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Lord Clement-Jones: My Lords, before the Minister sits down, does he have an answer to the point about nursing care versus clinical care?

Lord Hunt of Kings Heath: My Lords, the point is that clinical care was very much seen as a core issue in relation to private hospitals. The amendment that was brought forward in another place relates to nursing homes. Clearly in that context nursing care is crucial to the overall quality of the service being provided.

On Question, Motion agreed to.


5Clause 1, page 2, line 11, leave out ("An independent") and insert ("A")
6Page 2, line 20, at end insert--
("But accommodation shall not for the purposes of paragraph (a) be regarded as provided to children for a number of days unless there is at least one child to whom it is provided for that number of days; and paragraph (b) shall be construed accordingly.")
7Page 2, line 20, at end insert--
("( ) For the purposes of this section a person is a foster parent in relation to a child if--
(a) he is a local authority foster parent in relation to the child;
(b) he is a foster parent with whom a child has been placed by a voluntary organisation under section 59(1)(a) of the 1989 Act; or
(c) he fosters the child privately.").

Lord Hunt of Kings Heath: My Lords, I beg to move that the House do agree with the Commons in their Amendments Nos. 5 to 7.

Moved, That the House do agree with the Commons in their Amendments Nos. 5 to 7.--(Lord Hunt of Kings Heath.)

On Question, Motion agreed to.


8Clause 2, page 2, line 27, after ("illness") insert ("or mental disorder").

Lord Hunt of Kings Heath: My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 8. In moving this amendment, I shall speak also to Amendments Nos. 11, 193 and 197.

This is a minor change to the Bill but an important one. It was identified during the Committee stage in another place that the Bill's definitions had a slightly odd way of covering people with learning disability. In Clause 100, the definitions worked together in such a way that a learning disabled person was included within the overall definition of "illness". As was pointed out during the Committee stage in another place, learning disabled people are not ill and to describe them as such was not only inaccurate but might be taken to be offensive.

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It is quite right that "illness" is defined in Clause 100 in such a way as to include mental disorder and that "mental disorder" is defined as including,

    "arrested or incomplete development of mind",

which would be taken to cover learning disabilities. On reflection, we felt that it was an important point to tackle and that even though the effect of the legislation was not in question, the terms in which it had that effect were not satisfactory.

Amendment No. 193 therefore removes mental disorder from the definition of illness in Clause 100. Amendments Nos. 8 and 11 are simply consequential on that change. The amendments have the effect of separating out mental disorder from illness and listing it separately in its own right.

Amendment No. 197 has the effect of including mental disorder in the definition of disability in Clause 100. Since we were looking again at the definitions, my right honourable friend Mr John Hutton gave a commitment on the last day of the Committee stage in another place to look more widely at the definition of disability to see whether the wording could be improved while retaining the same meaning. The definition in Clause 100(2)(a) is the one used for all social care legislation since the National Assistance Act 1948. But the language shows its age, and Amendment No. 197 represents an updated form of the same definition. It is drawn from the Housing Grants, Construction and Regeneration Act 1996 and is, I believe, an improved version of the wording without affecting the meaning of the definition.

Moved, That the House do agree with the Commons in their Amendment No. 8.--(Lord Hunt of Kings Heath.)

Baroness Barker: My Lords, as the noble Lord, Lord Rix, is not present, I wish to thank the Minister on the noble Lord's behalf. The noble Lord drew the point to our attention and I am glad that it has been taken on board. I want to ask a question about Amendment No. 197. The Minister referred to mental disorder. Does that include conditions such as dementia and Alzheimer's? There is a crucial distinction. People living in care homes suffer from many forms of mental disorder. It is important that we make a distinction between different people who may be at different stages of their lives and suffering from different conditions.

Lord Hunt of Kings Heath: My Lords, my understanding is that the term "mental disorder" comes from Section 1 of the Mental Health Act and includes mental impairment, which is the term usually used for learning disability. My assumption is that it embraces the area raised by the noble Baroness. If I am wrong about that, I shall write to her.

Lord Clement-Jones: My Lords, perhaps I may offer the Minister an alternative. Clause 100(2), taken with Amendment No. 197, deletes paragraph (a) but keeps paragraph (b). It may be that that is where the relationship with dementia and Alzheimer's is found.

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It is extremely important that Alzheimer's and dementia are covered as so many of those who occupy care homes are--and the number will increase--sufferers from Alzheimer's and dementia.

Lord Hunt of Kings Heath: My Lords, my assumption is that the terms will fall within the definition of "mental illness" and thus will be appropriately covered. However, as I have said, if further clarification is needed here, I shall be happy to give it.

On Question, Motion agreed to.

10 p.m.


9Clause 2, page 2, line 27, after ("illness") insert ("or palliative care").
10Page 3, leave out line 11.

Lord Hunt of Kings Heath: My Lords, I beg to move that the House do agree with the Commons in their Amendments Nos. 9 and 10. I should like to speak also to Amendments Nos. 13, 16, 45 and 287.

This is a small group of amendments which tidy up the definitions of independent hospital and nurses agencies and the definition of dental services under general anaesthesia which we are inserting into the Registered Homes Act 1984 for the purpose of regulation.

Amendments Nos. 9 and 10 were brought forward as a result of concerns from those involved about the definition of "independent hospital". As originally drafted, Clause 2 of the Bill brings within the definition of "independent hospital" any establishment which provides any of the listed services in Clause 2(7). Those listed services include palliative care. However, there was concern that because a care home might provide some palliative care to patients who are terminally ill, as drafted the Bill would require such a care home to be registered as an independent hospital. We recognise that that would be totally inappropriate.

The two amendments clarify the distinction. Amendment No. 10 removes palliative care from the "listed services" in Clause 2, while Amendment No. 9 inserts it into the main definition of independent hospital to ensure that, as far as concerns palliative care, only those establishments, the main purpose of which is to provide palliative care, will be required to register as independent hospitals.

As I have said, the amendments have been tabled in response to concerns raised with us by those involved. They seek simply to ensure that establishments that specialise in providing palliative care, such as hospitals, will be regarded and registered as such and will be seen as distinct from care homes that provide care for terminally ill residents as a normal and appropriate part of their overall services.

At Third Reading I accepted an amendment tabled by the noble Earl, Lord Howe, the noble Lord, Lord Clement-Jones, and the noble Baroness, Lady Masham of Ilton, which required nurses agencies to be

18 Jul 2000 : Column 936

regulated by the national care standards commission. At the time I said that the amendment as drafted was defective and that it would need to be amended in the other place. This is what is achieved by Amendment No. 13. The amendment ensures that the regulation of agencies for the supply of nurses, midwives or health visitors will cover employment agencies, as defined in the Employment Agencies Act 1973. This may, for example, include staff recruitment agencies or agencies providing an introduction service. The amendment also ensures that employment businesses are covered, again, as defined in the 1973 Act, and which typically employ nurses to be supplied to the NHS, to private hospitals and to nursing homes, as well as directly to patients in their own homes.

This change has been widely welcomed and we shall, of course, be developing the necessary regulatory requirements and standards under which the commission will regulate nurses' agencies.

At Third Reading, the noble Baroness, Lady Masham, asked whether we needed to amend the Long Title of the Bill to reflect the regulation of nurses agencies. She was absolutely right. Amendment No. 287 adds nurses agencies to the Long Title.

Amendment No. 16 is an amendment that was accepted in the other place to correct a misplaced apostrophe.

Perhaps I may now turn to Amendment No. 45. Noble Lords will know that a number of tragedies have occurred recently of young people who have died under general anaesthesia during the course of dental treatment outside hospitals. When the commission is established, it will regulate private dentists who provide dental treatment under general anaesthesia. However, the commission will not be established until 2002 and we do not believe that we can allow the practice to go unregulated until then. The Bill therefore provides for the regulation of dental treatment under general anaesthesia under the existing Registered Homes Act 1984. This requires any dentist who performs such treatment to be regulated by the local health authority inspection units.

However, it is intended that only private dentists who provide treatment under general anaesthesia should be regulated under the 1984 Act. Amendment No. 45 makes this clear. That is not to say that dentists who treat NHS patients using general anaesthesia will not be regulated. We have no intention of creating such a loophole. We intend to amend NHS regulations to require dentists who provide treatment under general anaesthesia to NHS patients to be regulated under NHS arrangements.

All the amendments tidy up definitions used in the Bill. I hope that noble Lords will find them acceptable.

Moved, That the House do agree with the Commons in their Amendments Nos. 9 and 10.--(Lord Hunt of Kings Heath.)

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