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Mr. Tim Collins (Westmorland and Lonsdale): My hon. Friend makes a powerful case for amendment No. 3. Could he, for my benefit, and possibly that of other right hon. and hon. Members, clarify whether the commissioners who would have those specific tasks would be appointed by the Secretary of State or the chairman of the commission? Would they be appointed to the commission with a view to having a specific

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responsibility, and does my hon. Friend therefore envisage that people with a specific background would be appointed?

Mr. Hammond: I believe that the Bill provides that the Secretary of State will appoint the commissioners. Interestingly, amendment No. 32, tabled by Liberal Democrat Members, addresses my hon. Friend's point by suggesting that a member of the Commission for Health Improvement staff should be the deputy director of the independent health care directorate of the National Care Standards Commission. That issue is likely to be debated shortly.

Why is it necessary to establish a separate entity within the commission to address the needs and concerns of the independent acute health sector? A couple of general points have come to light, as well as a couple of specific points. First, which staff in the commission will carry out the inspections and the registration function? We believe, from what the Minister has told us, that many of them are carrying out inspection functions within health or local authorities, and will move across to the National Care Standards Commission.

In some areas--I emphasise "some"--there are historic tensions that do not bode well for a good working relationship. The old role of inspectors working within local or health authorities is different from the working relationships that the Government hope to inspire by this new model, in which people will work for an independent care standards commission. There is a concern in the independent sector that the same people will be wearing different hats--and probably earning higher salaries--after the move from one employer to another.

There are specific questions about the nature of inspection and the regulation of private hospitals. The term "independent hospitals" encompasses a wide range of entities. Sophisticated hospitals in central London and other large cities have sophisticated equipment, fully-fledged intensive care beds and the capability to carry out almost any procedure that can be done in the national health service. At the other end of the scale we have smaller, low-tech institutions. The smaller ones are often run by voluntary or charitable organisations; they may perform a general service to the community or to a particular group or community.

There is a wide range of competence and ambition between private hospitals. We must ensure that the regulation and inspection regime is sensitive to those differences, and that small hospitals seeking only to carry out relatively minor procedures are not rendered non-viable by a requirement to comply with regulations designed for hospitals that have loftier ambitions.

We agree with the industry that identifying a unit within the National Care Standards Commission that will address itself exclusively and specifically to these issues, will give a greater chance of achieving an appropriate, light-touch regime that will ensure proper delivery of consistent quality standards and proper compliance with appropriate levels of regulations without becoming oppressive. That is why we propose the establishment of the health care committee, and an associated commissioner.

I turn to the arguments for the nursing and care homes committee. In some cases, history does not offer much help when we consider working relationships in

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that sector. Local authorities have been providers of accommodation themselves, as well as purchasers of accommodation and services from the private sector and regulators of that sector. They have experienced considerable conflicts of interest, because they are asked to regulate homes that are in competition with those that they provide. There are many stories from many parts of the country about practices that we certainly should not accept. I know that the Minister would not accept them; that is, in large part, why the Government want to change the regime and to establish a level playing field.

4.45 pm

The Bill will separate the role of regulator from that of provider. For the first time, it will require local authorities that provide care home or nursing home accommodation to be regulated in the same way as their private sector competitors. We acknowledge that the establishment of that regime is an important element of the measure, and we welcome it.

People who are active in the sector are anxious about the fact that those with whom they have, with difficulty, built relationships on specific issues locally will arrive on their doorsteps as the inspectors for the National Care Standards Commission. Although everyone might be working on the new level playing field that the Government are creating, we all know that it is easier to change a title than to deal with deep-rooted, long- established personality differences that have grown up over a long time.

As the Minister acknowledged in Standing Committee, in some cases there will be real difficulties in ensuring that there are constructive working relationships between the commission inspectors and the providers of residential accommodation. Much confidence building and tender loving care will be needed to convince all the providers that the new regime genuinely represents a break with the past and with a system that many people feel is discredited. A dedicated commissioner and committee would send the right signals--a positive message to encourage all parties to build constructive relationships in the future.

The aims of the Liberal Democrats' amendment No. 32 are closely linked to those of amendment No. 3. An interesting twist in amendment No. 32 is that it provides for the appointment of a deputy chairman from the staff of the Commission for Health Improvement. I realise that the provision was designed to ensure that the committee includes a member with expertise in acute health care--indeed, that it is led from the top, or near the top, by such a person. That would address the fear expressed by those in the independent acute sector that their needs might be swamped by the broader responsibilities of the National Care Standards Commission for registering and regulating care homes. I anticipate that there will be certain practical problems with the Liberal Democrats' proposals, but I look forward to hearing the detailed reasoning for their approach to a problem that we have both identified. Their amendment deals with concerns that we share.

The Government have embarked on the creation of a level playing field for care home regulation and registration. In Committee they made a minor concession in relation to boarding schools, and made it clear that they did not want a distinction between independent and local

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authority schools. That was another step in the right direction, but we have come to a deeper philosophical divide in relation to acute hospitals.

The Under-Secretary, the hon. Member for Birmingham, Edgbaston (Ms Stuart), said openly in Committee that the Government were committed to the managed system of health care and to the Commission for Health Improvement, which has no power of deregistration. If it finds a problem in the national health service acute sector, all that it can do is report the problem to the management--which may be responsible for the problem in the first place. It will have to rely on the Secretary of State's powers for direction and central management of the national health service to try to deal with the problem. In the independent care sector, the National Care Standards Commission will have real teeth, because it will be able to deregister someone who is in breach of the standards or who has not behaved properly in any other way.

Our amendment and the Liberal Democrats' amendment seek to address the real concerns of the independent health care sector and to make the level playing field a reality. The amendments recognise that both sectors--the independent sector and the national health service--can learn from each other. There is not a monopoly of wisdom on either side, and no one thinks that there is.

The amendments will help to ensure--there is no guarantee--that independent sector providers are not saddled with inappropriate registration or inspection regimes, and that the many different functions of independent hospitals are properly recognised. The industry believes that there would be safety in having a dedicated commissioner, and amendment No. 3 seeks to provide for one. The Liberal Democrats have a similar aim in amendment No. 32.

In a letter to me dealing with outstanding matters from the Committee, the Minister described Government amendment No. 82 as a drafting amendment. However, as he said in his opening remarks, it addresses the question of how the National Care Standards Commission will operate. Will it mainly employ its own staff, or contract its functions out? In other words, will it follow the local authority or the Ofsted model? Will the initial position be enshrined in any way or may it change over time? Does the Minister envisage the position evolving once the initial cohort of staff, who will transfer from local authorities and health authorities, is replaced by other people? Members on both sides of the House will wish to explore that issue a little so that they can understand the significance of the change that the amendment will make to schedule 1.

This interesting and diverse group of amendments and new clauses will significantly improve the Bill--and I include the Government new clause and amendment in that description. I look forward to hearing in due course the Minister's answers to my questions.

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