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Lord Laming: If Clause 2 is to remain, I hope that the Minister will see this as a lifeline that he can grasp and hold to himself. I support the measure.
Lord Hunt of Kings Heath: I fear that I am not yet desperately diving for that lifeline. Although the noble Earl, Lord Howe, does not want us to go back over old ground, I must say that the Government's position in relation to the Commission for Health Improvement rests very much in the first instance on the different set of arrangements which we believe to be made in relation to the regulation of private healthcare and the management of the National Health Service. It is fair to say--this was always intended--that the Commission for Health Improvement was set up expressly to improve quality in the National Health Service. It has a major task to carry out in doing that. I do not believe that it would be right for the commission to be diverted from that task by taking on the job of inspecting private sector healthcare.
The very purpose of setting up a national care standards commission is to do that, as well as to regulate and inspect social care. It will have independent inspection teams which will be drawn from those people who are well able to carry out the
task. It will also be able to draw expertise from elsewhere, including from the Commission for Health Improvement, to help it in its work. I refer the Committee to Schedule 1 which I believe contains the ability for people to be seconded from agencies such as the Commission for Health Improvement to the care standards commission to help it in its work.However, the amendment goes further. It would require the Commission for Health Improvement to use the same standards in its inspections of the private sector as it does in its inspections of the NHS. That ignores the fact that we shall be setting out clear standards for the private sector which the commission's inspectors will be charged with enforcing.
It would be wrong to create a rigid requirement on the national care standards commission to have to sub-contract all its inspection work to the Commission for Health Improvement and to require exactly the same set of standards in this sector as in the NHS. I accept that inevitably in the development of national minimum standards the commission is bound to be informed by the work of NICE, CHI, national service frameworks and other service developments within the National Health Service, but, at the end of the day, it must be down to the commission itself to develop those standards and to have its own inspection arm in order to ensure that those standards are being kept to.
Lord Clement-Jones: I am disappointed by the Minister's reply, although it was not unexpected. The Minister has recited the mantra of regulation and management once again. He said that CHI would be diverted if it were to carry out these inspections on contract from the commission. However, he said that the commission will have its own independent inspection teams which might have secondees from CHI. It seems to me that if one is going to have secondees from CHI, why on earth not simply--
Lord Hunt of Kings Heath: The ability to second some members of staff from CHI to the commission is on a different scale to what is proposed in the amendment. That would involve the Commission for Health Improvement in a major exercise of work at a time when we wish it to focus on its very important responsibilities in relation to the National Health Service.
Lord Clement-Jones: Of course it has very important responsibilities in relation to the National Health Service. But it is a body whose expertise is being built up; it will be an extremely valuable inspection force. It seems to us on these Benches that with a little bit of additional resource it could do extremely well in regulating the independent healthcare sector as well. If one is going to second from CHI into the commission, why not simply sub-contract to CHI rather than have all this business of secondment? That of itself recognises that CHI is a receptacle for expertise.
Lord Hunt of Kings Heath: I come back to the point I raised: it is a very different issue. It seems absolutely
sensible and a matter of common sense for an organisation such as the Commission for Health Improvement to be able to second staff from time to time to the commission--and, indeed, vice versa. But the noble Lord's amendment describes a relationship much more fundamental than that in which the sub-contracting of inspections is mandatorily passed over to the Commission for Health Improvement. That is very different.
Lord Clement-Jones: Before finally replying, perhaps I may ask the Minister whether or not he would accept an amendment that said the commission "may" sub-contract to CHI?
Lord Hunt of Kings Heath: No. As I said, the Bill already allows for the secondment of staff. I should have thought that that would have met the noble Lord's position.
9.45 p.m.
Earl Howe: In that case, why did the Government's consultation document specifically invite views on the possibility of the regulator contracting--as I quoted--with another body such as the Commission for Health Improvement? If they were not serious about that proposal, why did they invite views on it?
Lord Hunt of Kings Heath: We are an inclusive Government who wish to listen to what people have to say in this area as in other areas.
Lord Clement-Jones: I apologise for once again interrupting the Minister. Perhaps I may ask him how many representations he has received against the notion of sub-contracting to CHI.
Lord Hunt of Kings Heath: The noble Lord has floored me on that because I do not have the results of the consultation to hand. However, I would again draw the distinction between the ability of the commission to employ various mechanisms to enable it to do its job effectively, including the secondment of staff, and the very heavy-handed approach which the noble Lord has taken in this amendment. It would take away all discretion from the commission.
Lord Clement-Jones: I thank the Minister for that further reply. I would have thought that, rather than being heavy-handed, this amendment is an elegant one. However, there is no accounting for taste in these matters.
I understand the Minister's objections and I appreciate why he has become so animated when responding to the issues raised here. However, he mentioned that, if inspections by CHI were made as a matter of course, then the amendment would require the same standards. Yes, the amendment does require the same standards. That is precisely why it is the second half of the Minister's reply that worries me greatly. It appears that, by saying that the Minister will issue standards under Clause 21 and so forth, the possibility exists of having two separate sets of
standards, one for the independent healthcare sector and one for the NHS. That is exactly what this amendment seeks to avoid. Simply to say that the commission is bound to be informed by the experiences of NICE and CHI is not sufficient.However, I appreciate that we have different perspectives on the matter, although I believe that after our discussions today, the Minister's view is in a minority in this Committee. Inevitably we shall have to return to the matter at Report stage. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Hunt of Kings Heath moved Amendment No. 32:
- After Clause 7, insert the following new clause--
(" .--(1) The Assembly may charge a reasonable fee determined by it in connection with the exercise of any power conferred on it by or under this Act.
(2) The Assembly may provide training for the purpose of assisting persons to attain standards set out in any statements published by it under section 21.").
The noble Lord said: We now move on to more serious matters; namely, the question of fees. In moving this amendment I propose to speak also to Amendments Nos. 171 and 172. I should like to speak to the later amendments first because these relate to the national care standards commission. I shall then deal with Amendment No. 32, which provides similar powers for the Welsh Assembly.
Amendment No. 171 is very straightforward. It will allow the national care standards commission to run conferences, seminars and other training events for people who are registered with it--and indeed for anyone else who is interested in attending. The purpose of such events will be to improve the quality of services by helping people to meet the national minimum standards published by the Secretary of State under Clause 21. This is a sensible amendment and forms an important part of the commission's role in trying to ensure that good standards are reached.
Amendment No. 172 deals with fees. In general, the intention is that the running costs of the commission will be met from the fees paid by the regulated services. Fees will be set by the Secretary of State and will consist of a registration fee and an annual fee. These fees will cover the reasonable costs of regulation. However, there are some activities that the commission will carry out which it would not be fair to expect all regulated services to pay for. This amendment allows the commission to charge fees for these additional "non-regulatory" activities.
For example, the commission will be able to give advice and help to applicants, if requested, before they submit their application for registration. In practice, this type of advice can involve several hours' work and include meetings, site visits and so on. The amendment allows the commission to set its own charges to recover the costs involved. It also allows the commission to charge for any training events it puts on. In both cases,
I turn now to Amendment No. 32. This amendment has the effect of allowing the National Assembly to have the same powers for Wales as are proposed for the national commission in England in relation to providing training and charging fees. The only difference is that the assembly will not of course require the consent of the Secretary of State for any fees it wishes to charge. The provision appears as a new clause as Schedule 1 does not apply to the registration authority in Wales. I beg to move.
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