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Lord Warner: I was trying to be cautious. We accept the need for convergence; we do not accept the need for convergence within a prescriptive timetable. I was saying that as services are provided by the independent sector under contract to the NHS, they will be assessed under the standards that apply to the NHS. They will have to meet those NHS standards that are set by the Secretary of State.

Lord Hunt of Kings Heath: I hope that my noble friend will give the matter further consideration before Report. Two issues arise from the matter. First, my understanding is that most independent hospitals provide some services to the NHS through contracts. If we are to take it that an independent hospital is providing services to those patients according to NHS standards, that would suggest that achieving convergence would not be a problem for many of those hospitals as they have already achieved convergence in relation to a proportion of their patients. Secondly, with the introduction of the choice policy and national tariffs, the issue of a level playing field surely relates as much to the independent sector as to the NHS. That is why it is important to give a date when convergence will be reached.

Lord Clement-Jones: I would like to make one further observation, at the risk of alienating the Committee at this time of night. From what the Minister has to say, theoretically over the next two or three years there could be two patients—one an NHS patient, another a private patient under an insurance policy or whatever—next to each other in the same ward or the same independent hospital with two different standards. That is a completely crazy situation, and not one envisaged by the merger or by the fact that the National Care Standards Commission is no longer dealing with acute healthcare, with everything going into CHAI.

Lord Warner: We are not denying that there is an issue. We are saying that we do not want to be prescriptive about the speed at which we can deal with the issue at the moment. I hear the concerns expressed by Members of the Committee, especially those from behind me, and I will take the matter away and consider whether we can do anything more to reassure them.

Earl Howe: The amendment is very simple and straightforward. It is not very ambitious in what it proposes. I am very grateful to the noble Lord, Lord Hunt, for his support, and I agreed wholeheartedly

20 Oct 2003 : Column 1387

with what he said. It should not matter to the patient where he is treated, only that the treatment that he receives is of the same high standard in any equivalent setting. Comparability, which I think was the word used by the Minister, does not carry the same connotations to me as uniformity and consistency.

My amendment proposes a time-scale that can be described as prescriptive but, if no time-scale is set, we could be sitting here in 10 years' time with nothing substantively having changed. If it is true that diagnostic and treatment centres and services provided under contract to the NHS will be judged under an equivalent set of standards, as the noble Lord, Lord Hunt, said, that suggests that achieving convergence will not be as difficult as the Minister makes out. This is really a matter of principle on which I would like to test the opinion of the Committee.

10.22 p.m.

On Question, Whether the said amendment (No. 371) shall be agreed to?

Their Lordships divided: Contents, 29; Not-Contents, 54.

Division No. 2


Addington, L.
Astor of Hever, L. [Teller]
Attlee, E.
Barker, B.
Blatch, B.
Bridgeman, V.
Byford, B.
Caithness, E.
Clement-Jones, L.
Colwyn, L.
Cox, B.
Ferrers, E.
Howe, E.
Hunt of Wirral, L.
Liverpool, E.
Luke, L.
Mancroft, L.
Montrose, D.
Noakes, B.
Northbrook, L.
Onslow, E.
Peel, E.
Roper, L.
Seccombe, B. [Teller]
Skelmersdale, L.
Smith of Clifton, L.
Strathclyde, L.
Wade of Chorlton, L.
Wilcox, B.


Acton, L.
Amos, B. (Lord President)
Andrews, B.
Archer of Sandwell, L.
Bach, L.
Bassam of Brighton, L.
Berkeley, L.
Bernstein of Craigweil, L.
Brennan, L.
Brooke of Alverthorpe, L.
Burlison, L.
Campbell-Savours, L.
Carter, L.
Chan, L.
Chandos, V.
Crawley, B.
Davies of Coity, L.
Davies of Oldham, L. [Teller]
Dean of Thornton-le-Fylde, B.
Desai, L.
Dixon, L.
Elder, L.
Evans of Parkside, L.
Evans of Temple Guiting, L.
Farrington of Ribbleton, B.
Faulkner of Worcester, L.
Gilbert, L.
Golding, B.
Grocott, L. [Teller]
Hilton of Eggardon, B.
Hollis of Heigham, B.
Howarth of Breckland, B.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Jay of Paddington, B.
Jones, L.
Jordan, L.
Listowel, E.
Lofthouse of Pontefract, L.
McIntosh of Haringey, L.
McIntosh of Hudnall, B.
MacKenzie of Culkein, L.
Mitchell, L.
Morgan, L.
Pendry, L.
Plant of Highfield, L.
Randall of St. Budeaux, L.
Sawyer, L.
Simon, V.
Warner, L.
Warwick of Undercliffe, B.
Watson of Invergowrie, L.
Whitty, L.
Young of Old Scone, B.

Resolved in the negative, and amendment disagreed to accordingly.

20 Oct 2003 : Column 1388

10.32 p.m.

[Amendments Nos. 372 to 374 not moved.]

Clause 101 agreed to.

Clause 102 [General Functions of CSCI]:

[Amendments Nos. 375 to 376A not moved.]

The Earl of Listowel moved Amendment No. 376B:

    Page 43, line 25, at end insert—

"( ) The CSCI shall have particular regard to support for residential care staff with responsibility for children."

The noble Earl said: The purpose of this probing amendment is to learn what priority support for residential child care staff tending children in care will have for the new inspectorate. I apologise for not drawing the amendment more narrowly to concentrate on children's homes, as had been my intention.

Despite recent welcome innovations, such as minimum standards, Quality Protects and Choice Protects, residential care staff in children's homes require special attention. They deal with our most challenging and needy children. For the most part, they remain unqualified in contrast to the high level of professional qualification required for such residential care staff across Europe. There has been delay in qualifying the workforce in National Vocational Qualification level three. We hope that 80 per cent of them will now be so qualified by 2005. NVQ level three is still well below that required on the continent, welcome though it is.

There has been a long, sad history of professional misconduct. The sector is small and shrinking further, so there is a danger of it being overlooked. Yet success in residential care provision is important to success in increasing placement stability and outcomes for children in care.

Staff require the support described in Chapter 8 of Choosing with Care—the report of the committee of inquiry into the selection, development and management of staff in children's homes, published in 1992. The committee was chaired by the noble Lord, Lord Warner—Norman Warner, as he was then. Staff in these homes need special support in working successfully as a team. In the recent National Children's Bureau report, Better than you think: staff morale, qualifications and retention in residential child care, effective teamwork was identified as a key attribute in improving outcomes for children in residential care.

In the conclusions of his report on safeguarding children living away from home, Sir William Utting made the important point that the best safeguard is an environment of overall excellence. In Germany, staff

20 Oct 2003 : Column 1389

have a degree behind them before going into such work. In fact, they normally have postgraduate qualifications before doing so. Children in care in Germany can expect to gain a good clutch of Abitur—the equivalent of A-levels. Sadly, children in care in this country do not do nearly so well, but I shall not describe the details. I shall try to be as brief as possible.

The manager of a care home that I visited recently said, "I'm afraid that I would call two of my staff semi-literate. They are barely able to put down on paper information about what is happening with the children so that other staff can understand what is going on". Very good work is being done in some children's homes and there are some excellent special residential schools, but so much more needs to be done.

Tomorrow I shall attend a lunch cooked by care leaders. This is Care Leaders Week. Margaret Hodge, the Minister responsible for children, will address the meeting. I am looking forward to my sushi for lunch tomorrow. Significant numbers of care leaders do well but, sadly, when one looks at the criminal justice system, one sees that one-quarter of inmates have had some experience of being in care. I believe that we need to do far more in this area and that it requires the special attention of the inspectorate. We need to ensure that the inspectorate gives a high level of attention to, and supports, under-qualified staff working in these difficult conditions. I look forward to the Minister's response to the amendment. I beg to move.

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