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Mr. Hutton: I do not know where the hon. Gentleman has been for the past 12 months or so, but he has obviously not been following this debate.
Mr. Hutton: The hon. Gentleman may have been following it closely, but if he has I am surprised that he should ask such a question.
Mr. Bercow: I have a family interest.
Mr. Hutton: I am pleased to learn that.
We have always made it clear that we want to establish proper national minimum requirement standards, and those standards will include room sizes. My grammar may be wrong. I have been picked up on that a few times before in this place and I am sorry if I confused the hon. Gentleman, who is obviously punctilious in his use of grammar. If it is easier for him to come to terms with "room size", that is what I am talking about.
If the hon. Gentleman is as familiar with "Fit for the Future?" as he says, he will know that we are talking about the separate room-size requirement in relation to nursing homes, as opposed to residential care homes. We have postulated the possibility of a different room size for residents who are permanently in wheelchairs, for instance. I am afraid that the suggestion that we ever discussed just one figure makes me less convinced than I otherwise would have been that the hon. Gentleman was paying as close attention as he would have us believe.
8.45 pm
Let me now deal with amendment No. 39. We consider it important for prospective patients to receive clear and accurate information about the treatment and services that are proposed. The Bill already contains scope for that in clause 22. The power that we already have, enabling
regulations and standards to be produced in relation to patients information requirements, is more flexible than the power in the amendment.The Government's response to the fifth report of the Select Committee on Health on the regulation on independent health care, produced in 1999, was that the powers in the Control of Misleading Advertisements Regulations 1988 were sufficient to control advertising. That, of course, is a matter for the Advertising Standards Authority and the trading standards departments of local authorities.
The amendment also deals with the question of the medical titles that people might use in cosmetic surgery clinics. As the hon. Member for Runnymede and Weybridge will know--he conducts his research carefully--section 49 of the Medical Act 1983 already makes it an offence for any person to pretend to be, or use the title of, a physician, Doctor of Medicine, surgeon, general practitioner or Licentiate of Medicine--I must say that in my travels across the country I have never come across anyone who has described himself as that. I think we have the right balance: there is already enough legislation to prevent such problems, and section 49 of the 1983 Act triggers liability for criminal sanctions.
Amendment No. 38 concerns the financial position of establishments and agencies. I cannot accept the amendment, which would remove a key power to ensure the protection of vulnerable people who depend on regulated care services. The purpose of this express power is simply to ensure that the establishment or agency is and remains financially viable. Would-be providers must be able to demonstrate that they have the means to run their businesses properly. Establishments or agencies providing care must be financially sound; otherwise, service users who depend on them will be put at risk.
The hon. Member for Isle of Wight rightly said that the focus of all this work should be on the consumers--those who live in residential homes. That is what the provision is about. It will, I hope, prevent unreasonable and unnecessary movements between care homes.
The principle was recognised in recent case law relating to fitness under the Registered Homes Act 1984, and therefore already forms part of the existing regulatory arrangements. In that case, the registration authority proposed to refuse registration on the ground of a lack of financial viability. The case was referred to the High Court for judicial review. As the hon. Gentleman knows, the care home owners challenged the decision. The court upheld the registration authority's view. The judgment confirmed that the consideration of the way in which it was intended to carry on the home must include the means available to provide the facilities and services.
The hon. Gentleman spoke of intrusiveness, but I think that most sensible people will see the power as simply a demonstration of common sense. Of course we need the provision in the Bill, and I would not advise my right hon. and hon. Friends to remove it.
I accept that our proposals may require commercially sensitive information to be made available to the commission, and I fully appreciate some of the concerns raised by the hon. Gentleman. However, as I told him in Committee, such information will be confidential, and the commission will have to observe high standards of
security in respect of it. Not to allow the commission to be able to satisfy itself about these matters would make it harder, not easier, for it to do its job properly. That should be our yardstick.
Mrs. Lait: Could the Minister clear up a point of confusion on a slightly different subject? Close care sheltered housing, quite rightly, will be regulated. However, on 14 June, in a debate on sheltered housing in Westminster Hall, the Under-Secretary of State for the Environment, Transport and the Regions, the hon. Member for Sunderland, South (Mr. Mullin), said:
- The Care Standards Bill . . . will introduce the regulation and inspection of all types of home care provision, including that provided in sheltered accommodation.--[Official Report, Westminster Hall, 14 June 2000; Vol. 351, c. 270WH.]
Mr. Hutton: If the hon. Lady will forgive me, I should like to look at that reference myself and confirm--[Interruption.] She is waving it at me. I cannot actually read it from here, but I am sure that we will have a chat about it in the Lobby in a minute. We tabled amendments to the Bill to make it clear what type of care homes we wanted to regulate. We do not intend to extend the category of homes currently being inspected and regulated by inspection units. We have tabled amendments to put that beyond reasonable doubt.
The difficulty is, as the hon. Lady will be aware--she has much experience in the matter--that none of those categories of sheltered housing is legally defined anywhere. Therefore, we have made clear in the Bill which care homes we think the new powers should relate to. We have tried to reassure care providers that the Bill will not widen or broaden the scope of registration. I hope that that clears up the point for the hon. Lady.
There has been substantial discussion on new clause 4 and amendment No. 2. They have led to a long discussion tonight, and the same subject led to extensive discussions in Standing Committee. New clause 4 goes to the nub of the Bill--how we intend the new regulatory system to work in practice, and the impact that it may have on the viability of some the establishments and agencies to be regulated. When debating these matters it is important that we maintain our primary focus on the benefits of the Bill's changes for the people--children, young adults and older people--who use the services that we intend to regulate.
Those people are at the heart of our regulatory reforms. It is important to know how vulnerable they are to shoddy, negligent and, in some cases, abusive care. We know that there are some operators who should not be in the business of providing care, whose performance damages the reputation of decent providers and has led to the destruction of public confidence in some areas. Our intention with the Bill is to establish a proper regulatory system that promotes good quality care services and supports those many providers--the vast majority, in fact--whom the public can rightly trust. Therefore, I want to argue against the amendment tabled by the hon. Member for Runnymede and Weybridge, both in substance and in practice. It should not be part of the Bill.
The regulations will, as it were, form the bones on which the minimum standards will be the flesh. The current system works similarly, but the main difference is
that under the present arrangements there are no national standards; there are only local standards. We want a level playing field between different providers. The independent sector has been calling for national standards for a long time--a point that was never acknowledged by Opposition Members during the debate. That is what we intend to deliver, but consistency must be balanced with discretion.In Committee, much of the debate on standards centred on "Fit for the Future?", the draft standards for care homes for older people. Through consultation, we established that nine of the 11 topic areas were widely supported. Standards cover fundamental aspects of quality of care for residents. They introduce principles of dignity, privacy and choice, and demand that residents are treated with respect by properly trained, competent and trustworthy staff. Two controversial areas--room sizes and staffing--have provoked concerted opposition from some sectors of home owners, especially owners of smaller homes, and opposition from owners in certain parts of the country rather than others. The wide variation in standards is in itself an argument for more consistency nationally.
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