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Lord Hunt of Kings Heath moved Amendments Nos. 149 to 156:

("(a) in relation to an adult who is not mentally impaired, means ill-treatment or the impairment of health;
(b) in relation to an adult who is mentally impaired, or a child, means ill-treatment or the impairment of health or development;").

    Page 58, line 47, at end insert--

("( ) an adult is mentally impaired if he is in a state of arrested or incomplete development of mind (including a significant impairment of intelligence and social functioning).").

    Page 59, line 3, at end insert--

("( ) References in this Act to a child's being looked after by a local authority shall be construed in accordance with section 22 of the 1989 Act.").

    Page 59, line 5, at end insert--

("(4A) Section 84(1) of the Government of Wales Act 1998 (payment of Assembly receipts into the Consolidated Fund) does not apply to any sums received by the Assembly by virtue of any provision of this Act.").

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    Page 59, line 8, at end insert--

("(5A) Subsection (5) does not affect the power to make further Orders varying or omitting that reference.").

    Page 59, leave out line 20.

    Page 59, line 26, at end insert--

    ("Independent clinic and independent medical agencySection 2")

    Divide Clause 97 into two Clauses, the first (Wales) to consist of subsections (4A), (5) and (5A) and the second (General interpretation etc.) to consist of subsections (1) to (4) and (6).

On Question, amendments agreed to.

Clause 98 [Commencement]:

Lord Hunt of Kings Heath moved Amendment No. 157:

    Page 59, line 30, after ("except") insert ("section 67(2) to (2C) and").

On Question, amendment agreed to.

Clause 99 [Short title and extent]:

Lord Hunt of Kings Heath moved Amendment No. 158:

    Page 59, line 36, leave out ("extends") and insert ("and, so far as relating to subsections (2) to (2C) of that section, sections (Schemes for the transfer of staff), (Effect of schemes) and 95 extend").

On Question, amendment agreed to.

Schedule 1 [The Commission and the Council]:

Lord Hunt of Kings Heath moved Amendment No. 159:

    Page 60, line 6, at end insert--

("(2) In this Schedule, in relation to the Welsh Council--
(a) references to the Secretary of State or to Parliament are to be read as references to the Assembly;
(b) references to the Comptroller and Auditor General are to be read as references to the Auditor General for Wales.").

On Question, amendment agreed to.

Lord Hunt of Kings Heath moved Amendment No. 160:

    Page 60, line 16, at end insert--

("( ) co-operating with other public authorities in the United Kingdom;").

The noble Lord said: My Lords, it is clearly essential that the councils should have the power to relate to other bodies to be able to give the public the full measure of protection we intend for them. Amendment No. 160 will provide the councils with this flexibility.

If the councils are to undertake their functions properly and to protect the public, the English and Welsh councils will clearly need to co-operate with each other. Further, they will need to co-operate with equivalent bodies that may be established in Scotland and in Northern Ireland. The kinds of areas in which we see the UK councils co-operating are in exchanging information about people who are refused registration, removed from a register, or who have some kind of qualified registration.

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This is a very useful schedule. It sets the pattern for the way in which we would like there to be co-operative arrangements across the UK in the future. I beg to move.

On Question, amendment agreed to.

Lord Clement-Jones moved Amendment No. 161:

    Page 60, line 24, at end insert ("and two of the members of each such authority shall be current users of services regulated under this Act").

The noble Lord said: My Lords, I know that the Minister, even at this late hour, has a horror of lists. We have had enough debates on previous Bills to know that.

The amendment seeks to add two service users to the commission itself. I do not believe that that is unduly extending the provisions of Schedule 1. It is extremely important that service users should be on the commission in order to inform its work.

In putting forward the amendment I take inspiration from a document which the Scottish Executive put out in December 1999 called Regulating Care and the Social Services Workforce. I am sure that the Minister will also take inspiration from his counterparts in Scotland, even though the Government Chief Whip may shake his head in these circumstances. Perhaps I may quote to the Minister a little of that document which I believe is extremely instructive. It states,

    "The involvement of people who use care services is central to our plans, as is the confidence of the general public in the work of the Commission. We therefore propose that at least one-half of the Commission membership will comprise people using services, their carers or their representatives. In appointing these members, Ministers will take account of the diversity of people using care services in terms of age, gender and ethnicity".

This amendment is considerably more modest than that, but I commend it to the Minister. I believe that there are very strong reasons which have been put forward by the Scottish Executive as to why those care users should be on the commission. I beg to move.

Earl Howe: My Lords, I rise to speak to Amendments Nos. 162 to 167 inclusive standing in my name, along with Amendments Nos. 170 to 175 inclusive and Amendments Nos. 178 and 183.

As regards Amendments Nos. 162 and 163, in Committee we devoted only a relatively short time to the composition of both the national care standards commission and the general social care council. I felt that this was an issue that merited further debate because the membership of each of these bodies and the range of skills within that membership will be absolutely critical to their success and to their public credibility.

It would have been very easy to put down the type of amendment which resembles a shopping list, and I thought that, as far as possible, I would try to avoid that temptation. As I said before, my concern about this Bill is that it was geared up as a vehicle for the regulation of what might loosely be termed "social

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care"--in other words, the whole spectrum of activities which currently fall under the aegis of local authority social services departments.

The inclusion of private healthcare within the same regulatory framework is, on the face of it, a gross anomaly. I said in Committee and I say again, that this element of the Bill almost has the look of a last minute bolt-on extra. I guess that that is not so far from the truth when we reflect that only a few months ago the Government were giving us to understand that private healthcare would be regulated by a body completely separate from the regulator of social care. That is why I believe that the focus of both the commission and the GSCC and the equivalent bodies in Wales should be balanced and that that balance should be reflected in the professional expertise present in the membership.

In Committee the Minister said that he was not drawn to the idea of making board members representative of individual interest groups. I thought that that was rather an underhand way, if I may say so, of dismissing what I believe to be the legitimate concerns of a number of us. I am not talking about interest groups, but about professionalism. It would be very helpful if the Minister could give us some idea of the expected composition of these bodies. In particular, I shall be grateful if he will say something about their clinical and medical focus. It seems to me that unless we are very careful, the focus on social care will be next to total. I believe that that would be wrong.

Amendment No. 178 in my name, which is very similar to Government Amendment No. 177, proposes the appointment of a director of independent healthcare as someone senior on the staff of the commission with specific responsibility for regulating the private health sector. I am further proposing that this individual, along with the chief officer--and because the post is so important, the children's rights director--should be members of the commission--in other words, that they should be appointed to the board.

If we are really going to have a single regulator for social care and private healthcare, then we cannot isolate the one from the other, not least because the experience of being in care is for many people a complex product of health and care services combined. The way in which those services are delivered determines how people feel about being in care. I hope that the Minister can provide some reassurance on those amendments.

I turn now briefly to the remainder of the amendments grouped in my name and to one of the very few issues debated in Committee which gave rise to considerable dismay on this side of the House as a result of the Minister's response. It is the issue of the regulation of healthcare in the independent sector and the structures to be established in the national care standards commission to exercise that regulatory function.

We have been told by the Government that they intend, within the commission, to see a separate division established to handle the regulation of private and voluntary healthcare. I believe that such a division

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may be workable. But if it is to do its job in a way that commands public confidence, it cannot be just another section or department within the commission; it must have a weight and standing that reflects the technical complexity and diversity of its remit.

I make no tendentious comparison with the regulation of social care, I merely say that the two could not be more distinct. Those charged with the regulation of acute private hospitals have to know their job and be seen to know it. Furthermore, the expertise of those in charge of the division should be brought to bear at board level within the commission as a whole. There is nothing wrong with a statutory framework for the committee that directly oversees that division. My amendment proposes a structure for such a committee to be laid down in regulation with its functions and procedures to be similarly defined.

One particular feature of the committee which I need to mention is the inclusion of a member of the Commission for Health Improvement. That is a small, but I hope significant, step toward achieving that which many of us on this side of the House want to see, which is consistency of clinical standards throughout the public and private healthcare sectors.

When in Committee I had expected to hear from the Minister some substantive information about the separate division that the Government proposed, but unfortunately we did not, either as to its functions or its structure. I hope that the intervening two and a half months have enabled some further thought to be devoted to those issues. I beg to move.

11.30 p.m.

Lord Hunt of Kings Heath: My Lords, it was at a late hour when we rushed through these matters in Committee, and I am afraid it is rather late for us to be discussing these matters tonight. Like the noble Earl, Lord Howe, I think that it is important because the quality of leadership that we wish to see within the NCSC is absolutely crucial in terms of the regulatory system. I am sorry that I disappointed the noble Earl with my replies in Committee. I am certainly prepared to try again.

Perhaps I may first of all speak to the issue of the regulation of private healthcare. I know that some concern has been expressed about the relative importance and emphasis that the commission will place on its responsibility for regulating independent healthcare. I have no reservations about that. It will be an important task of the commission. And in our monitoring of the commission we will wish to ensure that the commission fully recognises that importance. I do recognise that an additional reassurance is required. Amendment No. 177 is placed before the House to require the commission to appoint a director of private and voluntary healthcare. That director will be a member of staff of the commission. His or her functions will be prescribed in regulations. Exactly what is prescribed is a matter for further consideration. But the fact that we are doing this ensures that the importance of the private and

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voluntary healthcare regulatory elements are fully considered and that a senior member of staff will have direct responsibility for that.

As the noble Earl, Lord Howe, has pointed out, the requirement to appoint a healthcare director is one of the points raised by Amendments Nos. 164 and 165. But he proposes that the healthcare director as well as the chief officer of the commission and the childrens' rights director and the chair of the independent healthcare committee ought to be a member of the commission's board. I do have reservations about that. The members of non-departmental public bodies have a different function to that of senior staff. Accordingly, most of those bodies will not have staff as members. Indeed new Cabinet Office guidance for NDPBs--a guide which was actually published yesterday--confirms this position, where it says that it is unusual for staff of the NDPB, excluding its chief executive to sit on its board, and there is a general presumption against it.

I should like to reassure the House that, although the persons named would not be entitled to vote, we would expect them to attend and to be able to reflect their work interests at meetings of the commission's membership. That would be essential in keeping members of the commission informed. We intend the majority of the commission's 15-strong membership to be lay members. If all the other directors and the chief officers were to be members of the board, there would be much less scope for appointing non-executive members with the experience and skill relevant to the functions of the commission.

I turn now to the noble Earl's other amendments, Amendments Nos. 167 and 170 to 175. These amendments propose the establishment of a healthcare committee of the commission. I dismayed the noble Earl on the previous occasion. I have to say to him that it seems to be unnecessarily bureaucratic to specify such a committee. We have indicated our resolve to ensure that the commission undertakes its responsibility for regulating healthcare effectively by requiring the appointment of a healthcare director. That director will head the division within the commission. The introduction of a committee would simply add a further layer of administration which is not warranted. I also believe that it might have the adverse effect of detracting the commission itself from a focus on private and voluntary healthcare. Because of the presence of a statutory committee it might tend to push concerns in relation to that sector on to that committee rather being focused on it as a corporate body in its own right.

I have sympathy with Amendment No. 161. We have made it clear that lay members will be in a majority on the commission and the council. Service users will be included among these lay members. The direct involvement of service users will be an integral part of the credibility and success of these new bodies. Ministers will be responsible for making all the appointments to these bodies. I can assure the House that we aim to appoint at least two service users as members of each. However, some practical difficulties

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will have to be faced up to. We cannot be sure that there will be suitable service users who are willing and able to serve as members. It is unlikely, for example, that a resident of a nursing home or of a residential care home for older people will be able to participate sufficiently as a member of one of these authorities, and of course children will not be eligible. For those reasons, I cannot accept the amendment, but I certainly agree with the spirit of it. I very much hope that we shall be able to find at least two service users to appoint to each body.

I turn now to Amendments Nos. 162 and 163. These amendments provide that persons appointed to the membership of the commission or council should have appropriate skills. It is plainly the case that in addition to a lay majority, the commission and the council will need members with both the relevant skills and experience of the type of work which these new bodies will undertake. However, as I said in Committee, I do not think it is appropriate for me at this stage to reserve individual places for particular professional disciplines on the membership of these new bodies. I shall not go over the ground again, but I reaffirm the Government's intent to ensure that the new authorities each have the right balance of skills and experience.

I end as I started. We are all committed to getting very high quality members of these organisations who will come from different backgrounds and have different skills but who, together, will make a very strong impact on the work of these organisations.

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