asked Her Majesty's Government:

When they expect to start the pet travel pilot scheme.

My Lords, the pilot pet travel scheme will start on 28th February. From that date pet cats and dogs meeting the conditions of the scheme will be able to enter or reenter the United Kingdom without the need to go into quarantine.

My Lords, I thank my noble friend for that helpful reply. However, what is being done to make European vets, particularly French vets, aware of MAFF requirements? Will she consider launching a campaign so that British pet owners who take their pets abroad are aware that their pets must have treatment for ticks and ringworm before they re-enter Britain? Further, will my noble friend consider changing the 48-hour to 24-hour period in which this has to be carried out, to one of 24 hours only, so that it can be done at the point of re-entry? That would be far easier for people who are en route from a holiday resort. Instead of asking applicants to fill in a form to state that in the past six months their pets have not been in countries other than those participating in the scheme, will my noble friend consider making that part of the conditions for obtaining pet passports?

My Lords, my noble friend asks me a number of detailed questions on this matter which are important as the success of the scheme depends on our getting the detail right. I reassure my noble friend that the Chief Veterinary Officer has been in touch with colleagues across continental Europe about the requirements for the scheme. Good progress is being made with vets in western Europe on providing the necessary certification, and that, of course, is important for families with pets who are returning to this country. We shall launch a publicity campaign so that pet owners in this country who plan to travel abroad with their pets are aware of all the requirements of the scheme. It is in no one's interests for people to turn up with animals which are not eligible for the scheme. We shall launch what I hope will be a high profile and effective campaign directly at pet owners, but also through travel agents and vets.

The issue of "ticks and tapes" is a difficult one. These diseases can be dangerous for human beings and cause fatalities on the Continent each year. We do not want to import these diseases into this country when they are not endemic here. I recognise the concerns which exist as regards the difficulties of the 24- to 48-hour "window". We shall certainly look at that in terms of assessing the pilot scheme. I refer to the advice that we have at the moment from the expert committee in this regard. As regards the form and country of residence, that is the way we have arranged matters at the moment, but the whole aim of having the pilot is to address any difficulties before the main scheme is introduced next year.

My Lords, remembering that pets from non-participating countries will still have to go into quarantine, where the conditions often leave much to be desired, have the Government done anything about instituting a closer system of inspection for these kennels?

My Lords, there has been concern expressed on occasion about standards within quarantine kennels. Certainly the ministry does, and will continue to, take action when concerns arise about animal welfare being endangered in those circumstances.

My Lords, does the Minister agree that many people in this country are happy about the early introduction of the pilot scheme? Does the Minister recognise that a number of non-governmental organisations have been helpful in introducing the scheme, despite its various imperfections? I hope I may mention Passports for Pets which has been an effective organisation in this regard. If the pilot scheme is effective, will the Minister consider at an early opportunity the situation as regards the importation of animals from the United States and Canada?

My Lords, I echo the comments made by the noble Lord, Lord Soulsby. A number of organisations have not only been effective campaigners but now communicate well with pet owners to inform them of the detail of the scheme and what has to be done. Passports for Pets has been a particularly effective organisation in both areas and will continue to be relied upon to provide information to its members and other pet owners. We shall want to consider a number of issues in the longer term to determine whether it is possible to extend the scheme. As the noble Lord is aware, the position with regard to the United States of America was considered by Kennedy who recommended not implementing the scheme there. We shall conduct a further risk analysis next year when the main scheme comes into force.

My Lords, can my noble friend assure the House and the country that, where rabies is endemic and veterinary services leave much to be desired, there will be no possibility of a view being taken which would allow rabies to re-enter Britain?

My Lords, throughout the way in which we have framed the current pilot scheme and the long-term scheme the protection of public health has been uppermost in the Government's mind. That has to have the utmost priority. Equally, it has been recognised that science has moved on. Microchipping, vaccination and blood testing, coupled with the enormous efforts to stop endemic rabies in much of western Europe, mean that it is safe to implement this alternative scheme.

My Lords, does the certificate taken with the pet have to be issued abroad or can the preparatory treatment and the issue of the certificate take place in this country? That would be of particular use to those who need guide dogs and who have to go abroad for a day's business.

My Lords, if the noble is Lord is referring to the certificates in relation to rabies, microchipping and vaccination, they can certainly be issued in the country from which an animal is originally travelling. If a family is taking an animal on holiday with them, they would get the certificates in regard to its rabies-free status and its vaccination status here. If, for example, a service family is returning from Germany, they would get the relevant certificates there. The certificate or proof of treatment against "ticks and tapes" would normally be obtained at the end of a holiday or at the end of a period of stay abroad. In special circumstances—for example, where someone uses an assistance dog to go on a day trip—it will be possible to obtain that certificate here.

My Lords, will pets coming in through Heathrow airport, for example, be subject to a different system from the current one? I understand that currently the pet is booked on the same flight as its owner and that if, for any reason, there is not enough space the pet has to wait and travel on the next incoming flight. Is that included in this trial scheme? What is the position with regard to pets being booked on and travelling on the same flight if they are not going into quarantine?

My Lords, I am glad to say that dealing with the booking of pets will not be on my shoulders. We will be looking at the operating regimes that the individual transport operators are currently submitting to the Ministry. We must ensure that they fulfil the requirements of the scheme in terms of allowing appropriate checks for the animals concerned. That is the Government's most important responsibility. There will be a certain amount of consumer pressure about how individual operators choose to transport animals. As I understand it, at the moment the airlines that are thinking about participating are considering having animals and their owners on the same flight. However, ultimately, that has to be an operating decision for the companies and their customers rather than for the Government.

asked Her Majesty's Government:

What would be the effect on the Post Office and its network of the ending of the payment of benefits through the Post Office.

My Lords, there will be no change to existing methods of benefit payment before 2003 when the migration from order books and giro cheques to payment by automated credit transfer will commence. In the meantime, the automation of the post office counters network, due for completion by the spring of 2001, will enable the Post Office to extend its arrangements with the high street banks to offer a range of banking facilities at post offices. This will mean that benefit recipients who wish to access their benefits in cash at post offices will continue to be able to do so, both before and after the changeover, while post offices will be able to offer more services to all bank customers.

My Lords, I thank the Minister for that Answer, but does he agree that the first effect of this policy has been to push the Post Office into the red for the first time in more than 20 years? It has had to write off some £570 million expended on the Horizon computer system, which was originally devised to improve the payment of benefits and which is now no longer required for that purpose. Secondly, does the Minister also agree that approximately 8,000 post offices—getting on for half of the total—will have 40 per cent of their revenues eliminated as a result of this policy and that this will seriously jeopardise their future existence? Does not the Minister accept that it has been a little unwise to introduce such far-ranging changes and reductions in revenue for the Post Office at a time when it faces more intense competition than ever before?

My Lords, the loss to the Post Office is due entirely to what is, in effect, an accounting provision which has made it write off this very large sum of money. At the moment, the underlying profitability of the Post Office is extremely sound and it appears that it should remain so in the future. We have adjusted the external financial requirement and the profit target to take account of the fact that the Post Office will be paying for this project from gilts and assets held on its balance sheet. We should not think that the Post Office is in any financial difficulty at the moment. The change will not take place until 2003—it is not taking place at the moment—which is an extremely sensible timeframe for doing this. It is very difficult to calculate the exact impact on individual post offices. People have the right now to move to the ACT system and will presumably continue to do so. To calculate the exact financial impact we shall have to know what payments will be made by the Benefits Agency and the post office counters network to post offices, both in these circumstances an I the new ones. The timeframe is a good one. It should not push people into immediate difficulties.

My Lords, does the Minister acknowledge that, up and down the country, there are many thousands of elderly people who do not have bank accounts? In turn, they regularly go to their local sub-post offices to draw their pensions and other benefits, to chat to friends and perhaps to seek a bit of advice. Can the Minister give an assurance that our Labour Government will do nothing to curtail this very reasonable practice?

My Lords, let me make it clear that, even with the new system, in the future recipients of benefits will be able to go to a post office to get cash in exactly the same way as they do at the moment. What we are talking about here is a systems change that will introduce an automated accounting system to the transaction and will ease the migration out of order books. It will still enable people to go to the post office to get cash in the same way as they have in the past.

My Lords, is the noble Lord aware that the fact that something is to happen in three years' time does not make it any the less worrying? Is he further aware that the worry of many of us is that the last focal point in many rural communities will be extinguished if the average village post office ceases to be profitable, as suggested in the supplementary question of the noble Lord, Lord Ezra? Can the noble Lord tell the House whether the Government will look at the Post Office not only as a business—as was made clear in the first part of his Answer—pbut also at individual village post office counters as a matter of social importance and therefore political sensitivity?

My Lords, the Government are totally committed to the idea of maintaining a nationwide network of post offices. We are acutely aware that they play an enormously important role in the lives of the elderly and the less mobile. That is why the Prime Minister has asked the performance and innovation unit in the Cabinet Office to carry out an urgent study on the post office network to assess its contribution to the vitality of local communities, how it fits in with the objectives of the Government and what future objectives we should have for it. In the meantime, a great deal of action is being taken to help with the financial viability of individual post offices, including the introduction of the new pay system that gives postmasters fixed payments. Furthermore, we are working in conjunction with VIRSA to produce a leaflet which explains how local communities can support their local post offices. Lastly, action has been taken on rates so that very small post offices need only pay 50 per cent. These actions have been taken because the Government are well aware of the importance of the post office network within local communities.

My Lords, does my noble friend accept that we have no better example of the failure of the free market than the behaviour of the commercial banks? They seem either to provide seven or eight branches of different banks in the same locality or no branches whatsoever. Can my noble friend reassure noble Lords by stating that the Government support the view that, particularly in small rural communities, the Post Office should provide a basic banking service—which it is well set up to do—essentially for the purpose of cash transfer? That would deal with an area of business that the commercial banks are nowadays anxious to be rid of.

My Lords, for most people a credit account of that sort should not attract any charges. As the Secretary of State has made clear, we certainly wish to ensure that those on income support get the full amount of money they are entitled to from their benefits and that no deductions are made from those. That point has been actively considered in terms of setting up an appropriate service.

My Lords, we have entered the 18th minute and I know that the noble Baroness has tabled an extremely important Question.

asked Her Majesty's Government:

Whether, in order to permit the harness horse equality with the ridden horse on public rights of way, they will rectify the anomaly in the Department of the Environment, Transport and the Regions' consultation paper, Improving Rights of Way in England and Wales, which puts horse-drawn vehicles into the same category as the motorised vehicle.

My Lords, we have given careful consideration to the responses to Improving Rights of Way in England and Wales, including the noble Baroness's proposal that we should distinguish between the rights of horse-drawn vehicles and those of motorised vehicles when using different classes of highway. We shall take those points into account when we introduce new legislation soon.

My Lords, I am very fond of the Minister, but does she realise that, although she has tried her best, 15,000 harness horse drivers will be disappointed that they have not been able to receive a more formal response to my Question? Does she further realise that on this matter they have the support of ramblers, GLEAM and the British Horse Society? Lastly, does the noble Baroness agree that it is vitally important to keep horse-drawn vehicles off our congested roads as much as possible?

My Lords, I am deeply sorry to have disappointed the noble Baroness, Lady Trumpington. I should have liked to have been in a position, when wishing her a happy new year, to be able to respond to her Question in the manner she wished. Given her great experience of this position at the Dispatch Box, the noble Baroness will be aware that parliamentary privilege prohibits detailed revelation of the contents of legislation in advance. However, I can say to the noble Baroness that one-fifth of all the responses to the consultation came from those with equestrian and carriage vehicle interests. In addition, Ministers and officials met representatives of various organisations. This Government listen carefully and we shall pay full regard to those responses.

My Lords, when the House of Lords was the House of Lords—namely, before 1911—the horse-drawn vehicle could be equated with the motor vehicle now. How are the horse-drawn vehicle and the harnessed horse defined today from the point of view of legislation?

My Lords, the Question tabled by the noble Baroness relates to a consultation document issued by the Government. Further, the noble Baroness was certainly not alone in pointing out that the legislation did not seek to make distinctions on this point. We are dealing here with rights of way over which motorised vehicles are rightly prohibited. When the legislation is produced I hope to be in a position to demonstrate that the Government have listened to the points made.

My Lords, does the Minister appreciate that many of these rights of way are not metalled but are ordinary dirt roads. One of the problems here is that wheels tend to cut up the roadway very much more than do horses' hooves or human feet. As landowners are responsible for maintaining these rights of way, will the Minister take that point into consideration?

My Lords, the noble Countess, Lady Mar, is right to draw attention to the fact that wheeled traffic may cause damage, and that the traffic we are considering here should be allowed only where it does not damage the carriageway. However, I am of course aware that horse-drawn vehicles can benefit people living nearby who wish to grow roses.

asked Her Majesty's Government:

When they intend to publish their strategy for sport.

My Lords, the Government have been giving careful consideration to their strategy to improve sport in this country. We expect to publish in the near future, after consultation with key stakeholders in the strategy.

My Lords, did the Minister read in the Daily Mail of 6th January that out of 103 applications to sell school playing fields, 101 had been granted by the Government? That is a catastrophic betrayal of pre-election pledges by the Government. What confidence does that figure give that the so-called strategy for sport, requiring government resources and will to implement it, will deal with social exclusion and social deprivation, areas where sport has a unique opportunity to play a role?

My Lords, the noble Lord and the Daily Mail choose their statistics very selectively. The truth of the matter is that in the first year of this Government, only in 13 cases were there losses of playing field sites against the advice of the statutory consultees, Sport England. In the past 12 months there have been only six such cases. The loss of playing fields, except when justified, has dramatically reduced and gives us confidence that our sports strategy will cover issues of social exclusion to which the noble Lord rightly refers.

My Lords, can my noble friend say what progress has been made in finding a suitable athletics arena in London for world and European outdoor championships? Is he aware that there is very great public support for the decision taken by the Secretary of State and the Minister for Sport to remove athletics from the new Wembley stadium and to seek repayment of part of the lottery grant from the Football Association and Wembley National Stadium Limited?

My Lords, I am grateful to my noble friend for his comments about the Secretary of State's conclusion on Wembley. He will know that the Rugby Football Union has proposed to the Government that Twickenham should be used for major international athletic events. We are very receptive to that idea and are looking into all the issues in the hope that it may be a good solution for separate but still first-class provision both for athletics and for football.

My Lords, can the Minister give the House some guidance about school sports in particular? Will the time given in the national curriculum for school sports allow for the amount of travel faced by many inner city school pupils in getting to playing fields? I am sure the noble Lord will agree that if the school timetable provides for three hours of sport but pupils spend one-and-a-half hours traveling—leaving aside getting changed—there is no proper sports provision at all.

My Lords, the noble Lord is quite right. I can assure him that when the sports strategy appears it will give great prominence to the need for, adequate provision for physical education, including competitive team sports, in our schools. It is not within the legal power of the Secretary of State for Education and Employment to set a fixed period for any subject within the national curriculum, but the issue raised by the noble Lord of travelling to sports fields is an important one. It is an aspiration—an agreed aspiration—that there will be two hours of sporting activity all our schools.

My Lords, in order to give further emphasis to the favourable response of my noble friend to the noble Lord, Lord McNally, would the Government be prepared to consider suspending as of now all further disposals of school sports fields and also laying it clown that in future any assent given to a proposal to dispose of a sports ground should be signed and approved by a senior Minister of the Crown?

My Lords, I do not think it would be appropriate to ban every change of use for playing fields. For example, some are attached to schools which no longer exist and some are in areas where there is, as there certainly is not in all parts of the country, an excess of playing field provision. However, the thrust behind my noble friend's question is quite right. Perhaps I may point out that because Sport England is a statutory consultee it is necessary for local authorities to pay attention to the need for sporting facilities. The proceeds from any disposal of playing fields must go to education and to sporting provision. The Secretary of St ate now has the power, whenever it is necessary, to call in applications which affect playing fields. But I do not think that a blanket ban would be appropriate.

My Lords, will the Minister press with in government for more positive help for our four major ball game sports—rugby, tennis, football and cricket. During a constructive debate in your Lordships' House several months ago there was widespread agreement that, looking ahead, we would not be in a position to compete internationally in those four sports. It is a shattering state of affairs that our sports are on the floor. Can the Minister assure us that the Government really will take the problem seriously?

My Lords, I can certainly give the noble Lord that assurance. The pursuit of excellence is one of the criteria that will govern the final production of our sports strategy. But it must in turn depend, as I am sure the noble Lord will agree, on sports provision in schools and on the availability of sporting facilities and opportunities throughout life, even for those who cannot aspire to sporting excellence. The four major sports to which the noble Lord referred have been consulted and are being consulted in the preparation of the sports strategy.

My Lords, will my noble friend, who knows my interest in Rugby League as the chairman of Warrington Rugby League Club, ensure that super-Rugby League clubs receive the same educational grants as premier league and first division football clubs?

My Lords, I do not know the answer to that question.

My Lords, will the Government bear in mind in their strategy that sport in this country is carried on the shoulders of community amateur sports clubs? Is the Minister aware that they currently have no tax exemptions? They are not charities and they receive only discretionary rating relief. When the Government produce their strategy, will they contemplate giving them tax exemptions comparable to those available to charities?

My Lords, we are very well aware of the problem to which the noble Lord refers. We are discussing it with the Treasury and with the Home Office. However, even if we were to grant 100 per cent relief, as happens in Scotland, the difficulty is in deciding what is a worthy community sports organisation of the kind to which he refers and not just a very rich golf club or one that is very exclusive. We require some definition of what is worthy and we have to retain some responsibility for local authorities, which know the sports clubs concerned, to make a decision on that point.

My Lords, at a convenient moment after 3.30 p.m. my noble friend Lord Hunt of Kings Heath will, with the leave of the House, repeat a Statement that is being made in another place on influenza.

My Lords, I beg to move the Motion standing in my name on the Order Paper.

My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

moved Amendment No. 1:

Page 1, line 9, leave out ("subsections (3) and (4))") and insert ("the following provisions of this section)").

I should like to express concern about the definition of these schools as set out in Amendment No. 3. Will the Minister indicate whether the purpose of the clause is to protect particular children at a school? If that is so, I suggest that the amendment is not worded clearly enough. Some schools take in other children for holiday courses, which could easily extend over the 295-day period. The children who attend the school during the normal term time are one group and an entirely different category of children may attend during the holidays. For example, at a school with which I am familiar music courses are held during the holidays. Some clearer definition may be necessary in that respect.

In regard to Amendment No. 2, leaving out the words from "centre" to the end of line 8, what is a "residential family"?

In regard to whether the definition of "295 days" is appropriate, there is no intention to capture schools with normal terms which run residential courses during the holidays, as many do. As regards the definition included in the clause, the key reference is that the accommodation is provided for children for more than 295 days. I take that to mean children receiving schooling for more than 295 days in any one year, rather than a school using the holiday period for other children's holiday activities. The provision repeats the wording of the Education Act. I am satisfied that it does not need further clarification. However, I shall be happy to examine it in the light of the noble Lord's comments.

I thank the Minister for having had the courtesy to write to me about one of the amendments that he has tabled. His case is clearly that the provision in the Bill is largely a reintroduction of provisions included in the Children Act but with the exception of independent schools approved for the education of children with special educational needs. What consultations have taken place with such schools about the provisions? After all, this is a major new piece of regulation for them.

Perhaps I may take up the point made by the Minister in his reply to the noble Lord, Lord Northbourne. He said that it is not the intention of the clause to catch, for instance, schools that run music courses during the holiday. However, it may be desirable to reflect that point in the Bill rather than merely in a statement from the Front Bench.

On another point, independent schools are increasingly taking pupils from overseas. It is by no means unknown, particularly in the shorter school holidays, for some of those pupils to remain at the school, possibly being looked after by the family of one of the masters, during the Christmas and Easter vacations. In tho3e circumstances a school may find itself with several children who are there for more than 295 days. Would that convert the school into "a children's home", whereas otherwise that would not happen?

Perhaps I may deal first with the issue of special schools. We are extending the dual registration arrangements to cover independent special schools, which are not currently covered. That will bring a further 100 or so special schools into the regime. That is an important safeguard. Children who attend such schools will receive the extra protection provided by dual registration.

As regards the more general issue raised by the noble Lord, Lord Jenkin, I have said that I will reflect on the point raised by the noble Lord, Lord Northbourne, to make sure that the definition contained in the amendment does not cause problems to schools which use school premises outwith school term time. I repeat that the wording in the amendment follows current legislation. I am not aware that the present law has caused any problems to individual schools, either in the terms in which the noble Lord spoke or in terms of the point raised by the noble Lord, Lord Jenkin, regarding people coming from abroad who might stay in school premises.

I am very pleased that special schools have been included, but why were they not included in the first place? It is well known that some of these schools were strongly considered to be at risk and that serious abuses have taken place throughout the country.

It would be difficult for me to explain why special schools were not included in legislation that was enacted some years ago. The noble Baroness is right to point out the importance of introducing the safeguards into this Bill.

As regards the point about independent schools in relation to children with special needs, the originating concern came from the children's safeguards review. In reply to the noble Lord, Lord Clement-Jones, we have not yet held detailed discussions with the schools affected. However, I assure the noble Lord that we shall discuss detailed arrangements with them in due course.

Will the Minister indicate what the term "residential family" means?

The amendment is not aimed at omitting the word "centre" but the word "or". It is a drafting point in order to introduce a new definition of a dual registration school.

moved Amendment No. 2:

Page 2. line 7, leave out from ("centre") to end of line 8.

moved Amendment No.3:

Page 2, line 9, at end insert—

("(5) Subject to subsection (6). an establishment is not a children's home if it is a school.

(6) An independent school is a children's home at any time if at that time accommodation is provided for children at the school and either—

(a) in each year that fell within the period of two years ending at that time, accommodation was provided for children. either at the school or under arrangements made by the proprietor of the school, for more than 295 days; or

(b) it is intended to provide accommodation for children. either at the school or under arrangements made by the proprietor of the school, for more than 295 days in any year;

and in this subsection "year" means a period of twelve months.").

moved Amendment No. 4:

Page 2, line 12, at end insert ("and for the purposes of this Act an independent hospital shall include private patient units within a health service hospital").

I rise to speak to Amendments Nos. 11 and 18 in my name and to support strongly the observations of the noble Lord, Lord Clement-Jones. The Government are in a terribly complicated muddle over the regulation of private healthcare. The delivery of healthcare in this country does not issue forth from two conveniently separate channels, one labelled "public" and the other "private"; it is not as simple as that. The NHS frequently sub-contracts to the private sector, most notably in the field of mental health, and there are private wings and beds in NHS hospitals. If one decides, as the Government appear to have done, that, despite all the interdependence between the public and private sectors and the facts that most consultants work in both sectors and that the same patient can be treated in one sector and moved to another for further treatment, the public sector is to be regulated in one way and the private sector in another, anomalies are bound to occur.

My understanding based on the debates last year on the Health Bill was that the Commission for Health Improvement would be the regulator of all healthcare funded by the public sector, including care delivered to NHS patients in private hospitals. We shall deal with that anomaly when we debate Amendment No. 31. Meanwhile, I should like to hear from the Minister whether my understanding is correct. Now that we are about to have a national care standards commission with a separate division responsible for regulating private hospitals and clinics, are we to suppose that in practice CHI may sub-contract to the commission the job of overseeing NHS patients in private hospitals?

The anomaly addressed by this amendment, however, relates to NHS pay beds. Many people, including myself, are still unclear as to what role, if any, will be played by the Commission for Health Improvement in the supervision of standards in private wings and wards of NHS hospitals. The Minister was kind enough to address this issue in his winding-up speech at Second Reading, but I am afraid that I did not understand it, even on re-reading what he said. If CHI is not to be involved in the regulation of NHS pay beds, surely it follows that the national care standards commission must be; NHS pay beds cannot be left out in the cold.

The trouble with the Bill is that it begins by categorising different kinds of care services in terms of the physical premises that they occupy. That might have been the best that the lawyers could do, but it makes life awkward when part of the Bill is devoted to NHS care and part is related to private care. My amendments try to find a way through it by defining a new type of establishment; namely, an income-generating health service unit. Such a unit is, in other words, a private ward or wing of an NHS hospital. Under this proposal, the NCSC will assume responsibility for NHS pay beds alongside its responsibility for monitoring standards in private hospitals. I hope that that proposal is a logical one; certainly, it is meant to be constructive. I hope that the Minister will view that amendment with some sympathy.

I find myself in difficulty in this matter. I do not know whether the Minister is old enough to recollect Cullompton. At the time of the debates about the continuation of private beds in NHS hospitals when the noble Baroness, Lady Castle, was Secretary of State, there was considerable argument about whether it was appropriate that there should be pay beds within the premises of NHS hospitals, sometimes as an integral part of wards. Happily, in the end, sensible provisions prevailed, although it may have taken a year or two for the system to settle down.

I find myself in a dilemma in this matter. I completely understand the point to which the noble Lord, Lord Clement-Jones, referred. I also understand the points made by my noble friend in speaking to his amendments. But pay beds take many different forms. I take as an example Lindo Wing at the Middlesex Hospital or units at other teaching establishments which have premises separate from the main NHS hospital. In those circumstances, the intention behind the amendment moved by the noble Lord, Lord Clement-Jones, is wholly appropriate. That should be looked after by the new commission. In the Forest Health Care Trust, of which I was chairman for a number of years, the largest group of pay beds was in that part of the hospital concerned with maternity. We found that over the years there was a considerable demand, even in a relatively deprived area of north-east London, for privacy and the ability to receive visitors at all times, and that people were prepared to pay for it. After all, nowadays most mothers are not in maternity beds for more than a day or two and therefore the cost is not very great. Those beds were an integral part of the remainder of the maternity provision in the hospital. The idea that somehow there should be two lots of inspection, one for NHS beds and the other for pay beds, seems to me to be utterly absurd. One must look at the remit of CHI and consider whether in those circumstances it is entirely appropriate that there should be a single system of inspection. For that reason, I find it difficult to accept these amendments.

There is another category: amenity beds. As I understand the language used by my noble friend's Amendment No. 11—"income-generating health service units"—an amenity bed, which is much cheaper than a private bed, generates income and gives some of the advantages of a pay bed without the full cost being borne. Would those beds be subject to a separate system of control? I find all of this hugely confusing. I cannot believe that the Government do not now share that view. There will be a ridiculously overlapping system of inspection for what constitutes a single provision of beds which are occupied by patients under different terms.

If one is looking for a way to inspect the standard of care—we shall debate clinical care in later amendments—one single inspection system must surely be right.

Before he sits down, perhaps I may ask the noble Lord to consider Amendment No. 31. What he said demonstrates much of the absurdity relating to acute healthcare. The contradictions in the Bill are exposed clearly in this set of amendments. Perhaps the noble Lord will agree that that may be a more felicitous way of dealing with regulations so that common standards are met in NHS and independent healthcare beds.

Perhaps I may respond to the noble Lord. If that is the intention, I shall listen with great interest to those who speak to that amendment.

I hope that a satisfactory solution will be found. I have been a patient in a National Health Service hospital which had private beds. I visited some of the private patients. Many were in side wards. They were foreign, lonely and deprived. I thought that they were being ripped off. Sometimes their rooms were not dusted. Sometimes they were overlooked and not fed. It would be wrong to leave such patients out of the debate. I hope that a satisfactory solution will be found.

It has been interesting to listen to the different aspects put forward. The debate has revealed what a complex issue we are discussing. For some time I was chairman of the Royal Free Hospital which has private beds within the main hospital occupying half of a specific floor. Because there was need for more beds, national health patients were always given priority and those beds were used regularly for NHS patients although the private beds generated a large amount of additional income for the hospital and there fore were of great benefit to the national health patients.

The noble Baroness, Lady Masham, raised the issue of shabby wards. The point may be true in some areas. If the private wings in London hospitals are not smartened up to a considerable degree, one has no hope of getting patients into them. They prefer the luxury hotel surroundings of the new, completely private clinics. One has not only to provide the best medicine but also luxury surroundings to encourage patients to choose one hospital rather than another.

I wish to raise a different aspect. I like the phrase about the income generating health service. Some major national health hospitals run travel clinics. Patients pay for the injections and so on, which they need for travel. Such clinics are not a national health service and never have been. Yet such treatment is given in those hospitals.

I am not clear whether the Bill relates only to inpatients who are resident in hospital or whether it will also provide for people having treatment of any form. With the present influenza crisis, many businesses would happily pay 'or that national health hospital to give influenza injections. The cost would be far less than that lost due to illness. It would surely be viable through the travel clinics. The premises already exist. It would be an additional feature.

We differentiate between what one can and cannot have. However, the patient or someone on his behalf may be prepared to meet the cost. When I was a parliamentary candidate for the Commons, I exchanged a number of letters about pay beds in Plymouth with the then Dr Owen. Pay beds have always been a major issue. However, I agree with the noble Lord, Lord Jenkin. It is important to have one standard and, if possible, one inspectorate. Could that be better achieved by inspection through the National Health Service? The noble Lord's point is valid. To inspect perhaps half a dozen beds or one minor clinic within the institution will not only be irritating but also somewhat impractical. Everyone will be on the defensive and much goodwill that exists in national health hospitals may be destroyed.

I do not know whether to support the amendment. The more I have listened, the more uncertain I am. It is important that the Government apply their mind to a solution.

For 10 years I was a patient across the water at St Thomas' Hospital while my aortic valve, which was busily closing, was examined. Although taking advantage of the private facilities at York House across the road from St Thomas' Hospital, I was sent all the time to the national health testing beds in the hospital. Eventually I became an emergency patient and was admitted to the private rooms on the top floor of the hospital where, after further examination, the aortic valve was replaced.

For 10 years I mixed private care with national healthcare in that hospital. Yet it all took place on the same premises. I should have thought that an inspection by the same body was sine qua non.

Perhaps I may respond to the noble Baroness, Lady Gardner of Parkes. The patients I saw had unfortunately no choice because they had broken their backs or necks. They were sent for treatment by foreign governments.

I hope that the Minister will visit soon the Stoke Mandeville Hospital where he will see the situation for himself. He will also see how important is the income generated by those patients. That may help him sort out the matter. Two inspections would be a waste of time and resources.

The noble Baroness, Lady Masham, continually invites me to visit various excellent NHS facilities. I assure her that Stoke Mandeville is on my list.

The discussion takes us back to the debate at Second Reading and the distinction to be made between the need for the proper regulation of the private healthcare sector and the effective management of the National Health Service, including private facilities contained under its management. Far from there being confusion or a problem about distinction, everything contained in the Bill and as regards the regulation of the private healthcare sector rests on the premise that there will inevitably be different arrangements between the regulation of the private sector and the management of public sector healthcare services. We shall debate the issue more fully on later amendments. However, I felt that I should set the context in which we are debating the proper management of NHS pay beds.

Amendments Nos. 4, 11 and 18 seek to extend the national care standards commission's regulatory responsibilities to cover NHS pay beds and other income generating facilities. Amendment No. 4 would include NHS private patient units within the definition of an independent hospital in Clause 2 thereby bringing them under the remit of the commission. Amendment No. 11 would have the same effect but would also bring other NHS income generation undertakings within the commission's remit. Amendment No. 18 has the same effect.

In reply to the noble Lord, Lord Jenkin, I am not sure how widely the noble Earl, Lord Howe, intended the regulator's powers to go, because NHS trusts can generate income in a variety of ways. The noble Lord mentioned amenity beds, but one could include, for instance, renting out space to shops. I am sure that he did not intend to include such action within this provision.

I believe that the amendments are misconceived. They assume that NHS paybeds need to be subject to regulation because otherwise they would be subject to no control. That is not the case. NHS paybeds, including those in dedicated units, are the responsibility of the NHS hospital where they are sited. They will be subject to clinical governance and all the other controls which apply to the NHS. The amendments would mean that even though a perfectly good system of management and clinical governance covered the whole hospital, certain parts of the hospital would be subject to another regulatory regime. That would be duplicatory and wasteful of time and effort. It would also distract the national care standards commission inspectors from their key task of improving regulation of the currently poorly regulated private sector into inspecting parts of the NHS where perfectly good systems of clinical governance are in place.

Will the Minister clarify those important words? Is he saying that NHS paybeds are covered by the Commission for Health Improvement; and that the reviewing body will be the commission? Will national service frameworks apply to NHS paybeds? Will the NICE guidelines be applied by the CHI when it is inspecting those paybeds? That is implied in the Minister's statement that the full regime as applied to the NHS will apply to its paybeds.

That must be right because those beds are part of an NHS trust hospital. What applies to that hospital must apply to all the beds within it.In conclusion, I say to the noble Earl, Lord Howe, that I refute the muddle which he suggests we have fallen into. I reiterate the fact that NHS paybeds are already covered by clinical governance and that therefore there is no need to have them further regulated by the care standards commission. On that basis, I invite the noble Lord, Lord Clement-Jones, to withdraw his amendment.

I am grateful to the Minister for clearing up much fog and uncertainty that have descended upon the issue. He has done so extremely clearly. We have had a helpful short debate and at the appropriate time I shall not move my amendments.

I thank the Minister for clearing up one confusion. However, in clearing one fog another has descended. As was said by the noble Lord, Lord Jenkin, as some of the NHS paybeds closely equate to independent sector healthcare beds perhaps they should be regulated in the same way. However, as others, such as maternity units, closely equate to NHS beds, a common inspection regime should apply.

The common message is that a single set of regulations should apply across the board. The Minister repeated the distinction he made on Second Reading between the regulation of the independent healthcare sector and the management of the NHS. However, in many respects, it is a distinction without a difference. A common review and inspection system would be feasible, still leaving the regulation of the private care system within the commission. Future amendments are designed to achieve that.

We have had an interesting and well attended debate and I thank all Members of the Committee who have taken part. In the meantime, I beg leave to withdraw the amendment.

moved Amendment No. 5:

Page 2, line 23, after ("hospital") insert ("or any undertaking by one or more persons)").

The purpose of Amendment No. 5 appears to be to seek to regulate medical practitioners who do not work from a specific establishment. We are concerned to ensure that the new regulatory system protects patients and have therefore decided to extend regulation to private primary medical care premises. We regard it as being extremely important that such premises, which include private walk-in clinics such as medi-centres, operate to clear standards and are properly and regularly inspected. Our aim is to ensure that all such premises are regulated without regard to their ownership arrangements.

Amendment No. 6 seeks to bring all private general dental practice within the scope of the commission's regulatory powers. I understand the thinking behind the noble Lord's proposal, but I believe that such an extension of regulation is unwise. First, most dentistry, whether practised in the private or public sectors, does not present a great risk to patients. The great exception is in relation to dentistry under general anaesthetic, which has tragical ay resulted in deaths.

We are determined to regulate such property, and the Bill makes provision for the commission to regulate premises where that work is undertaken. Furthermore, Clause 37 will allow such treatment to be regulated under the existing legislation even before the commission comes into existence, so concerned are we to take action.

However, I must say to the noble Lord that it is a big step from regulating this aspect of dentistry to regulating the whole of private dentistry. We consulted on the issue last year and carefully considered the results. We concluded that it would not be right to extend regulation in the way proposed, not least because of the need for proportionality in our approach and the need to avoid unnecessarily increasing the regulatory burden on small businesses. That said, we stated clearly in Regulating Private and Voluntary Health Care chat we shall keep the matter under review and consider whether at some stage we should extend regulation to that and other sectors.

The noble Lord, Lord Clement-Jones, raised a specific issue concerning call-out services. All wholly private GPs will be covered. Therefore GPs would be covered wherever 'they were practising. We did not regulate only the premises. It is worth making the point that private GPs will also come under the regulatory provisions of the General Medical Council.

I should like to pass some comments on the Minister's remark that he does not believe that much dental hazard exists except in cases involving dental anaesthesia. As a dentist who has used thousands of general anaesthetics I believe that the general anaesthesia issue has gone over the to pat present. I feel strongly about all the poor children who have to wait three months before they may have anything done.

There is a further aspect to the matter. At the time when I was in practice the National Health Service was very much stronger than it is now. I deplore the transfer of dentistry away from the National Health Service. I was a member of the London local dental committee, and a procedure existed whereby we used to inspect any surgery or premises where there was any doubt whatever about the standard of cleanliness or hygiene. Today, when sterilisation is a most important feature of life in terms of transmission of infection—particularly HIV, although hepatitis is perhaps even more transmissible—it is important to ensure that all dental practices have adequate facilities in terms of autoclaving.

In my day when one started one used to mix up one's solution in a bottle of water and add the tablets. Nowadays people would be horrified by that. Unfortunately, disease has progressed to the extent where it is terribly important that one has a sealed individual capsule and an individual needle. The Minister might believe that practices do not act in such a way, but I recall clearly, when I sat on the disciplinary committee of the General Dental Council, the case of a NHS practice—it could now he a private practice—where the forceps were merely dipped under the tap after each extraction. The dentist concerned had a turnover of £1 million per year and was disqualified by the General Dental Council. Think of how many patients he had treated without sterilising anything. He had one set of forceps for four surgeries which he would dip under the tap and then run on to the next patient. The hazard of that to the patient is almost unbelievable.

Therefore, I cannot go along for a minute with the view that the only hazard in dentistry is general anaesthesia. It is important to consider this question. If I could find fault with the amendment tabled by the noble Lord, Lord Clement-Jones, it might be that to specify dental practitioners is not enough and that the amendment should refer to premises used by anyone in any allied profession. I do not know what the hazards are in an osteopathic or chiropractic practice. Perhaps the terms of the amendment are not wide enough, but it would certainly be a good thing to include dental practitioners, unless the Minister can assure me of some other form of examination being carried out to assess standards in private dental practice.

Will the Minister tell the Committee whether, where line 24 of Clause 2 states, "by medical practitioners", nurse practitioners are included?

I believe that the answer must be no.

It is a foolhardy Minister who tries to talk about dentistry when the noble Baroness, Lady Gardner, is in the Committee. She made some extremely valid points. I hope that I did not, by saying that the particular focus here relates to anaesthesia, give the impression that other issues do not need to be considered in relation to safety and hygiene within dental premises. The substantive point that I was trying to make is that this is an area of particular concern. I note the noble Baroness's comments as to whether too much is made of the anaesthesia issue. Certainly we in government have been concerned about the number of cases identified where use of anaesthesia has led to deaths in dental surgeries. The noble Baroness may well be aware that we are currently undertaking a review of that matter.

To move from regulating that aspect of dentistry is a large step and it seems to me sensible to focus on that area. In relation to the more general issues about dentistry raised by the noble Baroness, we hope to publish a strategy on dental services in the future as part of our efforts to try to ensure that those who wish to have NHS dentistry may receive it. Of course, GDS regulations exist in relation to NHS dentistry which are one component of the relationship between the NHS and dental services. We are keen to encourage such practices as continued education for dentists in order that we may update them and ensure that they keep up with current thinking and trends.

Before the Minister sits down I should like him to answer a question. Is dentistry carried out in care homes subject to a different regime or is it still subject to the same regime—that is, that such dentists are regulated only when operating under general anaesthetic?

I believe that that is right. I shall check the point and perhaps write to the noble Lord. In relation to dental services, the Bill certainly focuses on treatment under anaesthesia.

I thank the Minister for a number of assurances he made during his reply, in particular in relation to the long-awaited dental strategy. I have asked a number of questions on that point and it is probably now about 18 months overdue—that is merely a quick estimate of the period of time for which we have been awaiting it. We look forward to it because it should clarify some of the issues.

We hope that the strategy will be published shortly. It is always better to get it right than to rush it.

There can be no danger of the strategy having been rushed, so I am sure that it will be an excellent strategy once it arrives. I appreciate also the Minister's assurance that, although he does not agree that dentistry in general should be brought within the scope of the Bill, there will be a review. I must say that I found some of the points made by the noble Baroness, Lady Gardner of Parkes, rather telling. I ask the Minister to read Hansard and to consider whether that review should happen sooner rather than later. Clearly dental interests need to be consulted, but I suspect that, as so often happens in such cases, the better private practice dentists would welcome such regulation and only the worst practitioners would not welcome it, just as all the reputable independent healthcare sector organisations have welcomed greater regulation over their activities.

Finally, I thank the Minister also for clarifying the position relating to private general practitioners. That will be a matter of some considerable comfort because it was felt that the Bill did not cover those who did not practise out of a clinic or out of their own premises. As the Bill goes through the House, we shall no doubt consider further the question of dentists who do not carry out general anaesthetics and we shall take on board some of the points made by the noble Baroness, Lady Gardner. In the meantime, I beg leave to withdraw the amendment.

The debate on Clause 2 has been extremely helpful because it has revealed all too clearly the anomalies which the clause introduces into an otherwise very worthy Bill. The contributions made by a number of noble Lords have indicated well and truly that the inclusion of Clause 2 clarifies one anomaly but creates another.

As I indicated at Second Reading, overall I warmly welcome the Bill. The main reason I do so is because it ensures for the first time that whoever is the provider—local authority, voluntary body or independent organisation—all social care provision will be regulated and inspected by the same body according to the same standards. That kind of consistency is warmly welcomed. But it is torpedoed by the introduction of Clause 2. Whatever the connection between the care standards covered by the rest of the Bill and dental services that use anaesthesia, clinics that terminate pregnancies, obstetrics services and cosmetic surgery and so on, Clause 2 is in the Bill only because the services referred to within it are independent or provided independently of the National Health Service. However, the issue of pay beds within the National Health Service and some other points which have been made, especially by the noble Baroness, Lady Gardner of Parkes, and the noble Lord, Lord Clement-Jones, have indicated that those lines of demarcation are far from clear.

The national care standards commission will be an entirely new body with a huge range of responsibilities in the social care field. It will register thousands and thousands of centres and individuals who must be deemed fit to run such services. The services will cover the whole age range and an enormous variety of needs experienced by children, adolescents, people with learning disabilities or those with mental health problems, physical disabilities or problems associated with ageing. The commission will already need to employ a wide range of people with specialist knowledge and skills if it is to achieve its principal function; that is, the registration and inspection of care standards. It seems to me totally unrealistic to believe that a whole range of other skills necessary to deal with anaesthesia, anaesthetics, palliative care, cosmetic surgery and so on can be grafted on to that body. The Bill goes some way towards acknowledging those difficulties in that standards for the inspection of care services appear to be different from the standards applied to health provision.

I have great regard for the Minister and for his knowledge of health services. He comes from Birmingham. When he addresses the good people of Birmingham he will be able to tell them that wherever their relatives are placed in the social care system, because of the Bill the standards will be secured by a uniform system of registration and inspection. However, sadly, because of Clause 2, he will not be able to say the same about healthcare. Within Birmingham is a vast reservoir of specialist knowledge and skill across the whole range of health service provision. However, that skill and knowledge are within the National Health Service and should be applied wherever the provision is made. As several noble Lords have said, increasingly the National Health Service is using independent provision in a wide range of ways; sometimes for recuperation, sometimes for rehabilitation, and sometimes because there is insufficient provision in the health service and therefore the choice is made to use an independent provider. It is not sufficient to say that the use of independent providers will be dealt with on a contractual basis with contractual arrangements. Everyone must be assured that the standards which apply in one section of healthcare will apply in all sections.

I happen to be a great supporter of the National Health Service. However, I believe that wherever people receive healthcare treatment the standards of regulation and inspection should be the same. I do not believe that there is a sufficiently good argument for separating this area of activity from the remainder of the health service and for saying simply that the National Health Service is managed by the department. Whoever manages a service, that service should be subject to the same system of regulation and inspection. Unless the clause is removed from the Bill we shall have anomalies, of which pay beds in the National Health Service is just one.

Your Lordships will recall the long debates which took place in this House on the Health Bill and the detailed discussion about new ways of promoting and maintaining clinical standards and monitoring performance across the health service. In addition to the long-established systems within healthcare, there are now adequate ways to ensure that all healthcare, whoever provides it, can he regulated, monitored and inspected by one body. I was interested in a publication which I am sure your Lordships will have seen. It is a recently published Parliamentary Brief in which the Secretary of State for Health, Mr Alan Milburn, states:

"For the first time in the history of the NHS we are setting clear national standards—through National Service Frameworks and the National Institute of Clinical Excellence—to guarantee fair treatment wherever patients live".

Of course, wherever patients live; also, wherever patients are provided for. Mr Milburn goes on:

"And for the first time we are inspecting all parts of the health service—through the Commission for Health Improvement—to ensure that patients get the top class care they deserve".

I agree with that. However, if all aspects of the health service are to be inspected through the Commission for Health Improvement, surely it is possible to ensure that other health providers can be subject to the same type of inspection.

In my view, Clause 2 undermines the consistency of an otherwise extremely worthy Bill. If the clause remains, it will undermine public confidence in the safeguards for patients and patient care and treatment and it will complicate unnecessarily the task of the new care standards commission. I believe that it will put at risk the commission's effectiveness which, in the long term, will undermine its performance. I hope that your Lordships will take this opportunity to remove Clause 2 from the Bill.

I support the noble Lord, Lord Laming. I believe that I would have only to say, "Amen", and my task would be done. However. I repeat some of the questions raised by the noble Lord. He expressed the issues extremely eloquently. He quoted the Government against themselves. I believe that the only matter he did not mention was the Government's own conclusions in response to the Health Committee which, again, can be prayed in aid against them. As we go through the Bill, the contradictions posed by Clause 2 will become greater and greater.

As the noble Lord, Lord Laming, said, the provisions concerning independent acute hospitals have simply been grafted on to the Bill. Those of us who have been struggling with amendments during the recess have become acutely aware that the provisions regarding the regulation of independent care in the acute sector are simply bolted on and do not fit at all comfortably with the remainder of the Bill. The Bill is highly progressive and, as the noble Lord, Lord Laming, said, will provide consistent regulation across the social care sector. We see no such thing arising from that in the healthcare sector. Rather, we see a very different set of regulation. The best solution would be to get rid of Clause 2.

The Minister is known for his reasonableness. We had good discussions concerning almost everything relating to the Health Bill apart from the independent healthcare sector. That was the one area where we divided continuously. We did not play a great deal of "ping-pong" but we divided continuously from Report stage through to Third Reading and got no joy whatever from the Government. I cannot help believing that there is some ingrained ideological unwillingness inside the heads of Ministers who, although they proclaim the virtues of a mixed economy in social care, somehow cannot grasp the fact that we have also, albeit on a more limited scale, a mixed economy in healthcare. After all, only this morning the Secretary of State spoke about how the flu epidemic is being dealt with. He was trying to refute those who say that the independent healthcare sector is not being used sufficiently to deal with the epidemic. He said that we have contracts between local trusts and health authorities and the private healthcare sector. Therefore, in practice there is use of that sector. It is high time the Government responded to what is absolute common sense in this matter and agreed that we have a seamless system of regulation of healthcare across both the private and the NHS sectors.

I fully understand the reasons why the noble Lord, Lord Laming, does not want the national care standards commission to regulate the private healthcare sector. But we are determined to strengthen the current regulatory arrangements for this sector, not least to ensure the quality of care for patients. We believe that the most effective ways of doing that are contained within the proposals in this Bill.

It is clear that we shall have further debate on this subject later tonight and indeed as the Bill progresses. But before responding directly to the noble Lord, I should set out the Government's general approach to the regulation of private and voluntary healthcare.

We believe that the starting point is that those who operate private hospitals should be accountable for all aspects of care undertaken in them—both the clinical and the non-clinical services. This includes the work of doctors to whom they grant admitting rights. It is not acceptable for hospital owners and managers to seek to wash their hands of their responsibilities on the grounds that patients contract separately with consultants for medical care.

We believe that there should be a strong regulatory regime for private healthcare. There is no doubt that one of the many weaknesses with the current regulatory regime is that 100 different health authorities are responsible for inspecting private hospitals. I believe that that has led to an inconsistent approach and that some health authorities have found it very difficult to regulate private hospitals appropriately.

We believe that establishing a single body, the national care standards commission, with responsibility for regulating private healthcare across the country, will ensure a consistent and clear approach to enforcing the standards that we set. The inspectors will be focused on the healthcare sector and will develop the expertise and skills necessary to ensure proper regulation of this sector.

I know that the noble Lord would like to have a separate body—or I suspect the noble Lord would like to have a separate body—regulating the independent healthcare sector. This would have been appropriate when the Government planned to have regional commissions for care standards, as there would not have been the same expertise at regional level nor the same need for regulating private healthcare in some areas as opposed to others. But as we have decided to have a national commission, that is no longer the case. Her Majesty's Government very much believe that having one body regulating all the areas encompassed in the Bill is the best way forward.

Having one body regulating healthcare alongside social care will mean that the commission will be able effectively to regulate facilities that provide both health and social care, using inspectors skilled in both areas. As well as ensuring inspectors will have the appropriate skill mix, it will also benefit providers, who will only have to be inspected by one body, compared with the current system under which they are inspected by both the health and local authority.

If we set up a separate regulator for private healthcare, there would be substantial difficulty for some providers being forced to cut in half the work they do across both health and social care. For example, mental health provision is often provided across the range of care needs. Our overall approach to breaking down barriers between health and social care is encouraging providers to develop innovative and flexible mixes of provision. This would be seriously undermined if we asked providers to register separately their different provision with two different national regulatory bodies.

I hope that I have convinced the noble Lord that although he does not necessarily agree with how we have dealt with the private healthcare sector, there is every reason to include the private healthcare sector within the provisions of this Bill and encompassed within the care standards commission. We shall be returning to this issue later in debate and specifically to the various aspects of private healthcare regulation. But I hope, having heard the arguments, that the noble Lord will now agree that the clause should stand part of the Bill.

I regret to say that I am wholly unconvinced. I will say that again: I am wholly unconvinced by anything which the Minister has said. That is a first.

I find myself in a difficult position because I feel very strongly about Clause 2. As we go through the many amendments relating to Clause 2, I shall feel inclined to say: "Had you supported me in removing Clause 2, there would be no need to discuss this matter".

In the light of this discussion and what the Minister has said, and the fact that we will have opportunity to return to the matter, wise counsel suggests that should withdraw my opposition to the Motion. But I must say that I do so with an extremely heavy heart.

My Lords, I beg to move that the House do now resume.

My Lords, before we move to the Statement on influenza, I take this opportunity to remind the House that the Companion indicates that discussion on a Statement should be confined to brief comments and questions of clarification. Noble Lords who speak at length do so at the expense of other noble Lords.

My Lords, with the leave of the House, I shall repeat a Statement made by my right honourable friend the Secretary of State for Health in another place. The Statement is as follows:

"With permission, I would like to make a Statement on the outbreak of influenza that is gripping the country and the impact it is having on NHS services.

"As the House will be aware, the last few weeks have seen a particular strain of influenza—Sydney A—affecting thousands of people in all parts of the country. According to the Public Health Laboratory Service, which monitors the incidence of flu, it has been rising in all regions over recent weeks. The worst affected regions to date have been the north and central. Nationally in early December the numbers of people consulting their GP for the first time with flu-like symptoms stood at 40 per 100,000 population. Today I can tell the House that the latest provisional figure had more than quadrupled to 197 per 100,000.

"The Chief Medical Officer, Professor Liam Donaldson, has advised that the official figures only reflect the people, who have consulted their doctor and undoubtedly understate the true size of the outbreak. That is because heavy usage of the new service, NHS Direct, and the number of patients going to their pharmacist means many patients will not show up on the conventional GP-based tracking system.

"The previous highest levels of influenza seen since monitoring began were in 1968–69 and 1989–90. The CMO believes that the present epidemic will not reach those levels, but he considers that there are people missing from official statistics because instead of consulting their GP they have used alternative routes of advice. That means that unless present levels of influenza activity peak soon we could be heading for the worst epidemic in the last decade. That certainly chimes with most people's experiences. There can hardly be a family in the land that has not been affected by the flu. Everybody knows somebody who has had it.

"People also know that it is particularly severe in its effects. Professor Brian Duerdon, deputy director of the Public Health Laboratory Service, says that,

'it is a more prolonged illness, at 10 to 12 days before people start to feel better rather than four or five'.

"It is also having a particular impact on elderly people, some of whom have developed serious complications such as bronchitis and pneumonia. In addition to influenza, other viruses such as respiratory syncytial virus (RSV) are contributing to acute respiratory illness. I am advised that RSV illness is at its peak at present.

"Emergency admissions to hospital have risen as a result, with over 200,000 such admissions to hospitals in the past three weeks alone, an increase of almost 30 per cent over the past two months. The evidence that we are receiving from hospitals is that the patients who are being admitted are more ill than normal and are staying longer than normal.

"This serious flu outbreak has placed additional strain on local health services in many parts of the country. In the last three weeks the number of people attending accident and emergency departments in hospitals has risen to over 600,000. There have been a quarter of a million calls to ambulance services—up almost one-third on last year—and a similar number of calls to NHS Direct over the last three weeks, many of them flu related. According to Professor Mike Pringle, chairman of the Royal College of GPs, over the millennium GP co-operatives had 50 per cent more calls than last year, mainly due to the flu.

"These figures demonstrate very clearly that the flu outbreak has put very real pressure on NHS services. There is no doubt about that. Equally the evidence suggests that the NHS is dealing with these pressures. All acute hospitals across the country have remained open throughout the winter period. Of course both GP surgeries and hospitals are very busy.

"The highest priority is being given to patients who are most seriously ill. As is usual and as had been planned, most hospitals have been undertaking little routine elective surgery over the last few weeks in order to be able to concentrate their efforts on emergency cases. The number of emergency admissions remained unusually high last week because of the flu outbreak and many hospitals which had planned to start surgery today have decided to delay until the immediate emergency pressures subside. Hospital managers and clinicians will make judgments about how best to balance their workload in light of local experience over the next few weeks. This approach represents a sensible deployment of NHS staff and resources. It is allowing the health service to cope with the surge in emergency demand that the flu outbreak has brought.

"Thanks to the staff who are running critical care services, they too are coping with the demands being placed on them, despite the fact that intensive care is under very real pressure. About half of the patients being admitted to intensive care have flu or flu-like illnesses resulting in pneumonia or, less commonly, septicaemia leading to multiple organ failure.

"This year the Government have provided a record number of intensive care and high dependency beds. We have worked very closely with the Intensive Care Society to plan critical ca re facilities in hospitals.

"Patients who need acute and critical care are being looked after. There has been an increase of 100 critical care beds this year and, with exceptional demand, staff and facilities are being used flexibly to ensure patients receive the care they need. Staff are doing an excellent job in difficult circumstances. The number of beds available fluctuates by the hour, but I can tell the House that as of mid-morning today there were 22 beds available. Local surges in demand, particularly as the flu moves around the country, will however continue to place particular pressures on critical care facilities. Where appropriate, local NHS hospitals have made arrangements with local independent hospitals for critical care.

"Where transfers between intensive care units are required as a matter of last resort, the chief executives of NHS trusts have been asked to ensure that the arrangements run smoothly and that clinical staff are given as mush support as possible.

"So the influenza outbreak has put particular pressure on the NHS. But the NHS is coping. As the chairman of the BMA, Dr Ian Bogle, said earlier today,

'all parts of the NHS have been put under pressure but doctors and nurses are coping well from GP services to intensive care. The incidence of new cases of flu is uneven but wherever it is occurring it is a particularly nasty strain. Thanks to the high level of planning across the country we are coping'.

"Of course the NHS is under severe pressure. Winter is always the busiest time of year for the NHS. This winter the NHS and social services have also had to deal with the special pressures brought by the extended millennium period. That is why planning for this winter began earlier than ever before. Local winter planning groups were established in April 1999 in every part of England to co-ordinate the planning and provision of health and social services over the winter and millennium period. Each group includes health authorities, social services, NHS trusts, primary care groups, out-of-hours and deputising services, NHS Direct, police and fire services, CHCs and other local authority departments and the voluntary and private sector.

"Each local group submitted its plans for dealing with winter pressures by the end of September 1999. These were followed by visits from health and social care professionals from the Department of Health's Millennium Executive Team to ensure the robustness of the plans. We have extended the capacity of local health services to deal with winter pressures. Extra beds have been opened, and over the millennium period, for example, there were 45 per cent more ambulance staff on duty than the year before.

"Winter planning has also included a major public information campaign. The aim of the campaign has been to encourage the public to use the most appropriate service for their needs—whether that be the local pharmacy and NHS Direct or indeed self-care as a complement to GP or hospital services. The campaign was backed by the BMA, the RCN and the Patients Association among others. All of the evidence we have received to date suggests that the public have responded positively to this campaign by recognising that health services should be used responsibly and appropriately.

"The campaign was also supported by a large increase in flu vaccinations made available to the public through family doctors. Flu vaccine can never eradicate flu but it can help to provide further protection for vulnerable groups. This winter 8.6 million doses of influenza vaccine were made available: a million up on last year. We do not as yet have uptake levels for flu vaccine this year but we will be reviewing them when they do become available. I have asked the Chief Medical Officer to look at ways to enhance uptake in future years. Increased use of computerised call-up systems is one possibility.

"Over the last few weeks the NHS has risen to the challenges it has faced. That is not to say that services are not stretched. They are. We owe an enormous debt of gratitude to the staff of the NHS for making sure that services have been there for people when they need them. I hope that the House will want to join with me in thanking them for their efforts over Christmas, the millennium and now into the new year. The staff of the health service have done a quite magnificent job and I know the whole country is grateful to them. They are up against a very serious flu outbreak but I have every confidence that they will go on delivering care for patients where and when they need it".

My Lords, from these Benches, I thank the Minister for repeating the Statement. At the outset, I pay tribute to the nurses, doctors and other healthcare professionals throughout the country who are devoting their efforts so assiduously to the care of patients with influenza. It is a period of great pressure in many hospitals and at times like these we are glad to rely on the skill and conscientiousness of NHS staff.

The next sentiment which springs to mind is less happy. It is that we have been here before. What are the data which have led the Chief Medical Officer to classify the current outbreak of influenza, as I believe he has done today, as an epidemic? Is that assessment the result of a collation of recent hospital statistics, together with an extrapolation of reported cases of flu patients who have either visited their pharmacists or are recovering at home having been treated by their GPS? Will the Minister tell the House what is the official definition of an "epidemic"? The figure in the Statement falls quite a long way short of the figure which I thought defined an epidemic; namely, 400 reported cases in every 100,000. I am unclear whether the definition can rest on an extrapolation as opposed to definite reported cases.

I turn to the matter of intensive care beds. Can the Minister tell the House how many IC beds there are in the country? He said that there had been an increase of 100 critical care beds, which of course is welcome, but how many of the total number of beds are available and staffed for use as opposed to being available theoretically? How many IT beds are currently unoccupied in London where pressures are particularly severe?

I have read a report that stated that last Thursday all 275 intensive care beds in London were full. There appears to be a mismatch between beds that are nominally available and those that are actually available for use. Last week it was reported that only six out of the 10 intensive care beds at St Thomas's Hospital were available for use.

What is the Government's policy towards using the private sector? I believe that in London there are 30 empty IT beds available in private hospitals and yet flu patients are being transferred out of London—sometimes over long distances—to other hard-pressed NHS hospitals. That is a minor scandal which will not appear to be so minor if the patient being transferred happens to be you or a member of your family.

On vaccinations, can the Minister say what percentage of the elderly population has received a vaccination this winter? Can he expand on what the Statement said regarding a call-up process to vaccinate elderly people against influenza next winter? How far have those plans progressed? Does he recognise the contribution that the vaccination of hospital staff can make to reducing morbidity and mortality? Is he aware of a study in the Lancet which showed that vaccination of hospital staff could save many thousands of lives? Last year, in hospitals where half the staff were vaccinated the overall patient death rates fell to 13.6 per cent compared with 22.4 per cent in hospitals where staff had not been inoculated. How many hospitals offered their staff inoculation this winter?

I am left a little bemused by the Statement and why it has been made. Is the Statement related to the Government's pledge to reduce waiting lists? As the Statement said, elective surgery has been cut back severely. That may be a sensible response to the flu outbreak, but what penalties will be imposed on NHS trusts that do not meet the targets set by the Government? The Minister knows my views on the Government's waiting list pledge. I believe that the targets are gravely misguided. Can he undertake that such hospitals will not be penalised for failing to contribute to the Government's waiting list targets?

My Lords, like the noble

Earl, Lord Howe, I too thank the Minister for repeating the Statement. I also have a feeling of déjà vu On 11 th January last year, the noble Baroness, Lady Hayman, made a Statement of similar length. However, I believe that this year the politics in relation to the practical medical aspects are to the fore. It seems strange that, although there is a rising incidence—rather than an epidemic—the Government have announced that an epidemic is in train. I understand that "epidemic status" means 400 cases in every 100,000 people. Can the Minister explain whether or not we have reached that point or is the Chief Medical Officer simply saying that, although it is not yet an epidemic, if the incidence graph continues to rise at the current rate, we shall reach that situation?

Before asking the Minister a number of questions, I have to declare an interest. I am one of those winter pressures myself as I saw my GP over the winter Recess. I can testify to the length of the virus as in my case it lasted for four weeks and a day. I congratulate the NHS staff who have been involved, many of whom had to cancel holidays in order to assist with the enormous pressures.

Every winter it seems that the staff are asked to cope with such pressures and that we have a winter Statement. It appears that it is a tradition, rather like the 12 days of Christmas, that every winter the Government are obliged to make a Statement in a pear tree! Do the Government treat this situation as inevitable, rather like swallows in summer and the wind and rain in winter, or are they actively coping with the matter? On these Benches we cannot help but feel that declaring an epidemic status now is a way of disguising the fact that the Government are not injecting adequate resources into the NHS at the moment. There is no doubt that a full debate on the resources needed by the NHS is required.

The Government cannot simply apologise when the newspapers have filled their pages with horror stories of people having to travel hundreds of miles for intensive care beds. In some cases, people have died. It is no good the Government apologising to the House and telling us how good a planning process there has been when, in fact, the outcome of that process has been so bad. Can the Government assure us that they will review the way in which those plans were carried out? The Minister has described them, but clearly they have not been effective. There may not have been adequate resources. The scale of the epidemic may not have been contemplated.

The Minister quoted the president of the BMA. However, I can quote back to him the BMA's GP leader, John Chisholm, who said:

"The Government is to a certain extent using this as an excuse. Underneath it there is an endemic problem, with the lack of beds and lack of staff to meet the needs of the population".

Stephen Thornton, the chief executive of the NHS Confederation, which represents hospital trusts, said:

"It all adds up to the inevitability of a January crisis. Occupancy rates are so high, that when hospitals do get a burst of activity they can't cope. The Government is doing nothing to prevent it happening next year".

Stephen Thornton is a moderate person. He does not launch into great verbiage. He succeeded the Minister in the role of chief executive. As the Minister knows, in such a position one does not launch into tirades against the Government unless one feels extremely strongly because one depends on a good relationship with the Government.

What happened to the beds review? I have asked the Minister that question both orally and in written form. The beds review was designed to see how many beds and, in particular, how many intensive care beds we would need in future. That has long been promised but we have not yet seen it.

When will the Government end the crude efficiency targets? The NHS Confederation has asked for that in a press release, which says:

"NHS management is calling for an end to the crude efficiency saving targets that have been imposed on the service by successive governments—starting this year.

Stephen Thornton … said: 'The NHS is running too fast and hot. NHS hospitals have been encouraged by successive Governments to become more and more 'efficient'. This means that average bed occupancy has gone up from 70 per cent or so in the 1970s to over 90 per cent today".

What chance do hospital trusts have of coping with that sort of situation? What does the Minister have to say on bed occupancy?

Can the Minister discuss also the issue of anti-flu drugs such as Relenza? We know that the Government took a firm stance on the subject. Will they reconsider the matter? It appears that such new drugs will have considerable effect at least on alleviating some of the symptoms and will certainly help to get people back to work. When considering the type of flu that the Minister mentioned in the Statement, where periods of incapacity are much longer than they have traditionally been for other strains of flu, it seems sensible to consider expenditure on those types of anti-flu drugs.

My Lords, first, I thank both the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, for their tribute to the staff of the National Health Service. The contribution of doctors, nurses, ambulance crew, managers and indeed all staff of the NHS over the past few weeks has been tremendous. I am therefore happy to endorse those tributes.

Both the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, said that we have been here before. It is certainly true that at this time of the year the NHS is particularly prone to such things as flu epidemics and this year there has been the added pressure of the millennium period. However, the Department of Health in conjunction with NHS trusts throughout the country put an enormous amount of effort into preparations to handle the potential problems that might arise this winter. Those preparations have already contributed greatly to enabling the NHS to meet the problems that have already arisen. The noble Lord, Lord Clement-Jones, referred to my previous career in the health service. I can say that in the 25 years in which I worked in the NHS I have never seen it as well prepared as it has been this winter.

The question arose as to the definition of "epidemic". As the noble Lord, Lord Clement-Jones, said, the formal definition is 400 patients per 100,000 of population consulting their GP in one week. Last week we recorded 144 patients per 100,000 of population, but the levels are still rising. The final peak of activity is likely to reach the 200 to 400 range and it is fair to say that that range can be termed a moderate epidemic.

Throughout this period our advice to people with flu has been that it is better to stay at home and only to call the doctor if it is really necessary. Those figures are an indication of what is happening and do not aim to catch all cases. The signs are that over the holiday period—this is reinforced by messages we received from the National Health Service—fewer people may have consulted their GP. We have clearly had the added advantage of NHS Direct which, in those areas where it is fully operating, provided an effective alternative to visiting the GP. Also, our campaign, Choose the Right Remedy, encourages patients with symptoms to seek advice from their community pharmacist as an alternative to going to the GP. Therefore if we accept the likely under-reporting of flu-like symptoms because of the effectiveness of NHS Direct and the campaign to encourage people to visit their community pharmacist, there is no doubt that the health service has been under considerable pressure.

The noble Earl, Lord Howe, asked about the flu vaccine. The vaccine is offered to people of all ages with certain underlying medical conditions such as chronic heart or chest disease; to all people in long-stay residential accommodation; and to all those aged 75 years or over. Those groups are more prone to severe or complicated illness should they contract influenza. This year, exceptionally, the flu vaccine was also offered to NHS staff in order to minimise staff sickness over what we knew would be a pressurised winter period. The noble Earl asked also about the uptake of the vaccine. We will not know exactly who received the flu vaccine until later in the year, but over 8 million doses were made available by manufacturers.

The noble Lord, Lord Clement-Jones, asked whether Relenza would have helped. Our advice from the National Institute of Clinical Excellence is that Relenza's benefit is limited to merely reducing the average length of illness from six to five days. There is no evidence so far that it provides any specific benefit to older people and those who are most vulnerable to the serious effects of flu.

The noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, asked about the impact on waiting list targets and on the ability of the NHS to withstand the kind of pressures arising at the moment. The Government do not apologise for establishing waiting list targets. It must be a priority of the health service to reduce the number of people on waiting lists. We have done that successfully and will carry on doing so, but not at the expense of providing urgent emergency treatment when that is required.

The noble Earl, Lord Howe, asked how many ITU beds were available to the health service. He will know that we added an additional 100 this winter, taking the total up to 1,570. In relation to the use of private sector facilities where appropriate, many local arrangements are in place to use the private sector. There has never been any prohibition on NHS use of appropriate private sector facilities. Our understanding is that NHS trusts are in discussions with local private sector operators. We have no objection to that; indeed, we encourage it. In many cases, of course, the NHS is taking back from the private sector intensive care cases which may need the greater expertise and facilities the NHS has to offer.

The noble Lord, Lord Clement-Jones, quoted my distinguished successor as chief executive of the NHS Confederation in relation to finance. In fact, when the Comprehensive Spending Review was announced, he said it was beyond his wildest dreams. The three-year period of the review brought a considerable amount of extra resources to the health service. That indicates how important we feel the NHS is. It enabled us to expand services and facilities. I am confident that we will continue to see that kind of investment producing further improvement in services. It indicates the importance that the Government place on the National Health Service.

The noble Lord, Lord Clement-Jones, raised the issue of efficiency targets. Given the size of the NHS budgets, we can never be complacent in ensuring that we spend our resources wisely. It is extremely important that mechanisms are in place to ensure that the service is as efficient as possible.

My Lords, I thank the Minister for repeating the Statement. It may be because I am an innocent, but I was a little surprised that an epidemic only became an epidemic over the weekend.

However, I add my congratulations to the Government on the way in which they set about planning for the winter. Although the Minister concluded his Statement by rightly expressing gratitude to the staff of the NHS, will he also add congratulations to the staff of the social service departments, in particular the domiciliary care services? They went out of their way and are still doing so to attend to people who are not only house-bound but bed-bound. They are making extra visits and caring for people who often live alone.

The Minister said that the advice was for people to stay at home and indoors. That seems to be right, but many people who are at home and indoors need extra help, often of a personal nature. In this country we are fortunate to have home carers who go well beyond the call of duty in caring for people who are extremely dependent, particularly at this time.

Will the Minister acknowledge that local authorities have opened up respite care beds? They have also gone to great trouble to keep services going, even when key staff have fallen victim to the flu themselves. I hope that the Minister will acknowledge the contributions from social care.

My Lords, as part of the planning operations for the millennium and winter pressure period, I am happy to say that local authorities and social service departments were fully involved. I pay tribute to the tremendous work undertaken. During the Christmas period, I visited a number of social service facilities where staff were being employed and facilities opened. The point made by the noble Lord is relevant.

As for the preparations made for this winter by the statutory agencies, the most pleasing aspect has undoubtedly been the co-operation at local level between the NHS, general practitioners, local government, social services and all the other agencies in the voluntary and private sectors who have had a part to play.

My Lords, is the Minister aware that the deputy headmaster of a successful school near Leeds died over the weekend from meningitis when it was thought he had influenza? Will the Minister try to protect patients who have other conditions so that they are not neglected and sent home after being told it is flu? Does the Minister agree that when there is a big influenza problem, as there is now, extra care in diagnosing symptoms should be taken?

My Lords, it would be hard to disagree with the noble Baroness, Lady Masham and I was sorry to hear of the case she mentioned. I have no doubt that there are lessons to be learnt in relation to how the NHS responded this winter, not only in terms of planning and preparation but also in terms of the way clinicians and nurses have had to operate. While we must do everything we can to ensure that the right diagnosis is made at the right time, we should also understand the pressures on staff at present.

My Lords, does the Minister agree that self-diagnosis with NHS Direct could lead to mistakes of that nature being made?

My Lords, I understand the point made by the noble Lord, Lord Rix. The signs are that NHS Direct has worked well. Those of us who live in areas where it is available and who have used it have found it to be an effective system. Careful protocols have been developed for use by the highly qualified and professional people on the end of the phones at NHS Direct. We will constantly review the situation to ensure that the right advice has been given, but my judgment is that NHS Direct has been of enormous value to thousands of people who can obtain advice at the end of a phone. In being alert to the issues rightly brought to our attention by the noble Lord, Lord Rix, we should recognise that the introduction of NHS Direct and the recognition of the wider role that community pharmacists have to play in giving advice to the public are enormous gains.

My Lords, I agree that we should thank all NHS staff and others who have worked so hard and so well. However, does the Minister agree that there is a serious situation in the country and in the hospital service at this time? We read about in the newspapers and see on television screens patients on hospital trolleys for hours; people being put, I understand, into freezer trucks after they have died because there is no room for them anywhere else; and people waiting hours for treatment. At least one man has died through being taken a long distance to an intensive care bed. Does the Minister agree that it is no use saying that good plans were made if, at the end of the day, such things happen?

My noble friend Lord Howe raised the important point of the effect on hospital waiting lists and the fact that all those whose operations have been cancelled for weeks, I understand, will add to the backlog. Will the Minister make it clear that hospitals will not be judged as having performed badly? Above all, does he recognise the great concern not only of the patients themselves but of their families over this extreme delay? It is not a time for being complacent about anything. The situation is serious and critical and the Government ought to address the issues more forcefully than they have done so far.

My Lords, there is no question of the Government being complacent. It was hardly being complacent to set up the kind of preparations put in place over the past few months. There is no doubt in my mind that the preparations have enabled us to withstand tremendous pressure. However, it cannot be denied that there has been pressure on the system and that the public have had to wait. In certain circumstances, as the noble Baroness mentioned, it has caused distress. But the overall impression that we have of how the NHS is responding is that it is busy, but the situation is manageable and is being managed. As ever, we are anxious to learn the lessons in order to ensure that, year on year, we are better prepared. We learnt lessons last year. The previous government learnt lessons over many years in relation to the kind of pressures being faced.

As for waiting lists for non-urgent treatments, in planning the programme for the year we aimed at a reduction in the number of non-urgent treatments taking place over this period. As regards urgent treatments, of course, along with emergencies, they must be our priority and we are doing everything we can to ensure that patients are treated as soon as possible.

My Lords, I add my thanks to the Minister for repeating the Statement. I take up the point of waiting lists as chairman of an acute trust. Will the Government make any allowances at all for the slippage in the waiting list target as that target will be almost impossible to meet due to the cancellation of the elective cases? Last week in my trust 64 elective patients were cancelled and this morning 15 were cancelled. This morning we had four empty beds available, one of which had to be allocated to an orthopaedic patient who had been waiting 17 months to avoid exceeding the 18-month waiting period. Twelve patients were waiting for the four beds. If the Government will reassure the NHS that where the pressures are great allowances will be made, that would be a great help.

I, too, thank the staff. On New Year's Eve I walked around every ward and department. Many of the staff were working double shifts and were extremely tired, but I heard not one grumble. I walked to a street party of 70,000 people. The St John Ambulance staff treated 150 casualties and prevented 70 having to go to the accident and emergency department. I pay tribute to the planning that the statutory and voluntary agencies undertook for that evening.

This morning, the chief executive, the deputy chief executive, the medical director and the finance director of my trust were all off work with flu. I receive hourly bulletins on what is happening in the trust. It is a serious situation.

My Lords, the noble Baroness represents a group of people, the chairs of trusts and health authorities, who have carried an enormous leadership load over the past few weeks and months. In paying tribute to the noble Baroness and to the work of her trust, which is much admired, I recognise the pressures not just on doctors, nurses and ambulance crews but also on those in senior management positions and those who sit on the boards of the corporate authorities of trusts.

As regards waiting list issues, individual trusts will have to consider these matters in the light of their experience over the past few weeks. No doubt there will be dialogue between them and the regional offices of the NHS Executive. We have made enormous strides in reducing the number of people on waiting lists. It is important that over the year we maintain our efforts to continue to do that.

My Lords, if I heard the Minister aright, he said that there were 8 million "jabs" or doses available. However, as there are far more than 10 million old age pensioners, plus all the NHS staff and all those who may be at risk, is that really an adequate number?

My Lords, it is an increase on the previous year. As I said earlier, we made arrangements to allow the vaccine to be given to NHS staff. When the information becomes available we shall of course want to look at the figures and consider particularly who took advantage of the availability of the vaccine to determine what lessons need to be learned for future years.

My Lords, on behalf of health authority chairmen, of whom I am one, I thank the Minister for his kind remarks. I believe that the planning has been a huge success. I spent part of the millennium weekend in my part of Hertfordshire working with the staff of NHS trusts and considering intensive care needs. I recognise that the collaboration that occurred between local government, the police and different emergency services made a tremendous difference to the situation. Those who made the plans and the Government are to be congratulated on that.

I pick up the point made by the noble Lord, Lord Rix, about NHS Direct. Our area has a fully functioning NHS Direct. Due to the protocols involved, the staff err always on the side of caution. Indeed, some of our GPs complain that too many people are referred to them as a result of NHS Direct. That occurs as a result of erring on the side of caution, which we believe i s correct.

The noble Lord, Lord Clement-Jones, and the noble Earl, Lord Howe, mentioned déjà vu. I do not think that the flu epidemic is the fault of the Government. It is always a problem at this time of the year. All the staff in the NHS have been cautious as regards being exuberant at the success of the service over the millennium weekend. Many have said to me that they have to be sure the service can get through the winter. It is difficult to leave intensive care beds open on the off chance that a flu epidemic may occur. We try to keep our occupancy high because we are trying constantly to treat people. Therefore, when an epidemic arises—I am delighted that the Government have declared an epidemic so that we know what we are dealing with—we have to ensure that we can work together to resolve the issues. I congratulate all the staff, including t lose with whom have had the privilege of working in the past week, many of whom have worked on their days off, and the Government on the planning that has been undertaken.

My Lords, I am happy to endorse the remarks of my noble friend. I wish to make two points. Notwithstanding the serious pressures on the NHS, I believe that the service is better prepared for such pressures this winter than has ever been the case before. I refer to the point made by my noble friend as regards the use of NHS Direct. I believe that the service is well placed to respond to pressures such as a flu epidemic. Nurses taking a call can identify quickly those callers who might be at greater risk, such as those with respiratory problems, who may need professional help. In other cases, nurses have been able to give basic advice on the need to rest and to drink plenty of fluids, and on basic medication. We shall need carefully to evaluate how the service has worked at this time of pressure. However, I believe that the evidence we have seen so far will vindicate the service and show that it has been a source of enormous help.

My Lords, is the Minister able to answer the question of my noble friend Lord Howe regarding the difference, if any, in theory and practice, as to the availability of intensive care beds?

My Lords, I believe that I mentioned the more than 1,500 intensive care beds which were available. As regards the whole country I do not have the information on whether at any time any could not be used for whatever reason, for example, staff shortages. The NHS has been careful to plan the most intensive possible use of those beds. We have had information on the daily bed numbers available. We have kept a close check on the availability of those beds. At the end of this period we shall evaluate the numbers that have been used and learn what lessons we can for future years.

moved Amendment No. 7:

Page 2, line 42, after ("with") insert ("clinical,").

I would be concerned about the inclusion of the word "clinical" in the clause for fear that it would further narrow the definition. It seems to me that in the Bill we are attempting to apply standards, in so far as we possibly can, across the board as regards care in all settings. I would be concerned that the use of the word "clinical"—which has a medical connotation, a medical connection—would too much narrow the definition.

I am grateful for the letter from the Minister following Second Reading which clarified for me some of my anxieties about this part of the Bill. I welcome the single registration system for nursing and residential homes. It should lead to a much more flexible system which is better able to provide care tailored to the patient's needs.

However, I ask the Minister for some clarification about the financial implications of this provision for patients. As we know, at present nursing care provided in nursing homes is means tested, whereas all other health care, such as that provided in residential homes, acute and community hospitals and people's own homes, is provided free by the NHS. We seek some clarification and ministerial assurances that this change in the Bill will not be used to extend means testing of nursing care by the back door.

The amendment of the noble Lord, Lord Clement-Jones, seeks to bring an establishment which provides only clinical care and accommodation within the definition of a "care home". Clause 3(3) excepts hospitals and independent clinics from the definition of "care home" as they are defined elsewhere.

This does not mean that other key services for vulnerable people will fall in a gap between the definitions of care home and of independent hospital or clinic. For example, a hospice which provides palliative care would be covered within the definition of an independent hospital under Clause 2(6) as providing a listed service. Independent clinics and hospitals, as they are defined in Clause 2, are distinct services from care homes, and the Bill is drafted to allow different regulatory provisions to be made in respect of such services.

Regulations and standards will be needed for independent hospitals and clinics which relate to the provision of their particular services—for instance, the staffing required in terms of doctors and nurses in establishments carrying out surgical procedures under general anaesthesia.

Care homes will often provide a permanent home for their residents and so regulations will be needed to ensure that facilities and services are provided that would ordinarily be available to residents if they were in their own homes—clothes laundering, for instance.

So far as concerns the question about means testing and definitions, I do not believe that these provisions will have any impact on those issues. The registration process and the registration certificate that will be given to particular homes will specify the kind of home as which they are registered. If a home was a nursing home, it would continue to be registered as a nursing home. Therefore, the application of means testing would continue as heretofore.

I suspect that the Minister has moved on from the previous point about the clinical care carried out within a care home but, unless I misheard, I do not think that he said what system of regulation there will be with regard to clinical care carried out within a care home—for instance, the kind of rehabilitation and transitional care I described earlier. What regulation applies in those circumstances? That is what the amendment seeks to elicit.

That will very much relate to the regulations and the national minimum standards that will follow from them, and the role of the care commission in inspecting those homes. The definition of a "care home" in Clause 3 is that an establishment is a "care home" if it provides accommodation, together with nursing or personal care, for the persons listed. If in such a home clinical provision was being carried out, as I mentioned in relation to a hospice, it is most likely that that particular institution would be registered as a hospital. But clearly there are judgments to be formed, on the basis of both the regulations and the national minimum standards, in relation to whether an establishment is a care home as defined or an independent hospital.

Before we move on, perhaps I may further press the Minister about the definition of residential homes. Do residential drug and alcohol rehabilitation facilities come under this clause?

Clause 3 of the Bill specifies that,

"an establishment is a care home if it provides accommodation, together with nursing or personal care, for any of the following persons".

That includes,

"persons who are or have been suffering from dependence on alcohol or drugs".

I thank the Minister for his reply. I welcome his assurance about the means testing status quo, so to speak. I am no nearer feeling that I have had an answer about the clinical governance aspect. I recognise that the noble Baroness, Lady Pitkeathley, may have reservations about the particular expression in the amendment.

The amendment seeks to elicit an answer from the Minister about the kind of clinical governance regime that will apply to clinical care when it is provided within a care home. Following the Minister's reply, I am no nearer feeling that there is an answer than I was earlier. The Minister seemed to say that such a home has to be defined as an independent hospital before the clinical governance regime can take place. In this amendment we are talking about situations which may be thought of as half-way houses. That brings us back to the old chestnut we discussed earlier; that is, the question of seamless clinical governance between all sectors.

I thought that the main issued being raised here by the noble Lord was the question of an establishment that might fall under the category of a care home or under the category of an independent hospital. I have been trying to make it clear that the care standards commission will need to make judgments according to the regulations and the national minimum standards laid down as to how a particular home is to be registered. In the registration document, specific reference will he made to the services that are to be offered in that particular establishment.

As regards clinical governance, as it were, in care homes, inspectors will visit both residential care homes and nursing homes to check on the healthcare provided to ensure that it is appropriate. I can assure the noble Lord that regulations and standards relating to such provision of healthcare will be laid down. I hope that I have now addressed the noble Lord's queries a little more clearly.

I thank the Minister for that reply, but I am afraid that I must reply, "Not really" to his last comment. I shall read carefully all his responses in Hansard. However, we may well return to the issue because the point here is not only the precise definition of a "care home". We must be assured that a regulatory regime will apply just as much to the social care being provided within those establishments as it will to the provision of healthcare. It is vital that we achieve the right balance.

One problem in the Bill is that of trying to match the two halves of social care and it is a key issue that we must face as we progress through our discussions. In the mean time, I beg leave to withdraw the amendment.

moved Amendment No. 8:

Page 3, line 2, leave out ("suffering from illness") and insert ("ill").

When I read the amendment and found that I agreed with it, I am afraid that I had not appreciated the intricacy that lay behind it, which the noble Lord, Lord Rix, has just explained to the Committee. In my innocence, I thought that the noble Lord was engaged in a proper process of using the English language correctly; namely, using one word instead of three. I was prepared to applaud that and wondered whether I should have worked through the Bill with the same kind of toothcomb. The tendency to use convoluted phrases rather than simple English is something to be deplored. If that was all that the noble Lord, Lord Rix, was seeking to remedy with his amendment, he would have my full support.

However, that is not all. The noble Lord has made another most important statement. Those of us who have had responsibility for organisations that look after people suffering from handicap of whatever kind would simply say that "suffering" is not the right word to use. It is therefore for two reasons that I hope that the Minister will be able to make a short speech to tell the Committee that he will be happy to accept all three amendments. I believe that they have a great deal to commend them.

The noble Lord, Lord Jenkin, has already said much of what I was going to say. However, I should like to emphasise that when you have a disability, you generally have that disability for life or for the long term. "Suffering" and "illness" are confusing words in this context and they put out the wrong message. They also suggest that a person will get better. We are referring here to hidden disabilities, which are not dealt with directly in the Bill but are often referred to elsewhere. We must remember that legal language always makes reference both backwards and forwards through legislation. If one is suffering from an illness, one may recover from it. However, with a disability it is more likely that coping strategies will be developed. For that reason, if any ambiguity can be removed from the face of the Bill, that will aid not only the legislation before us, but also other Bills in this area. Furthermore, I can only concur with the noble Lord, Lord Jenkin, that one word is invariably better than three.

I rise briefly to support the amendment tabled by my noble friend Lord Rix. I shall not detain the Committee as it has already been clearly stated that two strong reasons have been given in support of it. The amendment certainly has my support.

I shall be brief. I fully understand the desire of the noble Lord, Lord Rix, to ensure that the wording of the Bill is as modern as possible when describing people who receive care services.

If the noble Lord will allow me, I shall take this amendment away and discuss the exact wording with him between now and Report stage. We shall then ensure that the Bill is rectified in due course.

I shall be happy to accept the proposal of the Minister so long as we agree that one word should be used rather than three. I am sure that this marks the beginning of a happy new year so far as concerns the Care Standards Bill and I hope only that my other amendments will be accepted as speedily and with such aplomb by the Minister. I beg leave to withdraw the amendment.

moved Amendment No. 12:

Page 3. line 11, at end insert—

("( ) "Home-based health care agency" means an undertaking which consists of or includes arranging the provision of health care that requires the supervision of a registered nurse or doctor in their own homes.").

I rise to speak to Amendment No. 15, which stands in my name. The amendment is identical in spirit to Amendment No. 12, to which the noble Lord, Lord Clement-Jones, has just spoken, although, with all respect to him, the wording of that amendment reads a little oddly as it suggests that the relevant home-based healthcare is provided in the home of the nurse or doctor, which of course is not the case.

I wish to re-emphasise a key point. Healthcare provided at home is becoming increasingly common. I refer not just to day-to-day nursing care but to often highly intensive and sophisticated medical procedures. The care of people in their own homes rather than in a hospital or a nursing home is to be welcomed. I believe that the Government are in agreement with that. The Bill should reflect current developments in healthcare. I urge the Minister to consider this issue with particular care.

A point closely allied to that is the need to regulate healthcare assistants engaged in delivering healthcare at home. I shall talk more about healthcare assistants when we reach a later group of amendments. Suffice it now to say that if both they and the work that they are doing for people in a domestic setting are unregulated, that runs directly counter to the theme of the Bill.

I suggest that these are amendments to which the Government will wish to give a good deal of thought. I referred earlier to the Forest Healthcare Trust, of which I used to be chairman. The trust ran a hospital-at-home service. Such services are becoming more and more common as a way of relieving the pressure on beds within hospitals and in many cases giving patients a very much better service in the familiar surroundings of their own homes. In fact our experience was that they received a much better service in the hospital-at-home.

I remember one dreadful case. I need not go into the details but it was the only case where I felt it right, as chairman of the trust, to sit through the whole of the coroner's hearing on the patient, who had in due course died. There had been rather deplorable treatment in the hospital, amounting to quite serious neglect. The patient was sent home to a hospital-at-home and the nurses immediately recognised what had gone wrong. The family said that under no circumstances did they want the patient to go back to hospital, but the person actually died of other causes.

The hospital-at-home is becoming a valuable service, but it needs to be effectively regulated. The example to which I referred came wholly under the NHS and therefore would come within the Minister's definition of "management". But it could equally well have been a service which the trust had contracted out to a private concern. In those circumstances, regulation should he applied because it is not always the case that the trust contracting out will have the resources properly to assess the value and quality of the care being given. Exactly the same can happen with respite services.

There is also the question of psychiatric services. It is increasingly the case that psychiatric care is given to patients in their own homes. There has been a transition— from doctors and nurses who have been used throughout their careers to a ward-based service in large psychiatric hospitals to a system of delivering psychiatric care in the patient's own home. Here again, if it is an NHS service, no doubt the NHS management and the CHI will provide a proper form of quality control. But if that service is contracted out—the Minister has already referred to the fact that a good deal of psychiatric services are now provided by independent concerns—it is all the more important that there should be effective regulation.

The noble Lord, Lord Clement-Jones, is on to a good point with at least some of these proposals. I hope that the Minister will take them away and examine them carefully. In a Bill that is supposed to bring the whole system under a single, common national standard of care, we do not want to find ourselves with any gaps.

Before speaking to my Amendment No. 17 which is included in this grouping, perhaps I may say to the noble Lord, Lord Clement-Jones, that I hope, if he proceeds with Amendment No. 13, he will take the advice of his noble friend Lord Addington, so that the subsections appear in plain English and use one word instead of three.

Amendment No. 17 seeks to provide a definition of day services to allow for their inclusion within the standards, registration and inspection provisions contained in the Bill. I believe that it will be of some help to the Minister and his department.

One of the great strengths of this legislation is that it seeks to bring coherence to the hitherto unco-ordinated registration and inspection regimes, which are often not comprehensive. I believe that the Bill 'will bring greater co-ordination to the social care sector and that it goes a long way to making the system more comprehensive. But with the exclusion of day services, it simply does not go far enough.

At Second Reading, I cited the example of a day centre in Sheffield where physical and sexual abuse had gone undetected over many years. It is our responsibility to act upon the evidence. I do not believe that there is a palpable distinction between residential services and day care services in terms of vulnerability and risk; indeed major independent inquiries such as the Longcare abuse inquiry in Buckinghamshire have also recommended that inspections should be extended to day services. Adults with learning disabilities spend substantial proportions of their everyday lives in services which are not registered, not approved, not checked and not accountable. That state of affairs must change. I should welcome the Minister's assurance that the political will exists to effect that change.

Perhaps I may make three brief points. First, respite care is a feature of many care establishments. It depends whether Clause 3 of the Bill as presently drafted incorporates both short and long-term care. If it incorporates both, it should incorporate respite care. If it is intended to convey only long-term care, the amendment proposed by the noble Lord, Lord Clement-Jones, seems essential. If I may say so with good grace, Amendment No. 15 seems to be an illustration of the difficulties that will remain throughout the Bill if Clause 2 stands.

As regards Amendment No. 17, I, too, am surprised that day services appear to have been excluded from the regulation and inspection system. The wording of Amendment No. 17 is extremely helpful.

Perhaps I may add a word about those who live at home and have carers. I implore the Minister to do something about regulation of the agencies and possibly the carers. The situation is impossible at present. Charges are extraordinary. In some agencies there is no regulation at all. Some charge an amazing amount. Perhaps I may talk to the Minister outside the Chamber about this matter. We need to employ two, if not three, carers for my husband. Some agencies are exceedingly good; some are very dangerous. There are many vulnerable people living in their own homes under a tremendous amount of medication and getting into serious difficulties. There is no regulation as regards people who may be alcoholics coming in to work. So much needs to be done. But it is the expense of care in the home which causes problems. I hope that during the passage of the Bill we shall be able to do something about it. I have sent some information to one Minister regarding the regulation of care homes. The matter needs addressing. If, at this very moment, all the New Zealand, Australian and South African people went home, very vulnerable disabled people would have a real problem.

I note the comments of the noble Baroness, Lady Masham. I have some experience of the issue and support every single word she said. There are serious problems. For example, when I asked one carer who was sent into my home about her training, she said, "I used to work in an electronics factory. I happened to pass by the care agency last Saturday and the people there said, 'There's a lovely job going. Would you be prepared to do it?'" It was ludicrous. She had no idea at all of how to cope with a disabled person. There has to be some regulation.

That will be precisely the function of the general social care council, when it is set up. All those workers will be regulated and inspected.

Perhaps I may turn first to Amendments Nos. 12 and 22 tabled by the noble Lord, Lord Clement-Jones. I am grateful to the noble Lord for explaining the purpose of his amendments. It was not entirely clear from the drafting, which, as it stands, could be taken to include general practitioner home visits and district nursing services.

I listened with great interest to the noble Lord's points about home-based care agencies and to the more general points raised about issues relating to private medical services undertaken in people's homes. Rather than say any more about the matter at this time, I should like to reflect on those issues without any commitment at this stage and take on board the comments made. No doubt we can debate the matter again on Report. Some important issues have been raised which require reflection.

Amendments Nos. 13 and 20 offer a definition of a "residential respite care establishment" and require such establishments to be registered. I am in full agreement that care homes which provide care on a short-term basis should be registered in the same way as care homes which provide people with permanent accommodation and care. It is certainly the intention that such respite centres should be registered with the national care standards commission, and the definition of "care home" in Clause 3 of the Bill is wide enough as it stands to cover that type of establishment.

The definition reads:

"an establishment is a care home if it provides accommodation. together with nursing or personal care, for any of the following persons",

and subsection (2) lists those who will come under the provision. The word "accommodation" is not qualified in any way, so I assure noble Lords that it would cover accommodation for as little as one night only. In other words, any establishment which offers nursing or personal care overnight for the categories of persons listed in subsection (2) of Clause 3 will need to be registered as a care home. I hope that I have managed to reassure the Committee on that point.

Amendments Nos. 14 and 21 define a "close care sheltered housing establishment" as being an establishment which provides people who are ill, disabled, infirm or dependent on drugs or alcohol with accommodation together with personal care or nursing—but not board—and require such establishments to be registered.

In the Registered Homes Act 1984, a residential care home is defined as an establishment which provides accommodation together with both board and personal care for persons in need of it by reason of old age, disability, past or present dependence on drugs or alcohol or past or present mental disorder.

We are aware that this current definition is unsatisfactory. We know that there are establishments which provide accommodation and personal care for vulnerable people and which are to all intents and purposes residential care homes but which escape the requirement to register because they do not provide board. For example, they may make residents pay for their meals each day rather than include food in the overall contract price. We do not believe that that is acceptable. The Bill therefore offers a new definition of "care home" as an establishment which provides accommodation together with nursing or personal care only. There is no longer any mention of "board". Therefore, in future, even if board is not provided, such establishments will be required to register as care homes.

I turn to Amendments Nos. 14A and 22A which concern nurse agencies. Under our proposals nurse agencies will have a level playing field regulated by the same system as other employment agencies, including all those supplying other healthcare professionals under the Employment Agencies Act 1973. I have listened with care to the points raised. I believe that to suggest that nurses agencies should be registered and inspected in addition to complying with the provisions of the 1973 Act may be taken to imply that nurses are less professional than other healthcare professionals. I am sure that that is not the intention of the Committee. We shall ensure that should any additional safeguards be needed they will be put in place. for example, through codes of practice for employers. I am convinced that what we propose for nurses agencies will provide better protection for employers, the nurses engaged by agencies and vulnerable people while also minimising the regulatory burden on business. I hope that I have reassured noble Lords on that matter.

I turn to Amendment No. 15. The new regulatory framework for domiciliary care is designed specifically to include care that is of a personal and non-clinical nature. It is not our intention to confuse this with nursing or clinical tasks which involve a fundamentally different training and skill profile. We believe that that would distort the nature and purpose of the domiciliary care regime and stretch it so widely that it would lose its focus and impact. That focus is specific to the needs of domiciliary care which is essentially a sector with extremely low levels of training and qualifications. The domiciliary care regulation scheme will be a powerful driver to address that deficiency. On the other hand, nurses are highly qualified and registered professionals with professional responsibility for their own clinical practice. I do not believe that to extend domiciliary care regulation to nursing and clinical services is a helpful move.

I turn finally to Amendments Nos. 16, 17 and 19 which all deal with day care services. However, Amendment No. 17 has a wider definition than Amendment No. 16. I am conscious that there is disappointment that day care services are not included in the services to be regulated when the national care standards commission comes into force and starts its work. I hope the Committee accepts that that is in no way because of lack of concern for people with, say, learning disabilities, who are major users of such services, or the quality and standards of day care. It rests upon the practical question of what we can sensibly expect the commission to do when it takes on its considerable and very important responsibilities. In addition to its responsibility for the many thousands of care homes and other services which are already regulated, the commission will be given responsibility for regulating a number of new services not previously regulated. This represents a very significant extension of the scope of regulation. We believe that that is as much as we can expect it to deal with at the beginning of its life. We do not want to overload the commission. We believe that it must be allowed to concentrate on carrying out its new duties effectively. We shall, however, keep the remit of the commission under review.

Clause 39 allows the Secretary of State to extend the provisions of Part II to other social care services equivalent to those which may or must be provided by local authorities in the exercise of their social services functions. It may be that in time other services, such as day services, will be brought within the scope of regulation. Certainly, the inclusion of such a clause in the Bill means that we have day centres in mind as a likely example. We have said as much in the Explanatory Notes. Although the noble Lord, Lord Rix, may press me, I cannot at this stage give an absolute assurance as to when this may happen. We must be careful that we do not ask the national care standards commission to undertake an impossible task with the risk that it simply cannot cope and vulnerable people are put at risk.

Before I conclude, I note the different definitions of day care in the amendments. I believe that the wider definition of day services, which may include a number of dispersed services not attached to any particular facility and not specific to those who receive care, will present significant difficulties in terms of boundaries. Regulation must always be appropriate, targeted and proportional. But I have already had a very helpful discussion with the noble Lord, Lord Rix, about this matter. There may be workable ways to define the tasks. That is one of the issues that will need a great deal of work and consultation before the Government can use Clause 39 to add such services to be regulated by the commission. I hope that the noble Lord is assured as to the possibilities of including day care in the regulatory system and will therefore not press his amendment.

Perhaps I may intervene on the question of the inspection of day care services. Obviously, I am disappointed that for the moment the Committee cannot obtain from the Minister a direct promise. The Minister used the expression "in time". That fills me with slight perturbation. It may mean when I am dead and gone. I believe that the need to regulate and inspect day care services at the very earliest moment is as great as for any care homes or housing. The scope for abuse in day care services is limitless. I told the Minister of a court case in the London area that occurred only three or four years ago in which, in the context of day care services, a young woman had been constantly sexually abused by a man. I hope that during the passage of the Bill through this House the Minister will be able to return to the Dispatch Box and give a slightly more definitive statement as to the future inspection of day care services rather than the expression "in time".

I endorse the observations of the noble Lord, Lord Rix. I believe that the general power in Clause 39 includes a number of activities which may not yet be in contemplation. We are dealing here with a whole group of vulnerable people. We have an ever-expanding population as people live longer and no doubt an ever-growing range of services may be available to it. To ensure that Clause 39 takes account of those matters which are not at present in contemplation is very sensible. It may well be that we shall want to consider whether it should be subject to affirmative rather than negative resolution. Nevertheless, it is there.

As to day care services, I believe that the noble Lord, Lord Rix, makes a very important point. I should like to consider whether an amendment can be tabled at a later stage of the Bill to place the Government under an obligation to extend the provisions of the Bill to day services so that we are not left with the rather vague and slightly depressing "in time". As Shakespeare said,

"In time the savage bull doth bear the yoke".

But that might be a very long time. I believe that the case made by the noble Lords, Lord Rix and Lord Clement-Jones, is a very strong one and I hope that the Government will reflect upon it.

Experience has shown that legislation is not always implemented on the first possible day. Getting something into legislation which can be implemented when the commission is able to take it on seems an entirely sensible proposition.

Perhaps I may ask the Minister about means testing. I believe he said that a care home with nursing was means tested.

I was asked whether the new regulatory system would have an impact on the current arrangements for means testing. I said that the process of registration and the registration certificate would specify the type of home. If it were a nursing home, it would be specified as a nursing home. Therefore, that would not have an impact on the means testing arrangements currently in place or on the distinction between care homes and nursing homes.

Is it correct that a care home is not means tested, whereas a residential home is?

If someone has to be in a home for weeks, who pays the mortgage and electricity bills, and the expenses of the children, or does the individual come out with large debts? If he is disabled and goes into hospital and perhaps into residential care, he loses his benefits. What happens when the bills pile up?

The noble Baroness widens the debate somewhat. The Government appointed a Royal Commission on Long Term Care to consider some of the issues and the pressures on people faced with that situation. The noble Baroness will know that the Royal Commission reported some months ago with a majority report and a minority report. The Government are considering how we respond to that.

It has been an interesting debate. Noble Lords have demonstrated, as always, their understanding and expertise in these areas.

The Minister's reply was welcome in some respects. He said that he would consider whether there were any gaps with regard to home-based healthcare agencies. He believed that respite care and close care sheltered housing establishments were caught by the terms of the Bill. I shall read carefully his words in Hansard.

The Minister also said that the necessary safeguards as regards nursing agencies would be put into regulation. I hope that regard will be given to the 1957 Act, aspects of which should be duplicated in the regulations. I refer in particular to inspection by a registered nurse. It may be right that the general framework of regulation should not be different but perhaps the system of inspection should vary from one type of agency to another.

The big disappointment—it has been expressed by other noble Lords—relates to day services. My amendment does not go as far as the amendment tabled by the noble Lord, Lord Rix. I prefer to be associated with the noble Lord's amendment. It is spot on with regard to the needs of those going out into the community from their care homes. That situation must be regulated by a certain date. The noble Lord Jenkin remarked that it was not good enough to say that at some stage in the future the matter will be regulated. During the course of the Bill we should like an undertaking from the Minister that day services will be regulated at the earliest practicable moment. We understand about work loads. However, we should like a definition in the Bill. Then Clause 39 can be triggered at the earliest practicable moment. That is the solution towards which we are aiming. As we move towards Report stage and Third Reading, I hope that it will commend itself to the Government. In the mean time, I beg leave to withdraw the amendment.

moved Amendment No. 23:

Page 4, line 20, at end insert—

("( ) It shall be the principal aim of the Commission to secure and promote the well-being of those cared for under the provisions of Part II of this Act.").

I support the amendments. I speak in particular to Amendments Nos. 45, 53, 65 and 151. In the first instance, some of us approached the Bill in a state of high expectation only to find that it has a number of gaping holes, one or two of which have been mentioned. However, one of the most serious is the absence of any duty on the part of the national care standards commission to monitor clinical standards or to promote quality of care for patients in private hospitals. Indeed, from reading the Bill one could be forgiven for wondering where the well-being of the service users came in. That is why I identify myself with the remarks of the noble Baroness.

The Government's quality agenda should be all embracing. It should not be confined only to the public sector. Maintaining high standards should be an across-the-board objective. That was my complaint during the passage of the Health Bill. Ministers apparently believe that the main issue for government is the protection of private patients. With respect, that is no more than a tiny fraction of the issue. Standards in the private sector are high. Everyone wants them to be even higher. But what the Bill says is that for all practical purposes it is up to the private sector to deliver whatever standards of healthcare it wants. We have moved far beyond that stage. Indeed, I do not think that people understand the attitude that if it is not done in the NHS, it somehow is not proper healthcare. That attitude is plain silly as well as being a slap in the face to the private sector.

The point of giving the national care standards commission a duty to publish statistics relating to its remit, and combining that with a duty to promote quality, is to ensure that standards of healthcare in the private sector will be capable of being assessed on a like-for-like basis with those in the NHS. That, in turn, will promote a verifiable consistency of standards in both the private and public healthcare sectors, which we all want to see.

Private hospitals also have a duty to play their part in informing the public. That is why I tabled Amendment No. 65. I welcome Clause 20(3)(k), which appears to introduce for the first time a line of accountability within private hospitals between practitioners and managers. However, the words "appropriate quality" and "appropriate standards" in the subsection must be given meaning and substance in addition to an element of transparency.

The time has come when we should make the quality agenda a reality in all branches of healthcare, and the Bill provides a golden opportunity to do so.

Surrounded by the praetorian guard of the noble Earl, Lord Howe, and the noble Lords, Lord Astor of Hever and Lord Clement-Jones, I feel secure in supporting Amendment No. 45. I welcome the emphasis on maintaining and improving quality, as must all Members of the Committee. However, without the direct control exercised over directly provided services, and without incorporation in contracts of specifications for bought-in services, that may be thought a vague requirement. In my book, it is an important requirement, even if it does no more than state an aim.

If the list of services within the scope of the Bill is broadened, as I hope will be the case—for example, to include day services—I trust that the quality requirement will also extend to those additional services. We are talking about vulnerable people and basic services. If the coffee in your Lordships' Dining Room were not of the highest quality, which of course it is, that would be an inconvenience, but it would not undermine the welfare of those who drink it or impair the fundamental enjoyment of their lives. But poor quality in the services we are discussing means misery for the people receiving them. Misery is not something we can wish on those who are now our neighbours and one day could well be us.

Increasingly, we are defining quality in terms of the experience of those receiving the service. A good quality service is one in which people—children or adults—are listened to, respected, treated as individuals and feel that the staff are there for their benefit and not that they are there for the benefit of the staff. Achieving that should be the prime aim of managers and owners.

I support Amendment No. 23. The Government accepted a similar amendment which I tabled in respect of the General Teaching Council. I believe that object or principal aim clauses are increasingly important in so far as any challenge to our legislation in the European courts will be looked at in the context of its overall objective. That should be stated in general terms and quite clearly at the beginning of the Bill.

I have a slight doubt about the drafting of the amendment. It is surely not right that the principal aim of the commission should be to look after only the children. We are also discussing old people's homes; perhaps some redrafting on Report may be appropriate.

I support Amendment No. 45. I want to give the Committee an example of a private hospital. My husband—I hope that he does not mind my quoting him—had to move from a National Health Service hospital, where he received exceedingly good care, to a private hospital. The NHS did not have a consultant to carry out an assessment for a particular condition. After six days in the private hospital in Leeds, I discovered that he had not had a wash. I was annoyed with myself for not having checked previously. I wrote to someone at the headquarters of BUPA who said that an inquiry would be conducted. A few weeks later I received a reply stating, "He never asked."

Someone who has had a stroke or who has diabetes, Parkinson's disease or various complications, does not ask; he or she expects it to happen, especially if a man! Therefore, it is most important to lay down minimum standards for all hospitals.

I support the idea behind this group of amendments and the emphasis which they suggest should be put on quality. Over the years and in various guises, many of us have visited homes for old people or those with handicaps. One can tell almost within minutes whether the quality of the service is good. When one is inexperienced one sees the bathrooms, the bedrooms and the facilities and says, "Gosh, what a marvellous place!" But with a little experience and using one's other senses—not least one's nose—one can quickly tell whether the quality of care is good.

I remember visiting a local authority home in Coventry. I was taken there by Mr White, a distinguished director of social services whom the noble Lord, Lord Laming, will know well. He said, "I want to show you what we can sometimes achieve." Within minutes of entering one sensed an atmosphere in which the standard of care was high. One visits some homes and sees, as I have said previously, a whole lot of "cabbages" sitting around doing nothing. One realises that the standard of care is poor.

I am sorry that I could not take part in the Second Reading debate, but I want to turn to a point that was made then. No doubt the document Fit for the Future? will provide much of the flesh which will cover the bones of the Bill, but one has the impression that the Government are still at the stage of dealing with the facilities; the size of the room, the number of plugs and so forth. They are measuring what can be measured. However, it is most important that there is a clear statement in the Bill that the overall quality of care lies at the heart of the whole process.

With great respect to the noble Baroness, Lady David, I share the misgivings that her amendment achieves that purpose. We shall need to reflect on what has been said today, but I totally support the view that the Bill must set out that objective in the clearest possible terms. People will refer to it—there will be an argument within the commission or between those who are being regulated and the regulators—and someone will say, "Look, this is what Parliament has required of us. We must go for the best quality of care that can be provided in all the circumstances", whatever the correct phrase may be. That it needs to be there seems to me clear beyond peradventure. I am not sure how many Members of the Committee remember the Pollution Prevention and Control Bill, which contained no statement of purpose at all. As a result of the efforts of my noble friend Lord Renton and others the Government took the Bill away, there was a recommittal and some good purpose clauses were put into the Bill. That is what this Bill requires. Most of us have supported the general thrust of securing an even more standard form of regulation of the services for vulnerable people, but the quality of the care of those people must lie at the heart of what it is all about. The Bill should set that out beyond peradventure.

There cannot be any ambiguity about the contributions of all Members of the Committee who have spoken so far: quality is absolutely of the essence of the Bill. It was therefore with some incredulity that I found, when reading Clause 7 for the first time, that the wording of the duty to encourage improvement in the quality of Part II services provided in England—which many Members clearly wanted to strengthen through their amendments—although not particularly strong by itself, had been deleted for independent acute services so that "Part II services" meant services of a kind provided by persons registered under Part II other than medical or psychiatric treatment or certain listed medical services. That seems to be going precisely in the wrong direction.

Therefore, on these Benches we greatly support the general thrust of the amendments. There may be differences about precise wording, but we certainly believe that quality should lie at the heart and that there should be a clear duty on the commission to promote that. The Private Member's Bill of my noble friend Lady Nicholson is designed to do exactly that. Clearly, running in parallel with a Bill such as this one makes it a rather awkward instrument to influence government policy. But there can be no doubt under that Private Member's Bill that a duty of quality is promoted by the regulating body. We believe that that should be reflected in the Bill.

At this point, I should like to apologise on behalf of my noble friend Lady Nicholson who is unable to attend to speak to Amendments Nos. 53 and 151 in her name. She is detained elsewhere in the European Parliament. It really is important that the Government take another look at the duty of quality right across the board. It seems to us that ideology seems to have raised its head again. Have we truly a Secretary of State for Health—and social services, so to speak—or is the Minister simply looking at particular sectors in a narrow way? On these Benches and from other Benches there appears to be a desire to make sure that the Secretary of State and the commission, through him, take as broad as possible a view of quality. It is the name of the game right across social care and across healthcare. We should wish to see that reflected in the Bill.

I support entirely what the noble Lord, Lord Clement-Jones, has just said. The noble Lord, Lord Jenkin, reveals his vast experience in sharing his thoughts with us, in particular on Amendment No. 23. I support entirely the thrust of the amendment tabled in the name of the noble Baroness, Lady David. I hope greatly that the Minister will feel able to agree to a. form of words which captures the spirit of the amendment. Without it, Clause 6 is really about process and does not deal at all with the well-being and quality of care for extremely vulnerable people. The whole purpose of the commission should be to ensure quality of standards and proper protection where it is needed for some of the most vulnerable people in our community, and the notion of promoting well-being as opposed to dealing only with inadequate performance. Promoting well-being should be at the centre of the work of the commission. I hope that the Minister will be able to take on the general thrust of the amendment and come forward with a form of words with which the noble Baroness is happy and which we may all applaud.

I understand the thrust of the arguments being put forward. I have no doubt at all that better regulation of the various establishments and services listed in the Bill will lead to improved quality of service for people who use those services. I have no doubt that that will come about through the establishment of a highly professional central organisation which will prove to be much more consistent in its approach to registration than the previous 200 or so health and local authorities, and that it will have available to it the expertise which local health authorities and local authorities have sometimes missed out on.

However, I make the point that the Bill itself and the purpose of the commission relate to regulation and registration. That is why the Bill is termed in the way that it is. Before I turn to Amendment No. 23, perhaps I may also pick up the point made by the noble Lord, Lord Jenkin, in his reference to Fit for the Future? and his suggestion that the emphasis of the draft consultation paper was rather too much on facilities and rather too little on quality and outcomes. The document is still out for consultation and we shall consider the results carefully. I wish to reassure the noble Lord that the Government are very much concerned with outcomes and not only with facilities. We shall take his remarks very much into account, and indeed, those made by other noble Lords when the Bill was discussed at Second Reading, when many similar points were raised.

I turn to Amendment No. 23, proposed by my noble friend Lady David. The independent nature of the new commission and its coherence and consistency will undoubtedly improve the quality of the services to be registered. As Members have already mentioned, the commission will have a general duty under Clause 7 to encourage improvement in the quality of Part II services. It will have powers also to ensure that the well-being of service users is secured and promoted. The Bill will achieve that by laying a clear and irreducible responsibility on service providers to secure and promote the well-being of those using their services and by ensuring that the commission vigorously carries out its functions.

I draw my noble friend's attention to Clause 20(1)(d) and (e), which give regulation-making powers to require providers to promote the welfare of the relevant service users. Corresponding provision is found in current legislation; for example, that governing residential homes. It is our intention to continue with that provision, and indeed, to strengthen it with the Bill. Regulations together with the national minimum standards provided for under Clause 21 will give strong powers to improve the quality of service provision. Similarly, nothing in the Bill will detract from the existing responsibilities of local authorities and health authorities in respect of the welfare of those for whom they commission or arrange services.

In relation to the question of statement of purpose, I reiterate that the Bill and the work of the commission rest upon the prime function of the agency, which is to regulate. It is through that regulation that the quality of services will improve.

I turn now to Amendment No. 45. I agree wholeheartedly with the noble Earl and the noble Lord, as I have said already, that ensuring the quality of registered services is vitally important. One of the Bill's main aims is to improve the quality of registered services. Its provisions centre on that and it is intended to deliver quality through the enforcement of regulations and the national minimum standards. As I have already mentioned in connection with Amendment No. 23, regulations made under Clause 20(1)(d) will ensure that persons registered in respect of a children's home, care home or residential family centre must secure the welfare of their residents. That is essential to maintaining a quality service.

Regulations under Clause 20(3)(k) will ensure that services provided in independent healthcare establishments or clinics are of appropriate quality and meet appropriate standards. Together with the national minimum standards provided for under Clause 21, regulations will improve the quality of service provision and ensure that registered persons continue to deliver quality. As the Bill already makes provision for maintaining and improving the quality of services, I hope that the noble Earl and the noble Lord will accept that the amendment is unnecessary.

We come to Amendment No. 30, which seems to be based on what I can describe only as a misconception about the role of government in relation to private healthcare. While the Government have a responsibility for the provision of public healthcare through the NHS, they have no such responsibility in respect of private healthcare. I believe that it will be wholly inappropriate to give the commission the same range of duties in relation to private healthcare as we place on it in relation to social care, where it will have wide-ranging responsibilities.

Similarly, it is not the responsibility of the commission or of government more widely to improve the quality of private healthcare. That responsibility rests squarely on the owners and managers of private healthcare establishments. That differs from the Government's role in relation to the NHS where, clearly, we have a responsibility for improving quality. Our role in relation to the private healthcare sector is to ensure that proper standards are laid down and that they are adhered to by those providing care. As I said at the beginning of the debate, that is the difference between the Government's role in managing the NHS and in regulating the private sector.

I turn to Amendment No. 53. I am sure that we all share the sentiments behind this amendment: that it is important for there to be proper arrangements in place to ensure the quality of treatment of patients in private hospitals. I recognise also the need to ensure that if residents in other establishments require medical treatment, they receive it. However, I do not believe that the amendment is necessary. First, as I have already said, we are taking powers in the Bill under Clause 20(3)(k) to make regulations requiring those who run private hospitals and other healthcare establishments to have arrangements in place to ensure the quality of the services which they provide, including clinical services. Secondly, we are already committed to introducing tough national minimum standards for healthcare providers and for those providing social care who will be regulated under this legislation. Thirdly, we are already taking powers to make provision for the welfare of those in children's homes, care homes and residential family centres. In short, we are already making the provision needed to secure proper care for those in private healthcare or social care establishments.

Amendment No. 65 would require managers of independent hospitals to publish information about their services in a form appropriate for the general public. There is nothing between the Government and the noble Lord on this matter. We are committed to ensuring that patients and potential patients have comprehensive information about the services being provided by private hospitals and clinics. We made that clear last spring in our consultation document and we welcome the general support which was given to that proposal by those who commented. As we said in Regulating Private and Voluntary Healthcare, in working out detailed regulatory requirements and minimum standards we shall take account of the comments which were made in consultation. Therefore, I oppose the amendment because I do not believe that it is necessary. The powers set out in Clause 20 will allow us to do what we and the noble Lord want.

Clause 20(3)(a) will enable Ministers to make regulations which cover, among other matters, the provision of accurate information about the services provided by a private hospital. I want to make it clear that we are unequivocal in wanting to impose tough standards and requirements on the private healthcare sector. I believe that I acknowledged previously that the regime which existed was unsatisfactory. We are determined to put that right and, through regulations and minimum standards, to impose stringent requirements on the private healthcare sector.

Amendment No. 71 would require the regulations, but not the minimum standards, which we make to be consistent with standards in the NHS where relevant. Again, I understand the intent behind that and, clearly, in drawing up standards for the private sector we shall want to take full account of requirements in the NHS. However, again, I must make the point that there is a difference between our role in regulating the private sector and our role in managing the NHS.

Therefore, we may lay down standards which are appropriate for the private sector but which may be different from those of the National Health Service, not least because the private sector may undertake many procedures which are not available on the NHS. I give an example: if an independent hospital clinic specialises in the type of low-risk cosmetic surgery under local anaesthesia where patients stay overnight at the most, it may not be reasonable to require it to have the same standards as an NHS hospital taking emergency cases involving seriously ill or injured people. That is not a case of standards being higher or lower, or better or worse, but rather of being fit for purpose. The key point is that, rather than slavishly follow provisions in the National Health Service, we must ensure that the regulations and standards which we lay down for the private healthcare sector provide protection for patients and assurance about the quality of care that they receive.

I turn to Amendment No. 151. Again, I thank the noble Baroness and the noble Lord for tabling the amendment and accept that the commission will need to collect and publicise information. Indeed, it is a regulator first and foremost and could not function effectively without collecting information. I believe also that in general the commission should make publicly available the information in its inspection reports and registers. However, there may be circumstances where it would not be appropriate for information to be available to the public; for example, cases relating to vulnerable children.

I move on to say that the Bill already provides for the commission to collect and publish whatever statistics or information are necessary for the discharge of its functions. Clause 31 provides for regulations to be made requiring services to make annual returns to the registering authority. That information will be supplemented by inspections. The powers under Clauses 28 and 29 will allow the commission to collect information to satisfy it that its service meets regulatory requirements and national minimum standards.

I believe that on that basis, and given that the framework of the Bill already allows provision for the commission to collect and publicise information for the exercise of its functions, Amendment No. 151 is not necessary.

Before the Minister sits down, perhaps I may ask a question. If an establishment does not adhere to an acceptable standard, will it lose its registration and be shut down after a warning? If not, what will happen?

There are a number of options available. The commission can bring to the attention of a home problems which it is hoped the home will wish to put right. If a serious situation arises in which the commission considers that harm may be done to residents, an application can be made to a magistrate for the home to be closed. If a situation arises which is not serious but in which none the less the home has refused to make good whatever are the deficiencies, the commission can go through a process which would lead to eventual de-registration. There are also offences in the Bill relating to homes which are carrying on as a home but are not registered. There is also an appeal mechanism, a tribunal to which homes can appeal if they are dissatisfied or aggrieved with the commission's action. There is a whole phalanx of actions that can be taken, depending on the seriousness of the case.

Can members of the public report deficiencies to the commission?

Yes, we would very much encourage the commission to invite comments from members of the public.

Before the Minister sits down—I apologise if I misheard him—did he say that if, for example, someone stayed overnight in an independent hospital providing cosmetic surgery, he would not need or receive the same safeguards as if, for example, he had that treatment in an NHS hospital or even an NHS pay bed?

No, I did not say that. I pointed out an example where, in relation to minor low-risk cosmetic surgery, the standard required for that surgery might be different from that required from a hospital providing major emergency services.

Patients may still get an infection.

I should like to thank those noble Lords who have supported me in my Amendment No. 23—the noble Lord, Lord Jenkin, even though he was not quite sure about the wording, and the noble Lords, Lord Laming and Lord Northbourne.

But I should like to say to the noble Lord, Lord Northbourne, that, in fact, the amendment does not refer to children at all. It refers to the users of the services—those cared for under the provisions of Part II of the Bill. When I spoke, I referred to the users of the services—children, elderly people, those with illnesses or disabilities. I hope that the noble Lord will understand that this amendment, unlike many of my others, is not about children alone.

As far as the Minister is concerned, I must say that I was rather disappointed with his response. I shall, of course, read carefully what he said and look at paragraphs (b) and (e) of Clause 20(1), as he asked me to. But I thought the thrust of my amendment was generally felt in the whole group and I shall read the whole debate on this group with great interest and consider what to do and whether to come forward with this amendment again with, perhaps, fresh wording.

moved Amendment No. 24:

Page 4, line 24, at end insert—

("( ) In the exercise of its functions the Commission shall give due consideration to the views of children affected by the provisions of this Act:).

I rise, very briefly, to support the noble Baroness, Lady David, in Amendments Nos. 24 and 26. The Bill, of course, makes provision for a children's rights director. But, in our view, that does not go far enough and we should like to see a separate commission appointed by the commission itself to provide a clear focus on children's issues. It would be separate, promoting the rights and interests of children and young people in accordance with the principles and standards of the UN Convention on the Rights of the Child, to which the noble Baroness referred.

Those articles of the UN convention complement recent government child-centred initiatives, such as Quality Protects and Sure Start, and therefore would be entirely consistent with that. But we believe that it is necessary to go further in the way the noble Baroness has suggested. We very much support these amendments.

Having been a member of a board of visitors of a young offender institution for many years, I have often thought those young people had much more protection than those in children's homes. They could come to a member of the board of visitors which had direct access to the Home Secretary and could take an issue forward. I should therefore like to support the two amendments. Children should have their voices heard.

I thank my noble friend for allowing us to discuss these very important issues.

I deal first with Amendment No. 24. There is no doubt that a crucial role of the regulatory process is that the views of service users are heard. I refer my noble friend to Clause 28(3)(f) which contains the relevant provisions. Clause 28(3) states:

"A person authorised by virtue of this section to enter and inspect premises may …

(f)—interview in private any patient or person accommodated or cared for there who consents to be interviewed".

Interviewing children during inspections is a core activity. It has been a requirement of the Social Services Inspectorate for a number of years. I assure the Committee that children's views will be at the forefront of the regulatory process, including inspection. Ensuring that children are listened to will be a crucial function of the children's rights director who will be a key senior appointment in the commission.

I turn to Amendment No. 26. I draw attention to the Government's previous statements as to the particular importance of children's rights as a responsibility of the national care standards commission. That is reflected in the establishment of a children's rights director in paragraph 10 of Schedule 1. It is extremely important for me to emphasise that that will be a senior post, accountable to the chief executive of the commission. The postholder will play a major role in safeguarding the interests of looked-after children or others in receipt of services regulated and inspected by the national care standards commission.

My noble friend put forward arguments for a children's rights commissioner. She referred to the first sentence of Article 4 of the UN Convention on the Rights of the Child which states that parties shall undertake all appropriate legislative, administrative and other measures for the implementation of the rights recognised in this convention. It is true that that sentence has been interpreted by those in the field of children's rights as a mandate for structures and/or institutions to be created such as an ombudsman or commissioner for children. Members of the Committee will appreciate that the remit of a children's rights commissioner in that interpretation will inevitably span the responsibilities of a number of departments, not just the Department of Health.

The Government considered whether there was a case for a children's rights commissioner to be appointed. It was considered by Ministers and discussed with children's rights groups early in 1998. The Government concluded at that time that they were not persuaded that it would be desirable to create such a national mechanism. However—it is important to stress this—the Government are extremely committed, through a range of other initiatives, to keeping the issues of children's rights and safeguards clearly and firmly on the Government's collective agenda. That includes the ministerial task force on children's safeguards and the proposal in this Bill to establish a children's rights director.

I turn to Amendment No. 26. A further tier within the national care standards commission, as proposed in the amendment, would lead to the risk of duplication and a general confusion of functions. I do not believe that such an arrangement—one body within another—would be practical or that it could work. Within the commission there must be clear lines of accountability and responsibility. I know that we shall return to those issues when we debate the schedule. I believe that children's rights and interests are best safeguarded through the commission having responsibility for them and through the establishment of a children's rights director.

I thank the noble Lord, Lord Clement-Jones, and the noble Baroness, Lady Masham, for their support. I think I can accept what the Minister said about Amendment No. 26. I see his arguments against the amendment and I think I accept those.

I am not so happy with his response to Amendment No. 24. It is extremely important that the views of children should be heard and that something about that should be on the face of the Bill. Providing for children to be interviewed, as the Minister said, is not at all the same as being able to listen to the views of children. I think that is important.

I believe that my noble friend referred to Article 4 of the UN convention whereas I referred specifically to Article 12. I am sorry that he did not accept that. I should like to think very seriously about this amendment. I shall read carefully what he said and I shall read Clause 28(3)(f) as he asked me to do. I am not altogether convinced, but I may return to the issue dealt with in Amendment No. 24 at the next stage of the Bill. I beg leave to withdraw the amendment.

moved Amendment No. 25:

Page 4. line 25, at end insert—

("(4) Regulations under this section shall correspond to section 23(3) of the Health Act 1999 with respect to the disclosure of confidential information which relates to and identifies a living individual.").

In speaking to this amendment, I shall speak also to Amendments Nos. 87, 98, 99, 100, 112, 113 and 114 which are all grouped with this amendment. First, I fully endorse everything which the noble Lord, Lord Clement-Jones, has just said.

During the passage of the Health Bill last year, my noble friend Lord McColl argued persuasively for better and fuller safeguards against breaches of medical confidentiality in the section of the legislation dealing with the powers of the Commission for Health Improvement. We all remember how appreciative we were when the noble Baroness, Lady Hayman, took away our concerns and later ensured that appropriate government amendments were tabled to address those issues.

I wholly agree with the noble Lord, Lord Clement-Jones, that there is a direct parallel between CHI and the national care standards commission. Identical provisions should apply in each case.

My Amendment No. 87 to Clause 28 is intended to put it beyond doubt that inspectors should not have an automatic right of access to medical records. Grouped with these amendments is a series of other amendments with a broadly comparable theme. We must be terribly careful about allowing reports on adoption or fostering agencies to be placed in the public domain when they may contain references to specific named children or adoptive or foster parents. It is more than possible to imagine such details being included in a report about a particular agency if the inspectors consider such information to be material and relevant. But access to such detail should be restricted to those few people who have a need to know. I hope that the Government will take away this issue and consider it.

All these amendments concern medical records and confidentiality. I shall begin by addressing the issues raised by Amendment No. 25.

Of course, I appreciate the concerns of noble Lords and why the amendment has been tabled in relation to disclosure of confidential information to registration authorities and persons authorised by them. It is the case that a registration authority will need access to confidential information in order to regulate services effectively. The Bill provides the registration authority with appropriate access to confidential information. Inspectors will, for instance, need to ensure that residents in a care home have a proper care plan.

The Bill already applies restrictions to the commission's access to documents such as medical records. As the commission will have to comply with the requirements of the Data Protection Act, I hope that the noble Lords will now feel reassured.

I am grateful to the noble Lord for raising the question of access to medical records in Amendment No. 87. Clearly, that is an important and delicate matter. It is also a matter covered by technical legislation, including the Data Protection Act 1998, which is due to come into force on 1st March this year. As I have already stated, the national care standards commission will be bound by that legislation.

The commission will regulate healthcare establishments that will be required to maintain records which will, of necessity, contain sensitive personal and healthcare information. In order to carry out its regulatory functions, for example, to ensure that proper care and treatment are being given, or to investigate concerns about the quality of such care, it may need to inspect medical records. That will, of course, have to be carried out by an appropriate health professional.

The current legislation already allows for clinical records held by a registered nursing home to be inspected by medical practitioners. I believe that the commission should also have that power to carry out its functions properly and, therefore, I would not advise accepting this amendment.

Turning to the other amendments in this group, particularly Amendments Nos. 98 to 100 and 112 to 114, I recognise that they are made with excellent motives in mind, those being the desire to keep the names of children, parents and foster carers confidential. We know that parents are concerned that their children should not be identified. We know that parents would not wish to be identified. We know that local authority foster carers and adoptive parents would not wish to be identified. The inspectors' reports are written keeping such matters in mind. We recognise that individuals want to be able to carry on their lives without the glare of publicity being turned upon them. It is right that their wish for privacy should be protected.

However, there may be legitimate times when private concerns may have to give way to a public interest. Although such occasions will be rare, as a general rule we would expect names to be kept confidential. That is good practice and we would expect it to be followed, but there may be times when it is in the public interest to name individuals. We need flexibility in the Bill to be able to do that.

Having heard our reasons for not accepting these amendments, I hope that noble Lords will withdraw them.

Before the Minister sits down, can he give the House an instance of the kind of situation in which it would be necessary to make names public? At the moment I cannot think of one, but I am sure that he has one in mind.

I have always found that one is on shaky ground when giving examples. However, one example that has come to mind is the case of Mr Roger Saint. A number of authorities approved Mr Saint as a foster carer although he had a conviction for indecent assault. Later he was charged and convicted on numerous charges of indecent assault against foster children in his care. If an independent fostering agency or a local authority were to approve a person as infamous as Mr Saint as a foster carer, the commission may want to name him when assessing the appropriateness of the behaviour of the authority or the agency. I am aware that that may be an excessive example, but there could be other cases where it may be appropriate to name an individual and we would want that power to be available. As I said earlier, I believe that that would occur rarely.

Perhaps I may press the Minister on this important point. The example that he has given is of a person who presumably has been before the courts and subsequently convicted, in which case his name would have been known publicly. As I understand the point made in Amendment No. 25 and in the amendment of my noble friend Lord Howe, we are not talking about people like that, but about possible prospective foster parents, adoptive parents and possibly children.

I believe that the whole issue of confidentiality is extremely important. I have listened to the arguments and the Minister certainly has not satisfied me on how the power will work. A lot of people could be genuinely concerned that their names may become public knowledge. The more people who know about the people involved, the more likely it is that there will be a leak. These days we are all conscious of how difficult it is to keep anything confidential.

We need to have the matter spelled out carefully. I suggest that one needs to have, certainly before the next stage of the Bill, much more detailed examples than the one given to my noble friend Lady Knight. How do the Government consider that this will work? Who would have access to such information and in what circumstances may it be made public? We need answers to those questions which are not hypothetical.

I said that I thought it was risky for me to use an example. I was seeking to suggest to your Lordships that there may be circumstances in which it is in the public interest for the commission to be able to name a person. In that context, it is important for the Bill to allow for that flexibility on the part of the commission. I accept that this is a serious matter and one that should not be undertaken lightly. That will be well understood by the commission. As a general rule, we would expect names to be kept confidential. I have said that I believe this is good practice and one that we would expect to be followed.

I am grateful to the Minister. I shall reflect carefully on what he has said as regards the confidentiality of foster and adoptive parents. However. I do not believe that he has covered the point I was seeking to make about children. I cannot think of any situation in which the identity of a child should he disclosed to the general public. Of course, there are circumstances when the name of a child needs to be mentioned in a re port, but my amendments seek to ensure that only those few people with a need to know —and nobody else— should have access to that sensitive information. Between now and Report stage, I shall reflect on how to take this issue forward.

I too thank the Minister for his reply. However, I am somewhat puzzled that he does not seem to have taken on board the points made during the course of this debate—a feeling expressed by other Members of the Committee who spoke. The Minister has not given satisfaction to those like myself who were seeking a more narrow amendment purely in terms of medical confidentiality; nor has he given satisfaction in relation to the broader range of amendments tabled by the noble Earl, Lord Howe.

The Minister seemed to be saying that the new commission will be subject to the new Data Protection Act and that that will solve everything. But I cannot see any reason why medical professionals—I proposed that this new commission should be on all fours with the Commission for Health Improvement which will also be subject to the new Data Protection Act— should not have the same protection for confidential information about their patients, and indeed for the patients to have that protection, as in the case of the commission. The rules of medical professional confidentiality were discussed at some length and were fully accepted by the Minister's predecessor, and I cannot see any reason why they should not be incorporated into this Bill.

I therefore urge the Minister, between now and Report stage, to look again not only at the narrower Amendment No. 25, but also at the broader anxieties relating to confidentiality raised in the debate. In the meantime, I beg leave to withdraw the amendment.

I am not sure whether opposing Clause 6 is the correct way to achieve my purpose. I hope that the Committee will excuse my inexperience in these matters. However, in speaking to this issue, I should like also to speak to my Amendment No. 27.

Members of the Committee will recall the Government's White Paper, Fit for the Future? In that White Paper the Government proposed that eight regional bodies should undertake the work of regulation and inspection of care facilities, which your Lordships have been discussing throughout this Committee stage. At the present time those functions are undertaken by 150 local authorities (more if we include Wales) and a large number of health authorities. There is therefore good reason for wanting to achieve a higher standard of consistency and greater uniformity of regulation and standard setting than can operate across such a large number of different organisations.

On the other hand, it is clear that in matters of this kind— the noble Baroness, Lady Masham, referred to this earlier—local intelligence is an important aspect of the work. Access to carers, to people who may have anxieties—members of staff and former members of staff—in relation to the standards being applied in homes or centres is essential. It is therefore important that there is good communication between the people charged with regulating facilities of this kind, which deal with some of the most vulnerable people in our community.

I assumed, when the Government recommended that eight regional bodies should undertake this work, they would follow the boundaries of the current regions of the National Health Service; and that the idea was to facilitate good communication across social and healthcare authorities where there is a responsibility to protect vulnerable people, and to ensure that those who have concerns have ready access to the regulatory body.

Since the White Paper was published the Government have come forward with the Bill before us. It does not recommend eight regional bodies; it recommends one care standards commission. As we have already said, this national commission will have an enormous range of responsibilities covering the whole age spectrum and most of the different aspects of social care needs that people experience in their lifetime. It is important that the way the work is undertaken commands the confidence not only of those who use the services and their carers, but also the wider community. The purpose of Amendment No. 27 is to secure an undertaking that if the Government intend to move away from providing eight local bodies, they ensure that the machinery is in place within the national body to facilitate that essential local contact.

The point made by the noble Lord, Lord Laming, is extremely important. I do not support his Amendment No. 27 in relation to regional authorities. In some areas regions are quite clear but in others they are very unclear. I am not sure that the amendment would be helpful either administratively or in any other way. I therefore do not support it.

However, a real issue arises in relation to Clause 6 and I should like to make two points. As the noble Baroness, Lady Masham, said, it is one thing to inspect things that are obvious—matters of hygiene, standards in buildings and so forth—but when one is trying to identify members of staff who may be the wrong sort of person to be employed, it is much more difficult. The only ones who will have any idea what is going on are those on the spot. A national commission is unlikely to identify anybody.

This is a difficult but important issue. For that reason, the lower the level at which such inspections are undertaken, the more prospect there will be of identifying those who need to be identified. The same happens in the world with which I am much more familiar, that of education. People can only be identified at school level; it is difficult to identify them anywhere else. They are hardly likely to say who they are and outsiders are unlikely to know unless they are familiar with the circumstances of the organisation concerned. A real point is being made which needs to be addressed.

As to whether Clause 6 should stand part, once again, it is a very general clause. For example, it says in subsection (2),

"The Commission shall, in the exercise of its functions act—

(a)—in accordance with any directions in writing given to it by the Secretary of State; and

(b) under the general guidance of the Secretary of State".

We do not know what that means. We do not know what the Secretary of State is going to say. It is therefore important, before the Bill completes its passage in this House, that we have a much clearer idea of what the Government have in mind on these important issues.

In a long working association I have rarely found myself in disagreement with the noble Lord, Lord Laming, but I am afraid I do tonight. I come from the same point of view as he, that of users and carers. But my experience and all the feedback that I have received tells me that users and carers want the establishment of a national commission in which standards can be applied across as wide an area as possible. The number of times people have asked me why things are different in Newcastle than in Plymouth leads me to say that.

That is where my disagreement with the noble Lord, Lord Laming, ceases because I agree with him that good communications and commanding confidence are essential for the commission. There is no doubt about it. Taking into account the points made by the noble Baroness, Lady Young, feedback from the local level, from the users and carers will be essential. But the establishment of standards is best done at national level so that everyone knows what they can expect.

I have been longing to ask who will carry out the inspection. How many people will it take? Perhaps we should have a national body to set the standards, but surely the people going into the homes must be local. I give an example of what can happen. I received a letter from a lady in a home in Leeds saying that as her letters were read, a friend had to take them out and send them to me and I had to send mine back through the friend. On paper there were qualified staff; in practice there were 16 and 17 year-olds at night. What was going on was appalling. At that time a friend of mine served on Leeds health authority. I asked him to visit the place and he made inquiries. To cut a long story short, that lady was transferred to a home in Harrogate. Afterwards she wrote to me saying, "It was like leaving hell and going into heaven". She arrived on her birthday and they made her a birthday cake.

Some people live in frightening situations. Therefore, there must be people attached to and visiting homes, so that residents have a contact. Someone had said, "Write to Lady Masham", as people have done over the years. That was one of my success stories, although there have probably been many that were not successes. There must be a proper establishment which must be local, even though it could be a national body also.

I find myself more in agreement with the noble Baroness, Lady Pitkeathley, than with the noble Lord, Lord Laming. I draw my reasoning from my experience of the Mental Health Act Commission. It is a national body which has been in existence for a good many years and which manages to carry out its inspections using people who are familiar with the particular hospital or institution but whose standards are entirely derived from a national standard-setting process. They command great respect; there is no question about that.

As chairman of the trust, I always made it a point to attend the final day when the MHAC was carrying out its inspection at Claybury Hospital. I was hugely impressed by the authority of the inspectors and the awe and respect which they commanded from the hospital staff. Almost everyone concerned made a point of turning up—and that is not always what happens in the National Health Service. They paid the utmost attention to the recommendations after the team had spent two or three days inspecting the hospital, talking to patients and so on.

I believe that one must have a national standard-setting body and on the whole, therefore, I am inclined to agree with the Government's change of heart. But I equally agree that it is essential that such people should be seen to command support, understanding and respect locally. That is a task which the Mental Health Act Commission has succeeded in performing over the years under a succession of able leaders. This commission is starting the task from scratch. Its members will need to apply some of the same skills, but they should start as a national standard-setting body. I agree with that, I apologise to the noble Lord, Lord Laming, if I cannot follow him on this occasion, but it is a case where second thoughts are best.

I support the noble Baroness, Lady Pitkeathley, about the national care standards commission setting the rules for the whole country. However, I am curious to know why the Government changed their mind about the eight regional officers. One needs local information and local people to go round ascertaining what is going on. I shall be interested to hear what the noble Lord has to say.

My experience with nursing is that the central body is the standard-setting body. It then devolves its functions to eight regional offices to ensure that the standards are carried out. I regret that I cannot support the noble Lord, Lord Laming, who sits in front of me. I support the noble Baroness, Lady Pitkeathley. There must be a central standard-setting body, but the process of enacting those standards must he devolved.

I shall deal first with why the Government changed their mind about the original intention to establish eight regional commissions as contained in the White Paper, Modernising Social Services, of November 1998. It was felt at the time that that would address the problems of a lack of independence and coherence in the current system. However, with eight care commissions there would still he problems of inconsistency between those eight. Although, probably, within each of the eight regional commissions, we would have had a more professional inspectorate and greater internal consistency, it was felt that there would none the less be inconsistency between the eight different commissions. In view of that and the many comments that the Government received, we felt in the end that it would be better to have one single national commission.

However, I very much recognise the concerns of the Committee that it would not work effectively if it were an organisation remote from the practice and experience of people working in the field at local level.

A number of factors should address the Committee's concerns in the area. First, we envisage that the commission will discharge many of its functions through a regional structure. Schedule 1 to the Bill gives the Secretary of State the power to direct the commission to appoint regional directors. But in association with that we would also expect the commission to have local offices because the people who will carry out the inspections will be locally based. Many of those who are currently employed within health and local authorities as inspection officers will transfer to the employment of the care standards commission. I take the point of the noble Lord, Lord Jenkin, about the calibre of the inspection officers. I argue that it is essential that we build on the foundation of the experience of those people.

I hope that in that way the commission will be informed by the experience and professionalism of its local inspecting officers and that, through their knowledge and the information they provide, the commission's work at national level will be undertaken with sufficient knowledge and understanding of the inspection process at local level. On those grounds, I hope that the noble Lord will withdraw his objection to the clause.

I am grateful to the Minister for that helpful reply. This has been a useful discussion because it has revealed that in all this there must be not only balance but an understanding of different levels of organisational accountability. The centre has a responsibility to set the standards, many of which will be accommodated in secondary legislation. The centre has the responsibility for promoting good practice, but, as the noble Baroness, Lady Young, rightly said, local authorities and those even more local than some local authorities, gain a great deal of knowledge about people working in their area and issues of local concern, such as the example given by the noble Baroness, Lady Masham. Therefore, there has to be a proper organisational arrangement which will accommodate both direction from the centre and local availability, access and sensitivity.

None of that is accommodated in the way the Bill is framed at this stage. I am grateful to the Minister for his comments. I hope that as the Bill progresses we shall be able to establish a greater understanding of how these different levels of responsibility will find an accommodation within legislation to make sure that we do not, as it were, throw the baby out with the bath water and move from the present arrangement with local authorities to a central commission without having the machinery in the middle which will secure the best of both of those worlds. However, in the light of what the Minister has said, I withdraw my opposition to Clause 6.

I beg to move that the House do now resume. In moving this Motion, I suggest that the Committee stage begins again not before 8.30.

rose to ask Her Majesty's Government whether they have checked all statutory instruments issued since May 1997 for compliance with the European Convention on Human Rights (and especially with Article 8, right to respect for private and family life); and whether they will in future attach to every such instrument a statement of compliance.

The noble Viscount said: My Lords, the House will know that in order to bring into force in October the Human Rights Act a great deal of energy is being spent on looking at primary legislation to see whether it complies with the provisions of the European Convention on Human Rights, and indeed a great deal of training in all sorts of public sectors is currently taking place. My concern is that this may not have reached the departmental lawyers who draft statutory instruments.

I have given a copy of the notes I propose to use to all those who are to speak in this short debate, except, I am afraid, to the noble Lord, Lord Marlesford, as I did not know that he was to participate. That at least enables me to avoid quoting vast quantities of statutory instruments. I should tell the noble Lord, Lord Bassam—as I think that I have already done in writing—that I do not quarrel with the merits of any statutory instruments; it is a point of procedure and compliance with the European convention that concerns me. I also take this opportunity to thank in advance all those who propose to take part in this debate as I cannot do so at the end.

I have chosen Article 8 of the convention which deals with privacy. I hope that other noble Lords may wish to discuss other articles as all of them are important. Article 8 deals with the privacy that a person is entitled to enjoy in relation to his home. There are limitations which allow interference with this privacy by a public authority in accordance with law and for certain purposes such as the prevention of disorder or crime or the protection of health, but always—this governs the whole of the article, and indeed many others— only so far as is necessary in a democratic society. That is an important proviso to the limitations that can be imposed on this, as on many other rights.

Under the jurisprudence of the Strasbourg court, when one talks about home the concept is not confined simply to the place where a person and his family live. It is wider than that. The German case of Niemietz dealt with a solicitor and his office. It occurs to me that there must be many similar examples in everyday life, for example, small farmers who keep their records at home and the owners of foodshops who live over the premises. In relation to a Starred Question asked before Christmas, the noble Lord, Lord Borrie, pointed to the increased commercial use of computers by people who carry out business interests from home. Therefore the dilemma is ever increasing.

Your Lordships will be aware that the classic method of preventing crime—whether it is being committed or has already been committed— by way of entry has been in the hands of the police. The police—this was encapsulated in the Police and Criminal Evidence Act— are allowed entry to a person's house, and indeed other premises, only if they have reasonable cause to suspect that a crime is being or has been committed and they obtain a warrant from the magistrate. The same applies under other legislation, for instance when they are looking for stolen goods, drugs, other illegal imports, obscene publications and so on. Woe betide the organisation that does not go through the proper processes. There was a case where police were persuaded to apply for a warrant of entry into the premises of a firm called South West Meat early in the past decade. It was simply an exercise whereby the meat intervention board wanted to snoop. The matter came before the courts which described the whole operation as a,

"deplorable abuse of power by public officials and police".

They awarded £25,000 exemplary damages. Therefore this is not a matter to be undertaken lightly. Warrants are not lightly granted.

There are now vast quantities of other officials who are entitled, particularly under statutory instruments, to enter into one's home. The power depends primarily on the main legislation under which the statutory instruments are given. I looked at the Banking Act 1987 and the Police Act 1997, both of which produced statutory instruments which allow entry but only after a period of notice has been given. That is probably suitable for that kind of subject matter. I refer also to the Agriculture Act 1970 and the Animal Health Act 1981 which require the same test of "reasonable cause to believe". This carries through into the statutory instruments made under those pieces of legislation.

Even under the European Communities Act— Section 2(2) is the prime source of subordinate legislation in this respect—there can be "reasonable grounds for suspecting" incorporated in the subordinate instrument. For instance, if I have potatoes originating in Egypt, under the potatoes originating in Egypt regulations of 1998 an inspector authorised by the Ministry of Agriculture can enter my house to look for them only if he has reasonable grounds for suspecting that I have them in the larder. I have no objection to that because I think that reasonable grounds for suspecting, or possibly notice, are exactly the kind of threshold which demonstrates that we are operating what is necessary in a democratic society. Therefore much of this is probably all right. I had a great deal of sympathy with the noble Lord, Lord Bassam, when he was unable to say how many statutory instruments gave powers of entry. The recent statutory instruments are not bound in the Library and a great deal of what I say is based upon inspired guesswork as to where I might look.

What I am really concerned with are the statutory instruments which grant a right of entry, usually to unspecified officials, simply on a speculative basis. I cannot believe that that is within the powers and the remit of the European convention. I suggest that it goes too far. It is frequently contained in statutory instruments. There is possibly trouble in the primary legislation. I looked at the Food Safety Act 1990. There is perhaps room there for a revision if the Government are anxious to make sure that all their legislation lives up to the requirements of the European convention.

The real trouble arises under the European Communities Act. There is no limitation in Section 2(2) on what kinds of powers of entry may be given; it is not mentioned at all. The power is absolutely general. It is there to give effect to directives and it frequently does so.

I have looked at a number of statutory instruments in the past two or three years which have been made in the realm of animal health for food safety, where the primary legislation —the British legislation—contains reasonable safeguards but where legislation made under the European Communities Act allows entry on a purely speculative basis.

I am sure that all noble Lords will agree that spongiform encephalopathy must be dealt with very firmly and radically, even where it occurs in sheep and goats. I may happen to be keeping a goat or a sheep in my outhouse. I am surprised, however, to find that a veterinary inspector or officer of the appropriate Minister has a right at all reasonable hours to come in to see whether that is so. He does not have to have any reasonable suspicion. All he has to do is to show some authenticating document. I shall not go through all the statutory instruments that I have found, but this is a pattern which occurs time and again, particularly when implementing directives under the European Communities Act 1972.

There is also a tendency, I fear, to stray in the direction of speculative entry. Not long ago there was a Prayer about the use of lead shot when shooting various wildfowl. The Prayer was not successful but the subordinate instrument was looked at. I see that it had been made under certain powers in the Environmental Protection Act. Those powers— I have looked at them—appear to include very reasonable restrictions on the Nights of entry, but the subordinate instrument does not. The authorised person—heaven knows who is the authorised person—can enter at any reasonable time any premises, including my house, which he has reason to believe it is necessary for him to enter. So he can come in to see if I am shooting moorhens from my bedroom window with cartridges containing lead pellets. He does not need to suspect that I am doing so; he simply comes in if he thinks it would be a good idea to do so. That is not in accordance even with the primary legislation.

My purpose in asking the Question is to see how far the Government are making progress in this matter. A useful development has recently taken place. After your Lordships rose for the Christmas Recess, a Statement was made in another place by the Home Secretary in which he said that he would introduce statements of compliance—which now apply to all Acts of Parliament— in relation to subordinate legislation which requires the affirmative resolution or which amends primary legislation. But it would not apply to negative instruments. I have been talking about negative instruments.

Let me make a Final point. If it is the intention of negative instruments passed under Section 2(2) of the European Communities Act to implement European law, I would suggest to the House that the implementation should comply with the Luxembourg codes—not the Strasbourg codes alone—which have a good deal to say about this. I have looked up some of the case law and I have given the noble Lord, Lord Bassam, some examples of it—Nold and Hoechst. There was a very interesting Greek case about television monopolies called ERT, which deals with Article 10 of the convention.

The way in which the Luxembourg court approaches this matter is that fundamental rights are part of the law of all the participating states in the European Union and should not be overridden in the course of pursuing European Union objectives. Therefore, if we are trying to implement directives under our own European Communities Act, I would suggest that we ought not do so in such a way as to violate Article 8, or indeed any of the other articles.

I leave this matter with your Lordships. I hope that others will develop it. I believe that the principle and the problem are much more general than has been recognised. I hope that the Government will take forward the very encouraging steps announced before Christmas and will guarantee to the House that all departmental draftsmen who draw up the statutory instruments are trained to comply with what everyone else will have to comply with, the Human Rights Act. Otherwise, it will all end up in the courts and prove extremely expensive.

My Lords, we all owe a debt of gratitude to the noble Viscount, Lord Colville of Culross, for introducing this subject. Because of the very wide range of public service he has given to these matters, I suspect that there is no one in your Lordships' House who is better qualified to raise such a very important subject as the granting of powers of entry into private premises by secondary legislation, in particular, and also by primary legislation.

There is nothing new in such powers; they have always been needed and always will be needed. But, as they are very strong powers, in each and every case where either primary legislation or statutory instrument grants them, they should be subject to public and parliamentary scrutiny to ensure that they are justified in overriding what should he the normal presumption against them.

My own interest in this was stimulated by a Parliamentary Answer from the Minister in which he was unable to give me a list of the occasions since the last election when such powers have been granted. I note that the noble Viscount, Lord Colville, had sympathy with him for not being able to answer that question. I have rather less sympathy. I should have hoped that a new and radical Government, who are aiming both to show a libertarian streak and to have a sound law and order policy— I have the highest esteem for the present Home Secretary, whom I regard as a personal friend of many years' standing—would at the very least have kept a careful record of the occasions on which they introduced such legislation (my question was about the period since they came into power) in order to ensure that they were not in any way overdoing it. I do not blame the Minister personally but I felt that the answer indicated a somewhat cavalier—maybe he would prefer the word "casual" — attitude to the whole question.

We then had the Prayer of the noble Earl, Lord Lytton, against the use of lead shot regulations (Statutory Instrument 1999/2170), to which the noble Viscount, Lord Colville, has referred, in which the justification for the draconian powers was questioned. In her reply, the noble Baroness, Lady Farrington, said that these powers would be mainly exercised by the police but that they also might be exercised by the Environment Agency or English Nature.

I have one question to put to the noble Lord, Lord Bassam, of which I gave his department notice this afternoon in order that he should be able to answer it. Have such powers been granted, or are there plans for them to be granted, either to the Environment Agency or to English Nature? I believe that it is dangerous to give such bodies powers of this kind unless it is absolutely essential. Furthermore, I believe that on occasions when any official other than the police or, by long-standing convention of powers held for centuries, officials of Customs and Excise, who has been given powers by a Secretary of State needs to gain access, he should always be accompanied by a police officer. At the very least, that will make the occasion more formal. Even to contemplate that an odd official from English Nature should enter people's private premises without a warrant is, I believe, unacceptable.

This matter emphasises once again the generally unsatisfactory use of Henry VIII legislation; that is, primary legislation that gives powers to the Secretary of State by order. However, what I believe is much worse is that all too often, such statutory instruments are in effect themselves Henry VIII clauses. That is because they allow the Secretary of State to authorise anyone he wishes to exercise powers of entry without specifying who that person may be. That is a legitimate ground for complaint.

I hope therefore that in future any use of statutory instruments in this way will be much more carefully considered as regards powers of entry and that arrangements will be made for appropriate parliamentary scrutiny. Those arrangements are not available at present. Furthermore, I hope that, under its new and more legitimate form, your Lordships' House may feel that it should have the power to pray against, with a vote, certain statutory instruments. Previously that was something that the House has not felt able to do.

While I yield to no one in my support for the forces of law and order to use all appropriate means to fight serious wrongdoing, the trivialisation of such grave powers, as I believe the lead shot example to be, erodes freedom in a way that reduces rather than enhances public support for the forces of law and order on which we all depend. Finally, I hope very much that the Minister will give a positive and detailed reply to the points raised so sensibly and necessarily by the noble Viscount.

My Lords, I am most grateful to the noble Viscount for initiating this debate on the important subject of effective parliamentary scrutiny of delegated legislation and in particular in the context of the right to personal privacy. In my remarks I shall not focus on the right to personal privacy, for reasons that I can briefly explain. Obviously it is vital that powers of search, entry and seizure should comply with the fundamental right to respect for private life anchored in Article 8 of the European Convention on Human Rights. One of the reasons Sir Stafford Cripps gave in 1949 for opposing the European human rights convention, when he was Chancellor of the Exchequer in the Attlee government, was that he wanted his inspectors to be free to search our homes without any safeguards being introduced. Half a century later, we have moved well beyond that point.

The reason why, with respect, I do not believe that the noble Viscount is correct in identifying a significant particular problem in the context which he has raised is because effective legal remedies are in place to deal with delegated legislation if it flouts the right to respect for personal privacy. First, if statutory instruments are made under Section 2(2) of the European Communities Act 1972, then they must be made with limits to their powers in accordance with European Community law. As the noble Viscount indicated, European law must be read subject to respect for human rights as laid down in the European Convention on Human Rights. It is beyond the power of Ministers or of this Parliament to produce statutory legislation which is not authorised by the 1972 Act and by the paramount law of the European Community. For that reason, if any subordinate instrument were made that violated the right to personal privacy, it could be challenged by way of judicial review and quashed. That will become even more the case when the Human Rights Act comes into force on 2nd October 2000. So the particular problem raised by the noble Viscount, although it is important that there should be safeguards of personal privacy, is dealt with through the legal process.

However, that does not answer the wider question raised by the noble Viscount, which does not concern legal remedies, but is about the effective parliamentary scrutiny of delegated legislation. That problem goes far wider than the particular question on the Order Paper. It has been addressed most helpfully by the Delegated Powers and Deregulation Committee of 10 Members of your Lordships' House, chaired by the noble Lord, Lord Alexander of Weedon. In evidence given to the Royal Commission on Lords Reform on 21st April 1999, it made a number of important recommendations with which I agree in their totality. The first matter that the Delegated Powers and Deregulation Committee supported was the establishment of a human rights committee, or a joint committee with the other place, and they referred to the commitment made by the Government to support the creation of such a committee. However, the Delegated Powers Committee pointed out that the terms of reference being proposed for the new committee had three particular gaps. First, there would be no proposed scrutiny of the compatibility of secondary legislation—a point raised by the noble Viscount—where much potential incompatibility may lie and which could be a very considerable task.

Secondly, the Delegated Powers Committee pointed out that there was no mention of second-guessing ministerial statements on compatibility as laid out in Section 19 of the Human Rights Act, only,

"the examination of draft legislation".

Thirdly, it pointed out that the new committee would need the power and resources to consider whether amendments tabled to a Bill would render it incompatible with the convention.

Finally, pointing out that we do not yet have a sensible structure, it recommended that we should set up a coherent committee structure in this House involving the creation of the following new committees in addition to ad hoc committees for the pre-legislative scrutiny of draft Bills: a human rights committee; a legal and constitutional committee—an important committee, given the special role of many second Chambers worldwide in relation to the constitution; and special scrutiny committees for detailed inquiry into selected statutory instruments.

I very much hope that the noble Lord, Lord Wakeham of the Royal Commission will find it easy to recommend those proposals to the House. If it does not, I hope that the House will itself seize the initiative. However, since that evidence was given on 21st April, it is my sad task to inform the House that was has happened since thin has been a most lamentable dragging of feet by the Government in failing to set up a Select Committee on human rights, as had been promised a long time ago, or to indicate whether its terms of reference would include the scrutiny of delegated legislation.

I shall not weary the House with a detailed recitation of all the occasions on which questions have been asked, not least by me, on this issue and answers not given, but it has gone on for month after month. As long ago as 20th May 1999, the Lord Privy Seal, the noble Baroness, Lady Jay of Paddington, indicated in a Written Answer that it was the Government's intention to set up a Joint Committee on Human Rights before the Human Rights Act 1998 came fully into force but that no decision had been taken on when exactly both Houses would be asked to approve Motions to appoint such a Joint Committee. Again and again the Government have been pressed and again and again they have refused to give an answer. There are some Questions down in my name for Written Answer at this very moment.

The reason why that matters is that until such a committee is set up we shall not have any scrutiny machinery to deal with the kind of problems raised by the noble Viscount. Until we have a Select Committee, whether joint or separate, we will not have the expertise or the information to be able to scrutinise measures, whether primary or subordinate, for their compatibility with convention rights.

It goes further than that. The Government put on the face of every Bill, as they must under Section 19 of the Human Rights Act, a statement of compatibility. It expresses the view that the Minister believes the Bill—I am referring to primary legislation—to be compatible. Indeed, as the noble Viscount indicated, the Government have agreed to do the same under the affirmative resolution procedure for delegated legislation. But that is of no value unless the Government also give their reasons for considering that a measure, primary or delegated, is compatible. Again and again the Government have been pressed as to whether they will make it standard practice to give their reasons in order that we in this House and Members of another place are able to test those reasons.

The issue arises again and again. Tomorrow the same Minister will be dealing with the Committee stage of the Race Relations (Amendment) Bill. I wrote to the Government and put down Questions to the Government so that we could be properly informed before the debate tomorrow—I said preferably by 4th January so that we could have plenty of time—as to the Government's reasons for believing that measure to be compatible with convention rights. I received a courteous reply from the Home Office indicating that those involved were on holiday and too busy and could not reply in time. We have not yet had a reply and the Committee stage is tomorrow. It is quite wrong that we should be scrutinising an important Bill in Committee tomorrow when we do not have a clue as to the Government's reasons for considering that the Bill is consistent with Articles 14, 6 and 13 of the European Convention on Human Rights in relation to access to justice, Ministers' liability and equality of treatment without discrimination. We do not have a clue. As a lawyer, I do not have a clue as to the Government's case on that; still less on compliance with the International Covenant on Civil and Political Rights, which, as a member of the Human Rights Committee, the noble Viscount knows so well; still less on the Convention on the Elimination of Racial Discrimination.

We are in a pathetically ignorant state. We simply do not have the material. Lawyer Members of the House like myself have to do our best to help other Members who are not lawyers to address some of these questions as unpaid professionals doing our best in the way that we can. It is not good enough. We need to have a proper committee structure to deal with the kind of questions raised by the noble Viscount and we need the information so that we can know what the Government's case is, we can test it and we can call the Government to account.

I hope that the Minister will provide that information in the debate tomorrow on the Race Relations (Amendment) Bill. But I am addressing, as is the noble Viscount, systemic failures. We talk again and again about parliamentary sovereignty but the reality is that Parliament, or at least the other place, is controlled by the executive for most of the time between elections. The only way in which we can call the Government to account is by having effective powers and effective information. That is now what we must press for. For that reason, and for many others, I am most grateful to the noble Viscount for initiating the debate. I very much hope that it will be considered at the highest level of government as a matter of priority.

My Lords, before the noble Lord sits down, perhaps I may ask him to add to those measures that he mentioned the Armed Forces Discipline Bill, with the Report stage of which we shall deal next week, as another Bill where it is less than clear whether either the current legislation or the proposed legislation is compatible with the convention or with the Human Rights Act.

My Lords, I do so with great pleasure because what I have said is true of every Bill. Every Bill has to have a statement of compatibility. Every Bill should be accompanied by or followed by reasons concerning compatibility. The same applies to the affirmative resolution procedure; and for the negative resolution procedure we need a proper committee system to look at selected delegated legislation, as the committee of the noble Lord, Lord Alexander, has made clear.

My Lords, like other noble Lords who have spoken, I am grateful to the noble Viscount, Lord Colville of Culross, for tabling this Unstarred Question. He has drawn attention to a most important consequence of the European Convention on Human Rights which seems to have escaped both the Government and Parliament. I understand that it was the 17th century English jurist, Coke, who formulated the legal principle that a man's home is his castle and every man's home is his safest refuge. It is therefore appropriate that this long-established principle of English law should find a place in the human rights convention, which has now been written into our statute law and comes into effect later this year. This nation and this House should be foremost in ensuring that the principle is carried into practice.

However, the noble Viscount has shown us that we have allowed the principle to be eroded. He made the clear distinction between the powers of entry given to the police, Customs and so on, which are necessary for the protection of law and order and which are now formulated in PACE, and the increasing number of powers given to other officials to enter and search premises which are wholly or partly domestic and which do not provide the same safeguards for the citizen. They provide instead for what can be called "fishing expeditions". That is not acceptable under the convention and it should not be acceptable in our country in any case.

That leads me to ask the Minister two questions. First, can he confirm that these powers, as they are now formulated without safeguards, will become illegal under the Human Rights Act when it comes into force later this year? I assume from what has been said, both by the noble Viscount and by the noble Lord, Lord Lester, that the answer to that question is clearly yes, but it would nevertheless be nice to have it confirmed by the Minister. Perhaps I may say this to the noble Lord, Lord Lester. I do not think it is sufficient to say that it does not matter whether these powers are excessive because they can be quashed through judicial review. I am sure that the noble Lord is right about that. I am not arguing with him as a lawyer, but I do not think that we should have legislation on the statute book which can mislead both the officials concerned and the public into thinking that the powers are greater than they actually are. Therefore, although the power to quash them is important, it does not finally answer the question.

My Lords, I am grateful to the noble Lord for giving way. I was simply pointing to the existence of a remedy for over-breadth, but I entirely agree that Parliament should not authorise excessive powers without safeguards against abuse. I was simply indicating that there are those safeguards, but it is not good enough to give blank cheques to public officials without the legislation itself containing safeguards.

I am grateful to the noble Lord.

The second question to which an answer is needed—not necessarily this evening, because it may be detailed—is: which statutory instruments confer powers which do not contain the safeguards? The noble Viscount has drawn our attention to some but has indicated that there are possibly many others. At present, none of us can be sure how many.

If the answer to my first question is that the powers are illegal, it will be essential for the Government, Parliament and others to know which statutory instruments we are talking about. Like my noble friend Lord Marlesford, I do not think that it is good enough to answer, as Ministers have recently done, that the Government have lost count of how many such powers there are and that they do not propose to find out. Apart from anything else, the officials concerned with implementing the various provisions need to be told to stop using them in the way in which they apparently think that they can. It is not good enough for the Government to rely on the belief that the powers may exist but no one will bother with them in the future. We need to know; and it would be helpful to have a list.

Underlying much of all this is the European Communities Act. Many of the offensive powers apparently stem from European Union agreements, sometimes known as directives. It may be that they have been over-zealously implemented here in being written into UK statutory instruments—the process known as "gold—plating" or it may be that the agreements themselves are defective in the light of the human rights convention. To eliminate the danger for the future, we need to provide both against the terms of the EU agreements themselves and against their overzealous implementation in the United Kingdom. A certificate of compliance, properly "policed", for all statutory instruments, whatever their parliamentary process, would provide a line of defence against gold-plating. I hope to hear a favourable response on that point from the Minister.

In addition, the European Union might adopt the practice of the present Government so far as primary legislation is concerned, and indeed affirmative instruments, and make the Commission certify that any agreement at which the Council of Ministers is about to arrive complies with the European Convention on Human Rights. I realise that the convention does not stem from the EU but from the Council of Europe, but all EU members subscribe to it, so presumably all will wish their directives and agreements to comply in future.

I am mainly concerned with the two questions that I have asked: is it certain that these instruments will become illegal; and will the Minister set out, presumably in writing, which statutory instruments confer these offensive powers? I have no doubt that we shall be told by the Minister, correctly. that the noble Viscount has raised an important issue. It has also become clear during this debate that it is one that will not go away.

My Lords, the noble Viscount, Lord Colville, deserves great credit, and our gratitude, for raising the important subject of preparations for the Human Rights Act. I shall attempt to outline them in general terms, and pick up particular points that have been raised.

Preparing for the Human Rights Act is a major task. It involves a great deal of work. The main burden of that work has to be shared by all government departments. But there can be no doubt that we all have an important part to play in the process. Debates such as this shine a torch on particular aspects of the preparatory work. This debate has been helpful to all concerned. It has also shown the parliamentary system working at its best.

The noble Viscount was right to stress the importance of the Human Rights Act, as have all noble Lords who have spoken. It is a defining event in our constitutional history and development. When the Act comes into force, on 2nd October this year, it will place on all public bodies in this country a new and important statutory duty to act compatibly with convention rights—unless, of course, primary legislation prevents them from so doing. The duty is significant and wide-reaching. The Human Rights Act will also mean that all of our legislation must be interpreted in a way that is compatible with convention rights unless it is impossible to do so.

But the new Act is not simply about compliance by public bodies with the new legal obligation. It is not merely about allowing people to raise convention points in UK courts without having to go to Strasbourg. The Human Rights Act is fundamentally about modernising our society and building a new culture of rights balanced by responsibilities within UK law. Rights and responsibilities go together. They are two sides of the same coin. The new culture that we want to build is one in which the Human Rights Act gives us a shared understanding of what is fundamentally right and wrong, a culture where people recognise the duties that citizens owe to each other and the wider community and are willing to fulfil them—and one in which public authorities understand that the Human Rights Act defines what the basic rights are. It will sometimes require us to be robust about an individual's rights if we are to maintain the rights of others. That is the culture that we want to build. That is what the Human Rights Act is all about.

There is no question that preparing for implementation of the Human Rights Act is a major task. It involves all public authorities, central and local government, the courts, the police, the utilities and private bodies in so far as they have to perform public functions. Public authority staff must be trained in an awareness of the convention rights and their new obligations. Public authorities are, as a consequence, reviewing the legislation, rules and procedures for convention points.

I emphasise that we do not expect the statute book to be rewritten overnight on 2nd October 2000. Nor do we pretend that it will be in a state of perfection. We have, after all, been fully signed up to the ECHR for half a century, and ECHR proofing of legislation has been a continuing and deepening process throughout that period. The statutory instruments mentioned by the noble Viscount, Lord Colville, were not prepared without regard to ECHR considerations. Indeed, most were prepared very recently, in the shadow of the Human Rights Act.

But the convention is a living instrument. It changes and evolves over time to reflect the way in which society has changed. That is one of its great strengths. It means that reviewing our legislation and procedures for convention points must be a continuous process. It cannot be a one-off event.

Each government department is responsible for reviewing its own legislation and procedures for compatibility with the convention rights. That is not a task which lends itself to bureaucratic or centralised structures. Each individual department must feel responsibility for assessing its own legislation and "take ownership" of the process. That is an important part of building the new culture about which I spoke earlier. We must mainstream human rights awareness throughout Whitehall and the devolved administrations so that considering human rights implications of a particular procedure or policy initiative is an automatic and instinctive part of the decision-making process. Only then can we hope to develop the new culture that we seek. In our view, individual departments are best placed to decide how to do that. Each department has different requirements and different priority areas, and each must satisfy itself as to the compatibility of its own legislation and procedures and processes.

The noble Viscount, Lord Colville, asks whether we have checked all the statutory instruments issued since May 1997 for compliance with convention rights. The short answer is that we have, or are in the process of doing so, but that the review of a particular statutory instrument or any other piece of legislation is a matter for the relevant department concerned. We have not sought to impose on departments a bureaucratic, centralised structure to review individual items of legislation or to maintain long centrally held lists which purport to show when a particular piece of legislation has been given a green light, as it were. Such an approach would go against our efforts to mainstream human rights considerations throughout government. It would also go against the need for continuous review in the light of the "living instrument" nature of the ECHR.

But the centre—in this case the Home Office and the Human Rights Task Force—is monitoring the general state of preparation in all departments. I can assure your Lordships' House that departments are well aware of their new responsibilities under the Human Rights Act and the impact of that Act on their legislation. Departments take very seriously the need to consider existing legislation, primary and secondary, for convention points. They are doing this not just because the Home Office has dictated that they should but because they understand that after 2nd October this year—this is an important point—the courts will be able to strike down secondary legislation that is incompatible with convention rights.

The noble Viscount cited in particular a number of examples of secondary legislation which he believed might raise Article 8 privacy issues. Your Lordships' House is aware that intrusion into the privacy of the individual is an issue that this Government take extremely seriously. Indeed, we are introducing a Bill this Session to ensure that the use of intrusive investigation techniques continues to be regulated for the protection of both the rights of the individual and society at large. Clearly, Article 8 considerations will be at the heart of that legislation.

But I make an important general point here. Central to the ECHR and the Human Rights Act is the principle of balance. The convention recognises that most of the rights within it are not absolute. There are circumstances where rights can legitimately be limited by the state and where a public authority must be tough on an individual's rights to protect the rights of society as a whole. The convention sets tests by which we can measure whether those limitations are in line with human rights principles. Are they in accordance with the law? Do they pursue a legitimate aim? Are they proportionate? The point is that there are circumstances in which the state is justified in interfering with a convention right, such as privacy. Clearly, Strasbourg recognises this. Simply to show that a particular action by a public authority touches on a convention right does not automatically mean that the right has been violated. The decision as to whether the legislation concerned is compatible with convention rights is not a precise science. After all, everything in the law is arguable. No Minister or official can be 100 per cent sure—certainly not before the Human Rights Act is in force and we see how the courts deal with convention points.

I cannot go into the provisions of the particular statutory instruments that the noble Viscount cited, although I shall be happy to pass on his concerns to the Ministers with direct responsibility for the legislation in question.

I turn to the suggestion of the noble Viscount, that in future the Government should attach to every statutory instrument a statement of compliance with convention rights. The current position has statutory and non-statutory elements. As has been widely recognised in the debate, the statutory provision is Section 19 of the Human Rights Act which requires a Minister when introducing a new Bill to make a statement that in his or her view the provisions of the Bill are compatible with convention rights. Alternatively, if he or she is not able to state that he must explain why the Government wish the House to proceed with the Bill. But Section 19 applies only to primary legislation. Parliament, wisely I believe, did not extend the operation of that scheme to all species of legislation, primary and secondary. I venture to suggest that that is because the Human Rights Act subjects secondary legislation to a number of very powerful safeguards.

Put simply, the general scheme of the Act does not permit secondary legislation which is incompatible with convention rights. In the first place, Section 6 of the Human Rights Act makes it unlawful for a public authority to act in a way that is incompatible with convention rights unless the public authority cannot act otherwise because of a provision in primary legislation. Unless that Section 6 saving applied, to seek to bring forward incompatible secondary legislation would be in conflict with the Human Rights Act itself.

As your Lordships are aware, secondary legislation must always be within the powers of the Minister who makes it. It must be (to use the relevant term) intra vires. A Minister has no power to make secondary legislation that is incompatible with convention rights unless primary legislation requires him to do so. The Joint Committee on Statutory Instruments and its Clerk devote much anxious attention to the vires of proposed new secondary legislation. Behind and above these considerations there is the simple fact—a point very ably made by the noble Lord, Lord Lester—that from 2nd October of this year such incompatible secondary legislation can be struck down at any time by a court. It enjoys no special protection under the Human Rights Act. I believe that that is an extremely powerful safeguard which provides the best protection of all.

My noble and learned friend the Attorney-General has already announced that from the beginning of the current Session a Minister who invites Parliament to approve a statutory instrument subject to affirmative resolution should, as a matter of good practice, always volunteer his or her view regarding its compatibility with convention rights. It is not essential that he or she should do so for the reasons that I have already given. But we believe that it would be odd if there were a debate about a proposed statutory instrument and the Minister made no comment about compatibility with convention rights. We have also said that as a matter of good practice the Minister should always give his or her view regarding secondary legislation which amends primary legislation. Such legislation falls into a special category: it is treated as protected primary legislation under Section 21 of the Human Rights Act. We believe that it is right for the Minister to give his view about compatibility in such cases even where the secondary legislation which amends primary legislation is not subject to affirmative resolution. For example, this may take the form of a letter to the Joint Committee on Statutory Instruments. Detailed guidance to this effect has been issued to departments.

I should like to deal with particular points raised in the debate. I believe that my earlier remarks have dealt with most of them. I can provide some comfort to the noble Lord, Lord Lester, on the question of the terms of reference of the joint committee to be established. It is our belief that the. terms of reference need to cover such matters as inquiries into general human rights issues in the UK. We also believe that that area should be covered by the joint committee in examining draft legislation and, in more general terms, that it should look at the longer term and perhaps the arguments surrounding the development of a human rights commission within the UK. We hope shortly to make an announcement of the date when the joint parliamentary committee will be set up. Clearly, there are important issues to be settled and debates to be had.