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Earl Howe moved Amendment No. 77:

Page 31, line 27, at end insert--
("(4) The Secretary of State may by regulations extend the duty in this section to Special Health Authorities of any particular description and to any independent hospital.
(5) In this section "independent hospital" means premises--
(a) within the meaning of "hospital" given by section 128(1) of the 1977 Act;
(b) which are not a health service hospital within the meaning of the 1977 Act nor any other premises maintained or controlled by a government department or local authority or any other authority or body instituted by special Act of Parliament or incorporated by Royal Charter; and
(c) which are used or intended to be used for the provision of health care within the meaning of this section,
but excludes--
(i) any premises used, or intended to be used solely or predominantly, for the reception of and the provision of nursing for persons suffering from any sickness, injury or infirmity;
(ii) any sanatorium provided at a school or educational establishment and used, or intended to be used, solely by persons in attendance at, or members of the staff of, that school or establishment or members of their families;
(iii) any first aid or treatment room provided at factory premises, at premises to which the Offices, Shops and Railways Premises Act 1963 applies or at a sports ground, showground or place of public entertainment;
(iv) any premises used, or intended to be used, wholly or mainly--
(a) by a medical practitioner for the purpose of consultations with his patients;
(b) by a dental practitioner or chiropodist for the purpose of treating his patients; or
(c) for the provision of occupational health facilities,
unless they are used or intended to be used for the provision of treatment by specially controlled techniques as defined in section 21 of the Registered Homes Act 1984 and any regulations made thereunder;
(v) any premises used, or intended to be used, wholly or mainly as a private dwelling; or
(vi) any other premises excepted from the definition of a "nursing home" for the purposes of section 21 of the Registered Homes Act 1984 by regulations made thereunder by the Secretary of State."").

The noble Earl said: My Lords, this amendment, in one sense at least, mirrors my earlier Amendment No. 47 in that it seeks to impose the duty of quality in Scotland on the independent hospital sector.

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Having carried the House with me on the earlier amendment, I give notice that I propose to press this amendment. I shall not repeat the arguments that I advanced earlier in relation to England and Wales, but the amendment enables me to highlight the same issues in the context of Scotland, as well as a general issue relating to Clause 41.

There is no question in my mind that quality standards in the independent sector in Scotland are as much in dispute there as they are in England and Wales, and that a unitary framework of regulation for both the NHS and the independent sector would provide a necessary and welcome degree of assurance to patients in Scotland.

My general point takes the form of a question. How is it proposed that adherence to the duty of quality will operate in Scotland given that the commission for health improvement is to cover England and Wales only? How will quality standards be monitored? How will doctors and hospitals be inspected and audited on a basis comparable to that south of the Border? I beg to move.

Lord Clement-Jones: My Lords, I support this amendment as we supported Amendment No. 47 in relation to England and Wales. Exactly the same arguments apply. The argument having gone one way on Amendment No. 47, it would seem highly illogical for it not to go the same way in relation to this amendment. I hope that for the purposes of future argument on the Bill in another place, the Government will accept this proposal.

Baroness Carnegy of Lour: My Lords, I support the amendment and I hope that the Government will accept it, the House having accepted Amendment No. 47. My noble friend asked how this will operate in Scotland. It seems to me that this is, like the other amendment, an enabling amendment. It would enable each special health board or NHS trust to put and keep in place arrangements for this purpose. Perhaps the Minister can tell us whether it will be left to the health board or to the trust to put these arrangements in place or whether it will be prescribed to them if the amendment is accepted. Obviously, he has not had time to think this through, but it would be helpful if we could have an indication. Quality in Scotland matters so much.

Lord Macdonald of Tradeston: My Lords, as was said, the amendment covers similar ground to that covered by Amendment No. 47, debated this afternoon. It seeks to extend the duty of quality to special health authorities. This is unnecessary as the clause as drafted achieves this already. Scottish special health boards are the counterparts of special health authorities in England. There is no statutory provision for the creation of the latter in Scotland. Special health boards will be subject to the duty of quality under the terms of the Bill.

In reply to the noble Earl, Lord Howe, perhaps I should say a little more about the arrangements that we have in Scotland relating to quality. As I explained in Committee, we have the well-established Clinical Resource and Audit Group (CRAG). We are in the

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process of establishing the clinical standards board for Scotland, which I am delighted to say that the noble Lord, Lord Patel, who spoke earlier today, has agreed to chair. These bodies are primarily concerned with the National Health Service, but their guidance and advice will be available to the private sector. We expect the private sector to take that advice and guidance fully into account.

The amendment also seeks to extend the duty of quality to independent hospitals, which it attempts to define. As was explained in Committee, we do not believe it would be appropriate to attempt to use the current Bill to place new statutory obligations on the independent sector. That will be a matter for the Scottish Parliament to consider in due course. No doubt it will wish to take account of the conclusions of the health committee's current inquiry into the regulation, monitoring and inspection of healthcare outside the NHS.

The guidance on clinical governance issued to the National Health Service in Scotland last November makes clear, however, that its provisions apply to services which the NHS commissions from other bodies. Thus, where the NHS contracts with a provider in the independent sector to provide a service to NHS patients, it should use those contracts to ensure that clinical governance principles are applied.

As your Lordships may be aware, my honourable friend the Minister for Health for Scotland published earlier this week a White Paper proposing new arrangements for the registration and inspection of nursing homes in Scotland. That would require a reconsideration of the current arrangements for regulating the private acute hospital sector. We expect the Scottish Parliament to take that work forward.

Your Lordships will understand the Government's reluctance to accept the amendment, given the earlier debate on Amendment No. 47. Furthermore, Amendment No. 77 does not properly reflect the Scottish legislation on these issues. However, in the light of the House's decision on Amendment No. 47, I am prepared to consider whether there are any further steps I can take to provide reassurance to your Lordships on this matter.

I should say, in reply to the noble Baroness, Lady Carnegy of Lour, that the Government have issued guidelines on clinical governance and that the clinical standards board will provide further guidance. If there is any detail that I have overlooked in that reply, I shall try to supply it to the noble Baroness in writing as soon as possible.

Baroness Carnegy of Lour: My Lords, before the noble Lord sits down, is there any reason why the Government should not put an enabling clause into the Bill which the Scots Parliament could then pick up? With all the careful arrangements that the Parliament will have with regard to secondary legislation, it could then proceed with the matter. It seems to me that there should be the same provision for Scotland in the Bill in that respect as there is for England. I understand that the

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arrangements will be totally different, but could there not be an enabling clause of that kind? I realise that this amendment is flawed.

Lord Macdonald of Tradeston: My Lords, as I said in the light of the House's earlier decision on Amendment No. 47, I am prepared to look at the matter again. It will be one of the issues that we shall consider. I hope that I shall be able to provide reassurance to your Lordships on this matter.

Earl Howe: My Lords, I am grateful to the noble Lord for that assurance. In the light of that and of his clarification that the amendment is technically defective, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Carter: My Lords, I beg to move that further consideration on Report be now adjourned. In moving this Motion I suggest that the Report stage begin again not before 8.20 p.m.

Moved accordingly, and, on Question, Motion agreed to.

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