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Lord Hunt of Kings Heath: My Lords, this has been a good debate. I listened with great care to what noble Lords had to say. But I am not persuaded. I believe that the Government's case throughout our debates has been absolutely clear and logical. I listened to the noble Lord, Lord Clement-Jones, as he repeated the words of the Secretary of State, Alan Milburn, and found myself wholly in agreement with what he said. The specific and clear point that we are making is this. First, we want effective regulation of the private and voluntary healthcare sectors. I accept the points made by the noble Baronesses, Lady Nicholson and Lady Masham, about issues in relation to the private sector. But the provisions in this Bill will undoubtedly allow for a much more effective regulation of the private healthcare sector than we have ever had before. It will be consistent. Instead of 100 different health authorities doing the same job, in many cases in a rather inadequate way, we shall have consistency throughout the country. Secondly, the Bill is so drafted as to allow much more focused regulation in relation to private hospitals than the existing legislation has ever allowed. Existing legislation has been very much built around nursing homes rather than the specific needs of private hospitals. I believe that the regulation will be improved by the much greater emphasis in these new arrangements that will be given to the quality of what is provided in those establishments. I should point out to the noble Baroness, Lady Nicholson, that, although she is disappointed as regards what appears on the face of the Bill, I believe that Clause 21 (which sets out the regulations that, in themselves, will set the context for national minimum standards) allows for the issues she has raised relating to quality and staffing to be very effectively addressed. I should refer her, in particular, to Clause 21(6)(j), which relates to the establishment of the complaints

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process within establishments, and to paragraph (k), which clearly sets out issues in relation to ensuring that the appropriate quality and standards are met. In addition, I believe that the great benefit that we see in this Bill is flexibility. The whole problem with previous legislation in relation to registered homes is that it has been inflexible and has not kept pace with developments. This Bill will allow us to keep pace with those developments. Above all, I believe that we shall have a much higher quality of inspections, with inspection officers given the right degree of support and training. I well understand the point made by the noble Baroness, Lady Nicholson. She is right to refer to the external consultation group, which, as she said, includes five people representing patients' interests and five people representing providers. I believe that the mix is carefully balanced. I have taken very careful note of what the noble Baroness said about the two organisations that she mentioned. I can assure her that they will be invited to become involved in the consultation around regulation of acute hospitals, which, of course, is their special interest. I have talked about the regulation of private hospitals. The situation with the NHS is different. We want to ensure high quality and consistent services for the service. That is why we introduced national service frameworks and clinical governance. Indeed, that is why we formed the Commission for Health Improvement. However, CHI is designed to work within the context of a managed system, which is what the NHS is: it is a system that is accountable to Parliament through Ministers. That is very different from the situation relating to independent operators within the private sectors. The whole function of CHI is related to performance management within the NHS in the context of a public, managed healthcare system. I do not believe that it is the right body to deal with the regulation--which is very different from the regulation of the private and voluntary sectors. However, CHI and the commission will not operate in isolation from each another. In establishing minimum standards, CHI is bound to be informed by good practice within the NHS. We have listened most carefully to the debates in your Lordships' House. The noble Earl, Lord Howe, was a little churlish in his remarks on that matter, because we have listened most carefully. I turn now to the remarks made by the noble Lord, Lord Laming. In a sense, he accused us of pragmatism. I do not believe that that is the response we are giving. We are saying that there are very different roles for CHI and the commission. However, there is equally a role for ensuring that they are enabled to work together. The noble Earl, Lord Howe, asked me how that might happen. The national care standards commission could delegate some inspection of private hospitals to the Commission for Health Improvement when CHI is due to review a particular institution as part of its three- or four-yearly rolling programmes of NHS reviews and there is a contractual relationship

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between the NHS institution it is reviewing and a particular private hospital. The national commission could be asked by CHI to do the same on its behalf. That seems to me to be the right way forward: sensible collaboration and sensible co-operation between two bodies which undertake different roles; the one regulating the independent, private healthcare sector, the other ensuring that issues in relation to quality in the NHS--a managed system accountable to Parliament--are dealt with effectively. The sensible outcome is to ensure that they are enabled to work and to collaborate together. I believe that that is the right outcome. I ask noble Lords to support it.

11 p.m.

Baroness Nicholson of Winterbourne: My Lords, before the Minister sits down, I welcome the fact that he will invite APROP and AVMA to join the consultative body. I commend the Minister on offering substance, not spin. I commend the Bill for offering a system that is better than in the past and which is consistent countrywide. However, does he not agree that by choosing the words "contracts for national standards" he highlights the fact that this is a non-definitive, non-prescriptive set of statements? The regulations may make provision and may impose requirements. That lies at the heart of the amendment of the noble Earl, Lord Howe, and at the heart of the amendment that the noble Earl, Lord Howe, my colleagues and I proposed in March. We do not seek an open-ended commitment but actual standards and regulations which are prescriptive and definitive.

Lord Hunt of Kings Heath: My Lords, experience with previous legislation in this area shows that, if one attempts to include all the measures the noble Baroness mentioned on the face of the Bill, it will simply not keep pace with fast moving developments in the healthcare sector. The Bill sets the clear parameters within which we expect regulations to be conducted and allows us to be flexible, to consult and to learn from experience. At the end of the day, I believe that it will be an extremely effective regulatory regime.

Baroness Nicholson of Winterbourne: My Lords, will the Minister substitute "will" for "may"?

Earl Howe: My Lords, this has been an important debate. I thank all noble Lords who have taken part in it. The Minister's reply was not entirely unexpected. There is no disagreement between us that better regulation of the private sector is both necessary and desirable. There is no disagreement between us about the inadequacies of the Registered Homes Act. However, as he knows, that was not the point I sought to make.

It is disappointing that the Minister did not extend at least a nod in the direction of the arguments that I advanced earlier. It is also disappointing that he should have offered what I fear is a spurious argument in defence of his own position. There is no suggestion in the amendment carried by the House that CHI

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should usurp the role of the commission as the regulator. The Minister is right to say that CHI's functions are not regulatory, in the accepted sense at least. As far as I am aware, it has not been suggested by anyone--certainly not by me--that under Amendment No. 20 CHI should do more than carry out inspections and in so doing be accountable to the commission as regulator.

The noble Lord admits implicitly in his own amendment that CHI is capable of performing the role I have suggested for it. He concedes that it is possible for the commission to delegate to CHI on a ad hoc basis. So why is there this hang up over a more permanent role along those lines?

I see opposite me the massing ranks of government supporters; by contrast, few such ranks are on this side of the Chamber. But I believe that this is an issue on which the opinion of the House should be tested. I beg to move.

11.5 p.m.

On Question, Whether the said amendment (No. 20A) shall be agreed to?

Their Lordships divided: Contents, 16; Not-Contents, 91.

Division No. 3


Astor of Hever, L.
Barker, B.
Blatch, B.
Clement-Jones, L. [Teller]
Ezra, L.
Henley, L. [Teller]
Howe, E.
Laming, L.
Lyell, L.
Mackay of Ardbrecknish, L.
Mar and Kellie, E.
Masham of Ilton, B.
Montrose, D.
Nicholson of Winterbourne, B.
Roberts of Conwy, L.
Thomas of Gwydir, L.


Acton, L.
Alli, L.
Amos, B.
Andrews, B.
Archer of Sandwell, L.
Ashton of Upholland, B.
Bach, L.
Bassam of Brighton, L.
Bernstein of Craigweil, L.
Billingham, B.
Blackstone, B.
Borrie, L.
Bragg, L.
Brooke of Alverthorpe, L.
Brookman, L.
Burlison, L.
Carter, L. [Teller]
Chandos, V.
Christopher, L.
Cohen of Pimlico, B.
Crawley, B.
Davies of Coity, L.
Davies of Oldham, L.
Desai, L.
Donoughue, L.
Dormand of Easington, L.
Dubs, L.
Elder, L.
Evans of Parkside, L.
Falconer of Thoroton, L.
Farrington of Ribbleton, B.
Faulkner of Worcester, L.
Fyfe of Fairfield, L.
Gale, B.
Gavron, L.
Gibson of Market Rasen, B.
Gilbert, L.
Goldsmith, L.
Gordon of Strathblane, L.
Goudie, B.
Gould of Potternewton, B.
Grenfell, L.
Hardy of Wath, L.
Harris of Haringey, L.
Harrison, L.
Haskel, L.
Hayman, B.
Hollis of Heigham, B.
Howells of St. Davids, B.
Hoyle, L.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Islwyn, L.
Jay of Paddington, B. (Lord Privy Seal)
Judd, L.
Layard, L.
Lea of Crondall, L.
Lipsey, L.
McCarthy, L.
Macdonald of Tradeston, L.
McIntosh of Haringey, L. [Teller]
McIntosh of Hudnall, B.
MacKenzie of Culkein, L.
Mackenzie of Framwellgate, L.
Massey of Darwen, B.
Mitchell, L.
Morris of Castle Morris, L.
Nicol, B.
Pitkeathley, B.
Ponsonby of Shulbrede, L.
Puttnam, L.
Ramsay of Cartvale, B.
Rendell of Babergh, B.
Sainsbury of Turville, L.
Sawyer, L.
Scotland of Asthal, B.
Sewel, L.
Simon, V.
Smith of Leigh, L.
Symons of Vernham Dean, B.
Thornton, B.
Tomlinson, L.
Turnberg, L.
Warner, L.
Watson of Invergowrie, L.
Whitaker, B.
Whitty, L.
Wilkins, B.
Williams of Mostyn, L.
Woolmer of Leeds, L.
Young of Old Scone, B.

Resolved in the negative, and amendment disagreed to accordingly.

18 Jul 2000 : Column 954

On Question, Motion agreed to.

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