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Lord Rix: Surrounded by the praetorian guard of the noble Earl, Lord Howe, and the noble Lords, Lord Astor of Hever and Lord Clement-Jones, I feel secure in supporting Amendment No. 45. I welcome the emphasis on maintaining and improving quality, as must all Members of the Committee. However, without the direct control exercised over directly provided services, and without incorporation in contracts of specifications for bought-in services, that may be thought a vague requirement. In my book, it is an important requirement, even if it does no more than state an aim.

If the list of services within the scope of the Bill is broadened, as I hope will be the case--for example, to include day services--I trust that the quality requirement will also extend to those additional services. We are talking about vulnerable people and basic services. If the coffee in your Lordships' Dining Room were not of the highest quality, which of course it is, that would be an inconvenience, but it would not undermine the welfare of those who drink it or impair the fundamental enjoyment of their lives. But poor quality in the services we are discussing means misery for the people receiving them. Misery is not something we can wish on those who are now our neighbours and one day could well be us.

Increasingly, we are defining quality in terms of the experience of those receiving the service. A good quality service is one in which people--children or adults--are listened to, respected, treated as individuals and feel that the staff are there for their benefit and not that they are there for the benefit of the staff. Achieving that should be the prime aim of managers and owners.

Lord Northbourne: I support Amendment No. 23. The Government accepted a similar amendment which I tabled in respect of the General Teaching Council. I believe that object or principal aim clauses are increasingly important in so far as any challenge to our legislation in the European courts will be looked at in the context of its overall objective. That should be stated in general terms and quite clearly at the beginning of the Bill.

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I have a slight doubt about the drafting of the amendment. It is surely not right that the principal aim of the commission should be to look after only the children. We are also discussing old people's homes; perhaps some redrafting on Report may be appropriate.

Baroness Masham of Ilton: I support Amendment No. 45. I want to give the Committee an example of a private hospital. My husband--I hope that he does not mind my quoting him--had to move from a National Health Service hospital, where he received exceedingly good care, to a private hospital. The NHS did not have a consultant to carry out an assessment for a particular condition. After six days in the private hospital in Leeds, I discovered that he had not had a wash. I was annoyed with myself for not having checked previously. I wrote to someone at the headquarters of BUPA who said that an inquiry would be conducted. A few weeks later I received a reply stating, "He never asked."

Someone who has had a stroke or who has diabetes, Parkinson's disease or various complications, does not ask; he or she expects it to happen, especially if a man! Therefore, it is most important to lay down minimum standards for all hospitals.

6.15 p.m.

Lord Jenkin of Roding: I support the idea behind this group of amendments and the emphasis which they suggest should be put on quality. Over the years and in various guises, many of us have visited homes for old people or those with handicaps. One can tell almost within minutes whether the quality of the service is good. When one is inexperienced one sees the bathrooms, the bedrooms and the facilities and says, "Gosh, what a marvellous place!" But with a little experience and using one's other senses--not least one's nose--one can quickly tell whether the quality of care is good.

I remember visiting a local authority home in Coventry. I was taken there by Mr White, a distinguished director of social services whom the noble Lord, Lord Laming, will know well. He said, "I want to show you what we can sometimes achieve." Within minutes of entering one sensed an atmosphere in which the standard of care was high. One visits some homes and sees, as I have said previously, a whole lot of "cabbages" sitting around doing nothing. One realises that the standard of care is poor.

I am sorry that I could not take part in the Second Reading debate, but I want to turn to a point that was made then. No doubt the document Fit for the Future? will provide much of the flesh which will cover the bones of the Bill, but one has the impression that the Government are still at the stage of dealing with the facilities; the size of the room, the number of plugs and so forth. They are measuring what can be measured. However, it is most important that there is a clear statement in the Bill that the overall quality of care lies at the heart of the whole process.

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With great respect to the noble Baroness, Lady David, I share the misgivings that her amendment achieves that purpose. We shall need to reflect on what has been said today, but I totally support the view that the Bill must set out that objective in the clearest possible terms. People will refer to it--there will be an argument within the commission or between those who are being regulated and the regulators--and someone will say, "Look, this is what Parliament has required of us. We must go for the best quality of care that can be provided in all the circumstances", whatever the correct phrase may be. That it needs to be there seems to me clear beyond peradventure. I am not sure how many Members of the Committee remember the Pollution Prevention and Control Bill, which contained no statement of purpose at all. As a result of the efforts of my noble friend Lord Renton and others the Government took the Bill away, there was a recommittal and some good purpose clauses were put into the Bill. That is what this Bill requires. Most of us have supported the general thrust of securing an even more standard form of regulation of the services for vulnerable people, but the quality of the care of those people must lie at the heart of what it is all about. The Bill should set that out beyond peradventure.

Lord Clement-Jones: There cannot be any ambiguity about the contributions of all Members of the Committee who have spoken so far: quality is absolutely of the essence of the Bill. It was therefore with some incredulity that I found, when reading Clause 7 for the first time, that the wording of the duty to encourage improvement in the quality of Part II services provided in England--which many Members clearly wanted to strengthen through their amendments--although not particularly strong by itself, had been deleted for independent acute services so that "Part II services" meant services of a kind provided by persons registered under Part II other than medical or psychiatric treatment or certain listed medical services. That seems to be going precisely in the wrong direction.

Therefore, on these Benches we greatly support the general thrust of the amendments. There may be differences about precise wording, but we certainly believe that quality should lie at the heart and that there should be a clear duty on the commission to promote that. The Private Member's Bill of my noble friend Lady Nicholson is designed to do exactly that. Clearly, running in parallel with a Bill such as this one makes it a rather awkward instrument to influence government policy. But there can be no doubt under that Private Member's Bill that a duty of quality is promoted by the regulating body. We believe that that should be reflected in the Bill.

At this point, I should like to apologise on behalf of my noble friend Lady Nicholson who is unable to attend to speak to Amendments Nos. 53 and 151 in her name. She is detained elsewhere in the European Parliament. It really is important that the Government take another look at the duty of quality right across the board. It seems to us that ideology seems to have raised

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its head again. Have we truly a Secretary of State for Health--and social services, so to speak--or is the Minister simply looking at particular sectors in a narrow way? On these Benches and from other Benches there appears to be a desire to make sure that the Secretary of State and the commission, through him, take as broad as possible a view of quality. It is the name of the game right across social care and across healthcare. We should wish to see that reflected in the Bill.

Lord Laming: I support entirely what the noble Lord, Lord Clement-Jones, has just said. The noble Lord, Lord Jenkin, reveals his vast experience in sharing his thoughts with us, in particular on Amendment No. 23. I support entirely the thrust of the amendment tabled in the name of the noble Baroness, Lady David. I hope greatly that the Minister will feel able to agree to a form of words which captures the spirit of the amendment. Without it, Clause 6 is really about process and does not deal at all with the well-being and quality of care for extremely vulnerable people. The whole purpose of the commission should be to ensure quality of standards and proper protection where it is needed for some of the most vulnerable people in our community, and the notion of promoting well-being as opposed to dealing only with inadequate performance. Promoting well-being should be at the centre of the work of the commission. I hope that the Minister will be able to take on the general thrust of the amendment and come forward with a form of words with which the noble Baroness is happy and which we may all applaud.


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