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Several hon. Members rose--

Mr. Deputy Speaker (Mr. Michael J. Martin): Order. Before I call the next Back Bencher, I point out to the House that five remain to be called. The winding-up speeches will begin at 6.30 pm, so hon. Members can draw their own conclusions. I have no power to restrict any contribution, but all five Back Benchers can be called to speak if speeches are curtailed.

5.45 pm

Mr. Steve McCabe (Birmingham, Hall Green): I begin by congratulating my right hon. Friend the Secretary of State on bringing forward the Bill. Regulation in this area is long overdue, and the clear aim is to raise standards and protect vulnerable people.

My right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) spoke about day care and domiciliary care. I understand that a Government amendment in another place means that establishments providing day care for elderly people will now be included in the National Care Standards Council. As the elderly population expands, and as we encourage the policy that people should be maintained in their homes for as long as that is practicable, the matter of day care provision and domiciliary care is likely to arouse as much concern as residential care. Will my hon. Friend the Minister say when he hopes that day care provision for elderly people will be subject to regulation and inspection?

It is worth noting that about a third of all psychiatric care in this country is conducted in private psychiatric hospitals and clinics. That is a vital sector, but it is also open to all sorts of potential abuse. It is right that we should seek to regulate it.

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We should also be concerned about the fairly substantial numbers of people who are transferred to national health service hospitals following failed treatments or procedures originally carried out in the private sector. Many of the operations are quite substantial. If they were carried out in the NHS, the consultant would be supported by three or four assistants, but in private hospitals he often performs operations without that help. It is probably no great surprise therefore that so many errors and mistakes arise. It seems to me that that is another area ripe for some regulation.

Clause 6 establishes the National Care Standards Council and is to be welcomed. However, what will be the relationship between the council and the social services inspectorate? At present, the inspectorate plays a significant role in promoting standards of good practice.

Ministers have given assurance that regulators appointed by the commission will be experienced people, with special expertise in health or social care. Will my hon. Friend the Minister say a little more about their recruitment?

I especially welcome the provision that a complaints procedure will be a condition of registration. Will my hon. Friend confirm that that requirement will apply too to private nurseries and child day care provision?

I recently had personal experience of a private nursery in my constituency. No complaints procedure was in place there, and the nursery had many other shortcomings. I understand that social services departments have limited powers with which to deal with such establishments. What makes it all the more alarming is that the proprietor of the nursery is an inspector for Ofsted--the very body that will be responsible for inspecting child day care provision. It cannot be right to employ as regulators people whose own standards of practice leave a lot to be desired.

There has also been criticism from the private residential sector of inspection work carried out by the local authority. There remains suspicion in some quarters--with reason, I think--that some individuals are unduly hostile towards the private sector. We need to have confidence that inspection or regulation will be truly independent. We should be careful about employing those who have ideological objections to a particular sector, allowing those with direct business interests to inspect their competitors, or employing those whose own standards of practice are flawed. I would be grateful if the Minister could reflect on that when considering the best way to recruit appropriate staff.

I welcome the establishment of the National Care Standards Commission, which seems to be a response to the Sutherland commission. I appreciate that I have nothing like the influence with the Minister that the hon. Member for Sutton and Cheam (Mr. Burstow) has. However, now that the Government have brought forward this Bill, which deals with one aspect of the problem, may I ask my hon. Friend the Minister whether it is not time to bring forward complementary proposals to deal with the question of payment for residential care? I welcomed today's announcement on guidance for domiciliary care charges, but we need to sort out who pays, what level of means-testing--if any--will be applied, and what charges should be applied across the country. The hon. Member for Sutton and Cheam pointed out that the recent Audit

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Commission report shows a remarkable variation in charges, but there is no correlation between the level of charge and the standard of care or service.

Quite a lot of time has been spent today on the private residential sector and the draft standards suggested in the consultation document, "Fit for the Future?" Significant costs could be imposed on the sector, leading to a significant reduction in capacity, if those draft standards are implemented too quickly or if there is too much rigidity when considering the physical features of homes.

A care home owner said to me recently that if he were to comply with the room size requirements, he would have to rip out all the en suite facilities that he has just installed at considerable cost. That makes no sense. I welcome recent ministerial comments that it is planned to phase in those requirements and that the emphasis will be as much on standards of care as on any physical feature.

The hon. Member for Woodspring (Dr. Fox) made the point that if Ministers are considering giving private care homes a new role in providing care for those leaving hospital and needing recuperation, we have a right to expect significantly higher standards in those establishments if they are to provide adequate intermediate care. In such cases, it is reasonable to demand increased numbers of properly trained and qualified staff and resources such as physiotherapy. The prospect of a new and quite lucrative market for care home owners surely means that they should wish to upgrade their establishments significantly. We should make a distinction between establishments that might seek that sort of business and other homes to which right hon. and hon. Members have referred.

I welcome the proposed General Social Care Council, but how will it be funded? Will it receive part of the budget now held by the Central Council for Education and Training in Social Work, which is about £600 million a year? What will the relationship be between the council and the register that it will establish at some time after April 2002, and the new nursing regulatory body, which I believe will cover health care assistance, which is likely to come into force in September 2001? We need to know whether there will be a point of contact or connection between these agencies.

5.55 pm

Dr. Peter Brand (Isle of Wight): I welcome the thrust of the Bill. It will allow us to catch up with changing practice over the past 20 years. There were fit people in part III homes 20 years ago, and we now have residential and nursing homes in which there are much greater levels of dependency. We have heard that the private sector does much work that used to be the natural work of the national health service.

The Bill does not address sufficiently the anticipated changes that I hope that its enactment will encourage. The contribution of the hon. Member for Wakefield (Mr. Hinchliffe) clearly made that point. If we are to use the private sector imaginatively, we should stop the current practice of using it as a sort of oubliette for difficult people with whom we do not want to bother the NHS. It is not a challenge for the private sector provider only to give us a modern service. The NHS must ensure that there is suitable outreach from the secondary care sector and other such areas. For that reason, I am extremely disappointed that we do not have a common final route of

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complaints--for example, using the health ombudsman for all patients irrespective of whether they are in the private sector or in the NHS, or funded through the private sector or the NHS.

The two inspection regimes will be extremely confusing. No doubt that issue will be explored when the Bill is considered in Committee. I welcome the inspection registration that will be set up for residential homes. However, I hope that there will be a reasonable amount of local discretion. Inspection and registration should not mean hitting people over the head and removing their ability to provide a service.

We have had an extremely good joint inspection and registration unit on the Isle of Wight. It did not merely inspect and regulate because it advised, supported and guided on better forms of practice. I hope that the local element of a national system will not be lost.

Flexibility of interpretation should be allowed when dealing with the draft standards that have been published. There is no need to say anything about that after the excellent speech by the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble). However, I shall use the example of an acute nursing home that is used by patients for only a short period, occupying their own room. Must such a place have enormous dining rooms, common rooms and smoking rooms if they are never to be used? There should be a degree of local discretion.

I shall engage briefly in the children's commissioner- children's director debate. I appreciated the contributions made by the hon. Members for Cardiff, North (Ms Morgan) and for Ceredigion (Mr. Thomas). I hope that we can benefit from the Welsh Assembly's more enlightened view. I think that the hon. Lady and the hon. Gentleman are being too modest in not pushing for what they clearly want to see in their home country to be set out in the Bill. We would support them because that is what we want to see in our home country. I hope that in Committee they will support amendments that may well take the form of a ten-minute Bill that was introduced not so long ago.

There is also the matter of child care, child minding and pre-school playgroups. I have some fear of Ofsted in that regard. Unlike our local inspection and registration unit, which is an enabling organisation, most schools in my local authority have not found being Ofsteded a positive experience; they tend to be relieved when it is over because they do not enjoy the process.

When dealing with small, flexible organisations such as pre-school playgroups, it is important that there is knowledge as well as structure--sympathy as well as regulation. That would be better achieved through the inspection and registration set-up that will be created, which would have a social care background, than through an assessment of how well children are doing on their tables or of the standard of their reading and writing.

I hope that the new regulations will resolve the anomaly over child minding under the child care tax credit system, whereby people can receive the credit only if they use a registered child minder, who must have a qualification for under-fives. Under the regulations, children with special needs or learning difficulties can qualify for those credits, but older children rarely benefit from the care of people who are trained specifically to look after the under-fives. At present, the system is far too rigid. It should be

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possible to assess individual carers as to their suitability to look after a particular child. If they are appropriate, the tax credit should not be denied.

In response to an intervention by my hon. Friend the Member for Sutton and Cheam (Mr. Burstow), the Secretary of State referred to domiciliary services. The royal commission was clear as to the difference between the provision of home helps, who traditionally give social support such as housework and shopping, and the domiciliary help that people need because they are physically or mentally frail. Our policy is to means-test charges--we would welcome a unified set of regulations--for social support in people's homes, but to work towards the provision of free personal care, whether delivered in a residential setting, such as a nursing home, or in people's own homes. That would eliminate the perverse incentive to shunt people off to homes, because, as has often been pointed out this evening, people want to stay in their own home for as long as possible.

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