Clause
15NHS
employment
Tim
Loughton: I beg to move amendment No. 139, in
clause15,page10,line10,after
‘body’ insert
‘, a provider of services contracted
by an NHS body, or single-handed
provider,’.
The
Chairman: With this it will be convenient to discuss the
following amendments: No. 140, in
clause15,page10,line10,after
second ‘employment’, insert ‘, paid or
unpaid,’. No.
141, in
clause15,page10,line19,at
end add— ‘(h) Mental Health
or Social Care
Trust.’.
Tim
Loughton: Again, these are probing amendments to try to
get to the definitions of exactly who is covered within various
health-related activities. We have dealt mostly with educational
establishments until now, and these three amendments are designed to
ensure that just about every health provider who should be included is
included, and that that is clear in the Bill. Again, this is a bit of a
grey area. I am sure that the Minister will be able to give those
assurances, but we need them on the
record. Amendment No.
139 would add a further qualification of “NHS body”. The
national health service is an increasingly complicated and fragmented
body these days. We know that it relies on a good number of private,
independent and not-for-profit providers from outside for operations
and other services. There are shortcomings in the explanatory notes,
because the note to clause 15 does not mention that. The only body it
refers to is NHS
Professionals. My
reading of subsection (2) as drafted is that the only people covered
are those who are directly on the payroll of a hospital, primary care
trust and so on. If that is so, what is the status of a private firm
providing cataract operations and other providers of therapies, such as
physiotherapy, in a hospital, domestic or surgery environment who are
not directly on the payroll of a hospital or primary care trust but
have been contracted by that hospital or primary care trust for a
certain number of services? The amendment would also cover
single-handed employers, so I am not seeking to cover only firms that
provide those services and would be responsible for their own staff.
There are occasions when operations and treatments are contracted out
to a single-handed
provider. We know what
certain single-handed GPs in the form of Dr. Harold Shipman can get up
to. He did not just abuse his patients, he killed them. Obviously, that
is one of the most extreme examples, but some single-handed providers
contracted by certain health trusts are not GPs and would not be
covered by the safeguards that GPs and others in the NHS
have. In the mental
health field, freelance consultants tend to offer various cognitive
behavioural therapies and other forms of talking therapy and
counselling. They are not employed by an NHS trust, but are contracted
by it—if they are lucky enough to be able to get hold of
one—to provide those services. The clause does not appear to
cover such individuals, and I think that it should. What is the
difference when that private counsellor is contracted to a mental
health trust by an employee of the trust and is providing identical
services? Will the Minister justify why they should be treated
differently? Amendment
No. 140 is a probing one; I am not calling for an enormous extension to
the number of
people covered by the provisions, but a question mark hangs over unpaid
workers. The NHS relies on a great many volunteers—leagues of
friends and people who regularly offer their assistance to vulnerable
people. That assistance can include counselling services and driving
minibuses to take vulnerable people to and from their homes. We need to
be assured that, without making it so onerous and prescriptive that
people would not want to volunteer—we must be very cautious
about that—there will be checks and balances.
I have qualified
employment therefore as “paid or unpaid” because those
people are retained effectively by a hospital or PCT, but strictly
speaking are not employed. What facilities are available for the
monitoring of volunteers and other unpaid people who offer their
services, and who have frequent and continuing contact with vulnerable
groups of people? On
amendment No. 141, I am sure that there is a perfectly clear
explanation, but it is not in the Bill or the explanatory notes. Seven
NHS bodies are defined but there is no reference to a mental health or
social care trust. Perhaps by a definition somewhere in the Bill of
which I am unaware, such bodies come under a special health
authority—I do not know. Either way, they need to be included,
because patients of those particular trusts are probably the most
vulnerable people of all in the NHS. So the amendment is a probing one
to see how a mental health trust, or a social care trust—many
are increasingly becoming known as the latter, given the joint
operation between social services and mental health trusts—will
be covered in the Bill. One would expect them to be in the list in
subsection (3), but they are not.
Sarah
Teather (Brent, East) (LD): Does the hon. Gentleman agree
that it is particularly important to ensure that social bodies are
covered, given the media coverage last week of patients being abused on
wards?
Tim
Loughton: The hon. Lady makes a pertinent point. The
report focused on the abuses in Cornwall and the most unacceptable
practices towards people with learning disabilities. In response to the
revelations in that report, we asked how the Bill would safeguard the
interests of people who had been abused, and about the
Government’s investigation on whether such abuse is more
widespread than we
know. 2
pm
Sarah
Teather: I was actually referring to the Mind report about
women being sexually assaulted on mental health
wards.
Tim
Loughton: There has been a plethora of worrying reports in
the past week. One of them dealt with learning disabled people in
Cornwall. Another was the Mind report, which has been sat on by the
Department of Health for no good reason for the past eight months,
since November 2005. It contains a catalogue of at least 100
cases—those are just the ones we know about—of rape and
abuse of patients in mixed-sex mental health wards. The Government said
some 10 years ago that they were firmly against such wards and that
they were looking to phase them out, but mixed-sex wards remain
prevalent in the national
health service—particularly in mental health trusts, and they
have become increasingly prevalent in those trusts in the past
12 months because of the financial pressures in the NHS that are having
a disproportionate impact on
them. I have visited a
number of mental health establishments in the past few months and there
are a number of examples of such establishments that now have mixed-sex
wards whereas previously they at least had some division between men
and women. In those establishments that still claim to have division of
wards, the divisions amount to a flimsy curtain or screen. Such a ward
cannot seriously be taken as a single-sex ward on any reasonable
definition. Two
reports have come out in the past week; or rather, the existence of one
of them has come out, though it has yet to be published—I hope
that the Minister will publish it soon. Given what we know from them
about the abuse that is happening, it is important that the legislation
protects people in mental health establishments, who are the most
vulnerable of all, and those with learning disabilities, both of which
groups are currently being threatened. Will the Minister therefore
confirm that such people will be covered by the Bill, and that the
reason why mental health and social care trusts are not mentioned
expressly is that they are covered either in the seven definitions of
NHS bodies or elsewhere in the
Bill?
Mr.
Lewis: When the hon. Gentleman said that Ministers were a
little shaky on the earlier clause, it was he who failed to spot the
specific reference to sheltered housing. I shall not hold that against
him, however, because I acknowledge that he makes a legitimate point in
amendment No. 139. The amendment concerns contracted-out staff who work
for an organisation that provides services to the NHS. I shall go away
and examine the point and present the Government’s view on
Report. We should consider not just those who are directly employed by
the NHS but those who provide services to the NHS through other
organisations. I do not know whether we can apply the same rules, but
the point is a legitimate one.
Amendment No. 140 is designed
to clarify that the arrangements apply to both paid and unpaid staff.
We have not sought to make the distinction in the clause or anywhere
else in the Bill. We believe that “regulated activity”
applies regardless of whether it is done formally or informally, so we
do not believe that the amendment is necessary.
The first point that I shall
make on amendment No. 141 is that we are united—across
the House—in our outrage at what happened in Cornwall. At the
beginning of the 21st century such occurrences are completely
unacceptable, and the abuse and exploitation of people with learning
disabilities in such settings is unforgivable. It was significantly
systemic, as well as involving individual behaviour. We have a joint
responsibility to put in place whatever systems and levers we can to
minimise the risk of such abuse ever happening again. I do not use the
word “eliminate” because no Minister can ever promise
that, but it is our responsibility to minimise the risk of such actions
and behaviour ever being allowed to happen again.
One of the priorities in my new
responsibilities will be to examine these issues in the context of how
people
with learning disabilities are treated more generally. My right hon.
Friend the Minister of State at the Health Department will be looking
at some of the issues that hon. Members raised about mental health
services as well. I
turn to something that is specifically linked to that point. A care
trust is used to described a partnership arrangement put in place by an
NHS trust or primary care trust and a local authority social services
authority. The status of the NHS trust or PCT concerned does not change
in these circumstances, and both the trust and the local authority
retain their original status, while changing the governance functions.
There is no other legal significance, and staff operating under
partnership arrangements will remain employed by the NHS trust, PCT or
local authority concerned. I can reassure the hon. Member for East
Worthing and Shoreham that these partnership arrangements are therefore
adequately covered by paragraphs (a) and (g) as they stand. I give him
a categoric assurance that the concerns he expressed about a
partnership arrangement or a mental health trust will be covered fully
by the Bill.
Tim
Loughton: I am grateful to the Minister. On amendment No.
141, I purely wanted to know where the definition of those trusts would
appear. The Minister seems adamant that they are covered in parts of
subsection (3). It is useful to have that stated, given the debate we
have just had. The
second point, that unpaid workers are fully covered, if I understand
the Minister rightly, will have many implications for voluntary
workers. I am not sure how extensive that coverage will be. Many of us
have been at pains to try to keep occasional volunteers out of such a
rigorous vetting system because they will be completely deterred
otherwise. If he says that my amendment is unnecessary in that respect,
we will take him at his word.
I am pleased, but alarmed,
about the Minister’s acknowledgement that amendment No.139 might
have some merit because it is not covered in the Bill. He knows, in his
position as a Health Minister, just how much NHS work is now contracted
out across the piece, not just short operations and episodes, but
ongoing treatment, rehabilitation and mental health services, and
everything else. Such things are provided by the independent sector,
and in some cases by not-for-profit organisations.
That is not new. It has been
going on for a while and it is certainly taken into account when
dealing with other pieces of legislation. In respect of all the
children’s legislation we have had in recent years, we raised
the question whether the private sector, to which work has been
contracted out, is covered. The Minister has always been able to give
us assurances that it is, which is what we
want.
Mr.
Lewis: As I understand it, the specific issue that we are
discussing is that when people move around in jobs while directly
employed by the health service there will be no need to recheck them
constantly. The point that we are making in this narrow context is that
the
same principle ought to apply to those who are working in independent
organisations that provide services to the NHS, be they in the third
sector or the private sector. When I say that I will come back on this
on Report, it is not about needing to come back on the question of
those employed in independent sector organisations, because they would
be covered anyway. The issue is that when they move around in terms of
their employment status the same common-sense approach would be applied
to those workers as to those employed directly by the
NHS.
Tim
Loughton: I am not entirely sure that I follow that. The
Minister appeared to say earlier that he was not sure what measures in
the Bill covered not people who move around opting in and out of
working for the NHS but full-time independent providers, whether
single-handed or part of private firms, who do NHS work but are not
employed by an NHS body. Subsection (2) covers only people employed by
an NHS body. Thousands
of people working for the NHS without being employed by it are
providing operations and treatment to many vulnerable people and should
surely be treated on exactly the same basis as directly employed NHS
consultants, doctors, nurses, therapists, physiotherapists, mental
health counsellors or whatever who deal with the same cohorts of
vulnerable people. Surely there should be no differentiation between
those on the payroll of the local hospital trust or PCT and those
contracted through a firm or single-handedly to provide identical
services to patients. What matters at the end of the day is not
structures or who produces the employment dockets; it is patients and
the treatment that they are getting, whether from a private and
independent, a not-for-profit or a state-run, directly employed NHS
source. I am
disappointed. I had hoped that I would be reassured by the Minister
saying, “Yes, it’s a very good point. In this part of the
Bill, of course all those independent providers will be
covered.” He might be able to say that now, from the looks of
it. If they are not, it should have been thought about earlier, and he
needs urgently to convince us now or on Report that they are covered.
If he wants to intervene to assure me now, that will be
welcome.
| 
