Previous Section Back to Table of Contents Lords Hansard Home Page

Lord Harris of Haringey: I am grateful to my noble friend for that reply. In particular, I recognise the points he has made; namely, that this new clause strengthens the commitment of trusts to the NHS. I recognise the significance of the duty of co-operation. My concern remains that Clause 9(2)(a) talks about interfering,

I think that I am grateful to him for the reassurance he has given that that is sufficient to cover the possible impact of activities on other parts of the NHS which are not directly related to the contracts of that particular NHS trust. In the hope that he will perhaps check this one more time between now and Report, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 66 not moved.]

Clause 9 agreed to.

Clauses 10 to 12 agreed to.

Clause 13 [Duty of quality]:

[Amendment No. 67 not moved.]

Baroness Sharp of Guildford moved Amendment No. 68:

Page 11, line 7, after second ("each") insert ("Health Authority, Primary Care Group and").

The noble Baroness said: Clause 13 concerns the duty of quality. We on these Benches greatly welcome the proposals in the Bill to impose a duty of quality on healthcare authorities and to require them to set up procedures for monitoring that obligation.

25 Feb 1999 : Column 1352

Amendment No. 68 makes the point that the duty of quality should apply to health authorities and primary care groups as well as to primary care trusts and national health trusts. Amendment No. 73 makes the point that if health authorities and primary care trusts are included in the process, some of the bodies concerned will be commissioners of services rather than just providers of services. We see these as essentially tidying-up amendments. I beg to move.

Baroness Hayman: I am grateful to the noble Baroness for her welcome for the duty of quality that the Bill imposes on primary care trusts and NHS trusts to put and keep in place arrangements for the purposes of monitoring and improving the quality of healthcare they provide to individuals. It has been placed on NHS trusts and primary healthcare trusts because they are, and will remain, the main NHS organisations which directly provide healthcare to patients and their service provision will impact directly on individual patients.

Health authorities in England and Wales perform some functions which might be regarded as provision; for example, with regard to public health and communicable disease control. However, such matters do not make up the greater part of their role. We believe it is important that a duty in such a potentially complex area is kept as simple as possible. That is why we feel that it should apply to those organisations which have direct provision of patient care as a major part of their core enterprise. The duty, as it stands, will cover provision by NHS trusts, PCTs and specified SHAs. We will make it clear in guidance that the principles of clinical governance will, in addition, apply to any provision by health authorities and to services commissioned by health authorities, PCTs and PCGs. However, we do not believe that those aspects of its implementation need to be supported by a statutory duty such as we propose to apply to direct service provision by NHS trusts themselves.

The principles of clinical governance need to apply throughout the NHS and we are committed to working with NHS bodies and relevant professional bodies to ensure that that happens and that we support quality improvement throughout the service. I hope that the noble Baroness will accept that we are suggesting that the provision of the duty of quality is properly directed in the main at those who are, for their main function, providing rather than commissioning services.

Baroness Sharp of Guildford: I thank the Minister for her reply. I do not think that we on these Benches are totally convinced that that is an adequate response to our feelings on these issues. However, we shall reflect on the matter and, in the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

11.30 p.m.

Lord Clement-Jones moved Amendment No. 69:

Page 11, line 7, after second ("trust") insert ("and private healthcare institution").

25 Feb 1999 : Column 1353

The noble Lord said: This is a fairly straightforward amendment. Several amendments similar in intent have been tabled and I have no doubt that other Members of the Committee will want to expand, perhaps at greater length, on the issues to which they relate.

Our amendments include Amendment No. 69, which relates to investigation; it does not relate to all the other aspects of the functions of the commission for health improvement. It also relates to the question of empty premises, under Clause 16, which it seeks to tidy up to ensure that the powers apply to private healthcare institutions.

Clearly, the amendments raise questions of definition, but the spirit behind all of them is pretty clear and I do not minimise their significance. There are over 200 hospitals in the private sector, comprising something like 10,000 beds. Therefore, bringing them within the remit of the commission for health improvement is not an insignificant step. However, the interface between the private healthcare sector and the NHS is already considerable, as we have seen and, in a sense, as we are seeing as the winter pressures continue. There is no doubt that the private healthcare sector has a considerable role to play as a safety valve--and a not unwelcome safety valve, in my view. In many other areas also, the private sector has a considerable role to play.

The current regime is rather patchy. Registered homes, registered as such under the Registered Homes Act, are subject to the regulation of local authorities. As we have seen from the social services White Paper, the Government plan to bring them within the regional commissioning mechanism. However, where healthcare and hospitals are concerned--I recognise that that may sometimes be difficult to define, but I do not believe that it is beyond the wit of the parliamentary draftsman to get it right, even if we do not!--the private sector should be brought within the remit of the commission for health improvement.

The private sector is very much behind this concept. It would certainly welcome a seamless system. After all, despite its name, the commission for health improvement is effectively an inspectorate. We on these Benches believe--I can see that others agree--that there should be consistency between the NHS and the private sector. We believe that patients, whether or not they choose to go in the NHS or in the private sector, should expect that degree of consistency.

The independent sector itself already subscribes in many ways to quality insurance schemes and it should not be too difficult for it to conform to the standards that will be set by the commission for health improvement. So we believe that this is a proposal with considerable merit. If it were to be adopted, it would be of considerable benefit, not only to those who choose to pay for private health insurance, but to the NHS itself when it uses the facilities of the private sector, which has been the situation over the past month or two. I beg to move.

Earl Howe: I rise to speak to Amendment No. 70 and in doing so I should like also to speak to Amendments

25 Feb 1999 : Column 1354

Nos. 79, 80, 94, 95, 97 to 100, 102, 103, 104, 113 to 117 inclusive, 122 and 123. These are very important amendments and their purpose is to impose a duty of quality on independent hospitals and also to extend some of the functions of the proposed commission for health improvement to such hospitals.

My understanding is that this amendment commands widespread and cross-party support in your Lordships' House and I can tell the Committee that it enjoys the wholehearted support of the independent healthcare sector. The other point I should like to stress is that these amendments would serve the interests of all patients, both NHS and private. It would enable the commission to monitor and ensure the quality of the services provided in both healthcare sectors and to identify and promote best practice wherever it can be found.

As the noble Lord, Lord Clement-Jones, has pointed out, independent hospitals and clinics are at present regulated under the Registered Homes Act 1984. The duty of monitoring and inspecting such hospitals and clinics is mostly delegated to district health authorities. Many districts have only one or two such hospitals and so it is hardly surprising that such inspections are known for their inconsistency--inconsistency of standards required, of process and of outcome. There are widespread concerns that district health authority inspections will become ever more erratic if and when parallel responsibilities for the inspection and monitoring of nursing homes are passed to regional commissions for care services.

If my intelligence is accurate, Ministers may be considering transferring the responsibility for the regulation of independent hospitals to regional commissions for care services. I have to say that this would be less than ideal: on a par, if I may say so, with sending tigers to the care of a cattery. Independent hospitals are part of the healthcare zoo. They may not all be tigers, but they are at the very least jaguars and pumas, not tabby cats and they should be regulated overall by an authority that has the technical healthcare expertise and the stature to ensure that a good job is done.

It is worth reflecting on the legislation that currently covers these hospitals. It was originally drawn up at the time when a nursing home was broadly considered to be a place of long-term convalescence for those recovering from bouts of illness or surgery. Nowadays I would suggest that most people consider a "nursing home" to be a residential home for chronically ill elderly patients requiring long-term nursing care. The old-style nursing home has turned into a fully fledged high-tech establishment, performing increasingly complex treatments and procedures which are now only rarely followed by long in-patient stays. Their regulation should reflect that change.

These amendments should also promote several other types of consistency: consistency of standards between NHS pay-bed units and independent hospitals; consistent standards when NHS and private care are provided alongside each other in independent hospitals, such as medium-secure psychiatric hospitals; and

25 Feb 1999 : Column 1355

consistent standards of clinical governance, so that consultants have no doubt as to the standards expected in all their practice.

The independent healthcare sector has responded very positively and constructively to the Government's quality agenda on a voluntary basis. I understand that a great deal of work has been done under the auspices of the private practice forum of the Academy of Royal Medical Colleges. I believe that that work should now be consolidated with a consistent and reasonable regulatory framework that realises the Government's own published principles and objectives of regulation. The amendments have been cast so as not to inhibit consideration of related issues by the Health Select Committee in the other place. However, this does establish the principle that independent healthcare providers should be regulated overall by the national institution best suited to do the job, and to do it well. I therefore commend the amendments to the Committee. I beg to move.

Next Section Back to Table of Contents Lords Hansard Home Page