HL Deb 18 July 2000 vol 615 cc940-2

20 Clause 7, page 5, line 37, leave out subsections (B) to (11)

Lord Hunt of Kings Heath

My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 20. I shall speak also to Amendment No. 22.

We come back to a favourite topic of your Lordships, which we seem to have debated not only in relation to this Bill but also in the passage of the 1999 NHS legislation. As regards the consensus approach which I have detected throughout the debate on this Bill, there is a common purpose here to ensure, first, the proper regulation of private and voluntary healthcare and to ensure that these services are provided to proper standards. There can be no doubt that the present regulatory system which regulates independent hospitals as care homes, is totally inappropriate and outdated.

Through this Bill, private and voluntary healthcare will for the first time be properly regulated, with independent hospitals being regulated as independent hospitals and having to meet national minimum standards developed to reflect the nature of the service provided.

We are putting in place a system where the private and voluntary healthcare sector will be regulated by the independent national care standards commission. Within the commission there will be a separate division dealing with private healthcare. That division will be headed by a director of private and voluntary healthcare, who will be a senior member of staff.

By putting in place a system that recognises the specific nature of private healthcare, we will ensure that proper quality of care is provided. We will do this through the regulations and national minimum standards which we are developing. But, importantly, and for the first time, we have a regulation-making power to ensure that private healthcare establishments provide quality care. I assure the House again that this will cover clinical care.

The amendment inserted by your Lordships during Report stage required the commission to contract all its inspections of independent hospitals to the Commission for Health Improvement. This amendment was removed in the other place but—and I stress this—our discussions in your Lordships' House served a very important role. They highlighted the need for the commission and the Commission for Health Improvement to work closely together. That is why we have brought forward Amendment No. 22 to ensure that that is the case.

Perhaps I may take this opportunity to explain the difficulties that the Government found with the amendment inserted by your Lordships. The commission and Commission for Health Improvement (CHI) were designed for different purposes. That is a point widely recognised within the National Health Service. CHI has been specifically designed and developed to help the NHS improve the quality of clinical care. Its primary interests are with NHS patients and the arrangements that NHS bodies have in place to ensure high quality healthcare for those patients. CHI is a very important part of our 10-year modernisation programme for the NHS. It is there to help drive up standards in the NHS by providing an independent, external check of NHS processes for monitoring and assuring the quality of clinical care.

Any system for monitoring and assessing the performance of a service sends very powerful messages about what that service is expected to deliver. CHI will play an important role which will complement NHS accountability arrangements and ensure that both quality and efficiency are central to the way the NHS is held to account. It will also provide organisations with access to the skills and expertise necessary to help tackle problems where local efforts have been unable to make a difference. I am absolutely convinced that, with the wider quality agenda, CHI's work will mean that fewer problems occur in future, and, where they do arise, they will be spotted and addressed earlier.

It is the responsibility of the regional offices of the NHS or the health authority concerned to ensure that CHI's recommendations are acted on, with agreed plans for addressing identified shortfalls. In some cases the commission may have a role in following up specific recommendations or may be invited to review progress where the need for significant further work has been identified. That is a very different role from that of the national care standards commission. That body is to be established to regulate, provide safeguards and apply national minimum standards for patients in independent healthcare. It is not responsible for private hospitals and clinics beyond that point, nor for advising the Government about the sector or nurturing the private sector generally.

The key principle of how the national care standards commission and CHI will achieve their respective responsibilities is the second main area of difference between the two bodies. The national care standards commission will be a regulatory body. It will, therefore, register independent healthcare providers and inspect them against regulations and set standards. If an independent sector provider does not comply with the regulations and standards the commission will be able to apply sanctions. CHI, on the other hand, is not a registration-holding, sanction-imposing, regulatory body. It will review the clinical governance arrangements in NHS bodies and provide advice as to how those arrangements may be improved. It will be vigorous but will also provide support to help NHS organisations with problems to tackle them effectively themselves.

The third key area of distinction between the commission and CHI is as to how they will operate in practice when undertaking their rolling programmes. For example, CHI will be concerned with the arrangements and systems that an NHS body has in place to ensure and improve quality. Where an NHS body has a contract with the independent sector to provide healthcare services to NHS patients, CHI will review the quality of services that those patients receive as part of the bigger picture of the clinical governance arrangements of that NHS body. That will be undertaken under a three to four-year rolling programme of clinical governance reviews in the NHS.

In contrast, the national care standards commission will be responsible for inspecting at least once a year every independent healthcare provider that it regulates. It will concentrate and specialise on the specific safeguards and quality assurances that each of those individual providers has in place for all patients. It will have a remit that goes beyond looking at arrangements to provide quality in clinical care.

There are also concerns in the field about how the amendment inserted by your Lordships may affect the successful establishment of the national care standards commission. The April edition of Registered Homes and Services reflected those views in commenting on the subsections introduced into Clause 7: At a practical level there are clear benefits in a broad-based national care standards commission. With private and voluntary healthcare outside its remit, the skills and experience which will be developed within its healthcare division will suffer". The Royal College of Nursing was also concerned about the polarisation of the regulation of healthcare services. However, our thinking on the relationship between the commission and CHI has moved on considerably since the Bill was introduced. The Bill now allows the commission and CHI to second staff to each other, and that will help skills development in both bodies. They will also be able to share information with each other. Another example of this co-operation is the development of the national minimum standards to be used by the commission. In that context, CHI has a representative on the consultation group that is developing those standards.

I believe that we have two separate bodies with two separate functions. I believe it logical that we should merge such situations in relation to the regulation of the care establishments and private health hospitals within the terms of the Bill and the way in which the NHS effectively manages its performance. We have seriously taken on board the suggestion that we must ensure that CHI and the commission work closely together. I believe that the amendments which the Commons considered enable that to happen and I ask for your Lordships' support.

Moved, That the House do agree with the Commons in their Amendment No. 20.—(Lord Hunt of Kings Heath.)