My Lords, I start by thanking noble Lords who have spoken in this debate. In the end, this turned out to be an eclectic mix of amendments. Given that, I hope I can get the right balance between giving noble Lords comprehensive enough responses, while bearing in mind the more basic need of a dinner break for some noble Lords who have been in this debate today. I will be as brief and as comprehensive as I can be.
I turn first to Amendment 144B. We should be clear that the CQC is not intended to be an investigative body for an individual seeking redress. Other statutory bodies already exist to investigate individual cases and complaints, including the NHS complaints system. If complainants remain unsatisfied, they can raise their complaint with the independent Parliamentary and Health Service Ombudsman. Where the risk is serious or life-threatening, the CQC can act on a single concern and take regulatory action. Similarly, complaints about adult social care services should be made first to providers. They can also be made to the local authority, if the local authority is commissioning the care. Thereafter, complaints can be made to the Local Government and Social Care Ombudsman. Providers must investigate all complaints thoroughly and take necessary action where failures have been identified. The CQC monitors health and social care providers’ complaints processes and can compel providers to provide a summary of complaints received and their responses. Failure to do so within 28 days is considered a breach of the regulation and could lead to prosecution of the provider.
On Amendment 147A, I hope to assure the noble Lord that work is already in place for a framework for assuring the quality of people working in social care. Registered managers are already assessed by the CQC, to confirm their fitness to be registered. Nurses are regulated by the Nursing and Midwifery Council and social workers by Social Work England. Any person delivering personal care must have a DBS check. If, in the future, it was decided that adult social care workers in England should be subject to statutory regulation, the power to do so already exists in Section 60 of the Health Act 1999.
I turn now to the amendments in my name. I start by thanking the noble Baroness, Lady Merron, for raising this issue with the House, and thank all those noble Lords, including the noble Baroness, Lady Finlay, who have raised concerns about the need for regulation of this ever-evolving industry. As I hope noble Lords will now acknowledge, the Government are committed to improving the safety of non-surgical cosmetic procedures by establishing a licensing system. This will support the introduction of consistent standards that individuals carrying out such cosmetic procedures will have to meet, as well as hygiene and safety standards for premises. The definitions in the amendment are intended to cover the broad range of cosmetic procedures which, if improperly performed, have the potential to
cause serious injury and harm. The subsequent regulations will set out in detail the treatments to be covered by the licensing system, and the detailed conditions and training requirements individuals would have to meet. The purpose of this amendment is not to ban procedures or stifle innovation, but rather to ensure that consumers who choose to undergo a cosmetic procedure can be confident that the treatment they receive is safe and of a high standard. The Government will work with stakeholders, including noble Lords, to put in place a licensing regime that works for both consumers and providers, protecting those who choose to receive cosmetic procedures without placing unnecessary restrictions on legitimate businesses.
The noble Baroness, Lady Finlay, asked me a number of questions, so I will try to answer them. I begin with radiofrequency. Given the broad range of skin-tightening procedures, proposed new subsection (2)(e) provides scope to encompass a variety of treatments which involve a wide range of application techniques, including radiofrequency and ultrasound devices. The aim of the licensing scheme is to protect the public from the risk of harm. To achieve this, the regulations will specify the standards of training required. The proposed new clause will also allow regulations to make provisions about the duration, renewal, variation, suspension or revocation of licences.
The range of non-surgical cosmetic procedures available to consumers is vast. Therefore, drawing up the regulations will require detailed consultation with a range of stakeholders. This will include a number of partners, such as the cosmetics industry and local authorities. We will try to do this as quickly as possible, while ensuring that the list is as comprehensive as possible. We will try to get that balance. For these reasons, I hope I can ask noble Lords to support these amendments and I ask the noble Baroness to consider not moving her amendment.
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Let me now turn to Amendment 181. A number of initiatives are under way to support future discharge routes in a way that is sustainable and cost effective and provides the choice for patients to return to their communities. These will be pursued locally by NHS trusts and NHS foundation trusts in ways that best fit their clinical requirements.
On the points made by the noble Baroness, Lady Greengross, about surplus land, which she has raised previously with me personally, I appreciate the sentiment but we believe that it is for local organisations, not the Secretary of State, to decide. However, if the noble Baroness is open to a suggestion, perhaps we could facilitate a meeting with NHS England to see whether it would be interested in discussing her plans—especially since she has gone to a number of lengths, including with architects, in formulating her amendment.
On Amendment 184ZBB, I am grateful to my noble friend Lady Cumberlege, for her constructive engagement. I hope she agrees that we now have a shared approach to increasing transparency around the interests of doctors and other healthcare professionals. We agree that information on healthcare professionals’ interests will be most accessible to patients if it is published by healthcare providers rather than by the relevant
professional regulator, including the GMC; we are now taking that forward. My department will work across the devolved Administrations to implement a system for all healthcare professionals to declare their interests. We have set up a series of working groups, prioritising the implementation of a system for doctors to declare their interests before moving on to other healthcare professionals. We hope to have a system for doctors by July 2022.
The only area where I do not agree completely with my noble friend is the need for primary legislation to address this issue. I assure the House that existing legislation in relation to the GMC and the Care Quality Commission can be used to achieve the same effect as this amendment, which we therefore believe is not necessary. Doctors are already required to declare their competing and potentially competing interests. The GMC can take, and has taken, action against doctors who fail to meet these requirements, and serious or persistent breaches that pose a risk to patient safety or public trust can put a registrant’s registration at risk. My department is working with the CQC and equivalent organisations across the devolved Administrations to ensure that effective monitoring of the system is in place.
My noble friend Lady Cumberlege raised the important issue of appraisal. As part of their annual appraisal, doctors are required by the GMC to submit a probity statement, which requires them to confirm that they have declared and managed any conflicts of interest appropriately. We are looking to take forward work in this area and we will work with stakeholders to make sure that this is clearer. Work is moving forward to ensure that doctors are open and honest about their competing and potentially competing interests, to avoid some of the problems that the noble Lord, Lord Mawson, pointed out. My officials would be delighted to meet my noble friend Lady Cumberlege and other Peers in early summer to provide an update on the progress of implementation.
With all that, I hope I have given noble Lords sufficient reassurance that they feel able to withdraw or not press their amendments and I commend the amendments in my name.