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Lord Bach: My Lords, I beg to move that the House do adjourn during pleasure until 8.32 p.m.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended from 8.25 to 8.32 p.m.]

Care Standards Bill [H.L.]

Consideration of amendments on Report resumed.

Clause 29 [Inspections by persons authorised by registration authority]:

Lord Hunt of Kings Heath moved Amendment No. 43:


The noble Lord said: My Lords, in moving the amendment, I shall speak also to Amendments Nos. 44, 45, 46, 54 and 55.

This group of amendments is intended to address points raised by noble Lords during the Committee stage about the inspection powers in Clauses 29 and 42 of the Bill. The noble Lord, Lord Lucas, was concerned that the commission might not have the power to see records which are not held on the premises of the establishment or agency. He was also concerned that computer records might be held in an encrypted format and that the commission would not have the power to require copies in a readable form. I am grateful to the noble Lord for bringing these points to our attention and I am tabling Amendments Nos. 43 and 45 to correct them. Amendments Nos. 54 and 55 make similar changes to Clause 42, which deals with inspections of local authority fostering and adoption services.

The noble Earl, Lord Howe, and the noble Lord, Lord Astor, urged us to include a power for the commission to conduct its interviews with registered persons in private. Inspectors already have the power to interview members of staff in private and I agree with the noble Lords that this should be extended to cover managers and persons carrying on the establishment or agency. I have therefore brought forward Amendment No. 44.

Finally, the noble Lord, Lord Rix, raised the issue of people who are incapable of giving their consent. He was anxious that medical practitioners and registered nurses should have the power to examine such persons in private and inspect their medical records. That is certainly our intention. We are grateful to the noble Lord for pointing out that the Bill as drafted may not allow for this as a person's consent is currently required before an examination or inspection of their

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medical records can take place. This is potentially a significant loophole and I am therefore bringing forward Amendment No. 46 to close it. I beg to move.

Earl Howe: My Lords, I thank the Minister for introducing these amendments and for removing the concerns that we expressed in Committee. They are very helpful amendments.

On Question, amendment agreed to.

Lord Hunt of Kings Heath moved Amendments Nos. 44 to 46:


    Page 14, line 34, after ("interview") insert ("in private").


    Page 14, line 38, at end insert--


("( ) The powers under subsection (3)(b) include--
(a) power to require the manager or the person carrying on the establishment or agency to produce any records, wherever kept, for inspection on the premises; and
(b) in relation to records which are kept by means of a computer, power to require the records to be produced in a form in which they are legible and can be taken away.").


    Page 14, line 46, at end insert--


("The powers conferred by this subsection may be exercised in relation to a person who is incapable of giving consent without that person's consent.").

On Question, amendments agreed to.

Earl Howe moved Amendment No. 47:


    Page 15, line 4, at end insert ("in a manner appropriate to the nature of the activity carried out on the premises").

The noble Earl said: My Lords, our debates in Committee on the subject of inspections covered some useful territory, not least the rules of conduct for such inspections and the way in which the very considerable powers of inspectors ought to be exercised.

My concerns today are connected but different. As the House is aware, the national care standards commission is to be responsible for regulating a very wide range of establishments and agencies. Even within a particular category of care--let us take private healthcare--we can think of a multiplicity of settings in which care is provided, ranging from a minor, non-invasive procedure in a consultant's private rooms to a complex surgical operation in a large acute private hospital.

If the regulation that emerges from the Bill is to be good regulation--in other words, regulation that carries with it a high degree of public confidence--it needs to take full account of modern healthcare. If it is to do that, its focus must be on process rather than on premises. It should be flexible enough to cope with the numerous levels of activity undertaken in private healthcare establishments. At the simplest level, if I can use that term, there are consultations, simple examinations and therapeutic advice. Those activities do not require the same level of inspection as premises used for invasive treatment.

So my questions to the Minister are simply these: will there be flexibility built into the system on the frequency of inspections to take account of the considerations I have outlined? How do the

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Government envisage that the standards will be set on the intervals between visits and the kinds of things that inspectors will be looking for?

There is an issue here of cost-effectiveness. Time spent on regular and too vigorous inspections of premises where non-invasive treatments are practised--for example, a doctor's consulting room--may well be at the expense of time better devoted to inspections elsewhere. Indeed, I should like to hear from the Minister what exactly the inspectors intend to inspect in a set of doctors' consulting rooms, and what regulatory burden will be placed upon doctors who rent private practice premises where no invasive procedures are carried out. I hope that we can take it as read that the composition of teams inspecting such premises will have the expertise appropriate to the task in hand and, if necessary, will be multi-disciplinary.

These issues of course apply as much to the other kinds of care encompassed by the Bill. To my way of thinking, the concept of minimum standards has a useful role to play in determining the extent to which inspectors' time should be taken up with a particular set of premises. Where there is real doubt about the implementation of minimum standards--in a care home, for example--the frequency and nature of inspections should be different from those which apply in cases where standards are patently and consistently excellent. I hope that the Minister can reassure me that my expectations are not misplaced.

Finally, I should like to pose a quite separate query to the Minister apropos Clause 29 as a whole. Can he say what will be the role of the Social Services Inspectorate once the Bill becomes law and is brought into effect? I am not clear to what extent the national care standards commission will usurp the role of the SSI in the future. I beg to move.

Lord Addington: My Lords, I believe that the noble Earl, Lord Howe, has argued his case very well. Unless there is good guidance, there is a capacity for wasting a vast amount of time to very little effect in a sort of bureaucratic paperchase. I hope that the Minister will be able to give us a very reassuring answer. Good inspection may very well make the situation much better for everyone, but, if it is merely a case of filling in forms and having a series of bureaucratic considerations taken into account--for instance and just to take an absurd example, whether one has a sterile capacity in a waiting room--or even the thought that that might occur, that might very well get in the way of good practice.

Lord Hunt of Kings Heath: My Lords, I could not agree more with the sentiments that have been expressed. The way in which the commission carries out its inspections must be appropriate to the type of service being inspected. The purpose of the inspection is to ensure that the establishment or agency is meeting the requirements of regulations under Section 21 and other relevant legislation. The commission will also need to take account of the national minimum standards in carrying out its inspections. But the commission cannot go beyond that. It can only act

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within that framework. It cannot begin looking at matters which are not covered by the regulations or standards. That in itself will help to ensure that inspections are appropriate.

That leads us to a point about the inspection methodology, if I may use that expression, to be used by the commission. I agree entirely that it is essential that this should be both sensitive and tailored to the type of service being inspected. Perhaps I may give some examples. Interviews with service users would be a key feature of all inspections, but there will be some service users who may have communication difficulties. In these cases it will be essential that the inspectors who carry out the inspections are trained in the use of appropriate communication or that they take someone with them who is appropriately trained.

Similarly, lay inspectors have a valuable role to play in inspections and we would expect the commission to make use of them. But it is important to select as lay inspectors those with whom the service users can feel confident. There are many other ways in which inspections will be carried out in an appropriate manner. The time spent on inspection will need to vary according to the size of the service. Clearly it should not take as long to inspect a small home with four beds as a large one with 50 beds. The time of day at which the inspection is carried out should also depend on the service. There is no point in inspecting a children's home during the day in term time because the children will be away at school. I believe that there are examples under previous regimes of that having happened. It is no wonder that they never got to the bottom of problems in certain homes. We are well aware of the need for inspections to be carried out in an appropriate manner. It is essential for the commission to work effectively to make that happen.

I also understand that implicit in all this is the concern that the commission's inspectors should behave in an appropriate way and should not go beyond their powers or act in an unreasonable or heavy handed manner. If such behaviour occurs, then the provider of the service will have every right to complain to the commission. We will ensure that the commission has in place a proper procedure for dealing with complaints about its staff. If a complainant is not happy with the commission's response it will then have the right to take the complaint to the Parliamentary Commissioner for Administration, since the commission will be a non-departmental public body.

It is also very well worth saying that the national care standards commission will be required to follow the Better Regulation Task Force principles of good regulation. These include transparency. Regulation must be clear, simple and easily understood. As regards accountability, that means accountability to Ministers, Parliament, users and the public. For targeting, regulation should focus on the problem and minimise side effects. As regards consistency, national laws should be applied evenly and predictably. Finally, and in some ways most importantly, proportionality should link risk and protection to cost and burden.

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As regards the issue of frequency of visits, which the noble Earl, Lord Howe, raised, that will be set in regulations. I very much agree with the noble Earl that that must be linked to the actual service so that there will be variations according to the particular type of service. As regards inspection by private doctors, my understanding is that that might cover staff qualifications, facilities for privacy, security of records and so forth. As I believe I said earlier to the noble Earl, I would certainly expect there to be multi-disciplinary teams involved.

So far as concerns the role of the social services inspectorate, the dividing line is this. That inspectorate will inspect the performance of the local authorities in their social services function, while the commission will inspect the providers of services. Therefore, in that sense I do not believe that there will be an overlap.

I hope that the noble Earl will recognise that I accept the points he has raised and that I would expect the commission to act in accordance with the principles I have set out, particularly that of proportionality.


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