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Lord Peyton of Yeovil: I want to make two points. First, I acknowledge the generosity that we always expect from my noble friend on the Front Bench. On this occasion he has rather exceeded himself. He might have challenged the Government by saying, "Let us bury, alive or half dead, the Commission for Health Improvement and the National Care Standards Commission". That would have put the Minister on the spot: he would have had to explain what useful functions these two bodies had ever performed and what degree of skill they had shown in doing so. Can the Minister tell the Committee whether their functions are so important and so well performed that they should be taken over by the health inspectorate?
My noble friend puzzled me. Subsection (3) of his amendment contains the words,
- "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".
It grieves me deeply that in the first two subsections of the amendment my noble friend did not see fit to go a little further and question the usefulness of the two bodies, and whether their functions should be taken over. I appreciate that it is better to have one body rather than two. I also feel slightly uncomfortable
about the prospect of inviting a Secretary of State to do something by order. That does not appear to be appropriate.
Baroness Carnegy of Lour: Out of kindness to my noble friend, I am bound to say that I believe that this is an extremely good idea. The battle appears to have been won and the Government appear to be persuaded that the private sector can be extremely useful in the National Health Service. They appear to have dropped their doctrinaire dislike of it. Perhaps that is dire necessity. The battle having been won, it appears to be pointless to have two bodies carrying out roughly the same task in two different parts of the service.
I agree with my noble friend Lord Peyton, who objects so much to subsection (3). However, my noble friend Lord Howe did not draft an amendment that he expected to be put on the face of the Bill verbatim. Many other amendments would have to be made to the Bill should this extremely good idea be adopted by the Government, so I am not too worried about subsection (3). In this Bill so many matters will happen by order that this particular requirement may disappear into oblivion.
I do not believe that the Minister should launch into an endless description of the system as it now stands. Perhaps he will tell the Committee why, given the fact that the battle in relation to the private sector has been won, we need two bodies. Why not have a single inspectorate?
Baroness Pitkeathley: I confess to a certain wry amusement on seeing this amendment. Earlier today and last week, we heard a great deal from the Opposition Benches about delay, about the state of unreadiness in PCTs and so on. Now we hear the opposite: that we should hurry to merge the functions of two bodies, one of which is not even yet in existence.
However, I am in sympathy with the spirit of the amendment. As the noble Earl, Lord Howe, has told the Committee, the Secretary of State has committed the Government to further integration of inspection services in the future. As your Lordships know because I go on about it endlessly, I am also in favour of anything that promotes further co-operation between health and social services. The commitment to that co-operation already exists in the bodies mentioned in the amendment, as I have reason to know from my role as interim chair of the General Social Care Council.
We have to ensure that there is an ongoing review of the functions of each body and of the relationships between them, as the Secretary of State and the Kennedy report have suggested, and that those bodies should be given the utmost importance as we proceed, together with their relationships with the Audit Commission and the Social Services Inspectorate. Please let there be no merger of the General Social Care Council before it has had an opportunity to put into practice its wide-ranging and significant powers,
and to capitalise on the welcome support that it will command among all those who work in the area of social care.
Baroness Masham of Ilton: Recently, there was an example of a mother who had given birth to twins in a private hospital and died because she had not had her blood pressure monitored. Patients are patients wherever they are treated. Surely they should all have the same minimum standards and Parliament should try to ensure their protection. I therefore support this amendment.
Baroness Fookes: I, too, support this amendment. In fact, I think that it is very important that there should be one common standard, and I saw no reason for having two sets of regulatory bodies when the legislation was first brought in. Now, I believe that it is even more important that the situation should be simplified: one standard for all. I therefore support the amendment.
9.15 p.m.
Baroness Northover: I, too, support the amendment, which proposes a health inspectorate that includes both CHI and the national care standards commission. As my noble friend Lord Clement-Jones explained on Second Reading—perhaps he has said this so often that he is blue in the face and it is now my turn to say it—we have long supported these proposals. We welcomed CHI when it was established in the Health Act 1999 and gave a general welcome to the Care Standards Act 2000, but we feel that the national care standards commission should be incorporated with CHI. This is a good time do that, before the National Care Standards Commission comes into effect and we have two bodies working in parallel.
In the other place, in relation to this Bill, we urged that the time had come to put the two bodies together. We also disagreed with the Conservative Party in the other place that the merger should include NICE and the proposed council for the regulation of the professions. We felt that the latter two bodies are expected to perform different functions and should remain separate. We therefore welcome the fact that, speaking for the Conservative Party in this House, the noble Earl, Lord Howe, has accepted the proposal that it is CHI and the care standards commission that should be merged. We are happy that we are speaking with one voice on this side of the House—a point which I am sure will not be lost on the Minister.
We are fully committed to the objectives of ensuring the highest possible quality of care for all patients. Patients deserve the best possible protection regardless of whether they are being treated in the NHS or the private sector. A single inspectorate should help to achieve uniform high-quality patient care across both those health sectors, avoiding, as we have heard, unnecessary duplication. If we merged these two organisations, we would ensure consistent standards between the NHS and other sectors. As the noble Earl, Lord Howe, has pointed out, CHI would be in a
position to use the expertise it has gained from inspecting the NHS and the same limited pool of expertise could be used.It should also be clear that we are certainly heading down that road. We on these Benches have noted what Mr Alan Milburn said in his response to the Bristol report—which the noble Earl, Lord Howe, has quoted—when he spoke of the,
- "organisational integration between the CHI, the social services inspectorate, the National Care Standards Commission and the Audit Commission".—[Official Report, Commons, 17/01/02; col. 456.]
The BMA has produced a chart showing the multiplicity of organisations that check on the various sections of the health service. Surely anything that streamlines the arrangements must be welcomed—although that does not seem to be the Government's intention, as demonstrated by their proposals to replace CHCs. I trust that the Minister will see the sense of this proposal. Nevertheless, even if he does not, I think that he will find that this type of arrangement is coming down the track.
Lord Hunt of Kings Heath: I should like first to say what a joy it is to welcome the noble Lord, Lord Peyton, back to our debates on the National Health Service. I was particularly struck by his reminiscences of the work of regional health authorities. Earlier, while looking wistfully back at regional health authorities, the noble Baroness, Lady Noakes, expressed her wish that they should speed on and be re-introduced. I suspect that the noble Lord, Lord Peyton, might have something to say about that.
As for the general point made by the noble Lord, Lord Peyton, on the accomplishments of the Commission for Health Improvement and the purpose of the National Care Standards Commission, I believe that they perform very important functions. The Commission for Health Improvement provides a means of reviewing the way in which clinical governance is undertaken within the National Health Service. I think that, in its first reports, it has shown its mettle and been very helpful in identifying issues to be raised and problems to be tackled within the NHS.
The National Care Standards Commission starts its work this April, and it will lead to a much more uniform, consistent quality of legislation within the private health sector, the care homes sector and various other care sectors. It will take responsibility from both health authorities and local authorities, and I am sure that it will lead not only to a much higher inspection standard, but, as importantly, to greater consistency. That is why care homes and other parts of the independent sector were so welcoming of the establishment of the National Care Standards Commission.
As far as the general principles raised in this debate are concerned, there is very little between us. The Government are certainly sympathetic to the thinking behind the amendments but consider that they are somewhat premature. At the moment, the Commission for Health Improvement and the National Care Standards Commission have discrete and distinct functions in relation to the inspection and regulation of health and social care in this country, but they already plan to work collaboratively where their respective roles impact on each other. This co-operation will also be assisted by, and extended to, other bodies through the new council for quality that we announced in our response to Professor Sir Ian Kennedy's report on Bristol. Noble Lords may well recall that the Bristol inquiry response referred to:
- "in the short term, a strengthened inspection role for the CHI working with the Social Services Inspectorate and National Care Standards Commission as appropriate to give the public an independent assurance that each provider of NHS services has proper quality assurance and quality improvement mechanisms in place".
- "We will take further steps at the earliest opportunity to rationalise the number of bodies inspecting and regulating health and social care".
As the noble Earl, Lord Howe, has already suggested, my right honourable friend the Secretary of State for Health, in a speech to the new health network, said:
- "The Commission for Health Improvement will take responsibility for the independent publication of information about clinical and organisational performance. It will have a greater inspectorial and reporting role over the health system's performance 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 whether they are provided by public, private or voluntary sector organisations".
There is nothing between us on this matter, therefore. Our intention is that there will be a convergence between the activities of these four bodies, including CHI and the National Care Standards Commission, drawing together their expertise in joint work where appropriate, and sharing best practice.
To give an example of how we will develop this, as the National Care Standards Commission starts its work in April and as the Commission for Health Improvement develops its inspection function, we will be looking for the development of common methodologies, where appropriate, and the co-ordination of visiting programmes. We have made it clear, however, that we believe that it would be premature to seek to rationalise the functions of CHI and the National Care Standards Commission, or indeed other relevant bodies, in the current Bill. These issues and possible legislative requirements are complex and they need to be given full consideration before we act.
We have, however, already made provision in the Care Standards Act 2000 for CHI to exercise functions of the National Care Standards Commission in relation to the independent sector. When we enacted the Care Standards Act, we considered it right that the regulation of private healthcare should be different from arrangements for the independent review of NHS bodies by CHI. But life has moved on. We have gained a lot of experience with CHI, and the Bill before us now gives CHI a new function of inspection, which will be against published standards.
While we are clear that private and voluntary health care must remain under a system of regulation or licensing of service providers, we believe that CHI should now act on the National Care Standards Commission's behalf to inspect independent hospitals. We will therefore be bringing Section 9 into force shortly and making regulations so that the Commission for Health Improvement may exercise the National Care Standards Commission's function of inspection in relation to independent hospitals.
I hope that in the immediate future that will go some way to meeting the points raised by noble Lords tonight. In the rather more long term, work will continue to look at how we can rationalise the different inspecting organisations I have mentioned. We will have to come back to that at a future stage. I hope, however, that in my remarks noble Lords will see that we are very much with the thrust of the points being put forward. We believe that this amendment is premature in terms of legislative action to bring the bodies together but, in bringing into action Section 9 in relation to CHI and the National Care Standards Commission, we are showing, I believe, that we are moving down that route.
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