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Lord Hunt of Kings Heath: My Lords, this is a very important debate. We believe that the regulation-making powers in Clause 21 are sufficiently wide to enable the quality of clinical care to be regulated in relation to those homes where it is appropriate for that to be done.

I think we need to reflect that the definition of a care home embraces residential homes and nursing homes. We also need to consider each of those separately in

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relation to this amendment, because although clinical care may be delivered in residential homes this would be carried out by general practitioners and the local NHS community nursing services. In those circumstances it would not be appropriate to make the residential home responsible for the quality of this care.

It is different with regard to nursing homes, because they themselves deliver clinical care. I entirely agree with the noble Lord, Lord Clement-Jones, that arrangements must be in place to supervise and monitor clinical practice in nursing homes in order to ensure that the clinical care provided is of an appropriate quality. I have no doubt whatever that arrangements for overseeing the quality of clinical care should apply in nursing homes as well as in private hospitals. I take the point raised by the noble Earl, Lord Howe, regarding the need for multi-disciplinary teams. That is extremely important.

As I said, we believe that the powers in Clause 21 are already sufficiently wide to ensure that such procedures are put in place in nursing homes. However, I assure noble Lords that I shall take away the issue and consider it further to ascertain whether there is any doubt about our powers being strong enough to cover concerns in that regard. If so, we should look to table an amendment in another place.

5 p.m.

Lord Jenkin of Roding: My Lords, will the Minister include consideration of the position of community psychiatric nurses and psychiatrists, whose work increasingly takes place in community settings; perhaps in nursing homes as well as in people's own domiciliary accommodation? Will he see whether the line about which he has just told the House can be drawn to cover such work and not leave a gap or have an untidy overlap? That area is changing extremely quickly.

Lord Hunt of Kings Heath: My Lords, I shall of course consider that matter. I do not see any reason why there should be any difference in terms of the line that I tried to draw.

Lord Clement-Jones: My Lords, I thank the Minister for his reply. It is not simply a question of the powers in the Bill; it is clearly a matter of the practice intended by the commission. The Minister's reply has been extremely helpful. I take the distinction--which the noble Lord, Lord Jenkin, teased out somewhat further--between nursing homes and residential homes. We simply want to ensure that there is a seamless inspection of quality and regulation of quality as between acute and intermediate care. Intermediate care is coming increasingly under the spotlight as a result of the long-awaited, and now delivered, national beds inquiry. I shall consider the Minister's reply carefully. We look forward to his deliberations. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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Lord Clement-Jones moved Amendment No. 15:


    Page 5, line 25, at end insert--


("(8) "Excepted services" means the provision of services referred to in subsections (7)(a) and (b).
(9) The Commission shall have the general duty of securing improvements in the quality of excepted services in independent hospitals (as defined in section 2) and shall carry out this duty through the contracting of inspections with the Commission for Health Improvement ("CHI") established by the Health Act 1999.
(10) For the purposes of subsection (9) above the Commission shall ensure that the relevant independent hospital pays the full economic costs of any inspection.
(11) The standards applied by CHI on any such inspection shall be those which it applies in any comparable inspection of a health service hospital.").

The noble Lord said: My Lords, the question of standards of regulation and of inspection in the independent healthcare sector is a long-running issue. We debated the issue not only in Committee but also on the Health Bill last year. It is rather like the Peninsular War: we fight a regular spring campaign after being behind the lines for winter. I hope that it will not take quite as long as that to achieve victory in this case.

The history of the issue is quite simple. After the Health Bill went through, the Government consulted on the regulation of the independent acute healthcare sector. The outcome of that consultation, however unsatisfactory, is now reflected in the Care Standards Bill. The Bill itself gives no assurance that a duty of quality identical to or even similar to that required for the NHS is required for the independent healthcare sector; nor is there any provision for regulation by the same body--the Commission for Health Improvement--responsible for healthcare inspections in the NHS.

The pattern of provision of private or independent healthcare is complex. It is provided in three main ways: first, healthcare is provided in NHS private beds and paid for privately; secondly, healthcare is provided in independent acute hospitals and paid for by the NHS; thirdly, healthcare is provided in independent acute hospitals and paid for privately.

In Committee, the Minister confirmed--as does the document Developing the Way Forward recently published by the Government--that inspections in the first two cases will be the responsibility of CHI: the Commission for Health Improvement. Yet in the last case it seems that a wholly different set of standards and methods of inspection will apply. Certainly, the Commission for Health Improvement will not be directly involved. It is as important for patients to know how well doctors are performing in their private practice as anywhere else and to know that the highest possible standards are being followed in private hospitals. If one asked ordinary people in the street whether they believed that there should be separate and different standards in private healthcare and in the NHS, they would be horrified. I am sure that most people believe that it is the Government's duty to ensure that standards are common across the board.

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At Committee stage, a similar amendment commanded widespread support both in and outside the House. On the Health Bill, the House convincingly passed a similar amendment. Regrettably, both the present Secretary of State and his predecessor set their faces against it. After our debates last year, the Secretary of State decided, despite the consultation process, to set up a completely separate method of registration and inspection to regulate the independent sector. There may well indeed have been some differences between Ministers. On 17th June last year, when we debated the then Health Bill, the noble Baroness, Lady Hayman, said in relation to the consultation document entitled Regulating Private and Voluntary Health Care, that,


    "the consultation document does, however, acknowledge that a regulator might wish to contract with another body, such as the commission for health improvement ... in order to help carry out local inspections. That is an issue on which we explicitly invite views".--[Official Report, 17/6/99; col. 459.]

Yet it now appears that the Government have firmly made up their minds against any form of contracting to CHI on purely ideological grounds.

As I emphasised in our debates last year, on these Benches we have no particular axe to grind for private health. However, we believe that every patient should have the right to common minimum standards of quality care and safety, irrespective of the sector in which they are treated. My noble friend Lady Nicholson has particular reason to believe strongly in the absolute need for that. In Committee, the Minister recited as a mantra the difference between the regulation of the independent sector and the management of the NHS. The amendment does not cut across that. Registration remains with the care standards commission. It is inspection which will be carried out by the Commission for Health Improvement. The purpose of the amendment is to ensure that the care standards commission contracts the carrying out of inspections in independent hospitals to the Commission for Health Improvement.

In Committee, the Minister made some helpful comments on the issue. He recognised that in the inspection of the independent sector there were skills and expertise possessed by the Commission for Health Improvement which would be of importance to the commission in running its own inspection system. Yet he did not go so far as to acknowledge the benefits of a single inspection system. Developing the Way Forward similarly nods in the direction of CHI but fails to go the last mile. The amendment would enable CHI to monitor and ensure the quality of the services provided in both healthcare sectors and to identify and promote best practice wherever it may be found. Common standards between the NHS and the independent healthcare sector could then be ensured. CHI would be in a position to use the expertise gained from inspecting NHS services and facilities and the same limited pool of expertise could be used in the independent healthcare sector.

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The amendment makes it quite clear that the relevant independent hospital will pay the full economic cost of any such inspection. No one is suggesting that the taxpayer should pay for CHI to inspect private healthcare. We have made no bones that the Bill as a whole is extremely welcome. It will provide common consistent regulation across the social care sector, irrespective of whether it is publicly or privately provided. But no such provision is being made for the healthcare sector. Ministers proclaim the virtues of a mixed economy in social care but somehow they will not admit the fact that we have also, albeit on a limited scale, a mixed economy in healthcare. After all, it was only recently that the Prime Minister acknowledged the contribution made by the independent sector.

There are over 200 hospitals in the private sector, comprising approximately 10,000 beds. It makes no sense at all to exclude some 800,000 treatments per year carried out in private hospitals and work carried out by more than 17,000 doctors, most of whom work also in the NHS. Very few consultants practise only in the private sector. The NHS itself spent some £450 million in the independent sector last year, mainly on elective surgery. Independent healthcare sectors should be regulated overall by the national institution best suited to do the job and to do it well. That institution is the Commission for Health Improvement and that is what the amendment is designed to achieve. I beg to move.


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