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Lord Clement-Jones: That is about as close to an apology for previous legislation that I have ever heard a Minister give. If the Minister wants to achieve such integration, will not further primary legislation be necessary?
Lord Hunt of Kings Heath: I was simply seeking to suggest to the noble Lord that, since our debates a couple of years ago, life has moved on and there have been developments. The relationship of the National Health Service with the independent sector has evolved. For that reason, it is right to reconsider the issues.
I accept that primary legislation will be required at the end of the journey to integrate national inspection systems against common standards. It would be premature to legislate in the Bill, because much work needs to be undertaken.
Lord Clement-Jones: I have one further question. Will that be before the National Care Standards Commission is even formed and up and running?
Lord Hunt of Kings Heath: That is because we generously allowed such a long lead time to allow the commission to establish its work.
Baroness Northover: I thank the Minister for his reply. We shall obviously share many more late nights here in future. I also thank the noble Baronesses, Lady Noakes, and Lady Masham of Ilton, for their support. I am intrigued and encouraged and shall have to read what the Minister said. To know that he is sympathetic to the amendment is obviously extremely nice. However, he says that it is premature to legislate at this point. Given that we are so busy setting up primary
care trusts with all their duties, it strikes me as strange that the amendments should be regarded as premature while we rush ahead in other areas.9.30 p.m.
Lord Hunt of Kings Heath: In his speech my right honourable friend did not confine himself to the National Care Standards Commission and the Commission for Health Improvement. He also referred specifically to the Audit Commission and the Social Services Inspectorate. The speech followed up our response to the Bristol inquiry.
These are complicated matters that need full consideration. Even if we wanted to wave a magic wand and say, "Yes, we'd love to legislate in this Bill", it would not be possible to bring forward carefully thought-out legislation at this stage.
Baroness Northover: It strikes me as ironic that it is fine to change the structure of the NHS fairly rapidly, which is a complicated thing to do, but in this area, where the lives of individual patients are affected, it is said to be premature to take action on the proper inspection of hospitals. That surprises me.
Lord Hunt of Kings Heath: The proposals in the Bill arise from the NHS Plan and Shifting the Balance of Power. They have been given careful thought and consideration by the Government over a considerable period of time. My right honourable friend's speech only a few weeks ago arose directly from the recommendations of Professor Sir Ian Kennedy in the Bristol inquiry, which reported only a few months ago. That is why it is important that we have time to reflect on the best way to achieve integration between these different bodies.
Baroness Northover: I thank the Minister for that reply. However, I point out that in this Chamber, which may not be the fastest-moving place, a decision was taken in 1999 and 2000 to include private hospitals in the inspection system. It is a shame that it is taking a while.
I am encouraged by the Minister's comments. I hope that when the inspection is extended—it certainly sounds as if it will be—it will cover the whole of the private acute sector and not simply those parts in which the NHS is involved. It is important for citizens as a whole—for all patients—to know that they are safe in the institutions in which they are treated. I look forward to reading the Minister's comments in Hansard. On that basis, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 12 [Further functions of the Commission for Health Improvement]:
Baroness Noakes moved Amendment No. 96:
- Page 18, line 11, at end insert—
The noble Baroness said: The amendment seeks to amend Section 20(2) of the Health Act 1999, which deals with the functions of the Commission for Health Improvement. The amendment would allow the regulations made under that subsection to include CHI taking into account the co-ordination of CHI's own visits with those of other bodies carrying out monitoring or inspecting the same premises. Trusts, GP surgeries and so on face a multitude of visits and inspections from various bodies in addition to CHI. There are visits by the Audit Commission, the Royal Colleges, CHCs and, if the Bill is passed, patient forums, and many other bodies, such as the Modernisation Agency.
My noble friend Lord Peyton of Yeovil told us on the second Committee day that the multiplicity of inspections was described to him as,
The bottom line is that every minute spent on such visits is a minute not spent on patient care, and anything that can be done to minimise their impact will be welcomed. The amendment does not seek to cure the totality of the problem but seeks to co-ordinate visits which are focused on monitoring and inspection. It is a modest contribution to the problem and I hope that it will commend itself to the Minister. I beg to move.
Baroness Northover: I support this amendment. We all agree that CHI is a welcome creation doing a good job. However, given the duplication—no doubt other Members of the Committee will have a copy of the chart from the BMA of the various ways in which doctors can be assessed, monitored, checked, revalidated and so forth—the complexity is obvious. We should do all we can to ensure that that duplication and that kind of complexity is made simpler.
Most of the visits made by those bodies are of course appropriate. But we can try to ensure that there is co-ordination and that inspections by the various organisations do not cause disruption. An interesting analogy was drawn in the other place where they talked of the digging up and re-digging up of roads. If we can simply co-ordinate the various bodies who have to dig up the roads, it would make more sense than endlessly having one digging up a road this week and another digging it up next week. On the basis therefore that we seek co-ordination of this kind of inspection, I support the amendment.
Lord Hunt of Kings Heath: From my remarks on our intent to rationalise the inspection mechanism at national level, Members of the Committee will understand that I am sympathetic with the broad arguments of the noble Baroness in terms of a rationalisation of inspectorates at local level.
I make two points. First, the reason why various organisations visit the NHS is to ensure that quality and safety—issues we have already debated—are paramount. One makes no apologies for the extension of those inspection agencies into primary care. However, I fully accept that there must be co-ordination and rationalisation, and that the burden put on busy people operating front-line services is as light as is possible consistent with a rigorous approach to safety and quality.
The Commission for Health Improvement is at the moment piloting its inspections of primary care trusts. Part of those inspections will involve visits to some individual GP surgeries. In the discussions that the department had with CHI we came to a mutual understanding that those visits will be light touch, for the very reason the noble Baroness put forward.
The CHI has also taken other steps to co-ordinate activity with relevant bodies. It has already agreed a draft statement of principles for consultation covering how it plans to improve co-ordination with the Audit Commission, including external audit, NHS internal audit, the Health and Safety Executive and the NHS Litigation Authority, including the clinical negligence scheme for trusts. CHI also has a memorandum of understanding with a number of relevant bodies including the commission, the Audit Commission, the Health Service Ombudsman, the General Medical Council, the UKCC, the National Clinical Assessment Authority and it is working to develop others, including the Health and Safety Executive. My understanding is that copies of those memoranda have already been placed in the Library.
Therefore the Commission for Health Improvement is well exercised of the need to ensure that there is co-ordination and to avoid duplication. We will encourage the commission to continue that good work, which is entirely consistent with what we seek to do at national level. We do not need the amendment as it is tabled. The Secretary of State already has the powers to encourage CHI to continue this process of co-ordination and I am satisfied, from my meetings with CHI, that it is fully cognisant of the need to move in the direction the noble Baroness suggested.
"( ) In subsection (2), at the end of paragraph (b) there is inserted "including co-ordinating visits to general practitioners, Primary Care Trusts or to NHS trusts with other bodies carrying out monitoring or inspections of those premises"."
"death by a thousand visits".—[Official Report, 18/3/02; col. 1203.]
The British Medical Association feels strongly about the issue and supports the amendment. I hope that the Minister will say whether the Government intend to do anything to streamline the visits and relieve the burden on doctors, other health professionals and their staff.
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