Private and Voluntary Health Care (England) and Care Home Regulations 2001

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Mr. Jonathan Shaw (Chatham and Aylesford): I, too, received the brief sent to the hon. Member for West Chelmsford (Mr. Burns). Perhaps it was the only brief that came through his letterbox, as it is all that he talked about. He spoke with great passion, but all hon. Members received that brief.

Mr. Burns: So that the hon. Gentleman does not suffer under a misapprehension, I can assure him that my speech is not based simply on a brief that I received in the post in the past three months.

Mr. Shaw: The hon. Gentleman could have fooled me. The hon. Gentleman spoke about intense pulsed light hair removal; I was bitterly opposed to hair removal for at least 15 years and when I first read the brief I thought that was what it was about. Then I read on and found that it was about the treatment of hair loss, of which I am obviously in favour. Perhaps I misread the document, but if my hon. Friend the Minister had told me that the Government were about to introduce treatments for hair loss, we would see eye to eye on everything and I would offer to deliver leaflets in her constituency.

The matter is important, as there has been an escalation in the number of people having cosmetic surgery, skin treatments and procedures to enable them to change their features. We have seen too many cases in our newspapers in which such procedures have

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gone wrong and perhaps constituents have come to see us at our surgeries seeking redress and wanting to know why no one is regulating the area.

Mr. Burns: Given that the hon. Gentleman raised the point, will he tell the Committee how many constituents have been to his surgery since 1997 making complaints about this specific beauty treatment?

Mr. Shaw: On the specific skin treatment, I did not say that I had received—

Mr. Burns: You did.

Mr. Shaw: I did not. The hon. Gentleman may care to check the record. [Interruption.] If the hon. Gentleman packs up his sedentary prevaricating, I will tell him that constituents of mine have sought removal of marks from the skin and found the treatment unsatisfactory. That happened. I shall not go into detail about this case, which would be particularly sad if it involved a child. I speak from some experience based on my constituents' cases. Treatments have expanded and more services are available, but we also know that things sometimes go wrong.

The hon. Gentleman spoke about sensible regulation, which people expect as the industry expands to meet demand. We need built-in safeguards. I hope to hear from my hon. Friend the Minister that consultation has taken place. Of course it is right to hear the views of people involved in the industry, but I also hope that she sought the views of people who have suffered long-term and damaging effects from these services.

I welcome the regulations, but I also seek clarification and reassurance from my hon. Friend the Minister.

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Dr. Evan Harris (Oxford, West and Abingdon): I am grateful for the opportunity to contribute to the debate. I listened carefully to the hon. Member for West Chelmsford who spoke about communing with the private sector in the delivery of health care. We then heard a debate about the appropriateness of the regulations on hair removal equipment.

Some even more important issues must be addressed. First, will the Minister clarify the meaning of the regulations with respect to a couple of provisions that are difficult to follow unless one is familiar with the Health and Social Care Act 2000, which amended the National Health Service (Primary Care) Act 1997? What is meant by the reference in regulation 4 to the meaning of ''independent clinic''? It is clear from regulation 3 that independent clinics will be exempt from classification as independent hospitals under the regulations. I am not clear about the prescription in regulation 4: are walk-in centres to be regulated under the NHS even if they treat private patients? Private companies have set up some innovative schemes at railway stations. Would they be classified?

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Will the hon. Lady explain paragraph 4 of regulation 3, which adds to section 2(7) of the amended 1997 Act? Cosmetic surgery is defined, but ear and body piercing, tattooing and other aspects are exempted from it. Does that mean that those aspects will not be covered by the regulations? Concerns have been raised on both sides of the House about the inadequate regulation of body piercing, especially in respect of young people or those whose ages are not clear. The same applies to tattooing. Are we not missing an opportunity here?

The Minister may be aware of articles over the last few days in the Financial Times about the behaviour of anaesthetic specialists on fee setting. It is alleged that anaesthetists providing services in the private sector are operating as a cartel, artificially raising prices—outrageous at worst, and at best failing to provide the transparency that a proper market requires. That is the best interpretation of this alleged behaviour and it greatly concerns insurance companies who procure these services and, indeed, patients who are faced with a higher bill.

Will the Minister tell the Committee what arrangements the Government are making either within regulations or, if that is not appropriate, around the issue to ensure that once the Office of Fair Trading investigation is complete such practice is made more difficult? Clearly, she cannot be held responsible for the actions of private specialists, but we must create a climate in which such behaviour is made more difficult.

It was alleged that patients are being presented with a bill directly by the anaesthetist at the time of pre-operative assessment. As the Financial Times said, it is pretty difficult for a patient who is about to go under the knife to quibble over the price with the anaesthetist when they are first presented with the bill the night before the operation. The tradition is that anaesthetists bill the patient directly, rather than as part of an entire price negotiated by the private sector, which would be more sensible. Regulation 7 concerns the patients guide, to which the Financial Times referred, and paragraph (1)(b) states that the guide shall include

    ''the terms and conditions in respect of services to be provided for patients, including as to the amount and method of payment of charges for all aspects of their treatment''.

Will the Minister clarify where it is provided that the guide is given to the patient well in advance of their pre-operative assessment? One cannot blame the anaesthetists for operating in the current system, but it is inappropriate.

The policies and procedures in regulation 9 discuss consent, but I cannot see any paragraph that provides that consent should be obtained by the surgeon who performs the procedure. That is established good practice, and it would not do any harm to specify that in the regulations. It is normal practice in the private sector, where there are fewer tiers of junior doctors than in the national health service, and such a move would be important.

Regulation 9(3)(d) provides that

    ''information about a patient's health and treatment is disclosed only to those persons who need to be aware of that information''.

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Will the Minister confirm what the limit of that is in relation to marketing and the provision of information? Could the information that a patient has had a treatment in a hospital be passed to a third party or another division of either the provider or commissioner—the insurance company—in order to send more information about other possible treatments? One can see the commercial opportunities and the wish to market directly to people who have used such services, but if a patient were identified as having a treatment in a specialist clinic, it would be a giveaway. Even without going to clinical details, one can usually work out what the problem is.

The regulations do not mention hours of work for staff. The Minister will know that there are broadly two provisions under the NHS. Standards are set out by what was called the new deal for junior doctors, although it is rather an old deal now. That sets specific limits not only on the total hours of work, which will be reduced further by European regulation, but on maximum shift lengths depending on the intensity of the work. The regulations do not seem to contain any provision to prevent hospitals from deploying junior doctors—they will usually be not training-grade doctors but resident medical and surgical officers—for long shifts that will run beyond the 24-hour limit that applies to the least intense work. That should be provided for. If it is unacceptable in the NHS for a junior doctor, even in a less hard-pressed specialty, to be on call for what is known as a long weekend, from Friday to Monday, I do not see why that should be allowed in the private sector. We know that tired doctors, particularly those who are junior, make more mistakes or take longer to avoid making mistakes. Indeed, as I know, several have managed to take longer in making mistakes. That appears to be a serious omission.

The Minister will be aware of the provision on the maximum working week for specialists covered by European legislation. Will that apply not only to the more junior staff who will be resident on call in many independent hospitals, but to the specialist staff? Will independent hospitals be required to comply with that duty?

Regulation 17 is remarkably short. It is entitled

    ''Review of quality of treatment and other services''.

It is surprising if the provision that relates to the duty of audit in NHS hospitals can be summed up in eight sentences for independent hospitals. The argument is that where patient choice exists it is a driver to the publication of more information on outcomes, which enables choice to be more informed. However, I am not sure that the degree of audit will be what some of us want without a firmer requirement that specifies the sort of clinical audit that should take place.

Under regulation 19, there is a question about the fitness of workers, and regulation 18 contains provisions about staffing. Does the Minister think it appropriate to specify in regulations a duty on such employers to abide by the regulations that apply to public authorities under the Race Relations (Amendment) Act 2000. I may have missed that, but I do not think that it is there. I am talking about making

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it clear that if a requirement were placed on staff to hold certain qualifications before being employed, which indirectly discriminated against staff from certain ethnic minorities who might find it more difficult to comply with, that would be a breach of the duty. That is a problem in medical practice.

I think that I have drawn the attention of the Minister's colleagues to a problem with the granting of certificates of completion of specialist training. It would not surprise me if certain posts in private hospitals were held open for Australian or white Commonwealth doctors to practise as clinical fellows or something similar, and that would reduce options for people from other ethnic minority backgrounds.

Clearly, these are extensive regulations. I echo the comments of the hon. Member for West Chelmsford, who spoke for the Conservative party. In a ''take it or leave it'' Standing Committee such as this, we do not have amendable regulations as we would like.

I have not been able to lay my hands on a copy of the report of the Joint Committee on Statutory Instruments. I was informed by the authorities that it had not yet been printed, but I understand that the hon. Gentleman was able to get a copy, so that is a little frustrating. He says that the Committee criticised the regulations for not being properly drafted. As they are so extensive, will the Minister assure us that there will be an adequate opportunity to review their operation?

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