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Lord Northbourne: I should like to express concern about the definition of these schools as set out in Amendment No. 3. Will the Minister indicate whether the purpose of the clause is to protect particular children at a school? If that is so, I suggest that the amendment is not worded clearly enough. Some schools take in other children for holiday courses, which could easily extend over the 295-day period. The children who attend the school during the normal term time are one group and an entirely different category of children may attend during the holidays. For example, at a school with which I am familiar music courses are held during the holidays. Some clearer definition may be necessary in that respect.

Lord Laming: In regard to Amendment No. 2, leaving out the words from "centre" to the end of line 8, what is a "residential family"?

Lord Hunt of Kings Heath: In regard to whether the definition of "295 days" is appropriate, there is no intention to capture schools with normal terms which run residential courses during the holidays, as many do. As regards the definition included in the clause, the key reference is that the accommodation is provided for children for more than 295 days. I take that to mean children receiving schooling for more than 295 days in any one year, rather than a school using the holiday period for other children's holiday activities. The provision repeats the wording of the Education Act. I am satisfied that it does not need further clarification. However, I shall be happy to examine it in the light of the noble Lord's comments.

Lord Clement-Jones: I thank the Minister for having had the courtesy to write to me about one of the amendments that he has tabled. His case is clearly that the provision in the Bill is largely a reintroduction of provisions included in the Children Act but with the exception of independent schools approved for the education of children with special educational needs. What consultations have taken place with such schools about the provisions? After all, this is a major new piece of regulation for them.

Lord Jenkin of Roding: Perhaps I may take up the point made by the Minister in his reply to the noble Lord, Lord Northbourne. He said that it is not the intention of the clause to catch, for instance, schools that run music courses during the holiday. However, it may be desirable to reflect that point in the Bill rather than merely in a statement from the Front Bench.

On another point, independent schools are increasingly taking pupils from overseas. It is by no means unknown, particularly in the shorter school holidays, for some of those pupils to remain at the school, possibly being looked after by the family of one of the masters, during the Christmas and Easter

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vacations. In those circumstances a school may find itself with several children who are there for more than 295 days. Would that convert the school into "a children's home", whereas otherwise that would not happen?

3.15 p.m.

Lord Hunt of Kings Heath: Perhaps I may deal first with the issue of special schools. We are extending the dual registration arrangements to cover independent special schools, which are not currently covered. That will bring a further 100 or so special schools into the regime. That is an important safeguard. Children who attend such schools will receive the extra protection provided by dual registration.

As regards the more general issue raised by the noble Lord, Lord Jenkin, I have said that I will reflect on the point raised by the noble Lord, Lord Northbourne, to make sure that the definition contained in the amendment does not cause problems to schools which use school premises outwith school term time. I repeat that the wording in the amendment follows current legislation. I am not aware that the present law has caused any problems to individual schools, either in the terms in which the noble Lord spoke or in terms of the point raised by the noble Lord, Lord Jenkin, regarding people coming from abroad who might stay in school premises.

Baroness Masham of Ilton: I am very pleased that special schools have been included, but why were they not included in the first place? It is well known that some of these schools were strongly considered to be at risk and that serious abuses have taken place throughout the country.

Lord Hunt of Kings Heath: It would be difficult for me to explain why special schools were not included in legislation that was enacted some years ago. The noble Baroness is right to point out the importance of introducing the safeguards into this Bill.

As regards the point about independent schools in relation to children with special needs, the originating concern came from the children's safeguards review. In reply to the noble Lord, Lord Clement-Jones, we have not yet held detailed discussions with the schools affected. However, I assure the noble Lord that we shall discuss detailed arrangements with them in due course.

Lord Laming: Will the Minister indicate what the term "residential family" means?

Lord Hunt of King's Heath: The amendment is not aimed at omitting the word "centre" but the word "or". It is a drafting point in order to introduce a new definition of a dual registration school.

On Question, amendment agreed to.

Lord Hunt of Kings Heath moved Amendment No. 2:

    Page 2, line 7, leave out from ("centre") to end of line 8.

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On Question, amendment agreed to.

Lord Hunt of Kings Heath moved Amendment No.3:

    Page 2, line 9, at end insert--

("(5) Subject to subsection (6), an establishment is not a children's home if it is a school.
(6) An independent school is a children's home at any time if at that time accommodation is provided for children at the school and either--
(a) in each year that fell within the period of two years ending at that time, accommodation was provided for children, either at the school or under arrangements made by the proprietor of the school, for more than 295 days; or
(b) it is intended to provide accommodation for children, either at the school or under arrangements made by the proprietor of the school, for more than 295 days in any year;
and in this subsection "year" means a period of twelve months.").

On Question, amendment agreed to.

Clause 1, as amended, agreed to.

Clause 2 [Independent hospitals etc.]:

Lord Clement-Jones moved Amendment No. 4:

    Page 2, line 12, at end insert ("and for the purposes of this Act an independent hospital shall include private patient units within a health service hospital").

The noble Lord said: I beg to move Amendment No. 4, the purpose of which is very similar to that of the two following amendments and the amendment in the name of the noble Earl, Lord Howe, and noble Lords on these Benches. I am sure that the noble Earl will have more to say on the subject. This is perhaps a fairly crude amendment but it is designed to deal with the straightforward question of whether or not NHS pay beds should be subject to regulation under the terms of the Bill. Currently, such beds are not subject to review by the Commission for Health Improvement under the Health Act which we debated some months ago. This amendment is designed simply to bring into the fold those NHS pay beds which, after all, should be treated on the same footing as those provided by any other independent healthcare provider. If they are not brought within the terms of the Bill, no form of inspection or review will be applicable to them. What guarantee can patients in those NHS pay beds have of good clinical practice?

I am very happy to see NHS trusts raise further funds by the provision of NHS pay beds. It is good to have a "mixed economy" in that sense. But I believe that one of the key matters in this Bill--as it was when we debated the Health Bill (now the Health Act)--is quality. The professions are themselves putting their house in order in terms of clinical governance. I believe that the Government in turn should ensure that the inspection and review regime is seamless not only across the NHS and the private sector, but also within the private sector. Both the private care sector and consumer interests believe strongly that that is a glaring omission. This particular amendment has been proposed by consumer organisations which feel strongly that, for the sake of the patients, Amendment No. 4 should be accepted by the Government.

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Earl Howe: I rise to speak to Amendments Nos. 11 and 18 in my name and to support strongly the observations of the noble Lord, Lord Clement-Jones. The Government are in a terribly complicated muddle over the regulation of private healthcare. The delivery of healthcare in this country does not issue forth from two conveniently separate channels, one labelled "public" and the other "private"; it is not as simple as that. The NHS frequently sub-contracts to the private sector, most notably in the field of mental health, and there are private wings and beds in NHS hospitals. If one decides, as the Government appear to have done, that, despite all the interdependence between the public and private sectors and the facts that most consultants work in both sectors and that the same patient can be treated in one sector and moved to another for further treatment, the public sector is to be regulated in one way and the private sector in another, anomalies are bound to occur.

My understanding based on the debates last year on the Health Bill was that the Commission for Health Improvement would be the regulator of all healthcare funded by the public sector, including care delivered to NHS patients in private hospitals. We shall deal with that anomaly when we debate Amendment No. 31. Meanwhile, I should like to hear from the Minister whether my understanding is correct. Now that we are about to have a national care standards commission with a separate division responsible for regulating private hospitals and clinics, are we to suppose that in practice CHI may sub-contract to the commission the job of overseeing NHS patients in private hospitals?

The anomaly addressed by this amendment, however, relates to NHS pay beds. Many people, including myself, are still unclear as to what role, if any, will be played by the Commission for Health Improvement in the supervision of standards in private wings and wards of NHS hospitals. The Minister was kind enough to address this issue in his winding-up speech at Second Reading, but I am afraid that I did not understand it, even on re-reading what he said. If CHI is not to be involved in the regulation of NHS pay beds, surely it follows that the national care standards commission must be; NHS pay beds cannot be left out in the cold.

The trouble with the Bill is that it begins by categorising different kinds of care services in terms of the physical premises that they occupy. That might have been the best that the lawyers could do, but it makes life awkward when part of the Bill is devoted to NHS care and part is related to private care. My amendments try to find a way through it by defining a new type of establishment; namely, an income-generating health service unit. Such a unit is, in other words, a private ward or wing of an NHS hospital. Under this proposal, the NCSC will assume responsibility for NHS pay beds alongside its responsibility for monitoring standards in private hospitals. I hope that that proposal is a logical one;

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certainly, it is meant to be constructive. I hope that the Minister will view that amendment with some sympathy.

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