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Lord Peyton of Yeovil: My Lords, the noble Lord is entitled to his view, and there is nothing that I can say to dislodge it. Nevertheless, I find it difficult to accept that total harmony will always prevail between those who set standards and those whose duty it is to implement them. The people who set standards—the noble Lord's department—will always be looking over the shoulders of the people who implement them. They will be anxious to burden them with advice that will often look very like instruction.

I recognise that I will achieve nothing by going on. Reluctantly, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Warner moved Amendment No. 291:

"( ) the availability and quality of information provided to the public about the health care;"

The noble Lord said: My Lords, Amendment No. 291 was tabled following our discussion in Committee of the areas to which CHAI should pay particular attention, in encouraging improvement in healthcare. We have also tabled Amendments Nos. 326, 334 and 353, relating to CSCI and the Assembly, to ensure consistency.

The amendments make it clear that it will be a function of CHAI, the Assembly and CSCI to be concerned about the quality of the general information on health services made available to patients and service users. They have been deliberately drafted with the intention of covering generic information that is not specific to an individual patient or service user—for example, leaflets, signage, telephone helpline services and other patient and service user information, such as information available about medical conditions generally.

The amendments do not extend a power for the inspectorates to evaluate the provision of specific information, such as medical advice given to patients in a consulting room, for instance. That might involve CHAI requiring far greater access to individual patient records than we consider necessary or expedient. Furthermore, it might place CHAI in a position in which it would be forced to make an assessment of whether the information given to patients in individual cases was clinically appropriate. That would be unsuitable.

As they are grouped with the government amendment, I could speak briefly to Amendments Nos. 309, 311, 336 and 337, although I am happy to wait until the relevant time. I beg to move.

6 p.m.

Baroness Noakes: My Lords, I shall speak briefly to Amendments Nos. 309, 311, 336 and 337 standing in my name in this group. They address a slightly different aspect of information to the public. We

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understand that the amendments to which the Minister has just spoken represent significant improvements in the way that information will be made available to the public. On that basis, I have no intention of pressing my amendments.

Lord Warner: My Lords, I have nothing further to add.

On Question, amendment agreed to.

Baroness Noakes moved Amendment No. 292:

    Page 17, line 24, after "of" insert "disadvantaged and vulnerable persons including"

The noble Baroness said: My Lords, in moving Amendment No. 292, I shall speak also to Amendments Nos. 335, 360 and 361, which are similarly worded. Amendments Nos. 292 and 360 relate to CHAI; Amendments Nos. 335 and 361 relate to CSCI. In exercising their functions, the Bill requires CHAI and CSCI to be concerned in particular with,

    "the need to safeguard and promote the rights and welfare of children".

If it is necessary to mention one group whose rights and welfare need to be safeguarded and promoted, that implies that other worthy groups are of less importance. In Committee, we discussed other formulations; that is, "elderly people" or "other vulnerable adults" being added after "children". Today's amendments take a slightly different approach; namely, that CHAI and CSCI should safeguard and promote the rights and welfare of disadvantaged and vulnerable persons, including children. We are using children as a specified example of disadvantage or vulnerability rather than the only specified focus for CHAI and CSCI.

Perhaps I may be clear that we are not seeking to diminish the roles of CHAI and CSCI in relation to children. In Committee, the noble Baroness, Lady Howarth, who knows much about the vulnerability of children, spoke in favour of the wording in the Bill because children get lost in hospital and those within the scope of social services are vulnerable. We have no problem with that; we agree with it. However, so much can go wrong for other groups that they, too, should have a special focus for CHAI and CSCI.

Not all elderly people are vulnerable, but that is not a good reason for excluding them. There are many stories of elderly people in hospitals who end up severely malnourished because no one ensures that they are fed. In care home settings, there are too many stories of abuse to be comfortable with the situation. Other groups, such as the disabled or those with learning difficulties, are not always treated fairly and properly in the health or social care systems.

I hope that the Minister will reconsider the skewed drafting and, as proposed in the amendments, be prepared to accommodate a more holistic approach to disadvantage and vulnerability. I beg to move.

Baroness Howarth of Breckland: My Lords, I have no difficulty with the amendment. At no time have I felt that vulnerable persons should not be included. In

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general, adults are not necessarily vulnerable when using services. Children, per se, generally are because they are dependent. Of course, I have a great vested interest in not losing children from the face of the Bill. However, I work across the spectrum of people with difficulties and conditions. Therefore, I would be very happy with the proposed amendment.

Baroness Carnegy of Lour: My Lords, following that extremely understandable comment made by the noble Baroness, it still seems that the Bill is odd. There may be good reasons for specifically selecting children, but the amendment puts the issue better in context. It reads better. I do not know whether the Minister will accept the amendment, but, as the Bill stands, it is slightly strange.

Lord Warner: My Lords, the amendments bring us back to our previous discussions regarding the need of inspectorates to pay particular concern to the needs of vulnerable people. I do not question the importance of the issues raised, but I continue to believe that the principle of CHAI and CSCI having regard to safeguarding and promoting the rights of all patients and service users is of paramount concern.

I hope that no one would call into doubt the integrity of Professor Sir Ian Kennedy. He has already outlined his intention that CHAI should promote a concept of "equal citizenship" by ensuring that the well-being and healthcare of vulnerable groups—including children, older people, people with mental illness or learning disabilities, people from areas of social deprivation or for whom English is not a first language—are fully reflected in CHAI's assessments and that rights are safeguarded. I am confident that such intentions are equally matched by Denise Platt, whose appointment as chair of CSCI follows a distinguished career in social services.

Having considered the issue further between Committee and Report, I continue to believe that it remains difficult to define precisely the term "vulnerable person". Therefore, it would be inappropriate to do so here. Noble Lords will recall that in Committee I explained the problems of providing an adequate definition of vulnerable adults that would not include large numbers of people who would not want to find themselves considered vulnerable.

I am therefore surprised that a new term, "vulnerable person", has been proposed, which is probably even broader and more difficult to define. It remains the case that individuals may be vulnerable in some context, but not in others. That was the burden of my argument in Committee, which I shall not repeat.

In my personal experience as a former director of social services, all users of social services potentially could be classed as vulnerable at some stage. The more particular groups are picked out, the more we move away from the idea that CSCI and, by extension, CHAI, should be concerned with the individual and the unique needs of particular service users. Therefore, for reasons that I explained previously, we have chosen

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to continue to ensure that children—in our view, the most vulnerable group in society—are covered specifically. I am sorry that the noble Baroness, Lady Howarth, is not with me on this occasion.

As I have already made clear, singling children out for particular attention does not mean that other vulnerable groups will not have their rights and welfare within the sights of both commissions. Resisting the amendment does not mean that the Government do not take their responsibilities for the well-being of individuals seriously. Having placed those reassurances on the record, I hope that this group of amendments will not be pressed.

Baroness Howarth of Breckland: My Lords, before the Minister sits down, perhaps I may reassure him that, whatever else occurs, I am convinced that children must be on the face of the Bill.

Baroness Noakes: My Lords, I thank the Minister for that reply. For the record, we are in no way doubting the integrity of Sir Ian Kennedy. That is far from what is in our minds. I have no doubt that Sir Ian Kennedy has all the issues debated in this context under control. The issue is not what Sir Ian Kennedy or Denise Platt would do in relation to CHAI and CSCI in the foreseeable future. The issue is what the Bill will drive CHAI or CSCI to do over the longer term or the implication it will carry to those without a detailed knowledge of our discussions in Committee. I regret that the Minister has chosen not to take this forward, but we shall not press the matter to the bitter end. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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