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Lord Hunt of Kings Heath: I understand the thrust of the arguments being put forward. I have no doubt at all that better regulation of the various establishments and services listed in the Bill will lead to improved quality of service for people who use those services. I have no doubt that that will come about through the establishment of a highly professional central organisation which will prove to be much more consistent in its approach to registration than the previous 200 or so health and local authorities, and that it will have available to it the expertise which local health authorities and local authorities have sometimes missed out on.

However, I make the point that the Bill itself and the purpose of the commission relate to regulation and registration. That is why the Bill is termed in the way that it is. Before I turn to Amendment No. 23, perhaps I may also pick up the point made by the noble Lord, Lord Jenkin, in his reference to Fit for the Future? and his suggestion that the emphasis of the draft consultation paper was rather too much on facilities and rather too little on quality and outcomes. The document is still out for consultation and we shall consider the results carefully. I wish to reassure the noble Lord that the Government are very much concerned with outcomes and not only with facilities. We shall take his remarks very much into account, and indeed, those made by other noble Lords when the Bill was discussed at Second Reading, when many similar points were raised.

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I turn to Amendment No. 23, proposed by my noble friend Lady David. The independent nature of the new commission and its coherence and consistency will undoubtedly improve the quality of the services to be registered. As Members have already mentioned, the commission will have a general duty under Clause 7 to encourage improvement in the quality of Part II services. It will have powers also to ensure that the well-being of service users is secured and promoted. The Bill will achieve that by laying a clear and irreducible responsibility on service providers to secure and promote the well-being of those using their services and by ensuring that the commission vigorously carries out its functions.

I draw my noble friend's attention to Clause 20(1)(d) and (e), which give regulation-making powers to require providers to promote the welfare of the relevant service users. Corresponding provision is found in current legislation; for example, that governing residential homes. It is our intention to continue with that provision, and indeed, to strengthen it with the Bill. Regulations together with the national minimum standards provided for under Clause 21 will give strong powers to improve the quality of service provision. Similarly, nothing in the Bill will detract from the existing responsibilities of local authorities and health authorities in respect of the welfare of those for whom they commission or arrange services.

In relation to the question of statement of purpose, I reiterate that the Bill and the work of the commission rest upon the prime function of the agency, which is to regulate. It is through that regulation that the quality of services will improve.

I turn now to Amendment No. 45. I agree wholeheartedly with the noble Earl and the noble Lord, as I have said already, that ensuring the quality of registered services is vitally important. One of the Bill's main aims is to improve the quality of registered services. Its provisions centre on that and it is intended to deliver quality through the enforcement of regulations and the national minimum standards. As I have already mentioned in connection with Amendment No. 23, regulations made under Clause 20(1)(d) will ensure that persons registered in respect of a children's home, care home or residential family centre must secure the welfare of their residents. That is essential to maintaining a quality service.

Regulations under Clause 20(3)(k) will ensure that services provided in independent healthcare establishments or clinics are of appropriate quality and meet appropriate standards. Together with the national minimum standards provided for under Clause 21, regulations will improve the quality of service provision and ensure that registered persons continue to deliver quality. As the Bill already makes provision for maintaining and improving the quality of services, I hope that the noble Earl and the noble Lord will accept that the amendment is unnecessary.

We come to Amendment No. 30, which seems to be based on what I can describe only as a misconception about the role of government in relation to private

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healthcare. While the Government have a responsibility for the provision of public healthcare through the NHS, they have no such responsibility in respect of private healthcare. I believe that it will be wholly inappropriate to give the commission the same range of duties in relation to private healthcare as we place on it in relation to social care, where it will have wide-ranging responsibilities.

Similarly, it is not the responsibility of the commission or of government more widely to improve the quality of private healthcare. That responsibility rests squarely on the owners and managers of private healthcare establishments. That differs from the Government's role in relation to the NHS where, clearly, we have a responsibility for improving quality. Our role in relation to the private healthcare sector is to ensure that proper standards are laid down and that they are adhered to by those providing care. As I said at the beginning of the debate, that is the difference between the Government's role in managing the NHS and in regulating the private sector.

I turn to Amendment No. 53. I am sure that we all share the sentiments behind this amendment: that it is important for there to be proper arrangements in place to ensure the quality of treatment of patients in private hospitals. I recognise also the need to ensure that if residents in other establishments require medical treatment, they receive it. However, I do not believe that the amendment is necessary. First, as I have already said, we are taking powers in the Bill under Clause 20(3)(k) to make regulations requiring those who run private hospitals and other healthcare establishments to have arrangements in place to ensure the quality of the services which they provide, including clinical services. Secondly, we are already committed to introducing tough national minimum standards for healthcare providers and for those providing social care who will be regulated under this legislation. Thirdly, we are already taking powers to make provision for the welfare of those in children's homes, care homes and residential family centres. In short, we are already making the provision needed to secure proper care for those in private healthcare or social care establishments.

Amendment No. 65 would require managers of independent hospitals to publish information about their services in a form appropriate for the general public. There is nothing between the Government and the noble Lord on this matter. We are committed to ensuring that patients and potential patients have comprehensive information about the services being provided by private hospitals and clinics. We made that clear last spring in our consultation document and we welcome the general support which was given to that proposal by those who commented. As we said in Regulating Private and Voluntary Healthcare, in working out detailed regulatory requirements and minimum standards we shall take account of the comments which were made in consultation. Therefore, I oppose the amendment because I do not

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believe that it is necessary. The powers set out in Clause 20 will allow us to do what we and the noble Lord want.

Clause 20(3)(a) will enable Ministers to make regulations which cover, among other matters, the provision of accurate information about the services provided by a private hospital. I want to make it clear that we are unequivocal in wanting to impose tough standards and requirements on the private healthcare sector. I believe that I acknowledged previously that the regime which existed was unsatisfactory. We are determined to put that right and, through regulations and minimum standards, to impose stringent requirements on the private healthcare sector.

Amendment No. 71 would require the regulations, but not the minimum standards, which we make to be consistent with standards in the NHS where relevant. Again, I understand the intent behind that and, clearly, in drawing up standards for the private sector we shall want to take full account of requirements in the NHS. However, again, I must make the point that there is a difference between our role in regulating the private sector and our role in managing the NHS.

Therefore, we may lay down standards which are appropriate for the private sector but which may be different from those of the National Health Service, not least because the private sector may undertake many procedures which are not available on the NHS. I give an example: if an independent hospital clinic specialises in the type of low-risk cosmetic surgery under local anaesthesia where patients stay overnight at the most, it may not be reasonable to require it to have the same standards as an NHS hospital taking emergency cases involving seriously ill or injured people. That is not a case of standards being higher or lower, or better or worse, but rather of being fit for purpose. The key point is that, rather than slavishly follow provisions in the National Health Service, we must ensure that the regulations and standards which we lay down for the private healthcare sector provide protection for patients and assurance about the quality of care that they receive.

I turn to Amendment No. 151. Again, I thank the noble Baroness and the noble Lord for tabling the amendment and accept that the commission will need to collect and publicise information. Indeed, it is a regulator first and foremost and could not function effectively without collecting information. I believe also that in general the commission should make publicly available the information in its inspection reports and registers. However, there may be circumstances where it would not be appropriate for information to be available to the public; for example, cases relating to vulnerable children.

I move on to say that the Bill already provides for the commission to collect and publish whatever statistics or information are necessary for the discharge of its functions. Clause 31 provides for regulations to be made requiring services to make annual returns to the registering authority. That information will be supplemented by inspections. The powers under Clauses 28 and 29 will allow the

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commission to collect information to satisfy it that its service meets regulatory requirements and national minimum standards.

I believe that on that basis, and given that the framework of the Bill already allows provision for the commission to collect and publicise information for the exercise of its functions, Amendment No. 151 is not necessary.

6.30 p.m.

Baroness Masham of Ilton: Before the Minister sits down, perhaps I may ask a question. If an establishment does not adhere to an acceptable standard, will it lose its registration and be shut down after a warning? If not, what will happen?


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