HL Deb 12 February 2003 vol 644 cc760-3

8.28 p.m.

Lord Williams of Mostyn rose to move, That the draft order laid before the House on 7th January be approved.

The noble and learned Lord said: My Lords, the main purpose, which chimes with what the noble Lord, Lord Glentoran, Mr Trimble, and the noble Lord, Lord Maginnis, said earlier, is to introduce measures to secure and to improve the quality of health and social care services delivered by the health and personal social services and by the independent sector in Northern Ireland. There was detailed public consultation which began in April 2001. It was gratifying to find widespread support for the introduction of these new arrangements in Northern Ireland.

The proposals to introduce the new arrangements and to bring forward legislation were approved by the Executive in May 2002. It was being considered as a Bill in the Assembly; it had passed Second Reading and had just entered Committee stage when devolution was suspended. Following the decision to bring forward the Bill as an order, the draft order was subject to a short period of consultation in November and December of last year. Those who responded confirmed their continuing support for the legislation.

The proposal will give protection to service users with regard to quality of health and social care; it will remove unacceptable variations in the standards of health and care delivered; and it will reduce the risk of abuse of, or harm to, service users. Those who live in England, Scotland and Wales have had those protections for some time and it is only right, just and appropriate that those who live in Northern Ireland should have the same protections. I commend the order to the House.

Moved, That the draft order laid before the House on 7th January be approved.—(Lord Williams of Mostyn.)

Lord Glentoran

My Lords, I have a brief from the British Medical Association. I want to reiterate some of its points. The BMA (Northern Ireland) notes and asks why the order does not appear to provide for the authority to assess value for money in the same way that the Commission for Healthcare Audit and Inspection will in England and Wales.

The BMA (NI) considers that the authority, as an independent body, should be subject to a statutory obligation to submit its annual report to the Northern Ireland Assembly. It suggests that that would enable the Assembly to scrutinise the work of the authority.

As regards GPs' surgeries, the BMI (NI) asks whether GPs providing NHS services from their premises where private work may also be undertaken will need to register with the new authority. Regarding personal care, which is dealt with in Articles 10 and 11 of the order, the BMI (NI) seeks assurances that the department will discuss these matters with organisations representing patients, carers, health and social care professionals.

Basically, there is considerable support for the order by the BMA (NI). On minimum standards of improvement, it comments that it would appear that a breach of an improvement notice does not in itself constitute an offence and that it would press for some examples of how the department envisages that a breach of the standards would be addressed.

Lastly, I deal with restrictions on disclosure of information. The BMA (NI) suggests that a code of practice setting out the circumstances in which disclosure without consent would be acceptable.

I apologise for reading the brief, but when I received it the points seemed pertinent and worth making to the Minister. Otherwise, I support the order.

Lord Shutt of Greetland

My Lords, I support the order. The Bill was called the Health and Personal Social Services Bill. One is tempted to suggest that it would have been an opportunity to look at the whole business of free personal care. However, that is perhaps a debate for another day. The devolved Assembly went so far, and perhaps it will return to the matter.

Lord Maginnis of Drumglass

My Lords, I welcome this order. In the light of some awful cases that have been in the public eye over the past few years—Harold Shipman or the Bristol Royal Infirmary, for example—there is a need to underpin best practice within the health service.

I welcome the provision for an all-encompassing regulatory authority to monitor the provision and quality of services and to specify necessary improvements. Monitoring of establishments and agencies has, until now, been less than satisfactory. Now standards of care will be regulated and residential homes will have to provide a basic standard of care.

Can the Minister tell us, however, how those standards will be set and how they will be enforced? Will there be a timeframe for meeting those standards and will they be checked on a regular basis? Can he assure us that they will be achievable and sustainable; and that they will be open and transparent?

I welcome the provision for the regulation and improvement authority to report annually. It is however, not unreasonable to assume that there will be occasions when the public, the department and service providers will need to be made aware of findings on an ongoing basis. What mechanisms will be in place and resources available to ensure that the regulation and improvement authority is able to fulfil that requirement?

Registration of care homes is comparatively easy to achieve, but there appears to be a lack of provision to ensure registration of self-employed childminders. It is unclear how parents and guardians can be certain that a childminder is registered. A home will be required to display a certificate. Will childminders do likewise? Will members of the public be able to gain access to a list of registered individuals and agencies? Will they be able to discover those who have had their registration withdrawn? Can the Minister assure us that, like homes and agencies, unregistered childminders will face fines and convictions? Can he reassure me that registration will not be effected on a one-off basis, but renewed annually, and that standards will be continually assessed and updated?

I welcome the provision for improvement notices. What is unclear is whether there will be a time limit attached to those notices. Will registration be cancelled if improvements are not made within the stipulated time? Will the improvement notices be available to the persons using the services? Surely they have rights in this respect.

Finally, although I welcome the commitment to improve quality, there appears to be no reference to the costs involved. The Ulster Unionist Party is concerned that huge amounts of money are being swallowed up without visible returns in terms of quality. The regulation and improvement agency will clearly require considerable support staff and sufficient finance to be able to fulfil its responsibility. I understand that it will be financed from the health budget. Does that not mean a further erosion of resources at the sharp end?

Quality is essential in our health service. It cannot be achieved in a stop/start manner. Standards should be applied regularly and in response to needs. I welcome the order and look forward to hearing the Minister's response.

Lord Williams of Mostyn

My Lords, I am grateful for the general welcome for the order. The noble Lord, Lord Maginnis, asked many detailed questions. If it is of assistance for similar future occasions. I am more than happy for such questions to be put to me in advance so that I can give a fully researched and authoritative answer. I know that the noble Lord will be patient with me if I promise to write to him about some of the fine detail because I would not want inadvertently to give a misleading impression.

The noble Lord asked about childminders. Childminders and the regulation of services to under-12s will continue to be within the remit of the trusts. Standards will be developed in conjunction with all stakeholders, including service users and providers. To answer his question about time, some standards will be phased in. To answer his question about review, yes, standards will be subject to continuous review.

I may able to deal with all of the noble Lord's questions; if not, I shall research Hansard and remedy the defects. He is right: improvement notices will state what action is required. To his specific question, "By what date?", the answer is yes—in other words, the date is specified in the order.

The noble Lord, Lord Glentoran, asked about GP surgeries. They will not need to register. On value for money, the full range of audit functions, including value for money work, will be introduced to the scheme. The noble Lord also asked about annual reports, which we find in Article 7, which includes the obligation to make a report to the department as soon as possible at the end of each financial year.

Questions were posed about enforcement and how offences were to be prosecuted. We find the answers in Article 24 and following articles. Article 24, at page 17, deals with failure to comply with conditions. Contravention of regulations is dealt with in Article 25; false descriptions of establishments and agencies in Article 27; and failure to display certificate of registration in Article 28, which in part deals with one of the points raised by the noble Lord, Lord Maginnis. Details relating to proceedings for offences—the compendious answer to the noble Lord, Lord Glentoran—are set out in Article 29. It says: Proceedings … shall not, without the consent of the Director of Public Prosecutions for Northern Ireland be taken by any person other than the Regulation and Improvement Authority". There is a fairly self-contained code in that section under the overall rubric of "Offences".

I agree with the noble Lord, Lord Maginnis of Drumglass, that there ought to be consultation and conversation with affected organisations. I have no doubt that appropriate consultation will take place. The noble Lord, Lord Glentoran, asked about the regulation and improvement authority. One of the authority's functions relevant to the noble Lord's question is set out at Article 35(1)(c).

I repeat that I am conscious of the fact that both noble Lords asked detailed questions. I am inclined to the view that I have not answered all of them. I shall check carefully, as I said, and I shall write to both noble Lords. As always, I shall copy that letter not only to the Library but to all noble Lords who have shown an interest in our continuing work in this context.

Lord Glentoran

My Lords, I thank the noble and learned Lord for that reply. I apologise for firing late questions at him. As the noble and learned Lord knows better than anybody, we are moving on to our 14th order this week or something like that. It has not been easy to get ahead of oneself.

Lord Williams of Mostyn

My Lords, I accept that entirely. Sometimes, the briefing comes in late. I say simply that, if your Lordships want to give me advance notice, I may be able to provide a more satisfactory or, at least, more immediate service.

On Question, Motion agreed to.