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Baroness Carnegy of Lour: My Lords, the Government's response to this amendment which your Lordships have made to the Bill is to me both disappointing and also surprising because it seems to me an astonishingly out of date attitude to have taken to the way private medical institutions should be brought up to quality. I am sorry now that we did not have a separate amendment relating to Scotland. If I remember rightly, the debate was a fairly general one. I expected the Government's response to be rather different and that Scotland would be able to follow what was decided for south of the Border. But in view of the fact that there is nothing about Scotland here--that is of course understandable--I wonder whether the noble Baroness can tell us the way the wind is blowing on this subject in Scotland, if she knows that, and whether the Government have been talking to the Scots Parliament about the matter. I hope she can tell us whether any consultation paper will be issued in relation to Scotland because it seems to me that this is an urgent matter north as well as south of the Border. I would have thought that potential--

Lord Patel: My Lords, I thank the noble Baroness for giving way. I reassure the noble Baroness that as far as I am aware there is no bar to the remit of the clinical standards board for Scotland extending to the private sector. It is responsible for quality standards in Scotland. I speak as a chairman of the standards board.

Baroness Carnegy of Lour: My Lords, I am grateful to the noble Lord for reassuring me on this matter. He is a neighbour of mine and he knows everything about what happens in Scotland. However, I am not sure that everyone in Scotland is completely happy about this situation. However, perhaps those comments exonerate the noble Baroness from replying to my question. I apologise if I have wasted noble Lords' time.

Baroness Hayman: My Lords, I am grateful for those comments. I always believe in cutting out the middleman if necessary!

Serious issues have been raised today and were raised in earlier debates we have had in regard to regulatory standards and how we ensure the protection of patients without there being any of the artificial divisions to which the noble Earl, Lord Howe, referred. I hope that I can give some assurances that the Government are not being ideologically obdurate in these areas. What we have said--I have said this to the House on many occasions--is that we must ensure that the processes that we have in place to ensure patient protection, quality of care for patients and the safety of patients, are appropriate to the environment in which they are receiving care. The processes and the structures which are applicable within the NHS--a managed service--will be different from the structures and processes that are in place within the independent sector. That is the argument I have been trying to propose.

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I say to the noble Earl that it is neither his fault nor mine that these issues were not debated on the Floor of the House in another place. I suggest in the gentlest of terms that if Members in another place had not decided to spend four hours debating the timetable Motion out of the five and a half hours that were available on Tuesday of this week, we might have been able to have a debate on these issues.

Earl Howe: My Lords, I am most grateful to the noble Baroness for giving way. Is she suggesting that Madam Speaker in another place was not regulating the Chamber as she should have been, because if she is suggesting that it is a disgraceful thing for her to say?

Baroness Hayman: My Lords, I would never suggest that. Madam Speaker was active on these matters. I believe that the Opposition had to be called to order 21 times in the course of Monday's debate. However, the allocation of time as between the timetable Motion and other discussions was in the hands of Members. Fortunately such considerations do not apply in your Lordships' House and we can return to the substantive issues before us.

The debate has focused on standards of care and the quality of care that is available and is to be ensured for all patients. In our consultation document we propose that as part of the regulatory framework we would establish a range of standards that would apply either to all private and voluntary establishments or to a particular kind of establishment. These might be set out in regulations or in a statutory code of practice but it will be a responsibility of the regulatory body to make sure that they are delivered.

We believe that this is much more than a safety net approach and that it addresses one of the weaknesses of the current regulatory regime: that standards and inspections tend to focus on facilities rather than on the quality of care available to patients. We are proposing that standards might be developed in a number of areas which relate more closely to the care delivered and which ensure that, where appropriate, there are parallels with the protection that is provided within the NHS.

Perhaps I may give specific examples. At present, staff working in private and voluntary healthcare can be employed in private and voluntary hospitals as, for example, chiropodists or physiotherapists, without being properly qualified and registered. The Government believe that all private and voluntary hospitals should ensure that they employ only state registered staff, as is already the position in NHS hospitals. So here we are bringing in a parallel that will increase protection.

It is also important that patients, their relatives and carers should have access to a comprehensive range of information about services being provided in a hospital or clinic where they may be treated. The Government consider that this should cover clinical as well as non-clinical services. It might include information on staffing, facilities available and the range of services provided. We propose that the provision of information for patients should be one of the standards for the new regulatory system--again ensuring some sort of parallel with what is available elsewhere.

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6 p.m.

Baroness Masham of Ilton: My Lords, perhaps I may ask the Minister a question. There are assistants to physiotherapists who do valuable work both in the health service and in the private sector. It is well known that there are not enough therapists. It might be very serious if the private sector and the National Health Service were not allowed to employ such assistants, who work under a qualified physiotherapist.

Baroness Hayman: My Lords, I hope that I can reassure the noble Baroness that there is no intention that appropriate services should not be provided by staff who are not necessarily state registered within their profession. The issue is about protection of title, to which I am sure my noble friend Lord Morris of Manchester will respond. It is also about an assurance to patients that they are being treated by someone who, if he says he is a chiropodist, is indeed a state registered chiropodist. That is not to undervalue the assistance that can be given by aides both in the public and private sector, but it should be at the appropriate level and no one should be in any doubt.

The issue of the complaints procedure within the private sector has been raised. A number of patients have written to me about that issue. We propose that, as a condition of registration, private and voluntary healthcare establishments should be required to make available a complaints procedure to patients and their relatives. That procedure must allow, as does the NHS system, for independent review of both clinical and non-clinical complaints.

We also believe that providers in this sector should be required to publish information annually on complaints received and that patients should have the right to make representations to the regulatory body if they are dissatisfied with the way their complaints have been handled. This would give private patients access to a wholly independent mechanism comparable to that provided for NHS patients by the Health Service Commissioner.

The Government expect there to be appropriate standards set out for the care of vulnerable groups, including children. It is extremely important that staff working with children are subject to proper recruitment and vetting procedures, that appropriately qualified nursing staff are employed and that children are treated in suitable, preferably dedicated, facilities. Again, this is common practice in the NHS.

The noble Earl, Lord Howe, used the expression "a level playing field". We are ensuring that the areas where protection is given to patients in the NHS are also covered by an appropriate mechanism in the private and voluntary sectors. A good example of this concerns the issue of suspensions, to which the noble Lord, Lord Clement-Jones, referred. It is obviously not possible for an NHS employer formally and legally to suspend a doctor who is working for somebody else. But in terms of protection for patients it is important that other employers of that doctor are aware of the situation and are under an obligation to take appropriate action. That is what we intend to put in place.

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I was asked specifically about ensuring that there were no obstacles to looking at and learning from the NHS in terms of overall quality improvement. I agree with the noble Earl that it would be quite possible. What we are doing on clinical governance is very open; we believe that it is the right thing to do. It would be appropriate for a private sector provider to take it into account and to adopt similar structures of clinical governance that would give reassurance to the regulatory body that it was taking appropriate measures to ensure high clinical standards.

In exactly the same way, the noble Lord, Lord Clement-Jones, asked me about the possibility of NICE guidelines proving of relevance to the regulatory body when in the course of its regulatory and inspection work it looked at quality standards in the private sector. Equally, existing clinical guidance, good practice or relevant sections of national service frameworks might be the common source of material drawn upon by the regulator of the private sector in implementing clinical governance, as it is by NHS trusts.

But we cannot import wholesale the system of one area into the system of another; they are designed for different purposes. We accept that we have a responsibility for fundamental standards--for example, in relation to staff qualifications and premises. Were there to be wholly inappropriate clinical practice by an individual clinician within the private sector, that would be a matter for the relevant professional regulatory body. Whether or not a particular procedure was an appropriate treatment to provide is not properly a decision for the Secretary of State. In areas where there is such doubt, the professional regulatory body must take precedence.

The professional standards of those bodies apply to individual health professionals regardless of where they work. That is another element of commonality between the two sectors. Good professional practice is good professional practice, whether within the NHS or the private sector. Doctors, nurses and other health professionals are bound by the same professional standards wherever they work. The drive to strengthen and modernise professional regulatory mechanisms, which this Bill underpins, will have a positive impact across the board.

I hope that I can reassure the House that the Government are happy to acknowledge that they have responsibility both for patients treated in the NHS and for patients treated in the private and voluntary sectors. The Government's responsibility for NHS patients are patently different. In that context, they are themselves the care manager and the provider of services. We need to use different mechanisms for the two sectors--a matter of horses for courses, if you like--but the underlying intention is to protect all patients and to ensure that the same high quality care is available for all patients.

As I said at the beginning, healthcare provision cannot be an unregulated, unmanaged free-for-all. We believe that all patients need to be confident that wherever they are treated they will receive care that is safe and of good quality. We are taking action to ensure that that is the case.

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I hope that my explanation of the Government's thinking on these issues and our intention that the legislation for the commission for care standards should also cover the regulation of the private and voluntary sector will reassure noble Lords that we have made progress since our earlier debates.

On Question, Motion agreed to.


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