Orders of the Day — Care Standards Bill [Lords]

House of Commons, 12 July 2000.

GENERAL POWERS OF THE COMMISSION

John Hutton (Labour, Barrow and Furness)

I beg to move, That the clause be read a Second time.

Michael Lord (Deputy Speaker, Central Suffolk and North Ipswich)

With this it will be convenient to discuss the following: Government amendment No. 53. Amendment No. 31, in clause 31, page 17, line 6, after "functions", insert "of regulation and inspection". Amendment No. 96, in clause 44, page 22, line 40, at end insert— '(1A) The description of premises referred to in paragraph (1)(b) does not extend to the private dwelling-house of a foster parent'. Amendment No. 3, in schedule 1, page 84, line 3, at end insert—'Committees and Directorates— 6A. The Commission shall establish— (a) an Independent Healthcare Committee chaired by a Commissioner who shall have specific responsibility for the Commission's functions in respect of independent hospitals; and (b) a Nursing and Care Homes Committee chaired by a Commissioner who shall have specific responsibility for the Commission's functions in respect of nursing and care homes. 6B. The Commission shall establish— (a) a Directorate of Independent Healthcare under a Director of Independent Healthcare, who shall report to the Independent Healthcare Committee; and (b) a Directorate of Nursing and Care Homes under a Director of Nursing and Care Homes, who shall report to the Nursing and Care Homes Committee. 6C. The Secretary of State may by regulations define the respective responsibilities of the Committees established in accordance with paragraph 6A.'. Amendment No. 32, in page 84, line 3, at end insert:—'Healthcare Committee— 6A. The Commission shall establish a Healthcare Committee chaired by a Commissioner who shall have specific responsibility for the Commission's functions in respect of independent hospitals. 6B. The Secretary of state shall appoint a Deputy Chairman of the Healthcare Committee from the staff of the Commission for Health Improvement ("CHI"), and the Deputy Chairman shall have specific responsibility for ensuring that the system of inspection of independent hospitals is common and comparable to the system used to inspect NHS hospitals. 6C. The Secretary of State may by regulation define further specific responsibilities of the Committee established in accordance with paragraph 6A.'. Government amendment No. 82.

John Hutton (Labour, Barrow and Furness)

In Committee, the hon. Member for Runnymede and Weybridge (Mr. Hammond) tabled a similar amendment, which would have allowed the commission to advise the Secretary of State on national minimum standards and other matters relating to part III services. I accepted the principle of the amendment but was unable to accept the wording. I am happy to put this more suitably worded new clause before the House. The new clause is similar in effect to clause 7(5), which gives the commission the power to provide the Secretary of State with any information that it thinks would improve the quality of part III services, as defined in the Bill. The clause allows the commission, in the course of fulfilling its inspection role, to report to the Secretary of State if changes need to be made to the national minimum standards to secure improvements to local authority fostering and adoption services, and on any other matter connected with the exercise of these functions. Through its inspection of local authority fostering and adoption services, the commission will be able to make a judgment on how effective the standards are. It is important that it should be able to pass on advice that would improve the quality of these services to the Secretary of State. This will ensure the continuing improvement of standards across the country. The Government are strongly committed to that. I thank the hon. Gentleman for raising this issue, as that will be an important function for the commission. On amendment No. 53, the hon. Gentleman tabled an amendment in Committee that would have had the effect of requiring Ministers to publish the reports of all inquiries held under clause 10. As I made clear to the hon. Gentleman in Committee, we certainly intend to publish the inquiry reports. It is crucial for the public to have confidence in the commission and in the services that it is regulating. It is clearly desirable for failings in those services, or in the regulatory system, to be open to public scrutiny, so that lessons can be learned for the future. The amendment makes it absolutely clear that all inquiry reports will normally be published, but allows the Government to withhold publication in exceptional circumstances only. As hon. Members will appreciate, there could conceivably be rare instances in which it would not be appropriate to publish a report—if, for example, it included unproven allegations against an individual that could possibly be interpreted as being defamatory. I hope, however, that that will never happen, and that it will be possible to publish all reports. Let me now deal with amendment No. 82. The Government have made it clear throughout that they intend the commission and the councils to employ their own staff, and intend their functions normally to be carried out by members of their staff. On occasion, however, they may need to sub-contract work to outside people and organisations. For example, the commission may on occasion need to contract some of its inspections to self-employed inspectors if its own inspectorate is reduced owing to illness or a sudden surge of vacancies, although I hope that such problems will not occur. More important, however, the commission may want to contract specialist expertise to help it in its inspection function. It may, for instance, want to contract an NHS trust to provide specialist pharmaceutical advice. Similarly, the councils may wish to contract an outside organisation to provide them with specialist advice. The purpose of this amendment to paragraph 13 of schedule 1 is simply to ensure that the commission and the councils have the power to sub-contract work, in an entirely sensible and pragmatic fashion.

Philip Hammond (Conservative, Runnymede and Weybridge)

It is perhaps fitting for us to start with a Government new clause that reflects our constructive discussion in Committee. On a number of occasions the Opposition tabled amendments that the Government could not accept—sometimes for drafting reasons, sometimes because they were not entirely happy with the precise way in which the Opposition had sought to amend the Bill—although they were willing to accept the principle. Although, in the true traditions of this place, we had heated discussions on some issues, by and large the Committee engaged in constructive consideration, which has led to significant changes. I believe that some 37 of the Government amendments and new clauses with which we shall deal today respond to issues raised by Opposition parties in Committee. The Government have reshaped those ideas into a form acceptable to them, and we appreciate that. New clause 16 gives the National Care Standards Commission a role in relation to the functions of local authorities which mirrors the role that the Bill gives it in clause 7(5) in relation to what it describes as part II services. The clause allows the commission to act as the Secretary of State's eyes and ears—to advise him on changes that might be required to national minimum standards in order to secure improvements in the delivery of services. As the Minister has acknowledged, we proposed such a measure in Committee. We referred to part III services, thinking that that would nicely reflect the reference to part II services in what is now clause 7. Sadly, however, while part II services are defined, part III services are not. The Minister therefore rightly described our proposal as defective, but, following consideration, has presented a way of achieving the objective within the confines of the definitions in the Bill. "Relevant functions" in relation to local authorities is defined in clause 43. 4.15 pm During discussions in Committee on the role of the National Care Standards Commission, particularly in providing information and advice to the Secretary of State, we expressed the view that it would be good if the commission could be a watchdog out and about among providers and users of services, and if it were able to flag up issues to the Secretary of State, quite apart from any areas where the Secretary of State might specifically require it—as he has the power to do—to investigate a matter and to report back. In other words, it might instigate such investigations itself. To give that role of watchdog, it would be necessary for that information to be published and widely known, so that people outside were aware of the concerns that the commission had identified and had reported back to the Secretary of State. We would have preferred a provision that required publication of the advice given to the Secretary of State in order to stimulate public debate. The Government were not prepared to concede that point. We had that argument and lost it. That somewhat limits the power of the care standards commissioner to flag up problems effectively for public scrutiny. Nevertheless, new clause 16 is a worthwhile extension to the powers and capabilities of the commission and we welcome it. I am grateful to the Minister for taking the time and trouble to redraft what we originally tabled and to bring it forward for inclusion in the Bill. Government amendment No. 53 deals with a slightly different issue that touches on some of the same concerns. I mentioned in relation to new clause 16 our preference for advice that was given to the Secretary of State to be published, so that it was available for public scrutiny. The amendment addresses a concern raised in Committee about the publication of inquiry reports. It makes it clear, as the Minister has said, that the norm will be that such inquiry reports will be published in a manner determined by the Minister. He has reserved for himself the power in exceptional circumstances not to proceed with publication. Again, in Committee, we sought to change that arrangement, so that it would be the person conducting the inquiry who determined whether the report should be published and, indeed, the mode of publication. The Minister was not able to agree with us on that point, but he acknowledged then that he expected the norm to be publication and that publication would be withheld only in exceptional circumstances. The amendment meets the Government's commitment in Committee to provide for that point on Report. The Minister gave us one example of what he might consider to be an exceptional circumstance: a situation where the contents of a report might be considered libellous. I had thought that he probably had in mind a situation where criminal proceedings might be contemplated and the material in the report might prejudice those proceedings and, thus, be inappropriate for publication at that time. I hope that he will acknowledge that in a case where, for example, criminal proceedings are contemplated, there is an argument for delaying publication of an inquiry report in order to allow those criminal proceedings to continue uncompromised by publication of the report. However, I suggest that, in those circumstances, it would be in the public interest that the report was published eventually. I can think of very few circumstances beyond the one that the Minister mentioned in which it would be appropriate not ever to publish. Even the circumstances that the Minister mentioned might be an argument only for delay, until the matters giving rise to the possible libel had been resolved. I should be grateful if, later in the debate, the Minister will say whether the libel situation that he intimated and the possibility of criminal prosecution are the only situations in which he envisages immediate publication not being possible, and also whether he agrees that, in the case of pending criminal proceedings, it would be possible for the report to be published eventually, at an appropriate time. The Liberal Democrats' amendment No. 31, which was tabled by the hon. Members for Sutton and Cheam (Mr. Burstow) and for Isle of Wight (Dr. Brand), seeks to tighten the commission's power to require disclosure of any information that it considers to be "necessary or expedient"—I emphasise those words— for the purposes of its functions. The amendment would tighten that power by making it clear that subpoenas can be used only in relation to material that is "necessary or expedient" for the purposes of the commission's functions of regulation or inspection. I expressed a concern in Committee that I am sure Liberal Democrat Members share—amendment No. 31 expresses a similar concern—but I am not sure that their amendment, albeit well meaning, really deals with the mischief that concerns us. The real concern that we expressed was that the Bill enables the care standards commission to conduct fishing expeditions—to seek information from registered persons without necessarily having to indicate a specific reason why it needs that information, and perhaps even to trawl widely in the hope of finding something that might incriminate the person or persons in question, leading ultimately to the deregistration of those people or that establishment. In this debate, it is important for us to explore with the Minister how he intends to prevent the commission from undertaking that type of fishing expedition. Perhaps he will be able to reassure us that he can use the extensive regulation-making power that the Bill gives to the Secretary of State to prevent that type of activity.

John Bercow (Conservative, Buckingham)

I think that my hon. Friend will recall that on Second Reading I inquired about the nature of the regulations that will be introduced attendant upon the Bill. Is he satisfied that any regulations on this subject will be subject to the affirmative procedure, and therefore open to hon. Members to debate?

Philip Hammond (Conservative, Runnymede and Weybridge)

Regulations made in relation to this aspect of the Bill, and to the great majority of the Bill, will be subject to the negative procedure.[Interruption.] While I understand that my hon. Friend is quite naturally disappointed about that, I have to tell him that it gets worse. In the next group of amendments, we shall be examining a subject on which significant material will be introduced by Ministers, not in the form of regulation subject to either the affirmative or the negative procedure, but in the form of documents that will not be subject to any form of parliamentary scrutiny. I hope that my hon. Friend will be in the Chamber for that debate, when he will be able to explore that issue a little more fully. In Committee, concerns were raised about the powers that the National Care Standards Commission will have to obtain information from a registered person. The Bill does not appear to include any exclusion for information that a registered person is gathering in contemplation of an appeal against a decision to deregister under the procedures in the Bill. I raised that issue with the Minister who, to paraphrase his response, agreed that it would not be acceptable for the commission to seek to sequester the evidence that an individual intended to produce to an appeal tribunal merely because it would be expedient for the commission to do so. Of course it would always be expedient to have sight of an opponent's intended evidence in any proceedings. The Minister made it clear that he did not contemplate such wide-ranging use of the power, but nothing in the Bill would prevent such action. Perhaps the Minister will prevent it through regulation, but I am certain that the hon. Member for Sutton and Cheam (Mr. Burstow) had such issues in mind when he framed his amendment. I am sure that he will wish to pursue the argument further, if he is fortunate enough to catch your eye, Mr. Deputy Speaker. Amendment No. 96, tabled by myself, addresses clause 44, which deals with the power of entry of inspectors. The issue at stake depends on the interpretation of the term in the clause about premises which are used…by a local authority in its discharge of relevant functions. Relevant functions are defined as functions of fostering and adoption and the clause gives powers of entry to premises that are used in that connection. If that means a power of entry to the town hall to have a look in the filing cabinet, at any time of the day or night and without notice—although we might have practical issues to raise—nobody would have a problem in principle with inspectors inspecting the premises of a public authority to ensure that records are in order. However, the advice that we received before the Committee debate on the subject was that it is not clear from the Bill's wording that the term does not include the private dwelling house of a foster parent who fosters a child for the local authority. Fostering is a relevant function and the local authority is procuring the discharge of that function. It is at least arguable that the private dwelling house of the foster carer is a premises being used in the discharge of that relevant function. I return to the issue today because the Minister sought to deal with the concerns during the debate.

Peter Brand (Liberal Democrat, Isle of Wight)

Does the hon. Gentleman believe that no powers of entry should be granted for the private dwellings of foster parents? Under existing arrangements and for the purpose of child protection, surely it is important that inspections can be made.

Philip Hammond (Conservative, Runnymede and Weybridge)

The hon. Gentleman is right. As he says, inspections can be made under existing legislation and will continue to be possible. If he will bear with me for a moment, I shall come to that point. Let me quote from an exchange in Standing Committee. I said to the Minister: My reading of the Bill was that the reference in subsection (1)(b) to premises used by a local authority in the discharge of its relevant functions would include the private home of a foster carer, where a child is being fostered as part of the discharge of the local authority's functions. Will the Minister say whether that is correct? The Minister replied: Other amendments are coming up that will allow us to discuss that. There will be an opportunity for National Care Standards Commission inspectors to have access to the homes of private foster carers, because that is entirely appropriate. I then asked the Minister the same question again: Will the Minister answer my specific question? Does the reference in subsection (1)(b) to premises used by a local authority for the discharge of its relevant functions include a private home in which a child is fostered? The Minister answered My advice is that it does not include the private homes of foster carers.—[Official Report, Standing Committee G, 22 June 2000; c. 428–29.] I have got to know the Minister quite well during the progress of this Bill and others. When he prefaces a remark by saying, "My advice is", that suggests that he has just a little doubt in his own mind, as when he is quite clear about something he is usually robust in saying so. Apparently, there is something of a contradiction between those two statements. The Minister said that there would be an opportunity for National Care Standards Commission inspectors to have access, but clearly that opportunity will not occur under clause 44. We need to hear from the Minister where it is stated in the Bill that National Care Standards Commission inspectors will have access to the private dwellings of foster parents. To answer the hon. Member for Isle of Wight (Dr. Brand), of course local authorities, as part of their contracting process, may require access to the private dwellings of foster carers. They may want to secure that access for National Care Standards Commission inspectors. I have no problem with that as it would be a contractual matter, and issues such as time of access and how much notice needs to be given could be agreed between the parties to the contract. That is quite distinct from a statutory power of entry. The amendment seeks to clarify what I think the Minister told me in Committee—that a private dwelling is specifically excluded from the definition of premises used by a local authority in its discharge of relevant functions. We believe that there is an important distinction to be drawn between the domestic dwelling of a private individual and premises such as the offices of a local authority. In addition, again referring to what the hon. Member for Isle of Wight said, there will still be powers of entry in certain circumstances—for example, to protect the safety of children under the Children Act 1989, although that power would probably not be exercisable by National Care Standards Commission staff. So, both through contracting and through the existing legislation for the protection of children, there would be access, but I am still baffled by the Minister's reference in Committee to the right of National Care Standards Commission inspectors to have access to private dwellings, and I look forward to some clarification on that point. Amendment No. 3, in my name and that of my hon. Friend the Member for Meriden (Mrs. Spelman), deals with the inspection of independent acute health care provision. This matter considerably exercised my noble Friends and others when the Bill was being considered in another place. I cannot speak for my noble Friends and other noble Lords as to how they might proceed when the Bill returns to them stripped of the provisions that they inserted on inspection of the independent acute health care sector. The Bill originally contained provisions that would have made the Commission for Health Improvement responsible for inspection, registration and regulation of the independent health care sector and the NHS. The Government have advanced some persuasive and largely pragmatic arguments why the commission would not be appropriate for the task. They said that it was designed with a different purpose in mind, and to work in the context of a managed service—the NHS—rather than in an independent system that requires arm's-length regulation. The debates on the matter have caused much rethinking on the issue by hon. Members of all parties. However, it is clear that the Government oppose the use of the Commission for Health Improvement as a single regulatory body for both independent and NHS provision. When Conservative peers pressed for that, they were keen to draw attention to the advantages—a level playing field and a clear and even-handed regulatory system that would ensure that patients were treated in accordance with appropriate and properly policed standards. That would be the case wherever they were treated and whoever was paying for the treatment. It is becoming increasingly ludicrous to distinguish between the private and NHS sectors. The Government have made clear their intention to use private-sector providers more regularly and widely in the provision of care to NHS patients. The Government tabled a new clause in Committee to allow cross-contracting between the Commission for Health Improvement and the National Care Standards Commission, to avoid the absurdity of double inspection, under which beds are inspected separately according to whether they contain NHS or private patients. One anomaly remains, however. Many private beds remain in the NHS, and they will still be inspected by the Commission for Health Improvement, rather than by the National Care Standards Commission. The independent acute provision sector will be regulated and registered, but its largest competitor—the NHS pay beds service—will not. Our preference would be for a single regulatory mechanism covering all sectors, but the Government will not countenance that. The independent sector and other observers have described the problems that they foresee, and we propose that two separate committees and directorates should be established in the National Care Standards Commission. Each would be led by a dedicated commissioner, who would be the figurehead responsible for, respectively, independent acute health care and for nursing and care homes. That recognition would give clear status to the importance of those two strands. The commission is a multi-functional body. We are dealing with two areas in which, by definition and by circumstance, large elements of the total provision come from the independent sector.

Tim Collins (Conservative, Westmorland and Lonsdale)

My hon. Friend makes a powerful case for amendment No. 3. Could he, for my benefit, and possibly that of other right hon. and hon. Members, clarify whether the commissioners who would have those specific tasks would be appointed by the Secretary of State or the chairman of the commission? Would they be appointed to the commission with a view to having a specific responsibility, and does my hon. Friend therefore envisage that people with a specific background would be appointed?

Philip Hammond (Conservative, Runnymede and Weybridge)

I believe that the Bill provides that the Secretary of State will appoint the commissioners. Interestingly, amendment No. 32, tabled by Liberal Democrat Members, addresses my hon. Friend's point by suggesting that a member of the Commission for Health Improvement staff should be the deputy director of the independent health care directorate of the National Care Standards Commission. That issue is likely to be debated shortly. Why is it necessary to establish a separate entity within the commission to address the needs and concerns of the independent acute health sector? A couple of general points have come to light, as well as a couple of specific points. First, which staff in the commission will carry out the inspections and the registration function? We believe, from what the Minister has told us, that many of them are carrying out inspection functions within health or local authorities, and will move across to the National Care Standards Commission. In some areas—I emphasise "some"—there are historic tensions that do not bode well for a good working relationship. The old role of inspectors working within local or health authorities is different from the working relationships that the Government hope to inspire by this new model, in which people will work for an independent care standards commission. There is a concern in the independent sector that the same people will be wearing different hats—and probably earning higher salaries—after the move from one employer to another. There are specific questions about the nature of inspection and the regulation of private hospitals. The term "independent hospitals" encompasses a wide range of entities. Sophisticated hospitals in central London and other large cities have sophisticated equipment, fully-fledged intensive care beds and the capability to carry out almost any procedure that can be done in the national health service. At the other end of the scale we have smaller, low-tech institutions. The smaller ones are often run by voluntary or charitable organisations; they may perform a general service to the community or to a particular group or community. There is a wide range of competence and ambition between private hospitals. We must ensure that the regulation and inspection regime is sensitive to those differences, and that small hospitals seeking only to carry out relatively minor procedures are not rendered non-viable by a requirement to comply with regulations designed for hospitals that have loftier ambitions. We agree with the industry that identifying a unit within the National Care Standards Commission that will address itself exclusively and specifically to these issues, will give a greater chance of achieving an appropriate, light-touch regime that will ensure proper delivery of consistent quality standards and proper compliance with appropriate levels of regulations without becoming oppressive. That is why we propose the establishment of the health care committee, and an associated commissioner. I turn to the arguments for the nursing and care homes committee. In some cases, history does not offer much help when we consider working relationships in that sector. Local authorities have been providers of accommodation themselves, as well as purchasers of accommodation and services from the private sector and regulators of that sector. They have experienced considerable conflicts of interest, because they are asked to regulate homes that are in competition with those that they provide. There are many stories from many parts of the country about practices that we certainly should not accept. I know that the Minister would not accept them; that is, in large part, why the Government want to change the regime and to establish a level playing field. 4.45 pm The Bill will separate the role of regulator from that of provider. For the first time, it will require local authorities that provide care home or nursing home accommodation to be regulated in the same way as their private sector competitors. We acknowledge that the establishment of that regime is an important element of the measure, and we welcome it. People who are active in the sector are anxious about the fact that those with whom they have, with difficulty, built relationships on specific issues locally will arrive on their doorsteps as the inspectors for the National Care Standards Commission. Although everyone might be working on the new level playing field that the Government are creating, we all know that it is easier to change a title than to deal with deep-rooted, long-established personality differences that have grown up over a long time. As the Minister acknowledged in Standing Committee, in some cases there will be real difficulties in ensuring that there are constructive working relationships between the commission inspectors and the providers of residential accommodation. Much confidence building and tender loving care will be needed to convince all the providers that the new regime genuinely represents a break with the past and with a system that many people feel is discredited. A dedicated commissioner and committee would send the right signals—a positive message to encourage all parties to build constructive relationships in the future. The aims of the Liberal Democrats' amendment No. 32 are closely linked to those of amendment No. 3. An interesting twist in amendment No. 32 is that it provides for the appointment of a deputy chairman from the staff of the Commission for Health Improvement. I realise that the provision was designed to ensure that the committee includes a member with expertise in acute health care—indeed, that it is led from the top, or near the top, by such a person. That would address the fear expressed by those in the independent acute sector that their needs might be swamped by the broader responsibilities of the National Care Standards Commission for registering and regulating care homes. I anticipate that there will be certain practical problems with the Liberal Democrats' proposals, but I look forward to hearing the detailed reasoning for their approach to a problem that we have both identified. Their amendment deals with concerns that we share. The Government have embarked on the creation of a level playing field for care home regulation and registration. In Committee they made a minor concession in relation to boarding schools, and made it clear that they did not want a distinction between independent and local authority schools. That was another step in the right direction, but we have come to a deeper philosophical divide in relation to acute hospitals. The Under-Secretary, the hon. Member for Birmingham, Edgbaston (Ms Stuart), said openly in Committee that the Government were committed to the managed system of health care and to the Commission for Health Improvement, which has no power of deregistration. If it finds a problem in the national health service acute sector, all that it can do is report the problem to the management—which may be responsible for the problem in the first place. It will have to rely on the Secretary of State's powers for direction and central management of the national health service to try to deal with the problem. In the independent care sector, the National Care Standards Commission will have real teeth, because it will be able to deregister someone who is in breach of the standards or who has not behaved properly in any other way. Our amendment and the Liberal Democrats' amendment seek to address the real concerns of the independent health care sector and to make the level playing field a reality. The amendments recognise that both sectors—the independent sector and the national health service—can learn from each other. There is not a monopoly of wisdom on either side, and no one thinks that there is. The amendments will help to ensure—there is no guarantee—that independent sector providers are not saddled with inappropriate registration or inspection regimes, and that the many different functions of independent hospitals are properly recognised. The industry believes that there would be safety in having a dedicated commissioner, and amendment No. 3 seeks to provide for one. The Liberal Democrats have a similar aim in amendment No. 32. In a letter to me dealing with outstanding matters from the Committee, the Minister described Government amendment No. 82 as a drafting amendment. However, as he said in his opening remarks, it addresses the question of how the National Care Standards Commission will operate. Will it mainly employ its own staff, or contract its functions out? In other words, will it follow the local authority or the Ofsted model? Will the initial position be enshrined in any way or may it change over time? Does the Minister envisage the position evolving once the initial cohort of staff, who will transfer from local authorities and health authorities, is replaced by other people? Members on both sides of the House will wish to explore that issue a little so that they can understand the significance of the change that the amendment will make to schedule 1. This interesting and diverse group of amendments and new clauses will significantly improve the Bill—and I include the Government new clause and amendment in that description. I look forward to hearing in due course the Minister's answers to my questions.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I look forward to the contribution of the hon. Member for Chatham and Aylesford (Mr. Shaw). The hon. Member for Runnymede and Weybridge (Mr. Hammond) said that he looked forward to the Minister's response in due course, and it remains to be seen how long, and how detailed, that turns out to be, as I know that some Members are minded to engage in a detailed dialogue on these matters. The Government amendments are wholly welcome and useful additions to the Bill, and rightly respond to concerns that were raised by Members on both sides of the Committee. The hon. Member for Runnymede and Weybridge broadly welcomed amendment No. 31, which we tabled and to which my hon. Friend the Member for Isle of Wight (Dr. Brand) will speak in some detail. When he does so, we shall see whether the amendment involves the degree of paranoia that was suggested might underpin it. My hon. Friend and I wish to ensure that the Minister addresses concerns on that matter. I wish to concentrate on amendment No. 32 and shall comment in passing on amendment No. 3, which was tabled by the hon. Member for Runnymede and Weybridge. Both amendments deal with the same issue, as the hon. Gentleman and I, as well as many other Members, are trying to find a route by which we can create a common architecture for establishing a sensible regime of standard setting across the health sector, regardless of whether services are public or independent. Our discussion is part of a long-running debate—indeed, I suspect that the Minister sometimes thinks that it has been running for far too long—which started with consideration of the Health Act 1999, when we had detailed discussion in Committee and on the Floor of the House about the role of the Commission for Health Improvement, and which continued with the progress of the Bill through all its stages in the Lords and in this place. It has begun to feel a bit like trench warfare, as there are two clearly defined positions, one on whether it is possible to establish a common framework in which health care standards are set and assured and the other on whether we have to have two parallel or separate structures to do that. To be fair, the Government have moved quite a long way from the position originally taken by the right hon. Member for Holborn and St. Pancras (Mr. Dobson), the former Secretary of State. When the Select Committee on Health conducted an inquiry into the regulation and inspection of the private health care sector, the former Secretary of State responded to a question from my hon. Friend the Member for Isle of Wight by saying that it was not the role of Government to provide a stamp of approval for the private sector. Clearly, things have moved on, and the Government recognise that there is a legitimate role for Government in providing a mechanism to give the public assurances and guarantees of standards wherever they receive health care. We welcome that movement, which has continued with the passage of the Bill through this place and the House of Lords. When the Bill was published, it was plain that the National Care Standards Commission would have a role in private health care, but that that would be clearly separate from the NHS. CHIMP was not to have a role in private health care because, as several Ministers said, CHIMP is a tailor-made institution, geared to dealing with the specific circumstances of the NHS, which is a managed service. By contrast, they said that private health care services needed to be brought into a regulatory framework. Somehow, those two things were completely different and could not be brought together in a single structure. Since then, however, in the other place, a majority of their lordships decided that the Bill was defective and a clause was added which would have given CHIMP a specific role in providing, on behalf of the NCSC, inspection and registration of the independent sector. That new clause was subsequently removed in Committee, much to the regret of my hon. Friend the Member for Isle of Wight, myself and many people outside the House. 5 pm We are particularly concerned that the Bill remains silent on the question of a duty of quality that will apply across the board, and not only to the NHS, in respect of which we have debated the rightful need for such a duty to exist. A similar, comparable standard should be applied to the private sector. The Government should now make further moves on that, and even if we cannot affect their actions in this debate, I hope that when the Bill returns to the other place, their lordships will closely examine our debates in Committee and on Report and give the Government an opportunity, by way of an amendment, to think again about how they can provide a consistent framework. There is no difference between a medical intervention in the private sector and one in the NHS—how can there be? I do not understand how clinical governance can be relevant in the NHS but irrelevant in the private sector. We were told that clinical governance was irrelevant in the private sector because it was defined only in regulations and not in a Bill. Surely it is not beyond the wit of the Government to find a mechanism to provide such a definition so that there is clarity about what clinical governance means in the private sector. It should mean exactly the same as it does in the NHS. The same applies to clinical management of patients. Surely that also requires common standards. That would be common sense, and we still do not understand why the Government are not prepared to put in place the mechanisms that will guarantee those common standards for everyone in this country. As I said, the Government's case is that the NHS is a managed service, but the private sector is not and has to be regulated in some form. However, the NCSC will be regulating managed services provided by the public sector, such as boarding schools and colleges, and care homes run by local authorities. Why is it that those institutions, which are provided for and managed by the public sector, have to be regulated and inspected, but the NHS, which is also provided for and managed by the public sector, is not to be regulated and inspected in the same way? What is the difference? Is it simply that the Government are not prepared to trust local government in this respect? What is the difficulty that means that the Government want to twist the logic of the case for a seamless system and have a two-tier system instead? The Minister has not explained that, and in Committee his colleagues did not adequately address that conundrum, which is at the heart of the Bill. Amendment No. 32, in my name and that of my hon. Friend the Member for Isle of Wight, is intended to provide a vehicle for debate about that and to give the Government a chance to reflect further on what mechanisms could be put in place to use the skills and resources that will be at the disposal of the Commission for Health Improvement to ensure that we are monitoring and driving up standards in the private sector. The hon. Member for Runnymede and Weybridge did an admirable job of explaining the purpose of that amendment, so I will not say much more about it. I am grateful for his broad support. Amendment No. 3 in his name takes a similar approach in trying, albeit by a very different route, to provide a structure that would bring together the two sectors. Ideally, the Commission for Health Improvement should be an arm of the NCSC. That would be logical and it would provide a better fit if we are to have a system that covers the independent sector and the public sector. When one considers that there are more than 200 hospitals in the private sector with more than 10,000 beds, and that last year, there were some 800,000 treatments in that sector, it makes no sense to exclude those treatments from a regime that guarantees standards. That is why we think that one regime with one set of standards and a common understanding of clinical governance would be far better than two separate regimes. In a sense, our amendment is about establishing a vehicle through the NCSC that will achieve that—albeit by dint of setting up a committee. Committees might not be the best vehicle, but they are a means of persuading the Government to consider the matter further. If we have two separate regimes, as we will under the Bill as drafted, there is immense potential for grey areas to engulf the issues of who has responsibility for the inspection of services, where the line should be drawn between acute and chronic care, and which body has responsibility for the public and the private sector. What if an NHS patient is taken into the private independent sector? Does the inspection regime follow the patient, or does it depend on which bed they occupy when receiving treatment?

Philip Hammond (Conservative, Runnymede and Weybridge)

Does the hon. Gentleman agree that the Government's introduction into the Bill of clause 7, which allows cross co-operation between the Commission for Health Improvement and the NCSC, averts some of the more bizarre possible outcomes while doing nothing to address the fundamental issue?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I agree absolutely. The hon. Gentleman allows me to acknowledge that, to some extent, the Government have changed their mind and addressed the concerns raised by Opposition Members and Cross-Benchers in the Lords. It is right to establish a mechanism whereby cross-contracting can take place. However, we want to go further—hence our amendment and our argument that, instead of allowing the possibility of contracting to take place between the two agencies, the Government should recognise the necessity of doing so, or—better still—make CHIMP part of the NCSC. Barring a miracle, it is unlikely that we shall be able to gather enough votes today to persuade the Government to accept either amendment No. 3 or amendment No. 32, but there is a possibility of our doing so in the other place. I hope that, when their lordships give the Bill further consideration, they will agree with Opposition Members that the matter is one that should not be left as it stands, with the Government amendments made in Committee, and that there is a long way to go before the public can be guaranteed common standards of care wherever they happen to be treated, whether in the independent health care sector or the NHS. That is what the public now want. When told that there are to be two separate regimes governing the quality and standards of care that they receive, the public are horrified. They want guarantees, continuity and standards that can be assured throughout the health sector. That is what the amendment is designed to achieve. I hope that the Government will accept it, but, if they do not, we hope that the Lords will do more.

Jonathan R Shaw (Labour, Chatham and Aylesford)

I welcome new clause 16. I hope that my hon. Friend the Minister of State will be able to advise me whether one of the matters that the commission may consider is private fostering. In Committee, I tabled an amendment requiring those individuals who carry out private fostering to be registered with the commission. I did so not only because of my personal experience, but because Sir William Utting referred to the matter in his report, as did former social services inspector Lord Laming during the Lords consideration of the Bill, and the social services inspectorate in 1994: all called for those who privately foster children to be regulated. However, because the arrangement is a private one, under the provisions of the Children Act 1989, such individuals merely have to notify the local authority that they are looking after children. Many eminent reports have stated that that does not meet the safeguards that we would want for particular children. We do not know how many children are privately fostered, often for a small amount of money. There will be far tighter regulations for day care, where children go home at some part of the day, than for children who may be with private foster carers for weeks, months or years. My hon. Friend the Minister said that he took the matter seriously. He repeated the response of my noble Friend Lord Hunt of Kings Heath that the social services inspectorate was also be taking the matter seriously and would be requiring local authorities to have greater regard to the responsibility to ensure that private foster carers notify local authorities so that they can be inspected. It has been repeated that there will be a national publicity campaign to ensure that people are aware of their responsibilities. Suppose that, following the national publicity campaign and the requirement on local authorities, the NCSC, perhaps in consultation with the social services inspectorate, was more rigorous in ascertaining how many children were in private foster care and whether they were being cared for to a standard that we would expect. Would the sharing of that information, if the NCSC raised concerns with my hon. Friend, lead him to introduce legislation of the sort suggested in my amendment, which has been recommended by distinguished Members of the other place who have long experience in these matters? Would my hon. Friend be able to make changes to the foster regulations under the Children Act 1989, or would he have to introduce primary legislation?

Eric Forth (Conservative, Bromley and Chislehurst)

Those of us who did not have the honour and privilege of considering the Bill in Committee now have the chance to express our thoughts about the Bill, including the matters immediately before us. I make a preliminary observation. My heart sinks whenever I see a Bill like this one and whenever I hear the dialogue that has already taken place, which is a sort of throat clearing for the main business that is to come. I am not surprised that we are already in something of a tangle with this group of amendments. I shall say a few words and ask a few questions about each one. We are in a world in which both the Government and the official Opposition claim repeatedly to be deregulatory, to believe in a free society and to wish to dismantle red tape and bureaucracy—I do not know whether the Liberal Democrats sign up to that—yet we are confronted with a Bill that will have precisely the opposite effect. I accept that on Second Reading and in Committee, it was agreed that there was a need to adopt the approach that is set out in the Bill. I do not intend to challenge that for the moment. That is also a preliminary observation. It is no surprise to me, however, that Members then become hopelessly bogged down when considering the minutiae of what the bureaucracy that we are now setting up will do. One would have thought that its aims were clear enough, but what will it do in detail? The new clauses and amendments that have already been touched on illustrate well how one can set up a well-meaning bureaucracy, but get into difficulty in defining not necessarily its aims, which can usually be pretty well defined, but the way in which the aims will be fulfilled. 5.15 pm New clause 16 is pretty opaque to say the least, certainly to the layman coming to it for the first time. On the face of it, it should be relatively straightforward. It refers to section 48, but if one goes to clause 48 for guidance and clarity, one is surprised to see that it refers to section 23. Clause 23(1) states: The appropriate Minister may prepare and publish statements of national minimum standards applicable to establishments or agencies. That is clear enough. Subsection (2) states: The appropriate Minister shall keep the standards set out in the statements under review and may publish amended statements. Subsection (3) states that the appropriate Minister shall consult any persons he considers appropriate. The Minister will undoubtedly be able to help us later, but given that the Minister shall keep the standards…under review and shall consult any persons he considers appropriate— not our old friend may, but shall, which is strong and prescriptive—I should have thought that, without any doubt, that means that the Minister will involve the commission in the review of national minimum standards. Yet new clause 16 states: The Commission may at any time give advice to the Secretary of State on…any changes which the Commission thinks should be made. I shall come in a moment to consider the commission's terms of reference—to look, as it were, through the other end of the telescope—but any reasonable person would be satisfied that, given clauses 48 and 23, the Minister would be most unlikely to discharge those elements of his responsibilities without fully taking the commission's views into account. Therefore, because of the obligation that I am assuming, the first question that arises is whether new clause 16 is otiose. The Minister may tell me later that I am wrong in that presumption, but, for the moment, I think that a reasonable person would want to take that view.

Philip Hammond (Conservative, Runnymede and Weybridge)

My right hon. Friend may not yet have had a chance to look ahead to new clause 4 in the next group of amendments, but, if he does, he will see that it puts precisely that obligation on the Secretary of State, before bringing forward any new standards under what will be a replacement for clause 23—that he must consult and seek certain information from the commission.

Eric Forth (Conservative, Bromley and Chislehurst)

I am grateful to my hon. Friend for that. I am a slow reader, so I have not quite reached that point yet. I shall want to look at it and listen to what he says at the appropriate time. I am even more puzzled because in clause 7, entitled "General duties of the Commission", subsection (5) states: The Commission may at any time give advice to the Secretary of State on— (a) any changes which the Commission thinks should be made…and (b) any other matter connected. I should have thought that that gives an extraordinarily wide—almost certainly rightly wide—remit to the commission to give advice to the Secretary of State. Yet new clause 16 seems to be in the business of gilding lilies, saying: The Commission may at any time give advice…under section 48. We need some clarification. I fear—this is my suspicion about this group of amendments, as I suspect it will be about the next group when I catch up with the reading that my hon. Friend has set me—that when we get into this, we will begin to see that we are wading not just knee deep, but waist deep in a mass of verbiage which, if we are not careful, will obscure the objectives, with which everyone appears to agree, of the new bureaucracy. That is, of course, the danger. Bureaucracies are bad enough as they are, and rarely achieve the ends that are set. Goodness knows, one can point to any number of examples in other walks of life where there are bureaucracies, commissions and regulatory regimes that hopelessly fail to fulfil their task. One hopes that that will not be the case with the Bill, but I, for one, do not set out with any great optimism. My problem with new clause 16 is that I cannot for the life of me see how it adds materially and usefully to the wording in the Bill. In Government amendment No. 53, we are in the "exceptional circumstances" business. The amendment refers to the publication of material and whether that should be done routinely. Again, I accept that the Minister tried to be helpful in his brief explanation. I can understand that he may want to move things along, as Ministers often do, but our job is not to move on until we are satisfied. We must consider what the words suggested in the amendment add materially to the Bill. I confess that I am somewhat mystified. The original words are: The report of the person who held the inquiry shall, unless the Minister who caused the inquiry to be held considers that it would be inappropriate to publish it, be published in a manner which that Minister considers appropriate. I accept what the Minister said—there is a presumption of publication. In the new world of open government, that is as it should be. However, the Bill already states that if the Minister considers publication inappropriate, the report will not be published. According to the amendment, the report will be published unless there are exceptional circumstances. For the life of me, I can see no material difference. Of course, I am not remotely querying the sagacity of the selection of the matter for debate—far from it—but there is an onus on the Minister, who is suggesting a different form of words, to explain to us more fully why he concluded that the original wording in his own Bill was not satisfactory for the purpose that he stated, and why the new words are a material improvement. That, after all, is why we are considering the matter. I thought that the original words were perfectly fit for the purpose. Obviously, I do not want to digress or delay the House unnecessarily, but we could get into a debate about that. The Minister gave us one or two examples of possible exceptional circumstances. We do not need to get bogged down in that, but we may want to know to what extent the Minister thinks that the power, in the existing words or the Government amendment, is likely to be invoked. The Minister wanted to reassure us that that would rarely happen but, as we all know, the good intentions set out at this stage in the proceedings to make us feel warm and comfortable about something often do not stand up in the cold, harsh light of the real world, when the matters on the statute book are tested in practice. Amendment No. 31, which was tabled by the Liberal Democrats, rather puzzled me. I got the impression that the amendment was designed to restrict the powers in the Bill, and I was not sure why that was necessary. The present wording is fairly general— considers it necessary or expedient to have for the purposes of its functions under this Part. The important question is whether adding "of regulation and inspection" strengthens, clarifies or limits it.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

It does.

Eric Forth (Conservative, Bromley and Chislehurst)

In typical Liberal Democrat fashion, the hon. Gentleman says, "it does" when I have asked three different questions. Perhaps he would like to pick one of the three and help me.

Peter Brand (Liberal Democrat, Isle of Wight)

Wait and see.

Eric Forth (Conservative, Bromley and Chislehurst)

The hon. Gentleman is reluctant to help, but his hon. Friend tells us to wait. I am really excited now. We have had a hidden Liberal promise of clarification to come. I shall contain myself for now, exercising patience in the expectation that the hon. Member for Isle of Wight (Dr. Brand) will regale us later with a much fuller explanation of what the amendment is all about. I shall restrict myself merely to posing my questions now, but if the hon. Gentleman does not keep his promise, I shall find some way to punish him. He can only guess right now at what my means may be, but they may become obvious as the night wears on. That brings us neatly and satisfactorily to amendment No. 96, which is much more interesting and with which my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) dealt very ably. More and more as we consider Bills, we debate the necessity and wisdom of giving powers of entry and investigation to authorities and bodies, and the extent to which we wish to make those powers general or to restrict them. I can see what my hon. Friend's amendment is driving at: he wants to restrict to genuine local authority premises powers that could be extremely wide and intrusive, and he wants to ensure that private dwelling houses are not covered. I confess that I wonder whether that would inhibit the legitimate purposes of the Bill and the bureaucracy. I am caught in a dilemma on this point: I have explained my reservations about bureaucracies, regulatory powers and powers of entry, but I must, reluctantly, accept that once the House has accepted the general purpose of a Bill, we can only ask whether it will be effective. There is a slight risk—I put it no higher—that amendment No. 96 could, in some circumstances, inhibit or restrict the proposed powers. I can imagine circumstances in which something happens in the private house of a foster parent about which we may have legitimate concern. Given the relationship between foster parents, local authorities and the proposed bureaucracy, we can query how far the Bill's powers should be restricted or left broad.

Ian Bruce (Conservative, South Dorset)

rose—

Philip Hammond (Conservative, Runnymede and Weybridge)

rose—

Eric Forth (Conservative, Bromley and Chislehurst)

My hon. Friend the Member for Runnymede and Weybridge can help me because he proposed the amendment.

Philip Hammond (Conservative, Runnymede and Weybridge)

I recognise my right hon. Friend's concern, but there are two points at issue. First, powers exist, particularly under the Children Act 1989, to allow entry in order to protect a child at risk. Secondly, we must make sure that our sanctions and intrusions are proportional to what we seek to do. I believe that my amendment has the balance right.

Eric Forth (Conservative, Bromley and Chislehurst)

I am grateful. If my hon. Friend cannot envisage circumstances in which his amendment would prevent the proper discharge of the duties in clause 44, I must be satisfied.

Philip Hammond (Conservative, Runnymede and Weybridge)

I should make it clear that the Minister has already told the Standing Committee that in the Government's view, there is no power of entry to a private dwelling house under this part of the Bill. The amendment would simply make the Bill clear, which, in my submission, supported by my right hon. Friend's interpretation, it is not at present.

Eric Forth (Conservative, Bromley and Chislehurst)

That is helpful. Of course my hon. Friend has just shown the disadvantage that those of us who did not serve on the Standing Committee have in such matters. I will not be tempted to dilate on Pepper v. Hart; he is not trying to do so. If the Minister has put that on the record in Committee, that may be good enough. Of course I accept what my hon. Friend says; he wants only to put such matters beyond doubt—even beyond the Minister's words, which are on record. The Minister has already said that that is an appropriate matter and I am grateful to my hon. Friend for that clarification.

Ian Bruce (Conservative, South Dorset)

I, too, did not serve on the Standing Committee. Indeed, I had not read clause 44 until warming up for the debate, but I have read the Regulation of Investigatory Powers Bill, which will restrict law enforcement officers and all sorts of other people from entering a private dwelling or whatever. It strikes me that, without amendment, the Bill could directly contradict another Government measure that is being considered in the House of Lords. Will my right hon. Friend comment on that extraordinary situation?

Eric Forth (Conservative, Bromley and Chislehurst)

My hon. Friend may think it extraordinary, but I am not sure that I do. He characteristically gives the Government the benefit of the doubt in assuming that they are consistent. I have never believed that and, in his perspicacious way, he shows that the Government are all over the place.

Ian Bruce (Conservative, South Dorset)

That is putting it mildly.

Eric Forth (Conservative, Bromley and Chislehurst)

Yes, it is. Perhaps my hon. Friend would like to develop that point in his own way; I do not want to encroach on his territory. I shall move on swiftly to amendments Nos. 3, tabled by my hon. Friends, and 32, tabled by the Liberal Democrats, by which they seek to pre-empt or prescribe the way in which the commission will discharge its responsibilities. That is an important issue. We should carefully consider whether it is beneficial for the House to prescribe how the commission will work, even in the way in which my hon. Friends suggest. Amendment No. 3 states: The commission shall establish…an independent Healthcare Committee…a Nursing and Care Homes Committee…a Directorate of Independent Health Care…a Directorate of Nursing and Care Homes… The Secretary of State may by regulations define the respective responsibilities… That seems to go a bit far, even for enthusiasts of bureaucracy. Either we have reasonable confidence about how the commission will discharge its duties, or we do not. Even at this late stage, my hon. Friends want to state in detail how the commission will be structured and how it will carry out its responsibilities. I make no apology for taking them to task, but they even want to state that there should be an Independent Healthcare Committee chaired by a Commissioner who shall have specific responsibility for the Commission's functions in respect of independent hospitals… I yield to none in my admiration of my hon. Friends' perspicacity and foresight, but for them to suggest that they can envisage, with such clarity, how the commission should function and discharge its duties seems to go a tad far, and I therefore remain to be convinced.

Simon Burns (Conservative, West Chelmsford)

I want to press my right hon. Friend on that matter. I fully appreciate the point that he makes, but we shall have only one stab at the Bill. Can he foresee how the law could be changed if such a provision were not included and the experience of the system working in practice suggested that what my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) proposes in amendment No. 3 was needed?

Eric Forth (Conservative, Bromley and Chislehurst)

In an attempt to justify the wording of amendment No. 3, my hon. Friend gives the game away completely. He has reminded the House, as I was about to, that it is difficult, though not impossible, to alter or remove a proposal once it has been included in a Bill. That is my worry. By my reading, if we do not use either the wording suggested by my hon. Friends or that suggested by the Liberal Democrats, the commission will be free—within the broad terms of its remit and, if necessary, under guidance from the Secretary of State, which is also in the Bill as a longstop or failsafe—to structure itself as it sees fit and to set up such sub-committees as it sees fit. That will provide the flexibility to enable it better to react to changes in circumstances. As my hon. Friend the Member for West Chelmsford (Mr. Burns) points out, if a well-meaning form of words is included, it will be there for ever, or at least until a future Government get round to trying to change it. Were the Government to be re-elected, we know that their legislative programme would be so full that the chance of changing the wording would be zero.

Jacqui Lait (Conservative, Beckenham)

I have huge sympathy with what my right hon. Friend says, but will he bear in mind that the Bill already provides for a children's rights director who, although not a commissioner, is specifically referred to? That is frightfully politically correct, and I accept his reaction to that, but does he accept that independent health care and social and nursing care, to which my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) refers in amendment No. 3, are the two areas in which the Government find the greatest anathema in respect of providing care across the spectrum? Therefore, specifying that a commissioner is responsible for those areas will make it palpably clear that the person appointed will be put under the spotlight to ensure that the commission's powers are exercised truly impartially.

Eric Forth (Conservative, Bromley and Chislehurst)

I am grateful to my hon. Friend and neighbour, who has given as elegant an explanation of amendment No. 3 as one could expect. I can of course see the force of what she says, but again my reservation is that circumstances can change rapidly, as we know, and sometimes to our cost. My worry is that committing ourselves to such a degree of detail at this stage would also commit the commission and create the danger of rendering it relatively inflexible when flexibility is of the essence. I still have my reservations, in spite of the valiant effort to persuade me.

John Bercow (Conservative, Buckingham)

Will my right hon. Friend give way?

Eric Forth (Conservative, Bromley and Chislehurst)

Yes, I shall let my hon. Friend have a go.

John Bercow (Conservative, Buckingham)

I understand my right hon. Friend's objection to, and general concern about, the excessive rigidity or specificity, but is there not another concern, which I would usually expect him to express? Unless there is some codification in the Bill, the danger is that unamended Henry VIII clauses will allow a usurpation of a power, to which he would usually object.

Eric Forth (Conservative, Bromley and Chislehurst)

Of course I accept what my hon. Friend says, but my assumption is that the Secretary of State will soon be a Conservative Secretary of State. Therefore, what my hon. Friends have in mind and what my hon. Friend the Member for Beckenham (Mrs. Lait) suggested a moment ago could be achieved elegantly and amply under the existing wording. I know that none of my hon. Friends assumes or even expects the Government to be re-elected, so there is no need to put a defensive and protective provision in the Bill and set it in concrete. However, my hon. Friend the Member for Buckingham (Mr. Bercow) has made an important point, as usual, and, as always, we are in a dilemma as to whether we, as legislators, believe in a general power for a Secretary of State, with the flexibility that goes with it, or think it preferable to include ever more detail in legislation—perhaps to restrict the opportunities for a Secretary of State to intervene. There are more than sufficient powers for the Secretary of State in the Bill. Henry VIII is wandering through the Bill, and this attempt to pre-empt or restrict that probably will not succeed. I remain to be convinced by the amendments, although I will listen to the many different views that will be expressed over the next hour or two. Amendment No. 82 may be the most interesting and worrying of the amendments and proposes something with which we have become familiar—the powers of delegation. It says: An authority may make arrangements with persons under which they, or members of their staff, may perform functions of members of the staff and of the authority. I will not repeat my earlier argument but I am not sure how this adds to the original wording. Such provisions always lead to wider issues, as we have seen in other Bills. How far does the Minister believe the proposal will go? Could there be restrictions on the persons with whom arrangements are made and to whom delegation is given? Either we take a fairly restrictive view or there will be a flexible arrangement. The Minister must assure us that the exercise of powers under the amendment would be limited and restricted and that a guarantee or safety mechanism will be available so that there is no danger of delegation to persons who are not fully qualified. If the authorities find themselves under pressure to fulfil their responsibilities, there may be a risk of delegating to the wrong people, and we will be right back at the difficulties with which the Bill is trying to deal. The present wording—even with the imprimatur of the Minister and the Secretary of State—worries me. I might have been reassured if it had said "appropriately qualified persons" or "persons with appropriate references". However, the current wording appears to leave the matter loose and over-flexible.

Philip Hammond (Conservative, Runnymede and Weybridge)

Does my right hon. Friend conclude that those persons to whom the powers are delegated will have all the powers of entry that inspectors have under the Bill?

Eric Forth (Conservative, Bromley and Chislehurst)

That must be a suspicion. Some wide powers may devolve, worryingly. to unspecified persons. It is not good enough for the Minister to say that flexibility is needed and that provision must be made for other people to be brought in. In this of all matters—given all the sensitivities that surround it, and all the history behind it—if we are to legislate properly, and provide the reassurances and guarantees that are required, we must have a form of words that gives us more reassurance than we have now.

John Bercow (Conservative, Buckingham)

As the devolution of responsibility may entail contracts with outsiders, can we at least be reassured by the Minister—in so far as he feels able to attend to the debate—that such arrangements will be undertaken only after a process of competitive tendering? Or will this take place simply on the basis of the old pals act?

Eric Forth (Conservative, Bromley and Chislehurst)

I hope that others are listening, although the Minister patently is not. Perhaps he will be appropriately advised at the appropriate time, although it may take quite a bit longer than he thinks if he carries on in the same way. I may have to repeat everything when I think he is listening to me, and I doubt that he would want that. My hon. Friend the Member for Buckingham has raised an interesting point. The mechanism whereby the delegation is to be achieved is unspecified. The wording gives no hint or clue about the connection between the delegating authority and those to whom the important powers may be delegated—including potentially, as my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) pointed out a moment ago, powers of entry, inspection or whatever. We are completely in the dark about who the people concerned may be, what guarantees or reassurances we may have about them, their relationship—contractual or otherwise—with the authority, and the extent to which the authority may have sought appropriate reassurances in terms of qualifications or references. We know none of that, and the wording gives no clues. I fear that amendment No. 82 poses at least the danger—I put it no higher than that: not the likelihood, but the possibility—that a risk of some kind could emerge. That, as I understand it, is exactly what the whole Bill is intended to avoid. The new clause and Government amendments illustrate all too well the dangers that we encounter when we embark on the route of bureaucracies, regulations, regulatory powers, regulatory mechanisms and the like. No matter how well justified such measures may appear on the face of it, we can readily see those dangers just from this first canter around the course. For we have not yet reached the meat of the Bill: although we are discussing important matters, there is much more to come. Already, in scratching the surface in a rather superficial way, we have dug up all sorts of difficulties. The Minister could not reassure us, and—if I may say so—even my hon. Friend the Member for Runnymede and Weybridge, in his much clearer and more concise speech, was unable to answer all the questions that, in my modest and very brief way, I have tried to pose.

John Bercow (Conservative, Buckingham)

Will my right hon. Friend give way?

Eric Forth (Conservative, Bromley and Chislehurst)

I will give way once more, but I am trying to conclude my speech.

John Bercow (Conservative, Buckingham)

I am exceptionally grateful to my right hon. Friend for his characteristic generosity. I am sorry to interrupt his flow, but I wonder whether he can answer a question. Speaking to amendment No. 32, the hon. Member for Sutton and Cheam (Mr. Burstow) argued that the regulations that he advocated should be subject to the negative or the affirmative procedure. The capacity to debate the regulations, however, is surely of the essence.

Eric Forth (Conservative, Bromley and Chislehurst)

It is to my hon. Friend and me, but I do not recall the hon. Member for Sutton and Cheam (Mr. Burstow) saying as much. I do not think that the Liberal Democrats are all that bothered about parliamentary scrutiny, or about negative or affirmative resolutions. They are not here very often, and when they are they seem to be in the Government's pocket. My hon. Friend and I pay close attention to such matters, but I do not think that we can look to the Liberal Democrats to help us, now or in the future. All in all, an awful lot more will have to be said about the new clause and some of the amendments before I am satisfied. Although the Minister did not listen to some of what I said—I cannot imagine why—I know that, having been properly advised, he will be able to give full and comprehensive answers to my points and those made by others. We shall have to make our judgment on the basis of those answers when—somewhat later, I suspect—we vote on the new clause and amendments. The position is certainly not self-evident to me.

Peter Brand (Liberal Democrat, Isle of Wight)

This is the first time that I have had the privilege of following the right hon. Member for Bromley and Chislehurst (Mr. Forth) and it is a curious experience. At the outset of his contribution, he declared himself as a legislative nihilist—he does not believe in regulation and clearly feels that the safety of vulnerable people should be left either to the marketplace or to self-regulation. He then talked about having more powers for the Secretary of State without making them explicit in the Bill, and turned that argument round and said that the Bill was not explicit enough, so I find that confusing. The right hon. Gentleman made a threat, which I did not find alarming; I was not surprised at his comment. It was not even an implied threat. It was that we might all be punished tonight by some means not yet declared if we did not toe the line. I am not aware that activities in the Chamber are designed to indulge either masochist or sadistic tendencies. I am sure that we will get many contributions from the right hon. Gentleman. If he would let me know how long he is going to take, we can rest while he makes them. I address my main remarks to amendment No. 31, which deals with clause 31. There is a concern that we do not give the commission undue powers. Clause 31 says that the registration authority can require—presumably, it is a statutory requirement—to have information made available if it is "necessary or expedient". I can see that it may be expedient for a registration authority to ask for all sorts of information, but I am also aware that red tape is a major imposition, especially for small businesses, and that information does not come free. It takes time and resources. Incidentally, it also takes time and resources to analyse it once it has been obtained. It is clear from the rest of the Bill and from some of the earlier comments that the commission will have a role over and beyond registration and inspection. It is right that the commission should have statutory powers to require information to be made available where it is dealing with the safety of the public. Therefore, in relation to its registration and inspection function, it is totally appropriate that anyone running an establishment described under the Bill should be made to provide information when it is requested, but I have an anxiety that that statutory requirement might be extended, because it is convenient and expedient for the registration authority, to other areas such as the giving of strategic advice to the Minister on how many beds might be needed in 10 years, and what the industry's intentions are on retirement and non-retirement. Those are important issues. Clearly, consultation with the industry is important, but it should be consultation on equal terms, rather than a requirement by law. It is a simple amendment. I hope that the Minister will take it on board. It in no way diminishes the powers of the registration authority in its primary function: the protection of the public. I touch on the other amendments in the group, notably Nos. 3 and 32. My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) Sutton has squared the circle in relation to regulation and inspection of acute and chronic services in the private and public sectors. In my clinical practice, I sometimes find it difficult to decide in which of the four categories a particular patient is in the course of treatment or the course of a disease. The permutations are quite large. It would be helpful if we had a common regulation and inspection regime. To have the Commission for Health Improvement as the specialist hospital arm, the specialist medical arm, of a national commission makes extraordinary sense. It would still allow the Government to have their own machinery to advise them, but it would also create a healthy, slightly arm's-length relationship, between the Secretary of State in his managerial function with regard to the national health service and the Secretary of State in his regulatory role through the Commission for Health Improvement. I urge the Government to look at that as a way of still accepting that the NHS is different from the private sector, but overcoming their dogmatic doubts about a common way of dealing with the problem. As usual—it is the usual phrase that we used in Committee—I look forward to the Minister's response. I hope that he will give us some confidence on small matters, but that he will consider the real nub of the argument, which is the safety and quality of standards for all people needing medical, nursing or caring services, irrespective of who provides it and where it is provided.

Jacqui Lait (Conservative, Beckenham)

Before I contribute to the debate on the Bill for the first time, I should like to put on record the fact that before I entered the House in 1992, the National Care Homes Association was a client of my lobbying business, but that subsequently, I have had no remunerative interest in the association at all. However, my husband is the leader of the Conservatives on East Sussex county council, and of course, all social service issues are a responsibility of county councils. For a brief period, he was chairman of the social services committee, and tried hard to persuade the county council to get rid of its substandard care homes. The Lib-Lab pact managed to defeat that, but the objective still remains. By putting those two things on the record, I hope that I have not only clarified my position, but made it clear that I have some knowledge of many of the areas that we are talking about. Indeed, I have long advocated the establishment of some form of national standards and care structure for the social care and nursing care sectors. Therefore, in principle, I do not have a difficulty with the structure of the Bill as it has emerged from the various stages of its consideration. It may cheer the heart of my right hon. Friend and neighbour the Member for Bromley and Chislehurst (Mr. Forth) that one of the most overbearing parts of the private sector care standards regime is being totally repealed by the Bill. The repeals list shows that the Registered Homes Act 1984 and the Registered Homes (Amendment) Act 1991 will both be repealed in total, so one form of bureaucracy—a very hard and overbearing bureaucracy—will disappear. I hope that my right hon. Friend—I see him nodding—will appreciate that occasionally, legislation can lead to the death of bureaucracy, as well as—as is happening in this case—the creation of further bureaucracy. It is the concerns about the further bureaucracy that I shall take up, as will many of my right hon. and hon. Friends. Government new clause 16 is about the advice to Ministers on fostering and adoption. I think that we have established the fact that the advice and how it is implemented will be covered by regulations, which will be taken under the negative resolution procedure. Most Conservative Members find that somewhat concerning, because that procedure makes debate so difficult. However, what concerns me even more is the lack of any assurance that before regulations are promulgated, those who will be affected by them will be consulted. That concern is reinforced by the fact that publication of the commission's advice will not be mandatory. 6 pm It is therefore possible, even for one who is not a conspiracy theorist, to envisage a situation remarkably similar to one with which many care homes are already familiar—the sudden introduction of an entirely new fostering and adoption regulatory regime, without any notification to those affected by the new regime.

John Bercow (Conservative, Buckingham)

I think that my hon. Friend is right to say that the Government have opted for the negative procedure. However, we have to know the reason for Ministers' knee-jerk reaction and preference. Is it because they do not think that we should be allowed to debate such regulations? Is it because they cannot trouble themselves to have such a debate? Or is it because we do not have sufficient time? The last explanation would be quite unsatisfactory to many hon. Members, who would be more than happy to attend a morning sitting of the House to debate the regulations, based on the authoritative advice that has been tendered to Ministers.

Jacqui Lait (Conservative, Beckenham)

I entirely agree with my hon. Friend, who makes some sane and sensible points. I also think that use of the negative resolution procedure is always very sinister. I am simply seeking assurances from the Minister that there will be proper consultation on regulations, and that the commission's advice will be published. The commission is a public body, funded by taxpayers. Therefore, it has a responsibility to taxpayers and the public to make public precisely what it is suggesting to Ministers. It is crucial that Ministers reassure us today that, one way or another, there will be proper scrutiny of proposals affecting fostering and adoption—both of which are so fraught with emotion and so important to people's futures. Very many bodies are involved in the subject, and they need to be consulted. As all hon. Members know from their surgeries, rumour and innuendo get around, and out of small acorns grow very large oaks. Rumour and innuendo can threaten an entire system. Therefore, correct information has to be placed in the public domain at the right time. Government amendment No. 53 deals with the publication of reports. Although I am not a lawyer, I absolutely accept the difficulty of the libel issue and of the possible consequences of prosecutions. It may come as no surprise to my hon. Friends to hear that I was the Parliamentary Private Secretary to the current Leader of the Opposition when he was Secretary of State for Wales, and the Welsh Office was debating whether he should establish the inquiry into the Welsh children's homes. We grappled at length with the issues of libel and prosecutions. However, my right hon. Friend had the guts and the courage to establish that inquiry, and to take on the chin the possibility of difficulties arising from subsequent legal action. If my right hon. Friend had the courage to do that, I cannot see for one minute why the Government cannot give us assurances today, or even write something into the Bill. They could abandon their amendment, so that reports of concern to the public were published. As I said, if the relevant information is not made public, rumour and innuendo will spread and the situation will get completely out of hand. I would not like to see any Government on the back foot in addressing issues that are so important to so many people. The Liberal Democrats' amendment No. 31 deals with the National Care Standards Commission. I have some difficulty with the idea of enabling the commission to trawl for information, in a fishing expedition. Such an ability was one of the reasons why the local government inspection system was regarded with fear and trepidation within the private care home sector. In that system—not in all cases, but in a sufficient number of cases to concern the industry—inspectors essentially had that power. I hope that in considering the information that it wants and needs from people, the commission will take into account the long history of difficulties between inspectors and the private care sector. To give those inspectors their due, the badly run businesses have now gone out of business. The commission will therefore usually be dealing with well-run businesses. The businesses that have survived—it has been a tough world for them—have done so because they are good businesses. Therefore, although there is no need to provide the power to undertake fishing expeditions, there is that history, and such a power is not beyond the bounds of possibility. I share the concerns expressed by my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) about the potential impact of amendment No. 31. Of course we very much hope that the horrors that we are envisaging do not materialise.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

The import of the hon. Lady's argument seemed to be that she was broadly supporting amendment No. 31—which is about preventing the very fishing exercises that she has been concerned about. Can she say whether she supports the amendment?

Jacqui Lait (Conservative, Beckenham)

I apologise to the hon. Gentleman; he is absolutely right. I am more likely to be supporting him than the Government on this particular issue. I share the concerns expressed in the official Opposition's amendment No. 96, not only because I am a great believer that an Englishman's home is his castle. I am surprised that I am the first hon. Member to use that cliché in this debate, because it is such an obvious one in discussing the amendment. Like many other hon. Members, I know people who have given a lot of their life, time, love, affection and emotion to fostering children. As I am sure all hon. Members will know, many of those children are very difficult and complex characters who have deep-seated needs that foster parents have to deal with. Consequently, over the years, in any well-run fostering regime, a body of law has developed that allows access to a foster parent's private home, either by agreement or—when potential child abuse is involved—by instant access. I am sure that many hon. Members will have had constituency cases involving neighbourhood conflicts and difficulties in which, on the flimsiest pretext, although the children themselves have often been difficult, neighbours have taken a dislike to each other and called in social workers and police. In those circumstances, foster carers' homes have easily been accessed by those who wanted or needed access. Therefore, on the basis of what we know happens in practice and what is often dealt with in statute, I do not know why the Government cannot reassure people by including in the Bill an exception ensuring that private homes are not covered by the Bill's provisions on rules of entry. It may be that legislation cannot impose a negative, but I do not believe that the clever people who draft legislation cannot come up with a form of words to reassure people who foster difficult children that, although their homes will continue to be accessed by social workers and police, as is required by statute, the Bill will not impose further requirements so that any misuse of its provisions presents a further barrier to people volunteering to foster difficult children who need loving homes. Hon. Members may have gathered that I support amendment No. 3 because I have concerns about the text of the Bill. When I first reached the conclusion that a national organisation would help the care home industry to provide better care, I was very clear in my own mind that the National Care Standards Commission would need to appoint people who represented and had thorough knowledge of the industry. The proposal for separate commissioners for the independent health care sector and for nursing and social care, with separate directorates, would meet that requirement and would go slightly further than the Bill does in respect of the children's rights director. Many of us who have some knowledge of the residential and nursing home sectors realise that it is not easy to consider them as indivisible. A nursing home provides nursing care. The demands and requirements on a nursing home are different from those on a residential home, which is a place where people live as independently as possible. They require totally different skills that require different training, although residential care homes for elderly people provide an element of nursing care. However, if a properly run rest home has people who need nursing care there is usually someone on the staff to provide that care and it is usually the sort of care that a district nurse can provide. If somebody is too ill for that, their medical condition will dictate where they are looked after—[Interruption.] I heard someone say, "nonsense" and I would be most interested in the reason for that remark.

Peter Brand (Liberal Democrat, Isle of Wight)

Over the past 15 years there has been a dramatic shift in dependency from nursing homes to residential homes and it is not unusual to have people in residential homes who might previously have been in nursing homes, certainly towards the end of their lives. I would not want people to be forcibly moved from what has been their home when they become terminally ill.

Jacqui Lait (Conservative, Beckenham)

I am not entirely certain that the hon. Gentleman and I are a million miles apart on this. If someone were terminally ill and living in a residential home, as that would be regarded as their home, they would get the same care that would be provided in their own home.

Peter Brand (Liberal Democrat, Isle of Wight)

Does the hon. Lady accept that a great many people who live in their own homes have a nursing dependency as great as people in nursing homes under hospital at home schemes and the like? The differentiation is not as clear as the hon. Lady implies.

Jacqui Lait (Conservative, Beckenham)

The hon. Gentleman and I could have a long dialogue on this, although you would probably call us to order if we did, Mr. Deputy Speaker. As I said, I do not think that the hon. Gentleman and I desperately disagree about this matter. However, the bulk of people in rest homes are not there—or should not be there—because of nursing requirements. That is part of the argument for national care standards and for removing the involvement of local social services in placement into rest homes. As I said earlier, I have long believed in that. 6.15 pm The amendments seek to ensure that two sectors in which the private sector has taken a strong interest—well-run private hospitals and nursing and rest homes—should receive the consideration that they require from the commission. I see that my right hon. Friend the Member for Bromley and Chislehurst has returned to the Chamber. Let me pick up his point about what should happen to the commission when we win the next election. I suggest that it would be helpful to have people with the right skills on the commission, and a directorate with specialist skills in the independent health sector and nursing and social care so that those two sectors get the attention that they require to ensure that they provide the highest care standards of which we would all approve. Another reason why I support the proposal for a social and nursing care commissioner was mentioned by my hon. Friend the Member for Runnymede and Weybridge in relation to inspectors. We probably expect that most local authority inspectors will move over to the commissions under the Transfer of Undertakings (Protection of Employment) Regulations 1981, if for no other reason. I sincerely seek assurances that the inspectors will receive the necessary training to act in an even-handed way. As I said earlier, a number of local authority rest homes are not up to the standards that are required in the private sector. Under the 1984 Act and subsequent legislation, inspectors have no statutory remit to close local authority homes. However, good inspectors in some local authorities—there are some—made sure that some of the local authority homes were aware of their responsibilities. However, we cannot—the private sector would find it difficult to live with this—send in inspectors who are still of the old school and are not prepared to be completely impartial. Let me briefly draw a parallel with Ofsted, which was mentioned earlier. Ofsted hires teachers and trains them to be inspectors. Unless the system has changed recently, once inspectors are trained Ofsted does not have the ability to decide whether they are good enough to do the job. Once somebody has been trained they automatically become an Ofsted inspector even if they are not suited to the job. I would not like the same loophole to exist in respect of commission inspectors. Once somebody has been trained, a decision will have to be made as to whether that person meets the required standards. The mere fact that somebody has been trained does not mean that they have attained the necessary standards.

John Bercow (Conservative, Buckingham)

I am sorry to interrupt my hon. Friend as she develops her argument, but is she referring to in-service training or to some other training?

Jacqui Lait (Conservative, Beckenham)

I made the analogy with Ofsted because everyone wishing to become a school inspector has to go through the training that Ofsted offers. However, all trainees become school inspectors after the training, regardless of the extent to which they fit Ofsted's requirements. I do not want the same system to be brought in for the commission. Finally, I have gained a little understanding of how what I have learned to call "CHI" works. A team from the health service is put together and sent to inspect a hospital. It usually consists of a medical director, a nursing director and a chief executive or member of senior management. Those people may be crucial to another hospital, but they are taken away from running their own hospital for at least a week. Given the state of the NHS and the number of hospitals needing inspection, will not the removal of such personnel for inspection purposes place an intolerable burden on all hospitals?

Peter Brand (Liberal Democrat, Isle of Wight)

Rubbish.

Jacqui Lait (Conservative, Beckenham)

The hon. Gentleman may say that that is rubbish, but perhaps he will tell me why. A hospital trust could be in trouble if even the smallest crisis emerged while its medical director was away for a week on inspection duties. We all know how long patients have to wait in accident and emergency departments in most hospitals, and how litigious they are these days, with hospitals often being challenged and asked to pay compensation. Taking key managers away from an understaffed and hugely pressurised health service is not the best way to ensure that our health service improves.

Peter Brand (Liberal Democrat, Isle of Wight)

I cannot follow the hon. Lady's argument. Is she really suggesting that inspections, by Ofsted, the Commission for Health Improvement or any other body, should be carried out by people who are not involved with the service that they are inspecting? I understand what she says about pressure being placed on services, but that can be solved by adjusting staffing levels. I assure her that the NHS carries out a great many inspections, and that about a tenth of consultants' time is spent on them. That is quite apart from their educational role.

Jacqui Lait (Conservative, Beckenham)

The hon. Gentleman is a GP and has a direct interest in how the NHS works. He probably knows how much inspection is carried out. I am merely pointing out, however, that the commission represents yet another layer of inspection. It will take people away from their real hospital work for a week, and then reports will have to be written. Taking out that level of management skill is not the best way in which to run the hospital service, let alone the NHS. The hon. Member for Isle of Wight will agree that the NHS faces huge staffing difficulties. Imposing an extra burden is not the best way forward.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

Is the hon. Lady aware that a Liberal Democrat amendment tabled in the House of Lords secured cross-party support and gave effect to the principle that the commission would have a role in inspecting provision in the private and public sectors? The Government removed that amendment, against the opposition of my hon. Friend the Member for Isle of Wight (Dr. Brand) and the hon. Member for Runnymede and Weybridge (Mr. Hammond).

Jacqui Lait (Conservative, Beckenham)

The hon. Gentleman and I differ in our view of what the commission is doing at present.

Philip Hammond (Conservative, Runnymede and Weybridge)

I thank my hon. Friend for allowing me to intervene and put in context what the hon. Member for Sutton and Cheam (Mr. Burstow) just said. I said earlier that my interpretation was that the Lords were trying to promote the desirability of a single regulatory system for both sectors. That was the essence of the debate in the other place.

Jacqui Lait (Conservative, Beckenham)

I would have no difficulty with a single regime for inspection. I am interested in the practical application of the commission's operation, given the difficulty in finding enough people of the right calibre to staff the NHS. We must not forget that the basic job of the service is to make people get well, and to prevent some from falling ill in the first place. Mine is a practical objection rather than an objection in principle. No matter how much money the Government throw at the health service, it will not improve all that much in the near future. The Bill will not help those hospitals that desperately need proper inspection—nor will it ensure that the independent health care sector does not provide a distraction. I have spoken for longer than I planned. These diverse amendments set the tone for the matters in the Bill that need to be considered and that concern me deeply, and the debate on them is therefore worth while.

Ian Bruce (Conservative, South Dorset)

I did not intend to speak to these amendments, but my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth) mentioned amendment No. 96, and thereby brought to my attention a specific problem. Clauses 44(3)(b) and 45(3) set out the powers that allow the inspection of documents or other material, including computers. They contravene clauses 47 and 48 of the Regulation of Investigatory Powers Bill, which deals with all aspects of surveillance. Schedule 2 of that Bill sets out which people can issue a warrant allowing someone to inspect computers. I believe that amendment No. 96, which would protect foster parents from such an inspection, should be more widely drawn. The Minister should know that any evidence obtained under this Bill without a warrant under the Regulation of Investigatory Powers Bill would be specifically excluded, by that Bill, from any legal proceedings. A proper investigation could be made that would then be ruled out of order because of the Regulation of Investigatory Powers Bill. I am no fan of that Bill, which I believe to be very flawed. It is extraordinary that the Department of Health and the Home Office should both introduce Bills in the same Session covering the investigation of what is on a computer in someone's premises whose provisions are in complete contravention of each other. My hon. Friend's amendment is very helpful in this respect.

Jacqui Lait (Conservative, Beckenham)

My hon. Friend might like to bear in mind the conflicts with the Data Protection Commissioner as to what information is protected, and the demands of the National Audit Office, particularly in the health sector.

Ian Bruce (Conservative, South Dorset)

I am grateful to my hon. Friend. Right-minded people might think that the Regulation of Investigatory Powers Bill is a sensible measure that can be used to investigate child abuse, for example. Police officers who go into premises to investigate could think from having looked at the Care Standards Bill that they are authorised to get the records from the computer, print them out—perhaps even getting the key for encrypted data. They then think, "The case is all there in black and white." However, the defence lawyer, who is always paid more than the prosecuting lawyer, says, "The Regulation of Investigatory Powers Bill specifically excludes you from looking at these data, and if you have looked at them, a clause in the Bill says that you cannot use them in a court of law." I hope that the Minister understands that I am not filibustering—this point hit me between the eyes instantly. I know that Department of Health Ministers have an awful lot to do—they cannot know what is going on in the Home Office. Frankly, somebody in the Government— I thought that this was supposed to be joined-up Government, after all—should have understood the problem. I hope that the Government will at least accept the amendment that would protect foster parents. I declare an interest, because my wife and I were short-term foster carers many years ago. I would not like to think that because we had volunteered to do that, our premises could be entered in the course of an investigation. From looking at the Bill, it seems that someone's home is available to be entered. The Minister may say that it does not mean that. Even so, a police officer could enter a person's home and be told, "You can't come in," but if he showed them the Bill, the person would read it and say, "Obviously you do have the power." The individual is hardly likely to read Hansard and contact a lawyer for advice: he would instead assume that those powers were in the Bill.

John Bercow (Conservative, Buckingham)

I shall certainly study Hansard tomorrow. Can my hon. Friend explain what wording in the Bill leads him to believe that there could be a laissez-faire approach to entry?

Ian Bruce (Conservative, South Dorset)

My hon. Friend just needs to read clause 44, which says: the registration authority may at any time require a local authority to provide it with any information relating to the discharge by the local authority of relevant functions which the registration authority considers it necessary or expedient to have for the purposes of its functions under this Part… The clause continues: a person authorised to do so by the registration authority— although such a person is not authorised by the Regulation of Investigatory Powers Bill because the registration authority is not one of the named bodies— may at any time enter and inspect premises which are used, or which he has reasonable cause to believe to be used, by a local authority in its discharge of relevant functions. What happens is that local authorities approach foster carers to foster a child. The Government have quite rightly said that they will do their best to close down as many children's homes as possible and to put children into foster care or have them adopted, because that is best. If the only avenue that a local authority has when it comes to placing children is a private foster home or adoptive parents, those must be the premises referred to in the Bill. The Minister tries to reassure us that the words in the Bill, which are as plain as a pikestaff, do not mean that, but I am afraid that he is misdirecting both himself and us.

John Bercow (Conservative, Buckingham)

I am grateful to my hon. Friend, who has duly alarmed me by pointing to the relevant provisions of clause 44. On the basis of his 13 years' experience in the House, will my hon. Friend confirm that it is commonplace, when discussing rights of entry for officers or other persons on public authority duty, for clauses to refer to "reasonable force"? However, as far as I am aware—my hon. Friend will disabuse me if I am mistaken—there is no reference in these provisions even to reasonable force, which opens up a worrying spectre of what might be entailed.

Ian Bruce (Conservative, South Dorset)

Certainly, there are no such words in the Bill. Let us assume that a police officer is called because an inspection authority officer is battering the door down. The person living there says that his premises are being invaded by the officer, who says that under the Bill he is authorised to enter and that, as he has been stopped, he is battering the door down. Nothing in the Bill says that there should be an individual at the premises—it is not about requiring people to allow entry to the premises, but about entry to the premises.

Philip Hammond (Conservative, Runnymede and Weybridge)

It might help my hon. Friend to know that I explored this avenue with the Minister in Committee, and the hon. Gentleman confirmed that there will be no power to force an entry under these provisions.

Ian Bruce (Conservative, South Dorset)

I am grateful to know that the Minister and my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) both know that. It is a pity that it is not made clear in the Bill.

John Hutton (Labour, Barrow and Furness)

You caught me by surprise by calling me, Mr. Deputy Speaker. I thought that we were in for a couple more hours of debate on these amendments. There is a small but substantial problem with amendment No. 31, in the name of the hon. Member for Sutton and Cheam (Mr. Burstow). We used to say in Committee—I am sure that the hon. Gentleman will not mind if I say it again today—that his amendments were largely unnecessary or technically deficient. Sadly, amendment No. 31 is both unnecessary and technically deficient, which is a first for his party on the Bill. I should like to reassure the House that the registration authority will require individuals to provide only information that is needed for its regulatory work. Clause 31(1) states that it may require only information that it considers necessary or expedient to have for the purposes of its functions under this Part. Part II is concerned only with the commission's regulatory functions. It will therefore not be able to ask for anything that is not necessary for fulfilling those functions under this part of the Bill. That is the purpose of the hon. Gentleman's amendment, and I can assure him that that is already how the Bill is constructed. Obviously, the commission will sometimes need to require a wide range of information from persons carrying on or managing an establishment or agency. I think that all right hon. and hon. Members will understand the common sense of that. The information will vary, according to the stage at which the service is being scrutinised. Inspectors will not have the powers to go on general fishing expeditions, however, if that is what the hon. Gentleman is concerned about. Nor will they have the power to require providers to give information that may be of general interest for statistical purposes, for instance. They might be able to request such information, and providers will, I hope, be happy to accommodate those requests, in the knowledge that national information of this kind can be useful to all concerned. However, such requests will not come with the force of clause 31.

John Bercow (Conservative, Buckingham)

I am extremely grateful to the Minister for giving way on that point. He says that the commission will not go on general fishing expeditions, and I accept his word. However, can I take it from what he has said that somebody seeking entry to conduct an inspection would subsequently, if there were a dispute, be obliged to prove that he or she had grounds for belief at the time?

John Hutton (Labour, Barrow and Furness)

That must be the case. The powers under the Bill can be exercised only if the conditions of the Bill have been complied with. If there is any argument about that, the appropriate place to hold it might well be the court; it is precisely the type of issue that could be tested by lawyers before a judge. We do not propose any provision that would give the NCSC unique powers to act above and beyond the law—of course not. The hon. Gentleman is correct; no such situation could possibly arise. Amendment No. 96, tabled by the hon. Member for Runnymede and Weybridge (Mr. Hammond), concerns the commission's powers to inspect premises under part III. In Committee, the hon. Gentleman rightly pointed out that that power to inspect applies to premises used by a local authority in the discharge of its functions. He asked me to look into the matter. Having taken further advice, I am satisfied that the power does not apply to individual foster homes, and we certainly have no intention that it should be used in that way. I agree that it would not be appropriate for the commission to exercise powers of entry to foster carers' homes in the same way that such powers would relate to local authority premises. The hon. Gentleman's interpretation of the wording is that it would include powers to inspect individual foster homes, but I can assure him that that is not our reading of the provision. The private homes of foster carers are not under the control of local authorities, so it would not be sensible to treat them as though they were premises used by local authorities. We cannot consider that the amendment is either justified or necessary. As I said in Committee, we expect that, in inspecting fostering services, the commission inspectors will need to speak to foster carers, and to satisfy themselves that the standards required of fostering services are being properly met through the foster carers approved by the authority. We all want assurance about that. That will mean that, sometimes, commission inspectors will need to visit foster carers in their homes, but the commission will not need general powers of entry to a foster home. As I explained in Committee, we intend to tackle the matter by setting out a requirement—perhaps through the foster placement regulations under the Children Acts—for approved foster carers to co-operate with the commission inspectors when they are carrying out their functions. That will be reinforced by individual foster placement agreements that will set out what might be required for co-operation with the work of the commission. That approach will not give the NCSC a general power to enter foster homes, backed up by an offence of obstructing inspectors. That would be too heavy handed.

Jacqui Lait (Conservative, Beckenham)

By giving those powers to the commission inspectors, will the Minister do away with other regulations that give other people power of entry to a foster home?

John Hutton (Labour, Barrow and Furness)

I assure the hon. Lady that we are not doing that. The Bill makes clear which provisions will and will not be amended. For example, we are not changing the powers of local authority officers in relation to their child protection functions; nor are we changing the powers of a police constable in the exercise of such functions. As the hon. Lady herself pointed out, it is important to retain measures to ensure that children placed in foster homes by local authorities are properly protected should there be any risk to their health or well-being.

Jacqui Lait (Conservative, Beckenham)

I am grateful to the hon. Gentleman for giving way again. Will he make it absolutely clear that the measure would give further rights to strangers to inspect a foster home and that foster carers would have to face additional bureaucracy?

John Hutton (Labour, Barrow and Furness)

With great respect to the hon. Lady, I think that she has completely misunderstood the point. I have made it quite clear that NCSC inspectors would not have a power of entry to private foster homes. I tried to make that clear. Under the Bill, there will be no general power given to NCSC inspectors to enter private foster homes. It is not the foster carer who will be regulated by the National Care Standards Commission, but the local authority or independent fostering agency. That is where the powers of the commission will rightly be directed.

Ian Bruce (Conservative, South Dorset)

By now, the Minister's officials will have had a chance to examine the Regulation of Investigatory Powers Bill. That measure makes clear the circumstances in which people can obtain information—especially from computers and other forms of investigation and surveillance. The Care Standards Bill is clearly in contravention of that measure. Will he address that point?

John Hutton (Labour, Barrow and Furness)

I am pretty sure that it is not in contravention. I may have to qualify my comment later in our proceedings, but I think that the reason that this Bill does not contravene the provisions of the RIP Bill can be seen in clause 44, in which the hon. Gentleman was extremely interested. Clause 44 gives the NCSC the power to require the local authority to provide information. That does not involve the issues raised by the hon. Gentleman in relation to the RIP Bill. We are not inspecting computers. The clause requires the regulated provider—in this case, the local authority—in relation to part III, to require information to be produced to the local authority under the powers of the Bill. If the hon. Gentleman will be patient, I think that the best way to deal with that point would be for me to give him a fuller explanation at a later stage of our proceedings.

Ian Bruce (Conservative, South Dorset)

The hon. Gentleman contradicts his own Bill. Clause 44(3)(b) states that the powers include in relation to records which are kept by means of a computer, power to require the records to be produced in a form in which they are legible and can be taken away. That is exactly what is dealt with in the RIP Bill. The requirements for obtaining such information are set out in that measure and they are not complied with in the Care Standards Bill.

John Hutton (Labour, Barrow and Furness)

With respect to the hon. Gentleman, I am quite sure that he is wrong. Later in our proceedings, I will find some way to satisfy him on that point. Amendments Nos. 3 and 32 are similar in that they require the commission to establish statutory committees to deal with specific aspects of its responsibilities. Amendment No. 32 was tabled by the hon. Member for Sutton and Cheam. I share the hon. Gentleman's wish to ensure that private and voluntary health care is regulated effectively by the NCSC. The Government's commitment to do so has, in our view, been amply demonstrated by the requirement that we introduced on Report in another place a power for the commission to appoint a director of private and voluntary health care, and to fund and head a health care division in the commission, whose functions will be prescribed in regulations. The independent health care sector has broadly welcomed those measures. Measures that we have introduced provide the necessary assurance as to the importance that the commission will attach to its responsibilities for regulating independent health care. The hon. Gentleman's amendment would require the commission to have, in addition, a separate and statutory health care committee. That is where our views differ. The hon. Gentleman's approach, which is mirrored by that of the hon. Member for Runnymede and Weybridge, is over-bureaucratic. The benefits of his proposed solution are not clear. It would duplicate the work of the private health care division. The amendment raises questions about the relationship between the Commission for Health Improvement and the NCSC in its role of regulating private health care. That is one of the issues that we have returned to throughout the passage of the Bill in both Houses. I accept that the relationship is important. The two bodies will between them have responsibility for standards throughout all the health care services provided in this country. They will have important common interests and shared experience. We have repeatedly spelt out the arguments—although perhaps not to the satisfaction of the hon. Member for Sutton and Cheam—and have pointed out that the role of CHIMP in the NHS is not the same as that of a statutory regulator in the private and voluntary health care sector. CHIMP has been designed to work within the context of a publicly managed national health service, which is ultimately accountable to the House through the actions of my right hon. Friend the Secretary of State. CHIMP fits into a range of levers, incentives and controls—all under the overall management of my right hon. Friend. Independent hospitals and clinics, on the other hand, are private businesses; they do not operate in a publicly managed system and are not under the control of the Government. If an NHS organisation is failing, it is the Government's job to do something about it. That is a responsibility and a burden that we take seriously. If necessary, the Secretary of State can intervene directly in the management of the NHS body, including, at the extreme, removing an entire trust board. Amendment No. 32 would introduce a rather clumsy mechanism to try to involve CHIMP in the management of the NCSC. I do not think that it would be practical. It would establish a wholly superfluous layer of administration that would not be able to do anything that could not already be accomplished by the National Care Standards Commission under the proposals that we have made. I ask the House to reject it. Amendment No. 3, which was tabled by the hon. Member for Runnymede and Weybridge, proposes a statutory committee to deal with independent health care, and I do not think that I need to repeat my comments on that subject. It also proposes a further statutory committee within the commission to deal with nursing and care homes, plus a statutory director of nursing and care homes and a separate division for dealing with those services. On a technical level, the amendment obviously leaves itself open to criticism. For instance, are care homes really to be dealt with totally separately from domiciliary care agencies? We all recognise that people being cared for today in residential settings may in future be equally well cared for in their own homes, but the amendment would run the risk of creating a new Berlin wall between those services in the way they are dealt with in the commission. Although I cannot accept the hon. Gentleman's amendment, it may help if I say a little about how external interests, including regulated providers, will be able to work with the commission to feed in their views and to engage generally in dialogue with the commission. The hon. Member for Beckenham (Mrs. Lait) raised that concern.

John Bercow (Conservative, Buckingham)

Given that we are waiting with bated breath and beads of sweat upon our brows, will the Minister please share with us the contents of the yellow piece of paper that the Secretary of State for Health has just passed to him?

John Hutton (Labour, Barrow and Furness)

I do not think that the hon. Gentleman would like that; the piece of paper might be about him. He might not like what he has invited me to say. Therefore, I will not read it out. However, as I said earlier, I shall come to the points that the hon. Member for South Dorset (Mr. Bruce) raised when we come to the appropriate point in the Bill. The commission, as a regulator, will obviously from time to time find itself in dispute with providers. From her experience, the hon. Member for Beckenham will be aware of such cases. However the commission's purposes will not be best served if it does not also engage in constructive and open discussion with service providers so as to allow feedback and proper suggestions from them and to work together to encourage improvement. We certainly intend that there should be mechanisms in place to ensure that such discussion is an on-going feature of the commission's work. We expect arrangements to be in place at a local level to allow for such partnership working and for arrangements to be put in place at a national level for a dialogue to be established between the new National Care Standards Commission and care home providers' organisations and interests. I said in Committee that the relationship between the commission and care home providers will be central to making the arrangements work in practice and I want that relationship to be characterised by professional respect and a clear mutual understanding of each's responsibilities and respective roles. I am sure that the commission will want, once it is established, to develop that relationship with care home providers from all sectors—public, private and voluntary. That will be critical to ensuring that the arrangements work in future. I hope that the hon. Members for Beckenham and for Runnymede and Weybridge are reassured that the commission will be open for business with regulated providers and others who have a stake in the work that it will do. If the hon. Gentleman's amendment is designed to ensure that care providers have a point of contact with the commission—that was partly his point—I think that we can make sure that that is available without having to set out the rigid structures that he suggested. If, on the other hand, the hon. Gentleman really thinks that Parliament should be setting down in primary legislation exactly how the management structures of the Commission will be arranged, I will probably have to disappoint him, because I cannot agree that that is a sensible thing for the House to do. If he decides to press his amendment, I shall urge my hon. Friends to vote against. My hon. Friend the Member for Chatham and Aylesford (Mr. Shaw) raised a point that is of concern to him and to my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson). My hon. Friend the Member for Chatham and Aylesford referred to the efficiency and efficacy of the arrangements that supervise private foster care arrangements. I remind him of what I said in Committee. We share with him a concern for the proper administration of the existing regulations. We took the view, and we have stuck to it, that the regulatory framework is robust enough to deal with issues of abuse and concern about the welfare of children who have been privately fostered. My hon. Friend asked me specifically whether I would be prepared to revisit the regulations about private care arrangements, and I say to him that I am prepared to re-examine them to satisfy myself once again that they are in the right shape to meet the concerns that he raised. I go further than that: if he and my hon. Friend the Member for Lancaster and Wyre wish to talk to me about how, in particular, they want the regulations to be improved, I am happy to have that conversation. To some extent, the amendments tabled by the hon. Members for Sutton and Cheam and for Runnymede and Weybridge are a rehash of previous arguments. We have been through the arguments about the right relationship between CHIMP and the National Care Standards Commission extensively in this House, the Committee and in another place. I think that the hon. Member for Runnymede and Weybridge welcomed clause 9—the hon. Member for Sutton and Cheam certainly did—and it will allow the two important new bodies to work closely and effectively together. We should get on with the job, get the organisations up and running and, in doing that, better serve the public interest.

STATEMENT OF NATIONAL MINIMUM STANDARDS

Philip Hammond (Conservative, Runnymede and Weybridge)

I beg to move, That the clause be read a Second time.

Michael Lord (Deputy Speaker, Central Suffolk and North Ipswich)

With this it will be convenient to discuss the following: Amendment No. 38, in clause 22, page 13, leave out lines 14 and 15. Amendment No. 39, in page 14, line 35, at end insert— '(m) make provision in the case of an establishment providing cosmetic surgery as to— (i) the nature of statements that may be made with regard to the services provided; and (ii) the titles that may be used to describe persons carrying on, managing or employed at such an establishment'. Government amendment No. 61. Amendment No. 2, in clause 23, page 15, line 3, leave out Clause 23.

Philip Hammond (Conservative, Runnymede and Weybridge)

New clause 4 and amendment No. 2, which is a paving amendment for it, would remove clause 23 from the Bill and substitute it with new clause 4. The new clause would do broadly the same things as clause 23, but with some important differences. For the benefit of hon. Members who did not serve on the Standing Committee, I shall briefly explain what clause 23 does. It gives the Minister the power to prepare and publish statements of national minimum standards applicable to establishments or agencies and to keep the statements of standards under review. The statements will not be subject to any parliamentary scrutiny; they will be prepared by the Minister and published after the consultation that he considers appropriate. Once the standards are published, they will "be taken into account"—that is a rather indefinite phrase—in making certain decisions and in any proceedings taken under the Bill. It also seems likely that the statements will be referred to in regulations made under other parts of the Bill. Therefore, the regulations that refer to the standards or incorporate them may be subject to scrutiny in the House, but the statements themselves will not be. Of course, the Minister will consult with whoever he considers to be appropriate before he publishes the statement of minimum standards. However, I remind the House that people's businesses and livelihoods may be at stake and they may be driven out of business if they do not comply with the statement that the Minister has issued. For it to become effective, all he has to do is publish it; there will be no parliamentary scrutiny whatever. New clause 4 and the paving amendment seek to do two things. First, the new clause would change the process of bringing into force a statement of minimum standards. It would place a clear obligation on the Secretary of State to prepare statements of minimum standards; he would not merely be allowed to publish them. The statements are a vital part of the structure that the Government are creating and the Secretary of State should have a clear obligation to prepare them. Secondly, new clause 4 lays down a procedure for consultation outside Parliament and for a process of interaction with the commission, along the lines suggested by my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth) in the previous debate. That process would require the Secretary of State to require from the commission an analysis of the likely effect of the statements of minimum standards so that he can make a proper appraisal of their probable impact on the supply of services and the cost of providing them. Finally, it provides for proper parliamentary scrutiny of the draft statement of minimum standards before it comes into force.

Simon Burns (Conservative, West Chelmsford)

Will my hon. Friend clarify proposed subsection (4)(b)(ii), which is a crucial part of the new clause and refers to the cost of supplying such services…? Does that mean the cost of supplying the service to the business providing it or does it mean the cost of supplying the service to the individual who is benefiting from it? Or does it mean both?

Philip Hammond (Conservative, Runnymede and Weybridge)

The two are obviously related, but the provision is intended to relate to the cost to the business supplying the service. Proposed subsection (4)(b) seeks to ensure that, when formulating a draft statement of minimum standards which is to be laid before Parliament, the Secretary of State has advice from the commission about the likely effect of such a statement on the aggregate supply of services in England and Wales and the likely cost of supplying them. My hon. Friend spoke about the connection between the cost to the business of supplying a service and the cost to the person enjoying it. Of course, he could go further and discuss the cost to the public purse because, in the majority of cases, the service will ultimately be paid for from the public purse. There is, therefore, a direct read-across from implications for costs on the businesses providing such services to implications for the public purse.

John Bercow (Conservative, Buckingham)

Did I understand my hon. Friend correctly when he suggested that, in the absence of new clause 4, regulations will become effective on publication? Is my hon. Friend telling the House that, under the Bill, there is no required minimum period of consultation for draft regulations, and no required gap between the consultative process and the required date of implementation?

Philip Hammond (Conservative, Runnymede and Weybridge)

As I understand it, the Secretary of State will consult such persons as he considers appropriate before publishing statements. However, those statements will become effective on publication. I am sure that the Minister will correct me if I have misunderstood that aspect of the working of clause 23. May I go back to the point I was making about what the new clause seeks to do? First, it deals with the process of bringing such a statement into force and, secondly, it makes it clear in proposed subsection (7) that someone who does not comply with the statement of national minimum standards will not be registered. Clause 23 states: The standards shall be taken into account in making decisions, in any proceedings for making orders and in any proceedings for an offence under regulations. That seems to be rather vague for a matter as important as national minimum standards. If a national minimum standard is to mean anything, it should mean that someone who does not comply with it cannot come to the table. New clause 4 would therefore provide that someone who does not comply with the standard cannot be registered. Of course, we accept that many standards are going to be made—indeed, some have already been made in draft. The Under-Secretary of State for Education and Employment, the hon. Member for Barking (Ms Hodge), has already circulated draft minimum standards on child minding. It would, therefore, be wrong to lead the House into thinking that statements of minimum standards published under clause 23 or, indeed, our new clause would relate only to care homes. However, everyone present will understand why I will focus on the statements of minimum standards for care homes, as there cannot be a Member who has not received correspondence from owners, operators and residents of care homes in their constituencies expressing concern about the potential impact of the national standards that the Government have circulated for consultation in the draft consultation document "Fit for the Future?". We accept the need for minimum standards, which are a central feature of the Bill and the structure that the Government are putting in place. However, standards must not simply be aspirations: they must be deliverable, and the question of cost must be addressed. We have repeatedly asked the Government whether they accept that higher quality equals high cost and that that cost must be paid for. Do they recognise that the great majority of those in nursing and care homes are paid for by the state and the public purse? Therefore, as I have asked the Minister many times, does the state accept the implications for public spending and is it ready to meet them? Throughout the industry, the concern is not that the Government want to raise standards—indeed, people would be delighted to operate to higher standards. The industry is concerned that the Government want to raise standards without paying the costs incurred, which will have a disastrous consequence. In the vast majority of cases, local authorities are the purchasers of this type of care. If they are not funded to meet the higher costs that these aspirations will impose, higher quality for the lucky ones will, inevitably, mean that no funding is available for others. Regrettably, the Government have consistently refused to address that point, and have not told the House or the Standing Committee whether they accept that there will be substantial costs and whether they are prepared to meet them in the case of those whose funding is met from the public purse. If the Government can reassure providers about that, many concerns will, at least, be diminished and, in some cases, will melt away completely. We cannot look at the matter in a vacuum. The new higher standards in "Fit for the Future?" are being introduced against a background of tight finances for providers in the care home and nursing home market. They are dealing with the consequences of the national minimum wage—which has an impact in some areas, but not in others—the working time directive and other elements of the Government's social and employment legislation that have involved significant costs. They work in an environment in which, to a great extent, they face cost inflation of the type faced by the NHS, which is significantly higher than general inflation in the economy. In particular, wage and pay increases for NHS personnel, however welcome, have an inevitable consequence for competing employers in the private sector who provide services to publicly funded residents in nursing and care homes. For many years, in many, if not most, parts of the country, providers of such care have faced below-inflation fee increases from local authorities that, with the best will in the world, cannot be more generous because their finances are too squeezed.

Simon Burns (Conservative, West Chelmsford)

Has my hon. Friend considered the possible financial implications for local authority providers of residential care? There is much evidence that local authorities that still have residential homes do not receive in their Government grant the financial resources that will be necessary to upgrade the quality and structure of their premises to meet any minimum standards that the Secretary of State may set under the Bill.

Philip Hammond (Conservative, Runnymede and Weybridge)

My hon. Friend is absolutely right to point out the difficulty in which local authorities find themselves. Local authority accommodation is some of the least compliant of any accommodation, and the Government's recognition of that is the main factor behind their intention to bring it into the regulated system. They want to create a level playing field and to ensure that the quality of that accommodation is improved. I say to my hon. Friend, however, that local authorities' ability to improve their accommodation, particularly through capital works, will depend ultimately on the Government making funding available or authorising local authorities to finance the necessary works in unconventional ways. Many private care home operators, particularly the smaller players in the market, do not have the luxury of being able to anticipate capital grants from central Government. As I shall show in a moment, they have found that the capital markets are closed to them because of the uncertainty created about the potential standards for nursing and care homes.

Ian Bruce (Conservative, South Dorset)

I do not know whether, in Committee, my hon. Friend received any assurances from the Minister that the Government would ensure that those who provide standards higher than the minimum—which, in looking after people, would be a natural way to get business—would not be financially penalised. It should not be possible for someone to say to them, "Although you are giving value for money in your provision, the minimum standards mean that you can provide the services for less," because that would force providers down to the minimum standard.

Philip Hammond (Conservative, Runnymede and Weybridge)

My hon. Friend has made an important point. One introduces minimum standards with the best of intentions, but if the contracting price is set at the minimum standard level, one compels anyone who wants to participate in the market to reduce their standards to the minimum. As I said in Committee, I fear that that is inevitable unless the Government introduce a method to incentivise the provision of care over and above the minimum standards. I shall not digress further because that is another debate. New clause 4 would require the Secretary of State not only to undertake the usual consultations, but to use his powers to require the commission to evaluate the likely impact on aggregate supply and cost. That is to ensure that decisions are properly informed and that the full impact of proposed national minimum standards is properly taken into account. The new clause provides for that information to be made available to Parliament. That would mean that a quasi-independent body would be required to review the cost and supply implications of any proposed standards or changes to standards. It would not be right to characterise the commission as a fully independent body because it is required to act on directions in writing from the Secretary of State. The new clause would therefore introduce objectivity into the debate about new or changed standards. 7.15 pm I shall contrast that with what the Government have achieved with their draft standards for residential care homes. As many hon. Members will know, the Government commissioned a report, which they have put out for consultation. I believe that it contains some 280 recommendations, some of which are not controversial and will not have significant cost implications. Others, however, are highly controversial, and many of my hon. Friends will know from their postbags that the standards relating to staffing ratios and room sizes, in particular, have alarmed providers. There is no doubt that the standards set in the draft document—10 sq m for rooms in existing accommodation and rooms of 12 sq m for wheelchair users and in newly built accommodation—would drive some providers out of business. I refer to particular individual providers whose accommodation is of a certain type and, perhaps, incapable of being easily converted. Other standards would have a more general impact across all providers in the sector; for example, recommendations for staffing ratios would have the straightforward effect of increasing costs for providers of all sizes.

John Bercow (Conservative, Buckingham)

My hon. Friend's grasp of the detail is positively Powellite, and I want to probe him on subsections (5) and (6) of the new clause, which properly require that a draft of the proposed national minimum standards should be subject to approval through a resolution of each House of Parliament. My hon. Friend will understand that I am troubled because it is not entirely clear from either subsection that the resolution of approval will require a debate.

Philip Hammond (Conservative, Runnymede and Weybridge)

My hon. Friend raises an important point. Subsection (6) says that the national minimum standards will not have effect until they are approved by a resolution of each House of Parliament. I understand that that is what we know as the affirmative procedure.

Jacqui Lait (Conservative, Beckenham)

On a point of information, my hon. Friend has mentioned smaller homes, but what regime will cover three-bed homes?

Philip Hammond (Conservative, Runnymede and Weybridge)

All homes will come under a standard regime. As my hon. Friend implies, some of the proposals in the draft minimum standards document will be more onerous for small providers than for large providers. If, for example, there were a requirement to have a member of staff in a management position who was supernumerary to the established staffing ratio, that would clearly be a more damaging blow to a very small home than to a large home provided by a large corporate provider. I shall give the House some measure of the impact that "Fit for the Future?" would have on provision in this country if it were implemented in full. I do not want to mislead the House: the Minister has made it clear that the document will not be implemented in full. On this issue, he can be characterised as a man on a bicycle pedalling very fast backwards, but unfortunately we do not know where he will have got to when he stops pedalling, so uncertainty still hangs over the marketplace. Let me illustrate the scale of the problem. The Department of Health has estimated that 20 to 23 per cent. of independent sector residential homes, 12 per cent. of independent sector nursing homes and 55 per cent. of local authority residential homes would not meet the draft space and amenity standards; and that 53 per cent. or more of nursing homes would not meet the draft staffing standards. Even those alarming figures ignore the impact of economics, considering only the possibility of meeting the standards by reducing the number of places and, thus, income; in the real world, in many cases, reducing the number of places would drive the home out of business. Regional and local variations are even more striking. In the Southampton area, more than 50 per cent. of capacity in the residential market will be non-compliant. In Hampshire, a survey has shown that, overall, 71 per cent. of nursing homes and 68 per cent. of registered care homes would be non-viable. The position is worse in Portsmouth, where 88 per cent. of registered care homes and 65 per cent. of nursing homes claim that they would be non-viable if the draft standards were imposed in full. In the constituency of the other Minister of State, Department of Health, the hon. Member for Southampton, lichen (Mr. Denham), 82 per cent. of registered care homes and 85 per cent. of nursing homes would be non-viable. In Blackpool, a staggering 91 per cent. of care home provision would be non-compliant with the 10 sq m standard; and I am told that in Blackburn that figure is an astonishing 100 per cent. of provision. The problem is serious and, unsurprisingly in view of the figures I have just read out, it has provoked—in a masterly understatement—a reaction in the market; actually, it has produced something nearer to panic. Lenders have withdrawn; many potential sellers of homes have found that they are unable to sell their property because the buyer cannot know whether it will be compliant with a standard as yet undetermined and unpublished; potential new entrants are being denied access to capital, because no one knows what the final standards will be; and the presence of distressed sellers unable to sell causes a downward spiral in values. The overall result is chaos and blight in the market.

Ian Bruce (Conservative, South Dorset)

New premises have to be larger to comply with the regulations, and someone selling a business will, in effect, lose his registration. Will a new business taking over the same premises with a new registration come under the regulations for new premises, or those for old premises?

Philip Hammond (Conservative, Runnymede and Weybridge)

That brings me back to my description of the Minister as a cyclist furiously peddling backwards. The concern that my hon. Friend expresses was circulating widely in the marketplace until very recently. However, the Minister recently wrote to me specifically confirming that transfer of ownership will not constitute a trigger event that would cause a change of status requiring the larger room size standard. To be fair, as I always try to be, the Minister has been doing his best to stem the tide of speculation that has been rising for the past year and causing considerable harm; he has been engaged in a damage-limitation exercise, drip feeding pieces of information as and when possible, in an attempt to dampen expectations of the final standards. However, the fact remains that he has been unable to make a definitive announcement of either the standards in the key areas that are the source of disruption in the marketplace, or, most critical of all, the time scale for compliance. To be frank, those are the only two pieces of information that will calm the market. The story becomes worse, degenerating into Whitehall farce. At the beginning of the Standing Committee's consideration of the Bill, the Minister said that he should be able to share with the Committee some of the detailed thinking—[Official Report, Standing Committee G, 6 June 2000; c. 29.] on the standards by the time that Committee reached consideration of the relevant part of the Bill. At that time, it was common knowledge that negotiations were being held with providers of residential and nursing accommodation about the detail of the most contentious remaining issue: room size. As the Committee made progress, hon. Members were delighted to be invited to the Department of Health, there to partake of the largesse of Her Majesty's Government and to look at a little display showing what the different room size options meant in practice: helpful plastic cut-outs had been laid on the floor and some plans prepared by NHS Estates were hung on the wall. That lunch set alarm bells ringing in the minds of some, because the plans clearly showed that the area of the room occupied by the sweep of the door as it opens—that arc—was to be excluded from the calculation of usable space, as were any en-suite bathroom facilities. I questioned the Minister in the Committee that same afternoon; he replied that it had always been intended that only usable space would be measured. I and people outside took that as confirmation that the area swept by the opening door and the en-suite bathroom would be excluded. I am happy to say that the Minister has since made matters clear in correspondence, which I have faxed on to everyone I thought might be interested. He has stated that it is not now the Government's intention to exclude the door-opening area and en-suite bathroom facilities when calculating usable space. I am delighted to hear that; otherwise, we would have faced the absurdity of care home owners who two years ago had spent large sums installing en-suite bathroom facilities—as one owner that I met had—being forced to take them out to comply with the minimum standard. That would have been bureaucracy gone mad, especially as surveys consistently show that the facility most valued by residents in care homes is an en-suite bathroom.

John Bercow (Conservative, Buckingham)

I am somewhat reassured by the letter my hon. Friend has apparently received from the Minister, but does he not agree that it is only right that such an assurance should have been forthcoming, given that, otherwise, the Minister would have been implying that en-suite bathrooms did not constitute usable space, which would have been bizarre, even by the standards of the current Government?

Philip Hammond (Conservative, Runnymede and Weybridge)

My hon. Friend is right. My point is that the process followed by the Government, if it were intended to introduce workable standards in an orderly fashion without damaging the market, has failed. Instead, that process has resulted first, in the breakdown of the negotiations that the Minister expected, wrongly, would reach enough of a conclusion to enable him to make an announcement to the Standing Committee; and secondly, in a lack of clarity about issues such as whether or not en-suite bathrooms and door-sweep areas are to be included. I am merely speculating, but, as the Minister makes announcement after announcement in an attempt to reassure the market, it strikes me that, in his efforts to make the arrangements workable, the Minister is having, time and again, to overrule civil servants who have led him seriously astray and left him with a system that would be unworkable and unaffordable. 7.30 pm We still have no definitive answer to clarify the mystery of what the minimum acceptable room size will be. Similarly, we do not have a time scale for compliance in existing properties. We are still in a mess. I do not pretend that the new clause will solve all the problems. Clearly this is a matter of process rather than one of legislation. However, I believe that the new clause would lead to cleaner, better, more informed and more transparent processes for arriving at national minimum standards. It would ensure that the Minister had all the relevant information. To put it bluntly, he would be able to see the size of the bomb crater that he would create in his own backyard before he published the draft standard. There would then never be a danger of disrupting a market by allowing rumour and speculation to get a hold. Critically, the new clause will provide for proper parliamentary scrutiny of these most important parts of the regulatory system. I suspect that my hon. Friends will agree strongly with me that it is outrageous that a key element of the Bill, which could destroy people's businesses and livelihoods, should lie outside and beyond the scrutiny of Parliament. I hope that the Minister will be able to give us some reassurance. Perhaps he will be able to tell us when he will make a definitive announcement, and what the time scale will be for compliance with the definitive room size that he determines. Of course, he will tell us that he is still in the process of consultation, and we have no objection to that. Indeed, it is valuable. However, we know that the Department can act when it has to. It managed to consult 12 million people in its so-called national health service survey in a fortnight. Apparently, it cannot talk to those responsible for about 17,000 care homes in much less than a year so as to get them on board and understand their responses to the consultation process. Meanwhile, individual owners of care homes and residents—those who live in fear of what will happen to their homes, many of them having gone into them expecting to live out the remainder of their lives there—are suffering from blight. Repairs are not getting done, and extension plans are being put on hold. The system has degenerated into chaos. It is easy, tempting and convenient for government to express national minimum standards for care homes in terms of what is easily measurable—for example, the size of a room, the number of staff, the number of choices on a menu and the number of square metres available per resident in the day room. I have serious doubts about that, which I know are shared by other hon. Members on both sides of the House. Are we measuring what matters or what is easily measurable? What matters to those who are being cared for is the quality of care being delivered. The danger of introducing prescriptive national minimum standards is the elimination of choice and diversity. It seems self-evident that if there is a given income—usually provided by a local authority—for housing a resident, it can be spent in several ways. For example, a larger bedroom may be provided, but there may be smaller areas of communal accommodation. Smaller rooms might be provided for both purposes, but there may be a vastly superior menu. There might be smaller rooms but a much higher staffing ratio, or much better qualified staff. There should be choices because different residents will have different needs. Someone who has limited ambulatory capability—in other words, someone who cannot walk about—will not have much use for elaborate day-room facilities. Someone who is active and sprightly may have little need for a large bedroom. It seems self-evident that there should be no one set of prescriptions to govern all the accommodation in the marketplace. That would have the effect of eliminating choice still further. The new clause would improve on clause 23. It would ensure that future proposals for new national minimum standards were better informed. It should help to avoid shambles such as those created by the circulation of "Fit for the Future?" Crucially, it would allow for proper parliamentary scrutiny of these vital national minimum standards, which have a huge impact on individuals and on the public policy agenda.

John Hutton (Labour, Barrow and Furness)

I am listening carefully to what the hon. Gentleman is saying, and he is setting out his case clearly. Will he confirm what I think I heard him say? Is he saying that there should not be a national room-size standard for residential or nursing care homes?

Philip Hammond (Conservative, Runnymede and Weybridge)

I questioned whether there should be rigid criteria which reduce choice and—[Interruption.] The record will show what I said. I shall clarify what is in my mind and what concerns me. The Minister knows of my concerns because he has heard me express them before. I believe that different people have different needs and different wants. We are talking about people, not statistics. There needs to be enough flexibility in the system to cater for people's diverse needs and wants. In an ideal system, we could have 12 sq m rooms for everybody, and payments high enough to allow care homes to provide additional services. However, if resources are constrained so that we are forced into choices, surely it is better not to lay down certain criteria and state that they will apply to all care homes, but to lay down some variable geometry. That might be sensible. Some care homes might provide better bedroom accommodation and fewer communal facilities. Others might provide better communal facilities and less bedroom space. One category of home will appeal to one category of resident and another type will appeal to a different category.

John Hutton (Labour, Barrow and Furness)

I understand what the hon. Gentleman is saying about the need for discretion in terms of a possible national minimum room-size standard. I shall take up his argument when I respond. However, does he think that there should be a national minimum room-size standard, perhaps subject to discretion?

Philip Hammond (Conservative, Runnymede and Weybridge)

The Minister knows very well that minimum standards are required by local authorities, and that they vary from area to area. I can see advantages in having national minimum standards—but we must regard them as the minimum. As I said in response to an intervention from my hon. Friend the Member for South Dorset (Mr. Bruce), if we introduce minimum standards we run the danger of their becoming the normal standards. If we introduce minimum standards at a level low enough to allow, within the resource envelope available, some discretion to provide above-minimum standards in other areas, we must always avoid the minimum standard becoming the norm. Some sort of variable geometry, which recognises the reality of a trade-off and takes into account the fact that different residents will have different needs and wants, is the way forward.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I wish to clarify the hon. Gentleman's exposition. He is saying that there is a clear link between quality and costs, and that standards may need to be lower to accommodate the current financial envelope. Which is his preference? Is he saying that we should increase resources to enable a higher standard to be achieved, or that we should lower the standard?

Philip Hammond (Conservative, Runnymede and Weybridge)

The hon. Gentleman misquotes me. I was saying that if we want room for discretion—and if we want diversity there must be room for discretion—the minimum standards will have to be set at a level which leaves some resource in the hands of the provider, so that he can add to that minimum provision in one area or another. If the minimum standard in each area where a minimum standard is set—room size, staffing ratio, meals—is at a level which, together, consumes all the resource available to the provider, there is no possibility of diversity and variation between providers, and the consequence of that is no choice for those entering residential care. Amendment No. 38 seeks to leave out from the powers to make regulations a reference to imposing requirements as to the financial position of an establishment or agency. The Bill seeks to level the playing field between public and private sector providers. It is unlikely that anyone will lay down requirements as to the financial position of a county council or unitary authority before it is allowed to operate or register a care home. Therefore, the provision allowing the Minister to set regulations regarding requirements as to financial position can only be taken to be addressed to private sector providers, and to open up again a distinction between private and public sector providers, which the Government have sought to close. I am not sure what the criteria will be. The Minister knows that a considerable number of care and nursing homes operate in receivership. That, I am afraid, is the nature of the pressures in the marketplace. The Minister assured me in a letter that the provision that we seek to omit, which concerns requirements as to financial position, would not be used to disallow the registration of an operator merely because it was operating in receivership. One's financial position cannot get much worse than operating in receivership, so I am not sure quite what the Minister has in mind. However, the provision will act as a barrier to entry. It will stifle new entrants to the sector if they are required to show a financial robustness which, typically, start-up businesses may not have. That would be a massive own goal for the Minister because competition among providers is essential to him in ensuring good quality and sensibly priced provision. We also run up against the problem of who will make decisions about adequacy of financial position. By and large, the people doing the inspecting, registering and regulating will be people who know about the care and accommodation of frail elderly people, not accountants, and that is a major problem. Amendment No. 39 will not get the attention that it deserves, but it is important, as it would enable the Minister to make regulations to make provision in the case of an establishment providing cosmetic surgery to control the nature of statements that may be made with regard to the services provided; and…the titles that may be used to describe persons carrying on, managing or employed at such an establishment. The first problem arises because there are many well-documented examples of misleading claims being made for cosmetic surgery and premises providing cosmetic surgery. The second provision is there because there is hard evidence that in some cases, people have been seen by, and indeed treated by, people who describe themselves as consultants, but who are sales consultants, not medical consultants. Whether or not the Minister is prepared to accept the amendment, he will share the worry about the fact that that is going on. Those are areas of concern, and the amendment is simply intended to highlight them.

Simon Burns (Conservative, West Chelmsford)

I add my support to the important new clause moved by my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond). However, I warn my hon. Friend that I have a grave reservation about part of it. As my hon. Friend said, minimum standards are a fundamental part of the Bill and of its impact not only on care home owners in the private sector but on local authorities that still own and control residential homes. As I said in an intervention on my hon. Friend, there is grave concern among many local authorities, not least Essex county council, about the bills that they will have to pay to upgrade their homes to a decent standard. For a variety of reasons, over the years some authorities have fallen behind in renovations and improvements, to the point where the cost of complying with any minimum standard issued by the Department of Health would be excessively high—and that is before we even come on to the issue of the quality of care. The quality of care could be, and in many cases will be, infinitely better than the quality of the buildings in which people may live. Therefore, I am concerned about who will finance local authorities' need to improve their homes. As I have said, Essex county council has a real problem. It already spends significantly above its standard spending assessment on social services. As the Minister will know, there is no relaxation or abatement in the demands that are being put on social service budgets by the needs of the populations that they and local authorities have to meet. To have to find on top of that a significant amount of money to enhance their residential homes stock will be an onerous burden. Has the Minister made any provision for helping local authorities through central Government grants to take that into account? Many hon. Members whose local authorities are concerned about that would be grateful if the Minister could deal with it when he replies.

John Bercow (Conservative, Buckingham)

Given the financial constraints that local authorities face, does my hon. Friend agree that those authorities would welcome from the Minister tonight a clear idea of the timetable within which they will be expected to achieve the minimum standards that he favours? Does my hon. Friend also agree that it is incumbent on the House in taking forward the Bill properly to distinguish between desirable standards and those that are essential to human safety?

Simon Burns (Conservative, West Chelmsford)

I am grateful to my hon. Friend for raising two crucial points. I hope that the Minister listened carefully to my hon. Friend's point about the timetable that the Government expect local authorities to use to bring the physical structure of their residential homes up to the standards required. With regard to the quality of care, there is probably no problem in the vast majority of residential homes. My hon. Friend's second point is critical. It would be desperately perverse if residential homes were penalised because they were way above the minimum standard. By definition, the service that they provided would be too good according to the criteria of the bureaucracy entailed in establishing any minimum standard. I hope that the Minister will bear that in mind. It would be terrible if care home owners were penalised because they had enhanced and improved, or were seeking to enhance and improve, the quality of their service way above the minimum standard

Jacqui Lait (Conservative, Beckenham)

I agree with my hon. Friend, but does he agree that the unintended effect of minimum standards could well be that local authorities get out of residential provision entirely, and such provision then becomes a private sector monopoly?

Simon Burns (Conservative, West Chelmsford)

That is a logical conclusion to draw from the situation facing several local authorities. Particularly in the case of Essex, unless the Government are exceptionally generous in providing ring-fenced additional money to help authorities deal with their residential home stock, local authorities will have to sell those homes into the private sector. If they do not, the homes will not reach the minimum standards that the Government plan to establish. Presumably, they would then have to be closed down, and that would be intolerable. I do not entirely agree with the conclusion of my hon. Friend the Member for Beckenham (Mrs. Lait) that it would necessarily be a bad thing for local authority owned residential homes to move into the private sector. There is a great deal to be said for that, particularly in view of the problems that the public sector has faced for many years because the financial resources have not been made available to it by central Government to allow it to keep pace with the standards and quality of private homes.

Desmond Swayne (Conservative, New Forest West)

Will my hon. Friend give way?

Simon Burns (Conservative, West Chelmsford)

Briefly.

Michael Lord (Deputy Speaker, Central Suffolk and North Ipswich)

Order. Before the hon. Gentleman gives way, I appeal to him to face the Chair.

Desmond Swayne (Conservative, New Forest West)

Given my hon. Friend's inference that the provision is a potentially welcome privatisation measure, those on the Treasury Bench no doubt welcome the fact that there is not a single Labour Back Bencher present to hear the real consequences of the Bill.

Michael Lord (Deputy Speaker, Central Suffolk and North Ipswich)

Order. We do not need to worry about who is not in the Chamber. We are in the Chamber. That is the important thing.

Simon Burns (Conservative, West Chelmsford)

I echo the comments of my hon. Friend the Member for Runnymede and Weybridge about minimum standards. When Governments start laying down minimum standards, there is a danger that an attitude of mind develops, and that what began as a minimum becomes set in stone. The troubles multiply as people try to enforce the minimum standards. If they have got it wrong in any way, tremendous problems can result for the care home owners providing residential care and nursing care to our citizens. Similarly, as my hon. Friend pointed out, there is considerable uncertainty about what the standards will be and how much parliamentary scrutiny the process of establishing them will receive. I assume that the Government intend the standards to be a movable feast as changes are needed in the light of experience and developments in the provision of residential care and nursing care for members of the community. There is one aspect of my hon. Friend's new clause about which I have serious concerns. I do not criticise my hon. Friend lightly, because he does not deserve criticism, but part of his new clause suffers from what may tactfully be described as careless or ambiguous drafting. I refer to subsection (4)(b)(ii). Under subsection (4), the Secretary of State shall consult such persons as he considers appropriate and request the Commission to give him advice as to the likely impact of the proposed statement or the proposed amendment on, according to subsection (4)(b)(ii), the cost of supplying such services in accordance with the statement of minimum standards. As I suggested to my hon. Friend in an intervention, the reference to the cost of supplying services could mean one of two things, or possibly both. It could mean the cost to the supplier of the service—the owner of the care home—or it could mean the cost to the person using the service.

Philip Hammond (Conservative, Runnymede and Weybridge)

I do not want to engage my hon. Friend in a detailed grammatical debate, but I feel obliged to defend myself. It seems to me that the cost of supplying a service can be incurred only by the supplier. The cost of purchasing a service will be incurred by the purchaser.

Simon Burns (Conservative, West Chelmsford)

I thank my hon. Friend. His knowledge of the construction of the English language is probably superior to mine. I do not want to continue to argue with him, and I accept his clarification, but that has implications for the person to whom the service is supplied. There should be a sub-paragraph (iii) referring to the cost to the user of the service supplied in accordance with the minimum standards. I have good reason for considering that to be important. The sheer horror of the situation will become apparent only next Tuesday. I expect that the Minister saw or had drawn to his attention the main story on the Channel 4 news last night. I do not know how many of my hon. Friends saw it. The subject, which has a serious impact on many hundreds of thousands of elderly people and their families, was the leak of what the comprehensive spending review to be published next Tuesday will say about long-term care, its cost and how that will be met. As the Minister will remember, although he was not at the Department of Health at the time, the former Secretary of State, when announcing the royal commission, said that it must complete its work swiftly. The original timetable set was 12 months from its inception in the summer of 1997. Because of the sense of urgency and the rhetoric, we expected the Secretary of State to consider the recommendations and make an announcement to the country fairly swiftly. The 12-month period would have ended in July or August 1998. It is now July 2000 and we have not heard a single word from the Department of Health about how it is to move forward. I understand from the Channel 4 report last night—this will have a direct bearing on new sub-paragraph (iii), which I urge my hon. Friend to include in new clause 4—that the state is to pick up the bill for nursing care in nursing homes. The Government would be absolutely right to make such a decision. The difference between what the health service should provide and what the individual should pay for has become increasingly blurred as the National Assistance Act 1948 has become more and more irrelevant to society's changing needs over the past 52 years. If that is what the Government intend to do, it is a step in the right direction.

Tim Collins (Conservative, Westmorland and Lonsdale)

The powerful case that my hon. Friend is developing seems to be an argument in favour of new clause 4. The Minister may be reluctant to accept subsection (4)(b)(ii) because the only advice that the Secretary of State will wish to take will be that of the Chancellor, who will tell him what he can and cannot spend. The Secretary of State has no interest in independent, possibly awkward, advice.

Simon Burns (Conservative, West Chelmsford)

My hon. Friend makes an extremely pertinent point in his correct analysis of the thinking in the Department of Health. He identifies the straitjacket within which Health Ministers must operate. They have received different moneys from the Chancellor for hospital and medical care, and I imagine that the Chancellor thinks that enough is enough. As Channel 4 said last night, pensioners will now be hit with a double whammy—the miserly 75p a week increase in pensions this April and the announcement—

Michael Lord (Deputy Speaker, Central Suffolk and North Ipswich)

Order. These matters are worth mentioning given that some people live on fixed incomes or are in long-term care, but the hon. Gentleman must not make a meal of them.

Simon Burns (Conservative, West Chelmsford)

I am grateful for your guidance, Mr. Deputy Speaker. In conclusion on that point, then, I feel that the new clause should include a subsection (4)(b)(iii). The Government will apparently announce on Tuesday that they will not fund long-term care. They may raise the £16,000 threshold, but will still expect families to sell their homes to pay for long-term care. That takes us to the need for an analysis by the commission or by those whom the Secretary of State consults of the costs of the minimum standards to the users of the services. Those costs must include the costs to families or individuals for living in a residential or nursing home. We shall not know until Tuesday whether Channel 4 was accurate, but if it was, there is even more need for a change to new clause 4. It is, of course, too late to amend the new clause tonight. I shall support my hon. Friend the Member for Runnymede and Weybridge if he wishes to pursue his new clause, but, without being unduly unfair to him, repeat that it is a pity that my additional proposal is not in the new clause.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I support the new clause, which provides a basis for exploring the Government's attitude towards national minimum standards and the process by which we have reached our present point. The Bill is primarily a vehicle for a series of regulation-making powers, giving the Minister powers to redefine and rewrite large chunks of the Bill. It also gives the power to introduce minimum standards in a range of differing care settings, and we must be clear what the role of the House will be, not only in passing the Bill, but for the future when standards are introduced. The Standing Committee explored in some detail an issue that we must revisit—the need for a clear and transparent process that gives the House and the other place an opportunity to debate both the statutory instruments that give effect to national minimum standards and those standards themselves. As we know from "Fit for the Future?", the standards will contain an awful lot of detail, and many devils lie in the details, which has raised much concern outside the House. The debate about national minimum standards is at least in part motivated by understandable anxieties among care home owners, and all Members will have had representations from them. It is important to record, however, that minimum standards exist for the safety and security of the consumers of the service, and act as a guarantee for them. That should be our starting point in constructing any minimum standards. I entirely accept that legitimate concerns exist about minimum room size, staffing ratios and so on. We must address those questions, but other standards—identified in "Fit for the Future?"—are welcome and should be implemented at the earliest opportunity. The debate about minimum standards will of necessity be better informed if we consider what has happened to date rather than talking only in the abstract about future domiciliary care, day care or any other type of care. It is crucial to bear in mind that a key element underlying minimum standards must be the principle of maintaining the independence and dignity of people in care. We must consider how to provide choice and how to ensure as much control as possible for the individual. "Fit for the Future?" covers such issues as social activities and other measures of quality that ought to be covered by minimum standards. I do not see room size as an adequate proxy for quality. That said, we must recognise that standards change over time and cannot be absolute. My generation may expect something different in a care home from what a future generation will expect. Perhaps there are differences in what those living in care homes expect. Those differences should be borne in mind. Equally, on choice, someone living in a care home may have chosen a particular location because it is a listed building with unique features. That may be the very reason why that person has chosen that home, and we should not lose sight of that fact as we implement standards. It would be wrong to drive out of business a home in which people are receiving the quality of care and life that they want just for the sake of complying with a minimum room size standard. The regulatory impact assessment attached to "Fit for the Future?" said that 7,000 additional nurses would be required to give effect to the national minimum standards. We know all too well from questions and debates that the Government are struggling to recruit and train enough nurses to fill the 17,000 vacancies in the national health service. To suggest that we can find another 7,000 beggars belief. As we consider "Fit for the Future?" and the emerging national minimum standards, we should be given clear timetables showing when consultation will end and when ministerial deliberations will be concluded. That would provide the maximum possible clarity on the minimum standards, which the industry—home care, day care or care homes—wants.

John Bercow (Conservative, Buckingham)

I agree with the thrust of what the hon. Gentleman says, but may I focus his attention on Government amendment No. 61? Given that clause 22, which will be amended under that amendment, contains no fewer than 10 subsection and 34 paragraphs, what precisely is the merit of, or the need for, Government amendment No. 61?

Paul Burstow (Liberal Democrat, Sutton and Cheam)

That is an interesting point. When the Minister responds, we may discover that the Government are attempting to respond constructively to concerns that were expressed in Committee by the hon. Member for Runnymede and Weybridge (Mr. Hammond). The hon. Member for Buckingham (Mr. Bercow) may have to wait to listen to the Minister's gracious comments on those matters. In Committee, several hon. Members expressed concerns about the impact that standards would have on the supply of places in care homes, but the availability of domiciliary care is also important. The Government need to accept that there is a crisis of confidence in the care homes sector. How many homes are closing in any given week may be a matter of dispute, but I have heard that one a week, possibly more, are closing. They may be closing for the perfectly legitimate reason that they do not provide a good standard of care. Such homes should be closed, but many others are closing because they cannot provide a decent rate of return on the investment that they have made in their businesses. Fees have not kept pace with costs. That key problem predates the Bill and national minimum standards, but the uncertainty about those standards has added fuel to it. As the hon. Member for West Chelmsford (Mr. Burns) has said, local authorities are under financial pressure on the provision of social care and the increasing demands that are placed on them. As a result, they must be ruthless in exercising their role in purchasing care places. They are undoubtedly holding down fees as much as they can. There have been some increases, but they have not been adequate in many cases. The link between quality and the cost of meeting the standards is not straightforward. The equation is more complicated than that, but there is a link. If the standards are driven up—I would entirely applaud and support that—it must be recognised that, at some point, that will have a bearing on the fees that need to be charged and the incomes that need to be provided. We shall expect care assistants and others involved in domiciliary care and care homes to receive more training to meet the new national minimum standards and to ensure that adequate numbers of staff are registered with the commission. All too often, better trained staff look for better paid jobs. Care assistants in care homes are not paid decent salaries. They can get better pay stocking the shelves at the local supermarket. If we do not recognise that problem, we shall store up problems for ourselves. There will be a flight from the sector as a result of improving the qualifications of its staff because they can get better jobs in other aspects of social care, where their skills are more fairly rewarded. The hon. Member for West Chelmsford, who is no longer in his place, rightly expressed concern about the link between improvements in standards and the potential increase in costs to the consumers—those who live in care homes. He linked that to reports of yet other leak about what the Government have in mind for long-term care and the relative distribution of the consequent costs between the state and the individual. We shall have to wait for the White Paper, rather than the comprehensive spending review, to find out whether the leak is true. If "Channel 4 News" is to be believed, I hope that the Government, even at this late stage, will give further thought to what the Prime Minister said before the general election. He said that he did not want to live in a country where old people had to sell their homes to pay for their care. The many hundreds of thousands of people who thought that the Government would take serious action on that feel betrayed and let down by the Government in that respect. 8.15 pm We shall have to wait until next week to find out whether the comprehensive spending review will provide a true idea of exactly what sums will be allocated to such matters. Time will tell, but I fear that we might have to wait until the White Paper is published, I hope, at the end of the month. If the hon. Member for Runnymede and Weybridge decides to press the motion to a Division, we shall support him. New clause 4 proposes an entirely right and proper structure in which the Government should discharge their responsibility to produce minimum standards. The House should have a clear role in scrutinising those standards. Its role should involve much more than approving a statutory instrument under the negative procedure. The affirmative procedure should be used, so that we can consider not only the regulations, but the details behind them. I hope that the Minister will be able to respond positively.

Sir David Amess (Conservative, Southend West)

I do not want to fall out with my hon. Friend the Member for West Chelmsford (Mr. Burns), but I congratulate my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) on his skilful drafting of new clause 4. I found his arguments entirely convincing and hope that the Minister will accept new clause 4. The Minister will know from our deliberations in Committee, that I feel very strongly about such matters. There are a huge number of residential and nursing homes in Southend. That should be no surprise because it is well known that Southend is the finest seaside resort in the country and elderly people are flocking to the town because the movement of the Thames estuary is extremely good for people's breathing. That is why our residential and nursing homes are so popular, especially those in Southend, West. I regularly visit those homes and I am in constant contact with the people there. The Minister takes a different view, but of course Conservative Members support national minimum standards. That is well understood, but he is saying "Trust the Government." I, for one, do not trust the Government. I am very concerned about those standards. As the Minister knows only too well, this is not about the curtains, the en suite facilities or similar matters, but about the love and care that many elderly people in those homes are given by the home owners. I baulk at using the expression "running their business", but it is not good enough for the Government to expect the owners of those homes to do whatever the Government want without proper and due consultation. I take my hat off to the Minister; he was kind enough to invite the Committee to 79 Whitehall to look at the different rules and regulations on which he was consulting. However, I ask him to consider new clause 4 carefully because it would be a tremendous fillip to all our residential home owners if it were accepted. He knows only too well that the Independent Healthcare Association, Leonard Cheshire, the National Care Homes Association, Help the Aged, William Laing and others have all been somewhat concerned about the overall tenor of the minimum standards. Perhaps the Minister will tell us that he has managed to placate those concerns in the past few days, but the magazine, "Caring Times" carried out a survey to discover the effects of "Fit for the Future?". That survey should be of concern to the Minister because more than 50 per cent. of respondents said that they could be obliged to close due to bankruptcy. We all know from our constituencies that the national health service is in crisis. My goodness, I experienced that myself at St. Thomas's accident and emergency unit in the wee hours of the morning on Monday, learning at first hand how the NHS is in great difficulty. Many of our constituencies are experiencing bed blocking. We have 56 people in hospital at the moment—

Michael Lord (Deputy Speaker, Central Suffolk and North Ipswich)

Order. The hon. Gentleman's remarks are wide of the new clause; he may want to return to discussing it.

Sir David Amess (Conservative, Southend West)

Of course, Mr. Deputy Speaker. A residential home proprietor in the north-east said of minimum standards: Basically, this is another idea developed by those who do not know and never ask. A nursing home proprietor in Scotland said: We are negotiating a loan to improve our facilities and have been experiencing difficulties with lenders directly due to the possible implication of these proposals. We are now having to alter plans and hope this will satisfy lenders. This will increase our loan and without an adequate increase in fees, budgets will be very tight. These are onerous standards, financially wasteful and will threaten small establishments. That is why we need the Minister's reassurance that there will be due and proper consultation. For that reason, I am an enthusiast for new clause 4. The Scottish proprietor continued: The larger homes can easily absorb costs. Is this the future—the large pies controlling the care sector? That is another concern. I do not want to cause controversy in Southend, West, but when I go round residential nursing homes and see chintzy curtains and plush facilities, I am not taken in for a minute. I am concerned about the quality of care. I have first-hand experience because next door to me is an excellent residential nursing home called Cherry Croft, and I pay tribute to the loving care and nursing that it gives to many of my constituents. However, I also have first-hand experience of another nursing home outside the area that I represent, although I shall not go public on that as I am trying to deal with the matter tactfully at the moment. One would think that the home is the cat's whiskers, but I happen to know that the care and attention that it provides are somewhat disappointing to say the least and there have been unfortunate outcomes. Recently, I had the privilege of visiting a small home with only eight beds in my constituency. It is struggling, and it told its Member of Parliament that it is struggling because it is concerned about minimum standards. It is looking for certainty, as it wants to plan for the long term. The people there love their residents, but they think that, unless there is the certainty that new clause 4 would provide, the home may have to close, adding to the 50 per cent. of homes that believe that they will have to close. A residential home owner in the midlands said: We've just spent a fortune upgrading to existing standards. If new standards are introduced, we would have to close. Residents would lose their homes, staff would lose their jobs and we would be devastated. That is happening right this minute in the midlands. Linda Nazarko, the director of the Registered Nursing Homes Association, said: Standards must be meaningful, and concentrate on quality, not merely on physical standards… The RNH is 100 per cent. committed to quality care but have been saying for some time that it is unjustifiable to raise physical standards any further in a climate of decreasing resources. That is a different argument, but we should not completely reject the points that she has made. A residential home proprietor in the south-west said: We comply with all the current regulations. I have difficulty comprehending how an increase in bedroom size can have that great an effect on the care and wellbeing of our residents. The vast majority spend no waking time in them whatsoever. We employ more care staff per week than the basic requirement, our staff are comprehensively trained and care is of the highest standard. These standards would bankrupt us. Eighteen residents would be homeless. Twenty-four staff, many of them breadwinners, would be unemployed. Another residential home proprietor in the south-west said: In our experience, most of our residents have used the bedroom only for sleeping in at night and a few for a nap after lunch. Recently, I attended a reception at which home owners gathered to debate the national minimum standards and I say to my hon. Friend the Member for Runnymede and Weybridge that I found them overwhelmingly enthusiastic about the proposals in new clause 4. I have received a letter from the Norfolk Residential Care Homes Association, which is very concerned about minimum standards. It says: We are seeing Home closures in Norfolk which result in residents being transferred up to 20 miles away and that is a problem for relatives and friends for…maintaining contact with their loved ones. I have also been contacted by the Brighton and Hove National Care Homes Association. It, too, is very concerned and I am advised that 17 of every 20 care homes for old people in Brighton and Hove—85 per cent.—will close as a result of the minimum standards. The councillor dealing with this matter said that the Conservatives were scaremongering and that the closure rate would be only 30 per cent. That is no comfort to the good people of Brighton and Hove. I ask the Minister to consider carefully the arguments made by my hon. Friend the Member for Runnymede and Weybridge. I support minimum standards—they are desperately important to the living standards and living conditions of elderly people—but where is the measure for the love, care and devotion that many home owners give to residents? An overwhelming number of residents have no relatives and might have lived in a home for 10, 15 or 20 years. They may not have en suite bedrooms or rooms that meet the standard that the Minister has in mind, but none of that is important to them. They do not regard home owners as wicked capitalists. In fact, morning, noon and night, they put their hands in their pockets to make sure that standards for residents are decent and they also celebrate residents' birthdays and provide all sorts of entertainment. None of that is recognised in the minimum standards. I know that the Minister has the best intentions, as he showed in Committee, but we need to be convinced that the minimum standards are in the best interests of residents. I hope that he will reconsider new clause 4.

Peter Brand (Liberal Democrat, Isle of Wight)

I am sure that the motives behind "Fit for the Future?" were right, but it has caused great concern, mainly because it does not necessarily address the issue of fit for the purpose. I have been struck by the complaints. Small care home owners are concerned about rigidity—the bricks, mortar and buildings—and are relaxed about the excellent quality standards for care and staffing. Conversely, the larger providers—those quoted on the stock market which run large granny factories—were relaxed about the bricks and mortar, but extremely concerned about meeting the staffing levels and qualifications. There is no doubt that care is more to do with staff than with buildings. It is right that the Government should set minimum standards for staffing and training, which are vital. We should commend the Minister for his efforts in that area. However, minimum structural standards for care homes could be best addressed through ministerial guidelines to the commissioning agents. Different homes suit different people. That is not only because different personalities are happier in different settings, but because their physical, emotional and social needs may be different. It would be sad if a fixed ratio were imposed on the double occupancy of bedrooms, as opposed to single occupancy. Even in a place such as the Isle of Wight, there are cultural differences. In one part of the island, it is the norm to share. In other parts, everyone wants an en suite room and not to talk to anyone else. We must accept that that is part of giving residents choice. The issue of communal facilities has been mentioned. In nursing homes dealing mainly with post-operative conditions, people spend a great deal of time in their bedrooms. They do not want to go out, mix or sit in a dining room. They want to rest in peace and quiet and then go home. If that is the business that the establishment is in, it seems unreasonable that it should be required by regulations to have facilities that it does not use. In Committee, I supported the imposition of statutory standards by affirmative resolution, but these should be backed by ministerial guidelines which, in time, may show where statutory standards may go in the fullness of time. That will help health authorities and local authorities in their commissioning role. There is a need for standards to rise even in places such as the Isle of Wight, where we have done well at the expense of some less effective and less successful home owners. One must accept that we are dealing with a part of the business sector, and that businesses should compete. With that goes grief from time to time. There is no doubt that what is happening to the sector is unreasonable. One of my slight criticisms of new clause 4, which is well drafted, is that it does not give a time scale for consultation. Consultation is vital. The Government consultation on "Fit for the Future?" was announced in October last year and it took until a week after Christmas before I could get copies to the people affected by it. It was difficult to get responses in within the deadline and, when people put in their responses, nothing happened. In the meantime, we have had a long period of uncertainty, which is having a detrimental effect on investment in raising standards and on those who were about to retire, but cannot at the moment. We have rehearsed the arguments and we have heard indications of comfort, but no real comfort from the Minister. I hope that he will go further than he did in Committee.

John Hutton (Labour, Barrow and Furness)

First, I wish to explain to the hon. Member for Buckingham (Mr. Bercow) why amendment. No. 61 has been tabled. The amendment will place an obligation on the Government to consult the people and bodies whom they think appropriate before making any regulations under clause 22 and before making any significant amendments to regulations made under clause 22. In tabling the amendment we are responding to concerns raised by the hon. Member for Runnymede and Weybridge (Mr. Hammond), who raised the issue in Committee. I assured him then, and I confirm today, that it was always the Government's clear intention to consult on all the regulations made under this clause. However, I am happy to table this amendment to put the matter beyond any reasonable doubt. I hope that the hon. Member for Runnymede and Weybridge will be pleased to see that we have actually gone further than his amendment would have required, in that we have included a requirement to consult on any substantial changes to regulations that have already been made under this clause. I hope that that will be welcomed by the hon. Gentleman and his colleagues. We have had a wide-ranging debate about some other issues, particularly new clause 4. This is a familiar theme to those Members who take an interest in national minimum required standards. The hon. Member for Southend, West (Mr. Amess) spoke with his usual passion—if not accuracy—about the subject. The hon. Member for West Chelmsford (Mr. Burns) spoke with substantial knowledge, gained from his time as a Health Minister. I thought that his contribution was important and useful. The hon. Member for West Chelmsford explained the difficulties that he had experienced in his own county, Essex. It is my own county, too; I lived there for many years.

Keith Simpson (Conservative, Mid Norfolk)

An Essex boy!

John Hutton (Labour, Barrow and Furness)

Indeed.

Stephen Day (Conservative, Cheadle)

That explains a lot.

John Hutton (Labour, Barrow and Furness)

It might explain a few things, but I do not think that we should go there today. The hon. Member for West Chelmsford was explaining some of the problems that small care home owners in Essex were experiencing primarily with the room size standard. He will be aware that the problem in Essex perfectly illustrates the need for the changes in the Bill and the new laws that we are proposing. Essex county council has had a 10 sq m standard since 1991, and the council gave care home owners 10 years to comply with the standard. The hon. Member for Southend, West was moaning about the standard, but it was introduced nearly 10 years ago in his constituency and that of his hon. Friend the Member for West Chelmsford. To be fair to both hon. Members, I must say that I have no information about the extent to which the standard has been implemented by the county council and, in particular, the social services department. It may be possible for us to correspond about that. The hon. Gentleman was concerned about the fact that the county council had never applied the standard to its own homes. In the Bill, we are creating a level playing field between the public and private sectors. I should have thought that the hon. Gentleman and his hon. Friends would at least welcome that advance.

Simon Burns (Conservative, West Chelmsford)

Will the Minister give way?

John Hutton (Labour, Barrow and Furness)

I will in a minute. Conservative Members have taken nearly an hour and three quarters; I have spoken for four minutes. An important point has been made today—all who have spoken made it effectively. We have tried to make it too; certainly, I made it repeatedly in response to the concerns expressed by the hon. Member for Runnymede and Weybridge in Committee. We absolutely must get the emphasis right. The quality of care must be measured accurately, and that cannot always be done with a tape measure. Not all hon. Members—although, to be fair, the hon. Member for Isle of Wight (Dr. Brand) probably came closest to it—have sufficiently stressed the importance of room sizes as a measurement of quality. We should ask ourselves whether, if we were going into a care home, we would want to be in a small room, or in a reasonably sized room. The hon. Member for Southend, West said that some care home owners were saying, "These people do not spend much time in their bedrooms." We should bear in mind, however, that in a typical residential or nursing home the bedroom is probably the only private space for residents. The care home owner may believe that a resident is not spending much time in the bedroom. That is an observation. It must be recognised, however, that for many people the size of the room is an important issue. I am certain that, whatever hon. Members on either side of the House may say, it would be important for us if the time arrived for us to be in care homes.

Philip Hammond (Conservative, Runnymede and Weybridge)

The Minister asks whether any of us would want to be in a small room. Viewing the question in isolation, everyone would probably prefer the idea of a larger room; but we cannot consider such questions in isolation. If limited resources are available, choices must be made. That, I think, is the point that some of my hon. Friends have been trying to make.

John Hutton (Labour, Barrow and Furness)

Obviously, the hon. Gentleman is right. The whole process of government and decision making in this place is about making choices. I will not pretend that we do not have difficult choices to make in setting national minimum required statements; of course we do. It would be naive to imagine that we could sail through it without having to make difficult judgments. What planet does the hon. Gentleman live on? Of course these are difficult issues. That is why the process is taking time—that is a matter of record; it is taking time to make the right decisions, but we are determined to get them right.

John Bercow (Conservative, Buckingham)

A couple of minutes ago, the Minister referred to room sizes, in the plural. In the light of his earlier challenge to my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond), will he confirm that he is irrevocably committed to a single national minimum room size?

John Hutton (Labour, Barrow and Furness)

I do not know where the hon. Gentleman has been for the past 12 months or so, but he has obviously not been following this debate.

John Bercow (Conservative, Buckingham)

I have.

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman may have been following it closely, but if he has I am surprised that he should ask such a question.

John Bercow (Conservative, Buckingham)

I have a family interest.

John Hutton (Labour, Barrow and Furness)

I am pleased to learn that. We have always made it clear that we want to establish proper national minimum requirement standards, and those standards will include room sizes. My grammar may be wrong. I have been picked up on that a few times before in this place and I am sorry if I confused the hon. Gentleman, who is obviously punctilious in his use of grammar. If it is easier for him to come to terms with "room size", that is what I am talking about. If the hon. Gentleman is as familiar with "Fit for the Future?" as he says, he will know that we are talking about the separate room-size requirement in relation to nursing homes, as opposed to residential care homes. We have postulated the possibility of a different room size for residents who are permanently in wheelchairs, for instance. I am afraid that the suggestion that we ever discussed just one figure makes me less convinced than I otherwise would have been that the hon. Gentleman was paying as close attention as he would have us believe. 8.45 pm Let me now deal with amendment No. 39. We consider it important for prospective patients to receive clear and accurate information about the treatment and services that are proposed. The Bill already contains scope for that in clause 22. The power that we already have, enabling regulations and standards to be produced in relation to patients information requirements, is more flexible than the power in the amendment. The Government's response to the fifth report of the Select Committee on Health on the regulation on independent health care, produced in 1999, was that the powers in the Control of Misleading Advertisements Regulations 1988 were sufficient to control advertising. That, of course, is a matter for the Advertising Standards Authority and the trading standards departments of local authorities. The amendment also deals with the question of the medical titles that people might use in cosmetic surgery clinics. As the hon. Member for Runnymede and Weybridge will know—he conducts his research carefully—section 49 of the Medical Act 1983 already makes it an offence for any person to pretend to be, or use the title of, a physician, Doctor of Medicine, surgeon, general practitioner or Licentiate of Medicine—I must say that in my travels across the country I have never come across anyone who has described himself as that. I think we have the right balance: there is already enough legislation to prevent such problems, and section 49 of the 1983 Act triggers liability for criminal sanctions. Amendment No. 38 concerns the financial position of establishments and agencies. I cannot accept the amendment, which would remove a key power to ensure the protection of vulnerable people who depend on regulated care services. The purpose of this express power is simply to ensure that the establishment or agency is and remains financially viable. Would-be providers must be able to demonstrate that they have the means to run their businesses properly. Establishments or agencies providing care must be financially sound; otherwise, service users who depend on them will be put at risk. The hon. Member for Isle of Wight rightly said that the focus of all this work should be on the consumers—those who live in residential homes. That is what the provision is about. It will, I hope, prevent unreasonable and unnecessary movements between care homes. The principle was recognised in recent case law relating to fitness under the Registered Homes Act 1984, and therefore already forms part of the existing regulatory arrangements. In that case, the registration authority proposed to refuse registration on the ground of a lack of financial viability. The case was referred to the High Court for judicial review. As the hon. Gentleman knows, the care home owners challenged the decision. The court upheld the registration authority's view. The judgment confirmed that the consideration of the way in which it was intended to carry on the home must include the means available to provide the facilities and services. The hon. Gentleman spoke of intrusiveness, but I think that most sensible people will see the power as simply a demonstration of common sense. Of course we need the provision in the Bill, and I would not advise my right hon. and hon. Friends to remove it. I accept that our proposals may require commercially sensitive information to be made available to the commission, and I fully appreciate some of the concerns raised by the hon. Gentleman. However, as I told him in Committee, such information will be confidential, and the commission will have to observe high standards of security in respect of it. Not to allow the commission to be able to satisfy itself about these matters would make it harder, not easier, for it to do its job properly. That should be our yardstick.

Jacqui Lait (Conservative, Beckenham)

Could the Minister clear up a point of confusion on a slightly different subject? Close care sheltered housing, quite rightly, will be regulated. However, on 14 June, in a debate on sheltered housing in Westminster Hall, the Under-Secretary of State for the Environment, Transport and the Regions, the hon. Member for Sunderland, South (Mr. Mullin), said: The Care Standards Bill…will introduce the regulation and inspection of all types of home care provision, including that provided in sheltered accommodation.—[Official Report, Westminster Hall, 14 June 2000; Vol. 351, c. 270WH.] Does that refer to all sheltered housing, or just close care sheltered housing?

John Hutton (Labour, Barrow and Furness)

If the hon. Lady will forgive me, I should like to look at that reference myself and confirm—[Interruption.] She is waving it at me. I cannot actually read it from here, but I am sure that we will have a chat about it in the Lobby in a minute. We tabled amendments to the Bill to make it clear what type of care homes we wanted to regulate. We do not intend to extend the category of homes currently being inspected and regulated by inspection units. We have tabled amendments to put that beyond reasonable doubt. The difficulty is, as the hon. Lady will be aware—she has much experience in the matter—that none of those categories of sheltered housing is legally defined anywhere. Therefore, we have made clear in the Bill which care homes we think the new powers should relate to. We have tried to reassure care providers that the Bill will not widen or broaden the scope of registration. I hope that that clears up the point for the hon. Lady. There has been substantial discussion on new clause 4 and amendment No. 2. They have led to a long discussion tonight, and the same subject led to extensive discussions in Standing Committee. New clause 4 goes to the nub of the Bill—how we intend the new regulatory system to work in practice, and the impact that it may have on the viability of some the establishments and agencies to be regulated. When debating these matters it is important that we maintain our primary focus on the benefits of the Bill's changes for the people—children, young adults and older people—who use the services that we intend to regulate. Those people are at the heart of our regulatory reforms. It is important to know how vulnerable they are to shoddy, negligent and, in some cases, abusive care. We know that there are some operators who should not be in the business of providing care, whose performance damages the reputation of decent providers and has led to the destruction of public confidence in some areas. Our intention with the Bill is to establish a proper regulatory system that promotes good quality care services and supports those many providers—the vast majority, in fact—whom the public can rightly trust. Therefore, I want to argue against the amendment tabled by the hon. Member for Runnymede and Weybridge, both in substance and in practice. It should not be part of the Bill. The regulations will, as it were, form the bones on which the minimum standards will be the flesh. The current system works similarly, but the main difference is that under the present arrangements there are no national standards; there are only local standards. We want a level playing field between different providers. The independent sector has been calling for national standards for a long time—a point that was never acknowledged by Opposition Members during the debate. That is what we intend to deliver, but consistency must be balanced with discretion. In Committee, much of the debate on standards centred on "Fit for the Future?", the draft standards for care homes for older people. Through consultation, we established that nine of the 11 topic areas were widely supported. Standards cover fundamental aspects of quality of care for residents. They introduce principles of dignity, privacy and choice, and demand that residents are treated with respect by properly trained, competent and trustworthy staff. Two controversial areas—room sizes and staffing—have provoked concerted opposition from some sectors of home owners, especially owners of smaller homes, and opposition from owners in certain parts of the country rather than others. The wide variation in standards is in itself an argument for more consistency nationally.

Simon Burns (Conservative, West Chelmsford)

On the question of national consistency and a level playing field, can the Minister answer the questions about how local authorities will be able to fund the upgrading of their residential homes?

John Hutton (Labour, Barrow and Furness)

I want to say something about resources in a minute. Labour Members still have to be persuaded that the hon. Gentleman and his friends are the right people to hand out any lectures about the level of public funding and public support for some of these important social services. His party, I understand, has something of a widening gap, or black hole, in its public sector finance policies after some of the recent announcements and U-turns by his right hon. and hon. Friends. Of course, the hon. Gentleman will be aware—again, because of his interest in the subject—that the Government are making record resources available to finance social services. The present comprehensive spending review provided nearly £3 billion-worth of additional expenditure during this period. There will be more to come. He will have to wait for those announcements, like everyone else, but the general financial situation is a positive one for local authorities and social services, with record resources going into those sectors. I was referring to two controversial areas that have caused legitimate concern. On staffing, I have already stated our intention to base trained nurse staffing levels on assessment of need rather than fixed ratios. That should be of considerable help to many small nursing home providers. On room sizes, it is important to state that 10 sq m is a reasonable norm, long established and widely observed. However, to balance consistency with discretion and to try to respond to some of the concerns that many hon. Members have expressed, I am considering criteria within which some flexibility can be exercised on that standard, to allow rooms smaller than 10 sq m to remain in use. I hope shortly to be in a position to provide the House, especially hon. Members who have an interest in the matter, with a fuller explanation of what the minimum required standards will specify. However, let me make it clear that there is no intention to prevent good quality homes from continuing to operate. We want to preserve the stability of provision for residents. Turning to the specific provisions of the amendment, the commission will have access to important information about the state of the care sector and will be able to advise the Secretary of State accordingly, but I personally do not believe that it is the commission's role to advise on standards in terms of their effect generally, or on the costs of their implementation. I believe strongly that that responsibility rests squarely with the Government. That is ultimately where it should remain. The issue of consulting on standards was well aired in Committee. We have given clear undertakings to consult on standards and on regulations, and the latter will be laid clearly before Parliament. Draft standards will also be made available to hon. Members for consultation. In Standing Committee last week, I extended to the hon. Member for Runnymede and Weybridge, who speaks for the Opposition on these matters, an opportunity to participate in some of the consultations on the Children (Leaving Care) Bill. I am more than happy to extend such an invitation in relation to the national minimum required standards to all the right hon. and hon. Members who speak for their parties on social services issues. It is self-evident that no establishment or agency will be registered unless it complies with the standards, and of course the regulations; otherwise there is no point in having them. That is one other reason why the hon. Gentleman's amendment adds nothing of value or substance. I have tried to address some of the concerns that have been raised in the debate. I do not want to go into all the nooks and crannies of the hon. Gentleman's description of proceedings in Standing Committee, but I do not think that he gave a completely accurate description of the exchange that we had on those issues. The hon. Gentleman referred in particular to a letter that I had written him, which he said indicated that we were not going to include en suite bathrooms in the standard. There was not, and is not, any such letter. The letter dated 6 July that he mentioned referred to the door-sweep implications. I have in front of me a copy of the letter that I signed dated 6 July—I remember it clearly—and it does not refer to en suite bathrooms. My recollection is that we had an exchange on the subject in Committee. Although I do not remember the exact wording that we used, I certainly did not write to the hon. Gentleman as he has implied. This has been a full debate. I have tried to share with the House a very important piece of information—although I am not sure that the hon. Member for Buckingham was even paying attention when I told him that we were providing for discretion on the 10 sq m standard. Perhaps he acknowledged that discretion; certainly some other Opposition Members did. Nevertheless, I hope that that discretion will send a reassuring signal for decent, good quality care home providers—whom we have no intention whatever of hounding out of the business. We need them, and we rely on them. We also want to encourage them to invest in their businesses so that they can be successful.

Hilton Dawson (Labour, Lancaster and Wyre)

Does my hon. Friend accept that what he has just said is tremendously good news for providers of good-quality residential care who want to remain in business and give excellent care, particularly for older people but also for people with all types of disabilities and difficulties? Do those comments not show that the Government are listening and taking on board the views of people throughout the sector?

John Hutton (Labour, Barrow and Furness)

I am pretty well bound to agree with my hon. Friend on all those points, and I am glad that he feels that way. We are trying not only to respond to the concerns quite reasonably expressed by the industry, but to meet the legitimate needs of our constituents. It is important that their voices are heard and their interests considered in addressing all the issues. That is the balance that the Government are trying to strike, and I strongly urge my right hon. and hon. Friends to reject this group of amendments, except Government amendment No. 61.

Philip Hammond (Conservative, Runnymede and Weybridge)

This has been a useful and wide-ranging debate. I am certainly glad that the Minister said that he himself had found it useful. When I said that I had received a letter from the Minister about door-sweeps and en suite bathrooms, I was working from memory. I do not have the letter with me, and I apologise to him if I misquoted it. However, I am rather more alarmed than I was if he has not ruled out the inclusion of en suite bathrooms, as that once again raises the prospect of home owners who have installed them having to rip them out to meet a future standard.

John Hutton (Labour, Barrow and Furness)

I am grateful to the hon. Gentleman for giving way on this important point. We are certainly looking to find ways of incorporating en suite bathrooms in the room size standard that we intend to develop.

Philip Hammond (Conservative, Runnymede and Weybridge)

I take that to mean that the Minister has not written to me to say that he is excluding en suite bathrooms, but that that is what he plans to do. I was disappointed that the Minister could not accept our amendments Nos. 38 and 39. He read out a great list of titles that could not be used under the Medical Act 1983. However, I did not hear him read out the title "consultant", which is the one causing particular concern. On amendment No. 39, the Minister said that financial viability was an essential attribute for a care home or an establishment, but he did not explain how it would be possible for an establishment in receivership to meet that criterion. The debate has focused mainly on new clause 4—or rather, it has focused primarily on the standards that will be promulgated, rather than on the new clause itself. The Minister has told us that he is now investigating ways of offering us a flexible response that will allow homes with rooms smaller than 10 sq m to remain in operation. I am grateful to him for sharing that information with the House. He also said that he hoped to be able to give us more detail soon. We shall, of course, wait with bated breath. New clause 4 itself is about the methodology for preparing and approving the statements of minimum standards, rather than the detail of the standards themselves. It is clear from this debate that our new clause 4 is an improvement on clause 23, which it would replace, and that it would allow proper parliamentary scrutiny of this very important sphere of legislation. I commend the new clause to my right. hon. and hon. Friends.

NATIONAL ADOPTION REGISTER

Caroline Spelman (Conservative, Meriden)

I beg to move, That the clause be read a Second time. We are most grateful that the new clause was included in the revised selection list. It provides us with an ideal opportunity to return to unfinished business that we began in Committee. Since then, important developments have taken place on adoption. The debate will allow us to contrast and compare the aims of our new clause and the Government's proposals. We could not engage in such a debate in Committee, although the Minister gave us heavy hints as to the imminent announcement of a national register. The new clause provides for an adoption register of parents qualified to adopt, to be held by the National Care Standards Commission, according to nationally established criteria set by the Secretary of State. The provisions on adoption and fostering in this wide-ranging Bill offer us an opportunity to help to amend the law on adoption. Hon. Members on both sides of the House probably agree that some amendment of the law is necessary. At present, the adoption process is too slow. Families need more support both during the adoption process and in the longer term. Help is needed when an adopted child enters a family, but difficulties can arise much later. Children adopted at the age of five or six might still manifest problems as they enter the troubled teenage years. That period is difficult enough, but it is even harder for young people who have to cope with the disruption to their life of being adopted when they were younger.

Michael Fabricant (Conservative, Lichfield)

Does my hon. Friend agree that part of the problem is getting adopted in the first place? Children who need to be adopted are available only to potential adoptive parents in a particular county or region. Will the provision of a national adoption register under the new clause ensure matching, throughout England and Wales, of parents who want to adopt and children who are available for adoption?

Caroline Spelman (Conservative, Meriden)

My hon. Friend exactly understands one of the main aims of the new clause. It would remove the lottery aspect of the process—in which the family wanting to adopt is constrained by the immediate geographical region and by the variation in eligibility criteria under different local authorities. The new clause would do away with that. At present, adoption is a postcode lottery. My hon. Friend touched on another important aim of the new clause. It would address the problem that 54,000 children languish in care—[Interruption.]

Alan Haselhurst (Deputy Speaker, Saffron Walden)

Order. I apologise for interrupting the hon. Lady. The conversation below the Gangway should cease. We are holding a debate.

Caroline Spelman (Conservative, Meriden)

Thank you, Mr. Deputy Speaker. We have a poor track record because so many children are in care—54,000. On average, it takes four years for a child to be adopted. It is obviously detrimental for children who have already been damaged by being parted from their birth family to languish in care. Often, they move between various foster parents before they find security and stability in an adoptive family. The new clause would impress on local authorities the urgent need to draw up plans for the children in their care. Contributing to the national register would increase opportunities for matching, which is restricted by geographical constraints on local authorities. As my hon. Friend the Member for Lichfield (Mr. Fabricant) pointed out, the creation of the national register would provide much better opportunities to obtain a good match.

Hilton Dawson (Labour, Lancaster and Wyre)

Does the hon. Lady accept that the views that she has expressed are accepted by hon. Members on both sides of the House? In fact, the proposal for a national register for adoption was included in the adoption consultation paper, which was published last week. As legislation is not required to do what she wants to do, is the new clause necessary? Can we not just accept that the whole House wants to do what is already in the consultation paper and therefore move on to the important clauses in the Bill?

Eric Forth (Conservative, Bromley and Chislehurst)

What a silly man.

Alan Haselhurst (Deputy Speaker, Saffron Walden)

Order.

Caroline Spelman (Conservative, Meriden)

If consultation papers had such a powerful effect, many more of the Government's good intentions might have had some force in law. It is because we doubt that the Government have enough time to enact a provision that has power and effect that we have sought more urgently to use a Bill that is going through the House to implement the measures for a national register on which we all agree. There are subtle differences between the Government's proposals in the consultation document for changing the process for adoption and our proposals, even though our aims are the same. It is worth while promoting the new clause to explain those differences. We believe that the Government's proposal for how and where the register should be held suggests that there will be a lack of independence. The National Care Standards Commission is independent and an ideal body to hold such a national register. We are not satisfied that a register held by some local authorities, which simply draw together their data, is sufficiently independent—and independence will be important. In the Government's document on adoption, the Prime Minister suggested that a new taskforce should be set up and that it should be called the new adoption and permanency taskforce. However, as I said to the hon. Member for Lancaster and Wyre (Mr. Dawson), how much power and force does a consultative document have? We have also grown sceptical about the power and force of taskforces; they are not always all that they are cracked up to be. We have a chance with this Bill to make progress and to proceed to implement the ideas that we have in common. I would describe our new clause as a bird in the hand, and a bird in the hand is worth two in the bush. The new clause offers us an opportunity here and now to make the changes. Two other aspects of the new clause need to be assessed against the Prime Minister's proposals for adoption. Our subsection (4) would recognise that the parents who have already gone through the mill and qualified as adoptive parents on the existing criteria and within the past five years should not have to go through the whole rigmarole again. That is important. People with friends who have had to go through the adoption process know that it is traumatic. It is long drawn out and involves a series of personal and far-reaching interviews. I do not dispute the importance of the interviews, but everyone will agree that it would be hard on people if they had to go through that process all over again.

Peter Brand (Liberal Democrat, Isle of Wight)

I will be interested to know whether the commission's role under the new clause would purely be to hold a register. Would it also have a role in determining the quality of vetting that took place before prospective adopters could go on to the register?

Caroline Spelman (Conservative, Meriden)

The hon. Gentleman's intervention is helpful. He served on the Standing Committee, so he will recall that part of the Bill is devoted to the question of raising the status of social work and the General Social Care Council. As much of what he described as the vetting procedure will be carried out by qualified social care workers, the Bill will have the advantage of bringing about a rise in the status of that profession. The hon. Gentleman asked specifically how we envisaged the role of the commission. We envisage principally that it would hold the national register, which would draw together all the adoptive parents registered with local authorities throughout Britain. However, if the vetting procedure is to work and be fair for adoptive parents and children, the cornerstone would be the national criteria set by the Secretary of State. Together, those two elements would make the vetting procedure fairer than the present system. The procedure would be carried out by qualified social workers, which would improve the position. Another important difference between the proposal in our new clause and the consultative proposals in the adoption document concerns the appeals procedure. Proposed subsection (5) of the new clause would create a proper appeals procedure involving the independence of the commission. The Prime Minister's review of proposals to introduce an appeals mechanism for potential adopters is rather unclear about that. We feel strongly that the appeals procedure needs to involve an independent body. Page 5 of the Government document states: appeals mechanisms for potential adopters should be put in place in all Local Authorities. We are concerned about having an appeals procedure in a local authority, as potential adoptive parents who have been refused have to make an appeal to the body that refused them. The appeals procedure will be stronger and better if the appeal can be made to an independent body, which is in marked contrast to what is the consultative document.

Hilton Dawson (Labour, Lancaster and Wyre)

I am sure that the hon. Lady accepts that adoption is first and foremost a service for children rather than for would-be adopters.

Caroline Spelman (Conservative, Meriden)

I do not dispute that it is first and foremost for the children. However, quite a few parents feel that, at the moment, the system does not deal with them altogether fairly, especially when they compare the grounds on which they were rejected by their local authority with the grounds on which their friends may have been accepted in another local authority. That has fundamentally undermined the confidence of potential adopters in an appeals procedure which is limited in all local authorities. There is therefore an important distinction to be made between the Government's proposals and what we would like to achieve in the new clause. I am bound to say that I believe that our proposal is better and would have more support from adoptive parents. It is important to grasp the nettle, as the Bill creates the opportunity to do something about adoption law. There is no question but that the time is ripe for reform. It is no secret that the previous Government had a draft adoption Bill ready in the last parliamentary Session, but ran out of time to introduce it. Even if the Government were to introduce legislation in the next parliamentary Session, that might not be a full Session so, to stop history repeating itself, we urge the Government to seize this legislative opportunity to introduce the national register which they said clearly in the consultative document they would like to accomplish. As the hon. Member for Lancaster and Wyre says, most important are the children. Once displaced from their birth parents, rather like war children, what they most need is security and permanence; they do not need to be moved from pillar to post in the care system. A Department of Health local authority circular, reference No. LAC(98)20, states: Many local authorities achieve high standards in the provision of children's services… However, recent Social Services Inspectorate reports involving a number of local authorities demonstrate a lack of consistency and co-ordination in England in the overall quality of their adoption services. We believe that that reveals the need to hold the list at national level and to have nationally set criteria. The information revealed in the Department's own document should lead Health Ministers to draw the same conclusions that we have drawn. The poor rate of adoption from the care sector reflects the poor level of therapeutic help available to displaced children. By involving the NCSC in a fresh approach to national adoption law, the new clause would create the opportunity to tackle the lack of such care provided during the process, both before and after adoption is complete. There is no doubt that a child who comes into care has already experienced some damage for which therapeutic help is needed; as the child moves into a transitional state—perhaps a foster home—more help may be required; and, as the child enters the adoptive family, yet more help will be needed. However, there are other groups in the critical triangle who also need such help. Often, the complaint is made that the adopting family receives inadequate support once a child has been adopted. The extremely high failure rate—it is estimated that 20 per cent. of all adoptions break down—must be attributed in part to the lack of therapeutic help provided to the child and the adopting family.

Julian Brazier (Conservative, Canterbury)

I entirely agree with my hon. Friend's point and I am sure she is right about the causes, but may I point out that 20 per cent. is not an especially high rate of adoption breakdown? The fact that 80 per cent. of adoptions succeed, often with no support of any sort being received and despite the fact that nearly all the children involved have experienced some sort of trauma, demonstrates what a successful institution adoption is.

Caroline Spelman (Conservative, Meriden)

By referring to the 20 per cent. breakdown rate, I was not implying that adoption was anything but an excellent solution for many displaced children. However, I hope that the strategic role assigned to the NCSC by the new clause will ensure that the breakdown rate is even lower. One more piece of the jigsaw could usefully be addressed by the NCSC: providing help to the relinquishing family. They are rather left out of the equation, which leads to the complex triangle between the child to be adopted, the adopting parents and the relinquishing family becoming unstable. Some adoption breakdowns are rooted in a poor process of relinquishment.

Hilton Dawson (Labour, Lancaster and Wyre)

Will the hon. Lady give way?

Caroline Spelman (Conservative, Meriden)

I know that the hon. Gentleman cares passionately about the subject, but I should like to make some progress before giving way again. There is no doubt that one of the advantages of having a national register would be improvement in the matching process. I carried out a little research into authorities local to me to find how practice can vary across the country. That is pertinent to the debate, because it is a problem that the new clause and the national register would address. I examined three local authorities which contrast in terms of size, socio-economic mix and other features. I would like to applaud their efforts, but I am using them to illustrate the extent of variation in practice between local authorities. I shall take the example of the Coventry adoption service. It allows prospective parents from the city and the rural hinterland of north Warwickshire to adopt children under 12 months from its care. Most people start with a wish to adopt babies, but very few are available. That trend has developed over the past 20 years, with the increasing amount of birth control and support for younger women who choose to manage single handed with a small child. Coventry placed only two babies last year. For children older than 12 months, the adoption team prefers adoption by parents who live within 50 miles of Coventry. However, adoption outside that radius is permitted, subject to the usual statutory checks by social services or by voluntary agencies such as the National Care Homes Association and Barnardos. Regional adoption is seen as the best option by the local authority because parents living further afield would face practical difficulties in attending Coventry's preparation groups in the run-up to adoption. Our new clause is designed to address a practical point. There are cost constraints on local authorities, and that is one of the reasons why they tend to focus on a tight radius. The authority is thinking about the costs that will have to be met by prospective adoptive parents, and we should not forget the cost to social workers, who have to travel from their headquarters to interview parents. When those journeys are further afield, that adds significantly to the costs of a social services department. That will need to be addressed if we are to have an optimum matching process that allows a countrywide national register to be held and for the best match to be found.

Michael Fabricant (Conservative, Lichfield)

Does my hon. Friend agree that speed is sometimes of the essence? Did she see a recent television programme that showed potential adopters, who said that they had been on the register for two years, but that after those two years of waiting they began to question whether they wanted to adopt, and came off the register? Sometimes it is a good thing that people can be matched early. That maximises the number of families that are prepared to adopt.

Caroline Spelman (Conservative, Meriden)

My hon. Friend makes an important and sensitive point. A couple may discover that they cannot have children quite late in life and quite close to the upper age limit, above which they are not able to adopt. The waiting process can be a time of terrible anxiety and uncertainty. Despite initial enthusiasm to adopt, some couples decide in the face of that sort of pressure that they cannot see the thing through to the end. It is hoped that, through the creation of a national register and much improved opportunities for matching and by setting national criteria that are clear and apply throughout the country, the process will become much quicker. The loss of confidence in the process and people giving up on it might become less common occurrences. I shall give some contrasting examples. Another large local authority near to my constituency is Birmingham. It faces a particular challenge because a quarter of the children in its care are of dual parentage. For that reason, Birmingham focuses particularly on other large conurbations for non-white parents. That is another practical problem that would be overcome by introducing a national register. The capacity for an authority such as Birmingham, with many children of mixed ethnic origin, to find the optimum match would be made more easy. I contrast that with a small authority, not to criticise that authority but to illustrate some of the problems and some of the reasons for the variation in eligibility criteria that would be resolved by the new clause. My constituency lies in the Solihull local authority. One of its difficulties is the matching process. Its age limit is children under two years of age. That is in contrast to the flanking local authorities. The age limit for parents is not applied in Birmingham and Coventry, but it is 35 in Solihull. Sometimes discretion can rightly be used, but that is Solihull's publicised upper age limit. Therefore, my constituents might well ask themselves why they should be subject to such an age limit when neighbours just over the border in other local authorities are not. Solihull tries to match children with parents from the same race as a first choice, if necessary placing them with parents outside the borough to achieve its aim. It simply has to because it is so small. That highlights the problem that local authorities are so different in their composition, which has led to the variation in criteria. 9.45 pm Some local authorities have restrictions on inter-country adoption. I had a constituency case where a couple particularly wanted to adopt from China. They had seen that moving documentary called "The Dying Rooms", which no doubt other hon. Members will have seen, about young Chinese girls left to die because in their society a baby boy is more revered than a baby girl. My constituent's response was to seek with total determination to adopt from China, but they were refused because of restrictions on inter-country adoption. I am not clear whether that is the key factor that contributes to another rather harsh statistic, but I have my misgivings. It is significant that, if we look at the number of inter-country adoptions by a comparable developed European country with a similar sized population, such as France, we find that there were 3,666 inter-country adoptions last year, compared with 250 in the United Kingdom. That marked contrast must, in part, be explained by some of the criteria set by our local authorities in terms of allowing children to be adopted from certain other countries. I have direct experience of some restrictions on inter-country adoption in my local authority, which may be contributing to the low rate of inter-country adoption. That reinforces the importance of the need for nationally set criteria. The new clause is all about making the adoption process easier and more effective, and, at its heart, helping children who languish in care—all to often for far too long for lack of a better process—to find permanency in a family that really wants to adopt them.

David Tredinnick (Conservative, Bosworth)

It may assist my hon. Friend if I recount my experience of helping a family adopt a Romanian child during the last Parliament when I was much involved with eastern Europe. A child was successfully adopted and the family are very happy, but the parents, who were British nationals, suffered great anguish and heartache because the law was unclear at both ends. They sought to take a child from an orphanage who had little future—we all know about Romanian orphanages—to give that child a life over here, but at one point they were extremely worried that they might be arrested. I shared their considerable heartache and I commend what my hon. Friend is trying to do in the new clause.

Caroline Spelman (Conservative, Meriden)

My hon. Friend underlines what we are talking about here, which is that there is a lot of heartache in the adoption process, not only for those who are unsuccessful in adopting, but often for those who succeed, but who find the process a lot more difficult than they thought, and also, often, for the children involved who may never fully recover from the damage caused by being parted from the family that has relinquished them. That is why we must proceed with sensitivity but also with haste, in order to address some of the real problems that could in part be corrected by the new clause. The new clause would be fairer both to the child and to the parents, given that the state has so obviously failed to fulfil its role as a corporate parent, as is shown by the statistics relating to children in care. We are dealing almost simultaneously with the Children (Leaving Care) Bill, and many of us have served on the Standing Committees considering both these Bills. Those of us who have served on both Committees are all too aware that 80 per cent. of children leaving care end up homeless, 75 per cent. have no educational qualifications and—this particularly affects me when I think about it and put myself in the girls' shoes—one in seven of the girls leaving care is pregnant or a mother by the age of 16. We cannot hold our heads up high when we think about the role that the state has played as a corporate parent to those children in care. For all those reasons, we strongly advocate a reform of adoption law so that it is possible for more of those children to leave care and to be adopted in a family—a family that is there not just till the child reaches the age of 16 or 18 or some other fixed limit, but in which, as in any family, a child is for life. That is a strong reason for reforming adoption law. The Government's proposals do not get to grips with the problem of variation in eligibility. Local authorities such as mine, which have an upper age limit of 35 or 40 for parents, are getting into difficult territory. Women are delaying the age at which they have their first child. There are various social reasons for that—women are looking for equal employment opportunity, and will often wait for a considerable time before stopping to have a family. They may not realise that their fertility has declined during that time, and they may find, too late, when they have passed the age limits for adoption, that not only can they not conceive, but adoption is no longer open to them. We strongly contend that there are parents over the age limits who offer good adoption opportunities for children in care, especially for children aged five, six, seven or eight and possibly children in their teens. Not enough consideration is given to the adoption prospects of children in their teenage years. It may well be right for them to be adopted by slightly older parents with more experience of slightly older children.

David Tredinnick (Conservative, Bosworth)

To support of her argument, will my hon. Friend remind the House that medical science is progressing so quickly that ladies can give birth much later in life? There have been newspaper reports recently of women up to the age of 60 giving birth. Does that not make my hon. Friend's case for raising the age limit?

Caroline Spelman (Conservative, Meriden)

I should like to be able to agree with my hon. Friend, but the Prime Minister's wife had my sympathy when she gave birth at 45. There is no question that managing a very small baby as one gets older is more difficult. My father, who is almost 92, may have found me quite wearing when I was born. The child must be the focus. A child coming from care with considerable luggage from the experience of being displaced may benefit from going into a family where the parents are older than 35 or 40, and joining a family in which the other children are of a similar age to the adopted child and the parents are experienced in dealing with children of that age. In Northern Ireland, there is an active programme to promote the adoption of children in their teenage years and older parents are actively sought. That experience shows that variable and arbitrary criteria can sometimes be obstructive in the adoption process.

Michael Jabez Foster (Labour, Hastings and Rye)

Is there not a risk that having the one-size-fits-all option of a national register may result in the individuals to whom the hon. Lady is referring falling outside it? The flexibility that authorities offer at present may give hope to individuals that they may not have if there is only one option.

Caroline Spelman (Conservative, Meriden)

Two points arise from that intervention. First, there must be full consultation on the criteria that the Secretary of State will set. We should agree on that as a basic principle. The criteria must also be simple, straightforward and easy to understand. Secondly, we need discretion, such as that exercised by my local authority. Children are individuals; they are not an homogeneous mass. Those who have been in care have individual problems that need specific assessment. The great thing about a national register and matching process would be that a child with highly specific needs would be far more likely to find the best match from a bigger pool of parents. The Government and the Opposition do not disagree on that, and the Government's consultative document states that they want a national register. Behind the new clause lies a sense of urgency. We should like to change the law sooner rather than later. In Standing Committee, we heard the Minister's reasons for resisting an amendment—to a different part of the Bill—that was intended to achieve the same as new clause 6. He resisted it first because the Government were about to make an announcement on adoption, as they have since done. He suggested that we should not debate the matter further until the Government's proposals were on the table, after which we could have the fruitful discussion that we are holding now. Secondly, the Minister argued that the Government could achieve a national register more quickly than would be achieved by an amendment to the Care Standards Bill. He said that the care standards commission would not be constituted until 2002 and that annual returns from local authorities, from which the national register would be drawn up, would not be supplied to it until 2003. I should like to revisit that point. The Government have produced only a consultative document, and I should feel much more confident if the Minister were to say that the Government would introduce a Bill early in the next session. I am offering a risk-benefit analysis along the lines of my bird-in-the-hand analogy. If the Government should lose the next general election—always a possibility—and given that it is tipped to happen next May, some of the legislative programme announced in the next Queen's Speech would be likely to fall. That is not an unrealistic scenario. To allow the national register to come into existence, debate would have to begin early in the next session. We are almost splitting hairs in saying that the legislation would come into force in 2001 while the care standards commission—the bird in the hand—will start in 2002. I cannot see why local authorities could not be urged to supply annual returns in time for when the care standards commission opens shop in 2002. Why lose another 12 months? Local authorities have the information, and we simply seek to legislate for that register to be held by an independent body.

Hilton Dawson (Labour, Lancaster and Wyre)

I am grateful to the hon. Lady, who has given way three times, but it is not clear from her remarks that anything that she wants to achieve requires legislation.

Caroline Spelman (Conservative, Meriden)

rose—

Caroline Spelman (Conservative, Meriden)

The hon. Member for Lancaster and Wyre has a background in social work and in Committee he contributed many points that informed our work. As relatively new Members, perhaps we can agree that we may not be world experts on the legislative process. However, in my experience consultative documents do not necessarily receive the force of the law that they need to achieve change such as that which we have described. For that reason, we have tabled the new clause. I hope that the Minister will give legislative effect to the consultative proposals. The hon. Member for Lancaster and Wyre nods, implying that he has the same hope. Obviously, I would like them to be finessed in the way that I have described, particularly on the point of the appeals procedure, which as proposed in the document is not sufficiently independent to inspire parents with confidence. Indeed, they do not have confidence in the process at present because it is far too in-house. I look forward to hearing what the Minister has to say. We need to move swiftly and, given that the reform has been a while in gestation, the difference between 2001 and 2002 does not strike me as huge. The important point is whether we are to have a Bill that will bring it into force.

Ian Bruce (Conservative, South Dorset)

The answer to the hon. Member for Lancaster and Wyre (Mr. Dawson) is simple. If the Minister does not need fresh legislation, it does not matter whether the new clause is included in the Bill. The Secretary of State could implement the reform under several pieces of legislation, but he needs the new clause to make progress if he does not have such a power at present.

Caroline Spelman (Conservative, Meriden)

I thank my hon. Friend for that intervention. He has much more experience of the legislative process than I, having been a Member for longer, so he knows exactly how to set out the choice—either/or. However, because this issue is sensitive and important, we do not want to be fobbed off. We need cast iron assurances that the reform will come into effect, as do all the parents who are frustrated by this tardy and haphazard process, which would be so much better were our new clause accepted.

Julian Brazier (Conservative, Canterbury)

I am grateful for the opportunity to speak to the excellent new clause 6, which was tabled by my hon. Friend the Member for Meriden (Mrs. Spelman). It is set against the background of the positive Government document to which she referred several times, part of which concerns establishing a national register. Our new clause deals with that matter. At this late hour, the House will be relieved to hear that I shall be brief. However, before dealing quickly with four detailed aspects, I remind hon. Members of the importance of establishing a national register and national standards. There are 54,000 children in care, of whom only slightly more than 2,000 were adopted last year. My hon. Friend gave some horrifying facts about the fate of many of those children. Up to a quarter of the girls become pregnant in care and we hear one sorry story after another. That is not to say that care workers and many devoted and loving foster parents do not do a good job, but in most cases adoption offers the best prospects for children in care because it provides permanence. The case for a national register is overwhelming, and the best evidence of that is the performance league table for individual local authorities. The top three councils have adoption rates of between 10.5 per cent. and 14 per cent. of the children in their care, but more than 20 councils have rates of less than 1.5 per cent. I wish to focus on one local authority that would benefit from a national register and some national standards. It happens to be a Labour council, but I do not mention it in a party political way. I should stress that the second best authority in the country, Middlesbrough, is a Labour council. Islington—left to itself, without a national register or national standards—has a miserable adoption rate of well under 2 per cent. of the children in its care. The Voice—a very good Afro-Caribbean newspaper—has a lot of good advertisements on adoption, including one recently placed by Islington council. It contained a description of a little boy who needed a two-parent adoptive family who could reflect and promote his ethnic and religious identity as closely as possible. I do not wish to reflect at length on the views of some black members of an adoption group to which I belong, the Adoption Forum, about the good experiences that they had with white parents. However, for a council to specify that it wants to match the religious identity and racial background of a little boy of less than two years old, and to imply that it is willing to hang on to that child—apparently indefinitely, as the council's poor figures indicate—if it cannot get that match shows how badly we need national standards and a national register. I do not want to go over the general argument any further, except to say that there can be only a national solution to a situation where local performance is so patchy, varying from a few good councils to a large number that perform so badly. My hon. Friend the Member for Meriden has mentioned the need for a proper appeals procedure. There is a complicated process, whereby someone who has not been certified by one local authority to get on a list could be considered by another local authority. I prefer the provision in the new clause which makes it clear that there is an independent appeal outside the local authority system. Independent management of the list is important. It would be quite wrong if the list were to be managed by the local authorities themselves. It would be wrong also if it were to be taken over by the British Agencies for Adoption and Fostering, because although it has an important role to play—given to it by the Government—the list will not be seen as independent by adopters or older children hoping for adoption if it is controlled by the local authorities. I was pleased to see in the back of the Government's consultation document that a large number of other groups—including the Adoption Forum, Adoption UK, which represents over 3,000 adoptive parents, and the National Organisation for Counselling Adoptees and their Parents, which represents many ex-adopted children—are being consulted. I believe that the association shares that view. It is critical that the measure is centrally funded. If the national register were set up and local authorities—some of which, such as Kent, are in difficulty with their social services funds—found that it became another service to pay for, there would be a danger that they would not use it. Also, the use of the register ought to be compulsory. I suspect that that is the Government's intention, but it is not clearly stated. The present position is terrible in many local authority areas. The new clause gives us an opportunity to press the Government to get on with provisions that the preliminary consultation paper suggests already exist in outline, or at least constitute—in part—their intentions. It is disappointing—all the more reason for the new clause—that the next step will be another consultation paper, or at any rate a White Paper, some time before the end of the year, followed by another consultation period. I urge the Government to act as soon as possible.

Peter Brand (Liberal Democrat, Isle of Wight)

I congratulate the hon. Member for Meriden (Mrs. Spelman) on making such a strong case for a national register for prospective adoptive parents. I also congratulate her on explaining that we are not just talking about a database for adoptive parents; the register would have to play an active role. However, I hope that the hon. Lady does not assume—as others appeared to—that being on the register would confer entitlement to a child for those who could find one. There is still much hard work to be done to ensure that prospective adoptive parents are suitable to adopt prospective adopted children.

Michael Fabricant (Conservative, Lichfield)

Of course I agree with the hon. Gentleman about that, but does he agree that—as I said earlier—speed is of the essence? Of course the safeguards of which he speaks should exist, but the new clause would help to speed up the process and to secure a better match, as it were.

Peter Brand (Liberal Democrat, Isle of Wight)

Undue delay is never useful, but, in the context of adoption, speed is also dangerous. I have a problem with subsection (4) of the new clause, which confers an automatic right if, five years ago, someone said that certain people were suitable adoptive parents. Things change with time; attitudes change with time. I would be worried about prospective adoptive parents who changed their minds after two years: I would be a bit concerned about how committed they had been to the adoption in the first place. The hon. Member for Meriden wants an agency that does not fit in with the National Care Standards Commission. The commission is a regulator and an inspector, not a deliverer of services. Adoption is very much an active process. It is not just about regulation; it is about ensuring that things are done properly.

Caroline Spelman (Conservative, Meriden)

I think that there are two misunderstandings of what I said. The first concerns the five-year period. Obviously, someone who no longer met the eligibility criteria that had been set nationally would not still be eligible. Secondly, I did not mention an agency.

Peter Brand (Liberal Democrat, Isle of Wight)

The commission is to set up the national adoption register, and run it. That worries me. I do not believe that the commission, which we discussed during—I think—22 Committee sittings, has ever been seen as a service deliverer. When I say "service deliverer", I mean a deliverer of personal social services, which is what we are talking about in the context of adoption. I support the hon. Lady's plea for appropriate and speedy action, but let me gently say to her that the problem has not arisen over the past few years. Many of us have discussed it over the past 20 or 30 years. Moreover, the extra complications that the new clause would cause in regard to inter-country adoption pose a significant problem. It would not be possible to develop a national policy to deal with it on the spur of the moment. 10.15 pm Therefore, I say with great regret that, although we recognise the need to look at a much better package for adoption—mainly to look after the interests of adopted children and the support structures that they and their adoptive parents will need after adoption—I cannot support new clause 6. I do not think that that activity sits happily with—

Julian Brazier (Conservative, Canterbury)

The hon. Gentleman queries the role of the particular organisation concerned. Does he none the less accept that it is critical that the register be handled by an organisation that is independent of the local authorities themselves?

The rest of the debate is in Hansard.