PART 1 (Hansard, 1 February 1983)

HL Deb 01 February 1983 vol 438 cc722-62 722

§ RESIDENTIAL CARE HOMES

§ Requirement of registration

§ 1.—(1) Subject to the following provisions of this paragraph, registration under this Part of this Schedule is required in respect of any establishment which provides or is intended to provide. whether for reward or not, residential accommodation with both board and personal care for persons in need or personal care by reason of old age, disablement or past or present mental disorder.

§ (2) Such an establishment is referred to in this Part of this Schedule as a "residential care home".

§ (3) Registration under this Part of this Schedule does not affect any requirment to register under the Nursing Homes Act 1975.

§ (4) Registration under this Part of this Schedule is not required in respect of an establishment which provides or is intended to provide residential accommodation with both board and personal care for fewer than 4 persons. excluding persons carrying on or intending to carry on the home or employed or intended to he employed there and their relatives.

§ (5) Registration under this Part of this Schedule is not required in respect of any of the following—

(a) any establishment which is used, or is intended to he used, solely as a nursing home or mental nursing home, as defined in sections I and 2 of the Nursing Homes Act 1975:
(b) any hospital as defined in section 128 of the National Health Service Act 1977 which is maintained in pursuance of an Act of Parliament:
(c) any hospital as defined in section 147(1) of the Mental Health Act 1959:
(d) any voluntary home or community home within the meaning of the Child Care Act 1980;
(e) any children's home to which the Children's Homes Act 1982 applies;
(f) subject to sub-paragraph (6) below, any school, as defined in section 114 of the Education Act 1944;
(g) subject to sub-paragraph (7) below, any establishment to which the Secretary of State has made a payment of maintenance grant under regulations made by virtue of section 100(1)(b) of the Education Act 1944:
(h) any university or university college or college, school or hall of a university:
(i) any establishment managed or provided by a government department or local authority or by any authority or body constituted by an Act of Parliament or incorporated by Royal Charter.

§ (6) An independent school within the meaning of the Education Act 1944 is not excluded by sub-paragraph (5) above if the school provides accommodation for 50 or less children under the age of 18 years and is not for the time being approved by the Secretary of State under section 1l(3)(a) of the Education Act 1981.

§ (7) An establishment to which the Secretary of State has made a payment of maintenance grant under regulations made by virtue of section 100(1)(b) of the Education Act 1944 is only excluded by sub-paragraph (5) above until the end of the period of 12 months from the date on which the Secretary of State made the payment.

§ General interpretation

§ 2.—(1) In this Part of this Schedule—

"disablement", in relation to persons, means that they are blind, deaf or dumb or substantially and permanently handicapped by illness, injury or congenital deformity or any other disability prescribed by the Secretary of State; "mental disorder" means mental illness, arrested or incomplete development of mind, psychopathic disorder, and any other disorder or disability of mind; "personal care" means care which includes assistance with bodily functions where such assistance is required; "prescribed" means prescribed by regulations under this Part of this Schedule; "psychopathic disorder" means a persistent disorder or disability of mind which results in abnormally aggressive or seriously irresponsible conduct on the part of the 723 person concerned, and requires or is susceptible to medical treatment: "registered", except where the context otherwise requires, means registered under this Part of this Schedule and cognate expressions have a corresponding meaning; "registration authority", in relation to a residential care home, means, subject to sub-paragraph (2) below, any council which for the purposes of the Local Authority Social Services Act 1970 is the local authority for the area in which the home is situated: and "standard scale" means the standard scale as defined in section 75 of the Criminal Justice Act 1982.

§ (2) The Council of the Isles of Scilly is the registration authority in relation to a residential care home in the Isles.

§ Meaning of "relative"

§ 3.—(1) In this Part of this Schedule "relative" means any of the following—

(a) husband or wife;
(b) son or daughter;
(c) father or mother'
(d) brother or sister;
(e) grand-parent or other ascendant;
(f) grandchild or other descendant;
(g) uncle or aunt;
(h) nephew or niece.

§ (2) In deducing any relationship for the purposes of subparagraph (1) above—

(a) any relationship by affinity shall be treated as a relationship by consanguinity, any relationship of the half-blood as a relationship of the whole blood, and the stepchild of any person as his child, and
(b) an illegitimate person shall be treated as the legitimate child of his mother and reputed father.

§ (3) In this paragraph "husband" and "wife" include a person who is living with a person carrying on or intending to carry on a residential care home as that person's husband or wife, as the case may be, and who has been so living for a period of not less than 6 months.

§ (4) A person, other than a relative, with whom a person carrying on or intending to cam, on a residential care home ordinarily resides, and with whom that person has been ordinarily residing for a period of not less than 5 years shall be treated for the purposes of this Part of this Schedule as if he were a relative.

§ Penalty for carrying on home without registration

§ 4. If any person carries on a residential care home without being registered in respect of it, he shall be liable on summary conviction to a fine of an amount not exceeding level 5 on the standard scale.

§ Registration of managers etc. and persons in control

§ 5. Where the manager or intended manager of a residential care home is not in control of it (whether as owner or otherwise) both the manager or intended manager and the person in control are to be treated as carrying on or intending to carry on the home and accordingly as requiring to be registered.

§ Optional registration

§ 6.—(1) A person who—

(a) is registered under the Nursing Homes Act 1975 in respect of any premises: and
(b) would be required to be registered in respect of them under this Part of this Schedule but for paragraph 1(4) above,

§ may apply to be registered under this Part of this Schedule in respect of those premises.

§ (2) If he does so apply, this Part of this Schedule shall have effect in relation to him as if he required to be registered under this Part of this Schedule in respect of those premises.

§ Registration

§ 7.—(1) An application for registration shall be made to the registration authority and shall be accompanied by a registration fee of such amount as the Secretary of State may by regulations prescribe.

§ (2) Subject to paragraphs 11, 14 and 15 below, on receipt of an application for registration and of the registration fee the registration authority shall register the applicant in respect of the home named in the application and issue to him a certificate of registration.

§ (3) It shall be a condition of the registration of any person in respect of a residential care home that the number of persons for whom residential accommodation with both board and personal 724 care is provided in the home at any one time (excluding persons carrying on or employed at the home and their relatives) does not exceed such number as may be specified in the certificate of registration: and the registration may also be subject to such other conditions (to be specified in the certificate) as the registration authority consider appropriate for regulating the age, sex or category of persons who may be received in the home.

§ (4) The registration authority,' may from time to time—

(a) vary any condition for the time being in force in respect of a home by virtue of this part of this Schedule: or
(b) impose an additional condition, either on the application of a person registered in respect of it or without such an application.

§ (5) If any condition for the time being in force in respect of a home by virtue of this Part of this Schedule is not complied with, any person registered in respect of the home shall be liable on summary conviction to a fine of an amount not exceeding level 4 on the standard scale.

§ (6) The certificate of registration issued in respect of any home shall he kept affixed in a conspicuous place in the home: and if default is made in complying with this sub-paragraph, any person registered in respect of the home shall be liable on summary conviction to a fine of an amount not exceeding level 2 on the standard scale and to a further fine not exceeding £2 for each day on which the offence continues after conviction.

§ Death of only person registered in respect of home

§ 8. Where—

(a) one person only is registered in respect of a residential care home: and
(b) that person dies.

§ his personal representatives or his widow or any other relative of his may for a period not exceeding 4 weeks from his death. or such longer period as the registration authority may sanction, carry on the home without being registered in respect of it.

§ Inspection of registers

§ 9. The registers kept by a registration authority for the purposes of this Part of this Schedule shall be available for inspection at all reasonable times, and any person inspecting any such register shall be entitled to make copies of entries in the register on payment of such reasonable fee as the registration authority' may determine.

§ Annual fee for registration

§ 10. The Secretary of State may by regulations—

(a) require persons registered in respect of residential care homes to pay an annual fee of such amount as the regulations may specify: and
(b) specify when the fee is to be paid.

§ Refusal of registration

§ 11. The registration authority may refuse to register an applicant for registration in respect of a residential care home if they are satisfied—

(a) that he or any other person concerned or intended to be concerned in carrying on the home is not a fit person to be concerned in carrying on a residential care home:
(b) that for reasons connected with their situation, construction, state of repair, accommodation, staffing or equipment, the premises used or intended to be used for the purposes of the home, or any other premises used or intended to be used in connection with it are not fit to be so used: or
(c) that the way in which it is intended to carry' on the home is such as not to provide services or facilities reasonably required.

§ Cancellation of registration

§ 12. The registration authority may cancel the registration of a person in respect of a residential care home

(a) on any ground which would entitle them to refuse an application for his registration in respect of it:
(b) on the ground that the annual fee in respect of the home has not been paid on or before the due date; or
(c) on the ground—

(i) that he has been convicted of an offence under this Part of this Schedule or any regulations made under it in respect of that or any other residential care home:
(ii) that any other person has been convicted of such an offence in respect of that home: or
(iii) that any condition for the time being in force in respect of the home by virtue of this Part of this Schedule has not been complied with.

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§ Urgent procedure for cancellation of registration etc. 13.—(1) If—

(a) the registration authority apply to a justice of the peace for an order—

(i) cancelling the registration of a person in respect of a residential care home;
(ii) varying any condition for the time being in force in respect of a home by virtue of this Part of this Schedule; or
(iii) imposing an additional condition; and

(b) it appears to the justice of the peace that there will be a serious risk to the life, health or well-being of the residents in the home unless the order is made,

§ he may make the order, and the cancellation, variation or imposition shall have effect from the date on which the order is made.

(2) An application under sub-paragraph (1) above may be made ex parte and shall be supported by a written statement of the registration authority's reasons for making the application. (3) An order under sub-paragraph (1) above shall be in writing. (4) Where such an order is made, the registration authority shall serve on any person registered in respect of the home, as soon as is practicable after the making of the order,—

(a) notice of the making of the order and of its terms; and
(b) a copy of the statement of the authority's reasons which supported their application for the order.

§ Procedure—general

§ 14.—(1) Subject to sub-paragraph (2) below, where—

(a) a person applies for registration; and
(b) the registration authority propose to grant his application, the authority shall give him written notice of their proposal and of the conditions subject to which they propose to grant his application.

§ (2) The registration authority need not give notice of such a proposal if they propose to grant the application subject only to conditions which—

(a) the applicant specified in the application; or
(b) the authority and the applicant have subsequently agreed.

§ (3) The registration authority shall give an applicant notice of a proposal to refuse his application.

§ (4) Except where they make an application under paragraph 13 above, the registration authority shall give any person registered in respect of a residential care home notice of a proposal—

(a) to cancel the registration;
(b) to vary any condition for the time being in force in respect of the home by virtue of this Part of this Schedule; or
(c) to impose any additionl condition.

§ (5) A notice under this paragraph shall give the registration authority's reasons for their proposal.

§ Right to make representations

§ 15.—(1) A notice under paragraph 14 above shall state that within 14 days of service of the notice any person on whom it is served may in writing require the registration authority to give him an opportunity to make representations to them concerning the matter.

§ (2) Where a notice has been served under paragraph 14 above, the registration authority shall not determine the matter until either—

(a) any person on whom the notice was served has made representations concerning the matter; or
(b) the period during which any such person could have required them to give him an opportunity to make representations has elapsed without their being required to give such an opportunity; or
(c) the conditions specified in sub-paragraph (3) below are satisfied.

§ (3) The conditions mentioned in sub-paragraph (2) above are—

(a) that a person on whom the notice was served has required the registration authority to give him an opportunity to make representations to them concerning the matter;
(b) that the registration authority have allowed him a reasonable period to make his representations; and
(c) that he has failed to make them within that period.

§ (4) Representations may be made, at the option of the person making them, either in writing or orally.

§ (5) If he informs the registration authority that he desires to make oral representations, they shall give him an opportunity of 726 appearing before and of being heard by a committee or subcommittee of the registration authority.

§ 16.—(1) If the registration authority decide to adopt the proposal, they shall serve notice in writing of their decision on any person on whom they were required to serve notice of their proposal.

§ (2) A notice under this paragraph shall he accompanied by a note explaining the right of appeal conferred by paragraph 17 below.

§ (3) A decision of a registration authority, other than a decision to grant an application for registration subject only to such conditions as are mentioned in paragraph 14(2) above or to refuse an application for registration. shall not take effect—

(a) if no appeal is brought, until the expiration of the period of 28 days referred to in paragraph 17(3) below; and
(b) if an appeal is brought, until it is determined or abandoned.

§ Appeals

§ 17.—(1) An appeal against—

(a) a decision of a registration authority; or
(b) an order made by a justice of the peace under paragraph 13 above.

§ shall lie to a Registered Homes Tribunal.

§ (2) An appeal shall be brought by notice in writing given to the registration authority.

§ (3) No appeal against a decision or order may be brought by a person more than 28 days after service on him of notice of the decision or order.

§ (4) On an appeal against a decision of a registration authority the Tribunal may confirm the decision or direct that it shall not have effect.

§ (5) On an appeal against an order made by a justice of the peace the Tribunal may confirm the order or direct that it shall cease to have effect.

§ (6) A Tribunal shall also have power on an appeal against a decision or order—

(a) to vary any condition for the time being in force in respect of the home to which the appeal relates by virtue of this Part of this Schedule:
(b) to direct that any such condition shall cease to have effect: or
(c) to direct that any such condition as it thinks fit shall have effect in respect of the home.

§ (7) A registration authority shall comply with any directions given by a Tribunal under this paragraph.

§ Service of documents

§ 18.—(1) Any notice or other document required under this Part of this Schedule to be served on a person carrying on, or intending to carry on, a residential care home may be served on him by being delivered personally to him, or being sent by post to him in a registered letter or by the recorded delivery service.

§ (2) For the purposes of section 7 of the Interpretation Act 1978 (which defines "service by post") a letter to a person carrying on a residential care home enclosing a notice or other document under this Part of this Schedule shall be deemed to be properly addressed if it is addressed to him at the home.

§ (3) Any such notice or other document required to be served on a body corporate or a firm shall be duly served if it is served on the secretary or clerk of that body or a partner of that firm.

§ (4) For the purposes of this section, and of section 7 of the Interpretation Act 1978 in its application to this section without prejudice to subsection (2) above the proper address of a person, in the case of a secretary or clerk of a body corporate, shall be that of the registered or principal office of that body, in the case of a partner of a firm shall be that of the principal office of the firm, and in any other case shall be the last known address of the person to he served.

§ Conduct of residential care homes

§ 19.—(1) The Secretary of State may make regulations as to the conduct of residential care homes, and in particular—

(a) as to the facilities and services to be provided in such homes:
(b) as to the records to be kept and notices to be given in respect of persons received into such homes;
(c) as to the notification of events occurring in such homes;
(d) making provision for children under the age of 18 years who are resident in such homes to receive a religious upbringing appropriate to the religious persuasion to which they belong;
(e) as to the form of registers to be kept by registration authorties for the purposes of this Part of this Schedule and the particulars to be contained in them; and
(f) as to the information to be supplied on an application for registration.

§ (2) Regulations under this paragraph may provide that a contravention of or failure to comply with any specified provision of the regulations shall be an offence against the regulations; and any person guilty of an offence against the regulations shall be liable on summary conviction to a fine of an amount not exceeding level 4 on the standard scale.

§ Inspection of Homes

§ 20.—(1) Any person authorised in that behalf by the Secretary of State may at all times enter and inspect any premises which are used, or which that person has reasonable cause to believe to be used, for the purposes of a residential care home.

§ (2) Any person authorised in that behalf by a registration authority may at all times enter and inspect any premises in the area of the authority which are used, or which that person has reasonable cause to believe to be used, for those purposes.

§ (3) the powers of inspection conferred by, sub-paragraphs (1) and (2) above shall include power to inspect any records required to be kept in accordance with regulations under this Schedule.

§ (4) The Secretary of State may by regulations require that residential care homes shall be inspected on such occasions or at such intervals as the regulations may prescribe.

§ (5) A person who proposes to exercise any power of entry or inspection conferred by this paragraph shall if so required produce some duly authenticated document showing his authority to exercise the power.

§ (6) Any person who obstructs the exercise of any such power shall he liable on summary conviction to a fine of an amount not exceeding level 4 on the standard scale.

§ Prosecutions etc

§ 21. Where an offence under this Part of this Schedule or any regulations under it committed by a body corporate is proved to have been committed with the consent or connivance of, or to have been attributable to any neglect on the part of, any director, manager, secretary or other similar officer of the body corporate or a person who was purporting to act in any such capacity, he as well as the body corporate shall be guilty of that offence and shall be liable to be proceeded against and punished accordingly.

§ 22.—(1) In any proceedings for an offence under this Part of this Schedule, subject to sub-paragraph (2) below, it shall be a defence for the person charged to prove—

(a) that the commission of the offence was due to a mistake or to reliance on information supplied to him or to the act or default of another person, an accident or some other cause beyond his control: and
(b) that he took all reasonable precautions and exercised all due diligence to avoid the commission of such an offence by himself or any person under his control.

§ (2) If in any such case the defence provided by sub-paragraph (1) above involves the allegation that the commission of the offence was due to the act or default of another person or to reliance on information supplied by another person, the person charged shall not. without leave of the court, be entitled to rely on that defence unless. within a period ending 7 clear days before the hearing, he has served on the prosecutor a notice in writing giving such information identifying or assisting in the identification of that other person as was then in his possession.

§ Regulations

§ 23.—(1) Any power of the Secretary of State to make regulations under this Part of this Schedule shall be exercisable by statutory instrument: and any statutory instrument containing regulations under this Part of this Schedule shall be subject to annulment in pursuance of a resolution of either House of Parliament.

§ (2) Any such power may be exercised—

(a) either in relation to all cases to which the power extends or in relation to all those cases subject to specified exceptions, or in relation to any specified cases or classes of case: and
(b) so as to make, as respects the cases in relation to which the power is exercised—

(i) the same provision for all cases in relation to which it is exercised, or different provision for different cases or different classes of case or different provision as respects the same class or classes of case for different purposes:
(ii) any such provision either unconditionally or subject to any specified condition:

§ and includes power to make such incidental or supplemental provision in the regulations as the Secretary of State considers appropriate.

§ PART II

§ AMENDMENTS OF ACTS RELATING TO REGISTERED HOMES

§ Nursing Homes Act 1975

§ 24. The following subsection shall be inserted after subsection (I) of section 3 of the Nursing Homes Act 1975—

§ "(1A) Registration under this Act does not affect any requirement to register under Part 1 of Schedule 2A to the Health and Social Services and Social Security Adjudications Act 1983 (registration of residential care homes).".

§ 25. The following section shall be inserted after that section—

"Prohibition of holding out premises as nursing home. matermity home or mental nursing home.

§ 3A.—(1) A person who, with intent to deceive any person.—

(a) applies any name to premises in England or Wales: or
(b) in any way so describes such premises or holds such premises out,

§ as to indicate, or reasonably be understood to indicate, that the premises are a nursing home or maternity home. shall be guilty of an offence, unless registration has been effected under this Act in respect of the premises as such a home.

§ (2) A person who, with intent to deceive any person,—

(a) applies any name to premises in England or Wales: or
(b) in any way so describes such premises or holds such premises out,

§ as to indicate, or reasonably he understood to indicate, that the premises are a mental nursing home, shall be guilty of an offence. unless registration has been effected under this Act in respect of the premises as such a home.

§ 26. The following paragraphs shall be inserted after section 6(c) of that Act—

§ "(ca) requiring persons registered under this Act to pay an annual fee of such amount as the regulations may specify; (cb) specifying when the fee is to be paid;".

§ 27. In paragrah (c) of section 7 of that Act for the words "imposed by section 8(1) and (2) below" there shall be substituted the words "for the time being in force in respect of the home by virtue of this Act".

§ 28. The following paragraph shall be inserted after paragraph (d) of that section—

§ "(e) on the ground that the annual fee in respect of the home has not been paid on or before the due date.".

§ 29. The following subsection shall be substituted for subsection (2A) of section 8 of that Act—

§ "(2A) The Secretary of State may make regulations—

(a) as to the variation of any condition for the time being in force in respect of a nursing home or mental nursing home by virtue of this Act: and
(b) as to the imposition of additional conditions.".

§ 30. The following sections shall be inserted after that section—

"Urgent procedure for cancellation of registration etc.

§ 8A.—(1) If—

(a) the Secretary of State applies to a justice of the peace for an order—

(i) cancelling the registration of a person in respect of a nursing home or mental nursing home:
(ii) varying any condition for the time being in force in respect of a home by virtue of this Act; or
(iii) imposing an additional condition: and

(b) it appears to the justice of the peace that there will be a serious risk to the life, health or well-being of the patients in the home unless the order is made, he may make the order, and the cancellation, variation or imposition shall have effect from the date on which the order is made.

§ (2) An application under subsection (1) above may be made ex parte and shall be supported by a written statement of the Secretary of State's reasons for making the application.

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§ (3) An order under subsection (1) above shall be in writing.

§ (4) Where such an order is made, the Secretary of State shall serve on any person registered in respect of the home, as soon as practicable after the making of the order,—

(a) notice of the making of the order and of its terms; and
(b) a copy of the statement of the Secretary of State's reasons which supported his application for the order.

Ordinary procedure.

§ 8B.—(1) Where—

(a) a person applies for registration in respect of a nursing home or mental nursing home; and
(b) the Secretary of State proposes to grant his application,

§ the Secretary of State shall give him written notice of his proposal and of the conditions subject to which he proposes to grant his application.

§ (2) The Secretary of State shall give an applicant notice of a proposal to refuse his application.

§ (3) Except where he makes an application under section 8A above, the Secretary of State shall give any person registered in respect of a nursing home or mental nursing home notice of a proposal—

(a) to cancel the registration;
(b) to vary any condition for the time being in force in respect of the home by virtue of this Act; or
(c) to impose any additional condition.

§ (4) A notice under this section shall give the Secretary of State's reasons for his proposal.

§ Right to make representations.

§ 8C.—(1) A notice under section 8B above shall state that within 14 days of service of the notice any person on whom it is served may in writing require the Secretary of State to give him an opportunity to make representations to him concerning any matter which that person wishes to dispute. (2) Where a notice has been served under section 8B above. the Secretary of State shall not determine any matter in dispute until either—

(a) any person on whom the notice was served has made representations to him concerning the matter; or
(b) the period during which any such person could have required the Secretary of State to give him an opportunity to make representations has elapsed without the Secretary of State being required to give such an opportunity: or
(c) the conditions specified in subsection (3) below are satisfied.

(3) The conditions mentioned in subsection (2) above are—

(a) that a person on whom the notice was served has required the Secretary of State to give him an opportunity to make representations to him concerning the matter;
(b) that the Secretary of State has allowed him a reasonable period to make his representations; and
(c) that he has failed to make them within that period.

§ (4) The representations may he made, at the option of the person making them, either in writing or orally.

§ (5) If he informs the Secretary of State that he desires to make oral representations, the Secretary of State shall give him an opportunity of appearing before and of being heard by a person appointed by the Secretary of State. Decision of Secretary of State. 8D.—(1) If the Secretary of State decides to adopt the proposal, he shall serve notice in writing of his decision on any person on whom he was required to serve notice of the proposal. (2) A notice under this section shall be accompanied by a note explaining the right of appeal conferred by section 8E below. (3) A decision of the Secretary of State, other than a decision to grant an application for registration subject only to conditions agreed between the applicant and the Secretary of State or to refuse an application for registration, shall not take effect—

(a) if no appeal is brought, until the expiration of the period of 28 days referred to in section 8E(3) below; and
(b) if an appeal is brought, until it is determined or abandoned.

Appeals. 8E.—(1) An appeal against—

(a) a decision of the Secretary of State under this Act; or
(b) an order made by a justice of the peace under section 8A above.

shall lie to a Registered Homes Tribunal. (2) An appeal shall he brought by notice in writing given to the Secretary of State. (3) No appeal against a decision or order may be brought by a person more than 28 days after service on him of notice of the decision or order. (4) On an appeal against a decision of the Secretary of State the Tribunal may confirm the decision or direct that it shall not have effect. (5) On an appeal against an order made by a justice of the peace the Tribunal may confirm the order or direct that it shall cease to have effect. (6) A Tribunal shall also have power on an appeal against a decision or order—

(a) to vary any condition for the time being in force in respect of the home to which the appeal relates by virtue of this Act;
(b) to direct that any such condition shall cease to have effect; or
(c) to direct that any such condition as it thinks fit shall have effect in respect of the home.

(7) The Secretary of State shall comply with any directions of a Tribunal given under this section.". 31. The following section shall he inserted after section 10 of that Act— Service of documents. 10A.—(1) Any notice or other document required under this Act to be served on a person carrying on. or intending to carry on, a nursing home or mental nursing home may be served on him by being delivered personally to him, or being sent by post to him in a registered letter or by the recorded delivery service. (2) For the purposes of section 7 of the Interpretation Act 1978 (which defines "service by post") a letter to a person carrying on a nursing home or mental nursing home enclosing a notice or other document under this Act shall be deemed to be properly addressed if it is addressed to him at the home. (3) Any such notice or other document required to be served on a body corporate or a firm shall he duly served if it is served on the secretary or clerk of that body or a partner of that firm. (4) For the purposes of this section. and of section 7 of the Interpretation Act 1978 in its application to this section, without prejudice to subsection (2) above the proper address of a person, in the case of a secretary or clerk of a body corporate, shall he that of the registered or principal office of that body, in the case of a partner of a firm shall be that of the principal office of the firm, and in any other case shall he the last known address of the person to be served.". 32. The following paragraph shall be substituted for subsection (1)(a) of section 13 of that Act (fines for failure to affix certificate of registration)— (a) to a fine of an amount not exceeding level 2 on the standard scale as defined in section 75 of the Criminal Justice Act 1982; and". 33. The following section shall be inserted after that section— Contravention section of section 3A. 13A. A person guilty of an offence under section 3A above shall he liable on summary conviction to a fine of an amount not exceeding level 3 on the standard scale as defined in section 75 of the Criminal Justice Act 1982.". 34. The following section shall be substituted for section 17 of that Act— 17. Where an offence under this Act which has been committed by a body corporate is proved to have been committed with the consent or connivance of, or to be attributable to any neglect on the part of, any director, manager, secretary or other similar officer of the body corporate, or any person purporting to act in any such capacity, he as well as the body corporate shall be deemed to be guilty of that offence and shall he liable to he proceeded against and punished accordingly.". 731 35. In section 23(2) of that Act for the words "the provisions of this Act relating to mental nursing homes" there shall be substituted the words "this Act".

§ Child Care Act 1980

§ 36. In section 56 of the Child Care Act 1980 (definition of voluntary home) for the words from "mental" to the end of the section there shall be substituted the words "nursing home or mental nursing home within the meaning of the Nursing Homes Act 1975 or a residential care home within the meaning of Part I of Schedule 2A to the Health and Social Services and Social Security Adjudications Act 1983".

§ 37. In section 57 of that Act— (a) the following subsections shall be substituted for subsections (3) to (5)— (3) On an application duly made under subsection (2) above the Secretary of State may either grant or refuse the application, as he thinks fit, or may grant the application subject to such conditions as he considers appropriate. (3A) The Secretary of State may from time to time—

(a) vary any condition for time being in force in respect of a voluntary home by virtue of this Part of this Act: or
(b) impose an additional condition, either on the application of the person carrying on the home or without such an application.

(4) Where at any time it appears to the Secretary of State that the conduct of any voluntary home is not in accordance with regulations made or directions given under section 60 of this Act or is otherwise unsatisfactory, he may cancel the registration of the home and remove it from the register. (5) Any person who carries on a voluntary home in contravention of the provisions of subsection (1) above or of a condition to which the registration of the home is for the time being subject by virtue of this Part of this Act shall be guilty of an offence and liable on summary conviction to a fine of an amount not exceeding level 5 on the standard scale, as defined in section 75 of the Criminal Justice Act 1982.": (b) in subsection (6)— (i) for the words from the beginning of the subsection to the end of paragraph (b) there shall be substituted the words— Where—

(a) a voluntary home is carried on in contravention of the provisions of subsection (1) above or of a condition to which the registration of the home is for the time being subject by virtue of this Part of this Act, or
(b) notice of a proposal to cancel the registration of a voluntary home is given under section 57A below,": and

(ii) for "58" there shall be substituted "57D": (c) in subsection (7), for the words "removes a home from the register" there shall be substituted the words "cancels the registration of a home": and (d) the following subsections shall be substituted for subsection (8)— (8) Any notice or other document required under this Part of this Act to be served by the Secretary of State on a person carrying on, or intending to carry on, a voluntary home may be served on him by being delivered personally to him, or being sent by post to him in a registered letter or by the recorded delivery service. (9) For the purposes of section 7 of the Interpretation Act 1978 (which defines "service by post") a letter to a person carrying on a voluntary home enclosing a notice or other document under this Part of this Act shall be deemed to be properly addressed if it is addressed to him at the home. (10) Any such notice or other document required to be served on a body corporate or a firm shall be duly served if it is served on the secretary or clerk of that body or a partner of that firm. (11) For the purposes of this section, and of section 7 of the Interpretation Act 1978 in its application to this section, without prejudice to subsection (9) above the proper address of a person, in the case of a secretary or clerk of a body corporate, shall be that of the registered or principal office of that body, in the case of a partner 732 of a firm shall be that of the principal office of the firm, and in any other case shall be the last-known address of the person to be served.". 38. The following sections shall be inserted after that section— Procedure. 57A.—(1) Subject to subsection (2) below, where—

(a) a person applies for registration of a voluntary home; and

(b) the Secretary of State proposes to grant his application the Secretary of State shall give him written notice of his proposal and of the conditions subject to which he proposes to grant his application. (2) The Secretary of state need not give notice of such a proposal if he proposes to grant the application subject only to conditions which—

(a) the applicant specified in the application: or
(b) the Secretary of State and the applicant have subsequently agreed.

(3) The Secretary of State shall give an applicant for registration of a voluntary home notice of a proposal to refuse his application. (4) The Secretary of State shall give any person carrying on a voluntary home notice of a proposal—

(a) to cancel the registration of the home:
(b) to vary any condition for the time being in force in respect of the home by virtue of this Part of this Act: or
(c) to impose any additional condition.

(5) A notice under this section shall give the Secretary of State's reasons for his proposal. Right to make representations. 57B.—(1) A notice under section 57A above shall state that within 14 days of service of the notice any person on whom it is served may in writing require the Secretary of State to give him an opportunity to make representations to him concerning the matter. (2) Where a notice has been served under section 57A above, the Secretary of State shall not determine the matter until either—

(a) any person on whom the notice was served has made representations to him concerning the matter; or
(b) the period during which any such person could have required the Secretary of State to give him an opportunity to make representations has elapsed without the Secretary of State being required to give such an opportunity: or
(c) the conditions specified in subsection (3) below are satisfied.

(3) The conditions mentioned in subsection (2) above are—

(a) that a person on whom the notice was served has required the Secretary of State to give him an opportunity to make representations to him concerning the matter;
(b) that the Secretary of State has allowed him a reasonable period to make his representations: and
(c) that he has failed to make them within that period.

(4) The representations may be made, at the option of the person making them, either in writing or orally. (5) If he informs the Secretary of State that he desires to make oral representations, the Secretary of State shall give him an opportunity of appearing before and of being heard by a person appointed by the Secretary of State. Decision of Secretary of State. 57C.—(1) If the Secretary of State decides to adopt the proposal, he shall serve notice in writing of his decision on any person on whom he was required to serve notice of his proposal. (2) A notice under this section shall be accompanied by a note explaining the right of appeal conferred by section 57D below. (3) A decision of the Secretary of State, other than a decision to grant an application for registration subject only to such conditions as are mentioned in section 57A(2) above or to refuse an application for registration, shall not take effect—

(a) if no appeal is brought. until the expiration of the period of 28 days referred to in section 57D(3) below: and
(b) if an appeal is brought, until it is determined or abandoned.

Appeals. 57D.—(1) An appeal against a decision of the Secretary of State under this Part of this Act shall lie to a Registered Homes Tribunal. (2) An appeal shall he brought by notice in writing given to the Secretary of State. (3) No appeal may be brought by a person more than 28 days after service on him of notice of the decision. (4) On an appeal the Tribunal may confirm the Secretary of State's decision or direct that it shall not have effect. (5) A Tribunal shall also have power on an appeal—

(a) to vary any condition for the time being in force in respect of the home to which the appeal relates by virtue of this Part of this Act:
(b) to direct that any such condition shall cease to have effect: or
(c) to direct that any such condition as it thinks fit shall have effect in respect of the home.

(6) The Secretary of State shall comply with any directions given by a Tribunal under this section.". 39. In subsection (4) of section 76 of that Act (inquiries) for the words from "mental" to the end of the subsection there shall he substituted the words "nursing home or mental nursing home within the meaning of the Nursing Homes Act 1975 or a residential care home within the meaning of Part 1 of Schedule 2A to the Health and Social Services and Social Security Adjudications Act 1983". Children's Homes Act 1982 40. In paragraph (c) of section 1(2) of the Children's Homes Act 1982 (institutions excluded from application of Act) for the words "the Residential Homes Act 1980" there shall be substituted the words "Part I of Schedule 2A to the Health and Social Services and Social Security Adjudications Act 1983".— 41. In section 4 of that Act— (a) the following subsection shall be substituted for subsection (2)— (2) A local authority may from time to time—

(a) vary any condition for the time being in this Act: in respect of a home by virtue of force this or
(b) impose an additional condition, either on the application of the person carrying on the home or without such an application.; and

(b) in subsection (3), after the word "impose" there shall he inserted the words "or varied". 42. The following sections shall be inserted after section 6 of that Act— Procedure. 6A.—(1) Subject to subsection (2) below, where—

(a) a person applies for the registration of a children's home: and
(b) the local authority propose to grant his application, the local authority shall give him written notice of their proposal and of the conditions subject to which they propose to grant his application.

(2) The local authority need not give notice of such a proposal if they propose to grant the application subject only to conditions which—

(a) the applicant specified in the application; or
(b) the authority and the applicant have subsequently agreed.

(3) The local authority shall give an applicant notice of a proposal to refuse his application. (4) The local authority shall give any person carrying on a registered home notice of a proposal—

(a) to cancel the registration;
(b) to vary any condition for the time being in force in respect of the home by virtue of this Act: or
(c) to impose any additional condition.

(5) A notice under this section shall give the local authority's reasons for their proposal. 6B.—(1) A notice under section 6A above shall state that within 14 days of service of the notice any person on whom it is served may in writing require the local authority to give him an opportunity to make representation to them concerning the matter. (2) Where a notice has been served under section 6A above, the local authority shall not determine the matter until either— 734

(a) any person on whom the notice was served has made representations to them concerning the matter: or
(b) the period during which any such person could have required the local authority to give him an opportunity to make representations has elapsed without their being required to give such an opportunity: or
(c) the conditions specified in subsection (3) below are satisfied.

(3) The conditions mentioned in subsection (2) above are—

(a) that a person on whom the notice was served has required the local authority to give him an opportunity to make representations to them concerning the matter;
(b) that the local authority have allowed him a reasonable period to make his representations; and
(c) that he has failed to make them within that period.

(4) The representations may be made, at the option of the person making them, either in writing or orally. (5) If he informs the local authority that he desires to make oral representations, the local authority shall give him an opportunity of appearing before and of being heard by a committee or sub-committee of the local authority. Decision of Local authority. 6C.—(1) If the local authority decide to adopt the proposal, they shall serve notice in writing of their decision on any person on whom they were required to serve notice of their proposal. (2) A notice under this section shall be accompanied by a note explaining the right of appeal conferred by section 6D below. (3) A decision of a local authority, other than a decision to grant an application for registration subject only to such conditions as are mentioned in section 6A(2) above or to refuse an application for registration, shall not take effect—

(a) if no appeal is brought, until the expiration of the period of 28 days referred to in section 6D(3) below; and
(b) if an appeal is brought, until it is determined or abandoned.

Appeals. 6D.—(1) An appeal against a decision of a local authority under this Act shall lie to a Registered Homes Tribunal. (2) An appeal shall be brought by notice in writing given to the local authority. (3) No appeal may be brought by a person more than 28 days after service on him of notice of the decision. (4) On an appeal the Tribunal may confirm the local authority's decision or direct that it shall not have effect. (5) A Tribunal shall have power on an appeal—

(a) to vary condition for the time being in force in respect of the home to which the appeal relates by virtue of this Act;
(b) to direct that any such condition shall cease to have effect: or
(c) to direct that any such condition as it thinks fit shall have effect in respect of the home.

(6) A local authority shall comply with any direction given by a Tribunal under this section. Prohibition of further application. 6E.—(1) Subject to subsection (2) below, where an application for the registration of a home is refused, no further application for the registration of the home may be made within the period of six months beginning with the date when the applicant is notified of the refusal. (2) Subsection (1) above shall have effect. where an appeal against the refusal of an application is determined or abandoned, as if the reference to the date when the applicant is notified of the refusal were a reference to the date on which the appeal is determined or abandoned. (3) Subject to subsection (4) below, where the registration of a home is cancelled, no application for the registration of the home shall be made within the period of six months beginning with the date of cancellation. (4) Subsection (3) above shall have effect, where an appeal against the cancellation of the registration of a home is determined or abandoned, as if the reference to the date of cancellation were a reference to the date on which the appeal is determined or abandoned.". 735 43. The following subsections shall be added at the end of section 16 of that Act— (4) This Act shall, in its application to the Isles of Scilly, have effect subject to such exceptions, adaptations and modifications as the Secretary of State may by Order made by statutory instrument prescribe. (5) A statutory instrument made in exercise of the powers conferred by subsection (4) above shall be subject to annulment in pursuance of a resolution of either House of Parliament.".

§ PART

§ REGISTERED HOMES TRIBUNALS

§ Preliminary.

§ 44. The following arc relevant enactments for the purposes of this Part of this Schedule—

(a) the Nursing Homes Act 1975;
(b) the Child Care Act 1980:
(c) the Children's Homes Act 1982; and
(d) Part I of this Schedule.

§ Constitution of panels for chairmen and members

§ 45.—(1) For the purpose of enabling a tribunal to hear an appeal under a relevant enactment to he constituted as occasion may require there shall be—

(a) a panel appointed by the Lord Chancellor (in this Part of this Schedule referred to as "the legal panel") of persons available to act as chairmen of any such tribunals; and
(b) a panel appointed by the Lord President of the Council (in this part of this Schedule referred to as "the panel of experts") of persons available to act as members.

§ (2) Tribunals constituted under this Part of this Schedule are to he known as Registered Homes Tribunals.

§ (3) No person shall he qualified to he appointed to the legal panel unless he possesses such legal qualifications as the Lord Chancellor considers suitable.

§ (4) No person shall be qualified to he appointed to the panel of experts unless he has had experience in welfare work, medicine. nursing or midwifery or such other experience as the Lord President of the Council considers suitable.

§ (5) No officer of a government department may be appointed to either panel.

§ (6) A person appointed to a panel shall hold office subject to such conditions as to the period of his membership and otherwise as may be determined by the person appointing him.

§ Constitution of Tribunals—general

§ 46.—(1) A Registered Homes Tribunal shall consist of a chairman and two other members.

§ (2) The chairman shall be a member of the legal panel appointed to the tribunal by the Lord Chancellor.

§ (3) The other two members shall be members of the panel of experts appointed to the tribunal by the Lord President of the Council.

§ Tribunals for appeals relating to nursing homes (including maternity homes) and mental nursing homes

§ 47.—(1) A Registered Homes Tribunal to hear an appeal relating solely to registration under the Nursing Homes Act 1975 shall include a registered medical practitioner.

§ (2) Such a tribunal shall also include—

(a) if the appeal relates to registration of a maternity home, a qualified midwife: and
(b) in any other case, a qualified nurse.

§ (3) A tribunal which is constituted to hear both an appeal relating to registration under the Nursing Homes Act 1975 and an appeal relating to registration under Part I of this Schedule shall include a person selected in accordance with sub-paragraph (2) above.

§ (4) In this Part of this Schedule— nursing home" and "maternity home" have the meanings assigned to them by section 1 of the Nursing Home Act 1975: mental nursing home" has the meaning assigned to it by section 2 of that Act: qualified midwife" means a person who is for the time being certified under the Midwives Act 1951 or registered under the Nurses, Midwives and Health Visitors Act 1979; and "qualified nurse" means—

(a) a person who is for the time being registered under section 2(1) of the Nurses Act 1957: or
(b) a person who—

(i) is for the time being registered under the Nurses, Midwives and Health Visitors Act 1979: and
(ii) would have been qualified to he registered under section 2(1) of the Nurses Act 1957

§ Procedure of tribunals

§ 48—(1) The Secretary of State may by statutory instrument make rules as to the practice and procedure to be followed with respect to the constitution of Registered Homes Tribunals, and as to proceedings before such tribunals and matters incidental to or consequential on such proceedings; and without prejudice to the generality of this paragraph such rules may make provision—

(a) requiring particulars to be supplied of matters relevant to the determination of an appeal;
(b) enabling two or more appeals to be heard together; and
(c) as to representations before a tribunal. by counsel or a solicitor or otherwise.

§ (2) Rules under this paragraph shall be subject to annulment in pursuance of a resolution of either House of Parliament.

§ 49. The Arbitration Act 1950 shall not apply to any proceedings before Registered Homes Tribunals except so far as any provision of that Act may be applied to such tribunals with or without modifications by rules made under paragraph 48 above.

§ Staff for tribunals

§ 50. The Secretary of State shall assign such staff as may from time to time be required for Registered Homes Tribunals.

§ Fees, allowances and expenses

§ 51. The Secretary of State may—

(a) pay to members of Registered Homes Tribunals such fees and allowances as he may, with the consent of the Treasury. determine: and
(b) defray the expenses of such tribunals up to such amount as he may with the like consent determine.")

§ The noble Lord said: My Lords, I rise to move Amendment No. 16. I was tempted to say that this is merely a drafting amendment and then resume my seat, but I suspect that your Lordships would find that puzzling. With permission, I should like to speak to Amendments Nos. 16 to 19 inclusive, 22 and 23, 68. 70 to 72 inclusive, 79, 82. 88, 101 and 102 and 104 to 107 inclusive.

§ I am glad to be able to say that this group of amendments is far less formidable than it seems. While heroic in number and volume, they are modest in their aspirations. In drafting terms, they represent a tidier way of achieving the intentions of the Bill concerning the registration of homes, and replace two clauses and two schedules with one clause and one schedule.

§ Schedule 3 to the Bill, as published, reproduced in an amended form five of the seven sections of the Residential Homes Act 1980. We have since decided that it would be better if all the registration provisions in that Act, as amended by this Bill, were reproduced in the Bill. This will he more helpful to those who have to operate this legislation: and that was a point made in Committee by my noble friend Lord Renton. This leaves only one remaining provision in the 1980 Act concerned not with registration. but with the provision of meals and recreation for elderly people. I will describe in a moment how a linked amendment later in the Marshalled List enables us to consolidate that provision in this Bill and to repeal the 1980 Act in its entirety.

§ As I have said, the new Schedule 2A, and the various consequential amendments, provide in the Bill a comprehensive statement of the law concerning the registration of residential care homes and the new appeal system and, just as in the published Bill, the new schedule also makes certain related changes in the legislation affecting nursing homes and residential homes for children. In addition to these drafting 737 changes, there are a number of minor changes of substance between the provisions of the published Bill and the new schedule.

§ Chief among these are a restatement and clarification of the procedure to be followed when a registration authority is considering an application for registration, or is proposing to cancel or to vary a registration, and clarification that homes registered under the Nursing Homes Act 1975 will not need to be registered as residential care homes, provided that they are used solely as nursing homes. Other homes will be registrable under both registration systems, if they fulfil the criteria for registration under both. This requires a consequential amendment to the definition of "personal care" and, as part of this general clarification, we have taken advantage of the helpful proposal made by the noble Lord, Lord Wallace, and the noble Baroness, Lady Jeger, in Amendment No. 20 on the Marshalled List.

§ Thirdly, a right of appeal is provided to the Registered Homes Tribunal, being set up under Part 111 of Schedule 2A, against an order given by a justice of the peace in relation to a nursing home or residential care home. Finally, it is made an offence for anyone, with intent to deceive, to describe an establishment as a nursing home, maternity home or mental nursing home if an appropriate registration has not been obtained under the Nursing Homes Act 1975.

§ To assist your Lordships, we have revised the notes on clauses for the registration provisions of the Bill, and I have sent copies of these to noble Lords who spoke on the subject and have placed other copies in the Printed Paper Office. I hope that that comparatively short description of what is certainly a formidable list of amendments will be of assistance to your Lordships. I beg to move.

§ Baroness Robson of Kiddington moved, as an amendment to Amendment No. 16, Amendment No. 16A:

§ After paragraph 13 insert— ("List of persons whose registrations hare been cancelled 13A. The Secretary of State shall keep a list of all persons who have had their registrations in respect of residential care homes cancelled.").

§ The noble Baroness said: My Lords, with the leave of the House I will speak to Amendment No. 16A and Amendment No. 16B because they deal with exactly the same matter and the necessity to put them in this form is governed by the way the new Bill has been presented to us, if I may call it the new Bill. These amendments are in very similar terms to the one moved by my noble friend Lord Banks at the Committee stage on 9th December. In the debate on that amendment we on these Benches came to the conclusion that we accepted the Government's argument that to keep a national register of all nursing homes or residential homes may have been an administratively cumbersome method. Therefore, in accepting that a register should be kept by the local authorities as it is done at present, it became to us obvious that it is even more important now that we should have a national register of those persons who have had their licences withdrawn, because of the danger, which was mentioned in the last debate on my noble friend's amendment, that people will move from one end of 738 the country to another and be granted a licence, when in actual fact they have fallen down in their duties in another part of England.

§ The noble Lord, Lord Trefgarne, referred to this list as a black list. Of course, it is a black list of some kind, but do we not have a duty to protect people, particularly the kind of people who live in residential homes or nursing homes, who are so unable to look after themselves? Thus, the maximum information about people who fall down in their duties of care should be available to a registering authority so that no mistakes are repeated. I believe it is not an uncommon thing in society for what the noble Lord called a black list to be kept. Professional bodies do so. It is essential to protect society and to protect the people who occupy these residential homes that we have the maximum information available to the registering authority.

§ It was also said that it would be unfair if a person loses his licence because of some local problem which was not necessarily the fault of the licensee. That should also exist on the register. Nobody envisages a register existing without the reasons why a person has lost his licence, so there would be no hardship from that point of view.

§ The noble Lord, Lord Trefgarne, finished up replying to my noble friend Lord Banks by saying that in his view—he had been informed—it would he possible without legislation to have a register of this kind if, after consultation, it was thought to be necessary. I am one of those people who prefer to have what I feel is necessary embodied in a Bill and not leave it to merely the possibility of such a register being made. I beg to move.

§ Lord Trefgarne
My Lords, it may be of convenience to your Lordships if I reply to the amendment of the noble Baroness, Lady Robson of Kiddington, now and we can then move to the discussion of the main amendment. When this question was raised during the Committee stage I said that we were examining just such a possibility as is proposed in these amendments. I confirm that and can tell your Lordships that we shall soon be consulting the various interests affected, including representatives of both the registration authorities and those carrying on the homes. Among other things, we shall be consulting on the form in which the list could be most effectively kept. As I said before, and the noble Baroness recognised, this is not a matter which requires legislation, but we shall keep Parliament informed of our intentions and I hope that the assurance will enable the noble Baroness to withdraw her amendment.

§ Baroness Robson of Kiddington
My Lords, I thank the noble Lord for his reply, but I am rather disappointed that between 9th December and today, from what I have heard him say, consultations have not started. I sincerely hope that we shall have further information on the results of the consultation at Third Reading. I beg leave to withdraw the amendment.

§ Amendment to the amendment, by leave, withdrawn.

§ 5.57 p.m.

Lord Wallace of Coslany
My Lords, now we can get back to the formidable list of amendments that the 739 noble Lord, Lord Trefgarne, referred to. Quite frankly, in view of the short time given to us for their reasonable and careful consideration, modest though the noble Lord might claim them to be, I do not intend to deal with them at length now but give notice that I and my colleagues will examine the amendments with great care and come back on Third Reading. Later on, with some of the amendments, we shall find ourselves in a Fred Karno situation where I have tabled amendments to a schedule, for instance, and below that there is another amendment from the Government to delete that schedule. How we will cope with that, I do not know, but this is due to the procrastination of the department in dealing with these amendments. Do not forget, these were put in last Tuesday when we should have been dealing with the Report stage, and we did not see them until Thursday. If the noble Lord thinks I shall spend all my weekend wading through his volumes of paperwork, when there is the chance to get out into the garden to get hack to sanity, he has another think coming to him. So far as I am concerned, I shall not say any more about these amendments except that when we come to my own amendments I shall want reasonable time to consider them.

§ Lord Kilmarnock
My Lords. in addition to the unfortunate results that the noble Lord, Lord Wallace, has pointed out of the very late arrival of these amendments, including this massive, mammoth amendment, there has been another unfortunate result—I am simply trying to be helpful to the noble Lord—in terms of drafting which seems to be faulty. I simply point out—and the draftsman may like to take account of it—that on page 27 of the Marshalled List, Section 41(2)(a) the two lines there are complete gobbledegook. They read: (a) vary any condition for the time being in Act in respect of a home by virtue of force this or". I submit that that does not represent the draftsmen's intention and perhaps they would like to have another look at it before it is reprinted for the next stage of the Bill.

§ Lord Renton
My Lords, in Schedules 3 and 4 to the Bill, as it was originally put before your Lordships, there was an appalling amount of difficult cross-reference to previous legislation. My attention was drawn to a very large number of minor mistakes in drafting. That was why at first I simply tabled to leave out Schedule 3 in order to draw attention to the fact that there was this appalling amount of cross-reference and a good many mistakes.
Although we have had rather short notice, I feel that we should be grateful to my noble friend Lord Trefgarne and to the draftsmen and those advising them. This schedule is in principle a very great improvement. It means that those who are going to establish residential homes and those who are going to be responsible for supervising them will find practically the whole of the law in one place. That is much better. It may well be that there are some details still to be corrected. However, I do not know. Like the noble Lord. Lord Wallace of Coslany, I have not had time to get down to it in great detail. But let us 740 acknowledge that my noble friend Lord Trefgarne has set a good example, for which we should be grateful, in putting before us a body of law which is all in one place. Other Ministers might well follow his example with advantage. Therefore, I should like to congratulate and thank my noble friend.

Lord Winstanley
My Lords, after a rough calculation, it seems that the noble Lord, Lord Trefgarne, has just moved an amendment which, together with the various other amendments to which he has spoken, add up to 32 pages of amendments to a Bill which itself runs to only 74 pages. I venture to say that this almost justifies another Second Reading debate.
I should like to underline what the noble Lord, Lord Renton, has said. My study of the amendments leads me and, I hope, my noble friends on these Benches to believe that most of the amendments which the noble Lord has brought forward are wholly satisfactory and greatly improve the Bill. Nevertheless, it appears to us that our proceedings have been somewhat truncated. We have suddenly been presented with these 30-odd pages at Report stage, which gives us no chance to scrutinise them with the kind of care with which in your Lordships' House we normally scrutinise amendments. While, therefore, I think that the noble Lord has made substantial improvements to the Bill by means of these amendments which he has brought forward, he must not be altogether surprised if he finds that the Third Reading stage of the Bill is somewhat more elongated than is usually the case.

§ Baroness Jeger
My Lords, before the noble Lord, Lord Trefgarne, gets too pleased with himself, in view of what the noble Lord, Lord Renton, has said, may I ask him why, although I welcome the amendments as improvements to the Bill, we could not have had them, if they are so essential. at the Committee stage, since that would have been the proper stage at which to discuss them in detail?

§ Lord Trefgarne
My Lords, the amendment which I have just moved includes at one point at least the essence of a recommendation which was made by the noble Lord, Lord Wallace of Coslany, at the Committee stage. Naturally it was not possible to do that until today.

Lord Wallace of Coslany
My Lords, I am very grateful for that, but the noble Lord should not use it as an excuse to get away with murder.

§ Lord Trefgarne
My Lords, I come to the Dispatch Box always ready to listen to the advice of noble Lords from all quarters of the House, in particular those noble Lords with experience both in Parliament and in relation to these matters, some of whom sit on the Benches opposite. I am grateful for the welcome which has been given to these amendments by my noble friend Lord Renton and other noble Lords. The noble Lord, Lord Kilmarnock, drew my attention to what I understand was a printing error in the original Marshalled List. This error has since been corrected. My noble friend Lord Renton also said that there were a number of errors of reference in Schedule 3.

741

§ Lord Renton
In the previous schedule.

§ Lord Trefgarne
My Lords, I was not quite clear whether those errors remained. I am glad to hear they do not. If they had remained, I should have wished them to be put right. I am grateful for your Lordships' reception of these amendments. Nothing further need, I think, be said. I beg to move.

§ The Deputy Speaker (Lord Murton of Lindisfarne)
Is the noble Baroness not moving No. 16B?

§ [Amendment No. 16B not moved.]

§ On Question, Amendment No. 16 agreed to.

§ Lord Trefgarne
moved Amendments Nos. 17, 18 and 19: Before Clause 7 insert the following new clause:

§ ("Registration of homes.

§ 6A.—(1) Part I of Schedule 2A to this Act shall have effect in place of the provisions of the Residential Homes Act 1980 other than those relating to meals and recreation for old people.

§ (2) The amendments to the Nursing Homes Act 1975, the Chid Care Act 1980 and the Children's Homes Act 1982 specified in Part II of that Schedule shall have effect.

§ (3) Part III of that Schedule shall have effect in relation to tribunals to hear appeals concerning the registration of homes.

§ (4) The Secretary of State may by regulations made by statutory instrument make such transitional provisions as he considers necessary or expedient in connection with this section.

§ (5) Regulations under subsection (4) above shall be subject to annulment in pursuance of a resolution of either House of Parliament.").

§ Clause 7 [General amendments of law relating to residential homes, nursing homes and mental nursing homes]: Leave out Clause 7.

§ Clause 8 [Appeals etc. relating to registration in respect of homes]: Leave out Clause 8.

§ On Question, amendments agreed to.

§ Schedule 3 [Residential homes and nursing homes]:

Lord Wallace of Coslany
moved Amendment No. 20: Page 33, line 8, after ("with") insert ("both"). The noble Lord said: My Lords, this amendment is at the beginning of the Fred Karno saga. Immediately after I have spoken and the noble Lord has replied the noble Lord will move the deletion of Schedule 3, aided and abetted by the noble Lord, Lord Renton. May I draw the attention of the noble Lord, Lord Renton, to the fact that my Amendment No. 21 has been put down simply because of the impression I received from him during the Committee stage that nursing homes should be inspected at least twice annually. I put down Amendment No. 20 in the hope of getting a little clarification from the Minister. If he is able to give me the right information, he may leave out Schedule 3 with my permission.
One of the most important aspects of the Bill relates to the parts dealing with the registration and control of residential care homes. It is essential that the present 742 confused situation should be rectified. There is a large number of private sector homes, many of which are quite unknown to local authorities. It is vital to clarify the exact status of small group homes which may be operating in the voluntary sector. Group homes must remain exempt from the remit of the Bill. My understanding of the wording of the schedule referring to "board and personal care" is that it is designed to ensure that only where homes are offering both full board and personal care will there he a requirement to register under the new Act. My amendment is specifically geared to making absolutely certain that there is no confusion in the minds of local authorities; namely, by the insertion of the word "both". I believe that this will clarify the position. A number of voluntary organisations at local level will have group homes on their books, although they will not be providing board and personal care as defined in the Bill.
It cannot he stressed too strongly that so far as former psychiatric patients, for example, are concerned, group homes are no different in kind from any small group of individuals living together as a household. I have visited some of these homes and had tea with the residents. No residential staff and no meals will be provided by others. There will be only limited external social support in the form of good neighbourliness. The aim of that support. such as it is, is to encourage independence, like everyone else, in ordinary living. In this context, I should be very grateful if the Minister could clarify that such small group homes are not to be included in the Bill and that they are excluded by the formula "board and personal care". All I ask for is clarification of the issue. With all my generosity, and so on, the noble Lord can then proceed to leave out Schedule 3.

§ Lord Trefgarne
My Lords, as I explained to your Lordships when moving Amendment No. 16, the new Schedule 2A supersedes Schedule 3. Amendment No. 22, with your Lordships' agreement, seeks to delete Schedule 3. I am happy to hear that the noble Lord, Lord Wallace of Coslany, may be prepared, if I give him the right answer now, to agree to the deletion of Schedule 3. I am further happy to say that group homes are indeed excluded from the provisions of the Bill. In the light of my assurance, I hope the noble Lord will not press this or the next amendment, and will agree to the subsequent one.

Lord Wallace of Coslany
My Lords, I am ever willing to help. I beg leave to withdraw the amendment.

§ Amendment, by leave, withdrawn.

§ [Amendment No. 21 not moved.]

§ Lord Trefgarne
moved Amendments Nos. 22 and 23: Leave out Schedule 3. Schedule 4 [Appeals relating to registration]: Leave out Schedule 4.

§ On Question, amendments agreed to.

743

§ Schedule 5 [Family Practitioner Committees]:

§ 6.10 p.m.

§ Lord Kilmarnock
moved Amendment No. 24: Page 45, line 22, leave out from ("locality") to end of line 24. The noble Lord said: My Lords, Schedule 5 provides in paragraph 2 that Section 15 of the National Health Service Act 1977 shall be rewritten to describe the duties of the family practitioner committees. We read that these duties are:

"(a) to administer the arrangements made in pursuance of this Act for the provision of general medical services, general dental services, general ophthalmic services and pharmaceutical services for their locality, and

(b) to perform such other functions relating to those services as may he prescribed."

The object of this amendment is to delete paragraph (b) on the grounds that the wording is too vague and too wide. Although it follows existing legislation, some health authorities are extremely concerned that in the new circumstances it might be used to extend the functions of family practitioner committees to include, for example, the administration of health centres or the employment of staff in the community services.
I want to be fair about this, and I understand that the noble Lord's department, the DHSS, objects to this amendment on the grounds that the removal of these lines could prevent FPCs from carrying out certain of their functions in relation to training and study leave for GPs. It will help me very much to decide whether or not to press this amendment if the noble Lord, Lord Trefgarne, can give me an assurance that there is no intention to use the schedule as drafted to extend the jurisdiction of family practitioner committees in the way feared by many authorities. I beg to move.

§ Lord Trefgarne
My Lords, I believe I can cut short discussion on this amendment to the satisfaction of the noble Lord, Lord Kilmarnock, by saying that I am willing to give the assurance for which he has asked.

§ Lord Kilmarnock
My Lords, I am grateful to the noble Lord the Minister for that happy outcome, and beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.

§ Lord Lyell
moved Amendment No. 25: Page 46. leave out line 14 and insert ("bodies") The noble Lord said: My Lords, this is a drafting amendment, and as your Lordships will see it contains the word "bodies", but there is nothing sinister in this. The word "bodies" is used earlier in the sentence concerned and for the sake of consistency we believe that it should be repeated in place of the word "authorities", which occurs later. It is purely a drafting amendment. I beg to move.

§ On Question. amendment agreed to.

§ Lord Trefgarne moved Amendments Nos. 26, 27 and 28 en bloc:

§ Page 46, line 14, at end insert— ("(4A) It is the Secretary of State's duty by order to secure as respects each committee that it includes additional members appointed in a manner specified in the order by voluntary organisations."). 744 Page 47, line 34, leave out ("not") and insert ("neither"). Page 47, line 35, at end insert ("nor appointed by virtue of an order under subsection (4A) above").

§ The noble Lord said: My Lords, at Committee stage the noble Lord, Lord Wallace of Coslany, and others, including my noble friend Lady Faithfull, pressed me to agree to the inclusion of additional members appointed by voluntary organisations to the joint consultative committee. I am happy to accept that advice, and it is for that purpose that I bring forward these three amendments. I beg to move them en bloc.

§ Baroness Faithfull
My Lords, may I just thank my noble friend the Minister.

§ On Question, amendments agreed to.

§ Lord Kilmarnock
moved Amendment No. 29: Page 54, line 36, leave out sub-paragraph (3). The noble Lord said: My Lords, at Committee stage I moved an amendment to abolish family practitioner committees and replace them with primary care committees within the district health authorities, with a view to the better integration of primary care with the other branches of the National Health Service. My party, as I explained then. is deeply committed to the promotion of health and the prevention of disease, and in our view these objectives can be achieved only by having an overall strategy for the NHS. I said at Committee stage, and repeat this evening, that the Government's decision to promote family practitioner committees to the status of fully independent health authorities seems to us to be likely to increase fragmentation rather than integration. However, I do not propose to pursue that argument any further during the course of this Bill.
My party's policy on this matter is in the process of formulation, and we shall take it to the country when the time comes. In the meantime, I am concerned merely to improve the Bill as it stands and to give the family practitioner committees a chance of working somewhat better within the framework the Government have designed for them. That is the main object of the few amendments I am moving this evening.
Amendment No. 29 seeks to remove the Secretary of State's power to appoint directly the vice-chairmen of family practitioner committees. We do not oppose his appointment of the chairmen, as the new free-standing family practitioner committees will be directly accountable to him. But we can see no good reason why the Secretary of State should need to appoint the vice-chairmen as well. This may seem a small matter hut, in the first place, it is an undesirable extension of his patronage; in the second, it does not even follow—and this is an important point—the practice of the regional health authorities and district health authorities, whose members appoint their own vice-chairmen. It is therefore not consistent with what happens in other health authorities.
The noble Lord may argue that this sub-paragraph is necessary in order to maintain a balance between lay and medical appointments, but it is not necessary to rely upon legislation to achieve this balance. If the Secretary of State appoints a contractor chairman, there is no reason why the family practitioner committee should not appoint a non-contractor vice- 745 chairman, and vice versa. Indeed, the family practitioner committees themselves have maintained just such a balance since they were established in 1974.
In case it should he felt that I am going out on a limb on this question, I should like to add that this amendment has the support not only of the National Association of Health Authorities in England and Wales (which might he thought of as an interested party) but also of the British Medical Association. I have in my hand a letter I have just received from the chairman of the association's general medical services committee, Dr. John Ball, who writes: We accept that the chairman of the newly-constituted FPCs will be appointed by the Secretary of State. However, all other health authorities are able to appoint their own vice-chairmen and therefore the FPCs will he treated differently in this respect. The general medical services committee can see no justification for this.". As I said at the outset, I am striving to he helpful to the noble Lord the Minister this evening and to see that the framework the Government want to set up will work as smoothly as possible. As I have said, this amendment has the support of the two main professional bodies and will in my view remove an undesirable and quite unnecessary extension of the Secretary of State's powers. I hope that the amendment will command wide support in your Lordships' House.

§ Baroness Jeger
My Lords, I should like briefly to support this amendment. We have discussed this matter before, and I have been told that the reason why this provision is in the Bill is that a vice-chairman might one day become chairman, and therefore it is important that the Minister should have that prospective patronage. But surely if the vice-chairman is good enough to become chairman and it happens that he is appointed in a different way and not by the Minister, the question provides its own answer. The case has been very well put by the noble Lord. Lord Kilmarnock, and I wish to register our support for it.

Lord Winstanley
My Lords, I, too, should like to support the noble Lord, Lord Kilmarnock, from these Benches in respect of this particular amendment. This does not necessarily mean that I agree with every single word the noble Lord said when making his preliminary remarks about the new situation of the family practitioner committees under this Bill. This is a matter that will be discussed by my noble friends on these Benches and by the noble Lord with his noble friends on other Benches: but on this particular amendment we are entirely at one.
The noble Lord, Lord Kilmarnock, is entirely right in saying that the Bill as it now stands would make an exception in the case of family practitioner committees. It is true that the present position is that FPCs appoint their own chairmen and their own deputy chairmen. That is the present situation. In this new situation, in which the FPCs are being changed, of course it would seem quite proper that the Secretary of State should appoint the chairman, and he does in fact appoint the chairmen of other health authorities, but other health authorities nevertheless still appoint their own deputy chairmen. Therefore, the FPCs are being singled out in this Bill for totally different treatment, having both their chairmen and deputy chairmen appointed by the Secretary of State.
746 As the noble Lord, Lord Kilmarnock, said, perfectly correctly, ever since these bodies were established in 1974 the system has worked entirely satisfactorily; these committees have always managed to make sure that the chairman has been a professional, perhaps a doctor, and the deputy chairman not a doctor, or vice versa. I think we can go back before 1974, to the precursors of these bodies, the executive councils—I served on one—when the same policy existed: always there was a duality, the chairman was one and the deputy chairman was the opposite. In other words, on a voluntary basis this kind of system that everyone is anxious to secure has always worked entirely satisfactorily.
The noble Lord said that the British Medical Association supported the amendment. The body that he quoted, the General Medical Services Committee, in strict BMA terms is what is known as an autonomous committee and represents all doctors, all general practitioners who work in the National Health Service. Therefore, its view can be taken to be the view of the Medical Practitioners Union, the Federation of Women Practitioners and all the bodies that are represented on the General Medical Services Committee, not only the BMA. So it is right to say that there is very substantial professional support for the noble Lord on this particular amendment, and to the best of my knowledge the support of all the lay elements of all the family practitioner committees that I know of; they believe they should still retain the right to appoint their own deputy chairman, even if the Secretary of State appoints the chairman.

§ Lord Rea
My Lords, even though I could he said to be speaking from a professional position, I would support this amendment from the point of view of some other people I have spoken to since this Bill was first published. These are secretaries and members of community health councils, and others who are concerned with the smooth running, the effective and fair running of the National Health Service. They feel that the proposals for family practitioner committees embodied in this Bill are retrograde, and they report to me the fact that even now family practitioner committees are not all that easy to communicate with, that it is difficult sometimes to achieve co-operation with them with regard to local issues, plans and developments, such as improved practice premises when required, better siting of surgeries for the needs of the people in the area and involvement of general practitioners in community activities of a preventive nature.
Such successes as have occurred have been despite the system rather than because of it, in co-operation, in setting up local arrangements which benefit local populations. By increasing the influence of the central Government in FPCs by the appointment of both the chairman and the vice-chairman, the Bill further removes the family practitioner committees from involvement in improving the services in the locality they serve, the needs for more integration with local plans and needs in co-operation with the district health authorities and the community health councils. I think the result of this Bill as it stands would be instead to tend towards more remote control from the centre and less co-operation on local issues.

747

§ Lord Trefgarne
My Lords, listening to the remarks of the noble Lord, Lord Winstanley, a certain apprehension crossed my brow to hear that there was some disagreement between him and the noble Lord, Lord Kilmarnock. There will, I suspect, be no disagreement, however, between him and his noble friend, if that is what I am to call them, on the opening words of the noble Lord, Lord Kilmarnock, when he said his party was deeply committed to health and prevention of disease. I suspect that all political parties are committed to that admirable sentiment; certainly mine is, I am happy to hear that his is, and no doubt also are the other parties represented in your Lordships' House.
My Lords, there are two factors that we took into account when deciding that it would be right for the Secretary of State to appoint the vice-chairman, as well as the chairman, although he does not do so in respect of health authorities. The first stems from the long established practice of maintaining a balance between contractor and non-contractor membership of the committees. It is well known, of course, that general practitioners are contractors to the National Health Service. Of course there is no such feature in health authority membership. It is our intention that in all the new FPCs the vice-chirman should not be drawn from the same group of members as that of the chairman. Thus, a contractor chairman would have a non-contractor vice-chairman and vice versa. Of course, sometimes the chairman of the FPC will be a contractor and sometimes a non-contractor, and clearly it is right that the vice-chairman should be from a different caste, if that is the right word.
Secondly—and this was the point raised by the noble Baroness, Lady Jeger—there will be instances when we identify a potential chairman, whom we would wish to appoint when he had acquired more experience of the work of the committee. It might well be that we would feel that the experience could be best gained by a spell as vice-chairman, and we need to be able to ensure that such experience could be made available. A similar amendment was moved in Committee but was withdrawn after I had explained the reasons behind the Government's proposal. I hope the noble Lord, Lord Kilmarnock, will now be persuaded of the merit of what we propose and will see fit not to press this amendment.

§ Baroness Trumpington
My Lords, may I, as a former vice-chairman of a family practitioner committee, say that I entirely agree with every word that the noble Lord has just said.

§ Lord Pitt of Hampstead
My Lords, I am afraid that I disagree with the noble Baroness, Lady Trumpington. The Minister has given no real reason for this different approach to the FPCs from the approach to the health authorities. The question of balance has been spoken to already by other speakers. In fact, the FPCs have always preserved that balance, although they now elect both their chairman and vice-chairman. You do not need the Secretary of State in order to get balance. As for the point about potential chairmen, that, I think, is really the wrong way of using the appointment of a vice-chairman. Far from being a strong point for agreeing to this, it is a very 748 strong point for opposing it. If you want a potential chairman, put him on the committee, let him develop with the committee, let him get au courant the committee; do not put him there automatically giving him status. Therefore, I would say that on both the grounds put forward by the Minister the amendment is preferable to the proposal in the Bill.
I would also want to add this. What the noble Lord, Lord Winstanley, said, is of great importance: the profession feels strongly about it. I hope the Government will take that into account. I gather that on most of the issues in relation to FPCs with which the Bill is concerned there has been general agreement between the department and the profession. But I know from the letters that I have received that the profession feels strongly against the suggestion that the Minister should appoint the vice-chairman of the FPC. Since the Government are not prepared to accept what is a strong desire on the part of the profession, I hope your Lordships will, by passing this amendment, change what is in the Bill.

§ Baroness Gardner of Parkes
My Lords, I wish to support the Minister, although I am quite surprised to find myself in agreement with him. On the last occasion I spoke on this point I made many of the points that have been made this evening. Even then I plumped for the non-appointment of both chairman and vice-chairman. I still think that that is the way it should be, and that neither of these people should be appointed. They should be elected from the committees as in the previous way, which is a method that has worked so well. If, however, the Secretary of State intends to appoint the chairman, the way that the Minister has put forward is perfectly logical, and that he should appoint the vice-chairman. Reluctantly, therefore, I feel I have to support the Minister on this, in a way that is quite contrary to my previous views. If I could persuade him to have both the chairman and vice-chairman elected from within the committee traditionally, in the way that has existed, as the noble Lord, Lord Winstanley, said, since long before 1974. and certainly since the days when I served on a executive council, I would still wish to press him for that, but I do not like this amendment which just goes for a vice-chairman who is not appointed.

§ Lord Banks
My Lords, I should like to make it clear that when I withdrew the amendment in Committee I did not do so because I had found the noble Lord's answer convincing. In fact, I said that I did not find it altogether convincing but I did not want to divide the house at that time. I confess that I still do not find the answer altogether convincing.

§ Lord Trefgarne
My Lords, if I have your Lordships' permission to speak again, I have advanced certain reasons why this amendment is not appropriate and I am grateful for the support of my noble friends who sit behind me, qualified though it was in one respect. However, I must say that I think that, in the light of what has been said, perhaps it would be wise if I took this matter away and had another look at it. I am not giving your Lordships an undertaking to change what is proposed because we have already given this matter considerable thought and the product of that thought is contained in the provisions of the Bill. Nevertheless, 749 I recognise that a number of distinguished noble Lords with a particular interest in this matter feel otherwise, and therefore perhaps it would be wise for me to take the proposals away, or at least undertake to consider the matter between now and the next stage, and write to noble Lords who have spoken in this debate.

§ Lord Kilmarnock
My Lords, I am grateful to all noble Lords who have spoken in this debate. I confess I have always had great admiration for the skill of the noble Lord, Lord Trefgarne, at the Dispatch Box, but I did not think that he put up a tremendously good case. The question of the contractor and non-contractor balance has already been settled very satisfactorily by the BMA, which said that this had been satisfactorily preserved over a number of years. The noble Lord's case was also further torpedoed by the noble Lord, Lord Pitt.
My own objection is what I consider to be the creeping power of the Secretary of State. I have always understood that the Prime Minister was against the nanny state, but it now appears that all Secretaries of State in this Government are becoming universal nannies.
There has been strong support all round the House for the amendment. The noble Lord said that he is prepared to consider it in view of the strong support, both lay and professional, that the amendment has received. However, before I decide whether to withdraw the amendment I should like to ask the noble Lord if, rather than simply writing, he would consider having a meeting with those of us who are particularly interested in this amendment to see whether we can arrive at a formula for the next stage of the Bill. Otherwise, we shall go into the next stage of the Bill and not know the Government's position and whether or not we need to table another amendment. Perhaps the noble Lord can tell me whether he is prepared to do that.

§ Lord Trefgarne
My Lords, if I still have your Lordships' permission to speak again, I am naturally happy to receive the noble Lord, Lord Kilmarnock, at any time. I am not sure that my room in the department is big enough to receive all the noble Lords who have spoken in this debate, but certainly if he wishes to bring other noble Lords with him. I would not for a moment object. Perhaps we can therefore proceed on that basis.

§ Lord Kilmarnock
In view of the noble Lord's assurance, I shall withdraw the amendment at this stage; but if we cannot come to a satisfactory agreement between now and Third Reading, I shall table an amendment in similar terms at the Third Reading of the Bill. I beg leave to withdraw the amendment.

§ Amendment, by leave, withdrawn.

§ 6.38 p.m.

§ Lord Kilmarnock
moved Amendment No. 30: Page 55, line 20, at end insert ("; such consultations shall include any District Health Authority whose district wholly or partly includes the locality of the Family Practitioner Committee and none of whose nominees have been appointed to the Family Practitioner Committee under paragraph 6A(1)(g)"). 750 The noble Lord said: My Lords, I think the object of this amendment is pretty clear. Schedule 5, Part II, paragraph 6A(1) (g) provides that four members of a family practitioner committee shall be appointed from persons nominated by district health authorities, any part of whose district is in the locality of the Family Practitioner Committee". In some cases, as your Lordships will be aware, more than four district health authorities are linked in this way to one and the same family practitioner committee. It seems quite improper where this occurs that one or more of them should be excluded. My amendment simply seeks to secure that where this occurs the excluded authority, or authorities, must he consulted under (h) concerning the final seven unspecified nominations in the Secretary of State's gift, with the clear implication that authorities unrepresented on the FPC under (g) should achieve representation under (h). I find it very hard to see how the Government could dispute the reasonableness of this amendment. I beg to move.

§ Lord Trefgarne
My Lords, paragraph 6A(1)(g) provides for four appointments to a family practitioner committee to be made from persons nominated by district health authorities in the locality of that committee. Although DHA nominations need not be confined to authority members, the general intention in making these appointments will be to secure cross-membership between the FPC and the DHAs. Where more than four DHAs are involved, the Secretary of State will naturally wish to consider the nominations of those not represented under (g) when making the appointments under head (h). There need, therefore, be no DHA without a nominee on the FPC. Since all DHAs will have been consulted under the nomination arrangements proposed. I see no advantage in having a second round of consultation, which in all probability would produce no new names.
I hope that the noble Lord, Lord Kilmarnock, will therefore be persuaded that the difficulty that he foresaw will not, in fact, arise in practice, and that he will see fit to withdraw his amendment.

§ Lord Kilmarnock
My Lords, I am afraid that I must tell the noble Lord that I am not quite satisfied with that. There is nothing in (h) which statutorily covers the position of the excluded DHAs. Item (h) reads: 7 shall be appointed after such consultations with such bodies as the Secretary of State considers appropriate". My amendment would merely add that along with these bodies the district health authorities not already represented should also be consulted. The noble Lord said that the Secretary of State would naturally consult, but there is absolutely nothing in the Bill to oblige him to do so. Therefore I find the answer unsatisfactory. The amendment is extremely reasonable and completely fair, and I think that I must test the opinion of the House.

§ 6.40 p.m.

§ On Question, Whether the said amendment (No. 30) shall be agreed to?

751

§ Their Lordships divided: Contents, 65: Not-Contents, 94.

752

DIVISION NO. 3
CONTENTS
Airedale, L.	Llewelyn-Davies of Hastoe, B.
Amherst, E.	Lloyd of Kilgerran, L.
Ardwick, L.	Longford, E.
Aylestone, L.	Lovell-Davis, L.
Banks, L.	McGregor of Durris, L.
Beswick, L.	McIntosh of Haringey, L.
Blease, L.	Mackie of Benshie, L.
Boston of Faversham, L.	MacLeod of Fuinary, L.
Brooks of Tremorfa, L.	McNair, L.
Bruce of Donington, L.	Milner of Leeds, L.
Chitnis, L.	Molloy, L.
Cledwyn of Penrhos, L.	Nicol, B.
Collison, L.	Paget of Northampton, L.
David, B.	Peart, L.
Davies of Penrhys, L.	Pitt of Hampstead, L.
Diamond, L.	Ponsonby of Shulbrede, L.
Donaldson of Kingsbridge, L.	Rea, L. [Teller.]
Elwyn-Jones, L.	Robson of Kiddington, B.
Evans of Claughton, L.	Rochester, L.
Fisher of Rednal, B.	Ross of Marnock, L.
George-Brown, L.	Segal, L.
Glenamara, L.	Stedman, B.
Hanworth, V.	Stewart of Alvechurch, B.
Hooson, L.	Stewart of Fulham, L.
Houghton of Sowerby, L.	Taylor of Gryfe, L.
Jacques, L.	Taylor of Mansfield, L.
Jenkins of Putney, L.	Underhill, L.
John-Mackie, L.	Whaddon, L.
Kagan, L.	White, B.
Kaldor, L.	Wigoder, L.
Kennet, L.	Willis, L.
Kilmarnock, L. [Teller.]	Winstanley, L.
Kirkhill, L.

NOT-CONTENTS
Airey of Abingdon, B.	Henley, L.
Alexander of Tunis, E.	Hives, L.
Allerton, L.	Hornsby-Smith, B.
Avon, E.	Hunter of Newington,L.
Belhaven and Stenton, L.	Hylton-Foster, B.
Bellwin, L.	Inglewood, L.
Beloff, L.	Kinloss, Ly.
Belstead, L.	Lane-Fox, B.
Bessborough, E.	Lauderdale, E.
Bethell, L.	Lawrence, L.
Burton, L.	Lindsey and Abingdon, E.
Caccia, L.	Long, V.
Caithness, E.	Lyell, L. [Teller.]
Campbell of Croy, L.	McFadzean, L.
Carnegy of Lour, B.	Mackay of Clashfern, L.
Cathcart, E.	Macleod of Borve, B.
Clifford of Chudleigh, L.	Mansfield, E.
Colwyn, L.	Margadale, L.
Cork and Orrery, E.	Marley, L.
Craigavon, V.	Marshall of Leeds, L.
Craigmyle, L.	Massereene and Ferrard, V.
Cullen of Ashbourne, L.	Mersey, V.
Davidson, V.	Milverton, L.
De La Warr, E.	Mottistone, L.
Denham, L.	Mountgarret, V.
Drumalbyn, L.	Mowbray and Stourton, L.
Elliotof Harwood, B.	Murton of Lindisfarne, L.
Elton, L.	Napier and Ettrick, L.
Faithfull, B.	Onslow, E.
Ferrers, E.	Orkney, E.
Fortescue, E.	Pender, L.
Fraser of kilmorack, L.	Platt of Writtle, B.
Gainford, L.	Rawlinson of Ewell, L.
Gardner of Parkes, B.	Renton, L.
Glenarthur, L.	Rochdale, V.
Gowrie,E.	St. Aldwyn, E.
Hailsham of Saint	St. Just, L.
Marlyebone, L.	Saltoun, Ly.

752

Sandford, L.	Thomas of Swynnerton, L.
Sandys, L.	Tranmire, L.
Savile, L.	Trefgarne, L.
Shannon, E.	Trumpington, B.
Skelmersdale, L.	Ullswater, V.
Stamp, L.	Vickers, B.
Stodart of Leaston, L.	Wakefield, of Kendal, L.
Swansea, L.	Winterbottom, L.
Swinfen, L.	Young, B.
Swinton, E. [Teller.]

§ Resolved in the negative, and amendment disagreed to accordingly.

§ 6.48 p.m.

§ Lord Kilmarnock
moved Amendment No. 31: Page 56, line 6, after ("locality") insert ("and any District Health Authority whose district partly or wholly includes the locality of the family Practitioner Committee"). The noble Lord said: My Lords, I beg to move Amendment No. 31. Schedule 5, Part II paragraph 7(1) gives the Secretary of State power to vary the composition and the size of a family practitioner committee as set out in paragraph 6A. Under paragraph 7(2) he is first obliged to consult the family practitioner committee for the locality concerned if he proposes to vary its size or composition. But, as we have seen under paragraph 6A(1)(g), some district health authorities might well be excluded from representation on the family practitioner committee. Even if the substance of my Amendment No. 30 were to be secured, their representation as of right under (h) would not be there; it would merely require the Secretary of State to consult them. So there still remains the possibility that a district health authority, whose district is partly or wholly included in the locality of the family practitioner committee, might be unrepresented on that family practitioner committee.
The amendment seeks to provide that, where the Secretary of State wants to vary the size and composition of the family practitioner committee, he must consult not only that family practitioner committee, but also all those district health authorities whose districts are partly or wholly included in the locality of the family practitioner committee, whether they are represented on that committee or not.
The intention is that he should consult district health authorities, not only in their capacity as family practitioner committee members, on which they would in any case be a small minority, but also separately and distinctly as organs of the National Health Service, in order to obtain their independent views on a matter that could be of very considerable concern to them. I beg to move.

§ Lord Trefgarne
My Lords, this is a thoroughly good idea. I accept the amendment.

§ On Question, amendment agreed to.

§ Lord Trefgarne moved Amendment No. 32: Page 56, line 13, leave out from beginning to ("for") in line 14 and insert—

§ ("31. The following sub-paragraphs shall be substituted for paragraph 2(d) to (g) of Schedule 7 (additional provisions as to Community,' Health Councils)— (d) the consultation of Councils by District Health Authorities or relevant Family Practitioner Committees with respect to such matters, and on such occasions, as may be prescribed: 753 (e) the furnishing of information to Councils by such Authorities and Committees, and the right of members of Councils to enter and inspect premises controlled by such Authorities; (f) the consideration by Councils of matters relating to the operation of the health service within their districts, and the giving of advice by Councils to such Authorities and Committees on such matters; (g) the preparation and publication of reports by Councils on such matters, and the furnishing and publication by such Authorities or Committees of comments on the reports; and". 32. In paragraph 3(d) of that Schedule,").

§ The noble Lord said: My Lords, with your Lordships' permission, perhaps with this amendment I can speak to Amendments Nos. 33 and 103. The Government accepted the principle of an amendment moved in Committee that there should be statutory links between CHCs and FPCs, and agreed to move an amendment on Report to that effect. These are those amendments. I beg to move.

§ On Question, amendment agreed to.

§ Lord Trefgarne moved Amendment No. 33: Page 56, line 16, at end insert— ("33. The following paragraph shall be added at the end of that Schedule— 8. A Family Practitioner Committee is a relevant Family Practitioner Committee in relation to a Council's district if any part of the Committee's locality is in that district, but is only a relevant Committee in relation to that Council to the extent that the Council performs its functions in relation to that Part.").

§ On Question, amendment agreed to.

§ 6.53 p.m.

§ Baroness Masham of Ilton
moved Amendment No. 34: After Clause 10, insert the following new clause: ("Funding of national hospital facilities. .—(1) The Secretary of State shall have power by order to designate hospitals or specialised hospital units as national hospital facilities. (2) Before the beginning of each financial year the Secretary of State shall specify, in respect of each national hospital facility, the sum of money which in his opinion will be required to meet the costs of that national hospital facility during that financial year. The Secretary of State may subsequently increase, but may not decrease, sums specified under this subsection. (3) The sums to be paid by the Secretary of State to Health Authorities under section 97(1)(a) of the National Health Service Act 1977 in each financial year shall include. in the case of a Health Authority providing a national hospital facility, the sum specified under subsection (2) above in respect of that national hospital facility. (4) It shall be the duty of a Health Authority receiving money in respect of a national hospital facility under subsection (3) above to ensure. as far as practicable, that the money is spent for the purposes of that national hospital facility."). The noble Baroness said: My Lords, once more I bring to your Lordships' notice an amendment which is concerned with the very important matter of funding national hospital facilities. Unlike the corresponding amendment, which I tabled for the Committee stage, this amendment does not provide for central funding of national hospital facilities. What it does is to try to protect such hospitals from competition for funds with other local hospitals. It does this by making it the duty of the Secretary of State to specify each year the sum of money which, in his opinion, will be required to meet the costs of that hospital, and this can be found in subsection (2). He must then pay that sum to the health authority 754 concerned, which is to be found in subsection (3). In turn, as far as practicable, they must spend it for the purposes of the hospital, which is subsection (4).
The funding of the National Health Service is very complicated indeed. I was pleased when the Minister, the noble Lord, Lord Trefgarne, said at the Committee stage that the Government had accepted the principle that services which draw patients from an area much wider than that of their own region should not have to compete directly for funds with services which the same authority has to provide for its own district. The Government have also said that they are setting up a forum to advise on which services should be covered by the new arrangements and the level of funding.
I must say here that I am pleased that spinal units, paediatric haemodialysis, chorioncarcinoma and the National Poisons Information Service have already been included in this category, which will be determined centrally and identified separately. Having had this assurance from the Minister about these four supra-regional specialties, I think it would be wrong if I did not seek assurance from the Government for other supra-regional specialties which also give lifesaving expertise, which the patients who attend them could not otherwise receive.
I know, more than ever now, that we have to be cost-conscious and aware of the need to justify the work done in all departments of the National Health Service. These very specialised units, which are of national interest, attract patients and act as national referral centres for particular difficult medical and surgical problems. They promote the development of special skills and high standards of practice in all departments. They attract staff with particular interest who otherwise might go abroad. They promote research and specialist post-graduate training.
It is vital that we do not restrict our medical choice of freedom; that patients, when their doctors feel it necessary, can cross districts and regions; and that a fair, just and simple way of funding is found. The recent reorganisation of the National Health Service has left some special supra-regional hospitals under the administration of the district in which they happen to be. I would ask the Minister to look at the Killinbeck hospital, which is in Leeds East district, as an example of what I mean.
This hospital has an international reputation as a major centre for heart surgery and investigation. Last week the healine in the Yorkshire Post newspaper was: Authority spends £1 million on patients not in its district. Outsiders face ban at cash hit hospital.". This is because 80 per cent. of the cardiac patients come from outside Leeds. Many of the other districts in rural Yorkshire do not have any special facilities at all. They depend on hospitals like this for specialised treatment. As this hospital is in my region, I am confident that, as long as funds are available, a satisfactory solution will be arrived at in view of the searching endeavours of my colleagues and the officers currently involved in this difficult matter.
But what of those patients who come from outside the region? There are patients from other regions who need the expertise of this hospital as well. Killinbeck is just one of the specialising hospitals throughout the country, nationwide, which must be under stress and 755 at risk. We need to rebuild the confidence of the public in the health service and in its entirety, and thereby ensure the continuance of the facilities currently available. I await with interest the Minister's reply. I beg to move.

§ Baroness Trumpington
My Lords, in rising to support this amendment and in agreeing with what the noble Baroness, Lady Masham, has said, I would point out that in the debate on 9th December my noble friend Lord Trefgarne stated, when he replied to a similar amendment to the one we are discussing today, that agreement had been reached with regional health authorities on proposals for earmarking funds for services which fall into the supra-regional category. He said that they would be discussing these proposals with the medical profession in January. I hope that my noble friend will be able to tell us the result of those discussions.
I believe that my noble friend the Minister is sympathetic to the problems caused to regional health authorities concerning the financing of specialised departments in training hospitals and hospitals specialising in one field, such as Papworth. My noble friend Lord Trefgarne mentioned four services which he hoped would receive a new form of funding arrangement this year, but they do not include a great many major specialist departments which play a national and international role. What are these departments meant to do during the period when they are excluded from any new financial arrangements? There is, of course, the fact that any income from aboard must be taken into account in assessing the cost of such units to the National Health Service. However, by their very excellence these units will attract extra patients which will further increase costs to the new funding arrangements and give rise to greater burdens on district budgets. I await my noble friend's reply with great interest.

§ 7 p.m.

§ Baroness Robson of Kiddington
My Lords, may I say something about this as a former regional health authority chairman. The problem of funding specialist hospitals is one that has been concerning the NHS for years. I have been party in the past to many meetings at the department when we have discussed what can be done. Within a region itself the regional specialties are funded off the top before the rest of the regional money is distributed. But that is not enough in itself, because the regions are short of money.
I agree that there are some specialties which are so outstanding that maybe only one is needed in the whole of the country, but if you fund off the top all it means is that the regions are getting less for standard services. This is one of the problems that exist in the NHS. We have some specialist hospitals, the postgraduate hospitals, which are special health authorities now, and they receive direct funding from the Department of Health. I believe that there is scope for a greater number with that kind of funding, but I would plead with the Government that in the present economic climate that has to be done without taking any money off the regional funding, because otherwise we just depress the services that the average person in this country uses.

756

Lord Wallace of Coslany
My Lords, I should like to support the noble Baroness, Lady Masham, and the new clause before the House. I would agree with the noble Baroness, Lady Robson, who has had great experience in the regional health authority field that this has been a continuing problem for years and has caused extreme difficulty. I hope that the Government can come forward with something positive on this. Certainly from these Benches we support this amendment.

§ Baroness Gardner of Parkes
My Lords, I should like to support the noble Baroness, Lady Masham, in this amendment. There are a few points that have been raised on which I should like to comment. The noble Baroness, Lady Robson, commented on the number of special health authorities that have been set up. It is quite true that this Government have created seven special health authorities which are all post-graduate teaching hospitals and very much on a national basis. By so doing this Government have surely recognised that there are national needs, and provided facilities for them.
I see that this amendment refers to hospitals, but even more particularly I would speak in favour of specialised hospital units because this is where the funding raises the greatest difficulty. If we look at the London picture we certainly have major teaching hospitals, under-graduate teaching hospitals, already within normal district health authority control. Therefore, there is no way that we could take them all out and make them special. After all, the whole Health Service was reorganised to put them in with all other health facilities, and it would be defeating the whole purpose. But within these hospitals there might be one with a specialisation in a bone marrow transplant, and another specialising in some other field. I know that if the noble Baroness, Lady Lane-Fox, were here she would tell us again of the wonderful one that does the work on the lung and chest conditions.
The point that has to be appreciated is the extreme rapidity of change in medical treatment now. I am pleased to have the right to serve at the moment as a member of the National Heart Board of Governors. That is one of the seven special health authorities. In the last two years alone the number of cases of cystic fibrosis has much more than doubled. Again the treatment for cancer, the oncology treatment, has gone up and up. There is the great technology that is now constantly before us in terms of pacemakers and nuclear cardiology. All these things create a vast demand for intensely specialised work and intensely specialised expenditure.
Although the National Heart Group has its own independence of management, of course it never has adequate funds. There is no way that the Health Service will ever have all the funds that they need for the advanced treatment we should like to give. We therefore have to look carefully at how best to spend our money. I speak from quite a different point of view from the noble Baroness, Lady Robson. She has been on a regional hospital authority, and I have been on an area health authority, which now would be closer to the current district health authority. The constant battle as a member of a small health authority is in trying to get more money from the region. The region 757 has a totally different view as to how it will allocate it within the areas. Whatever area you are on, or district now, you believe that that is the district which is not getting enough money.

§ Baroness Robson of Kiddington
My Lords, may I interrupt for just a second? It is true that most regions in this country allocate money to the special regional specialties before they allocate to the region. They send the money to the area to spend, but there is a special amount of money for the regional specialties in every allocation.

§ Baroness Gardner of Parkes
My Lords, I am most grateful to the noble Baroness, Lady Robson, for those comments. When one is sitting as an ordinary member of a district health authority one is constantly told that, whatever happens to be the little specialty within your area, it is the one that you should not go on financing because you are financing that for patients who do not live in your area and are not ratepayers in your area. This battle goes on all the time.
I served as a local authority member, and our one concern as local authority members was to see that our ratepayers in that area were getting the facilities and treatment they needed. Although we should have liked to have additional facilities and specialised units we were not really willing to sacrifice local needs. This is why this amendment is so good, because it asks for a definite earmarking of particular funds, so that when the funds went to the district health authority they would be specifically for that purpose.
I found the comments of the noble Baroness, Lady Robson, very interesting because she implied that that was already done, but I never saw that in operation at all on the health authority on which I served. However, if it has been done in some areas and regions so much the better. It is certainly what this amendment asks. Just to quote another example, in the last year the open-heart surgery in the Brompton Hospital increased by 27 per cent.—in one year. This shows how the demand for the specialised units and the specialised treatment is growing. I hope that the Minister will look favourably on this amendment.

§ Lord Molloy
My Lords, I believe that the House should take full cognisance of the contributions of the three noble Baronesses because we have been listening to three ladies with enormous experience.

§ Baroness Trumpington
Four.

§ Lord Molloy
Four. I am of the opinion that unless something drastic is done we are going to strangle the financial and administrative aspects of our National Health Service by this incredible miniature over-bureaucracy at regional level. I think it fair to say that if the Ministry of Defence ran their business in the same way as the DHSS runs the National Health Service we should find great difficulty in making an assault across the Round Pond in Kensington. This has to be taken seriously.
I could give numerous examples, but I believe that the speeches that we have had from the noble Baroness, Lady Masham, and the other noble Baronesses in support have more than adumbrated the 758 seriousness of the situation and indeed almost the stupidity of the situation. I should like to add one more dimension. I have known numerous cases where people outside a boundary laid down by some civil servants are a couple of hundred yards away from a particular specialist hospital, but they cannot go to it. If the Minister wants details I can given them. It is not half a mile, it is not a quarter of a mile; it is a couple of hundred yards. They cannot go to that one, but instead must go to one in their region, which is perhaps three or four miles away.
If I am told, "That is annoying to ordinary people, but it is difficult for them to understand the administration", then we have the process the wrong way round. We must make the administration fit the demands, requirements and desires of the people it serves. If, when the Minister replies, he will comment on the various points that noble Lords have made in this debate, I am sure that will help us to move forward to rectify some of the irritations about which I spoke last week.

§ Viscount Mountgarret
My Lords, in intervening at this stage I must admit to not being knowledgeable or an expert in the health and social services of the country, but I was interested to see the amendment tabled by my noble friend Lady Masham. I read an interesting editorial in the Yorkshire Post (a newspaper which probably not many noble Lords read, although it is a staunch supporter of the Government) commenting on the amendment and the idea in it, and it said: Provided that such a scheme would not entail a blank cheque from the Government and so long as it is understood that central funding necessarily involves centralised management, the idea has much to commend it". As there is obviously strong feeling about the idea, perhaps the right course would be for the Government to look at the whole issue again. I know they are not all that happy about it, but if they agreed to look into it again my noble friend might not press the amendment, as the issue could be discussed further.

§ Lord Trefgarne
My Lords, the noble Lord, Lord Molloy, urged me to consider that we should reduce bureaucracy in the NHS and improve its efficiency, and that is a sentiment with which I entirely agree. Indeed, in the nearly four years we have had responsibility for these matters we have moved a long way in that direction. We have removed one whole layer of bureaucracy from the NHS; and we have taken particular care to see that the regions and districts now operate at the best level of efficiency they can attain. We have regional reviews with each region, conducted on an annual basis; and we have all sorts of other matters which we press on regions and districts, to which they are responding admirably.
It is certainly the case that the total sum of money we can make available to the NHS must, I am afraid, be a finite sum, and I am certain therefore that it is incumbent on Ministers, as it is on those managing and working in the NHS, to secure the very best value for money that we can. Those are some general observations, and I now move specifically to the amendment.
In my reply to her similar amendment in 759 Committee, I described the new arrangements for funding supra-regional services which we intend to introduce in the coming financial year. These arrangements do not require legislation, as the powers contained in the present legislation are adequate for the purpose. If the House will bear with me, I will recall briefly the main features of those arrangements. Under them, the financial allocations to certain important services which need to be planned on a national, rather than a regional, scale will be determined centrally and identified separately from the normal allocations of the health authorities concerned.
We are also setting up a forum, whose members will be drawn from health authorities and the medical profession, to advise us on the claims of particular services for supra-regional funding and the level of funding they should receive. In the first place, the arrangements will apply to four services already recognised as performing a supra-regional function: namely, paediatric renal dialysis and transplantation, spinal services, the management of chorioncarcinoma and the National Poisons Information Service—and the noble Baroness referred to that in her speech. The new forum will be able to advise on the claims of additional services, and my honourable friend the Minister for Health confirmed in a Written Answer on 21st January to Mr. Morris, that the first one we shall be asking it to consider will be bone marrow transplantation, in the light of the recent report on this subject by Sir Douglas Black's working party.
I can bring the story up to date by saying that our proposals were discussed with the medical profession at a meeting between the department and the Joint Consultants Committee on 25th January, and are now agreed with the profession as well as with regional health authorities. Nominations have been invited from both health authorities and the profession for membership of the forum, and we hope that this can start work as quickly as possible. One noble Lord asked what progress we had made since the Committee stage, and that is it.
The present amendment goes further than the one moved by the noble Baroness in Committee in imposing specific obligations on the Secretary of State and on health authorities, and in defining a mechanism by which funds would be channelled through health authorities' allocations to the units in question. There is little I could disagree with in the spirit of the amendment. But it remains our view that legislation on this subject is neither necessary nor desirable, and I shall explain why we believe that.
The legislation on which the National Health Service is based has always been broadly framed in comparison to the health service legislation of some other countries. This has given a welcome flexibility in the operation of the service, within the constraints of parliamentary accountability, and has enabled it to work to the maximum extent by consensus and agreement, and to the minimum extent by direction. Generally speaking, Government have not sought powers in legislation unless they are absolutely necessary to enable something to be done. That, in my view, is a very sound principle, and one from which I should be sorry to see us depart.
760 In the case of national or supra-regional services, the need for special funding is agreed between all the parties—the Government, the health authorities and the medical profession—and we should have the new arrangements in operation very soon. I do not feel that any purpose would be served by defining in legislation something which the parties concerned are not only willing and able to do but are already doing. With respect, the amendment also omits any reference to something we regard as a key point in our proposals; namely, the mechanism for ensuring, through the new forum, that the claims of supra-regional specialties are properly balanced against those of local district services.
As to the proposed subsection (4), I am sure that a legal sanction is not necessary to ensure that health authorities use supra-regional funds for the purposes for which they are allocated. The amounts will have been agreed nationally at the highest level and will be known to the staff of the units and everybody else. I feel that this represents a quite sufficient sanction without having it spelt out in legislation.
There is one other specific point on which I must register my disagreement. The proposed subsection (2) would make it impossible to reduce the sums allocated to national hospital facilities. I have already made clear our view that supra-regional services should not be insulated from judgments about relative priorities. Duplication and over-provision can occur in them, just as in local services, and where this happens it can be harmful to patient care—because services are not provided in the centres best equipped for the job—as well as wasteful of resources. We see it as one of the objects of supra-regional funding to achieve rationalisation where it is desirable, and this is a point on which the medical profession have been in full agreement. I am sorry that I must sound a slightly discordant note when there is so little difference between myself and the noble Baroness on the spirit of what she proposes, but I hope that with the explanations and assurances I have given, she will be able to withdraw the amendment.
Before I sit down perhaps I may refer to the question of Killingbeck Hospital, which the noble Baroness specifically mentioned in her opening remarks. I hope that your Lordships will agree that this is not an occasion on which to run through the long list of hospitals which may be in the minds of some of your Lordships, but, if I may, I should like to respond to the noble Baroness on this particular point because it is a matter of special interest to her, and she raised it in her opening speech. There is, I understand, no question of babies requiring urgent cardiac care being refused admission to Killingbeck Hospital. Despite what was stated in some newspaper reports, both before Christmas and more recently, emergency operations are not being cancelled and urgent cases are dealt with as and when the need arises. As with other specialties, there is of course a waiting list for non-urgent cases, and I have no doubt that that waiting list lengthened somewhat during the recent industrial dispute.
Following the recent district review meetings in the Yorkshire region, the regional health authority, of which the noble Baroness is a distinguished member, has agreed to explore the possibility of finding an alternative mechanism for funding developments in 761 regional specialties. The characteristics of the cases being treated at Killingbeck have changed because recently developed techniques in cardiac surgery mean that babies can now be operated on at a very much younger age, and that in turn means that additional demands have been placed on nursing resources for intensive post-operative care. However, as I say, the regional health authority is fully seized of the problem, and I have been able to give the assurance that no babies requiring urgent cardiac care are being refused admission to the hospital.
I hope that I have been able to allay the noble Baroness's anxiety about both the specific case that she raised and the wider issue inherent in her amendment, and that she will see fit not to press it.

§ Baroness Trumpington
My Lords, before the noble Lord sits down, I should like to ask him about a point that I raised, which I do not think he has answered. He has listed some new things which will come into the new formula. What happens to the others? There will still be a situation in which other hospitals in an area will feel that the money is being creamed off their allowance for the specialties that are not included in the list of the new set-up. The hospitals will feel that they are suffering because of the hospital with its specialty, which is creaming off "goodies" from them.

§ Lord Trefgarne
My Lords, if I have your Lordships' permission to speak again, I would say that I am sorry that I did not cover the point that my noble friend raised. I fear it is the case that there will be a very large number of hospitals which think that they ought to be included in the new special arrangements to which I have referred. I have no doubt that many of them will have a very powerful case for inclusion. However, the fact of the matter is that if overnight we included all these hospitals in the special arrangement to which I have referred, the benefit of that special arrangement would disappear at the same time, because by its very nature it needs to be selective.
Therefore I am sorry to say that some hospitals which no doubt think that they are doing a job which justifies their inclusion in the special category, as indeed they may be, will not in the short term, or even medium term, be able to be included. However, we have now fully seized ourselves of the problem. We have moved to include four specialties already. A fifth specialty is now to be urgently considered, and others will no doubt be urgently considered just as soon as the forum can be created. So I hope my noble friend will agree that we are moving as fast as we reasonably can in this matter, and I hope, too, that like, I trust, the noble Baroness, Lady Masham, she will not wish to press the amendment.

§ Baroness Masham of Ilton
My Lords, I should like to thank all noble Lords and noble Baronesses who have spoken, I also wish to thank the noble Lord the Minister for his full reply. But one thing that he has said has really worried me. It is about the allocation to regions for specific hospitals—the RAWP allocation. I think that the instance I have in mind occurred before the noble Lord the Minister went to the DHSS, and I shall now tell your Lordships what happened. RAWP money was sent to the Oxford region for Stoke 762 Mandeville Hospital, but it was not spent on that hospital. In fact I know—and I heard this from the DHSS—that that part of Buckinghamshire was starved of the funds which should have gone to it. That kind of situation is a worry.
I was pleased that the noble Lord the Minister quite liked the amendment. He was worried about the funds, in case too much money was allocated to one hospital; but, after all, the allocation takes place each year and not much can be overspent in one year. Indeed, I should be very surprised if too much money was ever overspent in the National Health Service.
I want to raise the morale of the National Health Service and those who work in the specialised hospitals. We have before us another stage of this Bill, in which the Government could improve on the amendment. In that case I should like to divide the House to try to make those who are working in hospitals feel that people at Westminster really do care for them. That is the reason why I now divide the House.

§ Baroness Trumpington
My Lords, am I allowed to speak again?

Several noble Lords
No.

§ The Deputy Speaker (Lord Hayter)
The Question is, That Amendment No. 34 be agreed to? As many as are of that opinion will say "Content"? To the contrary, "Not-Content"? I think the "Not-Contents" have it. Clear the bar.
My Lords, the tellers for the Contents have not been appointed, pursuant to Standing Order No. 50, and the Division therefore cannot take place. I declare that the "Not-Contents" have it.

§ Lord Denham
My Lords, I think that this is probably a convenient moment to "have the gap". The consideration of the Report stage of this Bill will not be resumed until a quarter past eight. I beg to move that further consideration on Report be adjourned.

§ Moved accordingly, and on Question, Motion agreed to.