Clause 26

Part of Health and Social Care Bill – in a Public Bill Committee at 10:00 am on 17th January 2008.

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Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health) 10:00 am, 17th January 2008

There is some discussion to be had on this clause, because it concerns urgent cancellation, which is done on application to a justice of the peace. We will have a longer discussion on the role of justices of the peace when we debate part 3 of the Bill, and my hon. Friend the Member for Guildford will lead for us on that.

I assume that the clause is the legislative framework for the much trailed 24-hour closure of hospitals. The Committee should know that by agreeing to the clause it will be supporting that power. The Department briefed on this on 23 October, before the Bill was published. On 24 October, there was a written ministerial statement, which The Times and The Daily Telegraph both reported. They reported that the Secretary of State was angry that the Healthcare Commission did not step in to try to protect patients or alert the Government to the scale of the problem when it first made its report.

A draft of the Healthcare Commission report into the problems at Maidstone and Tunbridge Wells arrived at the Department on 3 May 2007, but no action was taken by the Department at that point. This is a useful opportunity for the Minister to explain why. The Times further reported:

“The Health Secretary is also expected to reveal in a Commons statement that the new inspectorate will have powers to sack doctors and trust chief executives immediately”.

The Secretary of State already has the power to suspend board members, but the previous Secretary of State did not use that power when she received the Healthcare Commission report in May. Furthermore, there was no mention of the Care Quality Commission having that power in the ministerial statement of 24 October, by which time we had a new Secretary of State. I cannot see a reference to the power in the Bill. No doubt the Minister will point it out to us if I have missed it.

The Committee should also note Anna Walker’s response to the hon. Member for Birmingham, Northfield when she gave evidence to the Committee. She said that the new powers to close wards “are not necessary” and that

“we do not overwhelmingly need them.”——[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 23, Q 32.]

However, she also said that

“we will use them if they are there.”——[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 23, Q 31.]

I am sure that the hon. Gentleman will remember that exchange, and I hope that he will tell the Committee what insight he gained from that line of questioning, which we thought interesting.

In the same sitting, Ian Kennedy said that

“anybody contemplating that you close a major accident and emergency unit...is not in a world that I recognise.”—[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 24, Q 33.]

In his statement to the press on the day of the Committee hearing, he said that

“it would be cavalier to close an element of a major public service without offering patients any alternative.”

Having highlighted those issues, I hope that the Minister will confirm to the Committee whether that is the current arrangement and whether it provides sufficient checks and balances.

With half an eye to the next clause, will the Minister also tell us how the Human Rights Act 1998 would be applied in circumstances in which urgent cancellation might breach aspects of that Act? For example, the cancellation of a nursing care home’s registration might lead to the quick eviction of its residents. One  can imagine such a scenario, and it is our job to work out how the rights of patients in such circumstances would interleave with the protection that must be afforded if something has gone sufficiently wrong that a notice withdrawing registration has been received. I appreciate that this point may be a touch legalistic, as I am not sure that if I had a relative in a home that had had its registration removed, I would be very keen for that relative to stay there a minute longer, because I expect that there would be good reason for such a move. However, if the relative were very frail, the speed of eviction might have to be balanced, so the issue of rights would be relevant.

We need to ensure that people’s choices in those circumstances are not limited by the absence of alternatives. There may be practical considerations for people who live in remote areas where there is only one care home for many miles, but equally often people do not have caring relatives or friends who can look out for them when such difficult urgent decisions need to be made.

I hope that the Minister will be able to deal with the question of how the power will help the CQC to deal with superbugs in hospitals, given the remarks made on behalf of the Healthcare Commission in oral evidence. Is the power to be granted on the basis of exigency rather than need? I hope that the Government are not trying to sound tough in the light of recent events. We saw that the Department had briefed The Times to the effect that the CQC will have the power to sack doctors and trust chief executives immediately; but at the moment we struggle to see where that power is set out.