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I remind noble Lords that anyone who has their care arranged by a local authority, even if they pay the full cost of that care, can refer a complaint to the Local Government Ombudsman. However, as I hope I made clear in Committee, we recognise that the fairness of current arrangements for those who arrange their own social care is an issue. We are talking to key stakeholders to agree a solution. We recognise the concern of the noble Earl, Lord Howe, and the noble Baroness, Lady Barker, who also raised the matter.

However, I am afraid that I am not able to say anything more in detail about that, other than that we expect to be able to put forward proposals soon. I hope to be able to make a statement regarding independent adjudication within the timescale of the Bill. The noble Baroness, Lady Barker, was correct that this is a complex issue. Therefore I should perhaps also say that, given the complexity of the ongoing discussions, we would not be able to bring legislative changes forward in the scope of this Bill. I hope that, given that assurance that we take the issue very seriously, the noble Earl will feel able to withdraw this amendment.

When we debated these matters in Committee, I believe that we all agreed that it is as important that action is taken to follow up and learn from complaints

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as it is that they are dealt with properly. Amendment No. 19 would ensure that regulations under Clause 16 included requirements about how recommendations following a complaint were taken on board.

I described to the Committee requirement 10 in the registration requirements, on which we have consulted. It would require providers to ensure that there were simple, clear arrangements for handling complaints and disputes, and that complaints were investigated and resolved promptly and effectively. Crucially in light of our debate now, it would also require providers to ensure that learning from complaints was reflected in risk management, quality assurance, clinical governance and training and development arrangements. Learning would be informed by a variety of sources, but we would expect recommendations from the ombudsman and other key sources to play a vital role. The commission will be able to use the full range of its enforcement powers to take action where people fail to meet those requirements.

I believe that we are in the same place here. However, I recognise concern that there should be a clearer indication in the Bill of the importance we place on this issue. I therefore undertake to consider Amendment No. 19 with a view to bringing back an amendment at Third Reading.

I turn to Amendment No. 20. The noble Baroness was absolutely right about the need to tackle health inequalities, on which she spoke with her usual great eloquence, and to ensure that services provide comprehensive healthcare to people even when they have particular needs that require specialist support. As I said in Committee, we have been consulting on registration requirements which are particularly relevant. However, every requirement is relevant, which is why it will be important that the commission enforces them all with equal rigour.

Amendment No. 20 seeks to address discrimination. I appreciate that it is driving at the ability of the commission to act in relation to a failure to implement the Disability Discrimination Act. The Bill already provides the commission with precisely such a power. It will be able to take action against a registered provider in relation not only to the requirements in this Bill but to those in other relevant legislation. I agree with the intention of the amendment, but there is no need to duplicate requirements that already exist in legislation. What we must provide for, as the Bill already requires, is that the commission is mindful of those requirements when it monitors services. In light of this, and my commitment to look again at Amendment No. 19, I hope that the noble Earl and the noble Baroness will agree not to press their amendments.

Earl Howe: My Lords, I very much welcome the Minister’s reply on the issues raised by Amendment No. 19. I am grateful to her for saying that she will take the matter away and look at it again. That is great news.

It was encouraging to hear the noble Baroness say that she is looking actively for a solution on self-funders, and that proposals are likely to emerge soon. It is a pity that she is not yet in a position to go further than that.

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We had some extremely useful contributions, notably from the noble Baronesses, Lady Meacher and Lady Barker. I completely take the point of the noble Baroness, Lady Barker, that local authorities would not wish to perform the function I propose if there is any possibility that they may acquire a liability for the complainant’s care. I am not sure how that could come about but, if it is a risk, the contingency should certainly be avoided.

The noble Lord, Lord Campbell-Savours, suggested an interesting way that the local authority might fulfil the function. I am grateful to him for that. Regrettably, this is not a matter that we will be able to take further this evening. I look forward to further discussions with the Minister, perhaps outside these four walls. For now, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 20 not moved.]

Lord Campbell-Savours moved Amendment No. 21:

(a) the prevention and control of health care associated infections;(b) the safeguarding of individuals (whether receiving health or social care or otherwise) from the risk of any increased risk of being exposed to health care associated infections or of being made susceptible or more susceptible to them;(c) the displaying, in a place accessible to the public on the premises of the service provider, information relating to the incidence of health care associated infections, subject to the following provisions—(i) that the display of such information be in a location agreed by the Commission;(ii) that the information be made available in a form prescribed by regulations;(iii) that the information made available relates to each and every outbreak of such infection on the premises of the service provider in the previous six month period;(iv) that the information on health care associated infections provided under this paragraph shall be confined to those infections required to be published by the Secretary of State.”

The noble Lord said: My Lords, I have been very brief on my last three interventions but will be longer on this one. This is the first of a series of amendments that fall under the general heading of transparency. I am hoping to move a number of similarly themed amendments on a number of other Bills. Some may appear controversial, but I am increasingly convinced that transparency plays a vital role in the exercise of influence over conduct in both public and private sectors.

In overview, transparency is a powerful tool to be used in securing greater economy, efficiency, effectiveness and accountability in the control of enterprise and in the provision of public services. It conditions conduct. I believe that we have not even begun to consider the scale on which it can be applied and what are the consequences. That principle underscores my amendments to the Bill.

Amendment No. 21 is based on my own observations over the years, both as a patient and as a visitor, of what happens in many hospitals. It also stems from my

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experience as an MP in the late 1990s in trying to extract information from my local area health authority on the incidence of MRSA in individual hospitals in Cumbria—not statistics on death but statistics on infection. The only statistics it was prepared to provide me with were trust-wide statistics, and the only way you could secure information about the incidence of infection in any particular institution at that time, or even ward, was through unofficial personal contacts, but of course that rendered the information gained as unusable.

I am more than conscious of the many programmes that have been put in place to help reduce the incidence of hospital-acquired infections—the use of hand-washing facilities and gels, the deep clean programme, the designation of responsible officers, the wearing of disposable garments, pre-admission screening, and hospital-based uniform laundering services. I am equally aware of the Winchester approach and arrangements in Holland. The Winchester and Eastleigh healthcare NHS trust has been very successful in its campaign to eradicate MRSA. Its use of pre-assessment screening techniques; the requirement that the use of cannula be prescribed and then monitored daily; additional care over the use of catheters; and the emphasis on stricter standards of ward cleanliness have all contributed to the collapse in the incidence of MRSA in the hospital. There has been only one case in the past six months, and that was community-acquired.

9.30 pm

Contrast that with the sloppy conditions that remain in some hospitals and the casual approach that some hospital staff have to the need to secure the highest possible standards of cleanliness. For example, some hospital toilets and even bathroom facilities are filthy, even today. Some hospital ward floors are not kept constantly clean. Some nursing staff, thankfully a minority, allow standards of personal hygiene to slip. Some ward managers run a highly intensive use of hospital beds, resulting in an increased risk of contamination. Some consultants believe that they are somehow beyond the rules and do not always apply them to themselves and are rarely challenged by ward staff. Some hospitals are unable to enforce contractual agreements on cleaning due to managerial inadequacy. Some hospitals suffer from failure due to ward politics and personality conflict.

I argue that applying principles of transparency could make a difference in the attitude of some staff and break down barriers to hygiene programme reforms where they exist. If you make a ward publicly accountable for its hospital-acquired infections by making statistics available in a public place, it will have a marked effect on attitudes to hygiene control within the ward. Wards would not want to be identified as at risk and ward managers, whether they be admin staff, matrons, sisters or whoever, would demand the highest possible standards and would challenge any activity which they felt would prejudice the inspection control integrity of their ward. Yes, it would cause ructions within hospital management structures. Yes, it would irritate a lot of people. Yes, it might even lead to ward boycott on occasions. But it would concentrate the mind of everyone involved in

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hospital care on the need to drive out infections. It would have a knock-on effect right up the line through to the national allocation of resources for this area of inspection control. It would unleash that backlash of public opinion which is often needed when major change is necessary and it would focus the minds of not only the movers and shakers in healthcare but the wider community on the need to stamp out this menace which now frightens millions of people in this country.

I close by reminding noble Lords of the European tables on hospital-acquired infection, particularly as regards MRSA. I shall not go through them in detail but they show that the UK has the highest incidence. I believe that if my amendment became law and were implemented by the new commission, it would have a marked effect on the whole incidence of hospital-acquired infections. I beg to move.

Baroness Thornton: My Lords, I thank my noble friend Lord Campbell-Savours who outlined these very serious issues in his usual clear and moving way. I welcome the opportunity to say how important it is that we take strong action to tackle infections.

Amendment No. 21 would restructure the existing provision in relation to infections to require the commission to require providers to display information on their premises about recent instances of infection. Let me say straight away how sympathetic I am towards my noble friend’s intention with this amendment. It is, of course, crucial that such information is easily accessible to the public. I believe that this will be the case even without this amendment, but there is also scope for regulations under Clause 16 to include requirements along these lines. Although this issue is not covered in the current consultation, we will be consulting further later this year on the detail of what regulations under Clause 16 will cover.

As noble Lords will be aware, these regulations will also include provision on managing infections and we will be revising the current code of practice on healthcare-associated infections, which will be used to determine compliance with those regulations, to apply to all regulated activities. Under the current code of practice, every NHS body is also required to have a director of infection prevention and control, who is required to make an annual statement on HCAIs in the organisation and to make this available to the public. In revising the code, we will consider how information on infections should be provided in all sectors. The revised code will be subject to a full public consultation so there will be an opportunity for people to comment on our proposals.

In addition, the Health Protection Agency collects data on instances of MRSA, C. difficile and other infections from acute trusts under the mandatory surveillance system. These data are available on its website, where patients and their families can access the rates for each trust. Some information is also available on the NHS Choices website.

Of course, the Bill already requires the commission to publish inspection reports under Clause 57(3), and Clause 80 requires the commission to make its reports available to the public, just as the current commissions do. I expect that, as now, reports will be available via the commission’s website and the public will also be

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able to request hard copies. We intend to publish regulations under Clause 85 requiring the commission to publish certain information about enforcement action that it has taken. This means that the public will be able to access information about how the commission is using the new powers it will have at its disposal to address infections wherever they occur. Of course, the commission will also publish information on how well services are performing for the purposes of public accountability, supporting people in making informed choices.

So, arrangements are in place for this kind of information to be made available to the public, either by the commission or others. I hope that I have reassured my noble friend that we want to ensure that the public can access information about the services they use, that the Bill will in fact strengthen these arrangements, and that he will therefore agree to withdraw this amendment.

Lord Campbell-Savours: My Lords, I am grateful to my noble friend and I shall refer her remarks to the colleague with whom I have been discussing these matters. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 22 [Notice of proposals]:

Lord Darzi of Denham moved Amendment No. 22:

On Question, amendment agreed to.

Clause 30 [Offences relating to suspension or cancellation of registration]:

Lord Darzi of Denham moved Amendment No. 23:

(a) a person (“S”) remains registered under this Chapter as a service provider in respect of the activity,(b) S’s registration remains subject to a registered manager condition, and(c) no-one has been registered under this Chapter as a manager in respect of the activity since the cancellation of M’s registration.

On Question, amendment agreed to.

Clause 35 [Bodies required to be notified of certain matters]:

Baroness Barker moved Amendment No. 24:

“( ) to the General Social Care Council, and”

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The noble Baroness said: My Lords, I do not know whether to be flattered or terrified that I have to do this in the presence of three former health Ministers with whom I have debated the existence of the General Social Care Council over the past nine years, as well as the current incumbents.

A noble Lord: Oh!

Baroness Barker: My Lords, it is such riveting stuff that it is desperately difficult to keep away.

I return to two issues that we debated in Committee. I put my hands up to the fact that these are issues for social care anoraks, but none the less they are important in the greater scheme of things.

Amendment No. 24 returns to the question of which bodies are notified when the commission takes action under Clause 35. We talked at length in Committee about what would happen if action were taken against an individual social care worker. I understand, following helpful discussions with the Bill team, that in Clause 35 the bodies which are required to be notified are those responsible for the provision of care. We have so far not dealt with the fact that one of the standards on which providers will be judged is that they should only use registered staff if they are to be compliant. It seems to me that if a provider is found not to be compliant because they continue to use unregistered staff, that matter should be automatically reported to the General Social Care Council. I understand that under Clause 35(1)(d), “other persons” could include the General Social Care Council, but the General Social Care Council has an importance within the field of social care, being the registering body for social care workers, so I think that it merits mention on its own.

Amendment No. 33 returns to the assessment of social care needs. I listened very carefully to the view put forward by the noble Baroness in Committee that commissioning would involve such an assessment. I disagree with that because very many PCTs, and increasingly local authority social services departments, are divesting themselves of their provider arms. They are in future unlikely to be commissioning large volume services for users with the growth of individual budgets and self-directed care. I was interested earlier to hear noble Lords talking about local authority homes. I do not think there will be local authority homes in future. In the group of amendments on agencies, spoken to by the noble Earl, Lord Howe, we underplayed the importance of brokers who will broker care for people who are going to buy it with individual budgets. So it is not fantastic to foresee a time fairly soon when local authorities will not be commissioning care, because that will be done under self-assessment and individual budgets. It is important to ensure that social care needs are assessed, even when they are not met and even when they are not recognised through the commissioning process. For that reason, I return to these two somewhat technical-sounding issues, but ones on which the quality of social care depends quite heavily. I beg to move.

Lord Darzi of Denham: My Lords, looking first at Amendment No. 33, I agree with the noble Baroness that assessing the quality of services provided is impossible

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without an assessment of the needs of the population that is being served. For local authorities, both individual needs assessments under Section 47 of the National Health Service and Community Care Act 1990 and joint strategic needs assessments carried out jointly with PCTs under Section 116 of the Local Government and Public Involvement in Health Act 2007 are relevant here. Joint strategic needs assessments relate to the needs where there is an overlap between what the PCT and local authority might provide and identify the current and future health and well-being needs of the local population. Local authorities are required to carry out individual needs assessments of those individuals who appear to them to require social services.

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