IOU/C _ HOUSE OF COMMONS SESSION 1998-99 HEALTH COMMITTEE Fifth Report THE REGULATION OF PRIVATE AND OTHER INDEPENDENT HEALTHCARE Volume I Report and Proceedings of the Committee Ordered by The House of Commons fo be printed 12 July 1999 LONDON she SVATIONERY OFFICE £10-60 | ~ HOUSE OF COMMONS SESSION 1998-99 HEALTH COMMITTEE WELLCOME TRUST INFORMATION SERVICE 29 AUS 1999 Fifth Report THE REGULATION OF PRIVATE AND OTHER INDEPENDENT HEALTHCARE Volume I Report and Proceedings of the Committee Ordered by The House of Commons fo be printed 12 July 1999 LONDON. THESTATITONERY OFFICE £10-60 28 1-I il FIFTH REPORT FROM The Health Committee is appointed under Standing Order No. 152 to examine the expenditure, administration and policy of the Department of Health and associated public bodies. The Committee consists of 11 Members. It has a quorum of three. Unless the House otherwise orders, all Members nominated to a committee appointed under this order shall continue to be members of that committee for the remainder of the Parliament. The Committee has power; (a) to send for persons, papers and records, to sit notwithstanding any adjournment of the House, to adjourn from place to place, and to report from time to time; (b) to appoint specialist advisers either to supply information which is not readily available or to elucidate matters of complexity within the Committee’s order of reference; (c) to communicate to any other committee appointed under the same Standing Order (and to the European Scrutiny Committee, to the Committee of Public Accounts, to the Deregulation Committee and to the Environmental Audit Committee) its evidence and any other documents relating to matters of common interest; and (d) to meet concurrently with any other such committee or with the European Scrutiny Committee or any sub-committee therefore for the purposes of deliberating, taking evidence, or (in the case of any other such committee), considering draft reports. The membership of the Committee since its nomination on 14 July 1997 has been as follows: Mr David Amess (added 20 July 1998) Mr John Austin Dr Peter Brand Mr Peter Brooke (discharged 21 July 1997) Mr Simon Burns (added 5 July 1999) Julia Drown Mr John Gunnell Mr David Hinchliffe Ann Keen (discharged I] February 1999) Mr Andrew Lansley (discharged 20 July 1998) Mr Ivan Lewis (added ] February 1999) Dr Howard Stoate Mr Robert Syms Mr Robert Walter (added 2] July 1997, discharged 5 July 1999) Audrey Wise Mr David Hinchliffe was elected Chairman on 17 July 1997. THE HEALTH COMMITTEE ili TABLE OF CONTENTS Page REPORT BUCO SAVY BDB AT Shsh g asta 0 9s > sets diet hy PR Vv LIST OF MEMORANDA INCLUDED IN THE MINUTES OF EVIDENCE .......... Vili List OrAPPENDICES TOAHE MINUUVES OREN LDN Ci den ot pendcaeme any ocf4 e-po res x LIST OF MEMORANDA REPORTED TO THE HOUSE BUT NOT PRINTED ....... xill LEAR TBE SEP 4R UGS BY Ta Bi Say yey in a gan? 01 ee eh a eR a XV Usage Se Lomo) Blia te stitel veel Seon 8 SS AM nets NE ee ASe d XVi Dial AU SCODe GCHIT CU TeeUlalIOli a iNethe, flte pie so « 4 .6 ein nay» XIX Other mechanisms of quality control: Medical Advisory Committees, insurance COMpanics anaality aSSULANCe SCHEMES ieee ee ae es bs £8 GOVeL MMe UItoEs soa Stale ONC Ya ct ct, ntlt atie ra reel: Caria et ence «cw XXi EE eesti erate taUrl AtLIO ON .%,3 .G enes iete cee (he Sup oyoay ise lecarslio fb6 8k lalecs XXii Mutual interaction of the NHS and independent sector .................... Xxil Brie cliOur om the. VUINErADI Ca ras Ak ne tS Ie Eis oe ix <c's ee ae XXil Hiawsin the:currentreoulation ..:.......<.667.. AcRoGf EErSe XXiil Picea Mr teF)ALL OU) meat sea ter eee fe, «acc RR TN ee Me REST ow’a yy do sa 0% XXIV ClintoalAssuesin. aspire pists oto s ee op eee ree ees A eOeY aon e yey XXVI1 SMC CU Olat tC Teenie fda eel ie ae RM EEN ORI Ales eS Cada aden 8 a's 0 4s XXVil SECETSTe Week ot a SIS MRD 2 2/5. Mme 9 ict i er XXVil COSMETIC SURGERY AND OTHER ACTIVITY INSMALL CLINICS ......... XXVII Eres oUlCS WIC TAUINIClS erratic Meetn On SIRE mR ieren tg esas sc 5 ew 68 XXVil ENOWRE CT So 3 ea Ny ee Pans aio. SNR ela npr ee Oe XXVIII BLEtOrnatiOn tO CONSHINICIS unite) wa, RMR Se on ese XXX iret nat eAnC AHCI LICALION Sarr innt s Sent Ee eRe on ek cs eg vhs XXXI POPPI IG LATS ES AA A Maya paLP Rl ea oo) 8 Ll XXXII UI Ra NTS ap Bdn Te Nca resF ei? Ceo a 9 ot a XXXil Planning ti the context of lOCauMEIS provision ie. clic fos cree net e's eee XXXili Be TOle nine MOCTIIANEICAILA ACE OMIIMISSION side sis calc isa se es ee nes XXXIV EMMD DO SMe ee Pe ea a ey One en ee ar rr XXXVI WTAE STN 8)Cv ANG) LIN ISO 90 8 oo 9 Ae XXXVII RPSTS o e ne A Lg WC AS bcp eines Le a a ea Se an a XXXVIil Poteeta Ee PU ALOT VyI NCCAAINaINIS tanta ae kee a uae csa oo!a 9 = a> belS iva ens es= XXXVIII Prigciples of regulations saree se oan, eo ete iiiy 6 en ee ed os XXXVIII Bete te CGS 11) (CEN E Uva Mae cree Pel cc's G4) Alayo hc vsF g ise 1a,b ose) Boas ea pe\'e Soke xlii Se CE TISILISE Il Ones tear Rae UEo R EMiteded ofo oy s+ b.5i'e's a pens alin wm ws xliv PS DeTOCU. CHING 1ull mmmmMErnCy Merrett tN et Aso aie 30kj ov v ia 0.4 Wie Gash wn «pd xliv Regnlation withinhe megical mrotessiony cgi givues: aoe taser perayais so os ee xlvi eA ANC CMA ae har ete ton CN chee han Wy 2 vip eia ssyo w cialv ose «she mis are xvi Thee See SCTCA tet RSLC LE se OATES br toe nih «6 dancin leo x ¥iete + sigue «wee A xlvil Role of Medical/A dvisommGommittees msgs pees pice sie ope os x ee ee xl viii OeOO se ms csr ag oA Pring HE sia iace sc dss 8 Hoe as Ee ea 8 od ss xl vill ReCOvery.OL COSIS on « epee a ate ammesth a er bg pita eee kee ti we tn eee eons wea wee xl vill ee APO re Oe MO eh ese ibe Sa aha alr bodis*¥ ans eos cp a poa lwlergus xlix iv FIFTH REPORT FROM COMPLAINTS: PROCEDURES pe eat at Sis ea Sekine eta on Fe es l Complaints tothe GMC }>-osen.u8 ah ldeale Saeeksapo wes Sabena | eth li Litigation’). 0.2:0s Ly oye Sains ee ponte eae ee ceed ee li Provision of information }feimn'sers. . i: tae eteeum, et ee. See de ieee li Accountability foricomplaints yd. ob corwn ites. chieienel aeder oe eee. Shan lii The case for a Health Service Commissioner for the independent sector ......... lii Mental health’ complaints 2250 56 os ercoeae © tes er ee oe Ce lili CONCEUSION} Fic crcirsls ee ake eee a vart aber ae ocs trc eo) Ooo a liv SUMMARY OF: RECOMMENDATIONS nic te ceeae arGieb- etaig- 1a apes. «oe eee gene lv LIST OR:ABBREVIATIONS USED: .3 stints Woloviwe Web. Sales fe al meant) tee Ixi THE HEALTH COMMITTEE Vv LIST OF WITNESSES [VOLUME II] Thursday 25 February 1999 Page DEPARTMENT OF HEALTH Mr M Staniforth, Mr S Mitchell, Mr M Brown and Mr R Heron .................... 10 NHS CONFEDERATION DISS AP CITY Bret rt aa ks eee ec eM POU MPL TeS S cise le obigss diode ai 3 10 NATIONAL NURSING HOMES REGULATION AND INSPECTION ADVISORY GROUP Nirs J Morton...) 2 asc ete Pea Ok LD ER AAMAS. cc heise ees 10 Thursday 4 March 1999 THE CONSUMERS’ ASSOCIATION Ms C MacKay and 'Ms'S Wallianis iA 20 ACI ATE FM PMAVCIA ow oc ee ee 38 NATIONAL CONSUMER COUNCIL vise? JO niistone avd 1S DiVieredithia. . tn, ws.s:. sameeren nme. cet Dd Goseh + ol sseceveu 38 ACTION FOR THE PROPER REGULATION OF PRIVATE HOSPITALS Mr J Lambie, Mrs C Buckley, Ms S Ryb and Mr G Maloney ..................005. 74 ACTION FOR VICTIMS OF MEDICAL ACCIDENTS Mr A Simanowitz, Ms(LThomas and’DriJiHines (Wy 10224 HALIDSE 2... 0... ee 74 Thursday 25 March 1999 INDEPENDENT HEALTHCARE ASSOCIATION AGS ELASSC1 e erste, re cay a ty ME PON Se oy Gl ds so ho die se ood 131 BUPA HOSPITALS Pope UCN Cem J WET aS tere tat shrek Wate ME rerum LION eels Scie hoe wise sie dss elviaie valde 131 GENERAL HEALTHCARE GROUP Mr-C Auldi 2s cc. Maa EIN ERC AO eT SEI i eee ese 131 NUFFIELD NURSING HOMES TRUST MrD Etvitieretc: -2vic. .o EaPermente, A OR AION PRPS EIN. coc icieels ease eee 131 COMMUNITY HOSPITALS GROUP Mr A: Pilgrim 2: 2.5 <itsAek ELONe CTR mas ceil)s Sk ee se eo ae wiles 131 Thursday 15 April 1999 INDEPENDENT HEALTHCARE ASSOCIATION eo CLIT eyP RR Ded RAUL UE EE SE aah Ns er RE 5 bata 164 GENERAL HEALTHCARE GROUP RAE PAEAITICN ce os cis kde se ocr ale © aad eC ROOIEIOL S87 bree ates). 164 WESTMINSTER HEALTH CARE ob BSG Pane EO Es RON BOER CHAD RA Oe PNET, oe ee oe ee en eS Fe| 164 vi FIFTH REPORT FROM PRIORY HEALTHCARE Mr 8S Pagentigsiauity-to ee CANT udu c.2 ste conten lew aoe rere ares eae ee 164 ST. ANDREW’S HOSPITAL, NORTHAMPTON Dr M Harrisgusitaiiitesit CORES. W ce ce a acdes is eta Se oe 164 DEPARTMENT OF HEALTH Mr M Brown «i oie 508s sade) RARER GE A OR ME CIE og cs a ee 180 MENTAL HEALTH ACT COMMISSION Dr WJertani: (0. REA We AR ed RO PR oso s5 's. ace eta a sears eee, = 180 MIND Ms MPedler GA AGU JACM) CAA MONT ASUS ISA Cane aie ae MOLT a: 180 ROYAL COLLEGE OF PSYCHIATRISTS Dr R JOneS) 6.6 ss hie ON eee eine ee eo ee ee ee ee ee 180 Thursday 22 April 1999 ADVERTISING STANDARDS AUTHORITY Mrs M. Alderson te sco iacoic id Ge op occ | et 8 ee a Re Tee 199 Mr. A Mohammed-aecs tsb osaicss ce choirs coy eee ec nm ecg er err gna 199 BRITISH ASSOCIATION OF AESTHETIC PLASTIC SURGEONS ME Bi Jones ivig ie co ee RR ce IF ee cm ae een oi BRITISH ASSOCIATION OF PLASTIC SURGEONS MrA vBeonardst5 0 oe coe ee aaa ren ee et eee nS en 211 HARLEY MEDICAL GROUP Mr'M Braham, Mr:PColes and MreD Hansen) ea. ceeee e e 230 TRANSFORM Mr D Coopers EGibbons:and Mr.) Pickering 204ete h 230 Thursday 29 April 1999 BRITISH MEDICAL ASSOCIATION Mr D Machin 00 oe oe ee oe oe ee ee eee ee ct ee 266 ROYAL COLLEGE OF NURSING Ms’S ‘Taber.and Ms/ Pi Goughiii. (35 4) ie eee er cr es 266 GENERAL MEDICAL COUNCIL Sir Donald Irvine and Miss I] Nisbet¥VR.1. WiGh. SMe ce ee ee ee 292 INDEPENDENT DOCTORS FORUM PIG |M atched hy scx vse fiaree swW s dy nlt ee ne 0 Ae oe a Rag) to et 292 MEDICAL DEFENCE UNION riC.Tomkins and.Mr.R Hoppenbrouwers 1o.'\/s\4../. = =e «ee ieee = + sos oy a 292 PRIVATE PRACTICE FORUM OF THE ACADEMY OF MEDICAL ROYAL COLLEGES Ooi J Jay. cc's se'bc 4 ew GAY a ores cee a CAE ee ele oe re ee ae Rt ec 292 THE HEALTH COMMITTEE Thursday 13 May 1999 DEPARTMENT OF HEALTH Rt Hon Frank Dobson, MP, Lady Helene Hayman and Mr M Staniforth Vili FIFTH REPORT FROM LIST OF MEMORANDA INCLUDED IN THE MINUTES OF EVIDENCE [ VOLUME II] Memoranda and supplementary memoranda submitted by: Page Department of Health [PMG Z]Tal- Feber ACL CS PREPS SO ee ae ] NHS Confederation and the National Nursing Homes Regulation and Inspection Advisory Group. (PM 46] 7) Soe 5e...) 0 ne ces Gp le mea rec gas eee = en Sees 5 NHS Confederation [PM 464A }10 7% oar iee iret eee ce en 28 Department of Health [PM‘77A.]. da... <2 pets ae ene ee 28 The Consumers’ Association [PM 92] 30 Sia eee oe mre 30 National Consumer Council [PM 56] 22. ce. 2 eee eee ce 36° Action foravietims of Medical:Accidents [PIMI33|%. 4... cc eee Pee ses ae 51 Action for the Proper Regulation of Private Hospitals [PM 49 Annex A] ............ ee Mr Graham Maloney, A PROP [DP NiGLOT y pire ei sate korea ay mene net ar ire ee eee 71 Independent. Healthcare, Association: [PM S38}. 2 eee ee eee 86 Independent Healthtare- Association [PMSA] Ae ene on tee es 105 BUPA: [PM 6B] sce 2085 tie ar aR St ece e 107 General HealthcdserCiroips FRIED Pane a Loca errs ep ates cp stbcss are eee 115 Nuffield Hospitals PM0361] |...) ie EE aa a a:G e ea 123 Community ‘Hospitals.Group (PINGS (9 ee re ere eae ee eee eae 127 Westminster Health Care: ]P M 73| cree eee eee eee ne ey ay oes 156 Priory. Health.Care [PM)2:7 |i Gai ro a, gee eM: tine oc we /s3 159 St; Andrew's Hospital, Northampton iPM 20a rar es Leet ecto eaepeees gs siete ene 160 St; Andrew’ stiiospital Northampton [EM JOA) ie peed sc <ie ncomulh heen ne ee 162 Mental Health Act Commission. (PNLS4) RIOT Sian a wee 174 MIND TPM: 85] fy5 eta ak a et ace ohh ogee Weta ea ct ag 176 Rovyal<iollege of Psychiatrists: [PML 7] is sty sn sno vee wae e eee eben ame otra Manic eee 179 Mental Health Act Commissioni{PIMO4B Fei 5s ROR, ick os ex ee ne eee 194 St. Andrew's Hospital; Northampton [PM 20BW) (isc peema ie cn vk eee ee 194 Advertising Standards Anthority,[PM 14]. Jj.) ais sence eee eee ey nok eee 196