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Lord Peyton of Yeovil: I cannot easily find words to express my gratification at being able to give such valuable support to the Minister in making such a wise decision.

Lord Filkin: I shall treasure Hansard for many years to come.

Lord Rea: I thank my noble friend for giving the attention that he has to these two amendments. I cannot agree with every word that he has spoken, particularly with regard to Amendment No.60. We shall look at his words in Hansard and decide whether

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to take it further. It may require further discussions. For the moment, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 55 to 58 not moved.]

Lord Filkin moved Amendment No.59:

    Page 6, line 7, after "services" insert "in the area of the Primary Care Trust"

On Question, amendment agreed to.

[Amendment No. 60 not moved.]

On Question, Whether Clause 5, as amended, shall stand part of the Bill?

Lord Peyton of Yeovil: I hate to disturb such rapid progress and to break into the harmony. I have long objected to this habit of putting two Bills into the same sausage skin. A new Bill is pushed rather rudely into the old Act of Parliament. The result is something which is not always easy to understand.

I do not know whether the noble Lord, Lord Hunt, or the noble Lord, Lord Filkin, will reply but I would just ask them to explain, in simple language, so that I and other of your Lordships can understand what I am now going to read out.

I would not dream of trying to inflict indefinite pain on the Committee, so perhaps two lines will suffice. Subsection (11) reads:

    "In subsection (1C) for 'subsection (A1)(b) or (c) or (B1)(b) or (c)' there is substituted 'subsection (ZA1)(b) or (c), (A1)(b) or (c), (A2)(b) or (c) or (B1)(b) or (c)'".

I call for a moment's silence of mourning over such disgraceful garbage being put on the face of a Bill. I recently complained about this same habit when it was practised by the parliamentary draftsman at the Home Office. My punishment was to see produced out of a conjuror's hat a fair copy of the Bill as it was hoped it would emerge from Committee. I visited the Printed Paper Office this evening to inquire whether, hidden away, there was to be a repeat of such a phenomenon. No one had heard of it. Your Lordships' House is faced again and again with this revolting habit of putting something plainly unintelligible—not even meant to be understood—on the face of one Bill after another.

The noble Lord, Lord Hunt, is someone for whom your Lordships have great respect. I hope he will justify that feeling of respect by taking this garbage away and saying it will not do.

Lord Hunt of Kings Heath: I am grateful to the noble Lord for allowing me to explain Clause 5(11)(a). I thought it would be abundantly clear to your Lordships. In essence, the clause is simply consequential on renaming health authorities strategic health authorities. It removes the need for local representative committees to be coterminous only with the relevant health authority and it provides for local representative committees to establish themselves at the level of one or more primary care trust area.

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I recognise that amended wording is difficult to follow. The noble Lord is right to point that out. The only crumb of comfort I can give is that work is in hand in the department on a consolidation Bill bringing together within a fairly short period of time all relevant health service legislation. This will make life easier, both for the legislatures and, more importantly, for the National Health Service.

Lord Peyton of Yeovil: The last comment is astoundingly good news. Only recently, when the Police Reform Bill was before your Lordships' House, I inquired at the Public Bill Office whether anybody had any thoughts about further consolidation measures. There were, I was told, European measures which were due for consolidation but otherwise nothing at all—a bleak nothingness between us and the horizon.

I am grateful to the noble Lord for what he said in his tribute to me, but I had hoped that he would produce a simple summary of this gibberish. In so far as he has succeeded in doing so—and one would need hours to check up on the matter—it entitles me to ask why he did not place it on the face of the Bill.

Baroness Fookes: I do not want to depress my noble friend too much, but I serve on the Select Committee which examines the consolidation of Bills. I have to tell him that the committee does not meet very often.

Lord Hunt of Kings Heath: All I can say is that work on such a measure has begun within the department. I do not know when it will be completed and when the matter will come before the noble Baroness's committee. All I would say is that I very much understand the need for a consolidation measure on health service legislation.

Clause 5, as amended, agreed to.

9 p.m.

Earl Howe moved Amendment No. 61:

    After Clause 5, insert the following new clause—

(1) There shall be a body corporate known as the Health Inspectorate, which shall take effect from 1st April 2004.
(2) The Health Inspectorate shall assume at that date the functions undertaken prior to that date by—
(a) The Commission for Health Improvement, and
(b) The National Care Standards Commission.
(3) The Secretary of State may by order make such amendments of the legislation relating to the health service in England and Wales as in his opinion facilitate, or are otherwise desirable in connection with, subsections (1) and (2)."

The noble Earl said: With the proposals in the Bill to widen the functions of the Commission for Health Improvement, an opportunity has arisen for us to examine CHI's role in the round. In particular, we have an opportunity to revisit a matter that was first considered by this House during the passage of the Care Standards Act 2000.

During the passage of that legislation, we debated—at some length, and not without some fairly energetic exchanges—the respective roles of the Commission for

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Health Improvement and the National Care Standards Commission, which the Care Standards Act brought into being. At the time, many noble Lords, including myself, urged the Government to consider whether the demarcation line that they were seeking so firmly to draw between the NHS and the private acute sector for the purposes of inspection and monitoring was really in the best interests of either sector, and, more particularly, of patients.

I believed then, as I still do, that for quality control purposes the distinction between the two sectors is, and should be, academic. The Secretary of State has a duty to ensure that wherever patients are treated, no matter who is paying for the treatment, standards of care are both uniform and of the highest possible quality. The doctors who treat patients in the NHS are the same doctors who treat patients in private hospitals.

That position begs the question of whether we need two full-blown inspectorates. Two years ago, the Government stuck firmly to their line, "Yes, we do", on grounds which I confess I have never fully understood; namely, that the NHS as a managed service, and the independent sector as a regulated service, should not be subject to the same quality control regime. I do not believe that it is unfair to say that behind that policy stance there lay a deep-rooted antipathy towards the independent sector in the minds of certain Ministers at the time. What we emerged with at the end of the day was Section 9 of the Care Standards Act, which provided for co-operative working between CHI and the NCSC, whereby each regulatory body could delegate functions to the other.

To be fair to the Government, a great deal has happened since the Care Standards Act was passed. There has been a tangible warming of relations between the Government and the independent sector. A concordat has been signed under which many NHS operations and procedures are being carried out in private hospitals. We have a target, I believe, of 100,000 such operations being performed in the private sector over the next year. As recently as last June, the Secretary of State was saying to Parliament:

    "by and large, we thankfully have one monopoly provider and that is the NHS. As long as a Labour Government are in power that will remain the position".—[Official Report, Commons, 26/6/01; col. 500.]

It was striking that only a few months later, in December last year, he should be saying completely the opposite:

    "Where we need to get to is a position where the NHS is no longer a monopoly provider of care, but it does become a monopoly funder of care".

That U-turn is to be welcomed because it recognises reality. However, it again opens up the issue of how quality standards should best be monitored. The more there ceases to be a meaningful distinction between the NHS and the private sector, the less one can justify the overlap and duplication inherent in having two inspectorial bodies, each imposing its own burdens on doctors, nurses and managers, each having to observe fairly artificial demarcation lines, and each separately

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staffed. It has to be said that the pool of expertise available for such monitoring work across the country is not that large in the first place. A single body would not only ensure consistent standards between the NHS and the private sector; it would also capitalise on the expertise gained in CHI as a result of work that has been done there to date.

I felt emboldened to table this amendment when I read the Secretary of State's response in another place to the Bristol report, when he said:

    "There will be greater co-ordination among those organisations responsible for assuring the quality of care in the NHS. That will necessitate closer working and, over time, organisational integration between the CHI, the Social Services Inspectorate, the National Care Standards Commission and the Audit Commission, so that health and social care services are subject to a common set of standards, irrespective of whether they are provided by public, private or voluntary organisations".—[Official Report, Commons, 17/1/02; col. 456.]

What a difference from a couple of years ago! The energy expended by the Government in putting up fierce resistance to exactly that argument from these Benches could have been more usefully directed elsewhere. But if the Government are now serious about organisational integration, why not make a start now, using this Bill? It is a golden opportunity. I beg to move.

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