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Lord Clement-Jones: My Lords, I rise to lend strong support to the amendment and I remind the House that it is the offspring of amendments tabled by both Opposition Front Benches in Committee and the ensuing debate.

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In Committee, the Minister said that the Government intend to consult soon on the regulation of the independent or private acute healthcare sector. Regrettably, however, she gave no assurance that a duty of quality, identical to that proposed for the NHS, will be required for that sector. Nor did she address the point that considerable benefits would accrue from that sector being regulated by the same body, and largely in the same way, as the NHS. Some of the benefits of this approach have already been outlined by the noble Earl, Lord Howe.

They include consistent standards when NHS and private care are provided alongside each other in independent hospitals such as in medium-secure psychiatric units; and consistent standards of clinical governance nationwide so that consultants have no doubt as to the standards expected in all their practice. It makes no sense at all to exclude some 800,000 treatments a year carried out in private hospitals and work done by more than 17,000 doctors, most of whom also work in the NHS. Very few consultants practise only in the private sector.

The overwhelming majority of independent sector hospitals, in membership of the Independent Healthcare Association, actively support the need for such change, as do key leaders in the medical profession. Individual independent sector companies such as BUPA and PPP have gone clearly on the record in support.

The major players in the independent sector have already committed to a framework for the conduct of private medicine under the auspices of the Private Practice Forum of the Academy of Medical Royal Colleges. This framework matches the quality in clinical governance duties proposed to the NHS, but it now applies only on a voluntary basis. The Government should seize the opportunity that the amendment presents; to reserve the power to apply these duties to non-NHS providers of healthcare by regulation.

The amendment, as the noble Earl explained, has been revised in the light of the Minister's previous comments. It would allow the Secretary of State to delay using the powers until the Government have reflected on their own consultation and the deliberations of the Health Committee in the other place. The amendment is not prescriptive in any way. It does not, for instance, prevent separate registration requirements being instituted. It merely provides a framework for the extension of the duty of quality and the functions of the commission for health improvement.

The amendment clearly commands widespread support. Regrettably, the Secretary of State seems, if a recent article in the Independent is accurate, to have set his face against it. Forgetting, no doubt, that separate amendments in Committee stood in the name of both Opposition Front Benches, a "ministerial spokesman" is quoted as saying:


    "The Tories are again pushing the agenda of the private health sector. We do think it needs regulating, but we don't think it's for the NHS to regulate private health care. The NHS would end up picking up the tab. We don't think it is right".

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After all our discussions about charging by CHIMP, that final comment in particular seems very wide of the mark. But in general, the comment appears to have no concept of the benefits of common regulation for healthcare in this country.

The noble Baroness herself said in Committee that there is no intention of applying the commission to the private sector as regards providing care for private patients. So much for future consultation. Indeed, from reports in today's Times, it appears that the Secretary of State is planning to set up a separate inspectorate to regulate the independent sector. It appears that the Government have firmly made up their mind on purely ideological grounds.

In a recent column, the health correspondent of the Financial Times and the author of the definitive history of the welfare state, The Five Giants, Nicholas Timmins, writes:


    "If the NHS wants a true picture of how well its doctors perform it needs the full picture, not just the NHS one".
He concludes:


    "Mr. Dobson has the chance to become the first Secretary of State for Health, not just the NHS. He should take it".
This Secretary of State prides himself on his common sense image. This amendments makes common sense.

On these Benches, we have no particular axe to grind for private health. However, we believe that every patient should have the right to minimum standards of quality care and safety, irrespective of the sector in which they are treated. I urge the noble Baroness to consider the amendment most carefully at a time when we have the legislative opportunity before us and to demonstrate the open-mindedness she has shown in many other parts of the Bill.

3.45 p.m.

Lord Skelmersdale: My Lords, it must be very rare for a Back Bencher in Committee to draw a bow to venture and land not one but two palpable hits on the senior spokesmen representing the two Opposition Front Benches. I am grateful to both of them for what they have said. They made a much better fist of it than I would have been able to do today.

It is absolutely vital that regulation and inspection of private hospitals and private practice is achieved by hook or by crook. From what the noble Baroness said in Committee, I know that she believes that too, but she wants to wait. I readily understand why she wants to wait, but I hope that that is not an argument for promoting the doctrine of unripe time. There is never a right time for these things, but she should grab the opportunity. After all, primary legislation is an uncertain vehicle as regards timing. That is why in Clause 47 and Schedule 3, which we shall debate later today, the Government are taking the opportunity to speed up the process of registration and so forth by--guess what--secondary legislation. That is exactly what my noble friend is asking for today.

Baroness Carnegy of Lour: My Lords, I believe that the resistance to including independent hospitals in the Bill is most revealing and rather distressing. We are told

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a great deal about how the third way involves partnership between the private and public sectors and the resistance is clearly a means of doing something different for people who pay as opposed to those who do not. It will be very disappointing to the public who are at present watching new Labour very carefully.

However, the Minister is the first to know that the people who are keenest of all to keep an eye on the standards of care for patients are the nurses. My experience is that when any maltreatment, or possible maltreatment, is occurring in a hospital, or involving a doctor, where nurses are involved it is often the nurses who blow the whistle. They may do so in a number of ways, but they do. They are the people who are writing most clearly to noble Lords to inform them that the issue is important now and that we should not wait. They are saying that extremely clearly.

Amendment No. 77, which relates to Scotland, matches this amendment. The feeling about the issue is every bit as strong in Scotland as it is south of the Border. Because there is no CHIMP in Scotland, it is important to discuss the matter separately and we look forward to hearing what the noble Lord, Lord Macdonald, has to say about it.

I support the amendment most strongly not only because the nurses are so keen on it, and they know, but also because it is very odd to treat people who pay, or people who are in pay beds but paid for by the public, differently from the rest.

Baroness Masham of Ilton: My Lords, is it not a fact that it is common practice for some health authorities to use the independent sector to clear some of their waiting lists? Therefore, should not those patients have the same protection as any other patient treated in National Health Service hospitals?

Viscount Bridgeman: My Lords, I too rise to support the amendment. The noble Baroness, Lady Masham, has just made the point about the interdependence at all levels between the private and NHS sectors in the service. I speak as chairman designate of an independent charitable hospital. The independent sector is more regulated at present than the NHS. Nevertheless the sector very much welcomes the possibility of further accreditation. Most hospitals are already accredited under the King's Fund. This is an extension of that. It is a more public and transparent standard of which all patients can be assured so that, wherever they are treated, they will be treated to the same standards in all hospitals--private and national health.

Lord Patel: My Lords, not having been in your Lordships' House in Committee, I beg your Lordships' indulgence for speaking now. I have read the Hansard report of that debate and noted in particular the statement made by the Minister to which the noble Earl referred earlier.

There are many issues to be addressed in relation to the regulation of the independent sector. Not least of those is the registration and inspection to ensure that standards of service and practice are met and enforced.

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There are other issues too and I shall refer in particular to those which mainly concern the medical profession. I believe that the public would expect that all doctors who provide care in the independent sector would have undergone the same level of training and assessment as those specialists who work in the NHS.

As has already been said, the vast majority of doctors who practise in the independent sector also hold consultant positions in the NHS. However, significant numbers do not. They should also be subject to the same regulatory processes, not only those of the General Medical Council but also of the other regulatory bodies, some of which have been mentioned; for example, the Royal Colleges. When I was chairman of the Academy of Medical Royal Colleges I was responsible for instituting the forum to which reference has been made. While it has had ongoing discussions, it has not resolved the issue.

In respect of the training of those who provide service in the independent sector, in my capacity as chairman of the specialist training authority I shall give evidence to the Select Committee.

There are other issues; for example, appropriate procedures relating to complaints and clinical governance. So yes, I agree with many of the things that have been said. We need regulation in the independent sector. I know that the independent sector would welcome a properly structured regulatory process established after consultation. I ask the Minister whether she will assure the House that an opportunity for the commission to have a potential role in the independent sector will not be missed if the amendment is not accepted at this stage.


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