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Dr. Brand: Over the past 15 years there has been a dramatic shift in dependency from nursing homes to residential homes and it is not unusual to have people in residential homes who might previously have been in nursing homes, certainly towards the end of their lives. I would not want people to be forcibly moved from what has been their home when they become terminally ill.

Mrs. Lait: I am not entirely certain that the hon. Gentleman and I are a million miles apart on this. If someone were terminally ill and living in a residential home, as that would be regarded as their home, they would get the same care that would be provided in their own home.

Dr. Brand: Does the hon. Lady accept that a great many people who live in their own homes have a nursing dependency as great as people in nursing homes under hospital at home schemes and the like? The differentiation is not as clear as the hon. Lady implies.

Mrs. Lait: The hon. Gentleman and I could have a long dialogue on this, although you would probably call us to order if we did, Mr. Deputy Speaker. As I said, I do not think that the hon. Gentleman and I desperately disagree about this matter. However, the bulk of people in rest homes are not there--or should not be there--because of nursing requirements. That is part of the argument for national care standards and for removing the involvement of local social services in placement into rest homes. As I said earlier, I have long believed in that.

6.15 pm

The amendments seek to ensure that two sectors in which the private sector has taken a strong interest--well-run private hospitals and nursing and rest homes--should receive the consideration that they require from the commission.

I see that my right hon. Friend the Member for Bromley and Chislehurst has returned to the Chamber. Let me pick up his point about what should happen to the commission

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when we win the next election. I suggest that it would be helpful to have people with the right skills on the commission, and a directorate with specialist skills in the independent health sector and nursing and social care so that those two sectors get the attention that they require to ensure that they provide the highest care standards of which we would all approve.

Another reason why I support the proposal for a social and nursing care commissioner was mentioned by my hon. Friend the Member for Runnymede and Weybridge in relation to inspectors. We probably expect that most local authority inspectors will move over to the commissions under the Transfer of Undertakings (Protection of Employment) Regulations 1981, if for no other reason. I sincerely seek assurances that the inspectors will receive the necessary training to act in an even-handed way. As I said earlier, a number of local authority rest homes are not up to the standards that are required in the private sector. Under the 1984 Act and subsequent legislation, inspectors have no statutory remit to close local authority homes. However, good inspectors in some local authorities--there are some--made sure that some of the local authority homes were aware of their responsibilities. However, we cannot--the private sector would find it difficult to live with this--send in inspectors who are still of the old school and are not prepared to be completely impartial.

Let me briefly draw a parallel with Ofsted, which was mentioned earlier. Ofsted hires teachers and trains them to be inspectors. Unless the system has changed recently, once inspectors are trained Ofsted does not have the ability to decide whether they are good enough to do the job. Once somebody has been trained they automatically become an Ofsted inspector even if they are not suited to the job. I would not like the same loophole to exist in respect of commission inspectors. Once somebody has been trained, a decision will have to be made as to whether that person meets the required standards. The mere fact that somebody has been trained does not mean that they have attained the necessary standards.

Mr. Bercow: I am sorry to interrupt my hon. Friend as she develops her argument, but is she referring to in-service training or to some other training?

Mrs. Lait: I made the analogy with Ofsted because everyone wishing to become a school inspector has to go through the training that Ofsted offers. However, all trainees become school inspectors after the training, regardless of the extent to which they fit Ofsted's requirements. I do not want the same system to be brought in for the commission.

Finally, I have gained a little understanding of how what I have learned to call "CHI" works. A team from the health service is put together and sent to inspect a hospital. It usually consists of a medical director, a nursing director and a chief executive or member of senior management. Those people may be crucial to another hospital, but they are taken away from running their own hospital for at least a week. Given the state of the NHS and the number of hospitals needing inspection, will not the removal of such personnel for inspection purposes place an intolerable burden on all hospitals?

Dr. Brand: Rubbish.

Mrs. Lait: The hon. Gentleman may say that that is rubbish, but perhaps he will tell me why. A hospital trust

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could be in trouble if even the smallest crisis emerged while its medical director was away for a week on inspection duties. We all know how long patients have to wait in accident and emergency departments in most hospitals, and how litigious they are these days, with hospitals often being challenged and asked to pay compensation. Taking key managers away from an understaffed and hugely pressurised health service is not the best way to ensure that our health service improves.

Dr. Brand: I cannot follow the hon. Lady's argument. Is she really suggesting that inspections, by Ofsted, the Commission for Health Improvement or any other body, should be carried out by people who are not involved with the service that they are inspecting? I understand what she says about pressure being placed on services, but that can be solved by adjusting staffing levels. I assure her that the NHS carries out a great many inspections, and that about a tenth of consultants' time is spent on them. That is quite apart from their educational role.

Mrs. Lait: The hon. Gentleman is a GP and has a direct interest in how the NHS works. He probably knows how much inspection is carried out. I am merely pointing out, however, that the commission represents yet another layer of inspection. It will take people away from their real hospital work for a week, and then reports will have to be written. Taking out that level of management skill is not the best way in which to run the hospital service, let alone the NHS.

The hon. Member for Isle of Wight will agree that the NHS faces huge staffing difficulties. Imposing an extra burden is not the best way forward.

Mr. Burstow: Is the hon. Lady aware that a Liberal Democrat amendment tabled in the House of Lords secured cross-party support and gave effect to the principle that the commission would have a role in inspecting provision in the private and public sectors? The Government removed that amendment, against the opposition of my hon. Friend the Member for Isle of Wight (Dr. Brand) and the hon. Member for Runnymede and Weybridge (Mr. Hammond).

Mrs. Lait: The hon. Gentleman and I differ in our view of what the commission is doing at present.

Mr. Hammond: I thank my hon. Friend for allowing me to intervene and put in context what the hon. Member for Sutton and Cheam (Mr. Burstow) just said. I said earlier that my interpretation was that the Lords were trying to promote the desirability of a single regulatory system for both sectors. That was the essence of the debate in the other place.

Mrs. Lait: I would have no difficulty with a single regime for inspection. I am interested in the practical application of the commission's operation, given the difficulty in finding enough people of the right calibre to staff the NHS. We must not forget that the basic job of the service is to make people get well, and to prevent some from falling ill in the first place.

Mine is a practical objection rather than an objection in principle. No matter how much money the Government throw at the health service, it will not improve all that much in the near future. The Bill will not help those

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hospitals that desperately need proper inspection--nor will it ensure that the independent health care sector does not provide a distraction.

I have spoken for longer than I planned. These diverse amendments set the tone for the matters in the Bill that need to be considered and that concern me deeply, and the debate on them is therefore worth while.

Mr. Ian Bruce: I did not intend to speak to these amendments, but my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth) mentioned amendment No. 96, and thereby brought to my attention a specific problem.

Clauses 44(3)(b) and 45(3) set out the powers that allow the inspection of documents or other material, including computers. They contravene clauses 47 and 48 of the Regulation of Investigatory Powers Bill, which deals with all aspects of surveillance. Schedule 2 of that Bill sets out which people can issue a warrant allowing someone to inspect computers.

I believe that amendment No. 96, which would protect foster parents from such an inspection, should be more widely drawn. The Minister should know that any evidence obtained under this Bill without a warrant under the Regulation of Investigatory Powers Bill would be specifically excluded, by that Bill, from any legal proceedings. A proper investigation could be made that would then be ruled out of order because of the Regulation of Investigatory Powers Bill. I am no fan of that Bill, which I believe to be very flawed. It is extraordinary that the Department of Health and the Home Office should both introduce Bills in the same Session covering the investigation of what is on a computer in someone's premises whose provisions are in complete contravention of each other. My hon. Friend's amendment is very helpful in this respect.

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