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Earl Howe: My Lords, the noble Baroness has taken a great deal of trouble to set out the Government's

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thinking on this amendment; as, indeed, she did in our earlier debates on Report. I should like to express my appreciation for that. What she has said undoubtedly takes us further forward. There was much in her speech which gives me cause to think that at least some of the points of principle that I and other noble Lords tried to articulate at earlier stages have not fallen entirely on deaf ears. Nevertheless, the amendment carried by your Lordships, which gave the Secretary of State power to extend to the independent hospital sector both the duty of quality and the remit of the commission for health improvement, reflected, I believe, some extremely important issues of principle. It was approved by a very significant majority of your Lordships and won the support of noble Lords from both sides of the House.

Although the Government have chosen to overturn that amendment in another place, their amendment bringing about that deletion has not been debated in another place by the whole House of Commons. It has only been debated in Standing Committee where the majority in the Government's favour was the narrowest possible one. If an amendment to a Bill is approved by your Lordships--especially one of this significance--I believe that the Government owe it both as a duty and as a courtesy to this House to allow the issue to be debated on the Floor of another place. The fact that this was not done is, I respectfully suggest, most regrettable.

I started with the thought that it would be by no means unreasonable of your Lordships to ask the other place to look at the Lords' amendment again. The logic of the case that it advanced remains clear. Day to day, the NHS and the independent sector work hand in glove; indeed, in many areas, the NHS would simply not survive without the ability to contract out to the private sector. In mental health, for example, 30 per cent of the beds in the independent sector are funded by the NHS. There are many thousands of doctors who divide their time between the NHS and private work. If the duty of quality is to apply to one part of the healthcare system in this country, it should apply across all parts of it.

From the point of view of the patient, there is no case whatever for seeking to draw artificial divisions between the NHS and the independent sector in terms of the standards of care that each should be delivering. Those standards, and the standards of clinical governance overarching them, should be consistent right the way across the board. If they are not, it is difficult to see how the Secretary of State's duty to safeguard and promote the health of the nation--that is to say, the nation as a whole--is being properly fulfilled. But that is the rub for this Government.

I would never accuse the noble Baroness of being ruled by dogma. Her message today was couched in balanced and reassuring tones. But those were not the tones of the press release that accompanied the publication of the consultation document on Tuesday. The headline says:


    "Regulatory Body to Tackle Failures in Private Health Care". The release continues:


    "Mr. Dobson said, 'Today's document responds directly to widespread patient concern about poor care in parts of the private sector. The small number of people who go private deserve protection'".

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    If that is what the Secretary of State believes this debate to be about, he really has lost the plot. But, of course, he does not believe it. He knows perfectly well that the concern of doctors and clinicians in the private sector is to see standards of care raised across the healthcare system as a whole. There is not a word in the press release to acknowledge that it is the private sector which has been campaigning for this regulation; not a word about the huge strides that it has made in establishing a coherent quality agenda alongside that being developed in the NHS.

"The small number of people who go private", in Mr Dobson's words, actually numbered 850,000 surgical patients in 1998. The total turnover of the private health and social care sector is £17 billion a year--a figure that includes 20 per cent of all acute elective surgery performed in this country. The truth is that the very existence of the independent sector is offensive to old Labour. If we want even more graphic evidence of that proposition, we need look no further than a recent statement by the chairman of the Health Select Committee in another place, Mr. Hinchcliffe. When asked to comment on doctors and other professionals who work in private practice, he replied:


    "I hate the bastards, and you can quote me". That is the sort of mindset we are dealing with. That is why I approach the new consultation document with a degree of scepticism. The whole thrust of the document is to propose what might be termed a "bargain basement" system of clinical standards for the private sector--a safety-net approach rather than a proper, fully-fledged quality agenda. That was not at all the thrust of the amendment approved by your Lordships.

In deciding my attitude to this amendment, I need to ask the Minister a few questions. Does she accept the suggestion that this consultation document, even if it does not usher in the kind of level playing field of clinical standards that I have been pressing for, nevertheless opens the door to such a level playing field. In other words, will she confirm that nothing in these proposals stands in the way of the adoption by the independent sector of clinical governance arrangements on a par with those in the NHS?

To be positive about this document, it does at least open up as a possibility that a new independent regulatory body could contract with the commission for health improvement, as the noble Baroness mentioned, to carry out inspections. It also suggests that clinical and professional standards in the private sector could be the subject of regulations or a statutory code of practice. All that suggests that there could be a de facto, if not a de jure, unitary framework of regulation. That is what the independent sector wants. It wants to come under the wing of CHIMP and NICE. It wants better regulation. It wants nationally consistent quality standards. I am the first to recognise that there may be more than one way of achieving those aims and I look to the noble Baroness for some further reassurance.

Lord Clement-Jones: My Lords, the motives of these Benches in supporting the original amendment

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were clear. Where healthcare and our hospitals are concerned, it seemed to us to be completely illogical and unfair that patients might be entitled only to minimum standards depending on whether or not they are treated in the NHS or the independent sector, or even whether or not they are an NHS or private patient in an independent hospital. Throughout the debates in both Houses our view has been that there should be consistency of standards between NHS pay bed units and independent hospitals and consistent standards when NHS and private care are provided alongside each other in independent hospitals, such as medium-secure psychiatric hospitals. We on these Benches 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.

As we have seen from the consultation paper, which we read with considerable interest when it was published on Tuesday, the Government are moving towards consistent standards of clinical governance so that, for instance, suspensions can take effect in the independent sector on receipt of an "alert" letter. There is therefore a strong prospect of seamless clinical governance between the two sectors which we welcome.

Moreover, we on these Benches look forward to further moves. We look forward to a prospect of wider consistency of quality of treatment. While not agreeing with the precise mechanics suggested in the consultation paper, we welcome the commitments the Minister has given and some of the statements in the consultation paper, for instance the clear recognition of the inadequacies of the existing regulatory structure and the commitment to protect all members of the public, including private patients as well as patients in NHS hospitals. Further, we welcome a recognition that it is important that patients who choose to use the independent sector are reassured that they receive services that are safe. We welcome the further statements made today by the Minister explaining the paper, and the preference for a single regulator for the acute independent healthcare sector rather than putting him under the regional commissions. We believe that is at least a step in the right direction.

We also welcome the recognition that that single regulator of independent healthcare might well want to take advantage--and be able to take advantage--of the particular expertise of the commission for health improvement. We believe that there is considerable potential synergy between the responsibilities of that single regulator and the work of the commission itself. However, we believe that some further assurances are needed. For instance, we need the assurance that NICE guidance for doctors in the NHS on the treatments that they use can also be adopted by the new independent regulator, and that the independent regulator could also introduce all or part of the national service frameworks.

The Select Committee on Health in another place has carefully considered the matter, as the noble Baroness mentioned. However, we seek the assurance that if it recommends--it certainly appears to be moving in this direction--that a common duty of quality is extended across the two sectors, the Government will carefully consider that proposal as part of the consultation

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exercise. We realise that the Minister cannot give an undertaking to provide legislative time to introduce a new system of regulation for the independent sector in the next Session but we hope that we have grounds for optimism on that score.


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