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Lord Glentoran: My Lords, in welcoming the order, I shall quote the comments that David Trimble made in Committee in another place. He said:
- "We maintained greater per capita expenditure on health in Northern Ireland than that in England and Wales . . . Unfortunately, although expenditure is higher in Northern Ireland, output is poorer. We have longer waiting lists and are not achieving the same level of health care as in England and Wales".
- "Consequently, I welcome the extension of the powers to increase the effectiveness and the efficiency of the audit in order to give us better tools to improve performance".—[Official Report, Commons Second Standing Committee on Delegated Legislation, 29/1/03; col. 11.]
Lord Shutt of Greetland: My Lords, I support the order. My noble friend Lord Sharman is behind it. He is a member of the Institute of Chartered Accountants in England and Wales, as I am. Therefore, it must be right. Clearly it is important that we have up to date audit and accountancy in Northern Ireland and I am happy to support the order.
Lord Maginnis of Drumglass: My Lords, my party welcomes the order. We regret that something as important as this and the other orders have to complete their stages through Orders in Council rather than by Bills.
The order is a response to the Sharman review and has clearly been tailored to meet those circumstances peculiar to Northern Ireland. It extends the powers of the Comptroller and Auditor General, bringing new bodies within his remit. In particular, echoing what the noble Lord, Lord Glentoran, has said, we welcome the provision for all National Health Service bodies to come within the Comptroller and Auditor General's bailiwick. That is patently sensible, given the substantially increased amount of public money going into the health service.
The noble Lord, Lord Glentoran, indicated that there is greater per capita expenditure on health in Northern Ireland than there is in England and Wales, although we still lag behind Scotland. Unfortunately, however, the output is, as David Trimble indicated, significantly poorer, with longer waiting lists and patients not receiving comparable health care to that available in Great Britain.
One questions why, with extra money being ploughed into the health service, we are not seeing a substantial increase in the quality of services. That is not be interpreted as criticism of all those who work in the health service. Those at the coal face are aware of the structural problems that need to be addressed. A more efficient and effective audit is but one measure that may begin to ensure that money is better spent.
I welcome the inclusion of some 13 non-departmental public bodies within the remit of the Comptroller and Auditor General's audit. The largest of those, the Northern Ireland Housing Executive with its substantial annual expenditure of around £750 million or £760 million, has long been the victim of protection racketeers. Between the Comptroller and Auditor General and the new Criminal Assets Bureau one would look forward to meaningful changes affecting both the housing executive and other such agencies.
The power to obtain information is important in so far as it will now take the audit beyond the public sector and into the private and semi-private sectors. Strengthening the Comptroller and Auditor General's powers is therefore vital to the long-term rehabilitation of our society. I welcome the order and look forward to the Minister's response.
Lord Williams of Mostyn: My Lords, notwithstanding the previous convictions of the noble Lord, Lord Shutt, I commend the order to the House.
On Question, Motion agreed to.
Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003
8.28 p.m.
Lord Williams of Mostyn rose to move, That the draft order laid before the House on 7th January be approved.
The noble and learned Lord said: My Lords, the main purpose, which chimes with what the noble Lord, Lord Glentoran, Mr Trimble, and the noble Lord, Lord Maginnis, said earlier, is to introduce measures to secure and to improve the quality of health and social care services delivered by the health and personal social services and by the independent sector in Northern Ireland. There was detailed public consultation which began in April 2001. It was gratifying to find widespread support for the introduction of these new arrangements in Northern Ireland.
The proposals to introduce the new arrangements and to bring forward legislation were approved by the Executive in May 2002. It was being considered as a Bill in the Assembly; it had passed Second Reading and had just entered Committee stage when devolution was suspended. Following the decision to bring forward the Bill as an order, the draft order was subject to a short period of consultation in November and December of last year. Those who responded confirmed their continuing support for the legislation.
The proposal will give protection to service users with regard to quality of health and social care; it will remove unacceptable variations in the standards of health and care delivered; and it will reduce the risk of abuse of, or harm to, service users. Those who live in England, Scotland and Wales have had those protections for some time and it is only right, just and appropriate that those who live in Northern Ireland should have the same protections. I commend the order to the House.
Moved, That the draft order laid before the House on 7th January be approved.—(Lord Williams of Mostyn.)
Lord Glentoran: My Lords, I have a brief from the British Medical Association. I want to reiterate some of its points. The BMA (Northern Ireland) notes and asks why the order does not appear to provide for the authority to assess value for money in the same way that the Commission for Healthcare Audit and Inspection will in England and Wales.
The BMA (NI) considers that the authority, as an independent body, should be subject to a statutory obligation to submit its annual report to the Northern Ireland Assembly. It suggests that that would enable the Assembly to scrutinise the work of the authority.
As regards GPs' surgeries, the BMI (NI) asks whether GPs providing NHS services from their premises where private work may also be undertaken will need to register with the new authority.
Regarding personal care, which is dealt with in Articles 10 and 11 of the order, the BMI (NI) seeks assurances that the department will discuss these matters with organisations representing patients, carers, health and social care professionals.
Basically, there is considerable support for the order by the BMA (NI). On minimum standards of improvement, it comments that it would appear that a breach of an improvement notice does not in itself constitute an offence and that it would press for some examples of how the department envisages that a breach of the standards would be addressed.
Lastly, I deal with restrictions on disclosure of information. The BMA (NI) suggests that a code of practice setting out the circumstances in which disclosure without consent would be acceptable.
I apologise for reading the brief, but when I received it the points seemed pertinent and worth making to the Minister. Otherwise, I support the order.
Lord Shutt of Greetland: My Lords, I support the order. The Bill was called the Health and Personal Social Services Bill. One is tempted to suggest that it would have been an opportunity to look at the whole business of free personal care. However, that is perhaps a debate for another day. The devolved Assembly went so far, and perhaps it will return to the matter.
Lord Maginnis of Drumglass: My Lords, I welcome this order. In the light of some awful cases that have been in the public eye over the past few years—Harold Shipman or the Bristol Royal Infirmary, for example—there is a need to underpin best practice within the health service.
I welcome the provision for an all-encompassing regulatory authority to monitor the provision and quality of services and to specify necessary improvements. Monitoring of establishments and agencies has, until now, been less than satisfactory. Now standards of care will be regulated and residential homes will have to provide a basic standard of care.
Can the Minister tell us, however, how those standards will be set and how they will be enforced? Will there be a timeframe for meeting those standards and will they be checked on a regular basis? Can he assure us that they will be achievable and sustainable; and that they will be open and transparent?
I welcome the provision for the regulation and improvement authority to report annually. It is however, not unreasonable to assume that there will be occasions when the public, the department and service providers will need to be made aware of findings on an ongoing basis. What mechanisms will be in place and resources available to ensure that the regulation and improvement authority is able to fulfil that requirement?
Registration of care homes is comparatively easy to achieve, but there appears to be a lack of provision to ensure registration of self-employed childminders. It is unclear how parents and guardians can be certain that
a childminder is registered. A home will be required to display a certificate. Will childminders do likewise? Will members of the public be able to gain access to a list of registered individuals and agencies? Will they be able to discover those who have had their registration withdrawn? Can the Minister assure us that, like homes and agencies, unregistered childminders will face fines and convictions? Can he reassure me that registration will not be effected on a one-off basis, but renewed annually, and that standards will be continually assessed and updated?I welcome the provision for improvement notices. What is unclear is whether there will be a time limit attached to those notices. Will registration be cancelled if improvements are not made within the stipulated time? Will the improvement notices be available to the persons using the services? Surely they have rights in this respect.
Finally, although I welcome the commitment to improve quality, there appears to be no reference to the costs involved. The Ulster Unionist Party is concerned that huge amounts of money are being swallowed up without visible returns in terms of quality. The regulation and improvement agency will clearly require considerable support staff and sufficient finance to be able to fulfil its responsibility. I understand that it will be financed from the health budget. Does that not mean a further erosion of resources at the sharp end?
Quality is essential in our health service. It cannot be achieved in a stop/start manner. Standards should be applied regularly and in response to needs. I welcome the order and look forward to hearing the Minister's response.
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