---

Baroness Nicholson of Winterbourne: My Lords, I welcome the positive comments that the Minister has put forward most warmly and most genuinely. He knows that I would prefer to see some of them on the face of the Bill, and perhaps I could leave that thought with him in case he should kindly offer me a further meeting when we could discuss them.

However, in the context of a Second Reading, could I ask him to assure me that the inspectors will look at clinical excellence in some way or another and that the procedure extensively described by the noble Lord, Lord Craig, in which clinical excellence is not looked at although the nuts and bolts of equipment are, will not in fact be what happens. Therefore it will not be just the shell but the actual procedures that are examined. I am grateful to the Minister.

Lord Hunt of Kings Heath: My Lords, the noble Baroness was quite right to refer to the remarks made by the noble Lord, Lord Craig: I think they were very helpful in demonstrating how an individual hospital can, through its own internal processes, look at quality and ensure that it keeps up standards to the extent that we would require. I want to assure the noble Baroness that this Bill intends to provide for the proper regulation of the independent healthcare sector and that must extend to issues of quality. It is not just about room size or the physical apparatus.

The Secretary of State will have powers to make the kind of the provision in regulations which I hope will reassure the noble Baroness: for instance, provision for ensuring that the professional staff employed are qualified and have the necessary skills and experience. There will be provision for making arrangements for clinical audit and for the keeping of effective clinical records, for equipment and services, and also for identification of management and clinical risk. Regulations will also require arrangements for the on-going training, development and support of staff.

Several noble Lords have raised the issue of CHIMP and NICE, the National Institute of Clinical Excellence. In some ways this is a re-run of our interesting debate during the passage of the health Bill during the last Session. The fact is that CHIMP and NICE are about improving quality in the National Health Service. They are part of a managed system; they are part of a series of measures, including National Service Frameworks, tied into performance management in the National Health Service. I believe that there is an inherent difference between managing public authorities--the National Health Service--which is the role of the Secretary of State, for which he is accountable to Parliament, and regulating the independent healthcare system. That is the reason for our different approach in this area.

I can say that as far as the working together of CHIMP and the proposed commission under this Bill, there is provision for staff to be seconded from one to the other. The noble Earl, Lord Howe, referred to

13 Dec 1999 : Column 77

NHS pay beds, and the reason for those beds being treated differently goes back to the original point I made earlier. NHS pay beds are part of the National Health Service management system, for which accountability arrangements are well tried and tested. I believe that we have to draw a distinction between management and regulation in the NHS.

Turning to a number of questions on financial issues, I recognise that there is concern about the financial implications of the new regulatory system. As a general principle, we owe it to the people receiving services to ensure that there is an effective regulatory system in operation, providing greater protection for vulnerable people. The cost to providers will be outweighed by the benefits to individual users. However, I hope I can provide some comfort by saying that we intend that the timescales will be realistic and we shall ensure that currently registered providers have sufficient time in which to meet the new standards.

It is also possible to differentiate between one standard and another when deciding on a date for their implementation. I understand the issue of the financial viability of a number of homes. My noble friend Lord Lipsey had some interesting things to say on that point. Of course there is over-capacity at the moment. On the issue of cost and the impact of that on the resources passed by the Exchequer to local authorities, I am afraid I cannot be drawn on that matter, save to say that this would be an issue for any future spending review discussions.

This leads me on to the Centre for Policy on Ageing guidelines and the remarks made by the noble Earl, Lord Howe, about whether the balance was too much towards physical requirements, as opposed to an emphasis on quality. Let me say to the noble Earl that the Government are very much concerned with outcome and overall quality. Although physical requirements are important, as several speakers have suggested, we are concerned that this regulatory system should ensure that issues of quality are given the importance that they deserve. I should also say to him that the first reference I could discover to the 10 square meter bedroom size goes back to 1973, when I think his party was in government. At that time building guidelines were issued by the department to local authorities. However, I have to confess that in the National Association of Health Authorities and Trusts guidance in 1985 we too mentioned 10 square meters, so that figure has obviously been around for quite some time.

I would emphasise the point made by my noble friend Lord Lipsey that the agencies in most difficulty if this 10 square meter size were to be accepted would be the local authorities. In general, the consultation period on this first tranche of potential national minimum standards has been extended to 21st January 2000. We shall consider them most carefully. I believe it is important that we get them right and we shall listen carefully to the remarks which have been made by noble Lords this evening.

13 Dec 1999 : Column 78

I turn to the General Social Care Council. As my noble friend Lady Pitkeathley said, that is an extremely important, long overdue measure. I pay tribute to her and to the members of her advisory council, who do so much good work to ensure that the preparations for the new council start with an excellent foundation. Both my noble friends Lady Pitkeathley and Lord Harris made clear that it is important that we have sufficient users and lay people as members of the council. I can confirm that a lay person will be appointed as chair of the council and that lay people will be in the majority.

In response to the question asked by the noble Lord, Lord Clement-Jones, regarding the budget, it is rather early to start talking about a definitive budget. However, as a guideline figure, the CCETSW had a budget of about £5.5 million. One could start from the transfer of that kind of money. In time, it may be that people registered by the council will pay fees. There is no question of the council having to break even simply on the fees that it might take in from those registered.

I also take the opportunity provided by the noble Lord, Lord Laming, to thank the CCETSW for its past work. Its experience will be invaluable in taking forward the work of the general council. In his notable maiden speech, my noble friend Lord Mackenzie asked about the method of registration. Registration will normally be based on completion of approved training. Any other basis will be no better than that which we have at present. We would expect the register of individuals to be opened when the majority or a sufficient number of members in any group have achieved the appropriate level of training.

In response to the point raised by the noble Baroness, Lady McFarlane, we do not seek the dual registration of nurses. We want to see professional regulatory bodies complement each other.

My noble friend Lady David asked about the issue of the children's rights director. The director's responsibility relates to the provisions in this Bill. I know that she is keen to see created a children's commissioner, but that is certainly outside the scope of the Bill and, as she will know, it is not present government policy. I can also confirm to her that there will be only one children's rights director in the move from eight regional care commissions to one. Of course, we believe that that director will have a crucial role to play in dealing with so many of the difficult issues in relation to the rights of children. With regard to whether there will be well publicised access to an independent complaints procedure for children in care, I confirm that the children will have such access and that inspections will ensure that those procedures are well publicised.

I listened with great interest to the noble Lord, Lord Rix, and particularly to the issue of whether people with learning disabilities who attend day care services could have those services regulated. I confirm that the Bill does not introduce regulation for adult day care services. I am conscious that there are those who regret that. We have included a provision in the Bill to allow further services to be brought within regulation at a

13 Dec 1999 : Column 79

later date without the need for primary legislation. In the meantime, I am sure that the noble Lord will be aware that my right honourable friend the Secretary of State recently announced a review of learning disability services, including the provision of day care.

I fear that the clock is against me. In relation to domiciliary care, perhaps I may confirm that, as a first stage of the implementation of this section of the Bill, local authorities and the NHS must use only registered agencies. I also say to the noble Lord, Lord Laming, that we would expect the great majority of those domiciliary care agencies to be registered immediately.

As always, I listened with great care to the wisdom of the noble Earl, Lord Listowel. The Bill generally will not cover hostels for homeless young people, although it will cover them when they act as refuges for young people who have run away from home. In such cases, the hostels will be registered as children's homes with special provision for runaways. I look forward to the noble Earl's amendment in Committee.

As he did when we debated the child protection Bill, the noble Lord, Lord Phillips, raised the issue of vulnerable adults. Overall, I believe that the Bill provides an effective procedure. As the noble Lord knows, the Secretary of State must receive a proper referral from an employer in the stated circumstances. A person can be put on the vulnerable adults list only after due process. The Secretary of State seeks views from the parties involved. He considers whether, on the balance of probabilities, the employer was right in forming a view that the person put a vulnerable adult at risk of harm. The individual will know at all stages what is happening. I agree with him that that is a serious matter for the person concerned. That is why we provide an appeal to an independent tribunal. We have also provided for a person to seek a review of the decision 10 years from the date of listing. At that stage, the tribunal could decide to remove the name from the list. I understand that the noble Lord's specific point of concern arises from provisional listing. I believe that that is--

---