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Baroness David: My Lords, do I understand that the Minister will not put anything on the face of the Bill to ensure that local authorities do their duty?

Lord Hunt of Kings Heath: Yes, my Lords. I believe that the Children Act 1989 contains sufficient powers for local authorities to undertake the task. I want to ensure that local authorities carry out their responsibilities.

Baroness David: My Lords, I confess I am disappointed by the Minister's response. It seems to me to be slightly complacent. However, he obviously intends to do a bit more about getting local authorities to do their duty. So, rather reluctantly, I will read again what he said and consider whether I can accept it, but for the moment I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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Lord Clement-Jones moved Amendment No. 17:

    After Clause 7, insert the following new clause--


(" .--(1) The Commission shall institute procedures by which dissatisfaction with the dealing of complaints by independent hospitals may be expressed.
(2) In the event that the Commission is satisfied that a complaint is upheld it shall be entitled to take account of such complaint in exercising any of its duties under this Act.
(3) In the event that the Commission is satisfied that a complaint has not been properly dealt with by an agency or establishment it shall refer the matter to the Health Ombudsman.").

The noble Lord said: My Lords, it is with some disappointment that I speak to this group of amendments. As the Minister will have noticed, they are identical to the amendments tabled at Committee stage. They are a mixed bag of various ways in which an independent complaints system could be assured for patients in independent healthcare.

There is considerable concern among both management bodies, such as the NHS Confederation, and professional bodies, such as the BMA, that there is no proposal currently before the House for the setting-up of an independent body to hear complaints, or to compel independent healthcare establishments to arrange for an independent system of hearing complaints. Discussions are going forward with a wide range of interested parties to secure that there should be such a body agreed between all the players in private healthcare.

I had anticipated that at this stage the Minister would bring forward an amendment designed to provide such an independent element. Indeed, his colleague, the Minister responsible for this area, Gisela Stuart, said:

    "Under the new arrangements, all private hospitals must have proper complaints procedures in place. They must make it clear to patients what to do if something goes wrong. And we will introduce arrangements for independent investigations where patients are not satisfied with how their complaint was handled".

So I look forward to what the Minister has to say on this subject, while holding any fire that we may wish to pour on him, so to speak. I beg to move.

Lord Hunt of Kings Heath: My Lords, I am sorry that the noble Lord is disappointed. I hope to reassure him that we take complaints very seriously and that within the framework of the Bill we can deal with them to his satisfaction.

I begin by confirming that it is definitely the Government's intention to make regulations under Clause 21(3)(j) requiring all registered providers to put in place an internal procedure for dealing with complaints about their services. The regulations will include key elements of how that procedure should operate; for example, that all complaints must be logged, investigated within a certain timescale, and that the outcome of the complaint should be recorded. The commission will ensure, through inspection, that these procedures are operating effectively and to the satisfaction of complainants. Service users will be

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asked whether they are aware of the procedure; whether they have made use of it and, if so, whether they were satisfied with the outcome. We hope the majority of complaints will be satisfactorily dealt with in that way.

In answer to the noble Lord, Lord Clement-Jones, I recognise that there will be cases where the complainant remains dissatisfied. Indeed, there may be occasions where the service user does not want to use the internal complaints procedure, perhaps because there is no member of staff whom it is felt could be entrusted to report the circumstances of the complaint. In those cases we intend that the complainant be able to take their complaint to the commission itself.

The commission will have power to investigate complaints as an integral part of its regulatory functions and we will ensure that it is properly resourced to do so. In investigating complaints, the commission will be able to use its powers of entry and inspection as set out in Clauses 29 and 30. If it finds the complaint is justified it will be able to use its enforcement powers to ensure that remedial action is taken by the providers. As noble Lords will know, ultimately that could lead to prosecution or to the initiation of cancellation procedures against the provider. Where it has concerns about the professional competence of an individual, the commission can refer that person to the appropriate professional body; for example, the UKCC or the General Medical Council.

We envisage that these procedures will also be available to patients who receive independent healthcare regulated by the commission. It will have powers to investigate any matter relating to a breach of the regulation or standard applying to the service. That means that the commission will be able to deal with all complaints including looking at whether there has been a failure in the clinical assurance systems that independent hostels have in place under Clause 21(3)(k). Where the issue is of an individual's clinical competence, as I have said, the commission will be able to refer such cases, as appropriate, to the relevant professional regulatory body. In our view that will provide complainants about independent healthcare with the assurance that remedial action will be taken to resolve matters with which they are concerned.

Amendments Nos. 17 and 40 propose that the health service commissioner should be involved in this procedure. As I believe I explained at Committee, we believe that the commission is the appropriate body to investigate complaints where a person is unhappy with how a registered establishment handled their complaint. I do not see a role there for the health service commissioner. The national care standards commission itself is independent of the providers and the commissioners of service. It has the enforcement powers to make sure that matters are put right where it finds that the complaint is justified. On that basis I hope that I have satisfied noble Lords in that respect.

Baroness Masham of Ilton: My Lords, before the Minister sits down, and with the leave of the House, perhaps I may ask him a question. Recently a Question

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was asked in your Lordships' House as regards the problem of female circumcision. Can the Minister say how the complaints procedure will take place should the matter occur in a private hospital? It might concern a member of staff who is the only person, apart from the interested parties, who knew that the procedure was taking place. Would they go to the police or through the procedure which the Minister has just explained?

Lord Hunt of Kings Heath: I would strongly recommend that the member of staff goes to the police.

Lord Clement-Jones: My Lords, I remain slightly confused by the Minister's response. I find it very helpful that he described the width of the powers that the national care standards commission will have. Indeed, he has developed quite helpfully some of the points set out in paragraph 24 of the paper Developing the Way Forward. Clearly, in a sense he has given an assurance that the commission will have overarching power and will not be limited in a sense by any doctrine of the exhaustion of remedies or whatever it may be. An individual can go straight to the commission which will have quite strong powers except as regards individual clinical competence. It is entirely appropriate that that matter should be dealt with by the professional bodies.

However, I am unclear as regards the situation where homes applying for registration have a particular form of internal complaints system, but no element of independence associated with it. I wonder whether a home will be registered in those circumstances and whether there will be any criteria by which the commission will judge the complaints system. I am particularly concerned because of the efforts being made by professional management bodies and others to construct a genuinely independent complaints system that will be available for the benefit of those care homes. It seems to me that we need some pushing from the Minister in order to secure a common system.

Lord Hunt of Kings Heath: My Lords, as I believe I have said already, the point here is that we shall make regulations under Clause 21(3)(j) requiring providers to put in place an internal procedure for dealing with complaints. Clearly, the regulations that we lay will be subject to consultation. As regards the terms of the procedures that we expect an establishment to operate, they will be very clearly set out. When the commission visits and undertakes its regulation, it will then be able to monitor whether individual establishments are operating the procedures effectively. What I cannot do at this stage is to go into the detail of what may be contained in the regulations.

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