Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2011

Baroness Jolly Excerpts

Monday 31st October 2011 Grand Committee

[Lord Collins of Highbury]

I have received a warning that I must not repeat myself, so I shall try to start from where I left off, which was highlighting the CQC report on out-of-hours services arising from the Daniel Ubani case, which highlighted that we have a nationwide problem. Delaying the requirement to register for a further year means that a lot of the issues that need to be addressed by proper monitoring of compliance will not be.

My other questions relate to which organisations are covered by the regulation. The estimate was about 230 organisations. Does that include the co-operatives such as SELDOC, established in south-east London? Is it simply those organisations separate from GPs? There is an issue about high-risk out-of-hours services stemming from provision within GP services by the use of locums employed directly. I would appreciate clarity about the risk assessments. What concerns me most is that within a 12-month period, the Care Quality Commission will be required to get in to 9,000 organisations, but the Government have given it 12 months to deal with about 230. Having been on the commission’s website and seen the processes and procedures, and the advice being given to primary health services, I think we have a difficult job ahead of us.

I leave my remarks to those few specific points. On the extension of out-of-hours—I must not say out-of-office services, that is my trade union background coming out—the flexibility of the provision of services by primary health services is most important. People are reverting to organisations that do not have their medical records or knowledge of their conditions because they have to work and cannot get to a surgery within its opening times. I know from personal experience that even booking a medical appointment can be extremely difficult. You have to do it within a particular time frame. With those concerns, I leave my remarks.

[Baroness Jolly]

I should like the Minister to clarify one point. Out-of-hours services providers need to register a year early if they are not in the practice of treating patients from outside their area. Can the Minister clarify the situation regarding itinerant or travelling workers? Where I come from, huge swathes of people come in to pick strawberries, daffodils or whatever. They certainly do not register. I am not clear whether the out-of-hours providers would treat them as temporary residents. What is the case in those circumstances? Would GPs who currently provide services in Cornwall in a co-operative be required to register a year early?

[Baroness Williams of Crosby]

My Lords, I, too, have a couple of questions. I very strongly support my noble friend's question about itinerant or temporary workers. In addition to the people about whom the noble Baroness, Lady Jolly, spoke, there is also the Traveller community, which does not stay permanently in a single place, as we know from the Dale Farm episode. I am very concerned—I am sure that others in the Committee are, as well—about the position of mobile workers whose life involves moving from place to place, and about where they will be picked up by the providers.

My second question concerns the position of out-of-hours services. The General Medical Council has raised many concerns about out-of-hours providers who are not familiar with the English language, let alone some of the other languages that we have in this country. Will there be additional requirements for out-of-hours service providers above the basic medical requirements that they will have to meet?

I should know the answer to my third question, but I confess that I do not. However, I am sure that the Minister does. When providers are registered, are the lists of those who are registered made available to local HealthWatch committees, local authorities and Parliament? That is very important. Transparency is almost invariably the best form of inspection.

Finally, with regard to the CQC, we all know—as the noble Lord and the noble Baroness, Lady Thornton, said—that it has been under heavy pressure. My question is: will the practice of non-notified inspections, as well as notified inspections, continue? I note that the Secretary of State referred to this just a couple of weeks ago in respect of the investigation of complaints about the treatment of elderly people when he called on the CQC to do an immediate inspection.

I have one final point. I do not expect the noble Earl to reply if he does not want to. The most effective form of inspection is by protecting whistleblowers. All of us are aware that whistleblowers are a very effective form of informal inspection. It was whistleblowers who came up with the terrible Winterbourne story. Are there any means of protecting whistleblowers, especially among NHS staff, from being forced into retirement or sacked? Among all possible forms of inspection, NHS staff are most likely to be able to alert the system too bad or poor standards. Have we given consideration to the possibility of protecting whistleblowers among NHS staff? I am sure that our colleague from the trade unions would be sympathetic to that idea.