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Baroness David: My Lords, before the Minister sits down, perhaps I may ask whether any kind of complaints procedure will be available for parents if they cannot get their complaints acknowledged or anything done about them.

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Lord Hunt of Kings Heath: Yes, my Lords. I believe that that is covered by wider work within the whole social care field. We are strongly committed to having a robust complaints procedure.

On Question, amendment agreed to.

7 p.m.

Lord Hunt of Kings Heath moved Amendments Nos. 27 and 28:

    Page 11, line 16, leave out from ("in") to end of line 17 and insert ("an establishment or provided with services by an establishment, an independent medical agency or a domiciliary care agency;").

    Page 11, line 34, at end insert--

("( ) Regulations under paragraph (d) of subsection (1) may, in particular, make provision--
(a) as to the promotion and protection of the health of persons such as are mentioned in that paragraph;
(b) as to the control and restraint of adults accommodated in, or provided with services by, an establishment;
(c) as to the control, restraint and discipline of children accommodated in, or provided with services by, an establishment.
( ) Regulations under paragraph (e) of subsection (1) may, in particular, make provision--
(a) as to the promotion and protection of the health of children such as are mentioned in that paragraph;
(b) as to the control, restraint and discipline of such children.").

On Question, amendments agreed to.

[Amendment No. 29 not moved.]

Lord Hunt of Kings Heath moved Amendments Nos. 30 to 32:

    Page 11, line 35, leave out ("also").

    Page 12, line 21, leave out ("or independent clinic") and insert (", independent clinic or independent medical agency").

    Page 12, line 23, leave out ("the establishment") and insert ("or for the purposes of the establishment or (as the case may be) for the purposes of the agency").

On Question, amendments agreed to.

Baroness Barker moved Amendment No. 33:

    Page 12, line 24, at end insert--

("(l) make provision requiring the person who carries on, or manages, an independent hospital or independent clinic to ensure procedures, agreed with the medical practitioners working in that establishment, are in place to implement clinical governance in respect of that establishment").

The noble Baroness said: My Lords, the purpose behind this amendment is to return to the question that we raised in relation to Amendment No. 14; that is, to establish that clinical governance is observed in the independent healthcare sector. We talked earlier about the fact that the lines between residential and social care are becoming increasingly blurred. We have spoken previously on these Benches about the growing incidence of clinical care that occurs in non-clinical settings. We return to that matter here.

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There is one particular reason why I rise to move the amendment at this stage. Increasing numbers of elderly people who are mentally frail are living either at home or in residential homes. Increasingly, they require clinical care which is not given in a clinical setting. The purpose of this amendment, which is promoted by the BMA, is to ensure that a responsibility exists for maintaining standards of clinical governance in those settings.

One effect of Modernising Social Services is that a great many more independent care providers supply services to people who are highly dependent and who need clinical services to be delivered to them in those settings rather than in hospitals. Therefore, we are making yet another attempt to ensure that equality of clinical governance exists in the different settings in which people receive care. Having given a favourable response to Amendment No. 14, I hope that the Minister will be able to do so on this occasion. I beg to move.

Lord Hunt of Kings Heath: My Lords, there is no doubt that this is an important matter. I believe that if one evaluated the current regulatory system, one would come to the conclusion that one of its main weaknesses is that the Registered Homes Act 1984 concentrated too much on facilities and equipment and never really got to grips with issues relating to healthcare quality. I believe that officers who attempted to inspect and operate the regulatory system did their best to ensure that they covered clinical areas. However, it was never satisfactory because of the way that that Act was written.

I believe that Clause 21(3)(k) is very important in that respect. It provides for regulations to be made requiring independent healthcare providers to have arrangements in place to ensure that the services they provide are of appropriate quality and meet appropriate standards. In developing those regulations and standards, regard will be had to various quality assurance programmes and initiatives which are in place or are planned. Those include the implementation of clinical governance in the NHS, the Supporting Doctors, Protecting Patients White Paper, the GMC's work on revalidation of doctors, and the work of NICE and of CHI.

Much of that work is to be developed over the next 12 months through consultation. However, we envisage that the type of clinical accountability system that healthcare providers must have in place will need to comply with quality assurance requirements, which include arrangements for the audit and review of clinical practice, the identification and management of clinical risk, and the keeping of clinical records. It is our intention that those measures will help to ensure that appropriate safeguards and quality of care are provided for patients.

I turn to Amendment No. 33, which proposes that regulations are made to put in place clinical governance through the regulatory system. I have no arguments at all with the sentiment of that. Indeed, as I have said before, and as one sees if one looks at the

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recent scoping paper, the most serious criticism of the current regulatory system is its lack of scrutiny of clinical quality. This Bill will change that.

The regulations and standards that I have mentioned will set out clear requirements for private and voluntary healthcare providers to have in place systems for ensuring full accountability for clinical services and qualities. That is very important. We shall require the registered persons to have satisfactory procedures in place for auditing the quality of healthcare delivered in their hospital or clinic and for spotting potential problems and dealing with them appropriately. I believe that a past problem has been that a person who runs a private hospital has, in effect, been able to say, "You can't talk to me about the quality of care. Your contract was with the consultant. All I do is rent out the facilities". Clearly, that is unacceptable. I can assure noble Lords that we shall require full and proper accountability for the services provided.

My own thought regarding the noble Baroness's amendment is that it is unnecessary because essentially it is a reworking of the current Clause 21(3)(k). The reason why we have not used the term "clinical governance", as the noble Baroness has done, is simply that we did not want to create unhelpful confusion regarding the clinical governance system in the NHS. However, I hope that the noble Baroness will be assured that we want to ensure, as much as she does, that clinical standards are of the highest order.

Lord Jenkin of Roding: My Lords, before the Minister sits down, perhaps I may ask him a question. He said something that I found very strange: that one of the weaknesses of the Registered Homes Act was that it concentrated on physical facilities and not on the quality of care. Does he recognise that precisely the same criticism can be addressed at the consultation paper Fit for the Future? under the heading "Modernising social services", and does he recollect that I pointed out in Committee that exactly the same fault existed there? That was drawn to my attention by the Registered Nursing Home Association, which rather liked what I said.

Lord Hunt of Kings Heath: Yes, my Lords, I certainly recollect that. I believe that at the time I said that we had taken very careful note of the comments that came back to us in relation to the consultation. As we come to prepare further drafts of the regulations and the national minimum standards, we shall be very careful to take on board those points. I believe that it is important that, while some of the debate about Fit for the Future? concerned room sizes--room sizes are one factor in all this--it is clearly important that the overall outcome relates to the quality of care.

Lord Jenkin of Roding: My Lords, the Registered Nursing Home Association wrote:

    "Our Vice President, Derek Whittaker, was a member of the Steering Group set up by the CPA. With some 20 years involvement as an owner of a nursing home he had a lot of

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    experience to offer as a practitioner, but repeatedly found himself frustrated by the failure of the group to be prepared to listen to any alternative view".

He had been constantly trying to say that it was the quality of care that mattered, not the number of plugs in the wall, and he was not listened to.

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