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Lord Hunt of Kings Heath: I thought that the main issued being raised here by the noble Lord was the question of an establishment that might fall under the category of a care home or under the category of an independent hospital. I have been trying to make it clear that the care standards commission will need to make judgments according to the regulations and the national minimum standards laid down as to how a particular home is to be registered. In the registration document, specific reference will be made to the services that are to be offered in that particular establishment.

As regards clinical governance, as it were, in care homes, inspectors will visit both residential care homes and nursing homes to check on the healthcare provided to ensure that it is appropriate. I can assure the noble Lord that regulations and standards relating to such provision of healthcare will be laid down. I hope that I have now addressed the noble Lord's queries a little more clearly.

Lord Clement-Jones: I thank the Minister for that reply, but I am afraid that I must reply, "Not really" to his last comment. I shall read carefully all his responses in Hansard. However, we may well return to the issue because the point here is not only the precise definition of a "care home". We must be assured that a regulatory regime will apply just as much to the social care being provided within those establishments as it will to the provision of healthcare. It is vital that we achieve the right balance.

One problem in the Bill is that of trying to match the two halves of social care and it is a key issue that we must face as we progress through our discussions. In the mean time, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Rix moved Amendment No. 8:

The noble Lord said: At the Second Reading of the Bill, befuddled though I was by the dreaded lurgy--although I was one of the 8 million who had the jab--I hope I made it clear then how much both I and Mencap, of which I am president, welcome this landmark Bill. For that reason, noble Lords may wonder why I have tabled so many solus amendments. Quite simply, I want to make certain that the improvements in standards for social services and the new safeguards being offered to service users apply equally and appropriately to one of the most vulnerable groups affected; namely, people with a learning disability.

I have had the privilege of submitting a paper regarding those concerns to the Minister, as well as having a lengthy meeting with him and his officials, at which they were most helpful. As a result, I have tabled

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28 amendments which appear to be alone and palely loitering, but I believe that the Minister will be well prepared with his responses and I can only hope that those will be favourable.

In speaking to Amendment No. 8, perhaps I may speak also to Amendments Nos. 9 and 10. The amendments to this clause all seek to remove the word "suffering" from the statutory definitions used in the Bill for people with disabilities, illnesses or substance dependence. I do not doubt that we can all cite examples of people who have indeed suffered within the context of all three sets of circumstances; none the less, I do not believe suffering to be integral to any of them. At best the term is superfluous and at worst it is confusing.

My particular concern is with the use of the word "suffering" in relation to people whose disability constitutes impairment of the intellect or a learning disability. As I have outlined on many occasions, suffering indicates the endurance of pain and implies the possibility of eventual cure, neither of which are normative expectations of people with learning disabilities. The noble and learned Lord, Lord Williams of Mostyn, was good enough to remove the term "suffer" from the definition of disability used in the Youth Justice and Criminal Evidence Bill in the previous Session. I hope that that will be accepted as a precedent and I urge the Minister to do the same in the context of this legislation. I beg to move.

Lord Jenkin of Roding: When I read the amendment and found that I agreed with it, I am afraid that I had not appreciated the intricacy that lay behind it, which the noble Lord, Lord Rix, has just explained to the Committee. In my innocence, I thought that the noble Lord was engaged in a proper process of using the English language correctly; namely, using one word instead of three. I was prepared to applaud that and wondered whether I should have worked through the Bill with the same kind of toothcomb. The tendency to use convoluted phrases rather than simple English is something to be deplored. If that was all that the noble Lord, Lord Rix, was seeking to remedy with his amendment, he would have my full support.

However, that is not all. The noble Lord has made another most important statement. Those of us who have had responsibility for organisations that look after people suffering from handicap of whatever kind would simply say that "suffering" is not the right word to use. It is therefore for two reasons that I hope that the Minister will be able to make a short speech to tell the Committee that he will be happy to accept all three amendments. I believe that they have a great deal to commend them.

Lord Addington: The noble Lord, Lord Jenkin, has already said much of what I was going to say. However, I should like to emphasise that when you have a disability, you generally have that disability for life or for the long term. "Suffering" and "illness" are confusing words in this context and they put out the wrong message. They also suggest that a person will get better. We are referring here to hidden disabilities,

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which are not dealt with directly in the Bill but are often referred to elsewhere. We must remember that legal language always makes reference both backwards and forwards through legislation. If one is suffering from an illness, one may recover from it. However, with a disability it is more likely that coping strategies will be developed. For that reason, if any ambiguity can be removed from the face of the Bill, that will aid not only the legislation before us, but also other Bills in this area. Furthermore, I can only concur with the noble Lord, Lord Jenkin, that one word is invariably better than three.

Lord Laming: I rise briefly to support the amendment tabled by my noble friend Lord Rix. I shall not detain the Committee as it has already been clearly stated that two strong reasons have been given in support of it. The amendment certainly has my support.

Lord Hunt of Kings Heath: I shall be brief. I fully understand the desire of the noble Lord, Lord Rix, to ensure that the wording of the Bill is as modern as possible when describing people who receive care services.

If the noble Lord will allow me, I shall take this amendment away and discuss the exact wording with him between now and Report stage. We shall then ensure that the Bill is rectified in due course.

Lord Rix: I shall be happy to accept the proposal of the Minister so long as we agree that one word should be used rather than three. I am sure that this marks the beginning of a happy new year so far as concerns the Care Standards Bill and I hope only that my other amendments will be accepted as speedily and with such aplomb by the Minister. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 9 and 10 not moved.]

Clause 3 agreed to.

[Amendment No. 11 not moved.]

5.30 p.m.

Clause 4 [Other basic definitions]:

Lord Clement-Jones moved Amendment No. 12:

    Page 3, line 11, at end insert--

("( ) "Home-based health care agency" means an undertaking which consists of or includes arranging the provision of health care that requires the supervision of a registered nurse or doctor in their own homes.").

The noble Lord said: The next group contains a large number of amendments. I shall speak to all of them except Amendment No. 17 standing in the name of the noble Lord, Lord Rix. The intention of my amendments is to draw attention to the number of gaps in Clause 4. Voluntary organisations are concerned that, as presently drafted, Clause 4 does not include some establishments that should be included.

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I am looking for the Minister's reaction to the establishments which we have set out in our amendments.

Amendment No. 12 deals with the home-based care agency, which we define as meaning,

    "an undertaking which consists of or includes arranging the provision of health care that requires the supervision of a registered nurse or doctor in their own homes".

We are talking here about home care, which in many ways seems to lack regulation in terms of the Bill.

Amendment No. 13 deals with respite care. I shall not go through the full definition. If, before tabling my amendment, I had seen the amendment of the noble Lord, Lord Rix, I certainly would have taken on board that much shorter and more desirable form of words. It is necessary to regulate respite care, which is not currently covered by the Bill.

Of even greater importance is the question of sheltered housing. Voluntary organisations in this sector are concerned that some close care sheltered housing might be care homes in disguise and might well become so in order to avoid inspection. The provision of such housing is growing and it is often financially driven because housing benefit is available. But people being cared for in that setting are frail and vulnerable and deserve the same protection as that afforded to those in care homes.

Amendment No. 16 deals with daycare centres, in relation to which there is a major hole in the Bill. Our definition may not be the most felicitous, but we have tried to bring in the kind of daycare that is generally thought of as being such. We do not understand why such daycare centres are not being brought within the terms of the Bill.

The other amendments in the group are by and large consequential except those dealing with nursing agencies. This issue has given rise to considerable discussion, particularly within the nursing organisations. Clause 90 abolishes the Nurses Agencies Act 1957, which required nursing agencies to be inspected and listed and that the placing of nurses by an agency should be supervised by a registered nurse. However, local authorities were applying the Act patchily and at least one local authority was not aware that it was supposed to be carrying out those duties. The intention of our amendment is that nursing agencies should be regulated in the same way as doctor and other medical employment agencies are regulated under the Employment Agencies Act. However, if that was followed through in the Bill, it would mean that the requirement for agencies to inspected, listed and supervised by a nurse would be lost.

We believe that that would be undesirable and that the requirement should be retained. The amendment would require nurses to be registered and inspected by the commission and would allow, under regulations, for nurse supervision of that. We believe that there are significant differences between the operation of nursing agencies and agencies supplying doctors. A nursing agency will supply nurses often at very short notice and often for very short periods--sometimes for just a few hours. In those circumstances, it is not

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always possible to ensure that the nurse is qualified and suitable for the placement. For doctors, it is normal for CVs to be sent by the agency to the client and for placements to be of a longer duration.

There is significant concern, particularly in the voluntary sector, that there are gaps in the Bill. I look forward to the Minister's response to the amendments. I beg to move.

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