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Lord Clement-Jones: I rise briefly to express my support for the noble Earl, Lord Howe, in this amendment. Indeed, our only quarrel with it is that it does not go far enough. We debated the issue of the remit of the Commission for Health Improvement and we certainly believe that that would ultimately be the best solution. However, pending that, or if that is not possible, clearly clarification is needed from the Government regarding their intentions on this separate division. As the noble Earl, Lord Howe, said, it is certainly unclear at this stage how that will operate in relation to the commission's regulatory role. There are important cultural differences between health and social services. They have different accountability mechanisms, different management systems, training requirements and budgetary arrangements. Therefore clarification is certainly needed as to exactly how that division will operate.
Will the national care standards commission have a separate board to oversee its functions? If so, how will that be composed? Will there be medical representation on that board, for instance? How will its members be constituted? How will this separate division be accountable to the chairman and board members of the commission? The cost of setting up the commission will, of course, be met by the Department of Health and the Welsh Assembly. However, once the commission is up and running it is unclear how the funding streams for the social care
and the independent healthcare sectors will operate. How will that relate to the separate division which the department intends to set up in this respect?
Lord Hunt of Kings Heath: I think that we ought not to go over the ground as to why private and voluntary healthcare is to be regulated within one national commission. As the Committee will know, the original intention was to have a separate regulator for the private healthcare sector but that was to run alongside the proposed eight regional care commissions. We decided that that was not the right way forward because we believe that consistency of approach throughout the country in relation to regulation is important. In bringing the proposed eight regional care commissions into one care commission it was then much more appropriate to include within those arrangements the private and voluntary healthcare sectors, which is what is contained in the Bill.
I have no disagreement with the contention that within the national care standards commission there has to be a high focus of expertise in relation to healthcare regulation. For that reason we intend that there should be a separate division of the commission to take forward that work. But where I part company with Members of the Committee opposite is as regards the suggestion in the amendment that there should be established a statutory committee within the national care standards commission to oversee the regulation of private and voluntary healthcare. The intention appears to be to establish a separate regulatory body for healthcare within the main commission with a status equal to that of the commission itself, with members appointed by the Secretary of State and with the right to establish its own independent committees and sub-committees. Obviously the details of this are probably not at all clear but I question whether that kind of structure is really workable within one corporate organisation.
I do not believe that it is necessary to go that far and to establish those kind of arrangements because, as I have said, we shall have a clearly identified division of the commission to handle regulation of private and voluntary healthcare. I believe that such a division will enable the commission as a whole to ensure that it has a proper focus on private healthcare matters, and that it will be able to have high calibre staff to advise on and operate the regulation of the private healthcare sector. I believe that that is the best approach. I also point out that the commission already has the power in the Bill to establish committees and sub-committees to help it carry out its work. There would be nothing to prevent the commission setting up a committee to look at, and be responsible for, issues in relation to private healthcare regulation. The commission being able to set up a committee is a very different matter from the proposal in the amendment to establish a statutory committee. That would make the relationship between the commission and the committee very difficult to manage.
Lord Jenkin of Roding: If it has done nothing else, the Committee stage of the Bill has exposed--I say this
in all charitableness to the Minister--the hollowness of the Government's arguments for their change of heart and for deciding not to have a separate regulator for private and independent healthcare. I have no doubt that between now and the Report stage, we on this side of the House--I hope I can include the Liberal Democrats in this--must come up with an amendment or a new clause which will fulfil what has clearly been the view expressed from almost all parts of the House: that the private and independent hospital service requires a completely different approach.It seems quite absurd that all the subjects we have been discussing about vulnerable adults, children, homes, child-minders and so on, should also take into account hospitals such as the King Edward VII, the Sister Agnes and the St John of God in Yorkshire, a wonderful voluntary hospital. I cannot believe that a sensible way of proceeding is for the high quality medicine which is practised in such hospitals to come under the same regime.
When we come to the later stages of the Bill, this House will want to send it on to the other place with a more sensible structure, perhaps with the CHI having extended terms of reference, or perhaps even with a separate regulator. With the greatest respect to the Government, that cannot be right.
Lord Clement-Jones: I agree with the noble Lord, Lord Jenkin. I am extremely disappointed by the Minister's reply. The noble Lord, Lord Jenkin, used the word "hollowness". I found the Minister's response extremely vague when set against the concrete nature of the amendment. It was difficult to discern precisely what kind of mechanism is intended for the running of the division. I do not think I received any particular answer to any of the questions that I posed about accountability, mechanisms, management systems and so on. I am sorry that the debate is taking place so late at night.
It all goes to show that the regulation of independent healthcare in the Bill is just an add-on; it has been bolted on. It is not coherent and should not be a part of the Bill.
Baroness Masham of Ilton: We should protect all patients. I am sure that many on the Cross-Benches will support the noble Earl, Lord Howe, at Report stage. There should be minimum clinical standards in whatever hospital.
Lord Howe: Like my noble friend Lord Jenkin and other noble Lords, I am disappointed with the Minister's response. He said that the proposal outlined in the amendment was not workable. I am not sure that he gave many reasons for that. It seems to me that there is every reason to think that a delegated structure would work. I see no reason why it should not.
The Minister failed to put any flesh on the bones as far as concerns the proposed separate division. He did not make clear what form the division will take; what the division will amount to; what the structure will be; who will run it, and so on.
I share the verdict of the noble Lord, Lord Clement-Jones, on the Minister's response. We must come back to this issue at a later stage because it is too important to let drop. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 161 to 170A not moved.]
11.30 p.m.
Lord Hunt of Kings Heath moved Amendment No. 171:
- Page 62, line 15, at end insert--
13A. The Commission may provide training for the purpose of assisting persons to attain standards set out in any statements published by the Secretary of State under section 21.").
On Question, amendment agreed to.
Lord Hunt of Kings Heath moved Amendment No. 172:
Page 62, line 19, at end insert--
14A.--(1) Subject to the provisions of this Act, the Commission may not, except with the consent of the Secretary of State, charge a fee in connection with the exercise of any power conferred on it by or under this Act.
(2) The Commission may charge a reasonable fee determined by it--
(a) for any advice, forms or documents provided for the assistance of a person who proposes to apply, or is considering whether to apply, for registration under Part II; and
(b) for any training provided by it under paragraph 13A.
(3) The consent of the Secretary of State for the purposes of sub-paragraph (1) may be given in relation to the exercise of a power either generally or in a particular case.").
On Question, amendment agreed to.
[Amendment No. 173 not moved.]
Schedule 1, as amended, agreed to.
Schedule 2 [Child Minding and Day Care for Young Children]:
[Amendments Nos. 173A and 173B not moved.]
Schedule 3 [Minor and consequential amendments]:
Lord Hunt of Kings Heath moved Amendment No. 174:
On Question, amendment agreed to.
Page 69, line 28, leave out ("registration") and insert ("appropriate").
The noble Lord said: In moving Amendment No. 174, I should like to speak also to Amendments Nos. 175 to 177. These four amendments are simply to change the shorthand term used in the Children Act, as amended by the Bill, to refer to the national care standards commission and the National Assembly for Wales. The term "registration authority" is potentially confusing as it could conflict with the new Part XA of the Children Act, as inserted by Part V of this Bill, which also uses the term "registration authority". There is no change of any meaning or substance as a result of these amendments. I beg to move.
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