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Lord Clement-Jones: Before the noble Baroness, Lady David, responds, perhaps I can make a few points. That was one of the most helpful responses the Minister has made this evening. A number of green shoots were lurking in his remarks which may grow into something larger as the Bill progresses through the House. In particular, what we need, even as regards matters in the Bill, is a little more teasing out of the chapter and verse. For instance, the Minister says it is a condition of registration that specific establishments must have a complaints system. Indeed, he went on to say that the requirement would be to provide an independent element to investigate complaints. On the face of it, the Bill makes no provision for that. However, that is a helpful indication of the way in which the Government's mind is working.

It was extremely helpful for the Minister to say that the commission should have an active role in pursuing complaints and that it will accept complaints and have wide powers. But again, that is not obvious from reading the Bill. In order to accept his view--I take it in good faith--that an independent review panel and public complaints directors are not needed as part of the commission, it is important that he provide us with further information as to the regulations proposed and as to how the Bill might be amplified in that respect. I appreciate his statement that alleged breaches of standards will be investigated by the commission and also that, within his definition, "services" is wide enough to encompass clinical services.

I was interested to hear the Minister talk of complaints in the independent healthcare system and the fact that there needs to be a clearly identified person in that regard. But, further, he said that the Government are committed to introducing an independent complaints mechanism and that there is no difference in principle between us. As I explained

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from these Benches, in a sense we were presenting some a la carte possibilities; the mechanisms are myriad, it is the principle that matters. The Minister's statement that he was considering how best to deliver that independent complaints system for private healthcare was a strong indicator.

I hope that the Minister will bring forward his proposals for amending the Bill at the Report stage here. Otherwise, we will engage in fruitless discussions, coming up with a further set of amendments, none of which will probably satisfy the Government. It would be much more satisfactory if the Government came back at Report stage with their amendments.

Baroness David: This has been an extremely useful and rewarding debate. It is clear from the number of amendments put down that the complaints procedure is not satisfactory as it stands in the Bill. I was relieved when the Minister said that he would come forward with amendments. As the noble Lord, Lord Clement-Jones, said, I hope that we shall have them at Report stage and that the Minister will reassure us about that. It would save a great deal of time, and avoid our putting down more amendments at the next stage, if he produces them, as I hope he will.

It is clear that the provision in the Bill is not satisfactory. We need the independent element which I stressed in my amendment, as did many other Members of the Committee. If we could have the assurance that we shall receive the amendments at Report stage, I should be happy to withdraw my amendment.

Lord Hunt of Kings Heath: I said that we would hope to introduce amendments either here or in another place. The matters are important and deserve careful consideration but while I should like to give the undertaking for which my noble friend asks, I am not in that position. It is our intention, before the Bill has completed its passage through Parliament, that amendments be brought forward.

Baroness David: I have to accept that, but if the Minister could put pressure on his department, it must be possible to produce something in another fortnight and I hope he will try to use his charm and pressure to bring amendments forward. However, I must now withdraw my amendment.

Amendment, by leave, withdrawn.

[Amendment No. 30 not moved.]

9.30 p.m.

Lord Clement-Jones moved Amendment No. 31:

    Page 5, line 6, leave out from ("than") to end of line 8 and insert ("the "excepted services" as defined by subsection (8) below.

(8) The "excepted services" means the provision of--
(a) medical or psychiatric treatment, or
(b) listed services (as defined in section 2).
(9) The Commission shall have the general duty of securing improvements in the quality of excepted services in independent hospitals (as defined in section 2) and shall carry out this duty through the contracting of inspections with the Commission for Health Improvement ("CHI") established by the Health Act 1999.

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(10) For the purposes of subsection (9) above the Commission shall ensure that the relevant independent hospital pays the full economic costs of any inspection.
(11) The standards applied by CHI on any such inspection shall be those which it applies in any comparable inspection of a health service hospital.").

The noble Lord said: We were talking earlier in the debate about standards being consistent and seamless across the NHS and the independent healthcare sector. That is precisely what the amendment seeks to do. We on these Benches could have been more radical and the noble Lord, Lord Laming, has perhaps been the most radical among us, in trying to abolish Clause 2 in its current form. I have a huge amount of sympathy with that approach. I believe that independent healthcare has been bolted onto the Bill in an inappropriate and last-minute fashion.

However, I have been thinking carefully about the way in which the Government put their case for a separate regulator and subsequently mentioned, as the Minister did today, the difference between regulation of the independent sector and management of the NHS. I have no doubt that we will repeat that mantra for the remainder of the Bill as it goes through the House.

It struck me that the best way of dealing with the matter is simply to say, "Let's not worry too much about the registration mechanisms, let's have a separate registration mechanism for the independent healthcare sector. It would be entirely appropriate and deals with the issue of regulation. But when it comes to standards, let's try to ensure that across the board the same standards are applied on inspections in the independent healthcare sector as in the NHS." That seems to me the common-sense formula.

If you asked ordinary people in the street whether they thought there should be separate and different standards in private healthcare from the NHS, they would be horrified. They would have thought it the Government's duty to ensure that standards were common right across the board. That is what the amendment aims to achieve. It proposes that the commission could contract,

    "with the Commission for Health Improvement",

set up under the Health Act 1999, to carry out its function of inspecting the independent healthcare sector. Consistent standards between the NHS and the independent healthcare sector could then be ensured. CHI would be in a position to use the expertise gained from inspecting NHS services and facilities and the same limited pool of expertise could be used for the independent healthcare sector. We propose that the relevant independent hospital pays the full economic cost of any such inspection. No one is suggesting that taxpayers should pay for CHI to inspect private healthcare. That was certainly a concern in the minds of Ministers when we tabled amendments to the then Health Bill last year.

This measure does not overturn the apple cart; it simply ensures--as I am sure the majority of Members of the Committee who have spoken in the debate today are intent on ensuring--that there is a common and consistent standard across both sectors. The BMA

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supports this measure and I know that there is considerable professional support for this set of amendments. It seems to be common sense that those people with expertise as regards review and inspection of NHS facilities should also take responsibility on a sub-contracted basis for carrying out that inspection in the private healthcare sector. I beg to move.

Earl Howe: I can be brief. I rise simply to endorse everything that the noble Lord, Lord Clement-Jones, has said. When we debated the then Health Bill on 17th June last year, the noble Baroness, Lady Hayman, said, in relation to the document entitled Regulating Private and Voluntary Healthcare,

    "the consultation document does, however, acknowledge that a regulator might wish to contract with another body, such as the commission for health improvement ... in order to help carry out ... inspections. That is an issue on which we explicitly invite views".--[Official Report, 17/6/99; col. 459.]

The view of these Benches is that an arrangement of that kind, a standing arrangement, would be a neat way of squaring the circle. It would be a neat way of creating at a stroke a means of delivering what we all want to see, which is consistency of clinical and care standards across the private and public sectors of healthcare, and consistency of enforcement. The Government's position on using the Commission for Health Improvement to regulate the private sector directly is well documented. I do not want to re-open that debate this evening. What we are talking about here is using the Commission for Health Improvement in a strictly limited role as a sub-contractor to the NCSC for a fee to inspect hospitals and monitor standards of care. Is the Minister now in a position to say what conclusions the Government have reached as regards this wider role for the Commission for Health Improvement?

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