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Lord Rix: Perhaps I may intervene on the question of the inspection of day care services. Obviously, I am disappointed that for the moment the Committee cannot obtain from the Minister a direct promise. The Minister used the expression "in time". That fills me with slight perturbation. It may mean when I am dead and gone. I believe that the need to regulate and inspect day care services at the very earliest moment is as great as for any care homes or housing. The scope for abuse in day care services is limitless. I told the Minister of a court case in the London area that occurred only three or four years ago in which, in the context of day care services, a young woman had been constantly sexually abused by a man. I hope that during the passage of the Bill through this House the Minister will be able to return to the Dispatch Box and give a slightly more definitive statement as to the future inspection of day care services rather than the expression "in time".

Lord Jenkin of Roding: I endorse the observations of the noble Lord, Lord Rix. I believe that the general

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power in Clause 39 includes a number of activities which may not yet be in contemplation. We are dealing here with a whole group of vulnerable people. We have an ever-expanding population as people live longer and no doubt an ever-growing range of services may be available to it. To ensure that Clause 39 takes account of those matters which are not at present in contemplation is very sensible. It may well be that we shall want to consider whether it should be subject to affirmative rather than negative resolution. Nevertheless, it is there.

As to day care services, I believe that the noble Lord, Lord Rix, makes a very important point. I should like to consider whether an amendment can be tabled at a later stage of the Bill to place the Government under an obligation to extend the provisions of the Bill to day services so that we are not left with the rather vague and slightly depressing "in time". As Shakespeare said,

    "In time the savage bull doth bear the yoke".

But that might be a very long time. I believe that the case made by the noble Lords, Lord Rix and Lord Clement-Jones, is a very strong one and I hope that the Government will reflect upon it.

6 p.m.

Lord Laming: Experience has shown that legislation is not always implemented on the first possible day. Getting something into legislation which can be implemented when the commission is able to take it on seems an entirely sensible proposition.

Baroness Masham of Ilton: Perhaps I may ask the Minister about means testing. I believe he said that a care home with nursing was means tested.

Lord Hunt of Kings Heath: I was asked whether the new regulatory system would have an impact on the current arrangements for means testing. I said that the process of registration and the registration certificate would specify the type of home. If it were a nursing home, it would be specified as a nursing home. Therefore, that would not have an impact on the means testing arrangements currently in place or on the distinction between care homes and nursing homes.

Baroness Masham of Ilton: Is it correct that a care home is not means tested, whereas a residential home is?

If someone has to be in a home for weeks, who pays the mortgage and electricity bills, and the expenses of the children, or does the individual come out with large debts? If he is disabled and goes into hospital and perhaps into residential care, he loses his benefits. What happens when the bills pile up?

Lord Hunt of Kings Heath: The noble Baroness widens the debate somewhat. The Government appointed a Royal Commission on Long Term Care to consider some of the issues and the pressures on people faced with that situation. The noble Baroness will know that the Royal Commission reported some

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months ago with a majority report and a minority report. The Government are considering how we respond to that.

Lord Clement-Jones: It has been an interesting debate. Noble Lords have demonstrated, as always, their understanding and expertise in these areas.

The Minister's reply was welcome in some respects. He said that he would consider whether there were any gaps with regard to home-based healthcare agencies. He believed that respite care and close care sheltered housing establishments were caught by the terms of the Bill. I shall read carefully his words in Hansard.

The Minister also said that the necessary safeguards as regards nursing agencies would be put into regulation. I hope that regard will be given to the 1957 Act, aspects of which should be duplicated in the regulations. I refer in particular to inspection by a registered nurse. It may be right that the general framework of regulation should not be different but perhaps the system of inspection should vary from one type of agency to another.

The big disappointment--it has been expressed by other noble Lords--relates to day services. My amendment does not go as far as the amendment tabled by the noble Lord, Lord Rix. I prefer to be associated with the noble Lord's amendment. It is spot on with regard to the needs of those going out into the community from their care homes. That situation must be regulated by a certain date. The noble Lord Jenkin remarked that it was not good enough to say that at some stage in the future the matter will be regulated. During the course of the Bill we should like an undertaking from the Minister that day services will be regulated at the earliest practicable moment. We understand about work loads. However, we should like a definition in the Bill. Then Clause 39 can be triggered at the earliest practicable moment. That is the solution towards which we are aiming. As we move towards Report stage and Third Reading, I hope that it will commend itself to the Government. In the mean time, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 13 to 22A not moved.]

Clause 4 agreed to.

Clause 5 agreed to.

Clause 6 [National Care Standards Commission]:

Baroness David moved Amendment No. 23:

    Page 4, line 20, at end insert--

    ("( ) It shall be the principal aim of the Commission to secure and promote the well-being of those cared for under the provisions of Part II of this Act.").

The noble Baroness said: Grouped with Amendment No. 23 standing in my name are Amendments Nos. 30, 45, 53, 65, 71 and 151 standing in the names of other noble Lords.

Amendment No. 23 introduces a principal aim for the national care standards commission. The amendment seeks to set in primary legislation the fact that the first duty of the national care standards

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commission should be towards the users of services--children, elderly people, and those with illnesses or disabilities--rather than the service providers.

The wording follows that used under Sections 37 and 41 of the Crime and Disorder Act 1998 in relation to the principal aim of the youth justice system and the corresponding duties of the Youth Justice Board. The principal aim under that Act was to prevent offending by children and young persons. The principal aim under this amendment is even simpler: to promote and secure the welfare of those who are cared for under the provisions of Part II of the Act.

The point of placing the commission under this primary duty is to make its job clearer and therefore easier. Without such a principal aim, other important considerations such as cost, staff morale, public/private management, or media or political opinion might have equal claim. Under Clause 7 the commission is placed under the vague general duties to inform the Secretary of State on availability and quality of services and to encourage improvement in that quality.

"Quality of services" is a phrase which can be used to defend all sorts of practices--for example, financial cuts under the name of efficiency--and needs greater precision, which the amendment provides. I hope that the Minister will look kindly on the amendment. I beg to move.

Earl Howe: I support the amendments. I speak in particular to Amendments Nos. 45, 53, 65 and 151. In the first instance, some of us approached the Bill in a state of high expectation only to find that it has a number of gaping holes, one or two of which have been mentioned. However, one of the most serious is the absence of any duty on the part of the national care standards commission to monitor clinical standards or to promote quality of care for patients in private hospitals. Indeed, from reading the Bill one could be forgiven for wondering where the well-being of the service users came in. That is why I identify myself with the remarks of the noble Baroness.

The Government's quality agenda should be all embracing. It should not be confined only to the public sector. Maintaining high standards should be an across-the-board objective. That was my complaint during the passage of the Health Bill. Ministers apparently believe that the main issue for government is the protection of private patients. With respect, that is no more than a tiny fraction of the issue. Standards in the private sector are high. Everyone wants them to be even higher. But what the Bill says is that for all practical purposes it is up to the private sector to deliver whatever standards of healthcare it wants. We have moved far beyond that stage. Indeed, I do not think that people understand the attitude that if it is not done in the NHS, it somehow is not proper healthcare. That attitude is plain silly as well as being a slap in the face to the private sector.

The point of giving the national care standards commission a duty to publish statistics relating to its remit, and combining that with a duty to promote

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quality, is to ensure that standards of healthcare in the private sector will be capable of being assessed on a like-for-like basis with those in the NHS. That, in turn, will promote a verifiable consistency of standards in both the private and public healthcare sectors, which we all want to see.

Private hospitals also have a duty to play their part in informing the public. That is why I tabled Amendment No. 65. I welcome Clause 20(3)(k), which appears to introduce for the first time a line of accountability within private hospitals between practitioners and managers. However, the words "appropriate quality" and "appropriate standards" in the subsection must be given meaning and substance in addition to an element of transparency.

The time has come when we should make the quality agenda a reality in all branches of healthcare, and the Bill provides a golden opportunity to do so.

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