NHS Reform & Health Care Professions Bill

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Dr. Harris: I am grateful for the opportunity to clarify the problem. I drafted the amendment to apply the definition of prescribed premises in section 23 of the 1999 Act, as amended by the Bill. That is jumping the gun, because the Bill is not yet an Act and—who knows?—may never reach the statute book. I hope that that is in order, Miss Widdecombe--if it is not, we shall have to return to the matter on clause stand part--to ask hon. Members to ensure that in lines 40-45 on page 18 the definition of prescribed premises in the new world of private sector delivery of NHS care is more appropriate.

Mr. Burns: I am extremely grateful for the hon. Gentleman's intervention and relieved that I allowed him to intervene. It has reduced my work and clarified what was becoming a somewhat confusing situation. So as not to add to the confusion, I will leave the hon. Gentleman's explanation of the amendment for the Under-Secretary to answer.

The clause contains some provisions outlining regulations that can be made. In the context of our discussion on the amendments and the fact that we do not have any draft regulations to examine, can the Under-Secretary explain one or two points? That will help us to make up our mind about whether our concerns, especially in amendments Nos. 209 and 210, will be met. Clause 16(3) says:

    ''The regulations may in particular make provision as to—

    (a) cases and circumstances in which access is to be permitted''.

It would help if the Under-Secretary could flesh out in more detail how the Government envisage the regulations reflecting clause 16(3)(a).

Clause 16(3)(b) refers to regulations making provisions about the

    ''limitations or conditions to which access is to be subject.''

My hon. Friends will be interested to know what limitations and conditions the Under-Secretary has in mind. That brings us to the nub of my original point about the balance that is necessary in the regulations—which, we hope, the Secretary of State ''shall'', rather than ''may'' make—to limit the opportunity for them to become too nanny-statish and interfering. That would be to miss the important point and function of the regulations.

We are also interested to know whether the patient forums, under the regulations that we hope ''shall'' be issued in line with amendment No. 209, will be allowed to go everywhere that the Commission for Health Improvement can go. The intention is unclear in the Bill and its provisions for what regulations the Secretary of State may or shall make, and we have not seen any draft regulations to make that clear.

My hon. Friend the Member for North-East Hertfordshire raised an important new point that he probably could not have made had we discussed the amendments on Tuesday. Today's media show an unfolding drama and a change of circumstances in the provision of health care that is happening under our very eyes. Unfortunately, we have only the ''Today'' programme reports and, presumably, leaks in the national media to tell us what the Government have in mind. As the House will be sitting in an hour and a half's time, we may be notified soon as to whether the Secretary of State will make a statement on the Floor of the House about the treatment abroad of patients on long waiting lists in this country.

I see that you are looking perplexed, Miss Widdecombe; you may be wondering whether this has anything to do with clause 16. I would hate, for various reasons, to test your patience, so let me reassure you. The amendments, and the regulations that would emanate from them, deal with inspections by patients forums. They will have the power to inspect and monitor the provision of health care for all patients in this country.

When using the phrase ''in this country'', we have always assumed it to mean what it says. Until August of this year, we understood that, legally, the health service had to treat patients in England, Scotland, Wales or Northern Island. However, a whole new approach has opened up for the Government, whereby patients, by law, can be treated in European countries. There have been pilot schemes in parts of the south-east of this country over the last two months. If the leaks are to be believed, there will be an extension of the whole policy, so that any patient who has to wait more than six months on a waiting list for treatment will have the opportunity to go overseas to be treated.


That raises the question of what inspection will there be of the service and treatment provided for our constituents who may be treated overseas. Unless I misunderstand our amendments and clause 16, it seems that once our constituents are travelling on a train, plane or bus to Europe to be treated, the powers of entry and inspection of premises to ensure the provision of health care, will be taken away. The powers for bodies to act on behalf of our constituents will be denied in those areas overseas where they are being treated. This is an area where the Minister needs to reassure us.

Will clause 16, with its powers of entry and inspection of premises, apply to premises in Europe? Will the regulations made by the Secretary of State, for the patients forums to carry out their duties in this country, equally apply to those premises in Europe? Will clause 16 help our constituents who are being treated under the Government's latest policy to try and undo their abject failure to bring down the waiting list times? If the answer to that question is no, the patients forums will not have that power and that our amendment No. 209, will not apply to regulations that are made by the Secretary of State for premises in Europe, then our constituents are being deprived. What mechanism will there be to ensure that the premises overseas are of a sufficiently high standard, and that the provision and quality of health care is of a standard that patients would expect in this country? Would the provisions of clause 16 and the application of amendment No. 209 apply to premises in Europe, as they do in this country?

If the answer is yes, patients forums would have the power of entry and inspection of premises overseas —because the Government have some deal with providers of health care in Europe that are going to be treating British subjects —then that raises more issues. One would want to know how the system would work overseas and what legality this clause would have to the entry and inspection of premises overseas. It opens up a Pandora's box of potential problems, and, I imagine, a legal minefield. I hope that the Minister will be able to give us an explanation and seek to reassure us on this very important issue.

In conclusion, with regards to amendments No. 209 and No. 210, for the reasons that I have outlined, I hope that the Minister will be minded to accept our two very reasonable amendments, which are solely to put down to seek to improve and enhance the quality of this part of the legislation.

Dr. Andrew Murrison (Westbury): In drafting the clause, the Government have taken into account only those matters that can be examined. They are going for the easy option, rather like the man who searches for his keys under a street light. Instead, the clause should deal with those areas of health care in which there is a crying and pressing need for inspection. In my experience, there is such a need in the prison medical service, but it seems that it has been specifically excluded. I should be grateful if the Under-Secretary would explain why.

It is taken as read in this country that the prison medical service is under-resourced, but it is also the subject of close scrutiny. As I have said, there is an extensive network of regulation, audit and inspection throughout the national health service—for the most part, that is welcome—but that simply is not true of the prison medical service. If one were to pick a group of people in this country whose health care was inadequate, it would be the prison population. It is the function of Government to focus on those areas in which they can do the most good first of all, but for some unfathomable reason they have ignored the prison medical service. I hope that the Under-Secretary will explain why.

The treatment of NHS patients abroad appears to be catching the Government somewhat on the back foot. When the Bill was drafted, the Government's plans for such treatment were not quite as well advanced as perhaps they now are, so the Bill needs to be updated to reflect the evolving picture. In terms of both the prison medical service and the treatment of NHS patients abroad—the two areas about which I am most concerned—the Government, patients forums and CHCs have a limited overview.

We have heard a lot about shipping people to the continent for operations, but little about quality control. If we are to accept the definition of health care that the Bill provides—we do not know whether the Bill's omission of these matters was deliberate or an oversight—we must ensure that patients treated abroad are covered by these forums in the same way as those treated in this country. Even though patients are being contracted out to a foreign provider, they deserve equally good health care. We have not heard much about quality control in and scrutiny of the provision of health care abroad on NHS trusts' behalf, and I hope that the Under-Secretary will clarify that issue.

Mr. Peter Atkinson (Hexham): I would go much further on this matter than my hon. Friend the Member for West Chelmsford (Mr. Burns). We are being asked to accept a clause that will give a potentially draconian power to patients forums, without first seeing the regulations that will govern the provision. That is an insult to the Committee; if my right hon. and learned Friend the Member for Sleaford and North Hykeham (Mr. Hogg) were in attendance, he would certainly spend an hour or two expressing his outrage at what is happening today.

Parliament is probably shell-shocked by the current volume of legislation curtailing the liberty of individual citizens. Many years ago, a proposal to give patients forums the right to access to what could be private premises would have prompted a huge debate, but we are being asked to nod it through without knowing what powers the Secretary of State will grant. I hope that the Under-Secretary will give us some idea of what those powers will consist of.

The Minister of State has added to the list of bodies that can grant such powers to patients forums. The list now includes health authorities, local health boards, local authorities and all who provide a service under the National Health Service Act 1977. I do not have a copy of the Act to hand, but I believe that it is widely drawn and might include those who provide drugs, and sole practitioners who practise from home. As members of patients forums, they would have a right of entry. Would they have the right, for example, to stage a dawn raid on a doctor's house, break down the door, examine patient records and fillet them for whatever information they wanted? According to the Health Act 1999, in effect, they do have such a right. A doctor or a pharmacist may well not want their premises to be turned over by unqualified people who are members of a forum simply because they were patients or belonged to a local voluntary organisation. Such people will have the right to enter the private premises of a pharmacist who lives above the shop, and loot his records for any reason that they like.

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