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Baroness Masham of Ilton: My Lords, I believe that there should be minimum standards in all hospitals, be they NHS or private, and that they should be inspected by the same body. There should be standards of infection control in all hospitals. I am sure the Minister knows that many bank and agency nurses and doctors work between NHS and private hospitals. Therefore, infection control standards should be the same. Good standards must be laid down.

I am sorry to say that I have first-hand experience of a private hospital in Leeds in which my husband had to be treated as the local NHS hospital did not have an endocrinologist at that time. After six days in the private hospital, I discovered that my husband had not had a wash. When I inquired why, a representative of BUPA told me that it would hold an inquiry. The answer came back that he had not asked for one. When patients are ill and disorientated, they do not ask. I had taken for granted that ensuring that patients were washed was part of good nursing procedure and care.

At the same private hospital, my husband was discharged on a Friday with a painful thrombosis in his leg. The nurses had taken no notice when he told them about it. The consultant whose care he was under was attending a conference. My husband was then admitted to the local NHS hospital as an emergency on the following Monday. In your Lordships' House, we have a Minister who understands the need for good care standards, and there are noble Lords on all sides of the House who use private hospitals. NHS patients are sent to private hospitals for various reasons. Patients are patients, wherever they go. All patients should be protected by standards of care enshrined in legislation. Therefore, I support the amendment moved by the noble Earl, Lord Howe.

Baroness Nicholson of Winterbourne: My Lords, the Minister has worked extremely hard on this Bill. I am very grateful that in the Queen's Speech in November of last year, the regulation of private hospitals was included in the package of legislation which this Government were willing to tackle. I thank him most sincerely for that. But the gravest weakness of this Bill, as other noble Lords and I perceive it both this evening and before, is that despite the Minister's clear and accurate statement that he seeks proper regulation and standards for private healthcare, there is nothing at all on the face of the Bill about clinical or administrative standards of healthcare. Not even the most minor point is deemed worth while to place on the face of this important piece of legislation dealing with healthcare. For example, there is no demand that internal complaints procedures in private hospitals should be triggered by patients as of right. Many of us have had experience that this does not happen in private healthcare. There is no statement that there should be enough staff to perform particular procedures or to

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staff particular wards. There is no demand that the staff should be qualified appropriately for the tasks which they are being asked to carry out. Nor even is there a statement saying that advertising for private hospitals should be screened and monitored; or that inaccurate advertising, which is often the case now, should not be allowed. In addition, there is the irony that we are talking about taxpayers' money. Many of these private hospitals are registered charities. A handful are even under royal charter. No standards of care are on the face of the Bill. The Minister told us this evening that the consultation body will take care of that. I wonder why, therefore, he has assembled a consultation group to advise on the drafting of the rules and regulations of a Bill which is dominated by private hospital groups and medical bodies, many of which are responsible for the series of tragedies which led to the Bill coming about in the first place. I remind the Minister that there is no representation from genuine patients and victims' groups; those who like many of us here tonight, have personal experience of the effects of iatrogenic injury. Action for Victims of Medical Accidents, for example, could and should be invited to form part of the consultation group. There are a few representative groups on this consultation body. Patients are represented by, for example, the National Health Service Confederation; the Association of Community Health Councils for England and Wales; the Patients Forum; the Council and Care Group and the Consumers' Association. However, these are not patient groups in the way that APROP and AVMA are. AVMA has a patient helpline and deals directly with patients who have been victims of iatrogenic injury in all the areas which the Care Standards Bill addresses. Tonight, the Minister said--I think I heard him correctly--that because the National Institute for Clinical Excellence is included as part of the consultative group, he has covered the ground to which I refer. But what we need are the real patients. Indeed, the consultation group will consult for 12 months. In other words, without anything on the face of the Bill, we are being asked to buy the Bill blind. I do not think that this is good enough. Many of us on this side of the House and, I believe, on the other side of the House, do not think that is good enough. That is why, in March of this year, we tabled the amendment which took the last resort of requesting the Minister to have at least a single body to monitor standards and to drive up standards of care in all our healthcare providers, public or private. That was a last resort. The Government will not do that either. I cannot understand this ministerial anathema to improving the standards of healthcare in the private sector. It is not like private education. In private education, which the Government do not much like either, children go to different schools, fee-paying or state. It is not the same in the medical world. The patients are the same people. We have learnt bitterly that they are the same people. They go to the ITU unit

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in the National Health Service just the same. For part of their treatment they use public health and, for part, to private hospitals. The consultants are the same people; they just happen to work in the private sector after hours. The nurses are the same people. They move from one health sector to the other. The training is the same. The National Health Service has been providing the training for everybody. The machinery and equipment are the same; except that in the public health sector there is probably more of it, just as in the public health sector there are teams of medical people, not just one, two or three. It is extraordinarily difficult to see why the Government maintain this ideological division, as healthcare knows no boundaries, save those drawn by money. Why is it, therefore, that the Government are so deeply unwilling to grasp the obvious, to move forward and to provide a proper standard of excellence for all patients throughout the United Kingdom and all sectors of health, irrespective of whether the patient pays at point of need for their treatment or it is paid for through the taxpayer? It is sad to see that a recent survey showed that three-quarters of the people of the United Kingdom had no confidence that the Government could adequately run the National Health Service. I have the greatest confidence that the National Health Service will continue to provide the healthcare for all our people for most of the time that they have medical need. But inevitably private healthcare will come into play, if only because many people in the private healthcare sector wish to make a lot of money out of healthcare provision. I urge the Government to take the decision not to move ahead with this amendment tonight; but to support the amendment of the noble Earl, Lord Howe, and go with the flow that this House offered the Government last time we debated this issue and to allow patients at least a common standard of excellence through a common body.

Lord Laming: My Lords, I find myself in complete agreement with all the previous speakers on this subject. It was well captured by the noble Baroness, Lady Masham, when she said that patients are patients wherever they are treated. Because all the points have been made so well, I shall be brief, save to say that, because the Government adopted the stance that they have over CHI, they have now brought forward what seems to be a pragmatic solution. However, I regret that I do not believe it will serve the best interests of patients or their carers. We have spent a long time in this House talking about the difference between the skills and expertise which are necessary to monitor the quality of healthcare services wherever they are delivered and those experiences and qualities that are necessary to inspect social care. Mention has already been made of the fact that the Government said that they have no objection to a greater use of the private sector, though

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for myself I prefer the NHS not to need that. However, it makes the point that nowadays patients move so easily between the different sectors that there needs to be a single organisation which is responsible for setting the standards and monitoring them across the whole of the healthcare services, wherever they are delivered. Amendment No. 22 blurs the distinction between the Commission for Health Improvement and the National Care Standards Commission. Of course it is right that those two organisations should collaborate and co-operate in the carrying out of their different activities. It may be that their interests coincide at some points; but they do not overlap. Encouraging co-operation should not be seen as meaning that those two activities can be regarded as being interchangeable. I believe that we are in danger of confusing the lines of responsibility; of blurring accountability and, at the end of the day, it will be the patients who will suffer. I hope that, even at this late stage and at this late hour, the Government will pause for further consideration and think again before pressing these amendments.

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