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Health and Social Care Bill

moved Amendment No. 16: 16: Clause 6, page 3, line 35, at end insert— ““( ) In this Part ““a person”” may include, in particular, an employment agency established to supply— (a) doctors, nurses or other healthcare workers to the National Health Service; (b) social workers to a local authority; or (c) nurses or other persons who may be employed by a service user to care for him in a private dwelling.”” The noble Earl said: My Lords, this amendment takes us to an issue which we have not previously debated at any length—the issue of employment agencies. The Department of Health’s consultation document, which sets out a registration framework to complement the provisions of the Bill, proposes, as I read it, that nurses’ agencies should cease to be regulated under the CQC. I seriously question the wisdom of this. At the moment, agencies supplying nurses are registered by CSCI and have been registered and inspected since 1957. It is my view that patient safety requires that regulation of these nurses’ agencies should continue and that similar regulation should be introduced to agencies supplying doctors, social workers and other health professionals. The hospitals and care homes which hire agency staff have neither the expertise nor the time to carry out the appropriate background and qualification checks on temps when they suddenly find themselves desperately short of staff. Agencies must establish a pool of pre-checked staff and understand properly the complex needs of health and social care roles in order to assign staff safely. Without a validated register of agencies that can do this to recognised standards, hospitals and care homes will have no way of knowing that it is being done properly. The Government’s proposal is that employment agencies dealing with permanent recruitment and agencies supplying temps should not be subject to registration by the CQC. The department argues that there is already adequate regulation under the Employment Agencies Act. However, under that Act there is no register of agencies able to supply healthcare staff to recognised standards. The regulatory provisions in the Act focus on worker rights rather than patient safety, and no routine inspection of the agencies takes place. Effectively, the inspectorate under the Employment Agencies Act does not know which all the agencies for healthcare staff are and does not check the sector expertise of those they do know. That is one area of concern. The other area relates to the regulation of organisations involved in arranging both care and nursing in people’s own homes—domiciliary care agencies. As I understand it, the intention is that regulation of these agencies should continue. However, there is a signal omission in the consultation document that I should like to query with the Minister. Domiciliary care agencies, whether for nursing or care, consist of three types. First, there are agencies known as direct service providers, which deliver a fully managed care service, and most, I understand, are of this kind. The second kind is employment businesses—a term of art, I believe—which supply staff to work under the direction and control of the service user. This sort of agency is becoming less prevalent but is regulated by CSCI to the same standards as direct service providers. If these agencies supply nurses, they have to register with CSCI as nurses’ agencies, even though they may be registered already under the Employment Agencies Act. However, the need for dual registration will cease under the current proposals. The third kind of agency is employment agencies that merely introduce care workers to service users, which then employ those individuals directly without the agency being involved in any way with the employment contract. Usually, the nurse or care worker will be employed under a series of fixed-term employments lasting two or three weeks and will live at the home of the service user. This type of agency comprises only a minority of domiciliary employment agencies but they are a significant minority. The key difference here is that the agency has no control over, or contract with, the worker during the time that he or she is employed by the service user. At present, these agencies are regulated by CSCI to a specially shortened set of standards which reflect that fact. The wording of the scope of registration in the consultation clearly includes the first two types of domiciliary care agency—that is, direct service providers and employment businesses—but it does not appear to encompass employment agencies at all. Indeed, there is no mention in the consultation of the kind of special arrangement that these agencies have in supplying staff to service users—a fact which indicates to me that the omission is a real one. Considerable numbers of people rely on the employment agency model to secure cost-effective and very flexible care. They also rely on a system of regulation which ensures that these agencies operate in a way that protects patients in an effective fashion. Although this is a somewhat technical area, it is important, and I should be grateful if the Minister could reassure me that he will look closely at the concerns that I have raised and re-examine the department’s policy. There are some important question marks over the scope of regulation in the area of employment agencies and these need to be resolved. I beg to move.