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Lord Roberts of Conwy: My Lords, is the Minister in a position to give us an assurance that the provisions in Clauses 5 and 8 are adequate for the Assembly to perform and carry out its functions as the Minister has stated?

Lord Hunt of Kings Heath: My Lords, it is certainly my understanding that the construction of the Bill, subject to further amendments which I am shortly to move, will allow the Welsh Assembly to carry out its responsibilities but in the way it so decides.

I refer also to the noble Lord's remarks in relation to the discussions within the Welsh Assembly about the establishment of a children's commissioner. My understanding is that the Assembly's Health and Social Services Committee will be exploring the details of these proposals. They are to be discussed further on 5th April. Following those discussions, an amendment may be tabled to the Bill in another place.

I turn now to the other amendments in the group which all relate to changes to provide for the National Assembly for Wales to have parallel powers to those provided in the Bill for England.

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Perhaps I may make one further comment about the reasons for amendments being made at this time. It is worth reflecting that the Assembly was established only in July and that, clearly, a great deal of consideration has had to be given to how it would wish to operate the arrangements set out in the Bill. That has delayed the drafting of amendments. I regret that they are being brought before the House at this fairly late stage.

I deal first with the amendments to Clause 9. These are to give the National Assembly the same powers in relation to inquiries as the clause gives to the Secretary of State for England.

Amendment No. 58 in Clause 51 confers both an English and Welsh name on the care council for Wales, an approach taken also in the Government of Wales Act.

Lord Jenkin of Roding: My Lords, perhaps the noble Lord the Minister might be able to pronounce that for us: Amendment No. 58.

Lord Hunt of Kings Heath: Yes, my Lords: I should have known that was coming! I will try: Cyngor Gofal Cymru. I do not think my pronunciation is very good, but that is the best I can do and I stand to be corrected.

Lord Roberts of Conwy: My Lords, the Minister is quite right in saying that it is Cyngor Gofal Cymru.

Lord Hunt of Kings Heath: My Lords, the noble Lord is very kind to me there. Turning to Amendment No. 107, Clause 69 concerns inspection powers for the Assembly for daycare and childminding services. They will ensure that the Assembly has equivalent inspection powers to those of Ofsted in England, but necessarily modified to the circumstances of direct administration by the Assembly. In relation to the protection of vulnerable adults list, it has already been agreed between the Department of Health and the National Assembly for Wales that the list should operate as a single scheme covering both England and Wales. Part VI therefore confers powers on the Secretary of State on an England and Wales basis.

Amendment No. 110 in Clause 70 provides that regulations under Clauses 70 and 78 shall be made by the Secretary of State but that the National Assembly shall be consulted before any regulations are made. There are a number of amendments to Clause 97. As a result of the devolution settlement, the Government of Wales Act provides for receipts to the Assembly to be paid into its own budgets rather than into the Treasury's Consolidated Fund, where this has been specified by primary legislation.

Amendment No. 152 puts these procedures into effect in respect of fees collected under the provisions of the Bill. Amendment No. 153 is needed to deal with pre-devolution legislation being amended after devolution, and ensures that the references to the statute are always up to date. Amendment No. 156 splits Clause 97 into two clauses to create a separate clause to deal specifically with these Welsh details.

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Finally, I turn to amendments to the schedules. Most are very minor and simply ensure that the provisions apply equally to Wales and to England. However, one or two are worthy of specific comment. Amendments Nos. 159 and 210 make changes to reflect the position following devolution in respect of Welsh public records and the Welsh Administration Ombudsman. Amendment No. 205 to Schedule 3 concerns the tribunal established under the Protection of Children Act 1999. As your Lordships will be aware, this is a tribunal which will hear all appeals against decisions made under this Bill. It will be established on an England and Wales basis. The Secretary alone will have regulation-making powers in respect of the tribunal. Very importantly, the amendment ensures that the Assembly should be consulted before such amendments are made. I hope that those explanations have been helpful to the House.

Lord Clement-Jones : My Lords, I should like to thank the Minister not only for his explanation of government amendments but also for his reply to Amendment No. 13. I put it forward in a spirit of inquiry, rather than seeking to impose on the Welsh Assembly what might be considered to be an English imposition. I am grateful for his explanation of where the Assembly has got to in its deliberations and how he envisages the Assembly governing care standards in Wales. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 7 [General duties of the Commission]:

Lord Clement-Jones moved Amendment No. 14:

    Page 5, line 3, at end insert ("including standards of clinical care provided in those services").

The noble Lord said: My Lords, this amendment provides for account to be taken of the clinical care provided in care homes as well as the nursing and personal care. It must be recognised that clinical care is being delivered increasingly in care homes. The commission's remit appears through the course of the Bill to address the structure of personal care provision rather than standards and health care. Surely one of the main objectives of the care standards legislation must be to establish the standards of clinical care in all settings. Certainly a number of professional bodies are unsure about whether the Bill's provisions, in their current state, will actually achieve this. It is essential that this duty of quality extends to clinical as well as nursing and personal care.

There is an increasing trend for nursing homes to be used to treat NHS patients. For example, when a hip is replaced in an NHS hospital as part of the treatment episode, the patient may well be discharged from an NHS hospital to a private nursing home for rehabilitation. Certainly "winter pressure moneys" around the country are being used to purchase space in care facilities in order to release beds in the acute sector.

Certainly one of the recommendations from the national beds enquiry is that at least two out of every 10 days spent by people aged over 65 in acute hospitals

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could be better provided for in alternative facilities such as intermediate care beds. A number of issues arise from the debate about the balance between acute and intermediate beds. For example, will those intermediate beds be sited in nursing homes? Will they be covered by the Care Standards Bill's regulatory procedures and how will the provision of clinical care in those homes be inspected?

It may be that when the Minister speaks on Amendment No. 28, which provides for regulations on the "promotion and protection of the health of persons" in various establishments he will be able to satisfy the points that I have raised on this amendment. There are concerns that there should be an emphasis on healthcare provision in care homes and other settings. Perhaps the Minister could explain whether his Amendment No. 28, for instance, means that regulations will be introduced to ensure that standards of clinical care will be inspected where appropriate. Perhaps he will also explain at the same time what procedures will be in place to assess the clinical care delivered to individuals transferred to care homes from hospitals as part of their treatment episode. There are a number of issues regarding clinical care in those social care settings, and I look forward to the Minister's reply. I beg to move.

Earl Howe: My Lords, I support the noble Lord, Lord Clement-Jones, in all that he has said. It may be that the Minister will tell us that standards of clinical care are to be understood as falling within the general definitions contained in Clause 7. I hope that he does. At the very least, though, there must be ambiguity on this issue in the light of the exclusions to Part II services set out in Clause 7(2).

As the noble Lord said, increasingly both residential homes and nursing homes find themselves looking after high-dependency patients, many of whom require clinical treatment. It cannot make sense to draw a distinction between clinical treatment on the one hand and personal and nursing care on the other. Both aspects of care have equal importance. Indeed, if clinical care were somehow left out of the assessment it would be very difficult to see how the promotion and protection of health of people in care homes--which I am delighted to see included in the Government's Amendment No. 28--could be judged in a meaningful way by the inspecting body. If standards of clinical care are to form part of the assessment, then I think we need to seek an assurance from the Minister that the inspection teams will be as multi-disciplinary as clearly they need to be to ensure that all relevant standards are being met.

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