Private and Voluntary Health Care (England) and Care Home Regulations 2001

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Peter Bottomley (Worthing, West): I am glad that we are taking the two sets of regulations separately. When we reach the second set, I shall ask some questions about adult placements and consultation responses. On these regulations, I shall go through four points in reverse order. Regulation 41 requires the notification of terminations. Given that relatively few places are licensed for terminations and as the number of terminations has to be notified, it would be a good idea for the Department to consider publishing reasonably up-to-date figures—every month or every quarter—on the number of terminations in the country. I do not ask for publication of the figures for each establishment.

The Minister of State, Department of Health (Jacqui Smith): I may have misheard the hon. Gentleman. I think that he said that regulation 41 referred to termination of regulations. Does he mean termination of pregnancies?

Peter Bottomley: In that case, I misled myself. Regulation 41 is headed ''Termination of pregnancies''. I was addressing the point about the number of pregnancies that are terminated. The information from independent and NHS clinics makes the number of terminations available to the health authority. That information should be published every month or every three months, so that it becomes as current as the information about the bank interest rate, the rate of change of retail prices or the number of people out of work who are claiming benefit. The plain

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truth is that 6,000 people a week in this country contribute to the avoidable distress and disadvantage of terminating pregnancies deliberately.

I do not want to argue about the law on terminations, but we have a choice when we are sexually active of realising only afterwards that we have conceived or deciding beforehand about contraception. We should get away from the rather useless idea that arguing about the law, telling people to ''say no'', birth control or family planning will make a significant difference. We should be able to cut the number of terminations in this country from 3,000 to about a quarter of that figure, if people become more aware and more grown up, whatever age they are—40, 30, 20 or in their teens—about what is going on. We miss the opportunity of putting out information. If we had information on unemployment only a year and a half after the figures were counted, we would pay far less attention to unemployment. I make a plea to the Minister to arrange for the information to be more current so that the rest of us, whether we are part of the media or the public, start to pay more attention. I do not condemn anyone who chooses an abortion, but I believe that many more people would like not to have to make that choice because they have been more grown up about their activity.

Ms Debra Shipley (Stourbridge): I have listened to the Conservative spokesman, who clarified the Opposition's position, and I was not drawn to the conclusion that they are in favour of sex education in schools—quite the reverse. Education, most probably in schools, is the key to the issue. We must catch people early. Does the hon. Member for Worthing, West (Mr. Bottomley) agree, and will the Conservative spokesman confirm the Opposition's view?

Peter Bottomley: The hon. Lady makes an interesting point. However, the greatest number of terminations occur among people in their 20s, 30s, and 40s. It clearly will not work to expect them to remember a lesson that they had when they were 15, although that could be a useful contribution. What matters is that people of whatever age and circumstances can discuss these issues openly and make choices, rather than experience the embarrassment that too many people have to experience.

Regulation 28—notification of events—refers to the death of, or serious injury to, a patient. Will the Minister assure the Committee that the death of, or serious injury to, a member of staff is covered by the usual health and safety at work regulations? Will she confirm that those deaths and injuries matter as much, and that the regulation is just a way of including those who are not members of staff, whose death or serious injury would otherwise not be reported? If the Minister does not have an immediate answer to that question, I do not mind a written response. I should have given her notice.

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The hon. Member for Oxford, West and Abingdon (Dr. Harris) made a point about fitness of workers. What happens to someone who has been disqualified or has suffered a penalty in a different jurisdiction? That applies especially to doctors, but it might apply equally to nurses. When they come to work in this country, is there any requirement for them to declare to the relevant registering authority that an event should properly be taken into consideration, whether they are registered or not? If they do not have to do that, I would be grateful if the Minister would give the matter consideration. I do not wish to chase the hard case in the north-east that has been in the papers, but it seems relevant to ask about previous events, as one might if someone were applying for a driving licence and had recently been disqualified in another country. Is information available that would help determine whether authority to practice can be given?

The last point that I wish to raise is about regulation 16 on the care and welfare of patients. The issue will come up again under the adult placement part of the next order. What powers do the people who run an establishment have to ensure that patients take medication, which may be one of the reasons why they are able to live in the community, or to strongly encourage them to do so? I am thinking particularly of people with mental illness, but the question might apply to someone with physical illness. Is it all right for an adult patient to decline to follow their prescription, which may be part of the reason why they are not in hospital? Can those who run the establishment do nothing in such a case?

We must face the problem, although it may come up rarely. Most mental illnesses are no more incapacitating than most physical illnesses; they exist, but should not worry anyone else in particular. However, in some cases, people are freer and more a part of society if they take the drugs that have been prescribed to improve their condition. If people around them learn that that they are not taking their medication, can the situation be reviewed to determine whether it is appropriate for them to remain in society, in a clinic or in one of the hospitals?

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Michael Fabricant: It is extraordinary that the Office of Communications Bill, a thin document, is being debated for four days in Committee, but we are discussing an order with 51 regulations and 4 schedules—a somewhat larger document—as a statutory instrument under the Care Standards Act 2000. So much legislation now involves secondary legislation, which can be rubber-stamped, as the regulation undoubtedly will be today, and which can be discussed for a maximum of 90 minutes on a take-it-or-leave-it basis, as my hon. Friend the Member for Worthing, West said.

One of the problems with the regulations, apart from the fact that my hon. Friend the Member for Colchester—

Mr. Burns: West Chelmsford—''Essex man.''

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Michael Fabricant: My hon. Friend the Member for West Chelmsford—Essex man—has pointed out that many of us have not received the documentation, so it is difficult to make a judgment. However, I wish to pick up on several points.

I, too, am concerned about the lack of information in the order about hours of work. The hon. Member for Oxford, West and Abingdon spoke about Government initiatives to control the hours of junior doctors working in the national health service, yet we all know that they are not effective. The issue has been omitted completely from the statutory instrument. How does the Minister intend to ensure that junior doctors—as well as senior doctors—who are employed by private hospitals are not worked to such a degree that their attention span is affected?

There are many regulations, but they are vague. In some ways, that may be a good thing—they will not drive hospitals out of business. On the other hand, they may lead to great uncertainty, which would be equally dangerous. For example, there are provisions about fitness for use of rooms, including sleeping facilities not only for patients but for staff—including, presumably, junior doctors—but there is no definition of fitness for use. Should the rooms be quiet, to enable people to sleep? Should they have windows and adequate ventilation? I do not have to go through the list. There seems to be such an empty vagueness in so much of the legislation.

Regulation 10 deals with the fitness of registered providers. Paragraph (3) states that the registered provider is required to be

    ''of integrity and good character''.

What are the definitions of integrity and good character? Regulation 10(3) is almost like a wish list. Of course we want someone of integrity and good character, but there is no definition of that in law, and no closer definition in the regulations. If the registered provider has a conviction, does that mean that he or she is not of integrity and good character? That clearly depends on the type of conviction and the maximum sentence for the offence. The same definition is used in regulation 12, which deals with the fitness of registered managers.

I anticipate what the Minister will say. The Opposition welcome regulations that ensure that managers and providers are of integrity and good character, and we want to see higher standards. There is no point, however, in providing a list of standards that are so vague that they create uncertainty and deter organisations from being set up or from continuing to operate, or provide massive loopholes before the Committee has passed the legislation. There must be greater clarity.

Regulation 19 deals with the fitness of workers, and contains another wish list. Paragraph (2)(c) states that he or she should be

    ''physically or mentally fit for that work''.

Again, who will be the arbiter of that? Will the Minister outline what system of inspection there will be to ensure that a person is physically and mentally fit for that work? Does the word ''workers'' include the health care professions? Does the Minister agree that

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the criteria should also apply to the quality of doctors and other medical professionals employed in the United Kingdom who are not UK nationals—a point that was also raised by the hon. Member for Oxford, West and Abingdon? I refer especially to the quality of doctors' medical training and language skills.

The Minister knows, as I do, that in theory the British Medical Association, the General Medical Council and other organisations test English language skills, but we will have heard of incidents in our constituencies of patients being unable to communicate adequately with doctors who do not have a good grasp of English. Does that mean that such a person is physically and mentally fit to carry out that sort of work?

It is a dreadful shame when a document of 31 pages must be accepted or rejected in full—take it or leave it. It makes a mockery of parliamentary scrutiny and of this Government when they say that they care about public health in the United Kingdom.

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