saying that during the last sitting, we had a heated debate about the Government's intentions. Liberal Democrat Members argued that there was no need to abolish community health councils and that the Government's proposals for patients forums were flawed.

Mr. Simon Burns (West Chelmsford): So did we.

Dr. Harris: Indeed, so did the Conservatives who spoke in that debate. However, the amendments that we shall discuss this morning are efforts to be constructive within the framework of the Government's proposals. In that spirit, I hope that we get a reasoned debate, a constructive response—that is likely with this Minister—and perhaps some give from the Government.

Mr. Burns: Clause 16 deals with the entry and inspection of premises, which—whether it relates to the national health service or any other area of service provision or commerce—is a critical power given to the authorities to enforce the provisions of legislation. In the past, various sectors and service providers have complained that powers of entry and inspection have been carried out in an over-bureaucratic and almost officious way.

Without wanting to get into arguments about Europe, a consistent source of complaint has been the fact that inspection powers that are brought on to the statute book via European provisions are often fine-tuned by British Governments, of whatever party, to make them much more onerous. That has been a particular problem in respect of food hygiene and standards. It is important to ensure that the provisions on inspection and rights of entry fulfil the intentions of the Bill without making it unnecessarily burdensome and officious, which is in no one's interests.

The clause gives the Secretary of State powers to issue regulations governing the nuts and bolts of powers of entry and inspection. In the first sitting of the Committee, my hon. Friends and I, and the hon. Member for Oxford, West and Abingdon (Dr. Harris), pointed out to the Minister that the Bill contains numerous regulation-making powers, yet we have not seen any draft regulations. It would have been extremely helpful to the work of the Committee, especially on this clause, had we been given a greater insight into what the Secretary of State may intend if he is minded to issue regulations.

Mr. Heald: My hon. Friend is making an important point. Does he agree that it is astonishing that we have not yet seen one draft regulation, given that we have now reached clause 16 and that the Minister promised at the very beginning of our proceedings, in response to my first point of order, that he would let us see them all?

Mr. Burns: My hon. Friend makes a powerful point, and he did indeed raise that point of order at the beginning of the first sitting. We are now approaching the end of the second week of our proceedings, yet we have seen no draft regulations in any shape or form.

The Government did not dream up the Bill in the last few weeks; it has been thought about for a long time. To return to the debate at the end of the previous sitting, this part of the Bill is frankly just a vindictive repetition of the provisions of the Health and Social Care Act 2001. I presume that, during the passage of that Act, the Department of Health must have been giving thought to powers of entry and inspection. That was in January, February and March of this year. We are now at the back end of the year and we still do not know how the Government intend to flesh out any regulations that the Secretary of State may wish to issue.

I should have thought that the Under-Secretary, having noted the Minister of State's response to the point of order made by my hon. Friend the Member for North-East Hertfordshire, would anticipate the debate and that the Department of Health would work overtime to prepare a skeleton of the draft regulations to enable us to get a better idea of the Secretary of State's intentions.

9.45 am

As the hon. Member for Oxford, West and Abingdon said, amendment No. 209 seeks to change the provisions in the beginning of clause 16 so that it would no longer be that the Secretary of State ''may'' make regulations, but that he ''shall''. That would place a duty on him—he would have to make regulations—and his choice would be removed; that would either strengthen the Secretary of State's hand or box him in, depending on one's point of view.

There is logic to the amendment. It is not desperately satisfactory to leave the decision up in the air and up to what the Secretary of State may want to do. If one concedes that patients forums should have the power of entry and inspection of premises, it would probably be in their best interests to have regulations that spell out those powers and how far they can act in fulfilling the duties in the Bill. I regret that we do not have such draft regulations.

The hon. Member for Oxford, West and Abingdon also tabled amendment No. 210, which deals with Prison Service health providers and allowing patients forums to have powers to investigate problems and the provision of health care in the Prison Service. As he pointed out, there is no statutory remit for community health councils to look into the provision of health services in our Prison Service—there is outside prisons—but a number of community health councils, on a voluntary and ad hoc basis, have liaised and forged informal ties with prison health services. On balance, that is a good thing.

I do not want to pre-empt the debate on clause 21, but it would be fair and right to say that during many years, under Governments of both political persuasions, the provision of health care in the Prison Service has been a scandal. Improvements have been made in recent years, but, to be brutally frank, the provision of such health care has been at a level that would not be tolerated by constituents outside of prison.

That is not a criticism of the medical profession working in the Prison Service, but of a culture that has grown over years, and of the reluctance—until recent times—of the Department of Health to take over the running of the prison health service because the cost of doing so would come out of its budget and not that of the Home Office. At a time when our health service has been under constant and increasing strains because of rising expectations, increasing demand and targets set politically—by this Government in particular—the Department of Health would have found it difficult to incorporate the funding of the prison health service within its budget without a knock-on effect.

In many ways, the prison health service is out of sight and out of mind, by definition of its location, and the issue has not been high on many people's political agendas. Because of that and associated problems, this measure would provide a positive step forward for patients forums, if they ever see the light of day. The Bill has a long and winding journey before it reaches the statute book; who knows what may happen to it during its long passage through Parliament? Its predecessor was derailed earlier this year.

On the assumption that the Government will get their way--the only assumption that we can make--patients forums could provide a welcome and useful service not only in the provision of health care in general, but to the enhancement and improvement of health care in the prison system. I see no reason why they should not be extended to the Prison Service health care system. We have accepted the principle that the health service outside prisons should be monitored and that our constituents should have an organisation to monitor health care and investigate individual problems. Why should not the Prison Service? Why disfranchise that part of health care simply because it deals with individuals who have been disfranchised?

I hope that the Minister will have an open mind and will think seriously about an amendment that is designed simply to enhance and improve the Bill. If she is prepared to accept the principle in relation to patients forums, a belt and braces operation would be an insurance policy for her. She might want to concede the point in relation to community health councils if they were to be saved from this vindictive Government.


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Prepared 6 December 2001