COMMONS AMENDMENT (Hansard, 20 March 1997)

§ Baroness Cumberlege
My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 2. I shall speak also to Amendments Nos. 3 to 6, 20, 23, 28, 89 and 107.
The whole question of who should be permitted to provide services under the Bill featured prominently in our earlier discussions of the Bill. We have in fact, I believe, always been entirely at one over the objective of the Bill—to enable NHS primary care to be delivered to even higher standards across the country, as part of the NHS. Nonetheless, we listened carefully to the views put to us, both in this House and by the professions, about the possible threat of commercialisation, and we took prompt action to deal comprehensively with that threat.
The amendments now before your Lordships make it explicitly clear that only those whom we have called members of the NHS family will be able to put forward proposals for pilot schemes and make contracts with health authorities for the provision of services under the Bill. The list of those who comprise the NHS family ensures that key groups who work in the NHS—doctors, 1064 dentists, nurses, NHS trusts—are included, but puts beyond doubt the exclusion of commercial organisations from these possibilities.
One important feature of the new provisions is that it ensures that all professional groups encompassed by the definition of the NHS family are treated equally under the Bill. We will look at all proposals which meet the new rules we have set on their merits, regardless of the professional group they come from. However, we will expect all proposals to indicate clearly how they intend to secure the medical or dental involvement that all pilots and permanent arrangements will require.
There has been a lot of concern about the danger of commercialisation resulting from this Bill. This has always been at the periphery of what the Bill is really about. The changes made to the Bill in another place deal fully with those concerns, and I am glad to say that the British Medical Association has endorsed the changes we have made. But the changes also refocus attention on the main thrust of the Bill which is and always has been about new opportunities for the existing primary care workforce. We believe strongly that it is the NHS workforce, with its range of professional skills and expertise and its commitment to NHS principles that will develop NHS primary care and take it into the next century. That is what we want, and that is what these changes help to underpin.
Moved, That the House do agree with the Commons in their Amendment No.2.—(Baroness Cumberlege.)

§ Baroness Jay of Paddington
My Lords, this is the first of a substantive group of amendments which importantly affect the operation and principle of the Bill as it was first debated and considered in detail in your Lordships' House. We certainly do not intend to debate every one of the amendments and on these Benches we accept that the amended Bill as it stands, as it has come hack from the other place, will be a useful tool for an incoming Labour Government.
Nevertheless, at this stage, it is appropriate to repeat the general point which has been made several times in the past 72 hours in your Lordships' House. It would have been more appropriate to the functions of this House if the 117 Commons amendments that are now before us on this important Bill could have been considered in more detail and with less haste than will be possible this afternoon.
That applies particularly to this group of amendments, which goes to the heart of the Bill, and, as the Minister has just explained, it contains the provisions which the Government are now suggesting to deal with the problem of commercialisation which was threatened by the Bill as previously drafted. That was one of the major concerns which we on these Benches have been raising ever since the Second Reading of the Bill. Had the Government been able to accept or redraft some of the amendments which we on these Benches proposed at earlier stages, which dealt precisely with that issue, we should not have needed this rather breathless consideration this afternoon.
We know—and the noble Baroness has referred to it—that one of the important matters in relation to the Bill has been the intervention of the British Medical 1065 Association. We know too that the BMA has made firm representations to the Government that, had they not achieved the terms of the amendment which are now before your Lordships, it was prepared to campaign on this issue during the forthcoming general election campaign. As has been mentioned several times on many other pieces of legislation in your Lordships' House within the past two days, that has greatly focused the mind of the Government. As the noble Baroness said, the amendments now before us deal with the issue of commercialisation and limit those who can propose pilot schemes to those within the NHS family.
As the Minister knows, because she has been kind enough to discuss this with me, we still have doubts as to whether the new clause is sufficiently strong to exclude positively commercial companies. We should have preferred a new clause which made that more specific and explicit. This afternoon the noble Baroness has said that that is done in the terms of the present amendment. But she knows also that there are private companies—for example, Unichem, BUPA and PPP—all of which have been saying very recently and publicly that they regard their plans for proposed pilot schemes as being very much still alive and on the table. I hope that they have now heard the message that the Minister has given clearly.
Finally, I ask the Minister whether she is now able to underline that commitment to the exclusion of commercial companies by correcting her earlier statement when she said: We do not want to rule out any sensible opportunities, including a GP being employed by a commercial organisation."—[Official Report, 17/12/96; col. 1403.] If she were able to correct that statement, that would lay our fears to rest and make the exclusion of the private companies about which we have been concerned since Second Reading much more remote.

Lord Campbell of Croy
My Lords, I should just like to remind your Lordships of the sequence of events when this Bill came to this House and during its various stages before we parted with it and it went to another place.
During the first stages of the Bill, the BMA gave its general support to what was in the Bill. It was only two days before Third Reading, just before it was leaving us, that it issued a press release—and some of us received a document from the BMA—saying that it was very worried about the possible commercialisation which might result from the Bill. On Third Reading, my noble friend Lady Cumberlege was very sensible in saying that rather than move amendments, the matter should be sorted out in the other place. Therefore, I am glad to note that it has been sorted out in the other place and with the BMA behind the scenes.
On Third Reading, I said that I thought it was wise of the Government to suspend what they were doing until they had had an opportunity to discuss the matter with the BMA and that they had time in the other place 1066 to make other changes or pursue different policies. I am sure that it was right for the Government to work closely with the BMA, the profession.
Only today, I received a document from the BMA indicating that it now appears to be happy with the restrictions on what is called the NHS family. Bearing in mind the atmosphere when the Bill left us to go to the other place, I am glad that those matters now seem to have been sorted out and that these amendments are being put forward.

§ Baroness Robson of Kiddington
My Lords, on behalf of these Benches, I too welcome these amendments. This is much too late a stage to start even trying to play around because it is not possible to achieve anything. We may not have 100 per cent. of what we were asking for but it is a tremendous improvement on the Bill as it was drafted and we welcome that.

§ Baroness Cumberlege
My Lords, I thank noble Lords for their support for the principle of the Bill. I understand the point made by the noble Baroness, Lady Jay, as to how we managed to clarify, throughout the course of the Bill, some of the fears and misunderstandings which were originally apparent.
At one point during the course of the passage of the Bill, the noble Baroness was concerned about my use of the word "chatter"; that there was a good deal of chatter going on as regards commercialisation. I should like to assure your Lordships that no organisation has approached us to explain how it thinks it might be able to provide services under the new provisions in the Bill. Therefore, I am very happy to put clearly on the record exactly what the provisions mean. We have taken great care to rule in members of the NHS family and to define that and to rule out others. Now the only companies whose proposals may come forward to the Secretary of State and which may make contracts with health authorities to provide services under the Bill are those which fall within the definition of a qualifying body. We have defined a "qualifying body" very carefully; that is, a company which is limited by shares all of which are legally and beneficially owned by persons falling within paragraph (a), (b), (c) or (c) of subsection (2)". I believe that the situation is now crystal clear. As my noble friend Lord Campbell of Croy said, we believe that we have the support of all the health professionals, including the BMA, and they can rest happily that their initial fears have been resolved.
Moved, That the House do agree with the Commons in their Amendment No. 2.—(Baroness Cumberledge.)