National Health Service and Community Care Bill

HL Deb 07 June 1990 vol 519 cc1515-69

3.32 p.m.

Report received.

Clause 1 [Regional and District Health Authorities]:

Lord Ennals moved Amendment No. 1: Page 2, line 6, at end insert: ("(2A) Appointments to any health authority or family health service authority under Schedule 1 to this Act shall be made with regard to the desirability of the persons appointed being persons who have experience of, and have shown capacity in, some matter relevant to the functions of the health service authority.").

The noble Lord said: My Lords, we are now on the first day of the Report stage of the Bill. Those who were present on 19th April will recall that we had a long debate about the composition of regional health authorities, district health authorities and family health service authorities. We were concerned that these new authorities with crucially important responsibilities might be composed of people with experience in business, administration and accounting—all very important qualifications in the running of the health service or any other service—but such people may not necessarily be in touch with health service needs.

We proposed in a series of amendments that membership should include consultants, general practitioners, nurses, other health service professionals, other staff within the National Health Service, people involved in community health councils, representatives of local authority associations and consumer organisations. We were anxious that minority groups and women should be included. We wanted to see a degree of continuity of service between those at present involved in management within the health service and the new authorities.

All the proposals, with the exception of that concerning the universities, were rejected at that time. I quote from the statement made by the noble Baroness, Lady Hooper, at col. 120 of Hansard of 19th April 1990: the aim is and must be to appoint the best person for the job in each case".

At a later stage (also at col. 120) the noble Baroness said: all appointments are made on the basis of personal qualities and experience of the individual concerned".

The first amendment standing not only in my name but that of the noble Baroness. Lady Cox, and the noble Lord, Lord Winstanley—therefore it is an all-party amendment—takes this into consideration. It seeks to write into the Bill the assurances that the Minister gave to us on that occasion. She set out the arguments—and I well understand her case—against people representing any particular service. We have built on that view as well.

The amendment therefore accepts the generality of the argument. It does not ask for anyone to represent special interests. It is not, to quote the debate, "prescriptive". It seeks to ensure, in terms which we hope will be acceptable to the Government, that appointments should be made, as the amendment states, of the persons appointed being persons who have experience of, and have shown capacity in, some matter relevant to the functions of the health service authority".

If this is accepted, as I hope it will be, it will give much assurance to those who are deeply concerned that we shall see a takeover of the National Health Service by business interests.

Some people already find the language of the proposed new National Health Service a little difficult to take and to understand. Those who have been dealing with the terms of the internal market understand it well. It is not well understood by patients. The concept of purchasing packages of care is also rather clumsy. There is a strong feeling that, even though terms may be difficult, if we get the right people, the job will be done well. We wish to ensure in this amendment that we have as members of these three types of authorities people who are committed to the National Health Service. We wish to see some continuity; we wish to see consumer interests reflected in the membership of these authorities. We want people who may also be involved in the provision of community care in order to ensure continuity between the responsibilities of the health authorities and of the social service departments of local authorities.

Nothing could be less prescriptive than the words in the amendment. It directly follows the line of argument already used by the noble Baroness. I believe that it would facilitate input from the health care professionals and consumers without appointees being seen as representatives of their respective bodies or organisations. To be effective, authorities will find such an input absolutely essential.

I believe that the amendment would also provide a safeguard for the future. It would ensure at all times that appointments were made on the basis of experience, whoever was Secretary of State and from whichever political party he came. The amendment safeguards the system from manipulation. I beg to move.

Baroness Cox

My Lords, I support the amendment for three main reasons. First, it respects the Government's concern which was repeatedly expressed during the Committee stage in your Lordships' House not to embody the principle of representation in setting up policy-making bodies.

Your Lordships may wonder why this and other related amendments are necessary, given the Government's declared commitments. However, I believe that they are necessary because they would provide and facilitate an input from health care professionals without our falling into the trap of legislating for those categories of representatives of various groups, which, as the noble Lord, Lord Ennals, said, is something to which the Government have expressed a deep-rooted antipathy.

The amendment also avoids problems associated with amendments proposed at the Committee stage which tried to ensure the professional input but which were also subject to the criticism that they violated one of the fundamental principles of the Bill: the division between purchaser and provider.

During the Second Reading of the Broadcasting Bill earlier this week it was stated that the Government had proved to be a listening government in another place. I believe that this amendment demonstrates that professionals have shown themselves to be listening professionals. They have modified their proposals, seeking to encourage professional input into decision-making bodies, but in a way which respects the Government's concerns. I hope therefore that the Government will show themselves to be a listening government and will listen to the proposals which the professionals have modified in the way in which the amendment phrases their concerns.

The second reason why I support the amendment strongly is that it provides a safeguard for the future. It will give reassurance that appointments will be made on the basis of relevant experience, whoever the Secretary of State may be in the future and from whichever political party he may come. The amendment would prevent or protect the system from potential manipulation which could have adverse effects on the delivery of health care.

Thirdly, it provides a much needed assurance for the health professions which are so intimately involved with the delivery of care that there is a greater likelihood that their expertise, experience and detailed knowledge would be taken into account in decision-making processes at all stages from the earliest tentative discussions to the final implementation. It is not sufficient to have a system where people with professional expertise are simply called in an advisory capacity when others deem that their contribution is necessary.

The wording of the amendment is gentle and highlights the desirability of the measure. I suggest that its provisions are crucial to the running of the health service in ways which are both cost-effective and care-effective. The wording does not violate the Government's most cherished principles which underpin the reforms enshrined in the Bill. But the amendment would do much to encourage confidence in the proposed changes among the professions and among the public. I therefore hope that my noble friend will see the wisdom of the amendment and will be willing to respond sympathetically.

Lord Winstanley

My Lords, I wish to support the amendment for the reasons given so clearly by the noble Lord, Lord Ennals, and the noble Baroness, Lady Cox. There was nothing incompatible about the arguments advanced by those two speakers from opposite sides of the House. This is not a party matter. I agree with the noble Baroness, Lady Cox, that it would be immensely helpful and reassuring to many people if the Government were to accept the amendment. If I may anticipate the reply of the noble Baroness, I fear that the Government may say that they accept the idea of the provision and that therefore it does not need to go into the Bill as that is exactly what will happen. Perhaps the Government will introduce the provision. But that is not what many people expect; nor do they believe that it has happened in the past.

The amendment is not unrelated to one I moved in Committee to the effect that people should not be appointed to any of these positions on the basis of party political affiliation. We shall of course be told that that is not the case. However, there was something of an argument between the noble Lord, Lord Jenkin of Roding, and my noble friend Lady Robson. The noble Lord, Lord Jenkin, pointed out that he had appointed my noble friend Lady Robson as chairman of one of the regional authorities. But there was an argument about her successor when the noble Lord who was then the Minister had asked about the politics of the person my noble friend had recommended.

I accept that appointments are not made on the basis of party political affiliation and I believe it is highly undesirable that they should be. It is even more undesirable that people should widely consider that appointments are made on a party political basis. It is widely thought that that is the case. When one talks to people they say it is a matter of jobs for the boys, or perhaps for the girls. However, that is not the case and it should not be the case. The words of the amendment are in part the words used by the noble Baroness in reply to my amendment.

The wording relates also to another amendment of mine moved in Committee on the extreme importance of providing continuity for what used to be the family practitioner committees. There is a great deal of anxiety among present members, officials and officers of the FPCs as regards what will happen when those bodies become family health services authorities and whether there will be continuity and proper professional expertise. I wholly accept that we do not wish to have representation. The noble Baroness has, pointed that out. We should not make it a requirement that these authorities must represent this or that body. However, I believe the Government should do precisely what they said they were going to do when they replied to two amendments moved at an earlier stage. It would be immensely helpful if that were written into the Bill. It would be reassuring to many people who are worried about the matter.

Lord Carr of Hadley

My Lords, I am distinctly nervous about the effects of the amendment, if carried. While I agree most strongly that some of those who are appointed to these authorities should have the kind of experience that is described in the amendment, I also believe it is of immense importance that there should be others who are completely fresh and with entirely independent experience. We need a mixture of people. As I assume is the case with other noble Lords, I am speaking about the non-executive members of these authorities. I believe that the non-executive members should constitute a mixture of those with the kind of experience that is mentioned here and—this is very important—others who can bring an entirely new perspective to the problems of the health service.

3.45 p.m.

The Parliamentary Under Secretary of State, Department of Health (Baroness Hooper)

My Lords, I appreciate the intention behind the amendment and the fact that we have moved forward considerably from the discussions in Committee. I appreciate too that proposers have sought to make the amendment as general as possible. However, I do not believe that even this formulation would be helpful. Further, I suspect that it would not achieve what the proposers have in mind. Indeed, it may produce the opposite effect.

I question whether we can define what the terms of the amendment actually mean in a way which will make the proposed provision workable. What is to constitute relevant experience and how is capacity to be demonstrated? We all have views on this, but our subjective judgments are likely to differ. It is really not helpful to introduce such concepts into legislation and leave room for doubt and dispute about their proper meaning. It will be said that the inclusion of the provision is meant to signify something and that it is intended to exclude someone. The courts may have to interpret what it is intended to achieve. Perhaps we should therefore consider what it might be construed as meaning.

People with a proven track record in finance, personnel or contracting in the private sector would certainly have experience and capacity relevant to the functions of an authority. On the other hand, it is much less likely that someone active in his local community in a way not directly related to the health and allied services could be said to have such qualities. I suggest that we should not place such obstacles in the way of considering candidates on their individual merits as is the Government's intention. There are many current and former authority members drawn from different walks of life who have made notable contributions to the health services in their localities, despite the apparent absence at the time of their appointment of capacity and experience in matters relevant to the functions of an authority. We should not take away the flexibility to make such appointments when it is in the best interests of the National Health Service locally.

As has been said, we have always made it clear that people will be appointed on the basis of their skills and personal qualities. I fully expect that people with a background in the health service and with a background relevant to that service will be the front-running candidates. However, I do not believe that the amendment would help in this respect. I hope that the proposers will not press it but will instead accept the value of casting the net wide and appointing the best people in all the circumstances.

Lord Ennals

My Lords, I am grateful to the Minister for her reply. She has said briefly and succinctly what she said repeatedly on a series of amendments on 19th April. However, I believe she is wrong in her conclusion. She has failed to recognise, or perhaps the Secretary of State has failed to recognise that there is a great deal of concern. That concern is to be found among the medical and nursing professions, among those who work in the National Health Service and among consumers of the services provided by the National Health Service. They are concerned not that there will not be flexibility but that there will be inflexibility. We want to see flexibility. Some of the people on these authorities will be new, and that is right. I agree with every word of the noble Lord, Lord Carr of Hadley, except his conclusion. We want to see new people on the authorities. If we merely wanted to see the same old people or young people as we have now, we would not be making the proposed change.

Although I still hold the same view, I have ceased going over the old territory. We want to have a balanced team of professional skills in management. We want the skills of professionals who are working within the National Health Service, the medical and nursing staff who have the interests of the patients at heart. Without making a list and being prescriptive, we wish the Bill to reflect that those who run the National Health Service should have a deep commitment to it and that among them must be those who have experience of it. It would be a mistake to think that we want something totally new and that all the people who are serving at present and who have given such valuable service are to go and a new bunch is to come in.

The Minister would have gained great respect for herself and the Government if she had accepted the amendment. We want people with proven experience both within and outside the National Health Service. We want to see flexibility on the basis of experience and skills. There are moments in our debates on the National Health Service when the Government ought to recognise that the time has come to move a little and accept something. So far, they have not recognised that. I am sorry that they have not because I feel that I must test the views of the House on the amendment.

Lord Carr of Hadley

My Lords, before the noble Lord sits down, can he clarify what he has said? At one moment he talked of persons "among" those non-executives appointed. I am in agreement on that point but I believe that his amendment means that all those persons appointed should have relevant service within the National Health Service. If he intends to divide the House it would be helpful if he would make clear whether he means what the amendment seems to me to mean or whether he means something different.

Lord Ennals

My Lords, I am grateful to the noble Lord for putting that question because it allows me to clarify the position. We refer to the desirability rather than an obligation of making such appointments. The amendment says: with regard to the desirability of the persons appointed". That indicates that we are not saying that everyone appointed must already work in the National Health Service. No such thing. There is flexibility, which I believe is reflected in the wording of the amendment.

Lord Carr of Hadley

My Lords, I am sorry to intervene again, but the noble Lord uses the word "desirability". Is it not also highly desirable that other people should be appointed to bring in entirely new experience? The desirability that is expressed at present is an exclusive one. I fear that I must object to that and vote against the amendment.

3.52 p.m.

On Question, Whether the said amendment (No. 1) shall be agreed to?

Their Lordships divided: Contents, 104; Not-Contents, 143.

DIVISION NO. 1
CONTENTS
Addington, L.	Listowel, E.
Airedale, L.	Llewelyn-Davies of Hastoe, B.
Ardwick, L.
Aylestone, L.	Lloyd of Kilgerran, L.
Birk, B.	Lockwood, B.
Blackstone, B.	Longford, E.
Blease, L.	McCarthy, L.
Boston of Faversham, L.	McFarlane of Llandaff, B.
Bottomley. L.	McGregor of Durris, L.
Brightman, L.	McIntosh of Haringey, L.
Broadbridge, L.	McNair, L.
Burton of Coventry, B.	Mais, L.
Campbell of Eskan, L.	Masham of Ilton, B.
Carmichael of Kelvingrove, L.	Mayhew, L.
	Meston, L.
Carter, L.	Milner of Leeds, L.
Cledwyn of Penrhos, L.	Mishcon, L.
Cocks of Hartcliffe, L.	Morris of Castle Morris, L.
Cox, B.	Mulley, L.
Darcy (de Knayth), B.	Nicol, B.
David, B.	Northfield, L.
Donaldson of Kingsbridge, L.	Ogmore, L.
Dormand of Easington, L.	Oram, L.
Ennals, L.	Peston, L.
Ewart-Biggs, B.	Phillips, B.
Ezra, L.	Prys-Davies, L.
Falkland, V.	Richard, L.
Foot, L.	Richardson, L.
Gallacher, L.	Robson of Kiddington, B.
Galpern, L,	Rochester, L.
Gladwyn, L.	Russell, E.
Glasgow, E.	Sainsbury, L.
Graham of Edmonton, L. [Teller.]	Seear, B.
	Serota, B.
Grimond, L.	Shackleton, L.
Halsbury, E.	Somers, L.
Hampton, L.	Stallard, L.
Hanworth, V.	Stoddart of Swindon, L.
Harris of Greenwich, L.	Strabolgi, L.
Hatch of Lusby, L.	Taylor of Blackburn, L.
Henderson of Brompton, L.	Thomson of Monifieth, L.
Holme of Cheltenham, L.	Thurso, V.
Houghton of Sowerby, L.	Tonypandy, V.
Howie of Troon, L.	Tordoff, L.
Hunt, L.	Turner of Camden, B.
Jacques, L.	Varley, L.
Jay, L.	Wallace of Coslany, L.
Jeger, B.	Warnock, B.
Jenkins of Hillhead, L.	Wedderburn of Charlton, L.
Jenkins of Putney, L.	White, B.
John-Mackie, L.	Williams of Elvel, L.
Kennet, L.	Willis, L.
Kilmarnock, L.	Winstanley, L. [Teller.]
Leatherland, L.
NOT-CONTENTS
Alexander of Tunis, E.	Auckland, L.
Allenby of Megiddo, V.	Belhaven and Stenton, L.
Ampthill, L.	Bellwin, L.
Arran, E.	Beloff, L.

Belstead, L.	Ironside, L.
Bessborough, E.	Killearn, L.
Birdwood, L.	Kimball, L.
Blake, L.	Kinnaird, L.
Blanch, L.	Layton, L.
Blatch, B.	Lloyd of Hampstead, L.
Blyth, L.	Long, V. [Teller.]
Borthwick, L.	Lurgan, L.
Boyd-Carpenter, L.	McColl of Dulwich, L.
Brabazon of Tara, L.	Macleod of Borve, B.
Brigstocke, B.	Malmesbury, E.
Brougham and Vaux, L.	Mancroft, L.
Burton, L.	Manton, L.
Butterfield, L.	Merrivale, L.
Butterworth, L.	Mersey, V.
Caithness, E.	Monteagle of Brandon, L.
Campbell of Alloway, L.	Morris, L.
Carnegy of Lour, B.	Mottistone, L.
Carnock, L.	Mountevans, L.
Carr of Hadley, L.	Mowbray and Stourton, L.
Cavendish of Furness, L.	Moyne, L.
Clanwilliam, E.	Munster, E.
Colnbrook, L.	Murton of Lindisfarne, L.
Constantine of Stanmore, L.	Nelson, E.
Cottesloe, L.	Nelson of Stafford, L.
Craigavon, V.	Norrie, L.
Crathorne, L.	Nugent of Guildford, L.
Crickhowell, L.	Orkney, E.
Crook, L.	Orr-Ewing, L.
Cullen of Ashbourne, L.	Oxfuird, V.
Cumberlege, B.	Pender, L.
Dainton, L.	Peyton of Yeovil, L.
Davidson, V. [Teller.]	Porritt, L.
Dilhorne, V.	Quinton, L.
Eccles, V.	Reay, L.
Eccles of Moulton, B.	Renwick, L.
Eden of Winton, L.	Rippon of Hexham, L.
Elibank, L.	Rootes, L.
Ellenborough, L.	St. Davids, V.
Elles, B.	Sandys, L.
Elliot of Harwood, B.	Seebohm, L.
Elliott of Morpeth, L.	Sempill, Ly.
Elton, L.	Shannon, E.
Erne, E.	Shaughnessy, L.
Faithfull, B.	Strange, B.
Ferrers, E.	Strathclyde, L.
Foley, L.	Strathmore and Kinghorne, E.
Fortescue, E.
Fraser of Carmyllie, L.	Strathspey, L.
Fraser of Kilmorack, L.	Swansea, L.
Gainford, L.	Swinton, E.
Gisborough, L.	Terrington, L.
Grantchester, L.	Teviot, L.
Gridley, L.	Thomas of Gwydir, L.
Haig, E.	Thomas of Swynnerton, L.
Hailsham of Saint	Thurlow, L.
Marylebone, L.	Trumpington, B.
Harlech, L.	Ullswater, V.
Havers, L.	Vaux of Harrowden, L.
Henley, L.	Wade of Chorlton, L.
Hertford, M.	Walton of Detchant, L.
Hesketh, L.	Wedgwood, L.
Hives, L.	Whitelaw, V.
Hood, V.	Wise, L.
Hooper, B.	Wolfson, L.
Howe, E.	Wyatt of Weeford, L.
Hunter of Newington, L.	Wynford, L.
Hylton-Foster, B.	Young, B.
Iddesleigh, E.

Resolved in the negative, and amendment disagreed to accordingly.

4.1 p.m.

Baroness Cox moved Amendment No. 2: After Clause 1, insert the following new clause: ("Evaluations .—(1) Regional health authorities shall evaluate and report annually to the Secretary of State on the implementation by them of their duties under this Act. (2) The Secretary of State shall lay before Parliament the reports submitted to him under subsection (1) above.").

The noble Baroness said: My Lords, this amendment might appear unnecessary because it could be argued that any and every regional health authority will automatically undertake the functions indicated. However, it is desirable for two reasons to put those requirements on the face of the Bill. The first reason is to ensure that regular, systematic monitoring of the changes following the legislation takes place so that any benefits and/or problems may be identified and appropriate measures taken by, for example, either building on and developing beneficial changes or remedying any unforeseen difficulties.

My second reason is even more important. It is desirable that those reports should be laid before Parliament, which will therefore bring them into the public domain. That means that the information obtained will be available for all concerned with the provision of health care. That requirement not only satisfies the fundamental principle of public accountability on a matter of national importance, but it would also help to fill the acknowledged information deficit which, even within the Department of Health, it is widely acknowledged still exists. It is feared that that information deficit may cause serious problems.

The Government are deeply committed to the idea of evolutionary change in the National Health Service, but I must emphasise that evolution and evaluation are not incompatible. Indeed, I would argue that they must go hand in hand. The amendment is an attempt to build on that principle and the mechanisms for evaluation systematically throughout the country to the benefit of everyone concerned with health care. That would reassure both the public and the professionals, especially those members of the royal colleges and the other professional bodies who have pleaded so earnestly, and with justification, for some systematic evaluation to accompany evolutionary change.

The amendment avoids the acknowledged pitfalls of the earlier proposals from the professional bodies, the royal colleges and the other colleges. Noble Lords may remember that those would have limited evaluation to two regions. The amendment makes evaluation an integral part of evolution and retains the principle in their arguments without the constraints which made them unacceptable to both the Government and, I believe, many Members of the House.

I therefore hope that noble Lords and my noble friend the Minister will receive the amendment sympathetically. I must emphasise—the names of noble Lords who have supported the amendment on the Marshalled List demonstrate this point—that it is not a party political amendment. It does nothing whatever to delay or impede the implementation and, I hope, the successful development of the changes proposed in the Bill, but it is based on, reflects and would allay professional concern about the changes that are likely to occur. It would provide for evaluation which, where things are working well, would demonstrate that good, high quality health care is being provided. If there are problems, it would enable them to be discussed and responded to constructively. It would show the Government's good intention that the good practice which it is hoped will follow from the reforms will become available for discussion and debate; it would help to remedy the information deficit which, as I have said, is widely acknowledged still to exist; and it would show that health care is continuing to be provided at a high level in each and every region. I beg to move.

Lord Ennals

My Lords, it is my pleasure to support the noble Baroness, Lady Cox, and to agree with every word that she said. There are matters on which we shall not always agree and I shall refer to one or two of them during my presentation.

This is a modest amendment. As we recall, the Government rejected the amendments which would have required that the NHS should not be plunged headlong into a new scheme of things with internal markets, NHS trusts and GP budget-holding practices, all of which they propose to introduce without prior evaluation, pilot schemes, experimentation, independent monitoring or research. Those proposals were all rejected.

My views have not changed and, so far as I know, nor have those of the royal medical colleges or the Royal College of Nursing, as the noble Baroness said, nor those of other professional organisations which supported the important document that was published before our Committee stage. The evidence from the East Anglian experience—named "Operation Rubber Windmill" for reasons about which I am not quite certain—confirms all our worst fears about the chaos that can follow the national implementation of untested concepts.

The Government have thrown out the concept of prior evaluation. There is no point in returning to that and arguing it now. The answer is that we shall learn from our experiences and mistakes. We shall be in a state of constant monitoring. That is the theme which Ministers have presented in reply, so our view is that we should take them at their face value. The amendment ensures that that constant evaluation happens and that reports are made available to the regional health authorities and by regional health authorities to the Secretary of State and then to Parliament, so that all of us—health authorities, bodies interested in the health service and individuals—can watch what is happening and learn from that constant evaluation.

In supporting the noble Baroness, Lady Cox, in her amendment, I withdraw nothing that I have said about the lack of Government wisdom in pressing ahead at a speed which in my view will lead to chaos in the National Health Service from 1st April 1991. I want to minimise that. I want to ensure that that constant monitoring is done. We are being plunged recklessly forward in a year in which—after 1st April 1991—there is almost certain to be a general election and when the Government will be hard pressed to provide the resources which the NHS so desperately needs. Let me add that the incoming Government will be in no way committed to some of the proposals in the Bill nor to sustaining them. But I believe that in a period of instability those matters that the Government have said will be done should be done and should be written into the Bill. If we are not to have the provisions that we proposed earlier, let us make the best job that we can of assurances given by Ministers. That is the purpose of the evaluation. I can see no conceivable reason for not accepting this modest amendment.

Lord Kilmarnock

My Lords, noble Lords will recall that the objections advanced to previous ideas on evaluation and pilot schemes were that they would in effect paralyse development in other parts of the service while the pilot scheme or evaluation was taking place. The noble Lord, Lord Ennals, knows that on those grounds I was not happy with his original idea that there should be a series of pilot schemes in two regions and that the remainder of the National Health Service should stand still while progress was monitored over a period of three years or something of that nature.

Having said that, the present amendment does not have any of those characteristics. It provides for evaluation—I believe that the jargon term is formative evaluation—over the whole range of the service during the implementation of the proposals in the Bill. We know that the Bill is to some extent an experiment. It will be implemented in tranches, with a number of hospitals acquiring trust status, and others perhaps following.

With that approach to the Bill, it seems eminently sensible and extremely desirable that this process of ongoing evaluation—that is the phrase of the noble Lord, Lord Ennals; formative evaluation is my phrase—should take place. The service can learn by successful outcomes and good practice in other areas of the country. There can be no foot dragging on the implementation of the Bill arising out of the amendment. On the contrary there would be constant evaluation and monitoring of the results and a learning process on the future implementation of the Bill.

The Government cannot possibly have any objection to the amendment. For the reasons that I have given, I have put my name to it. I very much hope that the Government will look with favour on it.

Lord Auckland

My Lords, I am a little concerned about the amendment. Any reorganisation of the health service or any other body will obviously need evaluation. As has been said many times, it is the first reorganisation of the National Health Service in 40 years. But I am worried at the burden that it will put on those who have to undertake the evaluation every year. I am not sure about the exact length of time of the evaluations or whether it will vary. But I should have thought that a triennial review would be much better. It would allow the matter to proceed more smoothly.

Schedule 1 (2) to the Bill requires that those serving on these authorities should be of a certain standard. Therefore, much as I sympathise with the principle of the amendment, the application will be difficult. It will put a burden on those who have to undertake the review. They must have time to make the evaluation. Twelve months is too short a period.

Lord Butterfield

My Lords, perhaps I may comment about this very interesting amendment. I am sympathetic to the philosophy that lies behind it, but I ask this question. Is it right for the RHAs to evaluate themselves in the report? I have been on RHAs, on and off, since the early 1970s in one area or another. Apart from a small amount of confidential business at the end of the meeting, it is conducted openly in front of the local press. It would not be unreasonable to say that the local press is frequently stimulated to give its own evaluation of what a regional health authority has been up to.

The noble Lord, Lord Auckland, suggested that the evaluation should be every three years. The work of the regional health authority is to produce a basic plan which usually runs forward for five years and is updated each year. Each year the regional health authority, through its officers, has to report to the Department of Health on the progress of the plan. A letter is sent to the regional authority from the Department of Health commenting on successes and failures. Sometimes it can be fairly critical. Fortunately in the areas in which I have been involved it has never been critical across the board but we have had our knuckles rapped for not doing what we said we are going to do. The letter from the department is produced openly, again in front of the press.

I am very sympathetic to the idea behind the amendment, but I am not sure that I wish it to be the regional health authorities that will evaluate and report. I hope that a rather more dispassionate way forward can be found.

4.15 p.m.

Baroness Hooper

My Lords, I too have no difficulty in accepting the underlying aims of the proposed new clause but I deplore the attempt to continue to scaremonger about the reforms. I know that the noble Lord, Lord Ennals, is strongly against them but I must correct the impression that he gave about the so-called rubber windmill experiment. As the regional general manager for East Anglia has said, the purposes of the exercise was to test the concept of contracting to see whether it could be pushed to breaking point. It showed that, while that is possible when pushed in the way that it was, the checks and balances built into our proposals, especially the emphasis on quality, will prevent it from happening in practice.

The measures contained in the Bill are intended to create a more efficient service which will improve the quality of clinical care and the delivery of care, which is something that we all seek. In order to achieve that we shall need to monitor and review the implementation of the arrangements. I also agree that both Houses of Parliament will want to take a close interest in those matters and hold Ministers to account for their stewardship.

However, as my noble friend Lady Cox has admitted, what is proposed is part and parcel of proper management and therefore requires no statutory provision. The National Health Service management executive has the responsibility on behalf of my right honourable friend the Secretary of State to monitor and review the implementation of policy by National Health Service bodies, including the implementation of legislation. There are already mechanisms in place to achieve this, as the noble Lord, Lord Butterfield, so helpfully explained. Each year objectives are agreed with the regional health authorities in the light of Ministers' policies and priorities and progress is kept under review. The regions are required to produce programmes and reports which focus on the key objectives that they have been set. The process culminates in a yearly meeting, chaired by the National Health Service Chief Executive at which progress is considered and fresh objectives set for the year ahead. A further ministerial meeting may be held if that appears necessary. Copies of the letters sent to each region at the end of this annual process are placed in the Libraries of both Houses.

I agree with the noble Lord, Lord Kilmarnock, that there is a need for evaluation; but it has to be a continuous management process. We do not want annual reports to become a single focus for this activity because that may constrain a region's flexibility to respond quickly to local developments.

It is the essential task of management to bring these systems into being and to use them consistently to ensure that objectives are set and that performance and effectiveness is monitored. In the next few years, there is no doubt that these arrangements will focus on the implementation of the reforms. They will provide the means to review progress and maintain momentum in the improvements in care which will flow from our continued record investment in the National Health Service and the improvements in its management which the Government have in hand.

The proposed new clause removes the flexibility to focus on the key issues and cuts across the specific responsibility of the management executive to account to Ministers for the implementation of policy in the NHS. In addition, I doubt that statutory provision for annual reports will appear particularly relevant in years to come when the initiatives contained in the Bill become a normal part of our NHS arrangements. There is already ample opportunity—far too ample, I sometimes think—for Ministers and health authorities to be called to account for their stewardship of the NHS not only in this House and the other place but through the workings of various Select Committees and the Public Accounts Committee. No doubt your Lordships will be keeping track of the implementation of the reforms and putting that high on personal agendas during the coming months.

Lord Peston: My Lords, I interrupt to ask the Minister a question in order to clarify what she is saying. Is she saying that the requirements contained in the amendment will happen any way, and therefore the amendment is not needed? If so, is she further saying that there is a statutory basis for that or that it will happen because it will happen anyway? In particular, I draw her attention to the second part of the amendment about laying reports before Parliament. Is she saying that that will happen anyway? If so, can she say whether it has a statutory basis?

Baroness Hooper

My Lords, I have said that this is part and parcel of proper management and requires no statutory provision. I also pointed to the mechanisms which already exist. As a result of the procedures to which the noble Lord, Lord Butterfield, referred, they include the placing in the Libraries of both Houses copies of letters referring to the monitoring in each region at the end of each year. I have also pointed to the mechanisms that exist in both Houses for ways of bringing Ministers to account. On that basis we believe that the amendment is not necessary.

Baroness Cox

My Lords, I thank noble Lords who have spoken in support of the amendment. I thank my noble friend Lord Auckland for expressing his anxiety. I sympathise with him but hope that to some extent his anxiety was allayed by the response of the noble Lord, Lord Butterfield. He pointed out that provisions already exist for certain reports to be made. However, I do not believe that that removes the need for the provisions contained in the amendment.

My noble friend the Minister has expressed the intentions, which I know are sincere, that the changes proposed in the Bill will improve the quality of clinical care, and so forth. When one is moving into an area where there are untried proposals and where, as is currently acknowledged, there is a large deficit of the information on which some of those changes will be based, it is essential that there should be systematic evaluation. It is also essential that the results of that evaluation should be in the public domain.

We fear that the kind of monitoring to which my noble friend has referred, undertaken by conscientious managers, is not the same as a systematic evaluation. We also fear that the findings of the monitoring which takes place in the regions may not be readily available on a systematic basis for nationwide appraisal of the effects of the changes in the legislation.

I was slightly worried about my noble friend's reference to accountability. In a democracy one cannot have too much accountability. In the field of health care people are immensely vulnerable. There are problems in the delivery of health care and unforeseen problems in the implementation of new policies which can cause real suffering. Information about problems must be quickly available on a regular basis. That requires systematic evaluation which is ensured and provided on a regional basis. Such information should come before both Houses of Parliament so that it is in the public domain. It can then be looked at as a totality and not on the basis of letters to particular districts, and so forth. It would be a systematic process of evaluation to accompany a systematic process of evolution to which the Government are committed.

I speak with deep anxiety. Like my noble friend, I hope passionately that the intentions of the Government will be realised and that the proposals before us will lead to better quality care. But hope is not enough. We must have demonstrated the good effects of the proposed changes. If problems exist, information about them must be made available quickly and systematically. That should be properly gathered on the basis of systematic evaluation.

Therefore, I am afraid that I was not convinced by my noble friend's reply. I represent widespread, non-partisan political anxiety. There is a deep professional anxiety among those in all the health care professions. They want to see the accountability and availability of systematic evaluation. We hope that the news will be good; in that case, there can be professional and national rejoicing. However, if problems exist, they must be recognised and brought to the attention of the people. Appropriate measures can then be taken to ensure that good quality health care is provided in every region on the best possible basis. I must ask for the opinion of the House.

4.26 p.m.

On Question, Whether the said amendment (No. 2) shall be agreed to?

Their Lordships divided: Contents, 104; Not-Contents, 135.

DIVISION NO. 2
CONTENTS
Addington, L.	Jacques, L.
Adrian, L.	Jay, L.
Airedale, L.	Jeger, B.
Ardwick, L.	Jenkins of Hillhead, L.
Aylestone, L.	Jenkins of Putney, L.
Birk, B.	John-Mackie, L.
Blackstone, B.	Kennet, L.
Blease, L.	Kilmarnock, L.
Bonham-Carter, L.	Leatherland, L.
Boston of Faversham, L.	Listowel, E.
Bottomley, L.	Llewelyn-Davies of Hastoe, B.
Brightman, L.
Bruce of Donington, L.	Lloyd of Kilgerran, L.
Campbell of Eskan, L.	Lockwood, B.
Carmichael of Kelvingrove, L.	Longford, E.
	Lovell-Davis, L.
Carter, L.	McCarthy, L.
Cledwyn of Penrhos, L.	McFarlane of Llandaff, B.
Cocks of Hartcliffe, L.	McNair, L.
Cox, B. [Teller.]	Masham of Ilton, B.
Crook, L.	Mayhew, L.
Dainton, L.	Meston, L.
Darcy (de Knayth), B.	Milner of Leeds, L.
David, B.	Molloy, L.
Donaldson of Kingsbridge, L.	Morris of Castle Morris, L.
Dormand of Easington, L.	Nicol, B.
Ennals, L.	Northfield, L.
Ewart-Biggs, B.	Ogmore, L.
Ezra, L.	Oram, L.
Faithfull, B.	Peston, L.
Falkland, V.	Phillips, B.
Foot, L.	Pitt of Hampstead, L
Gallacher, L.	Porritt, L.
Galpern, L.	Prys-Davies, L.
Gladwyn, L.	Rea, L.
Glasgow, E.	Richard, L.
Graham of Edmonton, L. [Teller.]	Richardson, L.
	Robson of Kiddington, B.
Gregson, L.	Rochester, L.
Hampton, L.	Russell, E.
Hanworth, V.	Sainsbury, L.
Hatch of Lusby, L.	Seear, B.
Henderson of Brompton, L.	Serota, B.
Hirshfield, L.	Shackleton, L.
Holme of Cheltenham, L.	Shaughnessy, L.
Houghton of Sowerby, L.	Stallard, L.
Hunt, L.	Stoddart of Swindon, L.

Strabolgi, L.	Walton of Detchant, L.
Swann, L.	Warnock, B.
Thomson of Monifieth, L.	White, B.
Thurso, V.	Williams of Elvel, L
Tordoff, L.	Willis, L.
Turner of Camden, B.	Winstanley, L.
Wallace of Coslany, L.
NOT-CONTENTS
Aldington, L	Hylton-Foster, B.
Alexander of Tunis, E.	Iddesleigh, E.
Arran, E.	Ironside, L.
Auckland, L.	Jenkin of Roding, L.
Beaverbrook, L.	Kimball, L.
Bellwin, L.	Kinnaird, L.
Beloff, L.	Layton, L.
Belstead, L.	Lloyd of Hampstead, L.
Bessborough, E.	Long, V. [Teller.]
Birdwood, L.	Lurgan, L.
Blake, L.	Lyell, L.
Blatch, B.	McColl of Dulwich, L.
Bolton, L.	Macleod of Borve, B.
Boyd-Carpenter, L.	Malmesbury, E.
Brabazon of Tara, L.	Mancroft, L.
Brigstoke, B.	Manton, L.
Brougham and Vaux, L.	Marsh, L.
Burton, L.	Marshall of Leeds, L.
Butterfield, L.	Merrivale, L.
Butterworth, L.	Mersey, V.
Caithness, E.	Monckton of Brenchley, V.
Caldecote, V.	Monteagle of Brandon, L.
Campbell of Alloway, L.	Mottistone, L.
Campbell of Croy, L.	Mountevans, L.
Carnegy of Lour, B.	Mowbray and Stourton, L.
Carnock, L.	Munster, E.
Carr of Hadley, L.	Murton of Lindisfarne, L.
Cavendish of Furness, L.	Nelson, E.
Clanwilliam, E.	Nelson of Stafford, L.
Clifford of Chudleigh, L.	Norrie, L.
Colnbrook, L.	Nugent of Guildford, L.
Constantine of Stanmore, L.	Orkney, E.
Cottesloe, L.	Orr-Ewing, L.
Craigavon, V.	Oxfuird, V.
Crickhowell, L.	Pender, L.
Cullen of Ashbourne, L.	Peyton of Yeovil, L.
Cumberlege, B.	Quinton, L.
Davidson, V. [Teller.]	Reay, L.
Dilhorne, V.	Renwick, L.
Eccles of Moulton, B.	Romney, E.
Eden of Winton, L.	Rootes, L.
Ellenborough, L.	Saltoun of Abernethy, Ly.
Elles, B.	Sandys, L.
Elliot of Harwood, B.	Sempill, Ly.
Elliott of Morpeth, L.	Strange, B.
Elton, L.	Strathclyde, L.
Erne, E.	Strathcona and Mount
Ferrers, E.	Royal, L
Foley, L.	Strathmore and Kinghorne, E.
Fortescue, E.
Fraser of Carmyllie, L.	Strathspey, L.
Fraser of Kilmorack, L.	Sudeley, L.
Gainford, L.	Swansea, L.
Gisborough, L.	Swinfen, L.
Gridley, L.	Swinton, E.
Haig, E.	Teviot, L.
Hailsham of Saint	Thomas of Gwydir, L.
Marylebone, L.	Thomas of Swynnerton, L.
Harlech, L.	Trumpington, B.
Havers, L.	Ullswater, V.
Hayter, L.	Vaux of Harrowden, L.
Henley, L.	Wade of Chorlton, L.
Hertford, M.	Wedge wood, L.
Hesketh, L.	Whitelaw, V.
Hives, L.	Wise, L.
Hood, V.	Wolfson, L.
Hooper, L.	Wyatt of Weeford, L.
Howe, E.	Wynford, L.
Hunter of Newington, L.	Young, B.

Resolved in the negative, and amendment disagreed to accordingly.

4.35 p.m.

Clause 2 [Family Health Services Authorities]:

Lord Kilmarnock moved Amendment No. 3: Page 3, line 7, leave out subsection (6).

The noble Lord said: My Lords, this amendment forms part of a number of amendments which I did not press in Committee. It is designed to make possible but not mandatory the amalgamation of district health authorities with family health services authorities. In Committee the noble Lord, Lord Henley, argued that that was not desirable as it would blur the distinction between the purchaser and provider, which is central to the strategy of the Bill. However, it was envisaged in the White Paper Working for Patients at paragraph 3.20 that as more and more hospitals opted to become self-governing, the providing arm of some district health authorities would wither away and that it would be worth considering, the possibility of sensible mergers with neighbouring Districts. Larger Districts might eventually become candidates for mergers with Family Practitioner Committees".

In my view there is no reason why such a merger should blur the purchaser/provider divide. Surely what would happen is that the merged district health authorities and family health services authorities would act as a purchaser for the whole range of primary and secondary services within the area of their responsibility. They would contract and enter into contracts with NHS hospital trusts, with community health trusts, ambulance service trusts and possibly even with complete district health trusts in the case which we have already discussed where all the services of a district health authority acquire trust status. That is a possibility which the Government have not put out of court.

I accept that that may be a pattern of development which lies some way in the future. However, so far as I can see it would be ruled out by subsection (6) which this amendment seeks to delete. If the subsection remains in the Bill, it will be necessary to bring forward new primary legislation to enable the developments which I have described. On those grounds it seems a pity not to use the opportunity which we have in the Bill before us to allow—and it is no more than that—for the possibility which I have described and to save future legislative time. That would accord with the flexible spirit of the Bill which has a number of enabling and permissive rather than mandatory provisions. The amendment is intended to be nothing but helpful. I beg to move.

Lord Ennals

My Lords, I support the amendment. I have sought to ask myself two questions. First, why is the subsection in the Bill at all? I find it difficult to discover what would be lost—and this is the second question—by the Government if the subsection were to be deleted. There is no question of principle here. I have no doubt—unless she intends to accept the amendment—that the Minister will be able to explain why the subsection must remain in the Bill.

Ever since the last reorganisation of the National Health Service when the noble Lord, Lord Jenkin of Roding, was Secretary of State, I thought—and indeed, I thought it before then—that it would be basically a good thing if the family practitioner services, as they then were, were brought together with district health authorities. That always seemed to me to be desirable; namely, that that was one of the layers of the health authority which we could do without. I recognise the special role that those services fulfil but it is a role, I believe, that could be met within the scope of a district health authority.

I have not sought to raise that argument. We have enough arguments regarding provisions already in the Bill, without making other controversial suggestions for the further reorganisation of the health service. I accept the argument of the noble Lord, Lord Kilmarnock, that we ought not to create circumstances which make it virtually impossible by legislative means to stop the coming together of FHSAs and district health authorities. It is in that simple way that I support the amendment.

Lord Henley

My Lords, The noble Lord suggests that we remove Clause 2(6) so as to make merger between FPCs (FHSAs as they will be) and DHAs possible. Subjection (6) does not rule out merger; it does not make it impossible. But it would need primary legislation. Subsection (6) does not prevent it, if the noble Lord follows my argument.

The noble Lord, Lord Ennals, rightly asks what subsection (6) does. FPCs, or FHSAs as they will become, are already excluded from the term "health authority" by Section 128 of the National Health Service Act 1977 as amended by the Health and Social Security Act 1984. That is because the term "health authority" is used in that Act to differentiate between FPCs and other types of authority such as the district and the regional authorities. The distinction is needed, for example, in defining authorities which may make staff and facilities available to local authorities covered by Section 26, or in defining doctors who work in hospitals as opposed to those who provide general medical services under Section 105.

The provision in the present Bill seeks to make that absolutely clear to avoid any confusion over the new title, family health services authorities, which contains both the word "health" and the word "authority". It does not seek to diminish the role of FHSAs which will be health authorities in all but name.

Lord Ennals

My Lords, if the noble Lord will permit me to interrupt, why, if we are trying to say that it is not an authority, have we consciously put in the word "authority"? It was a family practitioner service: in this legislation it is called a family health services authority. Having done that, a small clause is needed which says, "Of course we are calling it 'authority', but no one must think it is an authority". Why are we doing that? It does not make sense.

Lord Henley

My Lords, we shall have to ask another place. That provision was in response to amendments put forward in another place. I do not think they were government amendments. Although it is called a family health services authority, it is not an "authority" as defined by the principal Act.

Returning to the question of mergers, the noble Lord, Lord Kilmarnock, is correct that Working for Patients floated the idea of mergers between larger districts and their corresponding FPCs. However, that was very much a possibility for the longer term. We made it clear that the Bill should not be regarded as an opportunity for wholesale structural change. Both DHAs and FPCs, or FHSAs as they will become, have very full agendas implementing the three White Papers. It is too early to say whether or not the principle of merger would be the right step. That is why Working for Patients signalled merger as a long-term possibility. We would need to allow the districts and FHSAs to adjust to their new roles and to allow our reforms to bed down. As I said earlier, primary legislation would be needed.

4.45 p.m.

Baroness Seear

My Lords, before the noble Lord sits down, will he reconsider the wording? If your Lordships' House is confused by the title, family health services authorities, and is expected to understand that that means that it is not an authority, then I suggest that the public are likely to be equally if not more confused.

We have a chance to clear up the matter and so avoid a complete nonsense: that "authority" does not mean an authority. There are many other words that could be used. It does not have to be "authority". Perhaps the noble Lord, before Third Reading, will consider finding a term which does not need that extraordinary explanation. "Words mean what I want them to mean" as Humpty Dumpty said, but "authority" does not mean "authority".

Lord Henley

My Lords, I am sure that everybody will not be confused because I have explained to the House that the FHSAs are not health authorities as defined. The amendment in the name of the noble Lord, Lord Kilmarnock, will make matters even less clear.

Lord Peston

My Lords, perhaps I could interrupt the noble Lord.

Lord Henley

My Lords, it is Report stage, but I will give way.

Lord Peston

My Lords, it is Report stage. I thought I was allowed to ask a question. Indeed, I know that I am because I consulted the Clerks, who told me that I am allowed to ask a question, with all respect to the noble Lord.

The noble Lord drew our attention to Section 128 of the principal Act. That section defines a health authority. If it helps, I shall read it out: 'Health Authority' means a Regional or Area Health Authority or a special health authority". In other words, subsection (6) is not needed because it does not say that it means anything else. It says exactly what it means very clearly. Therefore, the noble Lord, Lord Kilmarnock, is entirely correct that this particular subsection is not needed. The principal Act makes the matter as clear as it is possible to make it.

Lord Henley

My Lords, it does not make it clear. The FPCs have been renamed "authorities" and we felt that it was important to make it doubly clear to avoid any confusion over the new title. To remove subsection (6) would create further confusion and leave the matter open to doubt, which I am sure is not the intention of the noble Lord.

The noble Lord's principal purpose in moving the amendment is to facilitate merger between FHSAs and DHAs. As I explained, subsection (6) is no bar to that. It would need primary legislation. That idea was floated in the White Paper and in time it is something to come back to, but not in this Bill.

Baroness Seear

My Lords, with the leave of the House, the noble Lord was in the process of answering my question when he was abruptly interrupted by the noble Lord, Lord Peston. I should like an answer as to whether it is possible at the third stage for the noble Lord to consider clearing up what undoubtedly is a confusion in the use of this term. There are many other words that he could introduce to convey the idea that he wants to convey. Why pick on the one word "authority" which is calculated to confuse?

Lord Henley

My Lords, of course we will look at it. It was something which emerged at Committee stage in another place. I cannot remember the name of the predecessor to FHSAs, after FPCs. Perhaps—dare one ask?—another place may have got it slightly wrong. We will be prepared to look at an alternative to "authority" if the noble Baroness or any noble Lord can come forward with an alternative. I leave the matter there.

Lord Winstanley

My Lords, the previous body was the family practitioner committee and its predecessor was the executive council. There are two alternatives—"council" or "committee" in place of "authority".

Lord Kilmarnock

My Lords, this has been an interesting discussion on the question "When is an authority not an authority?" The noble Lord, Lord Henley, is correct in saying that my principal objective was to pave the way—in the not too distant future—for the amalgamation of district health authorities with family health services authorities. He assures me that subsection (6) will not prevent that, but that primary legislation will be required.

I must accept his assurance. However, in the course of the debate, a certain amount of confusion has emerged. I am not sure that it was entirely satisfied by the technical explanation for the necessity of the term given by the noble Lord, Lord Henley. I was glad to hear him say that he will look at the matter.

The noble Lord, Lord Winstanley, made two suggestions; perhaps I could make another. We had a family practitioner committee; why can we not have a family health services committee? That would surely allay the confusion that has arisen in this short debate. Before I decide what to do with the amendment I hope the noble Lord will inform me that he will make representations to his right honourable friend and explain that this House is extremely confused regarding the subsection. We may not be the only people confused by it in the future. If he will give that undertaking I shall be happy to withdraw the amendment.

Lord Henley

My Lords, I certainly give the undertaking that I shall put to my right honourable friend the confusion in which this House found itself. I am sure that the House is no longer confused, because I have explained what the form is. But I promised to take this away and possibly we can come forward with a better title. They have already had a couple of attempts in another place but, as I said earlier, perhaps we can do better.

Lord Kilmarnock

My Lords, perhaps encouraged by us they may do better next time. With that assurance, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Schedule 1 [Health Authorities and Family Health Services Authorities]:

Baroness Young moved Amendment No. 4: Page 69, line 18, at end insert: ("(a) at least one of the persons appointed under sub-paragraph (1)(b) above must hold a post in a university with a medical or dental school; and (b) ").

The noble Baroness said: My Lords, I beg to move Amendment No. 4 and will speak at the same time to Amendments Nos. 6, 9, 11 and 14. In this group of amendments we return to the important issue of the role of the universities in the decision-making machinery of regional and district health authorities. I have re-read the report of our debate in Committee on 19th April, and on that occasion your Lordships emphasised the key role—in a sense, the unique role—which the universities play in undergraduate and postgraduate education and training, and their contribution to clinical research.

Your Lordships recognised how closely these two strands are interwoven. It is crucial that in planning and delivering their respective contributions to the National Health Service, the universities and health authorities should closely reflect each other's role. Otherwise, neither will operate to proper effect and the loser will be the patient.

I know that my noble friend the Minister accepts these points. Indeed she emphasised in this House in Committee the importance of collaboration and joint working, and some important steps have already been taken by the Government to underpin the relationship between the universities and the health service, not least in promulgating the 10 principles of effective collaboration drawn up by the steering group chaired by the Permanent Secretary at the Department of Health. This is an initiative which I warmly welcome.

Our debate in April revealed that the differences between us are narrow. The Government have said that they will make regulations under powers already included in the Bill, to ensure that all the district health authorities which have an important teaching involvement will include someone drawn from a university. They have also said that they expect that regional health authorities will often include someone appointed on a similar basis. Our differences boil down to what, if anything, should be included on the face of the Bill.

I appreciate that the Bill sets out a framework for the membership of the various authorities, which it is proposed to flesh out in regulations and, on the whole, I think that that is right. Things do change and it would be too inflexible for detailed membership of all authorities to be laid down. I also agree that we should avoid representative appointment, so as not to detract from the key management role which the new authorities will be expected to play.

But the role of the universities is different and, as I said earlier, unique. The universities are central to the proper management and future development of the National Health Service and, as I said at an earlier stage, they bring money to the table. Their contribution to the decision-making process is so vital that I am convinced that special provision needs to be made to safeguard this in primary legislation. The Government have recognised this in the case of the NHS trusts which have a significant teaching commitment, and, logically, I believe this must be extended to regions and districts.

These amendments bridge the gap between what the Government have already said and what many noble Lords who spoke with great conviction at Committee and Second Reading also believe. There is a requirement in them for each regional health authority to include someone from a university with a medical school, and for those districts, which will be listed in regulations—that is, the teaching districts—also to have at least one university member.

Perhaps I may also say that I was extremely grateful to receive a very helpful letter from an official of the department of my noble friend the Minister, in which he made the very important point that, in the case of the district health authorities, they would be drawn from a relevant university.

The amendments fit into the regulatory framework which the Government favour to keep options open for the future—for example, the definition of the teaching districts—and they consciously avoid any representative implication. But they enshrine the basic commitment to university membership, which I know will be valued by the academic community and which I regard as essential to the proper functioning, and the best functioning, of the NHS. I very much hope, therefore, that my noble friend the Minister will be able to accept these amendments. I commend them to the House.

Baroness Cox moved as an amendment to Amendment No. 4, Amendment No. 5: Line 4, leave out ("and (b)") and insert: ("(b) at least one of the persons appointed under sub-paragraph (l)(b) above must hold a post in a polytechnic or other institute of Higher Education; and (c)").

The noble Baroness said: My Lords, in moving Amendment No. 5 as an amendment to Amendment No. 4, and in speaking to Amendment No. 12 as an amendment to Amendment No. 11, I must emphasise that I am not in any way disagreeing with my noble friend's amendment. In case any noble Lord feels that I am not following the formal procedure, may I say that I believe I am and that the suggested listing in the groupings is not correct? I believe the procedure is that one speaks to an amendment to an amendment at the appropriate stage. I have just checked the form.

The Earl of Longford

My Lords, may I ask a question? I wonder whether somebody in authority—it must be the Minister, because I cannot see anybody else—can give us guidance. The Clerk cannot address us, so I must ask the Minister to tell us, with all the available wisdom of the Clerk, what is going on.

Baroness Hooper

My Lords, as I understand it, an amendment to an amendment must be taken in this order. I regret to say that this was not apparently taken into account when we were preparing the groupings, so it catches some of us on the hop.

Lord Peston

My Lords, on a matter of order, it is not just a question of catching us on the hop, because it will very much complicate questions of voting and decision-making generally. If I may be as blunt as I possibly can, I am extremely concerned that the amendment to which the noble Baroness, Lady Young, has spoken will be accepted, on the grounds, as I understand it, that it may be acceptable to the Government. I have no knowledge, although I hope that it is the case, whether the amendment to which the noble Baroness, Lady Cox, is about to speak will also be acceptable to the Government. But if this amendment is dealt with earlier than the other amendment, we shall find ourselves in some difficulty about dividing the House. I am wondering whether any enlightenment can be thrown on any of those matters.

Baroness Hooper

My Lords, perhaps I can help by saying that it is the Government's intention to accept the amendments tabled by my noble friend Lady Young and the noble Lord, Lord Dainton. Perhaps on that basis it will be helpful to continue in now discussing the amendment to the amendment.

Lord Peston

My Lords, this may well be out of order, but I should like to ask a question. Were it to happen that Amendment No. 5 of the noble Baroness, Lady Cox, was passed, is there any information that we can be given about what the Government view as the consequences of that, because we should then be debating the amended version of Amendment No. 4?

Baroness Cox

My Lords, as my noble friend looks slightly uncertain, may I say that I am not in the least unhappy about proceeding in the way which I believe to be the formal procedure of the House?—that an amendment to an amendment is taken. I am not sure that it is proper to proceed in any other way. I am sorry that it has caught noble Lords on the hop. It caught me on the hop when I saw the suggested groupings, because I thought that they might lead to some confusion. However, I hope that it will not affect consideration of the amendment of my noble friend Lady Young, and that other noble Lords who have put their names to it, because I do not think the amendments are incompatible.

I was just going to say that, in moving this amendment to the amendment in the name of my noble friend Lady Young and her other co-sponsors, I do not think I was in any way detracting from or disagreeing with my noble friend's amendment. It would be wonderful if my noble friend the Minister could accept our amendment as well, but I am pleased to hear that she will accept the amendment in the name of my noble friend. Do I have the agreement of the House that I may proceed on that basis?

As I appear to have your Lordships agreement, perhaps I may reiterate my point, which may not have been taken on board in the ensuing confusion about the order of the amendments. In moving Amendment No. 5, and in speaking to Amendment No. 12 as an amendment to Amendment No. 11, I am not in any way disagreeing with or trying to detract from Amendment No. 4. However, my colleagues and I felt it was important to raise what we deemed to be a related issue.

In so doing I am sadly aware that I speak on behalf of that sector of higher education which does not enjoy representation in your Lordships' House of the same size and stature as those who so powerfully and eloquently represent the universities. I suspect that I am the only member of your Lordships' House on these Benches who chose to study and later to teach at a polytechnic rather than at a university. I did so for a variety of reasons. I therefore feel a deep commitment to the non-university sector of higher education and to what at its best it has achieved. I must also declare an interest as a governor of Dorset Institute, which makes a significant contribution to the education of health care professionals.

During the passage of the Education Reform Bill the Government gave a number of pledges to evenhandedness in future treatment of polytechnics and universities. We now have funding bodies with broadly similar rules, regulations and constitutions. Therefore I believe that the position with regard to the relationship with the National Health Service is one in which this evenhandedness should also apply.

The universities train doctors and dentists and a very small proportion of other health professionals, including some nurses. But the polytechnics and other higher education colleges train the vast majority of paramedical staff—nurses, physiotherapists and a range of other health service professionals. Those staff greatly outnumber doctors and dentists and are quite as important to the future of the National Health Service as their medical counterparts in terms of the provision of high quality, safe care. There is also substantial investment in many polytechnics into joint research with National Health Service hospitals and with other institutions. Therefore, the only basis for training sufficient National Health Service personnel at appropriate levels must be close co-operation between both universities and polytechnics together with National Health Service policy-making bodies.

Obviously, medical and dental manpower and their research investment in universities are very important, but so too are the other professions necessary for the delivery of health care. It is estimated that in 1990 there will be more than 16,800 students on relevant courses in non-university colleges and the number will increase quite dramatically in the next few years as Project 2000 for nurse education gathers momentum. If my right honourable friend the Secretary of State is to maintain, and be seen to maintain, any degree of the promised evenhandedness with regard to institutions of higher education, and if he is to take seriously the planning of health services and their manpower requirements, it will be important for this amendment to be considered sympathetically. I very much hope therefore that my noble friend the Minister will do precisely that. I beg to move.

5 p.m.

Lord Dainton

My Lords, what the noble Baroness, Lady Cox, has just said has an obvious, instant and rather sympathetic appeal to us all. However, I should like to point out that there is a fundamental difference between the amendments proposed by the noble Baroness, Lady Young, and that which the noble Baroness, Lady Cox, has moved. Within the operation of the health service some of the premises are owned, many of them are equipped and many of the staff who are there are paid for by the universities. Reciprocally, it is the case that what is done within the universities affects the health service. It is therefore of the greatest importance that the university voice should somehow be heard at the decision-making table of the health authorities. In the same way the health authorities should have a voice at the highest level of the universities. However, the latter is not the issue before us today.

This is a fundamental difference which involves resources of all kinds. As the noble Baroness, Lady Young, said in an earlier debate, money is brought to the table. It is also brought to the table from other departments—from the Department of Education and Science via the Universities Funding Council, which spends a very great deal. Around 20 per cent, of total university resources is spent on medical education though only about 8 per cent, of the students are future doctors and dentists. It is also the case that the Medical Research Council, also funded by the Department of Education and Science, counts on certain facilities being available which can be provided only by health authorities. To that extent the universities are acting as surrogates for that department in those two activities of education and research, and are spending money on which the health authorities themselves count for their official running. I leave aside the question of the care of patients because that is a matter of common interest which involves nurses and paramedicals. I hope that I have made that distinction quite clear.

Lord Walton of Detchant

My Lords, while I support the points made by the noble Lord, Lord Dainton, perhaps I may say that I sympathise with the intentions underlying the amendment to the amendment. But having said that, and while I acknowledge the enormous contribution to the health care of the nation now being made by those trained in the polytechnics and other institutions of higher education, including not only nurses and physiotherapists but many of the other people working in the caring professions, the difference to which the noble Lord, Lord Dainton, has referred is crucial and fundamental.

I hope very much that in choosing the non-executive directors of health authorities, the Secretary of State, and in the case of district authorities, the regional health authority, will take account of the contributions, to which the noble Baroness, Lady Cox, has referred, which are made to the health care of the nation by those educated in those institutions. Therefore I trust that some individuals who are employed by those institutions will be chosen as members of health authorities. But the fundamental difference relating to the close inter-relationship between the universities and the hospitals of the NHS is such, as was so clearly put by the noble Lord, Lord Dainton, as to make their representation—forgive me, I must not use that word—their voice being heard in the health authorities much less fundamental than in the case made out so clearly by the noble Baroness, Lady Young, in relation to the university voice. I therefore, with reluctance, oppose the amendment to the amendment.

Lord Peston

My Lords, I rise with a great deal of sadness, especially after the intervention of the noble Lord, Lord Walton of Detchant. I was concerned about our procedure, which I entirely accept is standard procedure, because I did not want to make the speech that I am about to make about the role of the universities and conduct an argument between the universities and the polytechnics. But I shall now have to make it.

I say outright that I support Amendment No. 4. I have no problem with that at all. I simply hoped to make a short speech on Amendment No. 4, have that accepted and then move on to Amendment No. 5. It now appears that Amendment No. 5 in my name and in the name of the noble Baroness, Lady Cox, is much more serious than I had appreciated.

Perhaps I may refer your Lordships to the Education Reform Bill and reiterate the point made by the noble Baroness, Lady Cox. The noble Baroness, Lady Hooper, dealt with the Bill for the Government and I dealt with it for this side of the House. We were told that the Government were fully committed to treating universities and the polytechnics evenhandedly. The Government were not able to say much at that time about money—money is always a problem—but in terms of how they would approach the polytechnics the Government left us in no doubt of their view; and it was a view accepted fully by this side of the House.

Perhaps I may also say in regard to the Education Reform Bill that many people outside the House said to me that our proceedings showed yet again how the universities, and particularly the friends of the universities in your Lordships' House, manipulated the procedures so that they get their way, while no one else had that kind of leverage. To that I say, no, because in your Lordships' House we always discuss all matters on their merits and there is no question of leverage or anything of that kind which arises.

Nonetheless, in hearing the two interventions made by the noble Lords, Lord Dainton and Lord Walton, whom I normally support on pretty well everything, I see again the same phenomenon at work. I hark back, first of all, to the speech made by the noble Baroness, Lady Young, which carried the correct intellectual weight. She referred to the role of the universities in undergraduate and postgraduate education and training. She referred to their contribution to research and the collaboration between the educators, the trainers and those who acted.

Quite rightly, she also said that it was not a question of a representative but viewing the matter in terms of who could be helped. My argument is very clear. It carries over mutatis mutandis entirely to the polytechnics. They too train and educate large numbers of people. They train almost all the paramedics including the nurses, physiotherapists and occupational therapists. They also have considerable responsibility for pharmacists. The polytechnics also carry out research. It is not sufficiently appreciated how much research is going on in the polytechnic world. A great deal more would take place if the polytechnics were treated even-handedly when it comes to access to the research councils.

There can be no doubt whatever that the logic of this kind of amendment cannot be allowed to revolve around the argument of resources. That is a preposterous argument, though I will throw it into the balance in order to get the amendment through. However, that argument cannot carry any intellectual weight.

Lord Walton of Detchant

My Lords, perhaps I may intervene by raising one small point. In this connection I classify universities which do not have medical or dental schools in exactly the same way as the polytechnics and other institutions of higher education. It is because the universities with medical and dental schools bring money, facilities and premises to the table that I took the view that I did. I hope that that point is clarified.

Lord Peston

My Lords, I understand the point but I do not see the logic of it at all. We are here discussing due consideration for the appropriate membership of the regional health authority. Desirable though it is to bring money to the table, it cannot possibly bear the weight of the argument that we are discussing. We are discussing something deeper in terms of public policy. The polytechnics engage in this kind of education and training and no one doubts the importance of their contribution. The universities also engage in it. I have to underline the fact that I am not trying undermine Amendment No. 4 in any sense whatever. I am simply saying that the logic attached to Amendment No. 4 carries over to Amendment No. 5.

Finally, I echo the remarks that I made earlier. I have spent all my life as a university teacher. A great deal of my public service has been involved with the Council for National Academic Awards and with its economics committee, of which I was the first chairman. As I argued when we were discussing the Education Reform Bill, one of the great triumphs of higher education in this country is our success in the polytechnics. As we move forward I am always concerned to emphasise that that triumph must be reinforced. It is an area where I hope that the Government will accept what they have already said; namely, that the polytechnics must be treated in an even-handed way. I wait to hear what my good friend the noble Baroness, Lady Cox, says about this amendment. I press this amendment very strongly and ask at least for the Government to go away and think about it again.

5.15 p.m.

Lord Winstanley

My Lords, I shall try not to muddy the water still further. I am a fervent supporter of the polytechnics and that must be so because I have a son and a daughter who are lecturers in polytechnics. While they do a great deal of important work in the training of various people who work in the National Health Service, it is not my understanding of the nature of the polytechnics that any polytechnic actually has wards in which there are patients, whereas there are many universities or medical schools which have wards full of patients. They are doing National Health Service work.

Academic clinical staff employed by the universities are crucial National Health Service workers. There is a difference there and I hope that it can be understood. If I am a little bit uneasy about the noble Baroness's amendment to the amendment, it is on those grounds. It is absolutely essential that the amendment tabled by the noble Baroness, Lady Young, is carried. I have talked to the medical schools and I do not know of a single one—nor any university—in which people will not be desperately unhappy if the amendment of the noble Baroness, Lady Young, is not accepted. I accept that the polytechnics have to be properly looked after, but I ask noble Lords to accept that they are in a slightly different position because they do not treat patients. They train people who treat patients, whereas universities and medical schools actually treat and care for patients, and that is the difference.

Baroness Young

My Lords, I am bound to say—

The Earl of Longford

My Lords, is the noble Baroness winding up or is she going to speak again?

Baroness Young

My Lords, I am speaking to Amendment No. 5 with—if I may say so to my noble friend Lady Cox—considerable unhappiness at the way the discussion has gone on it. I am second to none in my admiration for the work done by the polytechnics. Though I cannot in any way equal the experience of my noble friend in a polytechnic perhaps I can show my credentials by saying that I was once a governor of a polytechnic though I am not now because other things have come into my life.

I believe that polytechnics have an immensely important role to play in our national life. It is different from that of universities but equally important. That is why I supported wholeheartedly all the proposals in the Education Reform Act which indicated the even-handedness to which my noble friend and the noble Lord, Lord Peston, referred. That is very important. I do not believe that there is anyone in your Lordships' House who does not accept that to be the case. There is, however, a difference in this particular set of amendments between my amendment, supported by the noble Lords, Lord Dainton, Lord Walton and Lord Adrian, and the amendment of my noble friend Lady Cox.

I said in my speech that there was one immediate distinction in that the universities bring money to the table. I said that at Committee stage and I repeated it today. It is about £240 million, which is not very much in the context of the National Health Service. However, as the noble Lord, Lord Dainton, quite properly said, it is a very large sum of money if it is taken from the total amount of money in university funds. There is a very real link between the universities and the Department of Education and Science on this particular matter.

Unlike the noble Lords, Lord Dainton, Lord Walton and Lord Adrian, I cannot speak from personal experience of medical research. However, I know enough about hospitals to appreciate these very important links. I know that professors of medicine actually have patients in hospital. As the noble Lord, Lord Winstanley, has quite properly said, they have patients whom they are treating. There is an interaction which is unique in our experience.

Therefore, I hope very much that my noble friend Lady Cox will not press her amendment. I believe that the Government will say that the relationship with the universities is a particular one and that it is different from other relationships. It would affect my amendment very much were my noble friend's amendment to be carried.

I wish to conclude my remarks by saying that what I have said is not meant in any way to denigrate the work of the polytechnics nor to pursue the argument that somehow the medical profession has such a sway over your Lordships' House that doctors have only to speak and we all fall at their feet. We are very fortunate in your Lordships' House in having the benefit of so many people with medical experience.

I really do not believe that Members of your Lordships' House are so unable to think for themselves that they are continuously swayed by one group of people on all issues. The situation is quite the contrary. I believe that the noble Earl, Lord Longford, will speak after me and I know of his great interest in polytechnics. Were we to have a debate on that aspect of the matter it would carry everyone's support.

In my view there are two great distinctions in the matter. I am delighted that my noble friend the Minister said that she would accept the amendment standing in my name and those of my noble friends. It would be most unfortunate if Amendment No. 5 were to be pressed. I think that it would alter the character of my amendment. Moreover, I could not be so sure that it would carry. I believe that my amendments are very important and I hope that my noble friend Lady Cox will not press her amendment.

Baroness Seear

My Lords, I am very confused by these most interesting statements about universities and polytechnics in relation to these amendments. I should like to ask one question merely for clarification. It seems to me that the distinction which is being made is not really a distinction between universities and polytechnics—if it were I would be entirely on the side of the noble Lord, Lord Peston, in saying that no such distinction should be made. Surely it is a distinction between institutions of higher education with a medical or dental school and institutions of higher education without a medical or dental school. That is the distinction which is being made.

It may well be that we ought to have included not only a medical or dental school but also a nursing school or some other school involving the paramedicals. However, that is not mentioned in the amendment so we cannot vote on the matter. It would help me a great deal if I could be told that that is the aspect about which we are talking—that they should be represented because they have these medical, dental or (and this is not in the amendment) other training schools and not because they are either universities or polytechnics. I should be very glad to receive some clarification on that point.

The Earl of Longford

My Lords, I rise to express my support for the amendment moved by the noble Baroness, Lady Cox. Both she and my noble friend Lord Peston put forward the argument more effectively than I could have done. On the whole, they speak with far more authority on the matter. However, I have but one claim to put to the House. I opened the first debate on polytechnics which took place last year and I have spoken twice on the subject this year. I know that the noble Baroness, Lady Young, will say that no one wishes to denigrate the polytechnics. However, no one over the past 45 years since I have been here has wanted to denigrate them; but no one has mentioned them in any serious sense.

The polytechnics have been treated—and this was generally accepted in the debate which I opened last year—as second-class citizens. That is the position in which they have found themselves. I am afraid that all the goodwill directed towards them in the abstract will not convince anyone concerned with them that they are receiving a fair deal.

We have heard many utterances and the noble Lord, Lord Peston, said that the Government stated that the polytechnics would be treated on an equal footing. There may be distinctions which have been drawn between the universities and the polytechnics, but I would say that this is a test case. However, a test case will not be the end of the story because I am sure that many other such cases will arise. I hope that in the next few years polytechnics, which, after all, educate more than half of those in higher education, will be treated much better than they have been in the past. But I am afraid that protestations of general goodwill without any actual support in practice cut no ice with me and I think that they would cut none whatever with anyone who loves polytechnics.

Baroness Hooper

My Lords, in the course of this short debate we have perhaps strayed slightly from the essential point. Nevertheless, I should like to preface my remarks by saying that the Government are fully aware of the essential part played by polytechnics and other institutions of higher education in the education and training of staff serving in many areas of the National Health Service. There can be no doubt of the parity of esteem in which the polytechnics are held as establishments of higher learning. I stress that point because in finding that I must reject the thinking behind this amendment, I wish to underline the gratitude we all owe to those whose work is to train the staff of the National Health Service.

As the noble Lord, Lord Walton, said, there will be nothing to prevent postholders at polytechnics and institutes of higher education from being appointed to health authorities. However, those appointments would be made on the basis of personal qualities. It would be for each authority to decide which knowledge and skills it needs among its membership. We do not wish to be prescriptive, as we have maintained consistently, nor do we wish the newly-streamlined boards to increase in size. It is important that the best person for the job is found in every case and that is not achieved by legal constraint.

I turn now to deal with the question of the difference in the position with regard to universities. This has been explained by many noble Lords who have pertinent personal experience. The special relationship between those universities which have a medical and dental school—as the noble Baroness, Lady Seear, pointed out, and which is the description in the amendment previously moved by my noble friend Lady Young—exists because of the situation mentioned by the noble Lord, Lord Winstanley; namely, that as a result of having that medical or dental school, they also have clinical academics who are directly involved in the provision of health care to National Health Service patients. I believe that that is an essential difference between the two groups of amendments. I hope that that difference can be accepted and that, on that basis, my noble friend will feel able to withdraw her amendment.

Baroness Cox

My Lords, I regret the confusion which arose at the outset of the debate. However, that confusion was not of my making. I hope that it has not detracted from the presentation of the arguments. I am most grateful for the arguments which have been put forward by noble Lords, and for the fact that there has been at least some support for the spirit of the two amendments standing in my name and that of the noble Lord, Lord Peston.

I still believe that there is an important point of principle involved in this matter. I am grateful for the point which was made regarding clarification. I refer to the remarks of the noble Baroness, Lady Seear, when she suggested that perhaps we were talking about those areas which contain institutions of higher education relating to the training of paramedical professionals. Indeed, I think that that was the spirit of our amendment and I shall take that point on board when thinking where we should take the matter from here.

Along with the noble Lord, Lord Peston, I believe that there are still many parallels which exist between both sectors of higher education regarding the institutes concerned in these amendments in terms of the size and the contributions of education and training, and, to a lesser extent—although to a significant extent—in terms of research. I accept that there is not a comparable input of resources. However, that is only one among a constellation of principles which were involved in trying to ensure that there was representation from the non-university sector of higher education in these important policy-making bodies relating to health.

I believe that the Government should be applying this principle of even-handedness in respect of the two sectors of higher education. To that extent, although I know that my noble friend the Minister voiced the sentiment, I am disappointed in the substance of her reply. I believe that it will send negative vibes through the non-university sector because it is still a symptom of an invidious and increasingly unwarranted distinction.

As I said at the beginning of the debate, I am happy to support the amendment moved by my noble friend Lady Young. I have no wish in any way to jeopardise that amendment. I am sorry that my noble friend thought that our amendment might do so. I am a realist and, therefore, I have no wish to jeopardise my noble friend's amendment.

I realise that until the reality of a parity of esteem reflected inter alia in representation in your Lordships' House and elsewhere—I recognise that that is not the only criterion—is recognised and achieved, the amendment as it currently stands is probably not the most appropriate one to put forward. I may wish to reserve judgment and consider whether an amendment which takes account of training establishments and their contribution to health authorities would be more appropriate on Third Reading. In the meantime, I do not believe that it would be a good use of your Lordships' time to press the amendment and I therefore beg leave to withdraw it.

Amendment No. 5, as an amendment to Amendment No. 4, by leave, withdrawn.

Amendment No. 4 agreed to.

5.30 p.m.

Baroness Young moved Amendment No. 6: Page 69, line 19, after ("the") insert ("other").

The noble Baroness said: My Lords I wish to place on record my thanks to my noble friend Lady Hooper and my right honourable friend the Secretary of State for the immense amount of help that they have given with the amendment, and also my thanks to the many officials in my noble friend's department who have been so helpful. I beg to move.

On Question, amendment agreed to.

Lord Ennals moved Amendment No. 7: Page 69, line 21, at end insert: ("( ) Without prejudice to the generality of the preceding sub-paragraph at least one person appointed under sub-paragraph (l)(b) above shall be a person with special knowledge of the needs of disabled persons and in selecting any such person regard shall be had to the desirability of the person with that knowledge being a disabled person.").

The noble Lord said: My Lords, with the leave of the House I shall speak also to Amendments Nos. 10, 15, 17 and 19. All the amendments deal with the role of disabled people. It may be argued that the principle behind the amendment is in conflict with Amendment No. 1 which we debated earlier and which of course was defeated. I submit that that is not so. There is no question with this amendment of giving any organisation or group the right to appoint onto health authorities or family health service authorities a person who is either disabled or has knowledge of disabled people. My argument is that there is at present an in-built prejudice against appointing disabled people to public posts. That applies not just to the health service, as it is now, but to many other public positions. We are dealing with the health service.

The thought, too often, is that disabled people are excellent people but that they could not cope. When we look at the role played in the health service and your Lordships' House by the noble Baronesses, Lady Masham, Lady Darcy (de Knayth) and Lady MacLeod, and many others who are not necessarily wheelchair borne, we see that they are living proof to the contrary. They can cope.

As I said in the debate which took place on 19th April, we are now better informed about the extent of disability as a result of the publication of the OPCS survey which discloses that there are more than 6 million disabled people in this country. The problem of disability, and the need to shape the health service to meet the challenges, is greater than we recognised it to be before the OPCS study. It is a community care problem and it is also an NHS problem, because an increasing proportion of the people using NHS facilities are disabled. Many of them are of course elderly. The majority of disabled people are elderly.

We are dealing with a growing proportion of those served by the NHS. Furthermore, as people continue to live longer, the proportion of disabled people increases. I drew attention to another point in our debate on 19th April; namely, that for many people illness or accident is a temporary break in a pattern of good health, but for disabled people their disability is something with which they live; and it is extremely important that we ensure that all levels of health authorities are conscious of the needs of disabled people. They should shape policies so that the health service meets the needs of disabled people.

At present disabled people are not served as well as they should be by the National Health Service. We have the unfortunate situation that significant parts of the Disabled Persons (Services, Consultation and Representation) Act 1986, which refers to the representation of disabled people—the amendment is in line with that Act—have not been implemented. I hope that your Lordships feel that the provision would be helpful. When replying to the debate on 19th April the Minister said: People from all groups would prefer to be judged on equal terms on their merits rather than be appointed on some sort of quota system".—[Official Report, 19/4/90; col. 209.]

The amendment does not suggest a quota system nor, as I said at the beginning, does it suggest that any organisation for disabled people should have the prescriptive right to make appointments. The amendment suggests: Without prejudice to the generality of the preceding sub-paragraph at least one person appointed … shall be a person with special knowledge of the needs of disabled persons and in selecting any such person regard shall be had to the desirability of the person with that knowledge being a disabled person".

I hope that the House will agree with the amendment. I am afraid that it is true, as I have said, that there is a prejudice against appointing disabled people. When that is the position, we sometimes have to have a little bias in the other direction. I call it a nudge towards recognising the needs of disabled people and perhaps towards involving them to an increasing extent. It is a bit of positive discrimination. I hope that your Lordships will give your support to it. I beg to move.

Baroness Masham of Ilton

My Lords, on behalf of disabled people I should like to thank the noble Lord, Lord Ennals for bringing up this matter. I have served on a regional health authority for some years. I hope that I did not serve on it because I was a disabled person. I should want to serve on it because of my interest in all health needs, whatever they may be.

On the other hand, I have found some amazing problems. A few months ago I went to the opening of a multi-million pound hospital. I was greeted and asked whether I should like to try out the lavatories. A special lavatory had been built on each floor for someone in a wheelchair, but one was unable to shut the door. The building had been skimped. I took regional officers to show them. I do not believe that they had ever done anything as lowly as going into a lavatory for disabled people. They were interested. The district blamed the region and the region blamed the Department of Health. No one owned up to having done anything wrong, but of course a great deal of money had been wasted.

The department should get its act together and pass down to regions and districts the necessity of having proper building regulations to cope with the needs of disabled people. It is useful to have people on the authorities who know about the needs of disabled people. Their knowledge needs to be wide because there are so many disabilities. It comes back to the need to have not just business and professional people on health authorities but people who understand and care about the many and varied needs of individuals and, in particular, of patients, many of whom will be elderly disabled.

Baroness Carnegy of Lour

My Lords, I am sure that the noble Baroness is right. It is crucial that at each level there should be far more awareness than there now is of the detailed as well as the general needs of disabled people. She made an important remark when she said that she was not on the authority because she was a disabled person. We all know about it and we also know that she is a very experienced person who would not consider that it was her job simply to speak up for disabled people all the time on the authority.

The noble Lord, Lord Ennals, understands and feels these matters deeply, he puts this subject before us assidously on many Bills. He is quite right to do so. With respect to him, however, it is not the best way to appoint somebody disabled to represent disabled people. I know that the noble Lord did not imply that, but that is what is likely to happen. If one is the statutory disabled person, one is inclined to feel that that is one's role. There is the wrong kind of watchdog operation, that person probably does not even notice the problems mentioned by the noble Baroness, Lady Masham. I hope that more than one person on an authority would understand disabled people, although they would not all be disabled, of course. However, the amendment is not the right way to deal with the problem. The noble Lord is right to put it before us, to remind us, but I hope that he will not press it.

Lord Ennals

My Lords, before the noble Baroness sits down, will she tell me what is the right way to do it? The problem is that, unless one gives a nudge and a reminder at the time when people are appointed, then too often what we want does not happen. If we took a poll of members of health authorities and asked how many of them—not necessarily those who are themselves disabled; I have tried to cover the matter both ways—were experienced in the needs of the disabled, we might find that the number is small. We must find a way of putting matters right when something is wrong. If the noble Baroness had not simply said that my method was wrong but had then suggested another method, that might have helped. However, in the absence of another method, this at least is one way of dealing with it.

Baroness Carnegy of Lour

My Lords, I thought I had suggested that it was extremely important when appointments were made to be quite sure that there were on the authorities people who understood, and probably more than one such person. There may be a number who understood. As the noble Lord says, this is a growing part of the task in the health service. I do not know what my noble friend has to say on this,—she may have an answer, but I do not feel that this amendment is it.

Baroness Hooper

My Lords, we recognise that the needs of disabled people account for a significant and increasing demand on health service provision. I quite agree with the general point and your Lordships know that the Government place a high priority on services to the disabled.

There will be nothing to stop disabled people from being appointed. As we have established with the example given by the noble Baroness, Lady Masham, some people already play a full role in the work of some health authorities. I believe, and I repeat what was reinforced by the noble Baroness, that people would prefer to be judged on equal terms on the basis of their own merits.

I also recognise that these amendments go further than simply requesting that disabled people should be represented on the boards. As regards putting people with experience of the needs of the disabled on boards, again many health authorities and FPC members currently have, perhaps not direct personal experience of disability, but experience through relatives, friends or neighbours. We find that those who do not have that personal experience make it their business to see that they are informed about the special needs and problems of disabled people. For example, they visit units that serve them and study the advice of professionals in the field. This will be just as important for members of the reformed health authorities and FHSAs as it is now. I take on board the example quoted by the noble Baroness, Lady Masham.

Against this background and given our firm intention that people should be appointed to health authorities and FHSAs for their personal qualities and not to represent interest groups of any kind, I believe that the approach suggested in these amendments is not the best way forward. I hope that the noble Lord, Lord Ennals, will therefore see fit to withdraw the amendment.

Perhaps I ought to make the point that in terms of guidance and encouragement and in every other way in relation to appointments being made, we shall of course encourage the widest possible—again I hesitate to use the word "representation"—spread of people on the boards.

Lord Ennals

My Lords, I am afraid I am not satisfied. Of course I am always grateful to the noble Baroness. The first point I wish to make is that if someone on the board is either disabled or conversant with the needs and interests of disabled people, those are not that person's only interests. The noble Baroness, Lady Masham, is the best example; we have already heard the noble Baroness, Lady Camegy, say that she is on the health board not because she is disabled but because she brings a vital element to it.

We now have far smaller health authority boards of approximately 11 members. Unless the provision is written upon the face of the Bill it is very likely that we shall find a group of 11 people none of whom has a particular knowledge of or interest in the needs of the disabled. This is a paramount interest in the health service, as the noble Baroness said. She told us that there was far more awareness and many more demands on the health service by disabled people. She underlined that there was nothing to stop disabled people being appointed. There is nothing in the Bill to stop Mandy Rice-Davies being appointed to a health service board or Bobby Robson or Charlie Farnesbarnes or anyone.

Nothing in the Bill says that anyone should not be appointed. However, I wish to ensure that disabled people or those who have experience of the disabled are appointed. In one way or another I personally have been involved in the field of disability, year after year, decade after decade. I have too often heard people say that it is not appropriate, and, because it is not appropriate, what we want does not happen. I suppose that that is why parts of the 1986 Act have still not been implemented. Of course I shall divide the House on the issue.

5.47 p.m.

On Question, Whether the said amendment (No. 7) shall be agreed to?

Their Lordships divided: Contents, 70; Not-Contents, 114.

DIVISION NO. 3
CONTENTS
Addington, L.	Kilmarnock, L.
Airedale, L.	Lawrence, L.
Aylestone, L.	Listowel, E.
Birk, B.	Llewelyn-Davies of Hastoe, B.
Blackstone, B.
Bonham-Carter, L.	Lloyd of Kilgerran, L.
Boston of Faversham, L.	Longford, E.
Bottomley, L.	Lovell-Davis, L.
Bruce of Donington, L.	McFarlane of Llandaff, B.
Campbell of Eskan, L.	Masham of Ilton, B.
Carter, L. [Teller.]	Mayhew, L.
Cledwyn of Penrhos, L.	Milner of Leeds, L.
Clifford of Chudleigh, L.	Molloy, L.
Clinton-Davis, L.	Morris of Castle Morris, L.
Darcy (de Knayth), B.	Nicol, B.
David, B.	Oram, L.
Donaldson of Kingsbridge, L.	Peston, L.
Dormand of Easington, L.	Phillips, B.
Ennals, L.	Pitt of Hampstead, L.
Ewart-Biggs, B.	Rea, L.
Ezra, L.	Robson of Kiddington, B.
Falkender, B.	Rochester, L.
Gallacher, L.	Russell, E.
Galpern, L.	Seear, B.
Graham of Edmonton, L. [Teller.]	Serota, B.
	Shackleton, L.
Hanworth, V.	Stoddart of Swindon, L.
Hatch of Lusby, L.	Tordoff, L.
Henderson of Brompton, L.	Turner of Camden, B.
Houghton of Sowerby, L.	Wallace of Coslany, L.
Jacques, L.	Warnock, B.
Jay, L.	White, B.
Jeger, B.	Williams of Elvel, L.
Jenkins of Putney, L.	Willis, L.
John-Mackie, L.	Winstanley, L.
Kilbracken, L.	Winterbottom, L.
NOT-CONTENTS
Aldington, L.	Brabazon of Tara, L.
Alexander of Tunis, E.	Bridgeman, V.
Allenby of Megiddo, V.	Brougham and Vaux, L.
Arran, E.	Burton, L.
Ashbourne, L.	Butterworth, L.
Auckland, L.	Caithness, E.
Belhaven and Stenton, L.	Campbell of Alloway, L.
Beloff, L.	Campbell of Croy, L.
Belstead, L.	Carnegy of Lour, B.
Bessborough, E.	Carnock, L.
Blatch, B.	Carr of Hadley, L.
Boardman, L.	Cavendish of Furness, L.
Bolton, L.	Coleraine, L.
Boyd-Carpenter, L.	Colnbrook, L.

Colwyn, L.	Monckton of Brenchley, V.
Constantine of Stanmore, L.	Monteagle of Brandon, L.
Craigavon, V.	Morris, L.
Crook, L.	Mottistone, L.
Cumberlege, B.	Mountevans, L.
Davidson, V. [Teller.]	Munster, E.
Denman, L.	Murton of Lindisfarne, L.
Derwent, L.	Napier and Ettrick, L.
Eden of Winton, L.	Nelson, E.
Elles, B.	Norfolk, D.
Elliot of Harwood, B.	Norrie, L.
Elliott of Morpeth, L.	Nugent of Guildford, L.
Erne, E.	Orkney, E.
Faithfull, B.	Oxfuird, V.
Ferrers, E.	Pender, L.
Fraser of Carmyllie, L.	Pennock, L.
Fraser of Kilmorack, L.	Peyton of Yeovil, L.
Gisborough, L.	Quinton, L.
Grimthorpe, L.	Reay, L.
Haig, E.	Renwick, L.
Hailsham of Saint	Richardson, L.
Marylebone, L.	Romney, E.
Halsbury, E.	Rootes, L.
Harlech, L.	St. John of Fawsley, L.
Henley, L.	Saltoun of Abernethy, Ly.
Hesketh, L.	Somers, L.
Hives, L.	Strange, B.
Hooper, B.	Strathcona and Mount Royal, L.
Howe, E.
Hunter of Newington, L.	Strathmore and Kinghorne, E.
Hylton-Foster, B.
Jenkin of Roding, L.	Sudeley, L.
Killearn, L.	Thomas of Gwydir, L.
Kitchener, E.	Thomas of Swynnerton, L.
Layton, L.	Trumpington, B.
Limerick, E.	Ullswater, V.
Lindsey and Abingdon, E.	Vaux of Harrowden, L.
Long, V. [Teller.]	Wade of Chorlton, L.
Lyell, L.	Walton of Detchant, L.
McColl of Dulwich, L.	Whitelaw, V.
Macleod of Borve, B.	Wise, L.
Malmesbury, E.	Wolfson, L.
Mancroft, L.	Wynford, L.
Merrivale, L.	Young, B.
Mersey, V.

Resolved in the negative, and amendment disagreed to accordingly.

5.55 p.m.

Lord Peston moved Amendment No. 8: Page 69, line 21, at end insert: ("( ) No person who is a member of a Regional Health Authority shall own shares in or be otherwise involved with the private medical sector. () A register of Regional Health Authority members' interests shall be established in which members will declare their business interests. This register shall be open to public scrutiny.").

The noble Lord said: My Lords, in moving this amendment I wish to speak also to Amendments Nos. 13, 16, 18 and 20 which are all logically connected and make much the same point. Noble Lords will recall that this amendment was brought before us in Committee. I do not wish to take up a lot of the time of your Lordships in going over all the ground again. However, when we debated these amendments fairly late at night in Committee I asked the Minister whether she would reflect on the issues involved. I pointed out in particular that I felt this matter involved the question of standards in public life. I do not know whether the Minister has reflected on this matter but I certainly have. The more I look at the matter, the more concern I have.

In Committee the Minister made a number of important points. She emphasised that there are already safeguards in any event. She referred us to the safeguards in connection with matters such as conflicts of interest. As I said at the time, I was obliged for the light that the noble Baroness threw on those matters. However, I come back to this matter, albeit briefly, to make sure noble Lords appreciate the nature of the change in the National Health Service that will result from the Bill.

My noble friend Lord Ennals often refers to language, but this is not just a matter of language. The Bill brings in more than the language of markets; it brings in, as it were, the methods of markets. The Bill is about competition and contracts. The Bill hopes to ensure that services which are provided at least cost or for a given cost are the best services that can be provided. There can be no doubt that some of the competition we have in mind is competition between what we would call, to put it simply, the public and private sectors. However, in terms of the public sector, as it were, some of the relevant inputs will concern competition between parts of the private sector.

There can be no doubt whatever that, whether we are discussing regional health authorities, district health authorities or family health services authorities—we know the latter are not health authorities, despite their name—we must bear in mind the need for openness and the need for the avoidance of conflict of interest and all the related matters. I return to this theme not because I wish to divide your Lordships' House on the matter but simply to remind your Lordships of its importance and to see whether the Government have had any further thoughts on it.

It may well be that my next point was implicit in what the noble Baroness said to me in her answer on a previous occasion. I understand from a statement that the noble Baroness made that the term "guidance" represents a strong form of action on the part of the Secretary of State. Will the remarks she made about taking possible conflicts of interest and possible pecuniary interests into account be covered by the guidance that the Secretary of State issues? I speak as someone who is not an expert on these matters. For all I know, such guidance may already exist. I raise this matter simply in the hope of hearing a little more from the noble Baroness. If she is unable to give me all the answers to my questions now, I am always content to have that information sent to me later. I beg to move.

Baroness Hooper

My Lords, your Lordships are already familiar with the Government's intention to leave health authorities and the new FHSAs as free as possible from membership restrictions. The suggested exclusion potentially could deprive the National Health Service of the benefits of much valuable experience. As my right honourable friend made clear in another place, and as I explained in Committee, health authority appointments will not be made where it is clear that there will be a substantial conflict of interest in relation to the authority. Those decisions can only be made by looking at individual cases. It would not necessarily be helpful to impose such a sweeping restriction as the one proposed here.

Lord Peston

My Lords, perhaps I may interrupt the noble Baroness, and also apologise to her for not having looked fully at my notes when making my own speech. On the last occasion she made the point that she has just made. I found what she said extremely encouraging. However, I meant to ask her this time how the people making the appointments will obtain that information. Will it become a standard procedure to ask anyone who is likely to be appointed to declare their interests so that they can be ruled out if they have the wrong interests? How will the Minister or whoever else is involved obtain the relevant information? I am sorry to have to come back to that point.

Baroness Hooper

My Lords, there will be the normal ways of finding out. A major conflict of interest may be apparent from the CV of the candidate. Obviously that kind of background information will be the norm. Otherwise, in terms of interviewing techniques it will be one of the questions that will be asked. It is our intention that the matter should be included in the guidance that will be issued in respect of these appointments.

I was going on to say that we have reflected on this issue and many others since the Committee stage. I cannot add anything to what I said in Committee with respect to the various safeguards that exist in terms of regulations requiring a chairman or a member to declare pecuniary interests. If anyone believes that a chairman or a member of a particular board might not declare a pecuniary interest which should be declared, whatever their motives might be, such a member would be just as likely to fail to declare his interests on a register. Therefore, I do not believe that there is a loophole there.

The matter will be dealt with in regulations rather than in guidance. I hope that on that basis the noble Lord will feel able to withdraw his amendment.

Lord Peston

My Lords, I thank the noble Baroness. She has thrown a little more light on the issue although, as always, having thrown some light on it she has raised another matter which leaves me again confused. I seem to go backwards every time I go forwards. Did I understand her to say that the matter would be dealt with by regulations and not by guidance? I did not think that it was a question of either regulations or guidance. I thought that one could have both regulations and guidance. Is the noble Baroness saying that it will not be included in guidance but it will be in regulations, or that it will be in regulations and may also be in guidance?

Baroness Hooper

My Lords, there will be new membership regulations that will be supplemented by guidance when necessary.

Lord Peston

My Lords, I thank the noble Baroness very much for that answer. Although I should obviously prefer my amendments to be on the face of the Bill, I find hers a good second best. I therefore beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Young moved Amendment No. 9: Page 69, line 35, at end insert ("but subject to sub-paragraph (3) below").

On Question, amendment agreed to.

[Amendment No. 10 not moved.]

Baroness Young moved Amendment No. 11: Page 69, line 38, at end insert: ("(3) In the case of a prescribed authority, at least one of the persons appointed under sub-paragraph (l)(b) above must hold a post in a university with a medical or dental school.").

[Amendment No. 12, as an amendment to Amendment No. 11, not moved.]

On Question, Amendment No. 11 agreed to.

[Amendment No. 13 not moved.]

Baroness Young moved Amendment No. 14: Page 70, line 1, leave out from beginning to ("in") in line 2 and insert: ("Sub-paragraphs (2) and (3) of paragraph 2 above apply in relation to sub-paragraph (1) above as they apply").

On Question, amendment agreed to.

[Amendments Nos. 15 to 20 not moved.]

Lord Rea moved Amendment No. 21: Page 71, line 10, at end insert: ("8A. At the end of sub-paragraph (1A) there shall be inserted— 1AA. Regulations or directions under sub-paragraph (1) above shall provide that the employment of staff by Health Authorities or NHS Trusts in the House Officer and the Senior House Officer grades shall be on terms which provide that—

1. (a) junior hospital doctors shall not be required, after 1st January 1993, to work or be available for work for more than 72 hours in any one working week, averaged over a one-month period, and
2. (b) the Secretary of State may by order from 1st January 1991 reduce the working hours specified in subsection (a) above in stages to 72 hours, and
3. (c) subsection (a) above shall not apply in the event of a state of emergency proclaimed by Her Majesty under section 1(1) of the Emergency Powers Act 1920, or a major accident procedure or its equivalent being put into operation, and
4. (d) on the application of a Health Authority or NHS Trust, the Secretary of State may by order make modifications or adaptations of subsections (a) or (b) above for individual cases in exceptional circumstances.").

The noble Lord said: My Lords, once again I wish to present to the House a matter which is fast becoming a hardy perennial—namely, the matter of junior hospital doctors' hours. The wording of Amendment No. 21 is very similar to the wording of the Private Member's Bill which your Lordships' House passed in all its stages last year. In speaking to Amendment No. 21, I should like to speak also to Amendment No. 68, which applies to the position of junior hospital doctors working in independent hospital trusts, where I should like the same regulations to apply.

The Government acknowledge that it is their aim that junior hospital doctors should not be required to be available for work for more than 72 hours, which is also the aim of the junior doctors in the Hospital Junior Staffs Committee of the BMA. However, at present they have not even achieved across the country a one-in-three rota, which in effect works out at at least 83 hours working or being available for work. Very often, however, with a one-in-three rota more than the contracted number of approximately 83 hours are worked. For example, on the evenings when a junior hospital doctor can go home, he or she usually is not able to do so promptly at 5.30 or 6 o'clock as should be the case. Frequently, as responsible professionals they are busy finishing off numerous tasks until 7, 8 or 9 o'clock in the evening, often after they have had an exhausting night on duty the previous night. As I mentioned at the Committee Stage, Dr. Robin Dowie, in her very careful survey in 1988—which, incidentally, was commissioned by the Department of Health—found that 90 hours working or on call was the average.

It must not be thought that being on call is an easy part of the job. More often than not, in normally busy specialties, 5 or 6 hours or less are available for sleep during a night on call. That sleep is often interrupted by several calls to deal with emergencies in which that junior doctor may have to make life or death decisions. That sleep-deprived doctor then usually has to do a full day's work before being able to rest. That will be the case even if the universal one-in-three rota which the Government are trying to achieve is achieved.

That is not good enough. A person running a family enterprise for profit—for example, a retail business or a restaurant—can work as long as he or she likes. A mistake is unlikely to result in loss of life, but that is not the case with health care, particularly health care being provided in a public enterprise, the National Health Service. Other occupations where lives are at risk from the possible mistakes of operatives—for instance, those involving public service vehicles, heavy road transport vehicles and airlines—have strict rules to prevent over-fatigue. But the National Health Service does not.

If the amendment is adopted, it will give the Government two and a half years to make the necessary changes in hospital working arrangements. It is the expressed wish of the Hospital Junior Staffs Committee of the BMA to press for legislation because of the slow progress of other measures. As a realist, I should like to tell the noble Baroness that I would be prepared to put back the date if that would help the legislation to reach the statute book.

The noble Baroness will no doubt tell us that to increase the number of junior hospital doctors in order to decrease their hours would put out of balance the ratio of junior doctors to consultants so that many junior hospital doctors would not have a career post to look forward to. However, several studies have shown that, to achieve 72 hours, only a small increase in the number of junior hospital doctors is required. The reduction in hours can largely be achieved by a rearrangement of current rota systems, by levels of cover and by bringing in from outside hospital general practitioners as assistants to help run out-patient clinics for which many of them are well trained, often having recently worked in the same hospital.

In the longer term, the balance between the different halves of the profession can be achieved by creating considerably more consultant posts than is proposed in the White Paper Working for Patients. That would greatly improve the efficiency of the National Health Service as well as enabling hours to come down to an eventual level of 60 hours per week which is the long-term aim of those working for a fair deal for this overworked group on whom the National Health Service depends. I beg to move.

Lord Pitt of Hampstead

My Lords, I support the amendment and I hope that the Government will accept it. I know that they are thinking along the lines that we proposed. I know from statements made by the Minister, Mrs. Bottomley, that she is sympathetic and is working towards trying to create exactly what we want. The amendment will strengthen her hand. I should therefore like included in the Bill this requirement regarding the hours worked by junior hospital doctors. That would strengthen the Minister's hand and accelerate the solution to the problem. I hope that when the Minister replies she will take that point on board. I believe that both sides of the House are in agreement about the principle, if not the approach. A little flexibility on the Government's part will enable us to achieve that aim. I hope to hear a little flexibility from the Minister.

6.15 p.m.

Viscount Hanworth

My Lords, I cannot accept the argument that increasing the number of junior staff need necessarily spoil the pyramid of promotion. It seems to me that, with a little more expense, you also increase the number of consultants. As it takes three months to see a consultant in certain cases, I should have thought that that was a good thing to do anyway. Having listened to the last debate on this subject, I remain unconvinced that consultants should not pull their weight more and take a certain amount of pressure off the junior doctors which, if it was done cleverly, would surely help to improve the situation.

Lord Boyd-Carpenter

My Lords, the amendment deals with an issue about which people in many parts of the House and the country are concerned. There is no doubt that in some hospitals the hours worked by junior doctors are unfair to them and perhaps even more unfair to their patients.

Whether legislation is the right answer is perhaps a more difficult question. Having been trained as a lawyer, my instinct is not to legislate unless it is shown to be absolutely necessary. The trouble with legislation is that you tie yourself down and often discover that you have imposed limitations which you did not intend. I therefore hope that my noble friend the Minister will be able to say something hopeful on the merits of the matter. I shall be interested to hear her view as to whether it is a matter which is best legislated upon or best dealt with as the result of competent direction of the service. I rather like the idea posed by the noble Viscount, Lord Hanworth, that some relief could be given by making senior consultants take over some of the work. In one or two hospitals that I have seen, that would be fair comment; it would do no harm to anyone. Indeed, it would do the patients quite a lot of good.

I hope that my noble friend will give a sympathetic reply on the merits of the issue. I am sure that she is aware that there is public concern and that the Government are expected to give a lead. Whether by legislation, by administration or by other means is a matter which she is much more competent to decide than I am. I ask her to reply sympathetically and to tell us what the Government intend to do.

Lord Richardson

My Lords, having been trained as a doctor, I have an instinctive dislike of the thought of any control through regulation or legislation of a doctor's duties towards his patients. For the most part, young doctors are extremely keen—they certainly should be—to learn and to work with patients during the early years of their training. They stay on duty because that is their wish. They follow the cases through because they know that that is how life will have to be for them, and they know that that is how they should carry on their affairs.

However, I agree that excessive hours can lead to exhaustion. In a long life, I cannot say that I have ever come across a single instance of a young house officer having made a serious mistake through exhaustion. It may well have happened in the case of consultants. I am therefore strongly in favour of urging the Government to make every effort to reduce the hours worked by most of these young people. However, I would be totally opposed to any imposition upon them to cut down their times so as to meet a schedule and thus interfere with their absolute right to care for their patients and to acquire experience in the early days of their careers, just as the rest of us felt it our right for the rest of our lives.

Lord Auckland

My Lords, anyone who has close family and friends working therapeutically within the health service is clearly very concerned about the implications of the amendment. I seem to recall that the problem of junior doctors' working hours has been continuing for some years. It is not a new matter. Similarly, those of us who do not work therapeutically in the health service are equally bothered about how the situation will be resolved. My noble friend Lord Boyd-Carpenter put his finger on the problem.

There is also the question of the geographical location of the hospital. A teaching hospital may well have sufficient junior doctors. I speak advisedly, and if I am talking through my hat I shall no doubt be told so. But I am thinking more of the district hospitals. For example, in Surrey I am president of the League of Friends in a very busy hospital. There are several others in the area near the M.25 motorway. I know that the amendment makes provision for emergencies, but it is difficult to lay down a certain number of hours.

Noble Lords may have watched a television series a year or two ago about two hospitals in Portsmouth. One was old and one relatively new. This problem was very much to the fore, as I recall. On the other hand, I suspect that that very interesting television series "Casualty" may rather overdo the situation. Again I speak advisedly.

The noble Lord, Lord Rea, has made a very convincing case. Whether or not 72 hours is the right number—semantics are always easy—I hope that the Minister will continue to give very serious thought as to how the problem can be resolved. I should have thought that 1993 was not an unreasonable year by which this problem could be largely resolved.

Lord Ennals

My Lords, first I congratulate my noble friend on his constancy. He brought a Private Member's Bill from another place which did not get further. He raised the issue at Committee stage and now at Report stage. He has raised it during Parliamentary Questions. There are certain issues where, unless one sees progress, it is important that they should be constantly raised in the House. It is not a party issue. The noble Lord, Lord Auckland, said that it is not a new issue. It is not. It was an issue when I was Secretary of State. It is an issue now.

I find it almost embarrassing to disagree with the noble Lord, Lord Richardson, for whom I have profound respect. I agree with what he and the noble Lord, Lord Boyd-Carpenter, said about the dedication of junior doctors. Because of their dedication and commitment they will never refuse to tend to the needs of patients to the best of their ability. I do not accept—if he meant it—that junior hospital doctors are quite happy to work the intolerable hours that some of them have to work. They are not happy to do so. They feel obliged to do so. They will not refuse to work them. They will not take industrial action. Sometimes they have demonstrated against such hours as they did at the time of my noble friend's Bill. But even if they accept them we should not accept that it is reasonable that young or old doctors (it makes little difference) should work until a time when their judgment is impaired and their alertness undermined. Whether or not 72 hours is the limit, like the noble Lord, Lord Auckland, I do not know. I agree with him that 1st January 1993 seems a reasonable time span to achieve an objective that the Government accept. If it is not achieved in 1993, let us suggest 1994. Those young doctors who are working themselves so hard in the interests of patients are entitled to know that at some stage there will be a limit on the number of hours that they work.

I do not believe that any other professional workers would stand for the requirement and expectation that we impose on those young doctors. There is no need for me to emphasise any further facts. They have been thrown at us. My noble friend has referred to them again. I hope that the Minister will be very sympathetic to the amendment. If someone says that legislation is not the right way to make such provision, I ask, "What is the right way?" It is another issue on which action must be taken. If action will be taken without legislation, that is fine.

If it is not to be taken without legislation, that is not fine. Legislation may be the way to achieve such provision.

Lord McColl of Dulwich

My Lords, I have great sympathy with the amendment, especially when I leave your Lordships' House at 1 a.m. and start work at the hospital at 7 a.m. By Thursday I add up the hours. They come to very nearly 70. I therefore have great sympathy with the amendment.

There is a number of problems involved in this issue. The problem is not the total number of hours in the week; it is the total number of hours on duty. During the middle of the week there is no problem provided that the rota worked is one in three. The problem comes at the weekends when quite naturally people want a long weekend off. In order to have a long weekend off they have to work more hours the previous weekend filling in for people who are having a long weekend off.

There is another difficulty. A committee is trying to reduce the number of junior staff over the country as a whole in order that they may have a reasonable chance of securing consultant posts. We have too many junior staff. I totally agree with that aim. The difficulty is that some districts may have 11, 20 or 30 hospitals. We need to close some of those hospitals and to concentrate the services in one, two, or even three, hospitals.

I know of one district health authority that had 11 hospitals in its domain of 25 square miles. Clearly it needed only two. But the problem arises when closing those hospitals. We need all the political parties to co-operate in helping us to do the right thing: that is, to have the right number of hospitals in each district without the great hullabaloo every time there is a suggestion about closing a hospital. We all need to work together to a common aim.

Baroness Hooper

My Lords, following our discussions earlier on similar amendments on junior doctors' hours, I had hoped that your Lordships would agree that talks recently begun by my right honourable friend the Minister for Health on this very important subject should be allowed to run their course and achieve the results that we all hope they will achieve. The Government have accepted that it is sensible to work towards a target of an average week of duty of 72 hours for all junior hospital doctors. The National Health Service trusts will also be expected to comply with Government policy on junior doctors' hours.

However, it would be irresponsible to agree to legislation or to similar changes in the conditions of service to limit junior doctors' hours without a clear and agreed view from all the parties as to how that can be achieved. By leaving many hospitals and wards without proper cover at night or at weekends, it could also be potentially damaging to patient care. I agree with my noble friend Lord Boyd-Carpenter. In our view there is no single solution to this longstanding issue. That is not to say that considerable progress has not been made.

It is worth referring again to the major initiative of June 1988. Regional reports indicate that by September of this year one in eight junior doctors will be on the one-in-three-rotas. That compares very favourably with the situation at the start of the initiatives when more than a quarter of junior doctors were estimated to be on rotas that were worse than one in three. Although there is still a long way to go that is an improvement on the problems identified in the Dowie Report referred to by the noble Lord, Lord Rea.

More needs to be done, but I agree with my noble friend Lord Boyd-Carpenter that passing a law will not solve the problem. We remain convinced that a concerted attack from all the parties, including the professions, is required. I agree that the profession has a major responsibility for organising the training of junior doctors, setting local rotas and so forth. For that reason my honourable friend the Minister for Health held a meeting on 10th April. As a result a working group was established representing all the interested parties: it will explore the key issues. The group will meet on Wednesday, 13th June. It deserves our support and encouragement. It should be given every opportunity to succeed.

I know that the noble Lord, Lord Rea, is anxious for rapid progress. I understand that. However, the problem has dogged the National Health Service since its inception. It has not as yet been solved because of its complexity and the parties concerned. Therefore, solutions will need careful consideration and, more importantly, the active support and commitment of all the parties including the consultants and the junior doctors. While we are extremely sympathetic to the aims and merits of the amendment I regret that I cannot accept it for the reasons that I have given and because we believe that substantial progress is being made.

6.30 p.m.

Lord Ennals

My Lords, the noble Baroness did not comment on paragraph (d) of the amendment. It recognises that there are certain circumstances in which one cannot prescribe 72 hours or any other number, and it offers flexibility. Secondly, all Members of the House will wish Mrs. Bottomley and her working party well. Would it not be useful if they had a target towards which they could work to have in place two-and-a-half years from now; namely the figure stated in the amendment which the Government have accepted as their target? I believe that that would encourage and help the working party. Does the Minister agree?

Baroness Hooper

My Lords, with the leave of the House, I believe that the working group should be given a fair chance to see what it can achieve. Any effort to put such a requirement into legislation would pre-empt that possibility.

Lord Rea

My Lords, we have had a useful little debate, answered, as usual, in a most charming manner by the Minister. My noble friend Lord Ennals raised two of the points that I had intended to put forward and did so effectively. The question of too many junior doctors and not enough consultants—that is the balance—was raised by the noble Viscount, Lord Hanworth, although it was the impression of other noble Lords that he was impersonating his noble friend Lord Addington whose name appears on the amendment. The question of the balance can be dealt with if proper thought is given to it. I wish to emphasise to noble Lords that, under special circumstances, paragraph (d) of the amendment allows any health authority to request permission not to adhere to the legislated 72 hours; for instance, in the case of an isolated hospital.

Legislation is necessary. The working party needs to have the additional stimulus of legislation in order to speed up its activities. The profession has often been blamed for failure to progress in this area. If legislation were on the statute book the profession might find a way to solve the problem. Therefore, I wish to divide the House.

6.36 p.m.

On Question, Whether the said amendment (No. 21) shall be agreed to?

^*Their Lordships divided: Contents, 49; Not-Contents, 87.

DIVISION NO. 4
CONTENTS
Addington, L.	Kilmarnock, L.
Airedale, L.	Listowel, E.
Birk, B.	Llewelyn-Davies of Hastoe, B.
Bonham-Carter, L.
Boston of Faversham, L.	Lloyd of Kilgerran, L.
Bruce of Donington, L.	Lovell-Davis, L.
Carter, L.	McNair, L.
Cledwyn of Penrhos, L.	Mayhew, L.
Clinton-Davis, L.	Molloy, L.
Dormand of Easington, L.	Monson, L.
Ennals, L.	Morris of Castle Morris, L
Ewart-Biggs, B.	Oram, L.
Ezra, L.	Peston, L.
Falkender, B.	Pitt of Hampstead, L.
Gallacher, L.	Rea, L. [Teller.]
Galpern, L.	Robson of Kiddington, B.
Graham of Edmonton, L. [Teller.]	Russell, E.
	Seear, B.
Hacking, L.	Serota, B.
Hanworth, V.	Stoddart of Swindon, L.
Hatch of Lusby, L.	Tordoff, L.
Jay, L.	Turner of Camden, B.
Jeger, B.	Wallace of Coslany, L.
Jenkins of Putney, L.	Williams of Elvel, L.
Kilbracken, L.	Willis, L.
NOT-CONTENTS
Aldington, L.	Clifford of Chudleigh, L.
Allenby of Megiddo, V.	Coleraine, L.
Arran, E.	Colnbrook, L.
Auckland, L.	Colwyn, L.
Beloff, L.	Constantine of Stanmore, L.
Belstead, L.	Crook, L.
Bessborough, E.	Cumberlege, B.
Blatch, B.	Davidson, V. [Teller.]
Boyd-Carpenter, L.	Eden of Winton, L.
Brabazon of Tara, L.	Elliot of Harwood, B.
Bridgeman, V.	Elliott of Morpeth, L.
Brougham and Vaux, L.	Erroll, E.
Burton, L.	Faithfull, B.
Caithness, E.	Ferrers, E.
Campbell of Alloway, L.	Fraser of Kilmorack, L.
Carnegy of Lour, B.	Hailsham of Saint Marylebone, L.
Carnock, L.
Carr of Hadley, L.	Harlech, L.
Cavendish of Furness, L.	Henley, L.
Clanwilliam, E.	Hesketh, L.

Hives, L.	Nugent of Guildford, L.
Hooper, B.	Oxfuird, V.
Howe, E.	Reay, L.
Hunter of Newington, L.	Richardson, L.
Hylton-Foster, B.	Romney, E.
Jenkin of Roding, L.	Saltoun of Abernethy, Ly.
Kinnoull, E.	Strange, B.
Kitchener, E.	Strathclyde, L.
Lawrence, L,	Strathcona and Mount
Lindsey and Abingdon, E.	Royal, L.
Long, V. [Teller.]	Strathmore and Kinghorne, E.
Lyell, L.
McColl of Dulwich, L.	Sudeley, L.
McFarlane of Llandaff, B.	Swinfen, L.
Macleod of Borve, B.	Thomas of Gwydir, L.
Mancroft, L.	Thurlow, L.
Merrivale, L.	Trumpington, B.
Mersey, V.	Ullswater, V.
Monckton of Brenchley, V.	Vaux of Harrowden, L.
Monteagle of Brandon, L.	Wade of Chorlton, L.
Morris, L.	Whitelaw, V.
Mottistone, L.	Wise, L.
Munster, E.	Wynford, L.
Murton of Lindisfarne, L.	Young, B.
Norfolk, D.

[^*The Tellers for the Contents reported 49 names, the Tellers for the Not-Contents 87 names. The Clerks recorded 48 and 86 names respectively.]

Resolved in the negative, and amendment disagreed to accordingly.

6.44 p.m.

Baroness Hooper moved Amendment No. 22: Page 71, line 15, leave out ("and") and insert: ("( ) after paragraph (c) there shall be inserted the following paragraph— (aa) the circumstances in which a member of an authority who is (or is to be regarded as) an officer of the authority may be suspended from performing his functions as a member"; and").

The noble Baroness said: My Lords, I speak also to Amendments Nos. 54 and 83. These amendments do not signify any change in Government policy. In page 105 of the Notes on Clauses we indicated it was our intention that if an officer (executive) member of an authority were suspended from his post of employment with the authority, he would automatically be suspended as a member. However as the Bill is currently framed it does not allow regulations to this effect to be made. A similar difficulty arises in relation to NHS trusts. These amendments will enable us to make such regulations. I beg to move.

On Question, amendment agreed to.

Schedule 5 [Health Boards, the Common Services Agency and State Hospitals]:

Baroness Blatch moved Amendments Nos. 23 to 26: Page 83, line 33, at end insert: ("2A. At the end of paragraph 5A of that Schedule there shall be added the words "and a direction under that paragraph may relate to a particular officer or servant or class of officer or servant specified in the direction"."). Page 84, line 9, at end insert: ("7C. Before making regulations under paragraph 7A or 8A, the Secretary of State shall consult such bodies and organisations as appear to him to be concerned. 3A. After paragraph 8 of that Schedule there shall be inserted the following paragraph— 8A. In connection with arrangements relating to community care services (within the meaning of section 5A(4) (local authority plans for community care services) of the Social Work (Scotland) Act 1968), regulations may make provision with respect to—

1. (a) the transfer to employment by a local authority of officers or servants employed by a Health Board; and
2. (b) the transfer to employment by a National Health Service body of officers and servants transferred to employment by a local authority by virtue of this paragraph,

and for the purpose of this paragraph "National Health Service body" means a Health Board, the Agency or an NHS trust."."). Page 84, line 37, at end insert: ("8A. After paragraph 8 of that Schedule there shall be inserted the following paragraphs— 8A. In connection with arrangements relating to community care services (within the meaning of section 5A(4) (local authority plans for community care services) of the Social Work (Scotland) Act 1968), regulations may make provisions with respect to—

1. (a) the transfer to employment by a local authority of officers or servants employed by the Agency; and
2. (b) the transfer to employment by a National Health Service body of officers and servants transferred to employment by a local authority by virtue of this paragraph,

and for the purposes of this paragraph "National Health Service body" means the Agency, a Health Board or an NHS trust. 8B. Before making regulations under paragraph 7B or 8A, the Secretary of State shall consult such bodies and organisations as appear to him to be concerned."."). Page 85, line 1, leave out ("and 7B") and insert ("to 7C and 8A").

The noble Baroness said: My Lords, in moving these amendments, I shall speak also to Amendments Nos. 97 and 207. The amendments do two things. First, they provide the Scottish equivalent of Clause 50 for England and Wales which allows the Secretary of State to make regulations about the transfer of health service staff to local authorities in Scotland, as a consequence of the transfer of patients from hospital into the community. The amendments fulfil an undertaking given in Committee in another place.

Secondly, the amendment to page 84, line 9, fulfils an undertaking given by my noble friend Lord Sanderson to the noble Lord, Lord Carmichael, during our debate in Committee. My noble friend promised that the Secretary of State would be put under a statutory duty to consult relevant bodies, before he made regulations about the transfer of staff within the health service. I beg to move Amendments Nos. 23 to 26 en bloc.

Lord Ennals

My Lords, we appreciate the extent to which the commitment made has been written into the Bill. I am grateful for that.

On Question, amendments agreed to.

Lord Hunter of Newington: moved Amendment No. 27: Before Clause 3, insert the following new clause: ("Standing Research and Development Advisory Committee .—(1) The Secretary of State shall by order constitute a Standing Research and Development Advisory Committee for the purpose of assisting him with his duties under the Act. (2) The Standing Research and Development Advisory Committee shall consist of the Director of Research and Development and eleven other persons appointed by the Secretary of State after consultation with the relevant industrial, scientific and medical research interests. (3) It shall be the duty of the Committee to advise the Secretary of State upon such matters as the Committee think fit and upon any questions referred to them by the Secretary of State.").

The noble Lord said: My Lords, on 25th April the Secretary of State, Kenneth Clarke, and the Permanent Secretary, Sir Christopher France, together with Mr. Jackson, the Minister responsible for higher education in the Department of Education and Science came to give evidence to the Select Committee on Science and Technology. The Government have spent some time studying the Select Committee's report on medical research with particular reference to the National Health Service. It had previously been indicated that they felt that there should be a chief of research and development.

The Secretary of State said to the Select Committee that it had been, decided to go for a Director of Research and Development making him a full member of the Management Executive—putting him in the middle of the NHS management".

He went on to say: I think I should make it clear that as far as the Health Service is concerned he will now be in a role which I think enhances his clout and credibility and puts him at the centre of decision-making, though obviously he has some activities that extend outside the Management Executive so far as the Department of Health's overall role of policy and strategy is concerned".

Mr. Clarke also said: I think we are setting up this Executive in order to have a clear management identity. They are part of my Department; nevertheless they are the people who are charged with the management reponsibility and what flows from it".

He also indicated that the proposed arrangements for the health service management executive would deliver that service in response to national priorities determined by the Government and, we will need his support necessarily in research and development in evolving our priorities".

Sir Christopher France indicated that the research management division of the department is at present some 4:5 strong and that an increase of one third was being considered. It was the intention that that increase should come from the National Health Service.

The Secretary of State stressed that one of the prime duties was to make sure that the Executive protects the position of clinical research in deciding its priorities, and also that the process of reform is conducted in such a way that clinical research is tested.

On Tuesday 15th May there was a press statement which announced that the Secretary of State had met representatives of the royal college and the profession's statutory bodies concerned with clinical standards. They agreed to the Government's proposal to set up a statutory multi-professional clinical standards advisory group. Its remit would be to advise and assist in the assessment and monitoring of clinical standards for all NHS patients in Great Britain, whether in a directly managed unit, a trust or the independent sector. I understand that the setting up of that group is welcomed by the royal colleges and statutory bodies.

I turn to the amendment and the proposal that there should be a standing research and development advisory committee. That proposal is based on the National Health Service Act 1977. It would have a substantially similar role to the Standing Medical Advisory Committee which has been so successful over the years. In obtaining the best possible advice over a wide range of research and development possibilities, such a committee is necessary. It is particularly important that it should advise the Secretary of State on such matters as it thinks fit, as the medical committee does, as well as questions referred to it by the Secretary of State. The membership should be wide in science, innovative industry, research and development, product development and other areas with perhaps a link to medical research and the chief medical officer's division of the department. I beg to move.

Lord Carr of Hadley

My Lords, I support Amendment No. 27 and its objective. I do not want to repeat the remarks made by the noble Lord, Lord Hunter, with which I agree. My personal objective in supporting the amendment is to ensure that the director of research and development—a new officer in the health service—and through him a new management board proposed in the National Health Service should have available to them information and advice on the widest possible basis in the field of research and development. I therefore pay particular attention to the importance of the words at the end of subsection (2) of the amendment which refers to, industrial, scientific and medical research interests". That means not only medical but also scientific and industrial research interests.

That is my purpose. Having said that, I confess that I normally have a natural disinclination to support the establishment of advisory committees. From my past ministerial experience in other areas I know that they can sometimes be a limiting rather than an expanding influence. If there is an official advisory committee, one may find oneself cut off from easy access to information and advice of a much wider basis. I only wish to have an advisory committee if it is a necessary means of achieving the objective which the noble Lord, Lord Hunter, stated and which I amplified from my point of view.

I cannot speak for the noble Lord, but whether I should wish to walk through the Division Lobby at the end of the debate depends to a large extent on what the Minister says in reply. I repeat that if I can be sure that the committee has been set up in a certain way and that the overt intentions behind the appointment of the new director of research and development are to make available to him and his management board the broad advice and information to which I refer, then I should rather it were done that way than through a form of advisory committee. Before I finally make up my mind therefore I shall wait to hear the Minister's comments; but I shall follow my noble friend whom I was delighted to support in tabling the amendment.

Lord Ennals

My Lords, perhaps I may point out that if there is no advisory committee, then there is nothing in the amendment. The amendment is concerned with establishing an advisory committee. If the noble Lord is doubtful as to whether there should be an advisory committee, he is not supporting the amendment.

Lord Carr of Hadley

My Lords, I am supporting the amendment, but I am doing that which I believe is traditional and common practice both in your Lordships' House and in another place: I am tabling a probing amendment. In the previous debates I have not heard enough to satisfy me that the input of advice in quantity and breadth through the director to the top management of the health service will be of the kind that I believe to be desirable. If I cannot be satisfied regarding that matter, then I shall vote for the amendment. If I can be satisfied in a way which I have not been satisfied before, I shall not wish to vote for the amendment because it will be unnecessary. That is not because I disapprove of it, but because the amendment will not be necessary. The objective might be achieved in other ways if the appointment is set up with the right terms of reference.

Lord Kilmarnock

My Lords, I put my name to this amendment on reading the evidence of the Secretary of State to the Select Committee on Science and Technology on 25th April, on which they issued a supplementary report. I was struck on reading Mr. Clarke's reply on page 6 of the supplementary report by the extremely wide range of responsibilities put on the director of research and development.

I am glad to say that he is to be a member of the management executive. That seems to me to be correct and is a step forward. He will also work to the Secretary of State, helping the Government on public health policy generally. He will also have a responsibility in the field of personal social services; he will have responsibility in the field of operation research vis-à-vis clinical research. The Secretary of State confirmed that he attached importance to operational research; the actual functioning of the National Health Service.

It is therefore an immensely broad remit which this very important person has. On page 9 the Secretary of State, speaking in the same terms as the noble Lord, Lord Carr of Hadley, said that no other director of the management executive is charged with the business of being advised by a set group appointed by other people outside. The Secretary of State went on to say that his own reaction was that he was not sure that it added to the director's clout and credibility, though it might be an additional resource. The Secretary of State therefore expressed a relatively open opinion on that point.

When we look at the amendment as drafted, we see that the director will not be advised by a set group appointed by people outside. He will be advised by a set group of people appointed by the Secretary of State after consultation with the relevant industrial, scientific and medical research interests. I should have thought that that went some considerable way to meeting the Secretary of State's point, and also to giving the director, with his wide field of responsibility, a necessary human resource to draw on. He will require financial resources, but it seems to me that given his remit he will also require human resources from the whole spectrum across the National Health Service.

Although I understand therefore what the noble Lord, Lord Carr, said, my inclination, on balance, is to come down in favour of the formula which appears in the amendment.

7 p.m.

Baroness Hooper

My Lords, I recognise the modifications made by the noble Lord, Lord Hunter, and his fellow proposers to similar amendments that we discussed at Committee stage. We agree that it is a good idea to have outside advice and that that advice should be broadly based to include the relevant industrial, scientific and medical research interests to which my noble friend Lord Carr referred.

We have already said in our White Paper response to your Lordships' Select Committee that the director of research and development will, as necessary, convene advisory groups on the development of the programme in specific areas. We also said that the director will wish to involve himself in the Medical Research Council, for example, and in scientific committees and advisory bodies. We expect the Director of Research and Development to consult widely and to maintain close contact with the research community.

Further powers already exist to create advisory arrangements. For example, the existing Standing Medical Advisory Committee and the Standing Nursing and Midwifery Advisory Committee have been created under the discretionary powers in Section 6(3) of the National Health Service Act 1977. Those committees, while discretionary, have remained in force since 1949. If the need is identified to have an advisory council, we can use these powers to appoint one. Such a standing committee would have a duty to advise the Secretary of State on research as it saw fit, as well as on request.

Perhaps I may also say to my noble friend Lord Carr in particular that a statutory committee may indeed become an encumbrance. It would have a very wide coverage, including primary and community health and hospital care, public health, health policy and possibly personal social services. This would imply a large, possibly inflexible, body. A better arrangement would be to target the work of particular groups on specific areas using relevant expertise in each case.

It would give a position to the Director of Research and Development in the work of the National Health Service Management Executive which is not enjoyed by any of the other directors. A fundamental difference like this could unbalance the work of the management executive by taking the director towards a national health research authority, which the Government have already rejected. The Government wanted as far as possible to integrate the processes of research with the management of the National Health Service.

Finally, we want to see the Director of Research and Development free, when he is appointed, to determine arrangements for advice and consultation. The noble Lord, Lord Dainton, recognised at the Select Committee hearing, to which my right honourable friend the Secretary of State gave evidence, that it was important not to be too prescriptive at the beginning and that the Director of Research and Development would need flexibility to establish his own arrangements. For these reasons, I find it difficult to accept this amendment and I hope that noble Lords will feel able to withdraw it.

Lord Hunter of Newington

My Lords, I thank the Minister for that reply which is very clear. It has clarified one or two points in my own mind. Particularly as this is a new venture, the views and advice of the new director should rightly be sought about future planning. He is already encouraged by the instruction, about which the Minister told us, regarding his future contacts and so on.

In the light of that, and in the light of the capacity existing quite easily for him to have this kind of thing if it is found to be necessary, and because the post is a very new venture and no one really knows how it will develop, I am inclined to withdraw the amendment.

I was concerned about only one point when the Minister was talking about the management board. He will be the only person with an advisory group, because there are discussions soon to be held by this House about the future of other aspects of the board as regards which other suggestions have been made. That is the only point that disturbs me. But on the basis of the first arguments—the newness of the post, the initiatives, the contacts that he is expected to have, his advice and the possibility of meeting his needs—I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Blatch

My Lords, I beg to move that further consideration on Report be now adjourned. In moving this Motion may I suggest that the Report stage begins again at eight o'clock.

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