§ 7.29 p.m.
§ Lord Warner rose to move, That the draft order laid before the House on 28 October be approved [32nd Report from the Joint Committee].
§ The noble Lord said: My Lords, this draft order makes changes that are consequential to Part 2 of the Health and Social Care (Community Health and Standards) Act 2003. Yesterday afternoon it was debated in another place. There my ministerial colleague, Stephen Ladyman, made a declaration that the draft order is compatible with the European Convention on Human Rights.
§ A regulation or order-making power providing for consequential changes to legislation is normally a standard power included in primary legislation to recognise that, despite best efforts, it is not always 825 possible to identify during the passage of the Bill every consequential change that might be needed to primary legislation.
§ The House of Lords Select Committee on Delegated Powers and Regulatory Reform, which considered the 2003 Bill, recommended in its 24th report, which was published on 10 September 2003, that the affirmative procedure should apply for all orders that amend Acts.
§ Section 195(5) of the 2003 Act applies that recommendation to Section 201 under which this order is made. That explains why this order is before the House today. The 2003 Act established the Commission for Healthcare Audit and Inspection, known as the Healthcare Commission, and the Commission for Social Care Inspection. On 1 April this year they both began their functions, and the former bodies—the Commission for Health Improvement and the National Care Standards Commission—were abolished.
§ The order introduces no contentious provisions, but is simply a tidying-up exercise intended to update legislation by replacing redundant references to the Commission for Health Improvement with references to the Healthcare Commission. It also adds references to the Commission for Social Care Inspection, where appropriate, so that both commissions are on an even footing.
§ Turning to the specific changes made by the draft order, Article 2(1)(a) substitutes a reference to the Healthcare Commission for the existing reference to the Commission for Health Improvement in Section 33(6)(c) of the Audit Commission Act 1998.
§ Article 2(1)(b) of the draft order adds a reference to the Commission for Social Care Inspection and also replaces the reference to the Commission for Health Improvement with a reference to the Healthcare Commission in the definition of "Crown" bodies for the purposes of Section 48 of the Copyright, Designs and Patents Act 1988.
§ Article 2(1)(c) substitutes a reference to the Healthcare Commission for the reference to the Commission for Health Improvement in Section 21(2) of the National Health Service and Community Care Act 1990.
§ Article 2(1)(d) concerns Section 20 of the National Health Service Reform and Health Care Professions Act 2002. The draft order replaces the reference in subsection (7) to the Commission for Health Improvement with a reference to the Healthcare Commission as being one of the bodies to whom the Commission for Patient and Public Involvement in Health might report a matter under this section.
§ Article 2(1)(e) adds the Healthcare Commission and the Commission for Social Care Inspection to the list of bodies that are subject to obligations under Section 71 of the Race Relations Act 1976. The current reference to the Commission for Healthcare Improvement is repealed by Article 2(2) of the draft order.
§ Article 2(1)(f) replaces the reference to the Commission for Health Improvement with a reference to the Healthcare Commission in Section 144(2) of the Road Traffic Act 1988. It also adds a reference to the Commission for Social Care Inspection.826
§ Lastly, Article 2(2) of the draft order makes a technical repeal to the Race Relations Act 1976 and a revocation to related subordinate legislation so as to remove from that legislation superfluous references to the Commission for Health Improvement.
§ The amendments in this order are not expected to have any financial or adverse impact or burden on the commissions, businesses or public bodies.
§ Under the 2003 Act, we are required to consult the National Assembly for Wales in relation to the Healthcare Commission and the abolition of the former regulatory bodies before the order is made. We have done so and the Minister for Health and Social Services, acting on behalf of the Assembly, has confirmed that she has no comments.
§ As the draft order makes changes to some UK-wide legislation, the Scottish Executive and the Northern Ireland Department of Health, Social Services and Public Safety have been made aware and have made no comments on the draft. The Healthcare Commission and the CSCI have also been consulted and did not wish to make any points.
§ Finally, as I said earlier, the draft order is compatible with the European Convention on Human Rights. I beg to move.
§ Moved, That the draft order laid before the House on 28 October be approved [32nd Report front the Joint Committee].—(Lord Warner.)
§ Lord Skelmersdale
My Lords, this is a very simple order. It updates, as the Minister has just said, miscellaneous references in a wide range of legislation to take account of the existence of the Commission for Healthcare Audit and Inspection—known by the acronym CHAI—and CSCI, whose full name is the Commission for Social Care Inspection. Both bodies came into existence by virtue of the Health and Social Care (Community Health and Standards) Act 2003.
That Act also amends the law relating to the recovery of NHS charges, makes changes to primary dental and medical services, and provides for a replacement of the Welfare Food Scheme, none of which applies to this order. But there is a third issue about which I would like to ask the Minister. It also provided for the establishment of NHS foundation trusts, which we said then and believe now were neither fish nor fowl nor fine red herring. So complicated was the procedure for applying that my own local hospital, Musgrove Park Hospital in Taunton, applied and then withdrew its application when it found out exactly what was involved. I should therefore like to know how many others were in that position.
Since the Act came into force the Government have announced that they plan to reduce the number of health quangos. How will that affect CHI in particular? As far as CSCI goes, I wish it well. I spent a year of my life in Northern Ireland trying to get social security staff to publish results of their research and practical achievements, which they were very reluctant to do, 827 mainly because it was a time when anonymity brought personal security. CSCI would have helped dramatically to counter that particular attitude.
Going back to the Bill, the House will recall that my noble friend Lord Howe fought a successful rearguard action to have the chairmen of these bodies independent of government. As a result, both they and their staff are appointed by the National Health Service Appointments Commission, making the organisations they chair just that little bit more devolved from government, which in my view had leaned rather too much on their predecessor authorities.
I was delighted to hear the Minister talk of Article 2(1)(e) and the Race Relations Act and its relationship to Article 2(2)(a) and (b). That was one of the questions I was going to ask and now do not need to.
However, I should like to ask something about Article 2(f). Section 144(2) of the Road Traffic Act 1988 is about exemptions from the requirement of third-party insurance or security. Are the vehicles, which will clearly have to be used by staff of both these bodies, insured at all? If not, why not?
That said, I have absolutely no complaint about the order, except to say that your Lordships' Select Committee on Delegated Powers and Regulatory Reform was absolutely right to suggest during the course of the Bill that this should be an affirmative order because of course it amends primary legislation.
§ Baroness Barker
My Lords, having spent many happy hours going through the Act from which these regulations are derived, I have no intention of going over them in detail. I echo the sentiments expressed by the Government and the Opposition in another place, which welcomed CSCI in the early months of its operation. Given that I work in the field of social care, I welcome the regulations with a slightly more tempered view than others, only because I listen to practitioners who have been subject to inspections. Some have had much more mixed experiences than was implied in last night's debate.
I wish to raise two points. The first relates to Article 2(1)(a), under which CHAI takes on some of the Audit Commission's functions. The relevant section in the Audit Commission Act 1998 is entitled "studies for improving economy etc. in services". Throughout our debates on the Health and Social Care Bill we had many discussions about how the emphasis was on evaluating the economy rather than the effectiveness of health services. To what extent will the role that CHAI assumes from its predecessor be driven by economic considerations rather than those of clinical effectiveness? My second question is simple. I can understand that the bodies may need to be given powers under the Copyright, Designs and Patents Act 1998 but will the noble Lord explain what they would do with them?
828 Apart from those points, I echo the view of the noble Lord, Lord Skelmersdale, that there is very little in the order to detain noble Lords.
§ Lord Warner
My Lords, I am grateful for the helpful remarks from noble Lords opposite. The noble Lord, Lord Skelmersdale, asked about the Government's policies on foundation trusts. The straight answer is that I do not have the numbers in my head. It is a little outside the scope of the order but I shall write to the noble Lord with the details. I am sorry that his local hospital appears to have been disappointed in the progression of its application.
The noble Lord asked about the insurance of vehicles operated or owned by the Healthcare Commission and the Commission for Social Care Inspection. I am reliably informed that they are all currently taxed and have insurance cover for third-party risk.
The noble Baroness, Lady Barker, asked about the role of the Healthcare Commission in carrying out its inspections. The 2003 legislation provided for the Secretary of State to set out standards for the NHS against which the Healthcare Commission would develop its own assessment criteria and inspect whether trusts adhered to and met the standards set by the Secretary of State. The Secretary of State has published the national standards. I will certainly be happy to send the noble Baroness, Lady Barker, those standards if she has not seen them. We await the assessment criteria, being developed by the Healthcare Commission, which I expect to receive before too long. It will then be for the Secretary of State to sign off those criteria. They will be the criteria against which the Healthcare Commission will inspect and assess performance against the national standards for NHS trusts. That is how the system is provided for in the 2003 Act.
Article 2(1)(b) in the draft order replaces the reference to Section 48 of the Copyright, Designs and Patents Act 1998. I shall have to look into the precise details of the Act. Generalist though I am, I do not carry the full details of the legislation with me. But I shall look into the matter and answer the noble Baroness's question by letter.
§ Lord Skelmersdale
My Lords, before the Question on the Motion is put, with which we will agree, perhaps he could answer my earlier question. Given the Government's intention to reduce the number of health service quangos, what effect will that have, particularly on CHI?
§ Lord Warner
My Lords, as I thought I had said in my opening remarks, the Commission for Health Improvement (CHI) disappeared on 31 March 2004. The new Healthcare Commission came into operation in April and will continue to operate. We made clear in the arm's-length body review, published on 22 July this year, that there would be no changes in the position of the Healthcare Commission.
§ On Question, Motion agreed to.