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Lord Jenkin of Roding: I find myself in difficulty in this matter. I do not know whether the Minister is old enough to recollect Cullompton. At the time of the debates about the continuation of private beds in NHS hospitals when the noble Baroness, Lady Castle, was Secretary of State, there was considerable argument about whether it was appropriate that there should be pay beds within the premises of NHS hospitals, sometimes as an integral part of wards. Happily, in the end, sensible provisions prevailed, although it may have taken a year or two for the system to settle down.

I find myself in a dilemma in this matter. I completely understand the point to which the noble Lord, Lord Clement-Jones, referred. I also understand the points made by my noble friend in speaking to his amendments. But pay beds take many different forms. I take as an example Lindo Wing at the Middlesex Hospital or units at other teaching establishments which have premises separate from the main NHS hospital. In those circumstances, the intention behind the amendment moved by the noble Lord, Lord Clement-Jones, is wholly appropriate. That should be looked after by the new commission. In the Forest Health Care Trust, of which I was chairman for a number of years, the largest group of pay beds was in that part of the hospital concerned with maternity. We found that over the years there was a considerable demand, even in a relatively deprived area of north-east London, for privacy and the ability to receive visitors at all times, and that people were prepared to pay for it. After all, nowadays most mothers are not in maternity beds for more than a day or two and therefore the cost is not very great. Those beds were an integral part of the remainder of the maternity provision in the hospital. The idea that somehow there should be two lots of inspection, one for NHS beds and the other for pay beds, seems to me to be utterly absurd. One must look at the remit of CHI and consider whether in those circumstances it is entirely appropriate that there should be a single system of inspection. For that reason, I find it difficult to accept these amendments.

There is another category: amenity beds. As I understand the language used by my noble friend's Amendment No. 11--"income-generating health service units"--an amenity bed, which is much cheaper than a private bed, generates income and gives some of the advantages of a pay bed without the full cost being borne. Would those beds be subject to a separate system of control? I find all of this hugely confusing. I cannot believe that the Government do not now share that view. There will be a ridiculously overlapping system of inspection for what constitutes a single provision of beds which are occupied by patients under different terms.

If one is looking for a way to inspect the standard of care--we shall debate clinical care in later amendments--one single inspection system must surely be right.

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3.30 p.m.

Lord Clement-Jones: Before he sits down, perhaps I may ask the noble Lord to consider Amendment No. 31. What he said demonstrates much of the absurdity relating to acute healthcare. The contradictions in the Bill are exposed clearly in this set of amendments. Perhaps the noble Lord will agree that that may be a more felicitous way of dealing with regulations so that common standards are met in NHS and independent healthcare beds.

Lord Jenkin of Roding: Perhaps I may respond to the noble Lord. If that is the intention, I shall listen with great interest to those who speak to that amendment.

Baroness Masham of Ilton: I hope that a satisfactory solution will be found. I have been a patient in a National Health Service hospital which had private beds. I visited some of the private patients. Many were in side wards. They were foreign, lonely and deprived. I thought that they were being ripped off. Sometimes their rooms were not dusted. Sometimes they were overlooked and not fed. It would be wrong to leave such patients out of the debate. I hope that a satisfactory solution will be found.

Baroness Gardner of Parkes: It has been interesting to listen to the different aspects put forward. The debate has revealed what a complex issue we are discussing. For some time I was chairman of the Royal Free Hospital which has private beds within the main hospital occupying half of a specific floor. Because there was need for more beds, national health patients were always given priority and those beds were used regularly for NHS patients although the private beds generated a large amount of additional income for the hospital and therefore were of great benefit to the national health patients.

The noble Baroness, Lady Masham, raised the issue of shabby wards. The point may be true in some areas. If the private wings in London hospitals are not smartened up to a considerable degree, one has no hope of getting patients into them. They prefer the luxury hotel surroundings of the new, completely private clinics. One has not only to provide the best medicine but also luxury surroundings to encourage patients to choose one hospital rather than another.

I wish to raise a different aspect. I like the phrase about the income generating health service. Some major national health hospitals run travel clinics. Patients pay for the injections and so on, which they need for travel. Such clinics are not a national health service and never have been. Yet such treatment is given in those hospitals.

I am not clear whether the Bill relates only to in-patients who are resident in hospital or whether it will also provide for people having treatment of any form. With the present influenza crisis, many businesses would happily pay for that national health hospital to give influenza injections. The cost would be far less than that lost due to illness. It would surely be viable through the travel clinics. The premises already exist. It would be an additional feature.

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We differentiate between what one can and cannot have. However, the patient or someone on his behalf may be prepared to meet the cost. When I was a parliamentary candidate for the Commons, I exchanged a number of letters about pay beds in Plymouth with the then Dr Owen. Pay beds have always been a major issue. However, I agree with the noble Lord, Lord Jenkin. It is important to have one standard and, if possible, one inspectorate. Could that be better achieved by inspection through the National Health Service? The noble Lord's point is valid. To inspect perhaps half a dozen beds or one minor clinic within the institution will not only be irritating but also somewhat impractical. Everyone will be on the defensive and much goodwill that exists in national health hospitals may be destroyed.

I do not know whether to support the amendment. The more I have listened, the more uncertain I am. It is important that the Government apply their mind to a solution.

Lord Rix: For 10 years I was a patient across the water at St Thomas' Hospital while my aortic valve, which was busily closing, was examined. Although taking advantage of the private facilities at York House across the road from St Thomas' Hospital, I was sent all the time to the national health testing beds in the hospital. Eventually I became an emergency patient and was admitted to the private rooms on the top floor of the hospital where, after further examination, the aortic valve was replaced.

For 10 years I mixed private care with national healthcare in that hospital. Yet it all took place on the same premises. I should have thought that an inspection by the same body was sine qua non.

Baroness Masham of Ilton: Perhaps I may respond to the noble Baroness, Lady Gardner of Parkes. The patients I saw had unfortunately no choice because they had broken their backs or necks. They were sent for treatment by foreign governments.

I hope that the Minister will visit soon the Stoke Mandeville Hospital where he will see the situation for himself. He will also see how important is the income generated by those patients. That may help him sort out the matter. Two inspections would be a waste of time and resources.

Lord Hunt of Kings Heath: The noble Baroness, Lady Masham, continually invites me to visit various excellent NHS facilities. I assure her that Stoke Mandeville is on my list.

The discussion takes us back to the debate at Second Reading and the distinction to be made between the need for the proper regulation of the private healthcare sector and the effective management of the National Health Service, including private facilities contained under its management. Far from there being confusion or a problem about distinction, everything contained in the Bill and as regards the regulation of the private healthcare sector rests on the premise that there will inevitably be different arrangements between the regulation of the private sector and the management of

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public sector healthcare services. We shall debate the issue more fully on later amendments. However, I felt that I should set the context in which we are debating the proper management of NHS pay beds.

Amendments Nos. 4, 11 and 18 seek to extend the national care standards commission's regulatory responsibilities to cover NHS pay beds and other income generating facilities. Amendment No. 4 would include NHS private patient units within the definition of an independent hospital in Clause 2 thereby bringing them under the remit of the commission. Amendment No. 11 would have the same effect but would also bring other NHS income generation undertakings within the commission's remit. Amendment No. 18 has the same effect.

In reply to the noble Lord, Lord Jenkin, I am not sure how widely the noble Earl, Lord Howe, intended the regulator's powers to go, because NHS trusts can generate income in a variety of ways. The noble Lord mentioned amenity beds, but one could include, for instance, renting out space to shops. I am sure that he did not intend to include such action within this provision.

I believe that the amendments are misconceived. They assume that NHS paybeds need to be subject to regulation because otherwise they would be subject to no control. That is not the case. NHS paybeds, including those in dedicated units, are the responsibility of the NHS hospital where they are sited. They will be subject to clinical governance and all the other controls which apply to the NHS. The amendments would mean that even though a perfectly good system of management and clinical governance covered the whole hospital, certain parts of the hospital would be subject to another regulatory regime. That would be duplicatory and wasteful of time and effort. It would also distract the national care standards commission inspectors from their key task of improving regulation of the currently poorly regulated private sector into inspecting parts of the NHS where perfectly good systems of clinical governance are in place.

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