COMMONS AMENDMENTS (Hansard, 18 July 2000)

§ Lord Hunt of Kings Heath
My Lords, I beg to move that the House do agree with the Commons in their Amendments Nos. 9 and 10. I should like to speak also to Amendments Nos. 13, 16, 45 and 287.
This is a small group of amendments which tidy up the definitions of independent hospital and nurses agencies and the definition of dental services under general anaesthesia which we are inserting into the Registered Homes Act 1984 for the purpose of regulation.
Amendments Nos. 9 and 10 were brought forward as a result of concerns from those involved about the definition of "independent hospital". As originally drafted, Clause 2 of the Bill brings within the definition of "independent hospital" any establishment which provides any of the listed services in Clause 2(7). Those listed services include palliative care. However, there was concern that because a care home might provide some palliative care to patients who are terminally ill, as drafted the Bill would require such a care home to be registered as an independent hospital. We recognise that that would be totally inappropriate.
The two amendments clarify the distinction. Amendment No. 10 removes palliative care from the "listed services" in Clause 2, while Amendment No. 9 inserts it into the main definition of independent hospital to ensure that, as far as concerns palliative care, only those establishments, the main purpose of which is to provide palliative care, will be required to register as independent hospitals.
As I have said, the amendments have been tabled in response to concerns raised with us by those involved. They seek simply to ensure that establishments that specialise in providing palliative care, such as hospitals, will be regarded and registered as such and will be seen as distinct from care homes that provide care for terminally ill residents as a normal and appropriate part of their overall services.
At Third Reading I accepted an amendment tabled by the noble Earl, Lord Howe, the noble Lord, Lord Clement-Jones, and the noble Baroness, Lady Masham of Ilton, which required nurses agencies to be 936 regulated by the national care standards commission. At the time I said that the amendment as drafted was defective and that it would need to be amended in the other place. This is what is achieved by Amendment No. 13. The amendment ensures that the regulation of agencies for the supply of nurses, midwives or health visitors will cover employment agencies, as defined in the Employment Agencies Act 1973. This may, for example, include staff recruitment agencies or agencies providing an introduction service. The amendment also ensures that employment businesses are covered, again, as defined in the 1973 Act, and which typically employ nurses to be supplied to the NHS, to private hospitals and to nursing homes, as well as directly to patients in their own homes.
This change has been widely welcomed and we shall, of course, be developing the necessary regulatory requirements and standards under which the commission will regulate nurses' agencies.
At Third Reading, the noble Baroness, Lady Masham, asked whether we needed to amend the Long Title of the Bill to reflect the regulation of nurses agencies. She was absolutely right. Amendment No. 287 adds nurses agencies to the Long Title.
Amendment No. 16 is an amendment that was accepted in the other place to correct a misplaced apostrophe.
Perhaps I may now turn to Amendment No. 45. Noble Lords will know that a number of tragedies have occurred recently of young people who have died under general anaesthesia during the course of dental treatment outside hospitals. When the commission is established, it will regulate private dentists who provide dental treatment under general anaesthesia. However, the commission will not be established until 2002 and we do not believe that we can allow the practice to go unregulated until then. The Bill therefore provides for the regulation of dental treatment under general anaesthesia under the existing Registered Homes Act 1984. This requires any dentist who performs such treatment to be regulated by the local health authority inspection units.
However, it is intended that only private dentists who provide treatment under general anaesthesia should be regulated under the 1984 Act. Amendment No. 45 makes this clear. That is not to say that dentists who treat NHS patients using general anaesthesia will not be regulated. We have no intention of creating such a loophole. We intend to amend NHS regulations to require dentists who provide treatment under general anaesthesia to NHS patients to be regulated under NHS arrangements.
All the amendments tidy up definitions used in the Bill. I hope that noble Lords will find them acceptable.
Moved, That the House do agree with the Commons in their Amendments Nos. 9 and 10.—(Lord Hunt of Kings Heath.)

§ Earl Howe
My Lords, I was particularly grateful when the Minister accepted my amendment at Third Reading to include nurses agencies within the remit of the commission. However, the issue of healthcare 937 workers supplied by such an agency to NHS trusts or other areas of the health service was left in the air. I wonder whether the Minister could clarify how agencies supplying healthcare workers who are not domiciliary care workers are regulated under the Bill.
I should also be grateful if the Minister could say something more about medical agencies. The question arose in another place that, although an independent medical agency is defined in Clause 2(5) as an undertaking that consists of or includes the provision of services by medical practitioners, there appears to be nothing in the Bill covering the direct supply of a nurse-led clinical service in the home. Will the Minister comment on that? Health services provided in the home by nurses unsupervised by a doctor can be far from straightforward, as I am sure that he knows. The examples of blood transfusions and chemotherapy were given in another place. The same lacuna, if I can call it that, appears to apply to services provided in the home by physiotherapists and occupational therapists. Am I correct in believing that those services are not covered by the Bill?

§ Lord Clement-Jones
My Lords, I generally welcome the amendments. However, I should like to ask about what appears to be a change of status for hospices. Have the hospices made any response to their change of status resulting from Amendments Nos. 9 and 10? What consultation was carried out with them about it? They are now to be treated as independent hospitals, which I had understood was not previously the case.
I welcome Amendment No. 13, which requires nursing, midwifery and health visitor agencies to register. I do not want to reopen a debate on whether all dentists, not just those who administer anaesthetics, should be covered, but I welcome the interim provisions in Amendment No. 45 on private dentists, bringing them under the 1984 Act, and the fact that NHS dentists in the same position will also be subject to regulation.

§ Baroness Masham of Ilton
My Lords, I add my thanks to the Minister. I repeat the question of the noble Earl, Lord Howe, about nurse assistants. Thousands of them, many coming from abroad, are used in people's homes. Many of them come from the same agencies as nurses. It seems wrong for them to be left out.

§ Lord Hunt of Kings Heath
My Lords, the noble Lord, Lord Clement-Jones, asked about hospitals. I am happy to provide further details about the nature of the consultation, although I do not have the information here. There was extensive discussion and consultation with all the establishments that were likely to be covered by the Bill. I believe that the outcome of those discussions was that it is right to draw a distinction between hospices—which in many senses can be regarded as hospitals—and the normal process of providing care for residents of nursing homes who may be dying. I hope that helps to clarify the position.
938 The noble Earl, Lord Howe, again raised the issue of nurse-led services and mentioned domiciliary physiotherapy services. There are two points to be made. Many such services will be covered one way or another, either through domiciliary care agencies or nursing agencies. An outreach service from a private hospital would certainly be covered.
The main comfort that I give to the noble Earl is the provision in Clause 39 which allows the power to extend the application of Part II. This is an important part of the Bill. The criticism that was always made of the Registered Homes Act was that it was inflexible and did not allow us to change the nature of regulation as the nature of healthcare changed. A good example is that of private hospitals; clearly, the Registered Homes Act 1984 was not up to the task of regulating those hospitals. The answer is that many of the services will be covered in one way or another. If in the future we identify gaps in the regulatory mechanisms, clearly the Government will need to consider whether it is necessary to bring Clause 39 into play.
So far as concerns the regulation of healthcare assistants, a number of messages of comfort can be given. First, many healthcare assistants would be employed through nursing agencies. As those agencies are covered by the scope of the legislation, that in itself provides a safeguard. Secondly, agencies outwith that situation will still be covered by the Employment Agencies Act. Although noble Lords have expressed scepticism as to whether that is sufficient, and that was reason noble Lords wanted nursing agencies to be covered in this way, it does represent some safeguards.
The third point is that the Department of Health has commissioned De Montfort University to examine the whole issue of the regulation of healthcare assistants. I am not in a position to say when its report will be published, but we need to keep the matter under review.
On Question, Motion agreed to.