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Lord Clement-Jones: My Lords, I do not wish to prolong this unduly, but the Minister used the term

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"interest groups", which in the circumstances is the most pejorative term he could use. Would not "expertise" be just as good?

Lord Hunt of Kings Heath: My Lords, for somebody who made a living for a long time representing an interest group, I do not regard the word as pejorative. However, the point made by the noble Lord is the same relevant argument. There can be no question that in the membership we wish to have people with a broad range of expertise. I would find it difficult to accept if different backgrounds were named in the Bill which would have prior claim to places. Those who come to make the appointments need to have as much freedom as possible to ensure that they obtain the right calibre and balance of membership.

I turn to the amendment proposed by the noble Earl, Lord Howe, seeking the appointment of a children's commissioner. I have said previously that we are concerned to ensure that the issues regarding children are given a great deal of prominence by the commission. However, we believe that the appointment of a children's rights director will best serve the interests of children covered by the Bill. That appointment will be a senior position within the commission. The specific role will require a great deal of consideration and, indeed, consultation. We would expect that many members of the commission will have significant experience of children's services and related issues. However, I believe that the specific point raised by the noble Earl is best met by the appointment of a children's rights director rather than by having a specific member of the commission so identified.

I turn now to Amendment No. 173. I have a great deal of sympathy with the intention behind the amendment. All the councils and the commission will be concerned with raising standards of care. That will involve a variety of ways of producing information so that as many people as possible can have access to it. It will mean including people for whom English is not their main language and others with particular needs, such as disabled people and those with a learning disability. We shall direct the councils and the commission to investigate ways in which they will need to make their reports available so that they can be accessed by as many people as possible, including people with disabilities.

I believe that the noble Earl, Lord Howe, transferred Amendment No. 158--

Earl Howe: My Lords, perhaps it will assist the Minister if I say that, although I intended to speak more fully to that amendment, I did not do so. If he would care to pass it over, I should understand perfectly. Perhaps we can revert to it at a later stage.

Lord Hunt of Kings Heath: My Lords, I apologise to the noble Earl. I thought he had referred to Amendment No. 158 which relates to the question of a medical practitioner.

Lord Jenkin of Roding: My Lords, perhaps I may say in response to the Minister's remarks that I have a

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different recollection of the National Health Service and Community Care Bill. I remember moving, as an exception to the rule that people should be appointed on merit, that where trusts have a teaching hospital, they should have a representative of the university. I recollect all the way through those debates the then government resisting firmly the idea of people being appointed to represent particular interests.

But the noble Lord, Lord Clement-Jones, had it right. We are looking for a balance of expertise. It would be strange if there was nobody on the commission with experience of the field of disability. That is all we are asking for. However, the Minister has said what he has. We should not pursue the matter further tonight. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Clement-Jones moved Amendment No. 154:

    Page 60, line 24, at end insert ("and a majority of the Commission members shall be lay people").

The noble Lord said: I shall move Amendment No. 154 and my noble friend Lady Barker will speak to Amendment No. 159.

This is not the right time of day to enter into a debate, but this is a continuation of the discussions in relation to the composition of the commission. There is a strong view that a majority of the members of the commission should be lay people. The Minister will no doubt recall that we spent many happy hours discussing similar matters in the health Bill last year.

There is a good case for the commission to have a lay majority. It should be in touch with the needs of service users. This is the same situation as when we argued for a lay majority on NICE--a special health authority--during the course of the debates on the health Bill. There may also be a case for a lay majority on the English and Welsh councils which are to be set up. We do not agree in any event that the councils should have a professional majority and the noble Earl, Lord Howe, will be proposing an amendment to that effect.

However, it is not the time to debate that issue now. Perhaps we can return to a more comprehensive debate about the composition of the commission in due course. I beg to move.

Earl Howe: At this juncture I propose to take my cue from the noble Lord, Lord Clement-Jones. I shall not be moving the amendments in my name in this group tonight.

Baroness Barker: I want briefly to discuss Amendment No. 159. In so doing, even at this late hour, I want to note the appointment of Evelyn Rank Petruzzietto, the first person with learning disabilities to be appointed to the Disability Rights Commission.

First, I want to congratulate the Government on making that appointment. Secondly, I want to congratulate her; thirdly, I want to pay tribute to the noble Lord, Lord Rix, and all those who have worked for so long for the rights of people with learning disabilities to take part in our society. That is worth

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celebrating, even just for a moment. Like other noble Lords, I do not propose to talk at length about the amendments in this group.

Baroness Masham of Ilton: I agree with the Minister in that there should be flexibility. I do not agree with Amendment No. 155, which proposes that the majority should be qualified social workers. The country still has a lot of fear of social services. I should like to leave the choice flexible and based on merit.

Lord Hunt of Kings Heath: I need only respond to Amendment No. 154. The Government believe that it makes sense that lay members should form the majority of the membership of the commission. It is our intention that both the commission and the council will have a majority of lay members.

Perhaps I may say to the noble Lord, Lord Jenkin, that I was complimenting him on the changes he made to the composition of area health authorities and district health authorities because they made those institutions more corporate and less representative.

Lord Clement-Jones: I thank the Minister for that extremely positive reply. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 155 to 159 not moved.]

11.15 p.m.

Earl Howe: moved Amendment No. 160.

    Page 60, line 39, at end insert--

("(6A.--(1) The Secretary of State shall by regulations make provision as to-- (a) the appointment of and constitution of a committee of an authority to exercise its functions under this Act in relation to independent hospitals and independent clinics; (b) the appointment of a chairman and other members of that committee (which may include persons who are not members of the authority) save that the committee shall comprise not less than 5 persons including the chairman appointed pursuant to this paragraph and the chief officer of the committee appointed pursuant to paragraph 8; (c) the tenure of office of the chairman and other members of that committee (including the circumstances in which they cease to hold office or may be removed or suspended from office); (d) the appointment of, constitution of and exercise of functions by sub-committees of that committee (including sub-committees which consist of or include persons who are not members of the authority); (e) the procedure of the committee and of any sub-committees of it (including the validation of proceedings in the event of vacancies or defects in appointment).
(2) The chairman and chief officer of the committee constituted under this preceding paragraph-- (a) shall be members of the authority; (b) shall be persons other than the chairman and chief officer of the authority.")

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The noble Earl said: We come now to Amendments Nos. 160 to 166 which constitute for me perhaps one of the most important groups of this Committee stage. I shall try to be as brief as I can.

When I first read the Bill and saw how the Government proposed to regulate the private healthcare sector, I cannot pretend that I was particularly enthused. In a Bill devoted principally to the regulation of personal care, social care and care workers, the addition of independent healthcare to the responsibilities of the national care standards commission seemed a serious anomaly; indeed, it almost has the look of a last-minute "bolt-on" extra. I do not believe that I was by any means alone in that reaction. The Government had led us to believe that private healthcare would be regulated by a body completely separate from the regulator or social care. That original proposal at least had the merit of logic to it, as well as the merit of treating the private healthcare sector as a wholly different animal from social care, which indeed it is.

However, when the announcement came, we learnt that there was to be no separate regulator. Further, we now understand from the Minister that one of the key assurances given to the House by the noble Baroness, Lady Hayman, during the passage of the Health Act is not to be honoured either. I refer to the undertaking that she gave that the Government were open minded to the possibility that the regulator of private healthcare might wish to contract with another body, such as the Commission for Health Improvement, in order to help carry out local inspections. We now learn that that possibility, which for many of us held considerable appeal, is no longer on the agenda. The Minister's assurance was undoubtedly one of the factors that influenced me in my decision not to divide the House a second time on the issue of the remit of CHI. Therefore, to put it at its mildest, what we have now been told is extraordinarily disappointing.

While it would have been possible to propose a raft of amendments setting up a separate private healthcare regulator, I have chosen instead to deal with the Bill as we find it. I have done so because I believe that there is a way of making the Government's proposals into something that is meaningful and that will work. The amendments that we are now considering attempt to give substance to the idea that the Government have indicated is their intention; namely, to give responsibility for the regulation of private healthcare to a separate division within the national care standards commission.

What form should that division take? I am proposing that it should be a separate and distinct committee of the authority which would be granted clear delegated functions with a clear framework of accountability. It would be responsible to the authority for all that it did but would essentially comprise an administrative structure, complete with a chairman, chief officer and dedicated staff whose sole remit would be the supervision and inspection of independent hospitals and clinics.

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I would envisage, too, that this division of the commission would be required to produce its own annual report and accounts to ensure full transparency of its operations and the cost of such operations. The amendments that I propose set out de minimis requirements beyond which government and the commission would retain considerable scope for manoeuvre. I think it would be fair to say that the independent healthcare industry's support for the proposed commission is largely contingent on a clear and transparent divisional structure for healthcare regulation. That focus is undoubtedly required because of the technical complexity and diversity of the issues that the division will have to address. Therefore, this set of amendments is designed to ensure that the regulation of healthcare is given sufficient weight within the commission and that it is both competent and transparent.

Unless the otherwise rather nebulous concept of a "division" is given real substance and unless the cultural divide between private healthcare and social care is recognised in a tangible way, we are in danger of creating a regulator of private hospitals that is less than credible. That should be avoided at all costs. I very much hope that the Government can see their way to support this set of amendments, at least in principle. I believe that such support would give considerable comfort to a wide array of people and organisations with diverse interests in this Bill. I beg to move.

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