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LORDS AMENDMENT

24Page 3, line 45, at end insert— "( ) The Secretary of State shall specify to the bodies charged with inspection of health and social services that they should monitor, at regular intervals, the impact of this Act on patients and their carers."


    The Commons disagreed to this amendment for the following reason:


24ABecause the inspection and monitoring system for health and social care services is adequate and the amendment is unnecessary.

Baroness Andrews: My Lords, I beg to move that the House do not insist on their Amendment No. 24, to which the Commons have disagreed for their reason numbered 24A. I will also speak to Amendment No. 25.

Amendments Nos. 24 and 25 would impose a permanent statutory duty on inspection bodies to monitor the impact of the Bill on patients and carers and a permanent statutory duty on the Secretary of State to report on an annual basis to Parliament on the outcomes of patients affected by the Act.

Perhaps I could restate the steps that the Government have taken not only to monitor the effects of policies on the NHS and social care in real time so that action can be taken if there are perverse effects, but also to evaluate policies. In addition, I remind noble Lords about the proposals in the Health and Social Care (Community Health and Standards)

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Bill to make the new inspectorates much more independent of government. In the light of that, the major problem that we have with the amendments is that it would be inappropriate, having just proposed that the Secretary of State would agree high level priorities only with the new inspectorates, immediately to start a detailed list of inspections that the inspectorates must perform. I hope that noble Lords accept that it would not be right to undermine their independence in that way.

Health and social care already involves a raft of ways of evaluating performance—performance indicators include delayed discharges, emergency readmissions, home care and people helped to live at home. We are also introducing indicators on the speed of service provision. Those indicators will quickly indicate if substantial problems arise, even if they are in only some local areas. The department is also carrying out work at the moment on improving the sensitivity of readmissions data, so that it more accurately reflects whether a patient is readmitted with the same problem as previously. We need to know that. Those mechanisms are robust.

The department's interest in reducing the unhappiness that delayed discharges cause will absolutely not stop when the Bill is implemented. In response to concerns about the impact of the Bill and incentives on behaviour in the NHS and social services and the effect on patients, we will commission an evaluation of the system and of its implementation during the first year of operation. We want to ensure that the system, and the incentives within it, are bringing about positive changes and identify any barriers to successful implementation. In addition, the implementation team, which is led and staffed by practitioners, will be encouraging local partnerships to have "dry-runs" of the system before commencement, which can also be evaluated by a wider reference group and fed back to the implementation team. We want to learn the lessons as early as possible. We will want to intensify that work from October until full implementation in January so that social services and the NHS feel supported when they introduce the new system of notifying each other and acting on those notices. At the same time, the implementation team can offer support to areas having particular difficulties—it will build on what has worked well elsewhere.

I return to the inspectorate. I know that noble Lords were concerned that there was a gap between the difference between collective quantitative information and quantitative information, so that we knew what was happening to the patient and the impact on him or her. I know that the noble Baroness, Lady Noakes, was concerned about that.

The Health and Social Care (Community Health and Standards) Bill proposes the establishment of two new health and social care inspectorates—the Commission for Health Audit and Inspection and the Commission for Social Care Inspection. One of their functions will be to validate performance statistics, but they will also monitor and report on the "whole system" with an emphasis on the experience of the

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patient and user of the service. We believe that that is a major step forward and one which noble Lords will welcome. The new CHAI inspections will include foundation trusts.

Noble Lords may be interested to know that the current inspectorates and the Audit Commission are already planning a wide-ranging and co-ordinated study of older people's services across health and social care. Field work will begin later this year and it will consider the new structures and report in 2005.

Both the new inspectorates will report annually to Parliament on the provision of NHS and social care. Their independence from the department will mean that instructions from the department about the detail and frequency with which they need to inspect older people's services would not be possible as the relationship between inspectorates and department is currently envisaged.

On that issue, the Commons reasoned that it was neither necessary nor appropriate to impose a permanent specific statutory duty on the inspection bodies to monitor the effects of the Bill or on the Secretary of State to report every year to Parliament specifically on the effect of the Bill. Therefore, I hope that noble Lords will accept that it is preferable to maintain this independence and that the additional evaluation that I have introduced today and the existing very robust mechanisms that we already have in place will meet the reservations raised at previous stages of the Bill.

Moved, That the House do not insist on their Amendment No. 24 to which the Commons have disagreed for their reason numbered 24A.—(Baroness Andrews.)

Earl Howe rose to move, as an amendment to the Motion that the House do not insist on their Amendment No. 24 to which the Commons have disagreed for their reason numbered 24A:


24BLeave out "not".

The noble Earl said: My Lords, I beg to move Amendment No. 24B and shall speak also to Amendment No. 25B. The noble Baroness's remarks today have demonstrated very encouragingly the weight that the Government appear to attach to the concerns that we on these Benches voiced in Committee.

An amendment which requires the Government to monitor the effects of the Bill looks innocent and straightforward enough but, in the context of this Bill, I suggest that it is of the highest importance. Even the Minister will acknowledge that the Bill takes us into new territory. Throughout our debates I have emphasised the possibility—indeed, the probability—of unintended consequences arising from its provisions.

What do we mean by monitoring? The noble Baroness is right. It will not be enough to collect quantities of bald statistical data. It will be necessary to tell the human story. We need to monitor the patient experience—that is, the effect that the Bill has on real patients being discharged from real hospitals.

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The role of CHI and its successor body will be critical in that regard. I was interested to hear the Minister say that new CHAI will be more independent. I can tell her that we shall be looking very carefully at that point as the Bill goes through the House.

CHI will need to gain a much better handle, for example, on the causal factors underlying emergency readmissions. At present, I understand that it is simply not possible to say from the statistics available how many patients are being readmitted to hospital on an emergency basis for a clinical condition for which they were previously being treated. That kind of information is essential if the Government are to have any hope of implementing the system of financial flows which they have announced.

There is a need for transparency with this measure if we are to be 100 per cent satisfied that patients are being treated fairly and that corners are not being cut. I should like to hear what other noble Lords have to say on the amendment, if anything. As it appears that there is not a mad rush to speak to it, I believe that it remains for me to say that I am grateful to the Minister for the welcome assurances that she has given.

The Chairman of Committees: My Lords, is the amendment not moved?

Earl Howe: My Lords, the amendment is not moved.

On Question, Motion agreed to.

LORDS AMENDMENT

25Page 3, line 45, at end insert— "( ) The Secretary of State shall report on an annual basis to Parliament on the outcomes of patients affected by this Act."


    The Commons disagreed to this amendment for the following reason:


25A Because the inspecting bodies for health and social care services will be able to make reports on the operation of the Bill.

Baroness Andrews: My Lords, I beg to move.

Moved, That the House do not insist on their Amendment No. 25 to which the Commons have disagreed for their reason numbered 25A.—(Baroness Andrews.)

On Question, Motion agreed to.

5.15 p.m.

LORDS AMENDMENT

26After Clause 3, insert the following new clause— "Duties of responsible NHS body following notice under section 2


    (1) The duties under this section apply where notice of a patient's case under section 2 has been given.


    (2) The responsible NHS body, and any other NHS body which is considering whether to provide services to the patient after discharge, must consult the responsible authority before deciding what services (if any) it will make available to him in order for it to be safe to discharge the patient.


    (3) The responsible NHS body must give the responsible authority notice of the day on which it proposes to discharge the patient.

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    (4) The notice under subsection (3) remains in force until the end of the relevant day, unless it has previously been withdrawn.


    (5) The responsible NHS body may withdraw the notice under subsection (3) at any time before the end of the relevant day by giving notice of withdrawal to the responsible authority.


    (6) For the purposes of this Part "the relevant day", in relation to a qualifying hospital patient, is the later of—


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