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Lord Hunt of Kings Heath: My Lords, I believe that confusion has arisen because noble Lords have spoken about two different areas. They have talked about care workers in the community, and I believe that the noble Baroness, Lady Masham, also referred to care assistants working in private hospitals. There is a difference.

Baroness Masham of Ilton: My Lords, and National Health Service hospitals.

Lord Hunt of Kings Heath: Indeed, my Lords. I was endeavouring to say that staff who are employed by domiciliary care agencies come within the regulation of the Bill as it stands. With regard to healthcare assistants within hospitals, we would expect those staff to be properly supervised and managed by the hospitals concerned. That would be a matter for the national care standards commission to check and inspect. So far as concerns the question of a nursing agency which might hire healthcare assistants to those private hospitals and establishments, that is an issue to which the Government would wish to give further consideration in the light of the debate this afternoon.

Baroness Masham of Ilton: My Lords, I thank all noble Lords who have spoken and, particularly, the Minister and the Chief Whip for their negotiations. I should like to make it clear to the Minister that nurse

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assistants are also employed in National Health Service hospitals. I am glad that he will look at that matter.

Lord Hunt of Kings Heath: My Lords, if the House will give me leave, I should like to point out that we have commissioned de Montfort University to study the question of whether healthcare assistants who are employed within the National Health Service should be regulated in the future. That work is ongoing and, of course, is in parallel to the other provisions in the Bill concerning the regulation of social care workers.

Baroness Gardner of Parkes: My Lords, before the Minister sits down, perhaps I may ask whether he is giving an undertaking to look at the position of care assistants who are not covered in any other way in the Bill? Will he consider whether they will be covered by this Bill rather than by the Department of Trade and Industry?

Lord Hunt of Kings Heath: My Lords, I believe that I gave a commitment to look at the specific regulations in relation to nurse agencies and to consider the extent to which those regulations should cover care assistants.

Baroness Masham of Ilton: My Lords, many people outside your Lordships' House will be very pleased with the outcome of our debate. The matter arose only at Report stage. I thank the noble Baroness, Lady Gardner, for calling the meeting which enabled me to table the amendment. I believe that the Minister understands the point made by the right reverend Prelate and by many noble Lords with regard to care assistants, and I hope that something can be done in another place to make the amendment perfect. I know that we in this House want to make it perfect; that is our job. However, we must work together. Therefore, I thank everyone concerned and beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

3.30 p.m.

Earl Howe moved Amendment No. 2:

    Page 4, line 8, at end insert--

("( ) "Nurses agency" means, subject to subsection (5), an employment agency for the supply of nurses registered with the United Kingdom Central Council.").

On Question, amendment agreed to.

[Amendment No. 3 not moved.]

Earl Howe moved Amendment No. 4:

    Page 4, line 31, after second ("agency,") insert ("a nurses' agency,").

On Question, amendment agreed to.

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Clause 21 [Regulation of establishments and agencies]:

Lord Clement-Jones moved Amendment No. 5:

    Page 13, line 25, after ("agency") insert ("which are independent of that person, establishment or agency and so far as possible in accordance with any common industry complaints scheme,").

The noble Lord said: My Lords, this amendment, which is similar but not the same as an amendment which I tabled on Report, concerns the requirement that care homes should have a properly independent system of complaints when they apply for registration.

At Report stage the Minister spoke helpfully at some length about how people envisaged that that system of registration would work and the kind of requirement that there would be for a complaints system. Indeed, to some extent the document Developing the Way Forward also expands on that. However, currently the Bill simply requires that there should be an internal system of complaints. Clearly, the department and the commission will try to ensure that for the care homes affected the internal system of complaints is satisfactory.

However, the purpose of my amendment at this and at Report stage is to secure an independent element in the complaints system. By that, I mean simply that there should be an external adjudicator for the complaints at the level of the care home. The Minister very helpfully explained the role that he saw the commission playing in terms of the independence of the complaints system at the higher level, but he did not quite give the assurance about the nature of the independent complaints system at the lower level.

Since then, the Minister has explained helpfully why currently there is no requirement in the Bill for an independent element. He wrote to me as follows:

    "However, there were concerns at the practical difficulties this might pose for small homes and single-handed owner-managers, together with an additional burden of cost and as a result we decided against including this".

Therefore, clearly a policy decision has been made against ensuring that that independent system is in place. As mentioned in Developing the Way Forward, the Independent Healthcare Association has been preparing a code of practice which will include an independent adjudicator as part of its local system of hearing complaints. I very much welcome that.

Therefore, my question to the Minister is: if the Independent Healthcare Association believes that that is an appropriate way forward for its members--and it has members among the smaller care homes as well--why does the Minister not believe that it would be appropriate to include that in the Bill? If it is not in the Bill, how will he ensure that those care homes adopt the helpful code of practice drawn up by the Independent Healthcare Association? It seems to me that those are the two key questions in this matter. If the Minister can assure me that in practice an

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independent complaints system will be adopted by nearly all those care homes, I for one shall be perfectly satisfied. I beg to move.

Lord Hunt of Kings Heath: My Lords, on Report, I set out at length how complaints against registered providers will be dealt with. Perhaps at Third Reading I may give only a brief summary.

We shall use the power in what is now Clause 21(6)(j) to require all establishments and agencies to have a proper procedure for dealing with complaints. The detail of that internal complaints procedure will be spelt out in regulations and has not been finalised at this stage. However, it is likely to include a requirement that all complaints must be logged, dealt with in a certain time, the outcome recorded and so forth. That is a significant advance in relation to the circumstances which pertain in many of the establishments which are to be regulated as a result of the Bill being enacted.

The second big advance made by the Bill is that any person who is dissatisfied with the outcome of the internal procedure will be able to take his complaint to the commission. The commission will have the power to investigate complaints as an integral part of its regulatory function. Service users will also be able to take their complaint direct to the commission if they have a good reason for not wanting to use the internal complaints procedure. Where the commission finds that the complaint is justified, it will be able to use the full range of its enforcement powers to ensure that remedial action is taken by providers.

The Government are confident that this system will give service users all the protection they need. On Report, the noble Lord, Lord Clement-Jones, said that he wanted to see a genuinely independent complaints system for the benefit of people in care homes and users of private healthcare. That is precisely what the commission will provide. It will have the power to investigate any matter relating to a breach of regulations or standards and it will be entirely independent of the registered establishments and agencies as well as of the purchasers of the services. Therefore, its investigations will be entirely objective and impartial.

On Report, the noble Lord, Lord Clement-Jones, argued that the internal complaints procedure should have an independent element. However, the amendment that he has tabled is different because it would allow regulations to be made requiring providers to set up an entirely independent complaints procedure. That would be instead of the internal complaints procedure.

We considered that issue when we were developing the standards for older people in residential and nursing homes set out for consultation in Fit for the Future?. However, we decided against that because we felt that it would impose an unfair burden on providers. We must recognise that some of the providers who will be regulated by the commission will be small businesses. Sometimes, they will be single-handed owners and managers. There is an issue as to the degree of burden that can be placed upon them.

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I noted with great interest the remarks the noble Lord made about the views of the Independent Healthcare Association, but one must recognise that it does not speak for all the many agencies and establishments which fall to be regulated by the Bill. Of course, we want to encourage the Independent Healthcare Association to set up its own independent complaints system. It will be free to do so and there is nothing in the regulations preventing it doing so. In answer to the noble Lord's specific question, the commission will encourage providers to consider an independent element within a complaints procedure as a matter of good practice, but I cannot agree that it would be appropriate to make it compulsory for all providers.

The fact is that what is proposed in the Bill will lead to an appreciable improvement in the complaints system. It will ensure that every establishment has a proper complaints system which will be checked and inspected by the national care standards commission, which will then be able to investigate complaints made to it by users of services in those establishments. On that basis, I invite the noble Lord to withdraw his amendment.

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