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Lord Hunt of Kings Heath moved Amendment No. 2:

But an establishment in which, or for the purposes of which, services are provided by medical practitioners in pursuance of the National Health Service Act 1977 is not an independent clinic.
(4A) "Independent medical agency" means an undertaking (not being an independent clinic) which consists of or includes the provision of services by medical practitioners.
But if any of the services are provided for the purposes of an independent clinic, or by medical practitioners in pursuance of the National Health Service Act 1977, it is not an independent medical agency.").

On Question, amendment agreed to.

[Amendment No. 3 not moved.]

Lord Hunt of Kings Heath moved Amendment No. 4:

    Page 3, line 7, at end insert--

("( ) except any description of undertaking from the definition in subsection (4A);").

On Question, amendment agreed to.

Clause 3 [Care homes]:

Lord Rix moved Amendment No. 5:

    Page 3, line 13, leave out ("suffering from illness") and insert ("ill").

The noble Lord said: My Lords, during Committee stage of this Bill I made the case for removing the word "suffering" from its association with the basic definition of terms such as "disability" on the grounds that it is both negative, and in many cases inaccurate. A number of your Lordships supported my suggestion for the same reason and for reasons of linguistic economy.

In the interests of linguistic economy, I shall keep my comments brief. I am delighted that the Government have already indicated that they are minded to accept my Amendments Nos. 5, 6 and 7 in relation to all three definitions in Clause 3. It demonstrates that the law can be modernised and used in more subtle and accurate ways. I beg to move.

Lord Addington: My Lords, I congratulate the noble Lord on having done away with suffering.

Lord Hunt of Kings Heath: My Lords, I am most grateful to the noble Lord, Lord Rix, for proposing these amendments. As he has indicated, I am pleased to accept them.

On Question, amendment agreed to.

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Lord Rix moved Amendments Nos. 6 and 7:

    Page 3, line 14, leave out ("suffering from disability or infirmity") and insert ("who are disabled or infirm").

    Page 3, line 15, leave out ("suffering from dependence") and insert ("dependent").

On Question, amendments agreed to.

Clause 4 [Other basic definitions]:

Lord Rix moved Amendment No. 8:

    Page 3, line 41, at end insert--

("( ) "Day Services" means any centres or other facilities for daytime training or occupation, including arrangements for supporting people using facilities generally available to members of the public, funded or provided, directly or indirectly, by a public authority for the use of persons over pension age or persons with a physical or mental disability.").

The noble Lord said: My Lords, I am dazed with expressions of gratitude! I speak to Amendment No. 8, which is grouped with Amendments Nos. 9 and 67. Amendment No. 8 will be familiar to noble Lords who braved the Care Standards Bill in purging the excesses of Christmas! As we are now approaching Easter, I am sure that your Lordships will not mind if I recap briefly.

This amendment seeks to include day services within the range of provisions regulated and inspected by the new commission for care standards. It is, quite frankly, absurd to legislate to protect the interests of vulnerable children and adults and then create exceptions based on where that care is provided. This is no minor exception. A substantial number of people with learning disabilities, young and old, spend a significant proportion of their week in the care of day services, and I suspect that the numbers relating to older people generally are also fairly substantial.

In Committee the Minister advised the Chamber that a power exists in the Bill to bring in day services at a later date. He also said that the omission of day services relates to the practical question of what can sensibly be undertaken by the commission. Today I urge the Minister to accept that practical challenge and clearly direct the commission to take responsibility at the earliest opportunity for care standards in day services for children and adults.

I am aware that from the outset staff working in day centres will be covered by the new general social care council provisions, and that is indeed welcome. However, I should be grateful if the Minister would clarify the extent of the coverage in this field. I look forward to the Minister's explanation of his Amendment No. 67, which is grouped with mine. Day care staff rarely remain in one geographical location while discharging their duties. These days, day care can cover a wide range of activities including sports, training, visiting libraries and other community resources. One would expect staff to be covered in all these settings, not just within the four walls of the day centre.

One final concern is whether staff undertaking a supervisory role in wider day service settings will be understood as providing "personal care" as the Bill requires. I should be grateful if the Minister could assure me on the breadth of the term "personal care"

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as interpreted in the Bill and as mentioned in his amendment. I hope that the Minister will be able to assure the House that he accepts the need to offer greater protection to the users of day services. I believe my amendment to be well within the spirit of this important piece of legislation. I beg to move.

Lord Clement-Jones: My Lords, I wish to second everything that the noble Lord, Lord Rix, has said. These Benches tabled a similar amendment in Committee, but we thought that it was best to join forces on Report, especially as we thought that the Minister might bring forward his own amendment. I am delighted to see that that is the case. It is clearly not only necessary to have a definition of "day services", but also to have the Minister's assurance of when that regulation will come into effect. We very much hope that in addition to putting forward his amendment, which we believe defines in a perfectly satisfactory way what those day services should be, he will also give us the kind of assurance that we sought in Committee; namely, that that regulation will be introduced as soon as practicable.

Lord Renton: My Lords, I apologise if your Lordships cannot hear me but I shall do my best. The Government are to be congratulated on the fact that in this Bill they have set out in the early clauses rather than the late clauses the ways in which it needs to be interpreted. Up to a point they have done that well. However, they have left out one or two things that ought to have been included, including the definition of "day services", for which the noble Lord, Lord Rix, has now put forward a definition and a useful amendment.

In order to save time, perhaps I may say in passing that the starred amendment of the noble Baroness, Lady Masham, seeks to introduce a definition of a "nursing and care staff agency". Both definitions will help with the interpretation of the Bill. I hope that the Government will regard the amendment of the noble Lord, Lord Rix, with which we are now dealing, very sympathetically.

3.30 p.m.

Lord Hunt of Kings Heath: My Lords, I am grateful for the contributions that have been made in regard to this very important question. I am particularly grateful to the noble Lord, Lord Rix, for raising this matter both at Second Reading and in Committee.

Let me begin by speaking to my own amendment to Clause 52, Amendment No. 67. Clause 52, which sets out the definition of a social care worker, allows for regulations to provide for staff in day centres to be defined as social care workers. It was pointed out in Committee that the Bill contained no definition of the term "day centre". My amendment provides that. It covers establishments that provide nursing or personal care on a non-residential basis, wholly or mainly for persons who are or have been ill, are disabled or infirm, or who are or have been dependent on alcohol or drugs.

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I have given careful thought to the issue of regulating day care in the light of the concerns expressed in our earlier debate. As noble Lords will remember, I said then that we must be careful not to overload the commission as it takes on its considerable and vital responsibilities, and that it would therefore not be practical to regulate day care from the start. But I said that the power existed in Clause 40 of the Bill to introduce regulation for further services, such as day care, at a later date.

From today's discussions it would appear that noble Lords--although they understand the necessary constraints that there must be when getting new arrangements off the ground--wish for greater certainty about our intentions for regulation in this area. I can confirm today that we will use the powers in Clause 40 to introduce regulation by the national care standards commission of day centres which provide nursing or personal care.

For the reasons that I gave at Committee stage, it will not be possible to do this from the start of the commission's life, but we will carry out a review within one year of the commission being established to decide the details of exactly how and when the regulatory regime will come into force.

Amendments Nos. 8 and 9 define "day services" more widely than those services that are provided in day centres. I have discussed with the noble Lord, Lord Rix, his concerns that a lot of activities for people with learning disabilities are arranged by day centres but take place outside the centre and may therefore not be covered by the provisions of the Bill. Regulation of dispersed day services not attached to a particular facility and not specific to those receiving care would present significant difficulties in terms of definition and boundaries. However, regulation of day centres will include inspection of fitness of staff and the appropriateness of activities arranged in and through the centre. An additional safeguard will be, as I have said, that day centre staff, as social care workers, will come within the remit of the general social care council.

The definition of "personal care", on which I was asked to comment, is to be found in Clause 97(3) of the Bill, which states:

    "In this Act, the expression 'personal care' or 'nursing or personal care' extends to advice and encouragement, but does not include any prescribed activity".

In essence, the term "personal care" is mainly intended to cover assistance with bodily functions--such as washing, feeding, dressing, toileting--and the words "includes assistance with bodily functions" are used in the Registered Homes Act.

The commitment I have given today means that for the first time there is a clear guarantee that day centres will be subject to a system of regulation and inspection to ensure proper standards of care and protection. In the light of that commitment, I hope that noble Lords will feel able to withdraw their amendments.

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