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Water Bill [HL]

2.57 p.m.

Baroness Farrington of Ribbleton: My Lords, I beg to move the Motion standing in the name of my noble friend Lord Whitty on the Order Paper.

Moved, That it be an instruction to the Grand Committee to which the Water Bill [HL] has been committed that they consider the Bill in the following order:

Clauses 1 to 33,

Schedule 1,

Clause 34,

Schedule 2,

Clause 35,

Schedule 3,

Clauses 36 to 54,

Schedule 4,

Schedule 8,

Clauses 55 to 78,

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Schedules 5 and 6,

Clauses 79 to 93,

Schedule 7,

Schedule 9,

Clauses 94 to 97.—(Baroness Farrington of Ribbleton.)

On Question, Motion agreed to.

Consolidated Fund (No. 2) Bill

Lord McIntosh of Haringey: My Lords, I beg to move that this Bill be now read a second time.

Moved, That the Bill be now read a second time.—(Lord McIntosh of Haringey.)

On Question, Bill read a second time; Committee negatived.

Then, Standing Order 47 having been suspended (pursuant to Resolution of 13th March), Bill read a third time and passed.

Community Care (Delayed Discharges etc.) Bill

2.59 p.m.

Read a third time.

Clause 1 [Meaning of "NHS body" and "qualifying hospital patient"]:

Baroness Finlay of Llandaff moved Amendment No 1:

    Page 2, line 2, at end insert—

"( ) The term "independent hospital" includes any hospice registered as an independent hospital (hospice acute category)."

The noble Baroness said: My Lords, I do not wish to delay discussion by revisiting the debate that we had at previous stages about whether or not hospices are included in the Bill. The Minister previously stated that he believed that they were not included. I am grateful to the Minister for having met me and Dr Andrew Hoy, chairman of the Association for Palliative Medicine. We had a fruitful discussion. At that time, we were able to provide the Minister with additional evidence to support our view that hospices should be included in the Bill. For the sake of the House, I shall run through that view very briefly.

The registration documents for in-patient units, which are specialist palliative care units, state that they are registered in the independent hospital service category (h)(a), which means "hospice acute". The National Care Standards Commission took over registration of such units, and at the time the designation of hospices was considered to be as independent hospitals providing acute care. Units with such a registration are in the process of establishing or have already established service-level agreements specifically for the care of NHS patients in their buildings.

A simple example is that 160 beds were available in Marie Curie for England and Wales in January. There were 207 admissions, with a 48 per cent discharge rate.

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More than 50 per cent of those patients needed social services packages to be discharged, and none will continue in care. Marie Curie has the largest number of hospice beds of any independent provider in England and Wales, and those figures are reflected in other hospices that have smaller numbers of beds.

Because there are service level agreements and carefully drawn contracts that specify what will or will not be done, it would appear that we are talking about acute patients in the hospice pursuant to NHS arrangements. Therefore, I hope that the Minister will be able to accept the amendment. I beg to move.

Lord Hunt of Kings Heath: My Lords, I am very grateful to the noble Baroness for the discussions that we have had on the issue of hospices and the extent to which patients treated by them are covered by the Bill.

The amendment is not necessary, because the term "independent hospital" in the Bill already includes hospices. That is the same definition as that in the Care Standards Act 2000. Section 2, which is in Part I of that Act, states:

    "A hospital which is not a health service hospital is an independent hospital".

In the sense of the Bill, "hospital" means,

    "an establishment . . . the main purpose of which is to provide medical or psychiatric treatment for illness or mental disorder or palliative care".

I understand that the noble Baroness has used her amendment as a way of eliciting from me further information about the important matters that she raises. Very helpfully, she let me see a number of copies of what are best described as service level agreements between individual hospices and NHS authorities. From an initial perusal of them, it is at least arguable that patients treated under those agreements are indeed treated pursuant to NHS arrangements and therefore could well fall under the Bill. There needs to be further discussion between my department and the representatives of hospices on that matter, but the noble Baroness has done a great service in bringing it to our attention and clarifying our understanding of the point.

Not all patients in hospices would be so covered, because not all patients will be treated pursuant to NHS arrangements. I also accept that there is a more general point about wishing to ensure a good relationship between hospices and individual local authorities, particularly when it comes to the support that might be required from a local authority for patients who have left a hospice and gone back into their own homes. I have asked my department to institute discussions with representatives of the hospice movement and local authorities, so that we can discuss such matters in great detail.

I hope that the noble Baroness will accept that I have found her intervention in the area extremely helpful. We take it very seriously and we will pursue those discussions in the future.

Baroness Finlay of Llandaff: My Lords, I thank the Minister for his reply. If I may return the compliment,

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I would like to thank him for having been so helpful and open to discussion. I feel that the integrated service that hospices have been trying to establish with the NHS is being preserved and built on by the action. There was a lot of concern that, if there was no ability for any hospice beds to be included, some of that work might fall by the wayside.

I am grateful to the Minister for his reassurance that the amendment is not necessary, and that hospices with patients pursuant to NHS arrangements with a formal contract are included. Therefore, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Hunt of Kings Heath moved Amendment No. 2:

    Page 2, line 4, at end insert—

"(3) An NHS body may make arrangements with any person connected with the management of an independent hospital in the United Kingdom for that person (or any employee of his) to do, on behalf of the NHS body and in accordance with the arrangements, anything which is required or authorised to be done by the NHS body by or under this Part in relation to qualifying hospital patients accommodated in that hospital.
(4) Anything done or omitted to be done by or in relation to the authorised person (or any employee of his) in pursuance of such arrangements is to be treated as done or omitted to be done by or in relation to the NHS body.
(5) Nothing in subsection (3) or (4) prevents anything being done by or in relation to the NHS body."

The noble Lord said: My Lords, we have been clear that we want NHS patients treated in independent hospitals to be treated under the Bill in exactly the same way as NHS patients in an NHS hospital would be. We believe therefore that a private provider treating an NHS patient should, where appropriate, be able to issue the notice of a patient's potential need for community care services under Clause 2 and to consult the local authority about follow-up services, on behalf of the NHS body that commissioned the care. I believe that that is logical in order to prevent the patient's discharge being delayed and to prevent unnecessary bureaucracy.

As the Bill is drafted, however, a private provider would not be able to carry out those duties on behalf of the NHS. That is because although Section 23 of the National Health Service Act 1977 allows NHS bodies to make arrangements for others to provide services under that Act on their behalf, the powers and duties conferred on NHS bodies under the Bill are not services under the 1977 Act.

The amendment will therefore introduce a power for private providers to undertake duties under the Bill on behalf of the NHS body, in pursuance of arrangements made between the private provider and the NHS body. The NHS body will of course retain ultimate responsibility for the functions carried out on its behalf and the services provided. I beg to move.

Lord Clement-Jones: My Lords, I would like to interrogate the Minister slightly further on that. I assume that the amendment relates to the letter that he

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had the courtesy to send to Front-Bench spokesmen on the subject. In Committee and on Report, he said that the PCT would actually levy any charge made. I hesitate to remind him, but I drew the example of a fictitious German hospital that would levy a charge. Is he now saying that a no-longer fictitious but real German hospital would actually levy the charges under the provisions that he stated?

Lord Hunt of Kings Heath: My Lords, that is a good question. However, if the noble Lord looks at the amendment he will note that proposed new subsection (3) states:

    "An NHS body may make arrangements with any person connected with the management of an independent hospital in the United Kingdom".

I can set his mind at rest. The scenario of a German hospital imposing a penalty on an NHS local authority would not operate, so far as the position of the PCT is concerned. For instance, the noble Lord might ask me whether independent acute hospitals that treated NHS patients would have the right to issue both the notice and the penalty charge. That would depend on arrangements reached locally by the primary care trust. The Bill allows it to happen but the primary care trust will come to a view on how the arrangements might operate in practice.

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