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Baroness Howarth of Breckland: I am grateful to the Minister for putting those assurances on record, for reasons that he will appreciate. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 87 agreed to.

Clause 88 [Power to require information etc]:

[Amendments Nos. 358ZB and 358ZC not moved.]

Clause 88 agreed to.

Clause 89 [Power to require explanation]:

Lord Warner moved Amendment No. 358A:


On Question, amendment agreed to.

[Amendment No. 359 not moved.]

Clause 89, as amended, agreed to.

Clauses 90 and 91 agreed to.

Clause 92 [Reviews and investigations]:

[Amendments Nos. 360 and 361 not moved.]

Clause 92 agreed to.

Clauses 93 to 98 agreed to.

Clause 99 [Power to require explanation]:

Lord Warner moved Amendment No. 361A:


    Page 41, line 19, leave out "prescribed" and insert "specified by the Assembly"

On Question, amendment agreed to.

Clause 99, as amended, agreed to.

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Clause 100 [Transfer of functions to CHAI and CSCI]:

Baroness Barker moved Amendment No. 362:


    Page 41, line 29, at end insert—


"( ) In the Care Standards Act 2000 (c. 14), after section 23(2) (national minimum standards) insert—
"( ) In reviewing standards the appropriate Minister must ensure that lower standards are not applied to Parts 2 and 3 services received predominately or exclusively by people at or above state pensionable age.""

The noble Baroness said: In moving Amendment No. 362 I shall speak also to Amendments Nos. 363, 364, 365, 367 and 368, which are grouped with it. These amendments deal with the transfer of functions to CHAI and CSCI. The latter two are designed to tease out exactly where responsibility for certain inspection functions will lie.

Amendment No. 362 deals with a subject close to the heart of many noble Lords, because we debated it at considerable length during the passage of the Care Standards Act—national minimum standards for residential and care homes. Earlier this year the Government rowed back from the exacting standards for building regulations which they set themselves in that Act. However, those standards applied only to services for adults and not to those for older people. Amendment No. 362 is designed to pose the following question. What happens when an adult who has been a recipient of care services in a residential setting reaches the age at which they are deemed to become an older person—usually considered to be pension age—as regards social care? Will they be moved? On their birthday will they be subjected to a lesser minimum standard? Will they be transferred by local authorities to different premises, and will CSCI report and investigate such matters?

Amendments Nos. 363 and 364 address the issue of non-NHS healthcare provided by an NHS or non-NHS body under the National Health Service Reform and Health Care Professions Act 2002. These amendments are designed to ask the following question. Where healthcare services are provided principally to people in residential care settings and they are provided by private providers, will CHAI or CSCI have the duty to inspect? A number of residential and nursing homes rely on private services such as private dentistry. Which of the two bodies will have the duty to inspect and regulate those?

The remaining amendments, Amendments Nos. 365, 367 and 368, deal with excepted treatments.

It is well known that one of the biggest challenges facing healthcare is the management of long-term and chronic conditions. These amendments question which body will have regulatory responsibility to look after the interests of people who have long-term conditions, which are not acute conditions, but are continuing conditions.

The amendments were clearly tabled some time ago. They have an added importance because the last day on which the Committee met, the Minister made his somewhat jaw-dropping assertion that the NHS retained little responsibility for long-term

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rehabilitation. To be clear and fair to the Minister, he said that they were matters which are now largely carried out in the community as a function of social services. Therefore, it is apt and right that we should ask the questions posed in the amendments. I beg to move.

Earl Howe: I rise briefly to support Amendments Nos. 365, 367 and 368, to which I have added my name. It may be that the expression "long term conditions" is not quite appropriate in the context of this clause, but the point made by the noble Baroness is, nevertheless, extremely well made. The difficulty with alcohol addiction centres, for example, and clinics which look after patients with acquired brain injuries, is that they fall across the definitional divide, as between mainstream healthcare and mainstream social care.

Often the reason why a particular facility is inspected by the NCSC rather than the Commission for Health Improvement is an accident of history. What we need to bear in mind is the need for institutions to be inspected by those who have a proper understanding of the work being carried out in them. Brain injury units—I visited one recently—have much more in common with acute hospitals than with residential care homes. Substance abuse clinics, equally, have precious little to do with social care and a great deal to do with specialised and intensive treatment regimes. I suggest that both should be under the wing of new CHAI.

Regulation, when it happens, needs to be appropriate. Like the noble Baroness, I am worried that arbitrary and inconsistent decisions may be taken over the regulation of these centres, which may not make sense or be appropriate to the activities in question.

Moving on briefly to my Amendment No. 370, this amendment has a very simple purpose which is to incorporate the Government's stated intention to allow CHAI to regulate private dentistry. The Bill is an obvious opportunity to meet that commitment. Earlier this year the OFT published its report into the private dentistry market, which highlighted a number of key concerns. Chief of these were that consumers are not able to access information to enable them to make informed choices; consumer complaint procedures are inadequate; and some regulation of dentistry may be unnecessary.

On the consumer front, work clearly needs to be done by the Government and the GDC to address standards of care in dental surgeries, as well as consumer-related issues, such as clear pricing, itemised accounts, whether this or that treatment is private or on the NHS, and what kinds of treatment are available. It makes sense for new CHAI to take an active part in the discussions and to be the body responsible for monitoring the standards when they are in place.

As regards complaints, there must obviously be an accessible procedure available for patients. Once again, CHAI and the GDC need to be in close

20 Oct 2003 : Column 1379

communication about how such a system is to work. I hope that the Minister will be receptive to the amendment. If he cannot accept it as it stands, I hope that he will at least wish to take the proposal away to look at it constructively.

Lord Colwyn: Perhaps I may be allowed a few seconds intervention. I have been sitting here since about three o'clock today. This is the first time that we have heard the words "dentists" or "dental services", and I am on my feet. I, too, welcome the amendment and support all that my noble friend said. It is important that CHAI—or having heard the noble Baroness, Lady Barker, perhaps it may be CSCI—should monitor availability, quality and access to dentistry and independent dental services. As the remit of the two bodies increases, I should like confirmation from the Minister that they will not include dealing with complaints and complaint handling.

As my noble friend Lord Howe has just mentioned, the OFT report has made quite a considerable impact on the dental profession. Indeed, as soon as the legislation is in place, the General Dental Council is planning to produce regulations to monitor the independent sector. Perhaps Clause 101 will negate the need for that, which would be wonderful so far as I am concerned because, year on year, an ever-increasing amount in respect of retention fee may not now be necessary. I look forward to hearing what the Minister has to say.

10 p.m.

Lord Warner: I feel a little like Marcus Trescothick on reaching his hundredth; I now take guard for the next hundred. In order to address the long wait mentioned by the noble Lord, Lord Colwyn, if the Committee will bear with me, I shall deal first with Amendment No. 370. We certainly support wholeheartedly the intentions behind this amendment. In June, in the Government's response to the OFT report, The Private Dentistry Market in the UK, we made a commitment to include private dentistry within CHAI's remit. The OFT concluded that the public needed better protection from a small minority of dentists who were providing poor-quality services and, often, being less than transparent about their charges for those services.

However, we are planning to introduce the necessary provisions by means of secondary legislation. Section 2(7) of the Care Standards Act 2000 contains a list of services within the remit of the National Care Standards Commission. Included in this list at Section 2(7)(b) are,


    "dental services under general anaesthesia".

Accordingly, the National Care Standards Commission is already empowered to regulate dental practices providing general anaesthetics. As a result of this Bill, the commission's responsibilities in relation to private health and dental care will become CHAI's.

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Section 2(8)(c) provides for the definitions of the listed services at Section 2(7) to be modified by regulation. We propose to modify the definition at Section 2(7)(b) to read,


    "dental services under local and general anaesthetic",

which, since local anaesthetics are an integral part of dental practice, will have the effect of bringing all private dental practices within the remit of CSCI and CHAI.

The advantage of this legislative route is that we are required to consult interested parties about changes in CHAI's remit. Shortly we will work up a draft together with greater detail on how the existing regulatory framework might be adapted to apply to wider dental practice and circulate it to the bodies concerned with dentistry and consumer interests. We would aim to have the regulations in place during 2004.

I hope that, in the light of those reassurances to the noble Lord, Lord Colwyn, the noble Earl will feel able to withdraw his amendment.

Turning back to Amendment No. 362, it is of course desirable that lower standards should not be applied to services for older people. It is already the case that the national minimum standards must be applied to services under Part 2 of the Care Standards Act regardless of the age of the individual receiving those services. The consultation process prior to the introduction of services ensures that the standards we develop do not have a disproportionate effect on any set of service users.

The amendment also appears to assume that discrimination against older people takes place in the application of national minimum standards. This is not the case. Those standards are based on the type of establishment or agency in or from which an individual is receiving services, and not the predominant age of the person receiving those services.

Section 24(3) of the Care Standards Act provides that the national minimum standards must be consulted before they may be introduced. This allows for the views of service user groups to be taken on board and acts as an extra safeguard to ensure that national minimum standards do not unintentionally discriminate against any one set of users. We do not think, therefore, that this amendment is necessary.

I turn now to Amendments Nos. 363 to 368, which concern the division of responsibilities between CHAI and CSCI. We have been over this ground at length, although the Government do recognise that it is not always easy to distinguish between where the provision of healthcare ends and the provision of social care begins for the purposes of regulation. This matter was considered in depth when the White Paper, Modernising Social Services, was published in 1998. At the time, Ministers decided, on the basis of the subsequent consultation and in the best interests of service users, that all provision that did not provide acute services led by medical staff, but provided substantial levels of personal care would in future be

20 Oct 2003 : Column 1381

regulated as care homes. This is the provision about which the Independent Healthcare Association, among others, has been concerned.

When developing the Bill, the Secretary of State decided that the future division of the National Care Standards Commission's responsibilities should be based on the current categories of establishments registered under the Care Standards Act to avoid confusion and disruption. This meant that services that would currently be registered as private and voluntary healthcare services would be transferred to CHAI. We believe that care homes providing nursing should remain registered by CSCI rather than giving regulatory responsibility to CHAI because of the very high levels of personal care provided in such services.

It is the Government's view that services providing long-term care and treatment for drug and alcohol abuse are not providing acute medical intervention, as do hospitals, for people with these conditions but are providing secondary care to aid recovery or to manage on-going secondary symptoms. These facilities may have substantial input by nurses and allied health professionals, but have limited input from doctors.

Nevertheless, these services are also providing substantial personal care for service users, including some of the most intimate forms of care, and, in common with other care homes providing nursing and personal care, we believe that these services should properly continue to be regulated by CSCI so that their welfare needs can be most appropriately met. CSCI will, of course, be able to seek assistance from CHAI where healthcare professional expertise is needed.

The amendments tabled have the intended effect of transferring the regulation not only of those services highlighted by some—for example, those supporting recovery from brain injury or recovery from drug or alcohol abuse—but of any long-term condition. So this would mean that elderly people with Alzheimer's who received any kind of nursing or other health service in their care home would be regulated by CHAI. The personal care and welfare needs of these service users, which most certainly are equal to or greater than any health need, and are probably their major need, would not be appropriately covered by the regulatory framework under the 2000 Act under these amendments. I was not saying earlier that rehabilitation was not an important part of healthcare; I was saying that in many of the cases we have discussed in regard to this issue personal care needs are the dominant factor.

Under Clause 118, the Bill provides for joint working between CSCI and CHAI. The intention here is that the commissions should be able to plan to work together to review the quality of joint services between the NHS and local authorities and share expertise where services regulated by either commission have substantial health or social care aspects. For the reasons I have given, we do not believe that the amendments are needed.

The effect of Amendment No. 369 would be to remove CHAI's duty to keep the Secretary of State informed about the general provision, availability and

20 Oct 2003 : Column 1382

quality of independent healthcare provision. CHAI's general duty of keeping the public informed about the provision of independent healthcare is well established.

It is entirely proper that the Bill clearly states that CHAI, in addition to its other duties, has a more general duty to keep the Secretary of State informed about the general provision, availability and quality of independent healthcare provision. It is a significant role of CHAI, using all the information it will have to hand about the performance of independent healthcare providers, to advise the Secretary of State on issues about the availability and quality of care—care which, in many cases, is used also by NHS patients.

CHAI has a prominent role to play in the continued evolution of independent healthcare provision. The amendment, if carried, would significantly hinder the fulfilment of this role.


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