Health and Social Care Act 2008 (Registration of Regulated Activities) Regulations 2009

I, too, thank the Minister for introducing the regulations and for the very helpful briefing that she and the relevant officials provided to us a couple of weeks ago. There is a degree of interest in this because these are the first of the regulations that will enable us to see just how the Health and Social Care Act 2008 will be implemented and how the CQC will assume responsibility for an area of work that all noble Lords would agree has been carried out extremely effectively by the predecessor bodies. Both the Healthcare Commission and CSCI have in the course of their work and by their reports driven up standards in this area. I have many of the same questions as the noble Earl, Lord Howe, but I want to ask a few more. Can the noble Baroness define for us what is an offence? Is an offence the same thing as an incidence? Are different incidences of healthcare-acquired infection different offences? If they are, the potential penalties become of a different order. Potentially, they will become a large imposition on what in future will be a much broader range of much smaller providers. Although we tend to think of acute hospitals when we think about healthcare-associated infections, we should not forget that the infections that have been mentioned are prevalent in a lot of social care settings and, in particular, residential homes. If a small-scale provider of residential care ultimately becomes subject in 2010 to the same fine regime as a large acute hospital, that will have a disproportionate effect. That is the first thing. The second is that I, too, have been thinking about the fact that in 2010 the independent sector will come under this regime. Has the department continued to think on in that vein about what happens if NHS patients exercise their right to seek treatment abroad if they have not been able to receive treatment in the United Kingdom? How do these orders relate to that? Looking to the future, what happens if individual budgets and direct payments bring in a whole tranche of small-scale healthcare providers? Who will regulate them? This is an interesting order, and I will be interested in the Minister’s response. It is a fair reflection of the legislation that this House passed last year.