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The noble Baroness said: Amendment No. 95 seeks to include private hospitals in the same inspection system as the NHS. I declare an indirect interest as my husband, as well as being an NHS surgeon, is also in private practice at the London Clinic and the King Edward VII hospital.
I was astonished when I first discovered that private hospitals were not inspected in the same way as NHS hospitals. That is quite wrong. The case for bringing private acute care within the same inspection system as that for the NHS has long been argued by my noble friend Lord Clement-Jones. I should not be surprised if Members of the Committee thought that they would hear from him on this amendment. The noble Earl, Lord Howe, has also argued this case and the Chamber has approved the proposal. So this issue may be quite familiar to many noble Lords today.
From these Benches we welcomed CHI when it was set up in the Health Act 1999. However, we felt strongly that patients should receive the same high quality care wherever they were treated. Therefore, we felt that it was appropriate for CHI to inspect acute care in private as well as NHS hospitals.
In the Care Standards Bill 2000 we welcomed the regulation and inspection of social care, and private and voluntary healthcare premises. But we argued again that acute care in private hospitals should be inspected to the same level as in NHS hospitals.
Patients really do deserve the best possible protection, whether they are being treated in the NHS or the private sector. I noted earlier with great interest that the Minister, in relation to medical registration and training, stated that there should be the same entry requirements wherever a doctor intended to practise, whether private or NHS. The same principle should apply here.
The Commission for Health Improvement covers independent institutions where NHS patients are treated and private care within NHS hospitals, but not private care within private hospitals. We were concerned that neither of the earlier Bills gave the assurance that a duty of quality identical or similar to that required for the NHS was required for the independent sector. But it is only when things go wrong that people discover that that is so. When one thinks of some of the cases that have come up in recent years, it is clear that those being treated in the private
Many institutions have such high standards, but it remains highly inappropriate for them to be inspected as though they were nursing homes. There are over 200 hospitals in the private sector which comprise approximately 10,000 beds. There are some 800,000 treatments carried out by 17,000 doctors, most of whom also work in the NHS.
As I have mentioned, in the relevant health Bills in 1999 and 2000, noble Lords supported the proposal that independent hospitals should be brought within the scope of the regulations. In the end the point had to be conceded in the face of government opposition in the other place.
We believe that every patient deserves common minimum standards of care. The Government have a responsibility to ensure that minimum standards are maintained and seen to be maintained. We need consistency in those standards and consistency in enforcement.
The Government have argued in the past that the two healthcare systems under which NHS and private hospitals operate are different; that one is a managed system and the other is a regulated system. But inspection is to do with regulation. It must be right that the Government take appropriate measures to protect their citizens within the private sector and for that sector to come within the thorough inspection system that we have now come to expect, and welcome, within the NHS.
In January, Mr Milburn's response to the Kennedy report was that there would be a coming together and better co-ordination of NHS inspection systems; and that the CHI is to be strengthened and made more independent. Now is surely the time, if not before, to ensure that the private acute sector is properly brought within the same kind of inspection system as that which applies to the acute sector of the NHS. I beg to move.
Baroness Noakes: We fully support the intent of the amendment—as with the earlier amendment about merging the function of the National Care Standards Commission and the CHI. In Committee on 18th March, the Minister mentioned, in respect of the Care Standards Act 2000,
Baroness Masham of Ilton: I, too, support the amendment. Patients can be at risk in a private hospital when they are in single rooms. In an NHS hospital, other patients are around. When a person gets into difficulty and there are no staff around—which often happens when there is a shortage, as there
Lord Hunt of Kings Heath: I have great sympathy with the broad thrust of the noble Baroness's arguments but it is a question of timing. The amendment is rather premature, in view of the amount of work that must be undertaken to take forward the rationalisation of inspection agencies at national level to which my right honourable friend the Secretary of State referred following the Bristol inquiry report.
We made provision in the Care Standards Act 2000 for the CHI to exercise functions of the National Care Standards Commission in relation to the independent sector. The noble Baroness kindly reminded me of the debates on that subject. She will recall that, when we enacted the Bill, we considered it right that the regulation of private health care should be different from the arrangements for the independent review of NHS bodies by the CHI.
Life moves on and there have been considerable developments since we debated that point. The Bill gives the CHI a new function of inspection against published standards. That responsibility will extend to services for NHS patients wherever they are treated, including those provided by the independent sector. It is clear from Government action in the past few months that an increasing number of NHS patients are being treated in the independent sector. It is clear also that—particularly during the transitional period, as we try to build capacity in the NHS—we will continue to use the independent sector. While we are clear that private and voluntary health care must remain under a system of regulation or licensing, the time is right for the CHI to inspect independent hospitals on behalf of the National Care Standards Commission.
The noble Baroness, Lady Noakes, reminded me that I made it clear on Monday night that we will bring Section 9 of the 2000 Act into force shortly and make regulations, so that the CHI may exercise the commission's function of inspection in relation to indpendent hospitals.
The noble Baroness, Lady Noakes, asked me to fill in some of the detail. Of course, we are still considering that and it will be contained in the regulations. However, essentially, the regulation of private healthcare institutions remains the responsibility of the National Care Standards Commission. We propose that the inspection function itself should be undertaken by the Commission for Health Improvement, but acting within the ambit of legislation that gives the overall responsibility to the National Care Standards Commission. It is a halfway house, as it were. We are trying to get as much consistency as possible in the inspections process, bearing in mind that the current legislative requirement is for the National Care Standards Commission to have the ultimate responsibility for private hospital regulation.
I said that that is a transitional phase because, as my right honourable friend the Secretary of State made clear, we are seriously considering have to obtain closer working and, over time, organisational integration between CHI, the Social Services Inspectorate, the National Care Standards Commission and the Audit Commission so that health and social care services are subject to common standards, whether they are provided by public, private or voluntary sector organisations.
That is clearly an extensive piece of work to be undertaken during the next few months. That is why it would be premature to legislate in the Bill to bring together CHI and the National Care Standards Commission. As I said, we are bringing Section 9 into operation as a means of having as much consistency as possible between CHI and the National Care Standards Commission. I hope that I have made clear our intended direction of travel. Although I do not recommend that we accept the amendments, I hope that the noble Baroness will accept that we are going in the same direction, but that a considerable amount of work will need to be done.
"INDEPENDENT HOSPITALS
The Secretary of State shall by regulations extend the functions of the Commission for Health Improvement set out in section 20 of the 1999 Act (functions of the commission) to any independent hospital as defined by section 2 of the Care Standards Act 2000 (c. 14) (independent hospitals etc.)."
"bringing Section 9 into force".—[Official Report, 18/03/2002; col. 1203.]
I understand that that would bring the inspection of independent sector hospitals within the remit of the CHI. What precise effect would that have—and to what extent would it meet the excellent points made by the noble Baroness?
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