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

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Jacqui Smith: We have had a wide-ranging debate, and I shall start by setting the context for our discussion, particularly in response to the hon. Member for Lichfield (Michael Fabricant). He pointed out that the regulations stem from the considerable debate given to the Care Standards Act 2000, which laid down the principles of, and much of the detail for, the basis of the statutory instruments of which the regulations are part. The regulations have been subject to considerable public consultation, so, given that consultation and parliamentary scrutiny, his arguments are slightly specious.

The important point is that we are discussing the implementation of a modernised and improved regulatory framework. It is worth considering briefly a comparison with the current position. Regulation of those independent and private health care providers who are regulated occurs largely under the Registered Homes Act 1984, which does not provide local authorities with any powers to inspect or assess the quality of the treatment or services provided. Inspections focus on the state of the premises, facilities and staff qualifications and numbers, and managers and owners are not held to account for the treatment provided in their establishments. They merely facilitate the provision of treatment by medical practitioners, to whom they grant practising privileges, and it is the medical practitioners alone who contract with the patient. That partly relates to the question about anaesthetists which was raised by the hon. Member for Oxford, West and Abingdon, but I shall return to that later.

The new system will bring a radical change to the regulatory framework for independent and private health care. Managers and owners of establishments will now be held responsible for the quality of the treatment provided and will have to have policies and procedures for clinical audit. The hon. Member for Lichfield asked who would do the inspection and how we could determine the integrity of the provider. The context of our debate is the regulations against which

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the National Care Standards Commission will inspect and regulate when it begins operating in April. There we have the arbiter. Yesterday we considered issues concerning the registration of providers and their fitness. Both the regulations and standards that underpin them contain a lot of detail about what considerations the people who carry out the inspections will have to bear in mind in relation to the integrity, character and other necessities of the provider.

The important point is that we now have, in a way we never had, a requirement for private and voluntary health care providers to put in place some overarching policies on clinical audit that consider the benefits of the patient. My hon. Friend the Member for Chatham and Aylesford (Mr. Shaw) made an important point about the extent to which patients who were dissatisfied with their treatment have not had any redress. That is an important objective of the new regulatory framework. Through channels such as the complaints procedures and the necessary statements of purpose, patients will have much more redress. I shall return to standards and regulations in a few minutes, but want to move on to more specific issues.

The hon. Member for West Chelmsford referred to the report of the Joint Committee on Statutory Instruments. It is not true that the report drove a coach and horses through these regulations. The Committee made a valid but limited point about the extent to which regulation 51 was contradictory with respect to regulations 14 and 29. The problem arose because regulations 14 and 29 lay down specific duties that must be complied with, whereas regulation 51 allows a more flexible approach for providers to explain the extenuating circumstances that brought about particular offences. The later regulations were introduced precisely because we wanted to provide such flexibility.

I can give the Committee my assurance, as I said yesterday, that we will examine how best to amend the regulations to make them more effective in dealing with offences. That is a relatively narrow aspect of the statutory instrument. Opposition Members may want to make more of it, but I can assure members of the Committee that the objectives and the details of the regulations stand unblemished and will fulfil the purposes that we set for them.

Mr. Burns: I fully understand the Minister's desire to gloss this over as a minor technicality, but let me read a brief extract from the 16th report. Paragraph 3 states:

    ''It was unclear to the Committee how the provisions of regulation 11 could be applied to a contravention of regulation 10 given that, once the specified day was past, compliance is no longer possible.''

That is not a minor problem; it goes to the heart of enforcing compliance.

Jacqui Smith: The hon. Gentleman now refers to registration regulations that were covered yesterday, but the point remains the same. It is about the extent to which we allow flexibility in the regulations. I am not

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attempting to gloss over it. I am explaining the reasonable objectives set by the Government and the action necessary to ensure that they are met.

Let us move on to intense pulsed light. Members of the Committee will be aware that intense pulsed light was not developed until after the Registered Homes Act 1984, which regulates class 4 laser technology. Around 1996, the Department began to receive letters from medical practitioners, radiation experts, laser providers and manufacturers urging us to remove the anomaly whereby only class 4 lasers were regulated and intense pulsed lights were not. In fact, we received more correspondence about intense pulsed lights than about any other independent health care issue.

In November 2000, the Department wanted to approach the intense pulsed light industry about the proposal to bring it into the scope of regulations. Precisely because it is not regulated, we have no direct contacts with the industry, so officials wrote to several trade associations representing people in the beauty industry and other organisations that might have connections with lasers or intense pulsed lights. The organisations that we approached included the Hairdressing and Beauty Industry Authority, four other cosmetic or beauty-related organisations, and associations of electrolysis practitioners, dermatologists and ophthalmologists. We received only a handful of replies, saying that they either agreed with the proposal or would consult their members and respond, but few contacted the Department with the views of their members. When the formal consultation began in July 2001, we had a good response from consultant physicists, health authority inspectors, laser protection advisers and laser service providers, among others. Bodies that welcomed the proposals include laser and IPL manufacturers and distributors, the Hairdressing and Beauty Industry Authority and the Institute of Physics and Engineering in Medicine.

There has been discussion about whether it is as important to regulate intense light as other laser technologies. The Institute of Physics and Engineering in Medicine set up a working group on the private use of lasers and intense light sources on the human body. The institute is an independent professional body that comprises experts in laser technology, medical physics, photobiology, imaging and radiation. It concluded that it was appropriate to regulate intense pulsed light as the Government propose.

My hon. Friend the Member for Chatham and Aylesford expressed his views on hair removal in general—I must say that he is perfect as he is, and does not need improvement from any source—and pointed out that what we are hearing is an understandable lobby from manufacturers and providers of equipment. It is right to weigh up those concerns, as the Government have done, against the considerable concerns expressed by a variety of professionals and users who think that the regulation is appropriate.

The hon. Member for West Chelmsford suggested that we intend that the providers of intense pulsed light treatment should have to act like private hospitals. We are certainly not trying to regulate them in that way. We are classifying them as independent hospitals in

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order to bring them under the Care Standards Act. For the purposes of regulation, the term ''independent hospital'' is defined in that Act, just as countless other terms have particular interpretations in other Acts. They will be only registered, not regulated, as independent hospitals. They will not, for example, have to incorporate the word ''hospital'' in the name of the establishment and they will not have to meet the acute hospital national minimum standards. They will have a unique set of service-specific standards.

That brings us to another important distinction that should be made. We are considering the regulations for private and voluntary health care providers. The regulations set the high-level, overarching rules that must be complied with by law. However, in response to the hon. Members who raised detailed issues, we have also developed a range of service-specific standards, and standards that address overall issues about the management and provision of private and voluntary health care, which go into more detail than it would be appropriate for the regulations to do. Those standards have been developed in consultation with, alongside, and in some cases by stakeholder groups to ensure that they address important detailed issues.

Mr. Burns: Will the Minister confirm one or two points? Am I right in believing that between April 2000 and July 2001, when informal consultations on the regulations took place, the Department chose to consult only a limited reference group, the membership of which was determined by the Department of Health? Will she also say whether the Department of Health has admitted that it failed adequately to consult the major companies that supplied intense light machines for cosmetic hair removal, and that her officials attempted belatedly to include them by seeking their views after the formal consultation? Will the Minister also say whether Lord Haskins intervened on their behalf with the Department?

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