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Lord Rix: I am grateful to the Minister for the comprehensive response which he has given all four of us who have moved amendments this evening. To a certain extent I am assured that at least his intentions are honourable and I hope that they will be fulfilled. However, it was such a comprehensive answer that I am sure he will understand if I consult with my noble friend Lord Northbourne, the noble Lord, Lord Astor of Hever, and the noble Lord, Lord Clement-Jones, when we have Hansard in front of us so that we may decide whether we wish to return to this matter on Report. With that in mind, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

9 p.m.

Baroness David moved Amendment No. 29:

("( ) The Commission shall receive and consider information on all representations including complaints made in respect of the provision and quality of Part II services in England.").

The noble Baroness said: Amendment No. 29 is tabled in my name and that of the noble Lord, Lord Clement-Jones, but also in this group are Amendments Nos. 33, 64, 66, 72, 169 and 170A, in the names of other Members.

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My particular amendment aims to give the national care standards commission a duty to monitor all official complaints relating to its remit. Section 26 of the Children Act 1989, with associated regulations and guidelines, set out a statutory procedure for responding to all representations, including complaints about Part III services. An essential element in that was the inclusion of an independent person in the local authority's consideration of all complaints received by the designated complaints officer. Independent advocacy was also an option, although it was not required. In addition, there was incomplete overlap with the procedure for adult services in the National Health Service and Community Care Act which required an independent element only for complaints which went on to the relevant review panel stage. Many local authorities have run the two procedures together and, for that and other reasons such as cost, have never fully implemented the statutory requirement to involve independent people, let alone independent advocates, in their procedure for children's services.

The guidance of subsequent Social Services Inspectorate reports rightly emphasised the desirability of dealing with as many complaints as possible informally, locally and quickly. That has been used as another reason for not implementing the procedure in full. The independent element is seen as a bureaucratic and time-consuming factor to be avoided even when complaints have not been successfully resolved informally and have been received by the complaints officer.

As SSI noted, in treating most or all complaints as informal, many authorities also fail to monitor them and thus to collect essential information on which to base the improvement of their services. Complainants, especially children, are often denied their statutory right to have an independent person involved in consideration of their complaint, as well as, arguably, even more valuable support from an independent advocate, which has not been a statutory right. The Utting report, People Like Us, recommended that that should be a right for children who are looked after, and that has been accepted by the Government.

The procedures have been applicable only to certain services and with some confusion; for example, how best to apply them in respect of children being looked after in private and voluntary settings. Some residential establishments believed that they had to devise their own procedures. As the Bill is currently drafted, there is a risk that some of those sources of confusion will persist. There would be an ideal opportunity in the Bill to ensure that a civil complaints procedure with an independent element based on that of the Children Act with the additional right to independent advocacy be required for all children needing or receiving children's services, especially those placed away from home. However, all complaints or their outcomes could be monitored centrally while the regional children's rights directors would have an important impact on the Government's ability to hear the views of the most vulnerable children and to improve services accordingly.

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Having re-read the Second Reading debate at the weekend, I believe that the Minister is quite responsive to some of those requests. Therefore, I hope that he will be pleased to support the amendment and to accept it when he comes to reply to this group. I beg to move.

Lord Clement-Jones: I rise to support the noble Baroness, Lady David. In speaking to Amendment No. 29, I shall speak also to Amendments Nos. 33, 64, 66, 72, 169 and 170A. All the amendments spring from a feeling that Clause 20(3)(j) is inadequate in the way that it provides for complaints to be dealt with in the independent sector, whether that applies to social care or healthcare. Certainly, the noble Baroness, Lady David, made a very strong case for complaints to be dealt with in the way that she described.

However, the amendments provide a somewhat a la carte possibility to the Minister and his advisers. There are several different ways of dealing with that issue. Some would say that what is needed is a consistent form of complaints system which is independent and with clearly defined standards across the board for the independent sector. There are those who would say that the way to achieve that is to bring in the health ombudsman--the Health Service Commissioner set up and codified in the 1993 Act. The amendments, in their various ways, attempt to provide different ways of doing that. Indeed, the possibility of establishing a public complaints director in Schedule 1 is another way of achieving some of the same aims.

In discussing in some detail the terms of Clause 20(3)(j), it is important that there is a uniform, robust complaints procedure which is acceptable to the commission. Surely that should be one of the requirements for registration of independent healthcare establishments. However, there is no current uniform complaints procedure within the independent healthcare sector. I am told that the BMA has been working on drawing up proposals for such a procedure. As part of its initiative, quite recently--in October--it held a major conference with the medical royal colleges. That involved a wide range of interested parties. The need for a coherent complaints procedure in private healthcare was discussed. Indeed, the BMA continues to have discussions with the various parties in an attempt to generate consensus about a uniform complaints procedure which would give patients a clear avenue for redress.

Amendment No. 33 attempts to deal with the matter by charging the commission with being proactive in dealing with complaints from the independent healthcare sector. If it is satisfied that a complaint has not been dealt with properly, it refers the matter to the Health Service Commissioner. I wonder what role the Minister believes that the commission should play in assisting interested parties to develop a complaints procedure. I wonder whether he believes that there is a role for the health ombudsman in that process. Also, it is not clear in Clause 20(3)(j) quite what services can form a subject of complaint. Amendment No. 64 is designed to include the word "clinical" so that that is made rather clearer.

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Another issue is that that complaints system should be compatible with that of the NHS. That has been raised with us by the NHS Confederation. The NHS commissions services from the private sector on behalf of its patients, often in instances where the NHS does not provide a service or where it cannot provide treatment immediately. In those circumstances, there must be a mechanism to lodge a complaint, and a complaints procedure must be able to cope with situations where a patient is passed from the NHS to private care. The information which the independent complaints commission collects about complaints must be in a common format to the NHS information. Indeed, the information collected by any complaints system, whether independent or not, must be in a common format to the NHS information in order to allow those complaints to be dealt with in an adequate fashion.

Amendment No. 72 is rather simple in its design. It brings in the ability of a complainant to be able to come to the health service ombudsman directly, whether he has been treated in the NHS or in the independent healthcare system. We believe that the remit of the health service ombudsman should be extended to cover the private sector. That means that patients who are not satisfied with the outcome of their in-house complaints procedure would have access as NHS patients to an independent review of their complaint, which is, after all, the object of the exercise.

The final amendment with which I wish to deal is to Schedule 1. This involves the appointment of a public complaints director working within the commission who would be able to discharge the functions of the commission in taking an overview of complaints made by those who have been treated in the private healthcare sector.

Some organisations which have briefed us on these Benches believe that cosy relationships may sometimes exist between inspectors and care homes which prevent complaints being investigated properly. This is encouraged by a situation where the same inspector is expected to foster a good working relationship with a home--to work on promoting good practice--and also to investigate misconduct and abuse. For that reason, it is intended to separate out dealing with complaints by creating a public complaints director. We believe that complaints should be dealt with separately from other functions and by different inspectors.

That is rather a compendium of different possibilities. I do not think we are wedded to any particular amendment on these Benches, but we believe that the Government should have an open mind about improving the system currently laid out in the Bill. We believe it to be wholly inadequate to deal with complaints in a proper fashion.

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