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Lord Clement-Jones: Before the Minister sits down I should like him to answer a question. Is dentistry carried out in care homes subject to a different regime or is it still subject to the same regime--that is, that such dentists are regulated only when operating under general anaesthetic?

Lord Hunt of Kings Heath: I believe that that is right. I shall check the point and perhaps write to the noble Lord. In relation to dental services, the Bill certainly focuses on treatment under anaesthesia.

Lord Clement-Jones: I thank the Minister for a number of assurances he made during his reply, in particular in relation to the long-awaited dental strategy. I have asked a number of questions on that point and it is probably now about 18 months overdue--that is merely a quick estimate of the period of time for which we have been awaiting it. We look forward to it because it should clarify some of the issues.

Lord Hunt of Kings Heath: We hope that the strategy will be published shortly. It is always better to get it right than to rush it.

Lord Clement-Jones: There can be no danger of the strategy having been rushed, so I am sure that it will be an excellent strategy once it arrives. I appreciate also the Minister's assurance that, although he does not agree that dentistry in general should be brought within the scope of the Bill, there will be a review. I must say that I found some of the points made by the noble Baroness, Lady Gardner of Parkes, rather telling. I ask the Minister to read Hansard and to consider whether that review should happen sooner rather than later. Clearly dental interests need to be consulted, but I suspect that, as so often happens in

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such cases, the better private practice dentists would welcome such regulation and only the worst practitioners would not welcome it, just as all the reputable independent healthcare sector organisations have welcomed greater regulation over their activities.

Finally, I thank the Minister also for clarifying the position relating to private general practitioners. That will be a matter of some considerable comfort because it was felt that the Bill did not cover those who did not practise out of a clinic or out of their own premises. As the Bill goes through the House, we shall no doubt consider further the question of dentists who do not carry out general anaesthetics and we shall take on board some of the points made by the noble Baroness, Lady Gardner. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 6 not moved.]

On Question, Whether Clause 2 shall stand part of the Bill?

Lord Laming: The debate on Clause 2 has been extremely helpful because it has revealed all too clearly the anomalies which the clause introduces into an otherwise very worthy Bill. The contributions made by a number of noble Lords have indicated well and truly that the inclusion of Clause 2 clarifies one anomaly but creates another.

As I indicated at Second Reading, overall I warmly welcome the Bill. The main reason I do so is because it ensures for the first time that whoever is the provider--local authority, voluntary body or independent organisation--all social care provision will be regulated and inspected by the same body according to the same standards. That kind of consistency is warmly welcomed. But it is torpedoed by the introduction of Clause 2. Whatever the connection between the care standards covered by the rest of the Bill and dental services that use anaesthesia, clinics that terminate pregnancies, obstetrics services and cosmetic surgery and so on, Clause 2 is in the Bill only because the services referred to within it are independent or provided independently of the National Health Service. However, the issue of pay beds within the National Health Service and some other points which have been made, especially by the noble Baroness, Lady Gardner of Parkes, and the noble Lord, Lord Clement-Jones, have indicated that those lines of demarcation are far from clear.

The national care standards commission will be an entirely new body with a huge range of responsibilities in the social care field. It will register thousands and thousands of centres and individuals who must be deemed fit to run such services. The services will cover the whole age range and an enormous variety of needs experienced by children, adolescents, people with learning disabilities or those with mental health problems, physical disabilities or problems associated with ageing. The commission will already need to employ a wide range of people with specialist knowledge and skills if it is to achieve its principal function; that is, the registration and inspection of care

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standards. It seems to me totally unrealistic to believe that a whole range of other skills necessary to deal with anaesthesia, anaesthetics, palliative care, cosmetic surgery and so on can be grafted on to that body. The Bill goes some way towards acknowledging those difficulties in that standards for the inspection of care services appear to be different from the standards applied to health provision.

I have great regard for the Minister and for his knowledge of health services. He comes from Birmingham. When he addresses the good people of Birmingham he will be able to tell them that wherever their relatives are placed in the social care system, because of the Bill the standards will be secured by a uniform system of registration and inspection. However, sadly, because of Clause 2, he will not be able to say the same about healthcare. Within Birmingham is a vast reservoir of specialist knowledge and skill across the whole range of health service provision. However, that skill and knowledge are within the National Health Service and should be applied wherever the provision is made. As several noble Lords have said, increasingly the National Health Service is using independent provision in a wide range of ways; sometimes for recuperation, sometimes for rehabilitation, and sometimes because there is insufficient provision in the health service and therefore the choice is made to use an independent provider. It is not sufficient to say that the use of independent providers will be dealt with on a contractual basis with contractual arrangements. Everyone must be assured that the standards which apply in one section of healthcare will apply in all sections.

I happen to be a great supporter of the National Health Service. However, I believe that wherever people receive healthcare treatment the standards of regulation and inspection should be the same. I do not believe that there is a sufficiently good argument for separating this area of activity from the remainder of the health service and for saying simply that the National Health Service is managed by the department. Whoever manages a service, that service should be subject to the same system of regulation and inspection. Unless the clause is removed from the Bill we shall have anomalies, of which pay beds in the National Health Service is just one.

Your Lordships will recall the long debates which took place in this House on the Health Bill and the detailed discussion about new ways of promoting and maintaining clinical standards and monitoring performance across the health service. In addition to the long-established systems within healthcare, there are now adequate ways to ensure that all healthcare, whoever provides it, can be regulated, monitored and inspected by one body. I was interested in a publication which I am sure your Lordships will have seen. It is a recently published Parliamentary Brief in which the Secretary of State for Health, Mr Alan Milburn, states:


    "For the first time in the history of the NHS we are setting clear national standards--through National Service Frameworks and the National Institute of Clinical Excellence--to guarantee fair treatment wherever patients live".

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Of course, wherever patients live; also, wherever patients are provided for. Mr Milburn goes on:


    "And for the first time we are inspecting all parts of the health service--through the Commission for Health Improvement--to ensure that patients get the top class care they deserve".

I agree with that. However, if all aspects of the health service are to be inspected through the Commission for Health Improvement, surely it is possible to ensure that other health providers can be subject to the same type of inspection.

In my view, Clause 2 undermines the consistency of an otherwise extremely worthy Bill. If the clause remains, it will undermine public confidence in the safeguards for patients and patient care and treatment and it will complicate unnecessarily the task of the new care standards commission. I believe that it will put at risk the commission's effectiveness which, in the long term, will undermine its performance. I hope that your Lordships will take this opportunity to remove Clause 2 from the Bill.

Lord Clement-Jones: I support the noble Lord, Lord Laming. I believe that I would have only to say, "Amen", and my task would be done. However, I repeat some of the questions raised by the noble Lord. He expressed the issues extremely eloquently. He quoted the Government against themselves. I believe that the only matter he did not mention was the Government's own conclusions in response to the Health Committee which, again, can be prayed in aid against them. As we go through the Bill, the contradictions posed by Clause 2 will become greater and greater.

As the noble Lord, Lord Laming, said, the provisions concerning independent acute hospitals have simply been grafted on to the Bill. Those of us who have been struggling with amendments during the recess have become acutely aware that the provisions regarding the regulation of independent care in the acute sector are simply bolted on and do not fit at all comfortably with the remainder of the Bill. The Bill is highly progressive and, as the noble Lord, Lord Laming, said, will provide consistent regulation across the social care sector. We see no such thing arising from that in the healthcare sector. Rather, we see a very different set of regulation. The best solution would be to get rid of Clause 2.

The Minister is known for his reasonableness. We had good discussions concerning almost everything relating to the Health Bill apart from the independent healthcare sector. That was the one area where we divided continuously. We did not play a great deal of "ping-pong" but we divided continuously from Report stage through to Third Reading and got no joy whatever from the Government. I cannot help believing that there is some ingrained ideological unwillingness inside the heads of Ministers who, although they proclaim the virtues of a mixed economy in social care, somehow cannot grasp the fact that we have also, albeit on a more limited scale, a mixed economy in healthcare. After all, only this morning the Secretary of State spoke about how the flu epidemic is being dealt with. He was trying to refute

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those who say that the independent healthcare sector is not being used sufficiently to deal with the epidemic. He said that we have contracts between local trusts and health authorities and the private healthcare sector. Therefore, in practice there is use of that sector. It is high time the Government responded to what is absolute common sense in this matter and agreed that we have a seamless system of regulation of healthcare across both the private and the NHS sectors.


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