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Session 2007 - 08 Publications on the internet General Committee Debates Health and Social Care Bill |
Health and Social Care Bill |
The Committee consisted of the following Members:John Benger, Celia Blacklock,
Committee Clerks
† attended
the Committee
Public Bill CommitteeTuesday 15 January 2008(Afternoon)[Mr. Jim Hood in the Chair]Health and Social Care BillClause 5“Health
or social
care”
4.38
pm
Mr.
Stephen O'Brien (Eddisbury) (Con): I beg to move amendment
No. 198, in clause 5, page 3, line 14, after ‘includes’,
insert
‘the promotion and protection of
public health,
and’.
The
Chairman:
With this it will be convenient to discuss
amendment No. 203, in clause 90, page 45, line 14, leave out
‘Except in Chapter
2’.
Mr.
O'Brien:
I hope that the Minister will be joining us. If
the Opposition can manage to be in two places at once, we would expect
the same of the Minister, not least as it is because of his
Government’s cack-handed management of the timetable that we
have ended up having to start the Committee late. So, it is a somewhat
unusual set of circumstances. [
Interruption.
]
There is the typical chuntering from the Government Whip that he does
not like debate on the Floor of the House, but it is the
Government’s own rather lazy timetabling that has ended up
forcing us to expose their inadequacies. If he does not like long
speeches, he should get the business right in the first
place.
Amendment No.
198 amends clause 5, in which health care has an encompassing
definition. Amendment No. 203 amends clause 90. Obviously, for
convenience, they have been grouped together for our debate in the
general interpretation of part 1. Amendment No. 198 seeks to give the
Care Quality Commission the power to inspect health, not just health
care issues. It seeks to ensure that the protection and promotion of
health, as well as the technical standards of health care, are covered
in the registration regime. It is important that we should make an
assessment of whether we want the leeway to divide those two, or
whether we want to look at matters in a general
way.
The amendment
arises from Anna Walker’s oral evidence last Tuesday, in which
she replied to my question by saying
that
“we are very
perturbed that at the moment the administration requirements explicitly
exclude catching work on health, as opposed to health care...we
believe...that people’s health needs to be looked after as
well as their health care”——[Official Report,
Health and Social Care Public Bill Committee, 8 January
2008; c. 12, Q12.]
She continued:
“The registration
requirements explicitly say that they cannot bite on public health
issues, only on health care issues.”——[Official
Report, Health and Social Care Public Bill Committee, 8
January 2008; c. 12,
Q13.]
Anna Walker also
raised the matter as far back as September, so it is not a new point
for the Minister. She told the Health Service Journal, which I
am sure is avidly read in the Department—as it is, of course, by
Her Majesty’s official Opposition shadow health
team—that
“There
has been some concern about whether this has been thought about
sufficiently clearly and rationally. We want people to concentrate on
health and health care and we want health care organisations to do it
because primary care trusts and hospitals can do a huge amount in terms
of the advice they give to people at critical stages. People who look
after health care are really important in looking after health.
Although regulation is not the only player in this it is a very useful
lever to improve public
health.”
There are three
distinct issues there. First, the health of the individual; secondly,
the health care provided to that individual; thirdly, the wider public
health policy within which health care operates and the
individual’s health is or is not safeguarded. My assumption
concerning the impact of clause 90, where public health is still
relevant to chapter 1 and chapters 3 to 6, is that in its reviews the
CQC can bite on public health issues, but in its regulatory capacity it
cannot. I would be grateful if the Minister confirmed
that.
The drafting of
clause 5 shows a lapse, I believe, in the judgment that has been
applied to the drafting of the Bill. If the Minister is truly moving
NHS policy toward patient-centred care, the key metrics are the health
outcomes for the individual. That is why we are committed to scrapping
top-down targets that are made when monitoring outcomes. We already
know from the absence of patient and service-user involvement, that
there is a vacuum at what is, in many ways the centre of the regulatory
body. Although we have had the Minister’s commitment that he is
considering the issue carefully, and his undertaking to return to the
Committee at a later stage with clearer thinking on it, we are very
concerned that the vacuum is so stark in this area. In clause 5, the
Minister seems to be preventing the CQC from taking health outcomes
into account; rather, the new body will monitor the processes. Surely
the processes will end up meaning nothing without the outcomes
alongside them.
As far
as public health issues are concerned, as the Committee will be aware,
the number of public health staff, excluding consultants, working in
the NHS has been more than halved in the 10 years since Labour came
into office. In 1997 there were 3,167 key non-consultant public health
staff, which includes nurses, nursing assistants and other key public
health support workers; but by 2006 that had fallen to 1,362—a
misrepresented cut of 1,805, or 57 per
cent.
In
2002, Derek Wanless served warning on the Prime Minister that a failure
to tackle public health challenges would contribute to an extra cost of
up to £30 billion a year by 2022. The Prime Minister’s
failure to do that forced the Government’s chief medical
officer, Sir Liam Donaldson, to raise the alert last July that the
country was following Wanless’s worst case scenario. He also
noted that there is strong anecdotal information from within the NHS
that tells a consistent story for public
health of poor morale, declining numbers and inadequate recruitment, and
budgets being raided to solve financial deficits in the acute
sector.
The amendments
are important to ensure that, as we take the legislation forward, the
inevitably narrower focus of health care and, therefore, settings,
rather than health as a more outcome-focused issue, will be vital. I
simply seek to chime with the rhetoric and sentiment that the
Government have proclaimed and advocate
themselves.
One
only has to look, for the purposes of the Bill and of the amendments
that enable matters apparently so close to the Government’s
heart, at obesity rates, sexually transmitted infections and levels of
substance misuse, all of which are rising. Since 1997, the proportion
of two to 15-year-old boys who are either overweight or obese has
increased by one third, and the corresponding proportion of two to
15-year-old girls has increased by 27 per cent. Those figures are from
the Department of Health. The situation has been exacerbated by the
Government’s abandonment in 1999 of the last Government’s
targets to reduce rates of obesity in the general population to 6 per
cent. among men and 8 per cent. among
women.
4.45
pm
For instance,
the definitional changes would relate to sexually transmitted
infections. Since 1997, in the 10 years since Labour came to
office, cases of syphilis have increased by 1,654 per cent.,
gonorrhoea by 44 per cent., chlamydia by 148 per cent., herpes by 17
per cent., genital warts by 17 per cent. and HIV by 111 per
cent.
The other
aspect that the amendments cover is substance misuse, which would
otherwise be excluded. Since 1997—the year for which I happen to
have the numbers, of course—the number of alcohol-related deaths
has increased by 40 per cent., and the number of young people receiving
treatment in hospital as a result of alcohol misuse has risen by 33 per
cent. Interestingly, smoking rates have fallen far more slowly since
1997 than they did in earlier years. In 2005, 24 per cent. of the adult
population smoked, compared with 27 per cent. in 1998, but between 1978
and 1996 there was a sharp drop from 40 per cent. to 28 per
cent.
Health
inequalities is a subject close to all our hearts. We should aim to
give greatest effect to addressing them through the Bill, and the
amendments would give us that opportunity. Although the inequality gap
in circulatory disease mortality has declined and is on track to meet
the target, the inequality gap in the infant mortality rate has not
reduced sufficiently to meet that target. The inequality gaps in male
and female life expectancy at birth have increased since the baseline
was established, and if current trends continue, the target will not be
met. The inequality in cancer mortality has declined since the
baseline, despite a slight increase in the latest period, and the
minimum requirement for the 2010 target has, indeed, already been met.
However, that is unfortunately irrelevant due to the meaningful outcome
measure of five-year survival rates—much argued over on the
Floor of the House.
We have proposed the amendments
and measures to protect public health budgets, which go hand in
hand,
in order to create a new structure for public health, allowing local
public health directors to determine how funding for services will be
spent. Independent public health budgets would be ring-fenced to ensure
that they were spent on prevention without being raided to support
hospitals in deficit, and the chief medical officer’s department
would be strengthened to make it more independent of
Ministers—another theme of the Bill—and the Department
advising the renamed Secretary of State for Public Health.
Given the
Minister’s repeated call for the Committee to allow the CQC to
establish its own regulatory best practice, I should have thought that
he would want to give it the power to bite on whichever issues it felt
were relevant to registration. Why does the Bill exclude public health
from chapter 2? Is it because of the Government’s dismal record
on public health and health inequalities, or is it simply an oversight?
I hope that it is the latter, because we could correct it by accepting
the amendments. If it is the former, I fear that the Minister will use
“reject” or any other word he can think of not to accept
the amendments. In that case, the Government stand accused of woeful
shortcomings on public health. Health outcomes depend on the public
health measures under discussion falling within the ambit and
expectations of the Bill.
The
Minister of State, Department of Health (Mr. Ben
Bradshaw):
I do apologise for arriving after this
afternoon’s proceedings were under way. I was told 10 minutes,
and the clock stood at nine as I came into the room, so if that was my
mistake, I apologise.
The
amendments stem from a basic misunderstanding of the distinction
between the new regulator’s public health remit concerning
activities that are not registered, and activities that are registered
under the chapter. For the purposes of chapter 2, clause 5 effectively
sets the outer boundary for the type of activities that could be
included as regulated activities in regulations under clause 4. They
have been framed deliberately widely to allow scope for new models of
provision to be added to the list of activities.
On public
health, the examples that the hon. Gentleman gave, such as substance
abuse, smoking cessation, alcohol abuse and so forth are all public
health activities that we envisage might be registered or considered
for review. However, the general publicity campaigns that health trusts
and Governments undertake would not be appropriate for inclusion in
that area of the Bill, but they are covered in other areas of
it.
The definition of
health care in clause 5 explicitly includes
“all forms of health care provided
for
individuals,”.
Therefore,
any public health services that provide health care to individuals
would fall with the scope of registration. Chapter 2 lists the sorts of
services that both I and the hon. Gentleman have mentioned. However,
the campaigns that I refer to, which do not involve the provision of
care to individuals, would not fall under that definition. We do not
think that they present the tangible risk that we are dealing with in
the registration provisions of the Bill, in the same way as provisions
or services to individuals do. We accept, however, that a far greater
emphasis should be put on public health, and it is important for the
commission to
look at those latter activities in respect of its
other functions. For example, if a primary care trust runs a public
health campaign, the commission should be able to consider that in its
assessment of how well that trust meets the needs of its local
population.
Clause 90
clarifies that such activities do not fall within the definition of
health care only for the purposes of chapter 2. They will fall within
that definition for the purposes of reviews, special reviews,
investigations and so on. Given those assurances, I hope that the hon.
Gentleman will withdraw his amendment.
Mr.
O'Brien:
I have made my position clear and I am sure that
we will find ourselves returning to the matter on a number of other
occasions, not least when we consider clause 90. I hope that, together
with the Minister, we have identified an area that needs to be
reinforced, and that there may be other ways to achieve the same goal.
Rather than labour the point, I beg to ask leave to withdraw the
amendment.
Amendment, by leave,
withdrawn.
Mr.
O'Brien:
I beg to move amendment No. 7, in
clause 5, page 3, line 16, at
end insert ‘including all forms of cosmetic
surgery’.
The
Chairman:
With this it will be convenient to discuss the
following amendments: (a), in Line 1, at end insert ‘and
treatments’.
No.
129, in
clause 45, page 22, line 27, at
end insert ‘including cosmetic surgery and
treatments.’.
Mr.
O'Brien:
I will speak to amendment No. 7, although I will
also touch on amendment (a) and No. 129, tabled by the Liberal
Democrats, who will doubtless want to address them in more detail. At
this point we must understand clearly that health care includes all
forms of cosmetic surgery and treatment. Amendment No. 7 would
insert
“including all
forms of cosmetic surgery”,
and amendment (a) would
add the phrase “and treatments”. Amendment No. 129 amends
clause 45, to which we shall return later, although here my point is
that regulations and regulated activities will include cosmetic surgery
and treatments. The amendments seek to bring cosmetic surgery and
treatments within the ambit of the CQC. Outside the NHS, new services
are emerging in the rapidly growing cosmetic treatments market, and are
subject to little or no regulation. That includes cosmetic fillers, for
example—something I am certainly not in any need of. That leaves
consumers at risk and can have harmful consequences.
Without taking up too much of
the Committee’s time, I will recall the item highlighted by
Which? magazine in August last year: isolagen. If members of the
Committee are interested, they should type the word into Google and
they will find a useful example of what we are talking about. In its
oral evidence, Which?
stated:
“The
administration of dermal fillers, including some that are
semi-permanent and permanent, of Botox injections and of such things as
chemical peels do not come under the Healthcare Commission’s
remit.”——[Official Report, Health and Social
Care Public Bill Committee, 8 January 2008; c. 76, Q173.]
I am perhaps minded to see some
reasonableness in the Minister’s contention about the question
of the justification of expecting the taxpayer to pay for the policing
of procedures. Like other members of the Committee, no doubt, I am also
sometimes sceptical about the thoroughness with which Which? brings
forward policy proposals on the back of research. It is our job to be
sceptical about such things. Having said that, it is important that we
proceed on the basis of evidence. Which?
contended:
“It
is a rapidly growing market and likely to grow more
rapidly”——[Official Report, Health and
Social Care Public Bill Committee, 8 January 2008; c. 76,
Q173.]
and that
“one in five of the British adult
population considers some form of cosmetic
treatment.”——[Official Report, Health
and Social Care Public Bill Committee, 8 January 2008; c. 76,
Q175.]
That somewhat takes my
breath away, but it is apparently the case. I am keeping my eyes down,
because it would be somewhat invidious to look around at every fourth
or fifth person in the room and to try to guess who has been subjected
to such
treatment.
Which? also
called the industry “cavalier” and noted
that
“people who
undertake such
procedures”—
I
think that it means
“undergo”—
“think
that they are regulated, and are quite unaware that they are not
protected in any sense.”—[Official Report, Health and
Social Care Public Bill Committee, 8 January 2008; c. 76,
Q175.]
Most persuasively, it
contended that
“the
consequences of getting it wrong can be significant, including long
term permanent harm”,
and
that
“the taxpayer often
ends up paying if it goes wrong, because the NHS picks up the
pieces.”——[Official Report, Health and
Social Care Public Bill Committee, 8 January 2008; c. 76,
Q173.]
I suspect that members of
the Committee recognise and acknowledge the need to contend with such a
knotty issue. If the market is growing in both demand and breadth of
supply, is there not a case for at least some self-regulation? The
Financial Services Authority, for example, is a publicly sponsored body
funded by its own industry. The Committee will be interested in the
Minister’s assessment of consumers’ perception of which
matters in the industry are
regulated.
Mr.
Stephen Crabb (Preseli Pembrokeshire) (Con): My hon.
Friend makes the important point that the growth of the market means
that regulation must at least be considered. Does he agree that, unlike
most other forms of surgery, for which there is a continuous demand,
the cosmetic industry has actively to create demand? It is therefore
peculiarly well placed to take advantage of vulnerable
people.
Mr.
O'Brien:
My hon. Friend makes an important point. When
anything is effectively market-led, people are keen to expand the
market. That said, even before the well known cosmetic surgery and
treatment market became well established in this country and others,
those of us practising law occasionally had to deal with
extraordinarily difficult personal injury cases. If someone on an oil
rig had a great chain smash them round the face, there were the most
fantastic cosmetic surgeons who could put them right, at least to the
degree that was possible. The skills existed, and
the market has tended to grow on the back of them. We need to be
careful not to say that but for a private market, such surgery would
not have existed—it did exist and the skills were there. The
question is about using that capacity outside the NHS in elective,
discretionary surgery. We should not underestimate the skills and NHS
training of many who have come to be among the world’s leading
cosmetic surgeons with the greatest understanding of techniques and
treatments for cosmetic
improvement.
All
markets need good information, even if it is not perfect. The
cost-benefit analysis that is based on the final cost to the taxpayer
will be most interesting because it will tell us whether Which? is
right in its contention that the NHS picks up the pieces. I suspect
that we all have a fair feeling of what the answer will be, but it is
vital to have the
evidence.
As the
Minister contemplates the matter, perhaps it will be instructive to
examine what BUPA has said. At the very least,
it
“would like to see all
invasive procedures including cosmetic procedures such as Botox
regarded as ‘regulated activities’ under the Health and
Social Care Bill, to ensure that the new Care Quality Commission
regulates these services and so protects patient
safety.”
Cosmetic
treatments also include non-invasive procedures, so there is a
difference in what BUPA
says.
I also wish to
ask the Minister for clarification. Page 25 of the explanatory
notes
states:
“The
provision of some cosmetic procedures is included in the definition of
health
care.”
So
far the Minister has not seen fit to alert hon. Members to the
distinction between cosmetic surgery and cosmetic treatment, which was
identified in oral evidence. Given that we have this reference in the
explanatory notes, the matter has patently been given close and careful
consideration by the Minister and his team. We can therefore now look
carefully at our amendment, reinforced, I hope, by the Liberal Democrat
spokesperson who seeks to amend
it.
5
pm
The only
explanation for cosmetic procedures appearing in the explanatory notes
is in the Queen’s Speech briefing, which highlighted the issue.
The reference seems to be a carry-over from that time, but it has not
found its way into the Bill. The Minister will understand that I have
tried to trace the genesis of the way in which these phrases are used.
Clearly they will have consequences, and we see that from what Which?
and BUPA say. These genuine and serious issues have to be
addressed.
There has
been no mention of the argument that the Minister advanced during oral
evidence. Of course, there was his comment that the taxpayer should not
pay for the regulation of these private procedures. He
said:
“I would
like to explore, although we probably shall not do so in the course of
the Bill,”—
more
is the pity; I hope that there has been a little bit of reflection on
that—
“the
justification for expecting the taxpayer to pay for the policing of
procedures that are purely cosmetic and not available on the national
health service.”——[Official Report, Health and
Social Care Public Bill Committee, 9 January 2008; c. 75,
Q175.]
There again he used the word
“procedures” rather than “surgery” or
“treatment”. I should like to give the Minister the
benefit of the doubt and hope that he was not seeking to conceal from
members of the Committee and third party organisations what was in his
mind when he drafted these
notes.
What assessment
has the Minister made of this market and its future growth? Would he
agree with Which? that it is a cavalier industry? What assessment has
he made of the perception of consumers in the industry about
regulation? What assessment has he made of the costs to the NHS from
picking up the pieces of these procedures? What action does he intend
to take in spurring the industry into self-regulation? It would be very
helpful to have an explanation from him of the explanatory notes and
the terms used therein. Having spoken to my amendment, I am happy to
register my broad support for the amendment to it tabled by the Liberal
Democrat
spokesperson.
Sandra
Gidley (Romsey) (LD): Amendment (a) to amendment No. 7
builds on that amendment, which, as has already been explained, would
include cosmetic surgery as part of health care. We welcome amendment
No. 7, and the context has already been explained. An ever growing
proportion of the population is considering cosmetic surgery. It is
quite a drastic step to consider going under the knife. We must also
bear in mind that anaesthetics are often involved, and there is a whole
range of procedures in cosmetic surgery that are regarded as purely
medical procedures.
If cosmetic
surgery goes wrong, the health service picks up the bill. I think we
all intuitively feel that this is a concern, but some clarity about the
costs would be useful when coming to an overall decision. The Minister
has raised concerns about the taxpayer footing the bill. However, much
regulation is paid for by those who are regulated. A lot of the
professional regulation is funded by medical professionals themselves.
One might think that costs would be passed on to the consumer, but the
proposal would reap an overall
benefit.
Which?
raised a number of major problems with the procedures, including the
aggressive marketing that puts pressure on consumers. The most
important problem, to my mind, is poor information, which means that
people who are trying to decide whether to undergo surgery or where to
go do not have an informed choice. There is often a lack of detail
about risks or possible complications. Many guides to cosmetic surgery,
although they are supposed to, do not include details of a
clinic’s latest inspection report or details about the
complaints procedure. If something goes wrong, the consumer or
patient—whatever we want to call them—can struggle to
know where to go. There is often a lack of clarity about the
qualifications of the person actually performing the
procedure.
All that
is bad enough, even if we are talking about only cosmetic surgery, but
amendment No. 7 does not cover procedures such as botox or fillers.
This is a rapidly growing market and new technologies are entering the
marketplace all the time. It is important to engage public confidence
from a Government point of view. The industry seems to promote public
confidence by presenting a quasi-medical image—the technicians
all wear starched white uniforms so that everything all looks terribly
clean and like there is nothing that would cause concern.
Let us consider botox as an
example. It is a prescription-only medicine, but there are some
doctors, who I would suggest are not a credit to their profession, who
regularly write prescriptions to enable people with little or no
qualifications to administer the procedure. That is wrong. It should
not be left to self-regulation and more must be done to monitor it. I
cannot understand why the Government would not want to protect the
consumer in that area. Stronger chemicals are being used, botox parties
are being held in venues such as hotel rooms, and invasive procedures
such as Smartlipo are being undertaken in offices. I am not sure that
those are the appropriate environments in which to carry out such
procedures—[Interruption.]
Sandra
Gidley:
I will return the compliment some time. The hon.
Member for Eddisbury
mentioned—[
Interruption.
]
Well, I
thought that it was called Isolagen, but I want to say that I am not an
expert and that was just a guess. It is one of those words that are
pronounced in as many different ways as they are
spelt.
Today, in the
Daily Mail, there was a report about women suing a clinic over a
claim, and some of the comments made quite interesting reading. The
report
states:
“The
women claim clinics, including several in Harley
Street—
which everybody
thinks of as being
medical
—duped them into
undergoing treatment which did nothing to reduce the impacts of
ageing.”
More
interestingly, Isolagen was withdrawn in America shortly before its
launch in the UK following concerns from the Food and Drug
Administration about the scientific trials. The procedure was overseen
by the FDA in America, but because it was not regarded as medical in
the UK, there was no such scrutiny, monitoring or licensing of the
technology. The amendment has been tabled to avoid such instances in
the future.
I hope
that the Government are at least sympathetic to the arguments and are
moving some way towards regulating this sector more strictly, even if
they do not wish to adopt the amendment. I believe that there is
supposed to be self-regulation in the cosmetics industry, but there is
not.
Amendment No. 129
would amend clause 45(2)(a) to make it clear that establishments
offering such procedures are subject to regular review. Again, the old
arguments apply: clinics can change hands, and the public must have
absolute confidence when undergoing such
procedures.
Mr.
Bradshaw:
As I said in our discussion during the
evidence-taking sessions, I welcome this debate. I have given the
matter some thought, and it is interesting because it is philosophical.
At some stage, a boundary must be drawn between where taxpayer-funded
regulation is justified and where it is not. One’s instinct when
one hears about a terrible case is that the Government should do
something, but the more I have thought about that, the more I have
asked myself how far is it justified to expect the
taxpayer to pay the
enforcement costs of the regulation of activity that is cosmetic and not
available on the NHS. In many cases, that would involve the regulation
of vanity. We would all do well to ponder that
question.
The
amendments are based on a misunderstanding that the Bill explicitly
excludes the sort of cosmetic procedures to which hon. Members
referred. The Bill already covers such matters and clause 5(2)
explicitly refers
to
“procedures that are
similar to forms of medical or surgical care but are not provided in
connection with a medical
condition.”
We
believe that that allows cosmetic procedures, whether surgical or other
treatments, to be regulated by the new commission, should that be
considered appropriate. As I said during the evidence-giving session,
we will shortly consult on what specific activities will be regulated
by the Care Quality Commission, and I want to encourage the debate to
continue in that
context.
Any cosmetic
procedures that, following the consultation, are deemed necessary for
registration with the new commission would also fall within the scope
of clause 45 and could, therefore, be subject to periodic reviews by
the commission as set out in that
clause.
Anne
Milton (Guildford) (Con): In what situation would the
procedures not be considered appropriate for
regulation?
Mr.
Bradshaw:
I do not think that that is for me to say now.
It is for us to have a debate. The hon. Lady may have a view of where
the boundary should lie, and I may have a personal view, but that might
change when I reflect more deeply on the issues, which we will do when
we embark on the consultation on the regulation system. I am not
prepared to give a judgment off the top of my head now. I indicated the
direction in which my sympathies lie during the evidence-taking
session, but I wanted to reassure the hon. Lady and those who support
the amendment that the Bill does not exclude the sort of procedures
that they seem to believe should be
regulated.
Angela
Browning (Tiverton and Honiton) (Con): If I have
understood the Minister correctly, he will, following the consultation
on which he is embarking—I welcome that—draw up a list of
procedures or treatments that will be subject to regulation. How will
that impact on private clinics? One serious problem has been leaking
silicone breast implants. The health service often has to do the repair
work when that happens because a women’s health can be seriously
damaged if the implants go wrong. If a clinic is involved, will just
the one procedure that it carries out be covered? If it is negligent
in, or not very good at, one procedure, there is a question mark
against all the other procedures carried out on its
premises.
5.15
pm
Mr.
Bradshaw:
We are talking about the registration
requirement and procedures carried out in a particular facility that
comes under that requirement. If it were decided that a procedure
should come under regulations, when the regulations are laid, any
facility providing that procedure would qualify.
I am grateful for the hon.
Lady’s intervention, because I was going to say, if the
discussion broadened out into a general debate on the issue, that it is
important—as the hon. Member for Eddisbury mentioned—that
we do not automatically exclude the importance of self-regulation and
do not lose sight of the fact of the sorts of instances that the hon.
Member for Romsey referred to, involving doctors breaking the rules in
terms of prescribing Botox. There are already rules in place, both for
professional conduct and in the law, that offer safeguards in these
areas.
There is a
question that needs to be addressed by the Committee and in the wider
debate. The estimates of the number of premises offering cosmetic
procedures could, in theory, mean that the vast majority of the
premises that the new Care Quality Commission is required to register
and even inspect are those offering cosmetic procedures, so it would be
doing that rather than focusing on the core responsibilities that we
are trying to ensure that the new independent regulator has in respect
of health and social
care.
This has been a
welcome opportunity to air some of these concerns and for hon. Members
to think a little bit more deeply about this matter, because doing so
will help inform the debate that we will need to have when we discuss
the
regulations.
Anne
Milton:
I thank the Minister for giving the matter further
consideration. It has become apparent that there needs to be some
clarity. Many people who go into a clinic, for want of a better word,
for a procedure perceive themselves to be in hospital, but in fact the
clinic may be registered under nursing home regulations. At the moment,
the private providers obviously want to slip under the lightest
regulatory regime possible, although not necessarily because they are
doing anything wrong. It is important that there is absolute clarity,
not only for Committee members but for the
public.
Mr.
Bradshaw:
Yes. The hon. Lady is right to draw attention to
the importance of good, accurate information and the importance of
individuals, who are thinking of undergoing such treatments, making
certain as far as they possibly can that the clinics that they are
using are well regarded and adhere to the existing
regulations.
Sandra
Gidley:
I have listened with interest to the Minister. I
am to some extent reassured by the fact that there will be a
consultation. I have a slight reservation inasmuch as the Minister
seems to be talking about a list of procedures that will be covered by
that process that, presumably, would be covered under regulations.
However, lists often have a habit of being set in time, so that when
new procedures come on board they may not be covered by regulations
that may have covered them had a technology been in existence when it
was first developed. Will the Minister give some thought to a set of
broad principles that can be applied in addition to a pure list of
therapies? I do not think that a list of therapies will stand the test
of time.
With that
proviso, there is clearly no point in putting amendment (a) to a vote
if amendment No. 7 does not succeed. It would be helpful to see how we
get on with that and possibly revisit the matter
later.
Mr.
O'Brien:
I think that I need to indicate, on amendment No.
7, that whether we will want to press this matter further at this stage
will depend on the Minister’s
response.
As the
Minister said, this has become an interesting debate. It has been
helpful to have this exposition of these issues, because there is
clearly a need to find a balance in the tension between what is
appropriate to regulate and what it is inappropriate for us to seek to
constrain from on high. I fear that the consultation that the Minister
is launching will not necessarily report in sufficient time for us to
be able to use its results for the benefit of drafting the legislation.
I hope to withdraw amendment no. 7, and I hope that the Minister will
take away from this that it may be useful for all, not least as part of
the context in which the consultation is importantly carried out, to
think—perhaps on Report—that there is something a tiny
bit more explicit than currently stands within the compass of the
definition in clause 5, which he prayed in aid, as covering. It might
possibly benefit from a little more explicit detail that indicates the
cosmetic, discretionary or non-essential—be it invasive or
non-invasive—treatments, or in his preferred words, procedures.
I note that we did not get an explanation of the explanatory note, and
I simply leave that on the record. However, with the agreement of the
Committee, I beg to ask leave to withdraw the amendment, and look
forward to us returning to us with some definite determination and
deliberation on
Report.
Amendment,
by leave,
withdrawn.
‘ and needs
assessments for care and health-related assessments of ability to
work.’.
The
Chairman:
With this it will be convenient to discuss
amendment No. 91, in clause 5, page 3, line 20, at end insert
‘ and all needs assessments for such
care.’.
Mr.
O'Brien:
The purpose of these amendments is to ensure that
organisations providing assessment of need for health or social care,
and organisations providing assessments of people’s ability to
work on the basis of health or disability, are included within the
scope of the new Care Quality Commission. The personal capability
assessment is a test used to assess long-term incapacity for work for
social security benefits. The high rate of successful appeals—60
per cent. in 2005—was evidence that the PCA did not accurately
capture people’s ability to work. This has, of course, been much
in the news recently. On 17 November last year, the Secretary of State
for Work and Pensions announced a replacement test, the work capability
assessment, to be introduced in October this year. I would not be
surprised if it happens to come into force at the time when many of the
provisions of this Bill, once it is enacted, may find themselves being
introduced.
I note
that the Secretary of State’s press release said that the new
test
“will assess what
you can do, not what you can’t do.
There are currently 2.64 million working
age people claiming incapacity benefits, which cost the country nearly
twelve and a half billion pounds in
2006/7.
Fifty per cent of those
who take the assessment will not pass it, meaning that 20,000 fewer
people a year will enter ‘sickness’ benefits as a result,
and will instead be given the support and skills they need to get a
job.”
I move on fast,
before contemplating whether the Secretary of State is contemplating
any kind of concern about the security of his own position. I note that
claimants undergoing the current PCA are assessed by ATOS Origin
doctors, using current PCA descriptors and the ATOS-designed computer
system, LiMA. The same doctors then make an estimate of the
claimants’ scores under the new PCA descriptors, and I assume
that a similar system will continue under the new test. I will leave
aside the question of whether this test does the best by disabled
people, or people with impairment, or whether it is another clumsy
attempt by the Prime Minister to win over a target audience by using
those
terms.
Health
assessments, similarly, occur in custody, both on arrival in custody,
by offenders or those on remand. That assessment is often outsourced,
and if the offender or the person on remand is admitted to jail, the
health assessments are made at the point of reception screening. It is
important to recognise that Rethink, the leading mental health
membership charity, and others, are concerned at the inability of the
CQC to assess, its accountability to assessors, and the unaccountable
nature of the assessments. The force of the amendment therefore would
bring that accountability into the system. I hope, therefore, that the
Minister will find this to be a helpful way of ensuring that so many of
the objectives that he has set out for the Bill will be
delivered.
Angela
Browning:
I support my hon. Friend on the amendment. In
one of our evidence sessions, I touched on the question of doctors who
put themselves forward as expert witnesses. There is some general
concern about medical professionals who carry out assessments.
Sometimes it is seen as a retirement job for people who have long left
practising medicine on a day-by-day basis and who can be quite out of
touch with assessing people with some of the more unusual or rare
conditions. They are often particularly out of touch with the way in
which we now regard people with learning disabilities, mental health
problems and autistic spectrum
disorders.
The
amendment would ensure that anybody who wears a badge saying that they
are an authority or an expert in the health and social care sector is
subject to the rigours that will come from the inspectorate. As Members
of Parliament we see far too many cases of people with sometimes quite
complex disabilities who are able to work. Equally, on the other hand,
we see people whose disabilities might be a little more invisible on
the day and who do not get the expertise and the fair assessments from
people who, one would hope, are experts in their
fields.
Very
often, the experts are on a panel or report to a panel of lay people.
It can be expected that a lay person on a panel will accept the
judgment and recommendations of a medical expert, whether or not the
person’s ability
to work has been undervalued. The vast majority of people with a
disability want to work. They might not necessarily be able to do a
full week’s work. However, there are many people who could work
and who want to work. It is right that their assessment should be
fair.
Under many of
the Government schemes, there are tiers at which people who have been
out of work or people in their 20s and 30s who have never been in paid
employment can be helped into employment. Making a fair assessment of
what needs to be an incremental introduction into the world of work
depends very much on the expert judgment. It would be unfair in most of
those cases to say, “Okay, 38 hours a week for you.” That
judgment is taken by a panel, which is dependent on the advice and the
assessment. There needs to be a much more subtle and flexible
understanding of the world of work and the particular disability or
incapacity that is being assessed. This issue is important because it
is a very grey
area.
In the same way
as I was concerned about expert witness earlier in these proceedings,
the judgment of the panel is looked at and is listened to. It can be
quite influential in where the person goes in life. It can be as
important as that. Bringing such people within the scope of this
legislation, as outlined in the amendment, is very
important.
Mr.
Bradshaw:
I entirely agree with the hon. Lady. I recall
the General Medical Council agreeing with the point that she made in
the evidence session on the expert witnesses, that it was vital that
the medical professional was qualified in the required speciality and
not in something
else.
I am grateful to
the hon. Member for Eddisbury for explaining the amendments. This was
the one small group of amendments that led us to scratch our heads and
wonder what they were about. Now that he has explained them, I can
reassure him because clause 4(2) states that an activity may be a
regulated activity if
it
“involves, or is
connected with, the provision of health or social
care”.
5.30
pm
As needs
assessments are part of the process of providing a service to patients
or service users, we are confident—at least our lawyers
are—that this would cover needs assessment as well, and that
needs assessments may be described as regulated activities because they
are connected with the provision of the said care. Through the
registration requirements, which we will be consulting on, providers
will need to demonstrate that they are providing a safe, quality
service that meets the needs of patients or service users. If those
activities are connected with the provision of health and social care,
they will be within the scope and will therefore cover needs
assessments.
Angela
Browning:
Will the Minister look at the other side of the
coin? I am thinking of social care. We heard in the evidence session, I
think from Baroness Platt, that, with social services assessments, very
often the eligibility threshold is raised quite considerably so that
there is a group of people who do not quite make the threshold but who
are none the less a cause for concern in terms of the
service—or, often, the lack of
service—that they receive. Is it within the scope of this Bill,
through the new commission, to pick up people who are omitted from
services when quite clearly they should be included at some
level?
I raise this
issue because, going back to mental health, learning disability and
autistic spectrum disorders, it is not uncommon at all for those who do
not quite meet the eligibility threshold and who sometimes receive
absolutely nothing by way of support, to deteriorate very rapidly,
becoming the next crisis for a social services review team because of
the way they then present. I accept that this is very hard, but might
the commission monitor where the social services assessments are made,
and whether the assessors are being fair and meeting the criteria and
the general thrust of this legislation to ensure that not only those
who are assessed are properly regulated, but that nobody falls through
the net as a result of the way they are assessed or the people
assessing
them?
Mr.
Bradshaw:
I suspect the answer to the hon. Lady’s
question will depend on the policy and the resources available as much
as on the work that the new regulator will do to enforce those
policies. However, I am sure that in the circumstances in which it is
clear that social care providers are not following Government policy,
or are setting the bar higher than the policy directed by the Secretary
of State would suggest, there would be a case for the regulator to look
into it. However, it is not the regulator’s job to set the
policy or, indeed, the funding for a particular service. Its job is to
ensure that the policy is implemented consistently and fairly, and that
service users are getting a fair
deal.
Mr.
O'Brien:
I am very grateful to my hon. Friend the Member
for Tiverton and Honiton for her, necessarily rather extensive,
intervention. It was particularly helpful to have before the Committee
a series of examples of the way things work.
I hope the Minister accepts
that we bring these amendments forward with the utmost sincerity. When
looking at the drafting in such a generic way, part of the problem is
making sure that we know what the Government are contemplating in
encompassing these issues. The great benefit of debating all these
points in Committee is not only that we bring expertise to the cause of
examining the Bill, such as that demonstrated by my hon. Friend the
Member for Tiverton and Honiton. It also enables us to put on record
how important it is to ensure that people looking back on our
deliberations can say, “Yes, that general set of words was
absolutely intended to be included” in that there are those who
may choose not to be caught within the ambit of regulation. After all,
they are the people we need to be most concerned about and we need to
be sure that they are covered in the Bill.
The Minister’s
reassurances have been worth while and give us some reassurance. In
particular, my hon. Friend’s example meant that we were able to
flush out where the true danger lies, and that is the people who might
fall between the gaps—in what is assessed and the assessors, but
also the method of the assessment process—and those who may need
support but are not meeting the various thresholds and are cut off from
eligibility. This has been a most useful exploration of
the issue and I hope that the Minister agrees. I beg to ask leave to
withdraw the
amendment.
Amendment,
by leave,
withdrawn.
‘(2A) The Secretary of
State shall have a duty to review annually the forms of health care to
which Part I of this Act
applies.’.
This
is a very simple amendment, which in many ways is an attempt to
future-proof the Bill or to clarify and tease out whether the current
definition of health care is wide enough. The reality is that health
care is changing all the time. It has been delivered in a variety of
different ways and from a variety of different venues. The amendment is
particularly relevant to cosmetic surgery, where new techniques and
procedures are coming forward all the time. In some cases, the
definition of health care can be a little fuzzy at the edges and let us
then factor into the equation the delivery of services. In the future
we are going to see polyclinics; no doubt they will be fully captured
by this, as will the super-GPs’ surgeries. There are plans for
such things as walk-in centres in supermarkets, so presumably part of
the supermarket will be regulated.
Currently, GPs’ premises
are often not covered. The extension of GPs’ roles to embrace
more services, including minor surgery, also needs examining. More and
more services are provided by other practitioners, such as pharmacists.
Locally, I can think of one that slightly blurs the edges; podiatry in
which services have been cut back extensively—no pun intended.
The local Age Concern group has trained people to a minimum standard
and services are being offered in places that would not normally be
regarded as standard health care settings. The amendment clarifies that
the forms of health care will be subject to regular review, so if
something has fallen through the gaps and has been missed , it can be
regulated as soon as possible.
Mr.
O'Brien:
Looking at the amendment put forward by the hon.
Lady and the Member for Leeds, North-West I can see that it is
admirable in keeping the CQC at the cutting edge—pardon the
pun—of regulation. Yet, it raises the question of whether there
should be a right of appeal for the CQC to add to the definitions, the
procedures and the practices that it comes across in its work. I
wondered why the hon. Lady had decided to table an amendment referring
only to health care and not also to social care, and she might wish to
reflect upon that. Although I think that it could be a very good
discipline indeed, I question whether in truth the Secretary of State
is the best person to deal with it. I dare say that the hon. Lady might
also want to reflect on that.
If the Minister is
contemplating the amendment or looking at the reasons why he is not
minded to accept it, I think it will be worth his noting whether clause
5 leaves the CQC with sufficient fleetness of foot in regulation.
Developments happen so quickly in so many ways and there will be
technologies that have a genuine impact, not just on health care but
also on social care. I am thinking of things such as telecare, which is
becoming a real way forward. There are some stupendously good examples
in my constituency that give people new and greater opportunities to
live
independent lives with appropriate support. I hope the hon. Lady will
realise that, with those comments, I am broadly supportive but would
perhaps find it difficult to support her if she forces the amendment to
a
Division.
Mr.
Bradshaw:
The arguments used by the hon. Member for Romsey
are exactly why we have drafted the definition of health care so
widely, because that will give us the flexibility that she wants to see
in the regulations. The definition, as we discussed earlier in
connection with cosmetic procedures, is drafted widely. Clause 42 also
makes provision for the commission to undertake reviews.
In response to the point made
by the hon. Member for Eddisbury, clause 49 enables the commission to
advise the Secretary of State about any changes that it considers might
be necessary to the regulations to determine regulated activities. I do
not think, given that, it is terribly sensible to require an annual
review of the definition of health care that appears in the Bill in an
enabling way. I think that is unnecessary. In the light of that, I ask
the hon. Member for Romsey to withdraw her
amendment.
Sandra
Gidley:
The amendment was really tabled for health care
because health care is a fast-changing environment with many different
providers. Social care is perhaps a more settled environment, although
I do take points of the hon. Member for Eddisbury about telecare, which
does change the dynamics. The amendment was tabled to probe the general
principle and try to establish whether clause 5 had sufficient
flexibility. I still think the issue of cosmetic surgery has to be
resolved and kept up to date. It is something that will perhaps require
regular review.
The
CQC can make recommendations and I see no problem with responsibility
belonging to the Secretary of State because they get the blame if
anything goes wrong. However, I hope that any Secretary of State would
take advice of the commission. In light of the fact that there seems to
be sufficient provision already, I beg to ask leave to withdraw the
amendment.
Amendment,
by leave, withdrawn.
Mr.
O'Brien:
I beg to move amendment No. 8, in
clause 5, page 3, line 17, after
‘of’, insert
‘formal’.
This,
too, is a probing amendment, so let us be clear from the outset. It
provides an opportunity to ask the Minister whether the clause gives
rise to a need to regulate informal carers. The CQC should certainly
support such carers, of course, in every way possible. Carers UK
estimates that informal carers save the UK about £87 billion a
year and, according to the organisation, over three in five people in
the UK will become carers at some time in their lives. There are around
6 million carers in the UK, although that is inevitably a broad
estimate. The 2001 census estimated that there were 175,000 children in
Britain caring for a member of the family, although that figure is
believed to be much higher by those who work in the field. I suspect
all of us believe from our own constituency caseloads that the national
number must be larger than
that. One has enormous respect and admiration for children who
selflessly dedicate themselves to their often ailing parent.
The
definition of social care in these wide terms, given its application to
the entirety of part 1, is welcome as regards reviews undertaken by the
commission, but I am looking at the way—and this is a probing
amendment—that the amendment might jeopardise that. We need to
be very careful how we operate here and I am trying to establish
whether we are dealing with all forms of care—formal and
informal.
5.45
pm
Sandra
Gidley:
I fully sympathise with the thought behind these
amendments, but would the hon. Gentleman, as a lawyer, clarify whether
introducing the word “formal” would require a definition?
Would there be a grey area between “formal” and
“informal”? Could this be a lawyers’ charter in
the long
run?
Mr.
O'Brien:
The hon. Lady is absolutely right to point out
the difficulty of introducing a phrase that is not therefore carried
through into the definitional area. To some degree, we are trying to
define what we mean and I am more than open-minded on the definition.
This is a probing amendment, but if we feel there is a valid point, we
may want to revisit it on Report and the Minister, with his army of
advisers, will be able to devise better definitions than I was able to
come up with at 3 am in the House library.
[
Interruption.
] It so happens that was the case on
this occasion; it will not always be so.
It
is important to test this issue because the Government’s
intention as to whether just formal or both formal and informal carers
should be regulated now becomes a moot point because of the most recent
pronouncement by the Prime Minister, which was spun out. We all recall
that as we were beginning our deliberations on 14 January, the Prime
Minister suddenly announced, as reported in the Daily Mail, that
the relatives of sick and elderly people would be paid a
“salary” for looking after them under proposals revealed
by the Government on 13 January. It was over the weekend that the Prime
Minister said he would be seeking to provide a “salary”
for carers. Looking at the proposals in detail, it is really important
to establish what we mean by formal care. Is it what one is able to
procure for oneself from a set of formal providers, or is it just the
informal care that any one of us could, as a family member, be expected
to provide?
I hope
people are not going to be cynical or sceptical, but that they will
take this point seriously. We now have a Prime Minister who has set a
new bar for us, because he has talked about paying a salary for carers.
This prompts the question as to whether they are now to be regarded as
formal rather than the informal carers we have now come to recognise as
absolutely vital to the future of the United Kingdom. With an estimated
cost of £87 billion, there is very little we could do to replace
them if they were not motivated and incentivised to do the right
thing.
I have looked
at the proposals of the Prime Minister in detail, and I hope that the
Minister will put my mind at rest. However, at the moment, one is
forced to conclude that the proposals are something of a sham,
because the proposal is to allow those receiving state funding for care
to employ family members to look after them. That is to say, to
redirect part or whole of their individual budget to a family member.
That does nothing, therefore, to reduce the £87 billion deficit,
as family carers are currently topping up where the state is failing to
provide care. Under the Prime Minister’s proposals, carers will
work double the amount but get paid for half the
time.
The
proposals also do nothing to support those who care for people who are
not eligible for state funding, and I think the Government’s
tactics have to be questioned on that point. If state funding is going
to be directed at informal carers—by payment of a salary or
whatever—for somebody to look after a grandmother or a parent, I
can see that down the line a Government who remain at heart
centralising, which is the charge we would level at the Labour
Government, could want some quality assurance about the care being
purchased.
I
hope that the Committee realises that it is not beyond the bounds of
belief that the clause could be used to bring regulation into the realm
of informal care—that is the best term that I could devise, but
if any Committee member can come up with a better one, please help me.
The same thing happened in education; look at how policy there has
changed over the past 10 years. Very gifted early-years carers, who are
often known as gifted amateurs, have been excluded by the Government,
because of the need to regulate them and prevent blame from falling on
other providers on health and safety grounds. That is very laudable,
but it has removed a whole cadre of people involved in informal
early-years care in a more educative
environment.
I
hope that the Minister will look at, listen to, and possibly confirm,
my assessment of the funding of the system. We support the commission
having the remit to include carers in its reviews, and I hope that he
will confirm that it will. However, we are concerned that informal
carers will have neither the time nor the resources to be formally
regulated. Often they are balancing their caring responsibilities with
jobs—be they full-time or part-time—or with educational
and skills development opportunities if they are child carers. Nothing
should be contemplated without consultation.
I hope that the Minister will
confirm that although the legislation leaves the door open to that,
neither he nor the Government have plans to require the registration of
truly informal carers or of those receiving money under the carers
allowance. The long-awaited Government proposal for a new deal for
carers, which was announced a long time ago by one of his fellow
Ministers, must be set against what the Prime Minister said recently,
which leaves us with some confusion. As I said, this is a probing
amendment—I say that with sincerity—but, given the
concerns that remain, all of us will recognise the need for
clarity.
Angela
Browning:
I declare an interest, because I am the named
carer on the care plan of a close relative and I also directly assist
him in managing his direct payments. I endorse the clarification that
my hon. Friend seeks. I am horrified to think that, if I do not
register as a service provider—I have been providing that
service for 36 years—I could be subject to a fine “not
exceeding £50,000”. I hope that the Minister will assure
me that that will not happen.
I shall move the debate on a
little to reflect on what I said in Committee this morning about the
relatively new arrangements for those with direct payments and the way
in which, with the agreement of the social services department, people
are directly employed. Before direct payments, all sorts of job titles
were attached to those working with people with learning disabilities
or autistic spectrum disorders, not because they needed a medically
qualified person with them, but because they needed assistance and
somebody to perform certain tasks and to carry out certain functions.
Sometimes they might need somebody with them to travel on public
transport. We are not looking at people whose qualifications make them
registrable.
With
direct payments, which I thoroughly support—they are extremely
good—people are not necessarily employed through registered
agencies. It is a very informal arrangement. Many people like to apply
the term “personal assistant” to those accompanying them
in order to enable them to do things that are part of their formal care
package. Social services and the social worker must agree annually that
that is the right use of the direct payments, and be satisfied with the
individuals providing those services, some of whom are paid, so that
they will fall within the “formal” classification. I know
of someone who works six hours a week as a PA, which is their only paid
employment, and who does not meet the national insurance threshold, but
who none the less carries out a valuable function. I would be horrified
if I thought that such people were likely to come within the formal
definition of chapter 2, as it would make life incredibly bureaucratic.
The cost of registering would result in them not doing the work.
Sometimes, those people are called befrienders, and some of them are
paid befrienders. It would be a great shame if regulations had a
disproportionately heavy impact on that group. I am sure that that is
not what the Minister intends, but we need to be certain that the
drafting does not make it a catch-all provision that sweeps up many
people currently doing good work in that
area.
Mr.
Bradshaw:
Once again, I entirely agree with the hon. Lady.
I reassure her and the hon. Member for Eddisbury that is not our
intention that the domestic or private arrangements that they outlined
should fall under the requirement for regulation. However, I do not
wish completely to pre-empt the outcome of the consultation. The
Committee will recognise that domiciliary care provided by an agency
will be covered, but the sort of private arrangements referred to will
not. It is certainly not our intention to cover the thousands or
millions—the army of people—currently in receipt of the
carer’s allowance.
Mr.
O'Brien:
I am obviously grateful for that assurance. We
have had a useful and important discussion on the amendment, not least
because it enlisted the expertise and experience of my hon. Friend the
Member for Tiverton and Honiton. I pay tribute to her, as she often
brings her experience to bear on these important subjects.
Many of us are conscious, when
dealing with this part of the Bill, that we are potentially speaking on
behalf of millions, who are looking for these provisions to be
established in the right and appropriate manner.
As I said, it is a probing amendment. When reflecting on our
proceedings, whether on Report or in another place, I am sure that
anything that can be done to give a greater assurance, rather than
people having to rely on our exchanges in Committee, would be welcomed
by all concerned. We do not want to disincentivise, militate against or
do anything other than support and applaud those who give so
selflessly—those who are known as the informal carers and who
are often the most trusted in the family setting. I beg to ask leave to
withdraw the amendment.
Amendment, by leave,
withdrawn.
Question proposed, That
the clause stand part of the Bill.
Mr.
O'Brien:
I want to speak briefly. I am sure that all
members of the Committee are wondering whether we are ever going to
reach the later clauses, and I appreciate that at times it must be
quite exacting for Government Back Benchers. However, the principles
enshrined in clause 5 form the nub of the Bill.
The Minister may be very
conscious of the fact that he now has quite a burden on his shoulders.
Perhaps on Report, he must ensure that the rights base—the Human
Rights Act loophole identified and articulated by the hon. Member for
Luton, North—is properly considered and addressed. In other
parts of the Bill, we need to add health care, as identified by Anna
Walker, when she gave oral evidence on public health and health
regulation and on the Health Commission’s approach.
We had a big debate on cosmetic
treatments and procedures, on invasive and non-invasive surgery, and on
health-related assessments for work. There is also a need for forms on
health care, perhaps on social care and, when it comes in, telecare, to
be reviewed annually. We also had a great debate on formal and informal
social care. On that basis, I hope that the
Minister—
5.59
pm
Sitting
suspended for a Division in the
House.
6.15
pm
On
resuming—
Mr.
O’Brien:
I was concluding my remarks on clause
stand part just as the Division bell rang and you adjourned the
Committee, Mr.
Hood.
Question put
and agreed
to.
Clause 5
ordered to stand part of the
Bill.
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| ©Parliamentary copyright 2008 | Prepared 17 January 2008 |