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Lord Clement-Jones: I wish to speak to Amendments Nos. 83 and 84 which are grouped with Amendment No. 80. They are similar. Both are designed to ensure that where national minimum standards are imposed by the department--in the way that compliance cost assessments are required in certain instances--the Minister and the department are required to,
I speak to these amendments from the basis of strong support for a regime of national minimum standards and indeed for the standards proposed in Fit for the Future? I am sure that the Minister has seen the responses to the consultation. There is obviously strong support in many quarters for those standards. I do not want to detract from our support either for the detail of the standards or from the principle that they should be imposed. However, the amendment is designed to prevent the arbitrary setting of standards which are in a sense responsibility free. It would be perfectly possible for the department simply to take the view that it was rather removed from the process of regulation and that in any event most of the homes were not run by local authorities, which may need to be funded, but by the private sector which needs to contract to local authorities. The department could take a rather lofty view as regards what the cost of achieving such standards should be.
We are concerned to ensure that when minimum standards are set, careful thought is given to the costs involved. As the Minister knows, different financial issues have arisen in regard to the provision of care. There has been much debate as regards whether adequate resources are available in the system. Certainly, the independent sector believes that in many instances it is not being fairly treated by local authorities who, in turn, complain of lack of resources themselves. We therefore believe that it is not good enough simply to set national minimum standards. There should be an overview as to whether there are adequate resources in the system. That should be an essential part of the process--akin to a compliance cost assessment, as I mentioned.
Amendment No. 84, although similar, is not quite the same. One of the concerns that I expressed at Second Reading is that there will simply not be a sufficient level of resources in the inspection system to ensure that minimum standards will be achieved. On Second Reading I mentioned the Almost Half report of 1992 which made the point that there were not enough resources in the inspection system to ensure that standards were met. It seems pretty fruitless to have a clause that allows minimum standards to be set only to find that there are not sufficient resources in the system to ensure that those standards are achieved. We believe that when minimum standards are set it is important that the department should ensure that the inspection resources will be available to ensure that they are put into effect.
Lord Hunt of Kings Heath: This debate has gone to the heart of most of the concerns expressed about how the regulatory system will work in practice and the impact that it may have on the financial viability of some of the establishments to be regulated. I hope that I can assure the Committee that these matters have been considered and that we intend--as ever--to keep the right balance between understanding the situation which providers will face and the necessary desire to ensure that vulnerable people are properly protected.
We have made clear our intention to consult on all national minimum standards, as we set out in the White Paper Modernising Social Services. As noble Lords will be aware, we have already produced Fit for the Future?--National Required Standards for Residential and Nursing Homes for Older People, and, as I have made clear on a number of occasions, we are considering responses, the closing date for which is in a couple of weeks' time. We shall give the responses careful consideration. I have indicated the flexibility of approach that we shall take when considering the responses to the consultation.
It is our intention to follow the same practice of consultation for each set of national standards and to seek views from all interested bodies and from people likely to be affected. However, we do not want to prevent the possibility of making minor amendments to standards or, perhaps, of responding rapidly with changes should circumstances warrant. We do not want our responses to be slowed down by a lengthy consultation process. It is here that we need some degree of flexibility. Standards on the use of measures to restrain and control, for example, may need to be amended quickly if they do not cover a particular type of unsafe or harmful practice identified in a particular home.
To summarise, we would expect to consult fully whenever developing national minimum standards, but I would be uncomfortable accepting amendments which would rule out any circumstances where a consultation might not be appropriate.
Amendment No. 81 concerns the discretion with which the registration authority may apply the national standards. I said, both at Second Reading and during our previous deliberations in Committee, that an element of discretion needs to be used when the national care standards commission is exercising its powers to make decisions. We think we have achieved that by the current wording "take into account", which we think is sufficiently flexible for those purposes.
It is worth recalling that the independent sector has, for a long time, been calling for national standards. That is because of the inconsistency of approach among many of the current registration authorities. We are determined to bring fairness and consistency to care services, but we accept that consistency has to be balanced with discretion.
The regulations will, as it were, form the bones on which the standards will form the flesh. So, for example, the regulations may require an establishment to provide adequate and suitable staffing, to take a point we have already discussed. These may be further defined in the standards to require, say, a minimum of 50 per cent of care staff to be qualified at NVQ level 2; they may bring in the ratios we have discussed; and they may bring in the national minimum data that the noble Earl has suggested we consider.
The noble Earl also mentioned the question of room sizes. We know that this issue causes concern. We shall consider responses to the consultation in this area; no final decisions have been made. However, to go back to the point I made at Second Reading, the 10 square metres standard, for instance, was contained in a building note issued by the Department of Health in 1973; and the National Association of Health Authorities, in its guidelines published in 1985, also used the same size area. So the issues concerning room size have been with us for many years.
Perhaps I may now turn to the question of whether there is a need for the national minimum standards to be laid before Parliament prior to them being published. As we know, there will be statements of national minimum standards for each type of registered service; each will be a detailed document building on the principles of the regulations to be made under Clause 20, as I have described. The aim of the standards is to give a more detailed indication of what will be required of registered services in those regulations.
We do not believe it is necessary for the national minimum standards to be laid before Parliament when it is already the case that the regulations on which they are based will have been laid before Parliament and subjected to its scrutiny. When one considers the amount of consultation which will take place in the development of each national minimum standard, I am certain that any person who wants to bring a point of view to bear will be heard.
Amendments Nos. 83 and 84 concern the resources needed by the providers and the regulators to implement and enforce the national standards. We have already discussed the question of resources to providers. I fully accept the intention of the amendments that all new standards should be based on a realistic estimate of the resources needed to meet them. That is why I have argued previously that the national minimum standards should be decided by Ministers in order that they can take those factors into account. That is why, as a matter of policy, the Government are committed to publishing a regulatory impact assessment alongside any new standards.
As regards the costs to the providers, much of our discussion relates to Fit for the Future? and the Committee will have seen that that contains such an assessment. We recognise that some homes will have difficulties meeting some of the standards proposed. I can assure the Committee that we intend to give reasonable time-scales within which those standards can be finally agreed and met.
However, we have to recognise that many homes already meet--or even exceed--those standards, in both the private and voluntary sectors. As the noble Earl hinted, one of the sectors which will have most difficulty with the sizes suggested will be the public local authority sector. It is also worth making the point that the trend towards single rooms has risen quite dramatically, from around 40 per cent to more than 70 per cent in the past 10 years. So the market itself has, in a sense, recognised the need to raise standards and many providers are doing just that. One has to ask whether we would be wrong to inhibit that rise in standards.
I can assure the Committee that as the standards are drafted for each service to be regulated, they will be published with similar assessments as to their likely impact. In carrying out this assessment, the Government will pay close attention to any pressures on public expenditure which might arise from a set of standards and will consider these in the Comprehensive Spending Review. I hope that I have gone some way towards meeting concerns on those matters.The noble Lord, Lord Clement-Jones, raised the issue of whether the registration authority itself would have enough resources to carry out its important responsibilities. Of course, the cost implications of any new standard will be considered by the Department of Health and by the Welsh Assembly in their annual determination of the registration authorities' budgets However, I can give a general assurance to the noble Lord that, of course, we want the new regulatory system to work and that means that we accept that the commission must be funded accordingly in order to carry out its work effectively. I hope that I have assured noble Lords on those matters.
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