Lords Sitting of 19 March 2001

Preamble
The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.
Prayers—Read by the Lord Bishop of Wakefield.

Millennium Dome: Sale
Baroness Noakes Baroness Noakes asked Her Majesty's Government:
What is the progress on the sale of the Millennium Dome.
The Minister of State, Cabinet Office (Lord Falconer of Thoroton): My Lords, we are currently conducting market testing prior to launching a new competition. Details of the timetable and process for that competition will be announced as soon as possible after market testing is complete.
Baroness Noakes: My Lords, I thank the noble and learned Lord for that reply. Can the noble and learned Lord clarify what he means by market testing being conducted "as soon as possible"? Perhaps I may also refer him to two Written Answers he has given; one around a month ago to the noble Baroness, Lady Gould of Potternewton, and one last week to myself. Both of those Answers stated that the process would be announced "shortly". Can he explain to the House what "shortly" and "as soon as possible" mean in Dome-speak?
Lord Falconer of Thoroton: My Lords, the process presently under way is that the Government have instructed professional experts to inquire of the market what would be the sensible course to take. Before we embark on another competitive process, it is right that we should be informed by the market's view. As soon as possible after that process has been completed, an announcement will be made.
Lord Barnett: My Lords, can I take it that my noble and learned friend has not ruled out the possibility of not selling the Dome at all if an inadequate response is received? Would it then be kept in public hands?
Lord Falconer of Thoroton: My Lords, the process currently under way will determine what the market wants. Once we know the details of that, we shall take the appropriate course and set up a competition.
Lord Crickhowell: My Lords, just over three-and-a-half months have now passed since the noble and learned Lord described the Legacy bid as "innovative" and " regenerative". At the time, Mr James told us that the total cost of the project was £834 million. Can the noble and learned Lord tell the House the total cost today, including the cost of attempted disposal?
Lord Falconer of Thoroton: My Lords, in addition to the costs that have been provided to the New Millennium Experience Company by the lottery, some £7 million have been spent on the competition. That needs to be added to the figure. Apart from that, no additional costs have been incurred.
Lord Elton: My Lords, in view of the cost of the Dome and of the careful regulation of expenditure on election costs, can the Minister tell the House how much will be left in the Labour Party kitty for election expenses after the Prime Minister's undertaking to use the Dome as the first paragraph of his election address?
Lord Falconer of Thoroton: My Lords, I did not quite understand that question; it meandered a little. However, as regards the suggestion that the Dome would form the first paragraph of the Labour Party manifesto, the only sighting of that comment has been in an article in the Daily Telegraph.
Lord Marsh: My Lords, will the final stages of this process or exercise be conducted with same level of professionalism that we have seen hitherto?
Lord Falconer of Thoroton: My Lords, at all stages the process by which the Dome has been marketed has been utterly professional. That means that at no stage has the process involved seeking merely a short-term gain. It has always had at its core the need to meet the long-term interests of regeneration in north Greenwich.
Baroness Sharples: My Lords, what are the current running costs of the Dome per day?
Lord Falconer of Thoroton: My Lords, the running costs of the Dome, including the pay of the people working in it, are something in excess of £1 million. I apologise; I should have said that those are the costs per month rather than per day. Once it is a question only of maintaining the site, the costs will fall to something in the region of £550,000 per month.
Lord Watson of Richmond: My Lords, when questions on this subject are raised, one feels increasingly that one is intruding into a matter of private grief. However, can the Minister say whether, even at this late stage, he can think of a theme for the Dome?
Lord Falconer of Thoroton: My Lords, I do not think that the Dome project should be regarded as a matter for private grief. If the noble Lord were to visit Greenwich and Woolwich, he would see how much that part of London has been regenerated. The London Borough of Greenwich has estimated that, over seven years, some 30,000 new jobs will be created. Far from this being a matter of grief, it is a matter of regeneration. So far as concerns a theme for the Dome, I think that it should be regeneration and the bringing of hope where previously there was only despair.
Lord Peyton of Yeovil: My Lords, I hope that the noble and learned Lord will give me credit because, out of sympathy for him, I have refrained for a long time from asking any questions about the Dome. I intervene now in order to tender a brief word of advice which I hope that he will accept. Will the noble and learned Lord please give urgent consideration to getting rid of this appalling thing as quickly as possible? It represents a load of shame on almost everyone who has been involved in it.
Lord Falconer of Thoroton: My Lords, I do not regard the Dome project as a "load of shame" as the noble Lord put it. It is something which has brought hope, jobs and regeneration to an area that was previously contaminated.
Lord Tebbit: My Lords, does the Minister recollect that recently I tabled a Written Question asking whether the Government's advisers agreed with the statement made by certain property experts who said that the site would be worth more with the Dome demolished than with it still standing? Can he give me an answer to that today?
Lord Falconer of Thoroton: My Lords, I can recall that Written Question and I believe that it has been answered.
Lord Tebbit: I have not had a reply.
Lord Falconer of Thoroton: My Lords, the noble Lord has made his remarks from a sedentary position.
So far as the Government are concerned, we think that the right course is to keep the Dome. It is a project which has brought regeneration to the area of north Greenwich. In considering what should be done in the future, one should have regard to regeneration, value for money and what is best for the local area.
The Countess of Mar: My Lords, the noble and learned Lord said that a previously contaminated site has been regenerated. As the contamination was extremely serious before anything was done about it, can the Minister give an absolute assurance that, whether the Dome stays there or is demolished, there is no longer any contamination in the soil beneath?
Lord Falconer of Thoroton: My Lords, the decontamination has been carried out to a standard commensurate with the expected use of the north Greenwich peninsula. Obviously, at some level there will be contamination, but for the uses envisaged in the planning, the site is safe.
Lord Haskel: My Lords, does my noble and learned friend agree that it is very easy to criticise a half-done business deal? Does he further agree that noble Lords opposite should save their criticisms for when the deal is completed rather than make them when it is half done?
Lord Falconer of Thoroton: My Lords, I agree.

British Culture: Promotion Overseas
2.43 p.m.
Baroness McIntosh of Hudnall Baroness McIntosh of Hudnall asked Her Majesty's Government:
What steps they are taking to promote British culture overseas.
The Parliamentary Under-Secretary of State, Foreign and Commonwealth Office (Baroness Scotland of Asthal): My Lords, the British Council is our principal agent for the promotion of British culture overseas. It projects the United Kingdom's creativity, cultural diversity and recent achievements and challenges outmoded stereotypes of the United Kingdom abroad. The council's funding will be increased by 10 per cent over the next three years.
The Foreign and Commonwealth Office, the Department for Culture, Media and Sport, the Britain Abroad Task Force and the BBC World Service also promote British culture overseas.
Baroness McIntosh of Hudnall: My Lords, I thank my noble friend for that helpful reply. Is she aware that the National Theatre, in which I declare an interest, recently visited Belgrade with a production of "Hamlet", which was supported by the British Council? This was the first visit by an international theatre company to Belgrade since the break-up of the former Yugoslavia and many senior politicians attended the first performance. Does my noble friend agree that visits of this kind not only give great pleasure—which they obviously do—but can help to cement, build and sometimes heal international relationships? Does she further agree that government money spent on visits of this kind is money well spent?
Baroness Scotland of Asthal: My Lords, I wholeheartedly agree with the noble Baroness. Indeed, the Foreign and Commonwealth Office was delighted to join in partnership in relation to this event. It was a hugely successful tour to Belgrade. It has done much for cultural diversity and has demonstrated beyond peradventure how great are the benefits of removing Milosevic.
Baroness Rawlings: My Lords, during the Second Reading of the International Development Bill in the other place, the Secretary of State for International Development said:
"The British Council, which is a fine body, is the cultural arm of British diplomacy".—[Official Report, Commons, 6/3/01; col. 241.]
I agree. I also agree that the British Council should be supported in a manner that befits the cultural arm of British diplomacy. Despite the Secretary of State's answer, can the Minister tell the House why the value of contracts between DfID and the British Council has

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fallen dramatically from £62 million in 1996–97 to £23.3 million in the last financial year? While the cultural arm of British diplomacy is being amputated, DfID is mutating at an alarming rate. Since 1997 it has grown by 323 staff and its budget by £9 million to £74 million.
Baroness Scotland of Asthal: My Lords, since the Government came into being they have given staunch support to the British Council. It is with great pleasure that we are able to increase the money given to the British Council by 10 per cent. The noble Baroness will know that the Department for International Development has rightly concentrated on the elimination of poverty. This is all funded by public money. We are extremely proud of the record that the Department of International Development has established worldwide. We are also extremely proud of the efforts made by my noble friend Lady Kennedy, who has led the British Council with great distinction since taking up its chairmanship.
Baroness Kennedy of The Shaws: My Lords, I am grateful to the Minister for making reference to my tenure of the chairmanship of the British Council, of which I am enormously proud. It is right that in recent times the council has received an increase in funding, for which we are grateful. However, the noble Baroness on the Opposition Benches is also right in saying that we have seen a great down-turn in the contracts we have fulfilled for DfID. The effect of that has been very real. Can the Minister assure the House that the impact of the British Council is considerable in promoting British culture abroad? Given that the impact is so important, does she agree that there should be a continuing increase in the funding of the council and that we can look forward to the Government making that possible in the next spending round?
Baroness Scotland of Asthal: My Lords, again I endorse what the noble Baroness has said in relation to the considerable contribution made by the British Council to promoting British culture abroad and, indeed, to helping reinforce the benefits of democracy. As a result—due in large part to the noble Baroness's leadership—the council has done increasingly well. I am confident that at the next spending round the council will be able to show that it uses its current budget extraordinarily well and that it will present a strong case for more funding.
Baroness Trumpington: My Lords, does the Minister agree that the excellent work done by the British Council is very much undermined by the presence of football hooligans abroad?
Baroness Scotland of Asthal: My Lords, those who behave badly abroad never bring distinction on to themselves or on to Great Britain. However, we hope that our other talents—which are considerable—will outshine them.
Lord Avebury: My Lords, does the Minister agree that the BBC World Service is also a tremendous ambassador for Britain? Quite apart from the excellence of its broadcasts, its website is one of the best in the world. Can the noble Baroness assure the House that the funding of the BBC World Service and its website is secure for years to come?
Baroness Scotland of Asthal: My Lords, we were also able to make an increase in relation to the BBC World Service. I agree that it plays a vital role in increasing respect and good will for Britain around the world. It set out to be, and has become, the best known and most respected voice in international broadcasting. For many, it will always be the voice of freedom. We are very proud of the BBC World Service and we shall continue to support it.
Lord Freyberg: My Lords, will the Minister join me in congratulating the British Council on recently winning the prestigious ARCO international award in Madrid, which is given to the institution that has done most internationally to promote, disseminate and educate in the field of contemporary art? Yet the council has seen a 25 per cent decline in its arts budget over the past five years and begins the next five years on a standstill budget. Can the Minister offer any help in this respect?
Baroness Scotland of Asthal: My Lords, I join the noble Lord in congratulating the British Council. The award to which he refers was extremely well received. The key tool was the British Council's collection of 7,000 works, of which some 5,500 are on show at any one time. In relation to the cut of 25 per cent over the past five years, the British Council has had to reallocate its resources taking into consideration a broad spectrum of points. I understand what the noble Lord says; however, these issues are being addressed energetically and there is a concentration on young artists, which will benefit us all in the long term.
Lord Puttnam: My Lords, is the Minister aware of the fact that in 1995 a conference was held in London under the title "Britain and the World", at which the Foreign Secretary, Mr Cook, the then Foreign Secretary, the noble Lord, Lord Hurd, and the then Prime Minister, Mr John Major, all confirmed unequivocally that cultural diplomacy represented the best value for money in presenting Britain to the rest of the world? Has anything happened in the past six years that would allow Mr Cook to think that that is no longer true?
Baroness Scotland of Asthal: My Lords, absolutely not. It is incredibly good value. Britain's creative sector, including music, design and advertising, generates more than £112.5 billion each year and employs more than 3.3 million people. It is growing faster than the economy as a whole: in 1997–98 it was growing at 16 per cent a year. Exports total £10.3 billion. It is a very vibrant sector, of which we are rightly and justly proud.

Rate Relief: Rural Public Houses
2.53 p.m.
Lord Beaumont of Whitley Lord Beaumont of Whitley asked Her Majesty's Government:
Whether they plan to extend mandatory rate relief to village and rural public houses on the same basis as village post offices and stores.
The Parliamentary Under-Secretary of State, Department of the Environment, Transport and the Regions (Lord Whitty): My Lords, the Government have today presented a Bill in the Commons to provide 50 per cent mandatory rate relief to all village food shops. They have also announced that they intend to extend this relief, by means of secondary legislation, to sole village pubs and petrol filling stations. The mandatory relief will be available to food shops with rateable values up to £6,000, the same as that currently available to sole post offices and general stores. It will be available to sole village pubs and petrol filling stations with rateable values up to £9,000. In order to assist farmers to diversify, the Bill also provides 50 per cent mandatory rate relief for five years for new small-scale non-agricultural enterprises on farms.
Lord Beaumont of Whitley: My Lords, I thank the Minister for that very helpful and welcome Answer. I seem to be timing my questions rather well this month. Is it true that the Bill removes the proposed restrictions on the kind of pub that will receive relief, so that it will be available to all rural pubs no matter who owns them or whether they have particular resources which make them a cultural centre? A pub is a pub, is a pub—and they are all worth supporting.
Lord Whitty: My Lords, first, I congratulate the noble Lord on his knowledge of pubs—although I suspect that most British pubs like to differentiate themselves a little from each other. As regards the changes, we have not pursued the definition "singly owned" in the Green Paper; in order to qualify, however, a pub must be the sole pub in the community.
Lord Jenkins of Putney: My Lords, will my noble friend give an assurance that the rate relief will be funded wholly by the Government and will not fall on local authorities?
Lord Whitty: My Lords, the mandatory rate relief to which I have referred will be fully funded. Under the existing scheme and under the scheme that is proposed, local authorities have further abilities to top up the funding to 100 per cent relief. In that situation the Government would fund 75 per cent of the top-up or discretionary relief.
Lord Tanlaw: My Lords, are the Government doing more to help farmers with diversification through access to broadband data transmission? ADSL will not be available in country areas for some time. I understand that there is a restriction on having two
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receiver dishes. Will the legislation be changed to allow a second dish to be installed so that farmers can diversify as a result of having access to broadband data transmission?
Lord Whitty: My Lords, the Government have in train a full strategy on the extension of broadband facilities which will include provision in rural areas. The number of dishes will be determined on the basis of local planning decisions. If the noble Lord is suggesting that a separate dish would be necessary for the part of a business that would be diversified, the particular circumstance would need to be taken into account. There is no primary legislation covering such matters.
Lord Borrie: My Lords, does my noble friend agree that, if the measures for mandatory rate relief for local food stores and petrol stations are to succeed, it is equally important to tighten up on planning permissions for new supermarket developments?
Lord Whitty: Yes, my Lords. In our new planning guidance we have clearly indicated to local authorities that we shall look hard and with great robustness at any proposals for out-of-town supermarket centres.
Lord Elton: My Lords, will the new provisions referred to by the Minister in his original Answer apply in Scotland; or is this a devolved matter?
Lord Whitty: My Lords, it is a devolved matter in Scotland. These provisions will apply to England and Wales.

Local Elections: Access to the Countryside
2.58 p.m.
Baroness Blatch Baroness Blatch asked Her Majesty's Government:
What guidance they intend to issue to county councils and the electorate about access to the countryside for the purposes of campaigning in the forthcoming local elections.
The Parliamentary Under-Secretary of State, Home Office (Lord Bassam of Brighton): My Lords, guidance is publicly available and is regularly updated on the website maintained by the Ministry of Agriculture, Fisheries and Food at www.maff.gov.uk/animalh/ diseases/default.htm. This includes guidance for the public on countryside activities and visits and on how to prevent the spread of disease. We believe that the guidance is relevant to those who are planning campaigns for the forthcoming elections. Political parties may wish to consult local electoral officers and MAFF guidance about access to the countryside in restricted areas.
Baroness Blatch: My Lords, that was an impressive Answer, but it did not refer to specific guidance to local authorities and the electorate in relation to the

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forthcoming county council elections. Does the noble Lord accept that, as we are a matter of days away from nomination day, they have to date received no guidance on the siting of polling stations in disease-affected areas and the possible need for disinfectant and cleansing facilities at those sites, and no guidance on the handling of what could be mass applications for postal votes? Time is short and guidance is essential.
Lord Bassam of Brighton: My Lords, the point that I made in my initial response was that advice from the Chief Veterinary Officer, Mr Jim Scudamore, is generally available for local authorities and, obviously, for local electoral registration officers. As to the other matters, it is clearly the case that local authorities will be expecting to deal with such issues. The Government have now made it much easier for people to acquire both postal and proxy votes. After all, they are now available on demand. Local authorities are expecting to gear up for that process. I am sure that electoral registration officers are fully prepared for that eventuality.
Lord Monro of Langholm: My Lords, I have telephoned many of my old constituents in Dumfries and Galloway, and others in Cumbria. There is no one in either of those great areas who considers a democratic election during the first week in May, whether local or national, to be anything but ludicrous. At present, there is no possibility of the normal, democratic process of face-to-face meetings, knocking on doors and the opportunity for candidates to put forward their personalities during the election. Indeed, the whole country will feel that the Government are letting us down very badly if they go ahead.
Lord Bassam of Brighton: My Lords, I am not sure whether there was a question in the noble Lord's intervention. However, do I now take it that it is the policy of the Official Opposition to suggest that we should be cancelling elections on 3rd May?
Noble Lords: Oh!
Baroness Gardner of Parkes: My Lords, can the Minister tell me about postal votes? For example, is the onus upon a person to apply, or will electoral officers notify each person of his or her entitlement to a postal vote? Can the noble Lord tell us how the mechanisms of postal voting are supposed to work?
Lord Bassam of Brighton: My Lords, it is a matter of application. As ever, the Home Office has been extremely diligent in these matters. We are ensuring that there is widespread publicity on postal vote applications. Indeed, I believe that we have provided 1.5 million postal vote leaflets, which are now being distributed through electoral registration officers. We are also working very closely with those officers to ensure that there is a thorough campaign to draw the new postal vote process to the attention of every elector.
Lord Dubs: My Lords, can my noble friend the Minister say whether the Government have received
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any representations from, or on behalf of, the British tourist industry to the effect that delaying the election would in fact send a very damaging signal about the tourist attractiveness of this country?
Lord Bassam of Brighton: My Lords, my noble friend has made an important point. I am worried, as I am sure is the case with others, about the dangerous signal that might be sent were we to abandon this year's local elections. We are very concerned about the tourist industry. I believe that the most helpful guidance issued by the Chief Veterinary Officer, Jim Scudamore, assists us greatly in that regard.
Lord Dixon-Smith: My Lords, the Minister's announcement that 1.5 million postal voting forms will be circulated to local authorities in the near future is most welcome. There is no doubt that those in the countryside will feel a little more hopeful if there is to be an election, which many of them believe would be inappropriate. Having said that, the handling of a very large number of postal vote applications by local authorities will almost certainly pose administrative, if not resource, problems. Therefore, if there is to be a poll at the beginning of May, can the Minister. assure us that adequate resources will be made available—if necessary, by using the Bellwin rules—to pick up the problem and ensure that absolutely no difficulty will be placed in the way of those who are confined to the countryside?
Lord Bassam of Brighton: My Lords, perhaps I may clarify what I said in this respect. I said that 1.5 million postal vote leaflets were being made available for distribution through electoral registration officers. We shall, of course, keep a very careful eye on the number of postal vote applications that are made. I am not aware that representations are currently being made as regards the need for extra resources. I am sure that county councils, and those new unitary authorities that will be going to the polls on 3rd May, will be mindful of the need for adequate resourcing to deal with any increase that may arise in the demand for postal votes.
Lord Faulkner of Worcester: My Lords, can my noble friend the Minister confirm that experiments have been carried out as regards the process of conducting local elections entirely by post, and that, on those occasions, the turnout was higher than had been the case previously?
Lord Bassam of Brighton: Yes, my Lords. Selected ward areas were covered by total postal voting during last year's local elections. I believe that turnout in some of those ward areas was as high as 60 per cent; indeed, perhaps a fraction higher. So the democratic process was protected, and there were greater levels of involvement in local elections than ever before. Those who conducted the experiments are to be congratulated on their work. It gives us great confidence to know that people in any sort of election will certainly be able to participate fully by casting their vote.
Lord Goodhart: My Lords, very considerable time pressures apply to the completion and return of such forms. Therefore, will the Minister consider the possibility of sending out application forms before a demand arises from voters in restricted areas?
Lord Bassam of Brighton: My Lords, as government, we do not have the power to do so. Clearly, that is a matter for each electoral returning officer properly to consider. I should add that such forms are also available on the Home Office website: www. homeoffice.gsi.gov.uk.
Lord Naseby: My Lords, is the Minister aware that only one-third of the electorate has access to the website? It is all very well to be told that there are 1.5 million postal vote forms for the remaining two-thirds, but how are those people to be told that such forms are available? Is there to be a major advertising campaign, or will it be just word of mouth from your Lordships' House?
Lord Bassam of Brighton: My Lords, perhaps I have not explained the process clearly enough. I said that 1.5 million postal vote leaflets have already been printed. These will be distributed by electoral registration officers. The Home Office is working with local authorities—and, for that matter, the Ministry of Agriculture, Fisheries and Food—to secure additional publicity so that people will be fully aware of their postal vote entitlement. I am sure that everyone in your Lordships' House will want to support that endeavour.

Health and Social Care Bill
3.6 p.m.
The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.
Moved, That the House do now again resolve itself into Committee.—(Lord Hunt of Kings Heath.)
On Question, Motion agreed to.
House in Committee accordingly.
[The DEPUTY CHAIRMAN OF COMMITTEES (Lord Boston of Faversham) in the Chair.]
Lord Clement-Jones Lord Clement-Jones moved Amendment No. 26:
After Clause 3, insert the following new clause—
"RETENTION OF PROVISION OF CLINICAL SERVICES WITHIN THE NHS
In section 14 of the Health Act 1999 (exercise of powers by NHS trusts) at the end there shall be inserted—
"(10) The exercise of powers conferred by paragraphs 10 to 17 of Part II of Schedule 2 to this Act may only be exercised to the extent that it does not involve or permit—

(a) the transfer of contracts of employment of registered doctors, registered nurses or professions allied to medicine from an NHS trust or Care Trust to a non-NHS organisation, or

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(b) the creation of contracts by an NHS trust or Care Trust with any non-NHS organisation for the provision of the services previously provided by registered doctors, registered nurses or professions allied to medicine to the Trust.""

The noble Lord said: At this stage, I believe that it is customary to speak for a few moments about generalities so that noble Lords are able to make their way out of the Chamber. Indeed, if I were to start speaking to Amendment No. 26, I am sure that the interest in its provisions would prove to be so overpowering that people would wish to stay to hear the profound arguments that I am about to make. However, I see that I have the Minister's attention, so what more could I want in the circumstances?
In moving Amendment No. 26, I shall speak also to Amendments Nos. 29 and 31. All these amendments are closely related: they relate to the new provisions that the Government are introducing as regards PFI/ PPP. We are not perhaps great fans of PFI/PPP on these Benches, not as a matter of principle but simply because we do not believe that those provisions have achieved some of the aims that they were originally meant to achieve. Moreover, they have not been a very transparent instrument of government in many respects. The intention of my amendments is to try to improve that transparency. As I am sure the Minister is aware, a number of outside organisations have considerable doubts about the width of the current provisions, and my amendments are also designed to narrow the scope of such provisions.
The Government's intentions seem reasonably clear, especially as regards the equity participation provisions. In his response, the Minister may care to explain the motives behind such provisions. There are some who would say—far be it from me to agree with them—that this situation arises because it is not possible to get agreement with the private sector in some circumstances because, quite frankly, the return is not there on some of these schemes if the money is put forward by way of debt, or companies expect to get the full return on their investment. That is why the device of allowing government participation in such companies has been adopted. The Minister needs to give us a very clear idea of the true picture. After all, current PFI/PPP powers are fairly wide, which means that this is a rather novel provision.
In addition, the concordat, which many of us welcomed, allows the private sector a strong relationship with the NHS. It allows a straightforward commercial relationship to exist between the NHS and the independent healthcare sector. That in itself seems to us to have advantages as it is perfectly transparent; the commissioning process is clear and the amount of money that is allocated is clear.
The key area of concern arises in the area of acute services. It appears that the new provisions are mainly directed towards LIFT, the primary care structure which is now to be adopted in order to improve provision in under-resourced areas. In many respects that is to be welcomed. By and large GPs are independent contractors unless they work under PMS contract. That kind of public/private sector

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partnership is welcome. These amendments are probing. However, in our view the Government should give an assurance on the extent to which clinical services could be the subject of PFI/PPP. By clinical services, we mean front line specialty services such as medicine, surgery, obstetrics, diagnostic services such as radiology, pathology, clinical biochemistry—services which are an integral part of the acute medical practice in our hospitals.
The case is being strongly made that it will be extremely difficult to have those services provided by PFI/PPP when other services are not provided by PPP. Indeed, we believe that the whole principle of providing clinical services needs much further debate than simply making it an adjunct to the clause. Indeed, it may be an unintended consequence of the clause but the Minister certainly needs to explain what his intentions are in that respect. I beg to move.
3.15 p.m.
Lord Hunt of Kings Heath: I am grateful to the noble Lord, Lord Clement-Jones, for allowing me to say something about the relationships between the NHS and the private sector which the Government wish to see developed. He mentioned two specific aspects: the concordat and the PFI development. I believe that the concordat, which was signed with the Independent Healthcare Association on 31st October 2000, provides a powerful framework that encourages a longer term more proactive relationship between the NHS and the independent sector but which allows for key decisions to be taken at local level. Over the past few months that has been extremely helpful in relation to winter planning and has enabled the NHS both to withstand the many pressures that arise during the winter and to ensure that we maintain progress in relation to waiting list targets. The concordat should be viewed as a wholly encouraging and responsible measure. We wish to see that relationship developed in the future.
As regards PFIs, we have made great progress since 1997 in our hospital development programme. Some 34 major PFI hospital development schemes have been approved since May 1997. In addition, there are a number of PPP arrangements connected with the delivery of IT and information for health projects. I see Clauses 4 and 5 as building on that general philosophy of co-operation and partnership with the private sector. Essentially, Clauses 4 and 5 are both concerned with providing the Secretary of State and the NHS with powers to invest in companies. That will provide a new way of developing public/private partnerships for the purpose of providing services to the NHS or generating income for the NHS. We believe that these two clauses open up exciting opportunities that have not been available to the NHS to date.
I take the point the noble Lord, Lord Clement-Jones, made about what I believe he described as the straightforwardness of a contractual relationship between the NHS and an independent provider, as opposed to what is enabled by the two clauses. One great advantage of what is being proposed here is that
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it makes the NHS much more involved as a key player in the organisation and direction of the kind of partnerships about which we are talking.
The noble Lord rightly referred to what we describe as NHS LIFT—that is another "anacronym" beloved of the NHS—the NHS Local Improvement Finance Trust. This is an exciting proposal, a public/private partnership to raise £1 billion to improve primary care facilities initially focusing on deprived areas. NHS LIFT will invest in local schemes, bringing the local health community and private sector partners, including property experts, into a local partnership to improve primary care facilities. As many Members of the Committee will be aware, the standard of many primary care facilities within deprived areas is poor indeed. We see NHS LIFT as a way of bringing in capital, both public and private, to enhance those facilities and also as a way of providing a great deal of expertise in primary care to develop first-class new facilities.
The first application we envisage of the investment in companies for income generation is the creation of intellectual property spin-off companies. The NHS through its research generates a huge amount of intellectual property, but I am afraid that it has not always realised the commercial potential of its discoveries and inventions. We see spin-off companies as being a recognised approach to exploiting intellectual property that is well understood and is used both by the universities and the commercial sector. Allowing the NHS to adopt the same approach will provide significant new opportunities to realise the value of NHS intellectual property.
I have considered with care the three amendments tabled by the noble Lord, Lord Clement-Jones. I consider that they would inhibit the kind of developments that we want to see. In addition, the amendments would place new restrictions on the manner in which NHS bodies currently deliver services. NHS trusts currently subcontract work to the private sector. The concordat framework is a good example of that. Amendment No. 26, if accepted, would prevent that happening.
Amendment No. 29 attempts to circumscribe the services which future public/private partnerships may provide. We have published a list of services which may be provided under contract by the private sector under existing public/private partnership arrangements. The NHS plan commits us to exploring new forms of partnership with the private sector. I say to the noble Lord, Lord Clement-Jones, that any proposals which include categories of services or staff other than those on the list must be approved by Ministers. I believe that his amendment would prevent the development of many new forms of partnership, for example—this is mentioned in the NHS plan—the proposals to develop partnering arrangements for modernising pathology services.
Amendment No. 31, if accepted, would prevent NHS trusts or care trusts from providing many of the services that they currently provide. It would stop those bodies providing clinical services for the

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purposes of generating additional income and it would mean that NHS trusts might have to close all private patient wards. I do not think that that is practical or desirable. I believe that the clauses that we have are sensible and enable the NHS to build on successful public/private partnerships. In particular NHS LIFT gives us a real opportunity to enhance the quality of primary care services.
Lord Clement-Jones: I thank the Minister for his frank response. My intention was not to divide the Committee but to elicit the frank response that he has given. Although it will not strike terror, it will cause some trepidation to those who are worried about the ultimate conclusion of PFI/PPP. The Minister said that there is a list beyond which the approval of Ministers will be required. I am not wholly familiar with that list; no doubt we shall familiarise ourselves with it.
However, we are into new territory here. The provision does not relate only to LIFT, as the Minister admitted. I should be happy if it were a matter of intellectual property—spin-off companies to exploit inventions or discoveries that have been made within the public sector—and so on. But we are talking about an extension. As originally conceived, various assurances were given about how far a PPP would go with regard to the provision of clinical services. We are clearly crossing another bridge here. I should be happy with that if the transparency were there; if the comparisons with the public sector were there. As a seeker after truth, I have considered every one of the PFI contracts and sought to calculate how the calculations about the transfer were made. I have had some co-operation with the department in that respect. I am baffled. The comparison between public sector financing and PFI is opaque. That worries me.
In the proposed system we are transferring services across to the private sector but the cost to the public sector is unknown. Whether the figure is calculated over 30 or 60 years, we seem to be on very tricky ground. It is an example of a creeping process of PFI/ PPP. It is interesting that the Minister uses the phrase "exciting opportunities". That is the way in which Ministers have always talked about the PFI. It strikes terror into my heart since it has a certain naivety about it.
Lord Hunt of Kings Heath: I cannot let that remark pass. I said "exciting opportunities". The quality of primary care provision in rented accommodation in many inner city areas is often of poor quality. The opportunity to bring in both public and private capital to enhance those premises must surely be exciting. It is one which I believe that GPs and other primary care providers in such areas will welcome warmly.
Perhaps I may give an example. There are GPs who are locked into many years of a lease. It is difficult for them to get out of that lease and move into better accommodation. One of the purposes of NHS LIFT would be to enable that lease to be bought up by an
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NHS LIFT, and an appropriate rental scheme developed in new premises for those GPs. I think that those possibilities are exciting.
Lord Clement-Jones: The Minister uses the best example. If the terms of the clause were limited to ensuring that LIFT were to take flight (perhaps the expression should be to ascend), I would have no quarrel with that. As I said in my introduction, the majority of GPs are independent contractors who should be free to make contracts with the private sector in the way they see fit. If this system is designed to facilitate that, that is all right by me and these Benches.
There is a tendency in the Bill to take a power for one purpose and say, "We think that that is a useful power. We'll make sure that it is available for all kinds of other purposes". We saw that under the finance sections in Clauses 1 to 3. We now see it in Clauses 4 and 5. It is a recurring theme throughout the Bill. That is what worries me. If the power were purely for LIFT, I should have no objection. But we now see a real sea change in what could be possible under the PFI in terms of the provision of clinical services.
The Minister may say that there are some safeguards; the Secretary of State has to approve. But if the Secretary of State gets over-excited about PFI, as Secretaries of State under this Government have done historically, I can tell noble Lords the answer to the request for approval.
We have worries about the power. I think that it is a sea change in the way in which the NHS is organised. Straight commissioning from the private sector is more honest financially, politically and otherwise; that is what I should prefer, rather than this overcomplicated scheme and the drawing of an opaque veil over the whole process.
If we have a further stage of the Bill—that is not known at this moment—we should wish to develop the argument further. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 4 [Public-private partnerships]:
Earl Howe Earl Howe moved Amendment No. 27:
Page 4, line 5, after "otherwise)," insert "or to issue (or procure the issue of) shares or other securities in the companies to any person,"
The noble Earl said: In moving the amendment, I shall speak to Amendments Nos. 28 and 32 to 35.
It is a pleasure to welcome in Clause 4 of the Bill an explicit acknowledgement by the Government of the value of the private sector in helping to deliver facilities and services to the NHS. As I said at Second Reading, we look forward to the arrival of NHS LIFT which holds the potential to bring much-needed improvements to GP premises but, equally important, to do so where there has been market failure in the normal commercial mechanisms for generating such improvement. That is where NHS LIFT will come into its own.
NHS LIFT is an acronym. I thought that the Minister said—I may be wrong—an "anacronym" which conjures up all kinds of pejorative connotations. The Minister's reply to the last group of amendments was helpful. However, there are still many gaps in our knowledge. We have only the barest outline in terms of how the new systems will operate.
One of my main concerns relates to the absence of any specific provision for parliamentary scrutiny. The companies which are set up to handle these activities will undertake very significant financial commitments. One has only to think back to recent history and the sad saga of the New Millennium Experience Company to realise the damage that can be done by, some would say, excessive secrecy when public money is being spent. Instead of shielding Ministers, that secrecy can expose them to an unending series of questions from the press and Parliament. It would be highly desirable if Parliament, as a matter of routine, were to have a statement from the Secretary of State when the powers in Clause 4 are first exercised and then annually so that the financial and other commitments made by the Secretary of State can be monitored properly.
I recognise that there are issues of commercial confidentiality here. I respect that completely. That is why Amendment No. 34, which inserts a new clause after Clause 5, refers to the laying of a written statement "as soon as reasonably practicable".
It is also important to provide for an annual report and accounts to be laid before Parliament in those cases where a company is publicly controlled or where there is any public stake. Those companies will not be non-departmental public bodies. If they were, the laying of accounts would be automatic. However, Clause 4 tells us that the Companies Act will define the rules for preparing the accounts. Therefore we need to create that link with Parliament.
Subsection (4) of Amendment No. 35 grants access rights to the Comptroller and Auditor General. That is consistent with the report prepared in February of this year by the noble Lord, Lord Sharman, entitled The Review of Audit and Accountability for Central Government. In that report, the noble Lord, Lord Sharman, recommends that the Comptroller and Auditor General should be entitled statutorily to audit publicly owned companies. I believe that my proposal fits in with the spirit of what the noble Lord suggests.
In Amendments Nos. 27 and 32 I have raised a separate and somewhat technical matter. In Clauses 4 and 5 the Government give themselves the power to form companies, but not to issue shares in those companies to a private partner. I recall that a specific provision was thought necessary to do that in the context of NATS. Is the same true here?
Amendments Nos. 28 and 33 were prompted by a political concern. I welcome the introduction of the new powers, but they are only powers. They would not have to be used by any future Secretary of State who was less open-minded than the present one obviously is on the suitability of the private sector as a vehicle for bringing about improvements. The thought that I should like to plant in the Minister's mind through the
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amendments is that the Secretary of State should have an obligation to consider in all such cases whether the private sector offers an appropriate means of delivering the desired outcome. I do not believe that the Secretary of State should have an excuse for ignoring the private sector option merely because he is ideologically hostile to it.
I conclude my remarks with a few questions for the Minister on the clauses. Clause 5 gives a power to form companies that in one way or another will work to the benefit of the health service. What will happen to the current terms and conditions of service of employees of the health service who are asked to go and work for one of those companies? Will TUPE rules apply to them?
Secondly, will the Minister provide some concrete examples of how the powers in Clause 5 are likely to be used? Will he expand on his reference to intellectual property? I am probably not alone in finding the Explanatory Notes slightly less than helpful here. In particular, will he lay to rest a current canard on anonymised patient data? There is a rumour going about that once the copyright for the information can be controlled by the Secretary of State, as Clause 67 provides, it is only a short step away from being vested in him. Once that happens, the information will be ripe for commercial exploitation by the Department of Health. I hope that that is an unfounded rumour, but it would be helpful to hear the Minister repudiate it.
Lastly, if the Government take only a minority stake in a company, as I understand is the intention with NHS LIFT, what leverage will they have to ensure that investment is channelled to where it is most needed? Where there is market failure in the normal mechanisms for attracting investment or loan finance, how will NHS LIFT ensure that those deprived parts of the country receive the money that they have been unable to generate elsewhere? I beg to move.
3.30 p.m.
Lord Hunt of Kings Heath: I am grateful to the noble Earl, Lord Howe, particularly for his general welcome for what is proposed and the benefits that he sees in NHS LIFT. I shall try to respond to the points that he has raised.
The aim of the clauses is to enable the Secretary of State to enter into public/private partnerships to deliver services to the NHS or for the purpose of income generation. The noble Earl has raised some important points, but they are covered. Amendments Nos. 27 and 32 would enable the Secretary of State to issue shares or other securities in a company to any other person or company. That is unnecessary because any company established under the powers in these clauses could issues its own shares. We would not want a power to allow the Secretary of State to issue those shares. The aim of the clauses is to allow the Secretary of State to participate in establishing a company as part of a public-private partnership. We do not envisage the Secretary of State setting up a wholly owned company and then issuing shares at a later date.

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The noble Earl asked what leverage the Secretary of State would have if he had a minority shareholding in such an organisation. Any companies so established would focus on NHS activities. If the Secretary of State was unhappy with the progress of a company and its policies, he could walk away from it. The credibility of such partnerships rests on the NHS having confidence in the arrangements.
I shall resist Amendments Nos. 28 and 33 because they would return us to the days when all proposals for capital investment had to be subject to testing for private finance. As part of our aim to decentralise decision-making to local level, we are not insisting on a rigid approach on that. The noble Earl will probably recall the Sackville pledge under the previous government. Testing of all investment for PFI led to a huge amount of bureaucracy and real problems in making progress. We require the NHS to ensure value for money in all proposed investments. Current guidance is clear that all procurement that would involve capital expenditure should normally consider PFI, but if an NHS trust considers that a project has very little chance of attracting private finance—for example, if it is a very small scheme—the interests of the NHS would not be served by testing for PFI and PPP. In those circumstances, the trust is exempted from a requirement to consider PFI. Each project is considered on its merits. It is best to leave that decision to individual NHS trusts.
The noble Earl asked about TUPE. It would apply either as a matter of law or under Cabinet Office guidance. I hope that that gives him the assurance that he requires.
I have come across an example of a spin-out company, which the noble Earl asked for. The Royal Marsden is developing what is called a PET scanner. A new company has been formed to develop that machine, but at the moment the Royal Marsden cannot take shares in that company. The NHS is integral to the development of new machines in such cases and it would be a matter of great regret if it were not allowed to enjoy the fruits of the work that had been undertaken.
I assure the noble Earl that any company formed under Clauses 4 and 5 will be required under Companies Act regulations to produce annual reports and accounts. It is our intention that all the companies formed under Section 96C(1) of the 1977 Act will be public companies. That means that a report and accounts must be filed with Companies House within seven months of the end of the financial year. The Secretary of State will ensure that the published reports and accounts are placed in the Libraries of both Houses promptly following publication.
To answer the noble Earl's specific point, the Department of Health's annual report will in future include a section providing details on all investing activities. It will include information on audited bodies, such as the name of each company, the purpose for which it was formed, the percentage of each class
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of share held by the Secretary of State, the amounts invested and the details of loans or guarantees provided.
Those reporting requirements will be in addition to the statutory reporting requirements with which the companies will be required to comply. Statutory reporting requirements will include the following: any share held by the Secretary of State or his nominee will be disclosed in the Department of Health's resource accounts, which will be published in compliance with the Government's resource accounting manual; and, in the case of Clause 4 for health authorities or primary care trusts and Clause 5 for NHS trusts, any investment will be disclosed in the annual accounts, which are required to be published under the National Health Service (Primary Care) Act 1997.
I come to the interesting point which the noble Earl raised with regard to the Comptroller and Auditor General. At present, the Comptroller and Auditor General does not have that power. However, the scope of his remit is currently being considered by the Government. We have already said that, under the review of companies which is being conducted by the Department of Trade and Industry, we shall consider the possibility of legislating to make the Comptroller and Auditor General a Companies Act auditor.
The noble Earl is right to say that that was recommended by the noble Lord, Lord Sharman, in his recent review of audit accountability for central government. I can assure the noble Earl, Lord Howe, that, if the recommendations of the review by the noble Lord, Lord Sharman, are accepted, clearly they will apply to any PPP. At this stage I cannot prejudge either the outcome of the review or the Government's response. However, I hope that the noble Earl will accept that we wish to ensure that that information is placed in the public domain.
Baroness Cumberlege: Perhaps I may press the Minister on something that he said. I may have misheard him. He mentioned that the Secretary of State would walk away from any partnership which he felt was unsatisfactory or possibly failing. I can understand his wish to do that, but how does that give confidence to the private sector? What guarantees will the private sector have?
Secondly, I want to ask the Minister whether he will respond to the question about attracting developers into the heartbreak wilderness areas, to which, in the past, they have not been attracted. What incentives does the scheme provide to ensure that developers go into those areas? If they do not, that will reinforce the inverse care law, which would be a great pity.
Finally, I want to ask about the spin-out companies which were mentioned by the Minister. In debate in another place, the Minister, Mr Denham, described the development of spin-out companies as exploiting intellectual property. I very much endorse that. I believe it is right that the NHS should benefit financially from innovation discovered within the service. However, without going into detail, in another place the Minister said that we must recognise that

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clear procedures are needed for managing risks with spin-out companies. I believe that it would be very helpful to the House if the Minister could set out the details of those companies. It may not be possible to do so this afternoon, but he may be able to place something in the Library which we can see before Report stage—if, indeed, there is one.
Lord Hunt of Kings Heath: In answer to the final point made by the noble Baroness, we shall, of course, need to set out guidance and procedures to ensure that the management of such companies is conducted properly and that we do not, for example, face a situation in which an NHS trust becomes rather over-entrepreneurial and seeks to make money at the expense of its core activities. We are clear that spin-off companies should enable the NHS to see a return. However, that is based very much on taking advantage of the work being done within the NHS trust. I shall find what information I can to send to noble Lords and to place in the Library before Report stage. However, clearly further work needs to be undertaken following the passage of this Bill.
In relation to the Secretary of State walking away from an agreement, I very much hope that that does not happen; indeed, I have been encouraged by the discussions that have taken place between the department and various potential public/private partners in the whole area of public/private partnership. Of course, the intention is that an agreement should be reached on the best way forward with a commitment on both sides to make the project work. I was simply answering the point raised by the noble Earl, Lord Howe, as to how to proceed in the event of a fundamental breakdown in the relationship. However, there will be a great deal of incentive on both sides to ensure that such a relationship does not break down.
The noble Baroness raised an interesting point in asking why this project will be more successful than others in improving the quality of facilities in primary care areas. I want to make two points about that. First, the Government will put money into the scheme so that it will be seen to have received commitment in a financial as well as a policy sense.
Secondly, because of the way that NHS LIFT will operate, there will be a greater opportunity to put together sensible programmes which will be successful. Perhaps I may give an example. At present, very often a problem in relation to primary care is that schemes are limited and small-scale and, therefore, are not particularly attractive to major investors. However, by batching together a number of different developments, savings can be made both in development and transaction costs.
A third area in which the project is likely to be more successful is in building up a residue of expertise. Again, at present, in attempting to sort out poor quality primary care facilities, a problem is faced in knowing where to turn in order to find expertise, particularly in relation to private sector investment. I believe that the whole package of NHS LIFT will be able to provide the type of expertise that is required.
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None the less, I believe that that is a great challenge faced in primary care. It fits together with our other plans to ensure that the resource allocation formula also provides financial incentives.
3.45 p.m.
Baroness Noakes: Perhaps I may press the Minister on the information that will be given when the new companies are set up. If I heard him correctly, he said that he would devote an extra chapter of the Department of Health's annual report to those companies and would give the information which Amendment No. 34 seeks to provide. The annual report is published six months or so after the end of the year. Therefore, if one of those companies were to be set up on, let us say, 1st April 2001, information might be made available to the public in October 2002. The amendment provides for early information to be given when one of those companies is set up.
I should be interested to know how the Minister saw information being made available to Parliament on a more timely basis. We must recognise that, in setting up those companies, significant financial commitments could be entered into, guarantees given by the Government, and significant projects could be entered into whether the Government have a minority or majority interest; that matters little. When the Government are involved in such companies, many issues are raised with regard to the Government standing behind the companies. Perhaps I may press the Minister on what information he envisages will be made available to Parliament in advance of the Department of Health's annual report.
Lord Hunt of Kings Heath: I rest my case on the information that I have already given. In terms of appropriate parliamentary reporting, the Department of Health's annual report provides the necessary information to ensure that Parliament is aware of what has occurred. The noble Earl, Lord Howe, hinted at the fact that it would be premature to bring information before Parliament at an early stage in the discussions or agreement. I believe that the suggestion in relation to a short period of retrospection would discharge appropriate information to Parliament. After all, as the noble Baroness said, the information would be available only a few months after the end of a financial year.
Baroness Noakes: Perhaps I may make the point that there would be a potential delay of 18 months after a transaction had occurred. That is rather a long time.
Lord Hunt of Kings Heath: I accept that, but we are not talking here about a requirement for parliamentary approval to be given. That is a matter for agreement between the Secretary of State and any of the companies involved. The question is how that action should be reported. I really believe that a period of six months or so after the end of the financial year is appropriate and, indeed, consistent with reporting by the previous government.
Earl Howe: I am grateful to the Minister for his very full reply and for the number of helpful assurances that he was able to give me. I shall obviously read extremely carefully what he said.
Perhaps I may pick up two points. The Minister indicated in response to my Amendments Nos. 28 and 33 that it was inappropriate to suggest that the Secretary of State should automatically consider the private sector whenever there is a proposal on the table for a new project under either of those clauses. He referred back to the regime of compulsory competitive tendering which used to operate. That was not in my head when I tabled the amendments. The wording of the amendments is chosen carefully to ensure that the Secretary of State should consider whether the facilities or services in question can be provided most efficiently and cost-effectively through the involvement of the private sector. So, if he were to decide that a process of competitive tendering was not appropriate because it was not cost-effective, then that would not happen. I was sorry that the Minister was not able to take on board the point I made in the spirit in which I was trying to make it.
The second point to which I want to refer is a point which my noble friend has just mentioned; that is, the ability of the Secretary of State to use NHS LIFT to direct investment to where it is most needed. I queried whether as a shareholder in a minority company, the Secretary of State would have much leverage in that sense.
I was rather surprised to hear the Minister say that in the final analysis, the Secretary of State could walk away from the company. Unless I am completely wrong, NHS LIFT will essentially be a finance company. Because the Secretary of State will have only a minority holding, the borrowing of that finance company will be off the public sector balance sheet. Although that borrowing will be raised at commercial rates, it will be at very favourable commercial rates, by virtue of the Secretary of State's shareholding.
I am not sure how reassured the City will be to hear that the Secretary of State could simply walk away from such an arrangement. That is a surprising thing to contemplate because the private sector needs to be given as much confidence as possible. The taxpayer and the general public need to be given confidence that there is proper value for money for public funds.
We all look forward with great interest to what NHS LIFT will bring to us.
Lord Hunt of Kings Heath: Perhaps I may respond to that. First, we are earmarking £175 million for investment in NHS LIFT over four years. That is a very substantial degree of investment and it shows the degree of commitment which we have to making NHS LIFT work. Equally we want to move on as quickly as possible the refurbishment of primary care facilities in this country. That will certainly not happen overnight. Therefore, the City can look to continuing support and enthusiasm for what is planned from the Government.
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The point I am trying to make is that, if the Government have a shareholding in a particular company, they can do what other shareholders can do in companies, no more than that.
Earl Howe: I hear what the Minister says. We both hope that it will never come to that. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 28 and 29 not moved.]
Baroness Northover Baroness Northover moved Amendment No. 30:
Page 4, line 23, at end insert—
"(6) For the purpose of subsection (1) above, the Secretary of State shall make regulations to establish and require systems of operation that safeguard patient interests, in particular to ensure adequate care standards, accountability and transparency.
(7) Before making any regulations under subsection (6) above, the Secretary of State shall consult such bodies who represent the interests of those likely to be affected by the regulations."
The noble Baroness said: This amendment provides that the Secretary of State must make regulations to ensure that systems are in place which safeguard patients' interests, especially in ensuring adequate standards of care, accountability and transparency. It states also that before making such regulations, the Secretary of State,
"shall consult such bodies who represent the interests of those likely to be affected by the regulations".
In particular, this amendment would ensure that commercial interests were not put ahead of patients' interests. In another place, it was implied by the Minister in Committee that that provision is mainly about the provision of premises. I thought that might have been an accidental slip, but the noble Lord, Lord Hunt, with a long history in the NHS, also emphasised that in his reply to my noble friend Lord Clement-Jones. However, that is not what the Bill says.
The Bill includes services. Clause 4 permits public/ private partnerships to employ doctors and nurses and to provide clinical services. The remit of the private sector extends there into the mainstream NHS. I have severe reservations about that and the fact that this has been slipped in here and, therefore, there has been very little debate on the issue.
However, given that that is what it does, we must make explicit that patients' interests are paramount. Such arrangements must provide the highest standards of care. It is vital also that arrangements should be transparent and accountable. That is what this amendment would help to achieve.
The NHS should place patients and their interests at the heart of its thinking, regardless of how and where that patient is treated. I beg to move.
Lord Peyton of Yeovil: I do not wish to disturb the rather excessive calm of the afternoon but I find myself on what I hope is the Government's side. I hope that the noble Lord will not accept the noble Baroness's amendment for the very good reason that while I do not fall over backwards ever to applaud the inborn intelligence and vision of any Secretary of State, I

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cannot see how any Secretary of State addressing those problems can possibly fail to have in mind the need to establish and require systems of operation that safeguard patients' interests. If he is not interested in patients' interests, then, manifestly, he should not be in the job at all. We should not waste our time instructing the Secretary of State to do anything quite so obvious as this.
I will go so far as to say that Secretaries of State are not absolutely congenital idiots. To suggest that they need to consult those who represent the interests of those likely to be affected by the regulations is somewhat superfluous, to put it very mildly, and I hope that the Minister will reject the amendments.
Lord Hunt of Kings Heath: I find myself in agreement with the noble Lord, Lord Peyton. Indeed, perhaps it is an opportunity for me to plug again his excellent autobiography of ministerial life which no doubt he would consider to be a pattern of consistency across his own work as a Minister and what is being proposed here today.
He is absolutely right. Clearly, it is difficult to conceive of any circumstances in which a Secretary of State would agree to any of the proposals under these clauses were he not to believe that they were in the best interests of patients.
I do not want to go through a whole list of responsibilities, obligations, current regulatory checks and financial legal requirements that exist in relation to any action that is undertaken by the Secretary of State or NHS bodies in relation to the NHS generally and the use of these new powers, but they are extensive. There is the legal duty of the quality of care, clinical governance, the role of the Commission for Health Improvement, the NHS performance assessment framework, the NHS clinical governance support work and the establishment of the National Institute for Clinical Excellence. All those mechanisms—some noble Lords believe there are too many—are in place to ensure that the NHS operates in the best interests of the public.
I want to make it clear that Clause 4 does not seek to establish new ways of working for the private sector. Any service or facility delivered as a public/private partnership will need to be to a specified standard. That specified standard will be no different from that required of any other provider, whether in the NHS or the private sector. The sanctions that are in place within any contract to ensure a high quality of service and the requirement and duty on the Secretary of State and NHS organisations always to act in the best interests of patients and the public surely are safeguards enough.
4 p.m.
Lord Peyton of Yeovil: Courtesy obliges me to say how much I am indebted to the noble Lord for his kind reference to my autobiography. In fairness to the
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Minister, I should make it absolutely clear that, in the present political climate, I shall not be paying him any commission!
Baroness Northover: It is refreshing to hear such trust as the noble Lord, Lord Peyton, has expressed. I am obviously of a cynical, younger generation.
Lord Peyton of Yeovil: The noble Baroness speaks of "such trust". My tribute to Secretaries of State was that I thought that they were entitled to the assumption that they were not congenital idiots. I did not go very far!
Baroness Northover: I hope that he will be proved right. We shall see. The Minister reassures me and at this stage I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 4 agreed to.
Clause 5 [Income generation]:
[Amendments Nos. 31 to 33 not moved.]
Clause 5 agreed to.
[Amendment No. 34 and 35 not moved.]
Clause 6 [Terms and conditions of employment by health service bodies]:
On Question, Whether Clause 6 shall stand part of the Bill?
Earl Howe: At Second Reading the Minister took me to task for describing this Bill as a series of centralising measures. However, like it or not, in Clause 6 we have a classic example of a centralising measure. The clause creates a new power for the Secretary of State to intervene in laying down the terms and conditions of the staff employed by NHS trusts and primary care trusts. The explanatory notes speak of the need to modernise the NHS pay system—the word "modernise" is greatly overused—and the Government's desire to deliver better, fairer awards for staff.
No one can argue with the desire for fairness in the awards for staff, but why it is thought to be fair to have a uniform set of terms and conditions imposed from above on each area of the country is not explained. To me it is self-evident that different conditions of employment exist in different areas. Someone living in the south-east of England will have a higher cost of living than someone in the north of England. The quality of life in low-cost areas is often a great deal better than in high-cost areas. I am baffled as to why the Government want to treat those two cases as identical, instead of doing exactly the opposite, which is to recognise that the NHS needs local structures and local flexibility to address the problems that it faces in different areas.
The health service suffers from many difficulties, but in my opinion at the heart of all of them is the problem of recruiting and retaining staff. That problem will not be solved by regulation and direction-making powers that seek to determine the way in which every NHS trust and PCT deals with its staff.

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That is not what happens in the commercial world, where, typically, power and responsibility are devolved downwards.
When NHS trusts were first set up an important element in the design was operational freedoms. Managers of NHS trusts run complex businesses in which staff costs represent a major part of the annual budget. To deny local freedoms, as proposed by this clause, is a significant inhibition. Once you tell managers that they must abide by national regulations and directions, it is difficult to see what real freedoms exist.
I shall be glad to hear from the Minister that I have interpreted this clause in an over-literal way and that local flexibilities in the setting of pay and conditions will still be allowed to continue. Can the Minister tell the Committee how the Government view the future shape of pay structures being determined and the extent to which managerial discretion will play a role in such matters?
Lord Peyton of Yeovil: I am in the happy position of being able to agree with every word spoken by my noble friend. Not being restrained by the discipline of being on the Front Bench, I can perhaps be a little freer in the expression of my opinions. I rely entirely on the Explanatory Notes which on such occasions the Government kindly provide. Paragraph 48, with an air of novelty, states:
"The NHS Plan commits to modernisation of the NHS Pay system to deliver better, fairer awards for staff".
There is nothing new about that. I believe that generations of Ministers and Governments have aimed at precisely that. No matter how intelligent, or unintelligent, they have been, none of them can ever claim that their profound and continued efforts have resulted in total satisfaction for anybody in the whole of the National Health Service. We have been here before. What is the point of repeating exercises that so far have failed? Or is this to be something totally and fundamentally new?
Before I leave that paragraph and despite what I said about Secretaries of State not being congenital idiots, I go further and congratulate them on the degree of—I almost said courage, but that is the wrong word—daring that they show in promising this. If anyone believes them, I would place a large wager that their hopes will eventually be disappointed.
The next paragraph in the Explanatory Notes gives powers to the health authorities to employ people on such terms as they think fit. The sentence breaks off and this is added:
"but subject to regulations or directions by the Secretary of State or the National Assembly for Wales".
What on earth is the good of saying, "They can do what they like as long as they agree with me"? That is what the Secretary of State is saying. There is no point in doing that. All of us understand perfectly that neither the primary care trusts nor the NHS trusts could possibly act in the matter of salaries and awards without the consent and agreement of the Secretary of
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State. Why, in the name of conscience, do the Government not say so, instead of giving us all this flannel?
Baroness Cumberlege: Will the Minister elucidate one point for me? In dealing with Clause 6, the Explanatory Notes state:
"The NHS Plan commits to modernisation of the NHS Pay system to deliver better, fairer awards for staff".
The Minister will remember that during his distinguished career in the NHS we saw the rise of the pay review bodies. They were introduced because staff felt that the awards they were receiving were not fair. They felt that they needed an independent body which would assess their work and make recommendations about their pay and conditions.
Where in these provisions do the pay review bodies appear? Will the Secretary of State take into account their recommendations and will he either overrule them or agree with them?
A great benefit of the pay review bodies is that they take evidence from everyone concerned and it is published. Everyone in the NHS knows what is happening. However, the Explanatory Note states:
"Before making any such regulations the Secretary of State … would be required to consult representative bodies".
Does that mean that he will take evidence in the same way and will that evidence be published? If not, how do we know on what basis the Secretary of State is making the decisions?
Lord Hunt of Kings Heath: We return to the debate which has run through all our discussions in Committee; that is, the balance between national determination in relation to the NHS and local freedom of action for NHS employers.
I was interested in the noble Lord's analysis of efforts made by previous Ministers to deal with pay, staff and recruitment in the NHS. Looking back over 52 years of the NHS, we see that during most of its life a centralised system of pay determination was undertaken through the Whitley councils and latterly through pay review bodies in relation to doctors, nurses, midwives and health visitors. There was little discretion at local level and that became frustrating for local employers.
In response to that, the previous government introduced local pay but in the end that was not successful. First, it is interesting to note that, although most trusts introduced local contracts of employment, the vast majority of those contracts simply mirrored national agreements. Therefore, although the procedure could be defined as local pay determination, in practice it was still local administration of national agreements.
Secondly, a wholesale translation of decisions on pay to local level ignores the fact that the NHS is a national service. Often, as regards the group of staff we are seeking to attract, there is a finite number of people whose sole employment is within the NHS. In those circumstances, it does not make sense to have a free-for-all at local level.

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Thirdly, the failure of local pay determination, as the previous government tried to introduce it, was also due to the fact that those in the NHS never wanted it and never accepted it. There were always problems when not only the workforce but managers were not signed up to the devolvement.
We are trying to get the balance right.
4.15 p.m.
Lord Peyton of Yeovil: We can all recall and remind ourselves of past failures and shortcomings. However, I am asking the Minister to enlighten me on how the Secretary of State will improve on matters with his interventions. What magical balm will he breathe over these awkward problems?
Lord Hunt of Kings Heath: I was just coming to that. We were faced with a local pay system which was not working, disparate employment practices and an inflexible structure at national level. For example, even as regards Whitley contracts which are agreed nationally, there are large variations in payments between different staff groups for, say, working unsocial hours and overtime rates. That makes it difficult at local level to introduce team working and to break down barriers between professions.
In answer to the noble Lord, Lord Peyton, in discussions with staff organisations we are proposing to get the balance right between the national framework for employment, which the clause will help ensure is followed in every NHS trust, and the local flexibility needed by individual employers in the NHS. For instance, if the current negotiations are successfully concluded, we will give NHS trusts local flexibility over defining the skills and knowledge needed to do particular jobs, but a national framework for core skills and knowledge applicable to all staff in similar jobs. Again, we would give trusts the freedom to determine the working patterns which they need to deliver services, but a consistent and simplified framework for rewarding staff whose working patterns are particularly demanding.
Returning to what the noble Lord, Lord Peyton, said, it is not the intention to regulate for everything that must be done at local level. That is why the Bill allows for trusts to retain their existing freedoms to decide whom to employ and to reach local agreement about terms in the areas where regulations and direction have not been made.
Most NHS terms and conditions are already determined nationally for most staff, and have been under successive administrations. In the light of that, many employers have already indicated their desire for an approach to contracts that is somewhere between purely national and purely local by developing what they describe as hybrid contracts. That would include some local elements but also replicate or import many of the terms and conditions in national contracts.
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The clause seeks to develop that intermediate approach further by defining a national framework where that is to the advantage of the NHS nationally, leaving other matters to local employers where there is advantage in so doing. A good example of that is in job evaluation. Under the current national system, jobs are defined centrally and pay is determined centrally. Under the new system currently under negotiation, jobs can be defined locally. If a trust identified the need for someone who combines skills for different occupational areas, it would be able to devise such a job. It would not need to have a central edict telling it how to do it.
I say to the noble Earl, Lord Howe, that in determining pay, a trust would also have the facility to make allowance for labour market shortages. However, the long-run basic pay for the post will need to be determined by a nationally agreed job evaluation system in order to ensure consistency with equal pay principles and thus protect the NHS from subsequent equal pay claims.
I accept that there will always be debates about where the balance between national and local rests, but I do not believe that it detracts from the principle of trying to get local flexibility. However, where national guidance and direction is required, the procedure will enable that to happen.
As regards the points raised by the noble Baroness, Lady Cumberlege, about pay review bodies, the position remains the same. It is the job of the independent pay review bodies to make recommendations. It is then up to the Government whether or not to accept them. I believe that the record of the current Government in accepting the recommendations of pay review bodies is absolutely excellent, in sharp contrast to previous efforts where phasing was introduced in providing awards. That was a very demoralising factor for NHS staff.
In the end, no one can pretend that to devise a pay system which meets everyone's desire is easy. As to that. I accept the strictures of the noble Lord, Lord Peyton. But where we can make progress on agreements with staff organisations at national level, which in the main allow for a national framework that is put in place locally, we need the powers provided in the Bill.
Baroness Cumberlege: We could have a ding-dong on this matter. It is true that the previous government phased awards, but the Labour government before them were alone in failing to honour nurses' awards. If the framework is already set by the pay review body and Whitley councils, what will happen to the Whitley councils in future? The previous government introduced local pay which provides the flexibilities about which the Minister speaks. I believe that this clause usurps the agreed framework of the pay review bodies and the Whitley councils and substitutes the Secretary of State. As to that, there are real reservations on this side of the Committee. Secretaries of State come and go. It is right that National Health

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Service staff should know where they stand. They should be aware of the framework and have an input into it, as they do now.
Lord Hunt of Kings Heath: The discussions with staff organisations and employers have shown great support for the direction in which we are proceeding. I believe that nothing I have said could undermine the role of pay review bodies. They are independent bodies which make recommendations to the Secretary of State. If we want a modern pay system, the real problem is that there are different groups of staff with different terms and conditions at local level. That is inflexible and sometimes it is very difficult to enable staff to cross professional barriers. The NHS Plan is very keen, rightly so, to try to break down some of the professional barriers. Job evaluation is a very important component in trying to break down those barriers so that there is greater consistency of approach between different staff groups. That will not work unless there is confidence that when agreement is reached at national level it will be implemented at local level. But the whole purpose of an area like job evaluation is to allow for local flexibility, and that is why the power would be used only when it was needed. As always, we wish to ensure that there is as much local freedom as possible.
Earl Howe: I thank the Minister for his comments. I am also grateful to my noble friends Lord Peyton and Lady Cumberlege whose remarks are, as ever, 100 per cent apposite. Despite the Minister's reasonable tone, there are lingering worries about the clause. The noble Lord spoke about the setting up of a national framework to facilitate hybrid contracts of employment. I cannot help but believe that, at the end of the day, the local flexibilities which remain will be a good deal narrower than those that obtain at present, which is a pity.
I should like to put one further question to the Minister, who apparently seeks to respond in any case. I may have an unworthy suspicion. Can the Minister tell the Committee whether the clause is perhaps a Trojan horse? Is it seen by Ministers as a means by which a consultant contract could be imposed unilaterally by the Government?
Lord Hunt of Kings Heath: Of course, this clause could be used in relation to the employment of doctors. But I assure the noble Earl that the current situation causes real problems for local employers in securing the flexibility they want. Even with the so-called freedoms on local pay, which they have very great difficulty in implementing, the health service is hidebound by years of tradition and national agreements, all of which produce different terms and conditions for different groups of staff. If at national level we can sort out a good deal of that, we can provide greater flexibility at local level and ensure that as between employers and different staff groups there is more effective team working because of greater consistency of approach.
Clause 6 agreed to.
Lord Clement-Jones Lord Clement-Jones moved Amendment No. 36:
After Clause 6. insert the following new clause—
"COMMUNITY HEALTH COUNCILS: ADDITIONAL FUNCTIONS
(1) The Secretary of State shall make regulations providing, in relation to Community Health Councils ("Councils") in England, for—

(a) the delivery by Councils of support and advocacy services to patients and others with complaints about health services;

(b) Councils to advise and make recommendations to the relevant overview and scrutiny committee, Health Authority and trust about matters arising from complaints;

(c) reports on the operation of the complaints support service to be compiled by Councils and provided to the Secretary of State to the relevant overview and scrutiny committee, Health Authority, trust, and other appropriate organisations;

(d) annual reports to be published by Councils detailing the arrangements maintained in that year for obtaining the views of patients;

(e) the establishment of sub-committees of each Council to be known as Patients' Forums, for each NHS and Primary Care Trust in the district of the Council, made up of representatives of the Council, and co-opted representatives of the local authority overview and scrutiny committee, patients, carers and the wider community, with duties to—

(i) monitor and review the operation of services provided by, or under arrangements made by, the trust to which it relates;

(ii) obtain the views of patients, carers and the wider community about those services and report on those views to the Council and the trust;

(iii) provide advice and make reports and recommendations about matters relating to those services to the Council, the relevant Health Authority, and the trust to which it relates;

(iv) make available to patients, carers and the wider community advice and information about those services;

(v) in the case of primary care services, carry out the functions as may be prescribed by regulations made by the Secretary of State;

(vi) carry out such other functions as may be prescribed by regulations made by the Secretary of State;

(f) the appointment of representatives from the Patients' Forum as non-executive directors to the board of the trust to which the Forum relates;

(g) for functions of Patients' Forums to be performed under joint arrangements between Councils, where such arrangements are appropriate to meet the needs of their communities;

(h) the extension of Councils' rights of inspection to all premises from which services as defined in subsection (3) are provided; and

(i) matters of concern which Councils may refer to the National Institute for Clinical Excellence, the Commission for Health Improvement, the Audit Commission and the Secretary of State.

(2) References in subsection (1) to "services" are references to—

(a) services provided as part of the health service (within the meaning of the 1977 Act) in England;

(b) services provided in England in pursuance of arrangements under regulations under section 31 of the Health Act 1999; and

(c) services provided elsewhere in pursuance of such arrangements with a local authority in England.

(3) In subsection (2)—

(a) "relevant overview and scrutiny committee", means the committee of the council or councils whose district corresponds, or is included within, the community represented by the Council,

(b) "relevant Health Authority" in subsection (1)(e) in relation to a Patients' Forum for a Primary Care Trust, means the Health Authority whose area is, or includes, the area for which the trust is established.

(4) Before making regulations under this section the Secretary of State shall consult with Councils and such patients' and carers' organisations as he considers appropriate."
The noble Lord said: The Committee moves on to what I believe will be one of the most contentious parts of the Bill. I do not intend to rehearse all the arguments against the current structure set out in the Bill which many of us on all Benches expressed at Second Reading and in other debates in this Chamber. In moving Amendment No. 36, I should like to speak to Amendments Nos. 85, 88, 90 to 95 and 139, but not 136 and 137, which should come later in the Committee's deliberations.
I should like to present a menu of possibilities which the Minister may care to inspect. Both in Committee in the other place and, to some degree, in the run-up to this debate the Government have demonstrated some flexibility in relation to the pattern that they tried to establish in the national plan, which was a hasty concoction. They produced for our inspection a very fragmented plan which effectively disaggregated consultation from advocacy, advocacy from scrutiny, scrutiny from representation, and so on. We were in danger of being left with so many different bodies doing different things that the public would be even more confused than we as politicians might be. A number of these amendments try to bring some of this together.
Various approaches are reflected in the amendments. The first one, which is reflected in Amendments Nos. 36, 85 and, to a degree, 88, is more or less a return to a reformed status quo. The amendments try to indicate that the way forward is to build on the existing CHCs. It is probable that too much water has gone under the bridge for that approach to be the right one to adopt. Nevertheless, in passing many of us believe that that is the approach which the Government should have adopted originally, and if at later stages of the Bill in this House the Government do not demonstrate flexibility, that might be the approach that we would be forced to take, simply because there would not be time to adopt a structure which would build in more of the powers and safeguards that we believe are right. I simply place that on record for the benefit of the Minister.
The second approach is not to be very prescriptive about the way forward. Amendment No. 139 attempts to put together something along those lines. One may say that reform is necessary and the Government should have powers to achieve it. That does not appear to be wholly satisfactory, since obviously Ministers are given far too much discretion on which to build. Nevertheless, it has the benefit of preserving the CHCs
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in a transitional period and would allow the Government to take rather longer over this somewhat hasty set of reforms.
The third approach, which, for the purposes of this Committee, we on these Benches prefer, is to try to pull together and add to the powers of the patients' forums and patients' councils to give them some additional meaningful powers and duties. In particular, would commend to the Minister Amendment No. 92, which provides for independent advocacy services to be brought into the net of the patients' councils. We believe that it is very important that there should be a clear nexus between the two. That nexus is not sufficiently clear under the terms of the current Bill.
We believe that further, more radical restructuring is required so that the patients' councils, rather than the patients' forums, become the units on which we can build. The patients' forums are in danger of proliferating. If we had a patients' forum for each trust, we would have a large number of patients' forums, which would make it difficult for members of the public to identify who was leading in terms of consultation, representation, etc. We believe that the patients' councils should form the key units, with the patients' forums essentially bolting underneath them.
Amendment No. 94 grants further power to the councils. Amendment No. 97 includes coverage of the complaints system, which we believe is a very important function performed (perhaps non - statutorily) by the CHCs and should be continued by the patients' councils. In passing, we also believe that the complaints system should cover not only acute trusts and other parts of the NHS but also care homes and the independent healthcare sector. We have previously debated that point. However, I believe that the Minister's reaction to it would be of great benefit.
I should emphasise certain key points about these amendments, many though they may be. I think that if the independent advocacy services were pulled under patients' councils, we should have made great progress in this matter. In addition, if the oversight of the new complaints system, however it is shaped, were in the hands of patients' councils, many of us would feel much more sanguine about the scheme that the Government have adopted. I beg to move.
4.30 p.m.
Earl Howe: I rise to speak to my amendments included in this group, namely, Amendments Nos. 85 to 88, 90 to 95 inclusive, 97 and 319.
Those amendments, like those of the noble Lord, Lord Clement-Jones, leapfrog us forward to Clause 13. Perhaps I may begin by saying that, in tabling almost every one of my amendments to this part of the Bill, my main aim was to try to make the structures proposed by the Bill more coherent, less confusing, and generally more joined-up. These amendments to Clause 13 are perhaps the most important in that category. Although at first sight they may seem complicated, they are in fact designed to rationalise and improve the fragmented arrangements that otherwise appear to lie in store for us.

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The Minister knows my strongly-held views on CHCs. There are effective ones and less effective ones. The best are excellent and achieve a very great deal on behalf of patients and the community. Others have not made such an impact. Unless I misrepresent him, I believe that the Minister is of the view that CHCs overall have failed to live up to the promise that they generally enjoyed when they first started in 1974, and that he uses that argument to justify their abolition.
My view is different. I believe that the rational approach would be to consider the powers and functions of CHCs, decide what are their good points and which of them are worth preserving, decide also how they are deficient, and then work towards reforming them.
As currently constituted, CHCs have a great deal going for them. Perhaps their most obvious useful feature is that they are a one-stop shop. They combine the role of watchdog with that of complaints handling. They have the right to be consulted in the planning and operation of services and to make recommendations about those services. They inspect premises, including private sector premises. The best CHCs have established advocacy services as part of their day-to-day functions. Every CHC has the precious privilege of a direct line to the Secretary of State. Above all, they are valued, and hence respected, because they are independent.
I therefore suggest that the extent to which the CHCs have failed to deliver is not the fault of their structure. It has much more to do with the level at which they have been resourced and the fact that their powers are not sufficiently all-embracing. Advocacy has never been a statutory duty of CHCs, but many CHCs have either supported or provided advocacy services. We should try to build on that.
It will not be an easy task to reshape this Bill to give effect to what I have just said. However, I believe that it is possible to take a number of the Bill's provisions as the starting point for effective reform. In so doing, we should aim to deliver both what the Government would like to see, which, I take it, is an enhanced degree of involvement and empowerment for the patients and the public, and what I would like to see, namely, a way of building on the inherent advantages and merits of CHCs, and, in that process, provide better and more effective CHCs. Like the noble Lord, Lord Clement-Jones, I suggest that the way to achieve that is through patients' councils. I believe that CHCs, if reborn as patients' councils, would be a major move in the direction of rationalising the fragmented structures currently proposed by the Bill. That rationalisation would also serve to reconcile what I fear is an otherwise irreconcilable gap between us and the Government. Patients' councils would preserve the existing structures for patient representation and advocacy, except that independent advocacy would become a new core function.
To give effect to this, I have transposed the key elements of Clause 17 to Clause 13, with the notable additional feature that the advocacy role undertaken
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by patients' councils would extend to patients of private hospitals and care homes. Patients' councils would be able to report and make recommendations to NHS bodies, to local authorities and to the Secretary of State, thus facilitating the essential sharing of information. Like CHCs, they would have a statutory right to be consulted by health authorities, and they would have the right to whistle blow.
I suggest that it would make a great deal more sense if patients' forums, instead of being separately constituted bodies, were established as subcommittees of patients' councils. In that way, there would be absolutely no doubt in the public's mind as to the independence of patients' forums, which, rightly or wrongly, I fear may be an issue in the future if the Government proceed. Under my model, there would be no prospect at all of the members of patients' forums feeling isolated or lacking in proper support.
One of the beauties of that approach is continuity. Looking at the Government's proposals, I confess that I am worried about the transitional arrangements that may be put in place, and about the expense of running two systems in tandem, which for a while would doubtless be necessary. The benefit of enabling CHC personnel, with all their expertise, to continue in post would be obvious. As I said at the beginning of my remarks, these amendments may seem daunting. However, I hope that the logic is clear and that the Government will take them in the constructive spirit in which they are offered.
Baroness Cumberlege: I strongly support my noble friend's amendments. There is a feeling, which I am sure the Minister will seek to dismiss eloquently, that the proposals now tabled have not been very well thought through, and that one structure has been piled upon another to resolve any problem that exists. I have tried really hard to get through this issue. Your Lordships will know that I am a slow learner. I have looked at the whole issue from a patient's point of view. I am not looking at the matter from the point of view of a community health council, but from that of a patient, a complainant, someone seeking redress.
I have called my patient Mrs Archibald. Mrs Archibald, aged 80, suffers a stroke one night. Her relatives contact her GP who refuses to come out. They dial 999 for an ambulance. There is a long delay before the ambulance arrives. On arrival at the hospital Mrs Archibald is left on a trolley in the A & E department for three hours before being seen by a doctor. She spends a further 14 hours before being sent to a surgical ward. That is because the medical wards are full and there is no dedicated stroke unit. Her stay in hospital is three weeks longer than necessary as no suitable place can be found to meet her very dependent needs. On leaving hospital she is inappropriately assessed. She is sent to a residential home instead of a nursing home which she requires.
That short vignette raises six associated policy issues: first, the access to a GP out-of-hours; secondly, the response times of the ambulance service; thirdly, the performance standards in the A & E department;

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fourthly, stroke care; fifthly, delayed discharge; and, sixthly, quality and multi-disciplinary continuing care assessment.
As is so often the case with complainants, Mrs Archibald's daughter is keen that no other patient should endure what her mother has suffered. She wishes to prevent that happening by making a complaint. She has heard of the PALS system, but since this case arose at night none was on duty. The Minister would agree that even if they had been on duty, it is doubtful whether they would have been able to persuade a GP to turn out at night. The ambulance trust PALS and the PALS in the hospital would have had a problem to expedite the ambulance or to overcome the shortage of beds that night.
In this case three patients' forums have a policy remit: the PCT forum, the ambulance trust forum, and the hospital trust forum. Mrs Archibald's daughter goes to the patients' council with her complaint. The council "anonymises" the details and sends the complaint to the three chairs of the three forums. Each chair is a non-executive director of the corresponding trust. Each forum discusses a section of the complaint relevant to that trust and asks the respective chair to raise the issue at the next trust board meeting.
The chair of the hospital forum is reluctant because it has recently had a great deal of bad press over its A & E service. The trust chair has instructed all the non-executives to try and promote a positive image. The forum non-executive agrees to raise the issue in the private part of the meeting after the press and the public have been excluded. However, that means that he cannot report back to the relatives as he has a duty to keep the discussion confidential.
The PCT forum's non-executive raises the issue of GP out-of-hours services. Although, through the health authority, the board can influence the generality of out-of-hours services, it cannot influence the services a GP directly provides because he is an independent contractor. There is no patient's representative on the health authority to raise the policy issue.
The ambulance forum non-executive raises the issue of response times. The board agrees that it needs more money from the commissioning bodies to improve these times, but it does not know if it will be forthcoming and "unbadged". There is no forum where discussions on delayed discharges and multidisciplinary assessment can be raised.
Mrs Archibald's daughter is advised to raise these policy issues with a local authority scrutiny committee. She could also write to the PCT forum concerning the NHS element of the multi-disciplinary assessment. The scrutiny committee discusses the delayed discharge and agrees that it is very unfortunate that the council's cabinet decided to cut the social services budget. It will make a report to that effect. It does not have time to consider the issue of multi-disciplinary assessment as its work programme is over-committed.
The relatives are thoroughly dissatisfied, but they have no redress against the scrutiny committee for its refusal to consider these matters, although, of course,
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I suspect that they will vote against their local council in the next election. In the meantime, the exhausted daughter is becoming increasingly concerned about the council's residential home and the inappropriate care given to her mother. She seeks out the independent advocacy service provided by the patients' council. The advocate is employed by the local authority, either directly or through the patients' council. The advocate is clearly nervous about giving even informal advice about the local authority issue as his contract is held by the local authority. In addition, he has no remit over the care sector. The complaint process continues for 18 months and the relatives finally give up.
Noble Lords will agree that this is a monolithic labyrinthine system compared with our present system—a one-stop shop, locally-based, accessible and known to the local community, with statutory powers. The Government are proposing three sets of PALS, three different forums, a patients' council, a local authority scrutiny committee and an independent advocacy service.
At the moment, Mrs Archibald's daughter could deal with one body which is able to handle all aspects of the problem except the quality of care in the residential home. That is an issue that needs to be addressed, and has not been addressed in the Bill. Within CHCs lines of accountability are very clear. In these proposals there is an inbuilt conflict of Interest between the non-executive appointees to the trust board and their loyalties to the forum. Even the Institute of Directors questions how corporate responsibility can work with this half-baked system. Furthermore, as Elizabeth Manero is quoted as saying in this week's Health Service Journal, the independent advocacy service, if commissioned by local authorities as suggested in the Bill, ensures a conflict of interest between representing users of joint health and local authority services.
CHCs have been seriously unpopular with the Secretary of State, but were lavishly praised by the Prime Minister. When the CHCs celebrated their 25th anniversary the Prime Minister's agent wrote:
"Tony would certainly like to add his congratulations to the work the CHCs have done over the last 25 years and wishes them every success in the future".
Those are odd words to choose when signing a death warrant.
And the Secretary of State continues to plot that death sentence. The truth is that the CHCs hold the truth— how it really is—and the Government cannot bear the criticism.
As Donna Covey, the director of ACHEW, in an article by Anthony Browne, the health editor of the Observer, said:
"Getting rid of the CHCs will not get rid of the problems for the NHS, but it might make them more difficult to detect".
She is right. In all public services we need a regulator, an independent scrutineer to detect the problems. It is right that they should carry out surveys of trolley waits, waiting times for out-patients' appointments, dirty kitchens and so on, but the big picture is often gleaned from the individual complaint.

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It was complaints to the CHC which brought to light events at the Bristol Royal Infirmary, the Alder Hey Children's Hospital, and the situation of Mr Rodney Ledwood, Harold Shipman and others. An article in The Times headed "Complaint by patient uncovered list scandal". which appeared last Saturday, stated:
"A telephone call from one disgruntled patient led … investigators to discover the waiting list scandal at Stoke Mandeville Hospital. The patient was fed up at hearing official claims that only a handful of patients nationally were waiting longer than 18 months for treatment".
That is the point. Every government are prone to exaggeration of their achievements. Claims are made and when probed turn out to be somewhat fragile. A complainant needs the confidence that there is an independent body which will not only take up his complaint but will piece complaints together to build a big picture.
Finally, it is surprising that the General Medical Council, the BMA and other professional bodies have been championing the retention of CHCs. One might think that they were an irritant to such bodies. That is not so. They recognise that CHCs, with their coherent and comprehensive role, are a safeguard to maintaining quality in clinical care locally and, with the establishment of a national body to which we shall come later in the debate, nationally, in providing the big picture.
I strongly support the amendments put forward by my noble friend. They aim to bring the system together in order to be coherent, to be more joined up and to give patients a chance to understand the complaints system and to have confidence that it will be really effective.
Lord Weatherill: I support what the noble Baroness, Lady Cumberlege, said about the amendments proposed by the noble Earl, Lord Howe. As the Committee may know, I represented the Borough of Croydon for many years and I have been urged by Croydon Council to participate in this debate. I shall do so briefly because I am not the kind of expert in these matters that the noble Baroness is.
What has been said is absolutely right. The amendments would give continuity to the present system, in contrast to what the noble Baroness said about the various other bodies that would be involved if the Government have their way in this matter. Croydon Council recently passed a unanimous resolution. My contribution will be to read it to the Committee. It states:
"This Council is proud of the way that the Croydon Community Health Council provides a strong and independent voice for the people of Croydon on NHS matters and is proud of the way that the CHC carries out its functions as the local watchdog. This Council judges that the involvement of an independent watchdog role is essential in helping the Council undertake its proposed new responsibility for scrutiny of the NHS and in adding cohesion to. and commanding public confidence in, other initiatives proposed in the NHS Plan. This Council encourages the Healthy Croydon partnership to include the expertise of the present CHC in developing a future model of health scrutiny and patient advocacy in Croydon".
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I suspect that that resolution, if not passed by other councils, will be equally strongly felt by them. It is in that spirit that I warmly support this group of amendments.
Lord Peyton of Yeovil: I agree with every word said by my noble friend Lady Cumberlege, who served with distinction in the Department of Health and therefore knows far more than I do about this matter. I hope that the Minister will take note of what she said and will perhaps be influenced by it.
We are in a slightly awkward position. I make no criticism of the noble Lord, Lord Clement-Jones, but we are discussing an amendment which suggests that the community health councils should be given extra powers. Later in the Bill, however, community health councils are to be abolished. I should like to ask the Minister two questions. I hope that his answers will be fairly specific. What have community health councils done wrong? I do not include under the heading of "wrong" becoming a thorn in the flesh of Ministers. Ministers frequently deserve and fully earn the painful injection of a thorn in the flesh. I would not object to that. I want to know what the Government hold against community health councils, apart from the fact that they are a source of inconvenience to themselves. What I am driving at is that I do not believe that causing inconvenience to Ministers is necessarily or indeed at all a cardinal sin.
The Bill is in such a muddle that I do not know the correct order in which to take matters. In dealing with the abolition of community health councils, we have left on one side for a moment the question of scrutiny committees. The very thought of scrutiny committees, directed by Ministers, is a source of horror to me. I very much suspect that, like many such committees, they will consist of a mixture of people whose time would probably be better used elsewhere and people with nothing better to do elsewhere who find themselves on yet another committee.
I do not claim the knowledge of my noble friend, but I am chairman of two charitable trusts. As such, I fairly frequently go to hospitals and universities. In both I hear the same lament—that there is too much bureaucracy and too many committees. I do not see in the Bill any remedy to that. Perhaps I may remind the Minister that not long ago I asked a Question. It was a very unfair question. I asked the noble Lord how many committees were sitting under the aegis of the National Health Service. Very reasonably, the noble Lord said that he did not know. No blame is attached to him for that. My Question was the height of optimism. The only thing that could have been slightly worse would have been to ask him to say how many grains of sand there are on a piece of sea shore. Somewhat naturally, the noble Lord gave the very honest answer that he had not the slightest idea. I urged him then to get out his gun and shoot a few of them.
Lord Hunt of Kings Heath: If the noble Lord recalls, I offered to set up a committee to see whether we could find out the number of committees.
Lord Peyton of Yeovil: If the noble Lord had been prepared to arm that committee with penal and terrible powers, I would have supported him.
I have two questions. First, why are the Government displeased with community health councils? Secondly, is it the intention—this is my suspicion—that in future scrutiny committees will be asked to fill the role now carried out by community heath councils? I should be grateful for answers to those two questions.
Lord Rea: With this group of amendments and his introduction to them, the noble Lord, Lord Clement-Jones, has given us an opportunity to canter around all the various successor bodies that it is proposed will follow the CHCs. Grouped together, the amendments begin to provide a rational framework as to how they should relate to each other. I hope that my noble friend has given them serious scrutiny.
I very much commend the linking of the functions of the independent advocacy services with the patients' councils so that the councils can learn the lessons that come from patients' complaints to the advocacy services. Similarly, at a lower level, the patients' forums will be able to pick out from the trusts—even perhaps liaising with the PALS—some of the more local complaints and feed them up to the patients' councils themselves. I hope that that will fulfil many of the functions presently undertaken by the CHCs. As we come to later amendments, we shall be able to examine this in more detail. However, I believe that this general framework provides an extremely good start.
5 p.m
Baroness Masham of Ilton: Great concern has been expressed that the patients' forums and councils will not be independent of the health trusts. To feel comfortable, patients or their representatives need to be totally independent, as should the members of any body representing patients. At the moment, CHCs can delay the closure of hospitals rather in the same way that the House of Lords can delay legislation. I should like to ask the Minister this: can the bodies being proposed by the Government delay hospital closures?
I feel that the Government should build on CHCs to make them more effective. Sometimes patients need easy access to help and advice. They need to know where to go without the risk of confusion. I agree with the noble Earl, Lord Howe, that there should be an overall watchdog for all patients, NHS or private.
The Government's proposals here look very fragmented. That is just what patients do not need. We should seek to avoid confusion and fragmentation. Surely, this is something that, with the goodwill of the Minister, we can get right in your Lordships' House.
Lord Harris of Haringey: The noble Earl, Lord Howe, suggested to my noble friend Lord Hunt that the reason why the Government have proposed the abolition of the CHCs is that they had failed to live up to their early promise in 1974. However, I have to say that I am not clear about exactly what was that early
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promise. If one reads the documents produced at the time, it is clear that, as the concept of community health councils was being created—the aim was to reintroduce a level of democracy into the health service because the then government had removed great chunks of it during that year's reorganisation—bright civil servants thought of many new duties which could be given to the new bodies.
The reality was that CHCs were created as a hotch-potch of powers and responsibilities, none really worked through. Interestingly, a parallel can be drawn with some of the proposals before us in that it is clear that an incremental approach was then adopted as regards what CHCs should do, just as the proposals before us today have grown considerably from those originally contained in the NHS Plan. However, the result of that difficult beginning for community health councils—here I am conscious that my noble friend Lord Hunt was one of the foundation CHC chief officers at the time—is that a series of problems was inherent in the operation of those bodies.
First, although CHCs were more independent than the proposed PALS might be, they were not truly independent of the local health authority structure. I hope that, during the course of our debates in your Lordships' House, it will be possible to ensure that whatever is brought forward to replace CHCs is given genuine independence from the local NHS structure.
Secondly, concerns were expressed about resources. I can recall reading a report on CHCs which described them as bodies comprising one man and a dog. The expression was decried at the time for being rather sexist. Perhaps more pejoratively, they were described in terms of, "How many times can you re-use a teabag?". That indicates the extent to which resources were limited. Over time, successive governments have made available rather more resources to CHCs, but in reality an enormous expectation has been placed on what CHCs could achieve without necessarily providing the resources to ensure that such expectations could be met.
However, the biggest weakness here, and perhaps the reason why successive governments have considered this problem—we should be clear that over the past 20 years, successive governments have considered the abolition of CHCs—is the fact that no proper mechanism was built into the legislation concerning the quality control and performance management of CHCs. As a consequence, a wide variation has grown up in the way in which CHCs interpret their role and the quality of the work they undertake. That is a strong reason why a number of people, including myself when I was the director of the Association of Community Health Councils, acknowledged that it was important to reform the CHCs and to develop their role in addressing relevant issues.
It is clear that widespread dissatisfaction was felt both in your Lordships' House and elsewhere with the initial proposals that emerged from the NHS Plan. However, major developments have taken place and the Bill now before noble Lords is nearly there in terms

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of addressing some of those issues. That is why I have some difficulty with this group of amendments. As the noble Lord, Lord Clement-Jones, acknowledged, we have in effect an à la carte menu of ways in which the problems in relation to CHCs or the Government's proposals might be addressed. Indeed, while listening to the noble Lord's speech, it was difficult to work out exactly which of his à la carte amendments he was interested in pursuing and which had been added merely as fallbacks in the event of, say, the first 15 proposals failing for one reason or another.
Nevertheless, the noble Lord made certain key points, one of which was that it is essential that the principle of independent advocacy, properly made available to the public, should be enshrined in the Bill. That is entirely consistent with the general objectives set out in the NHS Plan. But the manner in which the proposals are presently contained in the Bill, following amendments made in another place, does not make it absolutely certain that such independent advocacy arrangements will, in practice, be independent of the local trust or the local service. That must be remedied, whichever of the à la carte amendments is favoured or in terms of whatever response to the debate will be made in due course by my noble friend.
I believe that it would make sense for those independent advocacy arrangements to fall within the ambit of the new patients' councils. That is important because one of the main strengths of CHCs has been their ability to draw from their experience, based on the wide range of functions they perform, and to learn the lessons. They have learnt both from their advocacy work and from their complaints work. For that reason, it would be extremely sad if the independent advocacy arrangements to be put in place do not permit the learning of lessons from cases being pursued, so that those results can be applied elsewhere in the health service.
We need to address one other point: the question of independence. During the debate on Second Reading, I referred to the strange position of the staff of CHCs. We have an opportunity, during our discussions on these amendments and other amendments later this evening, to address precisely that question. We must ensure that we do not put in place the strange situation where staff are seen as accountable at a local level to the local health service. Furthermore, the question of resources needs to be taken away from the local decision-making process. It needs to be seen as something that will not be dependent on whether the CHC or patients' council—or whatever body is finally agreed on—has offended local NHS managers.
Major changes were made to the Government's proposals in another place. First came the specific proposal to set up a patients' council in all areas. That clearly signals the need to build a structure which is at least as good as, if not better than, the existing arrangements. The second change was the introduction of the clause about independent advocacy, which, as I said earlier, is nearly there but not quite enshrined. There is a lack of clarity, and that is why changes need to be made.
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The noble Baroness, Lady Cumberlege, who spoke about the worthy Mrs Archibald and her problems, suggested that what we have before us today was not thought through initially and is still not thought through. We have the opportunity in this debate and in considering the amendments to make sure that the system is integrated; that it works better than the existing arrangements through CHCs; that it is genuinely independent; and that it provides a seamless service for members of the public who wish to make complaints.
The noble Baroness, Lady Cumberlege, is wrong to suggest that Mrs Archibald's family would have to pursue these matters through a number of patients' forums, through the independent scrutiny committee on the local authority and through the patients' council. We need to make sure that the arrangements for individuals who have complaints and concerns that they want to pursue are seamless. We must make sure that the final proposals which emerge from the Committee address all of those questions and that the arrangements are seen to be independent and properly resourced and enable members of the public to be satisfied that they will get a seamless service.
Ultimately, we must make sure that the lessons learnt from those cases and the lessons learnt by members of the patients' forums and the patients' council are properly utilised so that we end up with an NHS which is better because of the interventions of those bodies. That is a prize we can achieve. In going through these amendments—it is unfortunate that they are grouped together in this way—we can pick out the various elements and ensure that they are addressed.
The Earl of Listowel: I support the amendments of the noble Baroness, Lady Cumberlege. Speaking as a volunteer, I decry the way in which the community health councils—which are mostly staffed by volunteers—seem to have been treated by the Government. The perception is that they have been abruptly discarded without consultation or consideration. I have other reasons for supporting the amendments, which I shall come to as we proceed. At this point, I simply state that involving community health councils in the new arrangements—for instance, giving them charge of the independent advocacy service—would be a good way to recognise the work of volunteers and staff in the past. I support the noble Baroness's amendment.
5.15 p.m.
Lord Hunt of Kings Heath: This has been taken as a debate on the principle surrounding the abolition of community health councils and the arrangements that we seek to put in place to provide an enhanced mechanism for public involvement and representation in the National Health Service.
My noble friend referred to my background in community health councils when they started back in 1974–75. It was an exciting time because the NHS was not used to the concept of user or patient involvement. My noble friend is right. Some of the community

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health services which were previously run by democratic local government were brought over for the National Health Service to run. Certainly my experience in those first two years was quite exciting in terms of developing this new concept, of seeing the impact that it had on the culture of the NHS—community health councils were quite a culture shock for the health service—and, importantly from my point of view, of encouraging the NHS to think rather more than it ever had before about how the delivery of its services impacted on individual members of the public.
I have no hesitation in saying that the work of CHCs over those 27 years has been positive; that people have been helped; and that the NHS has been encouraged to start to look at changing its culture. But, at the end of the day, can we absolutely say, in 2001, that the NHS is sufficiently patient and public orientated? Can we really say that it is a health service which really deals with issues and complaints as immediately as it ought? The record is that we still face many issues and challenges in attempting to make the NHS as user and public friendly as possible.
I fully accept that there is a choice. Is it better to reform and change CHCs—I certainly pay tribute to my noble friend for the work that he did at the ACHCEW in establishing a fundamental review of CHCs—or is it better to produce a new and better system of patient involvement and representation? The decision that the Government have quite clearly made is that we want to start to build a new system.
The noble Lord, Lord Peyton, asked what CHCs had done wrong. Had they been too inconvenient to Ministers? No, that is not the purpose of the changes. We are making the changes because we believe that what will come through will be a much more powerful public involvement in the National Health Service and that the National Health Service itself will have many more incentives to change and improve the way in which it delivers services to the public. That is the test on which these proposals should be based.
If we go back to the NHS Plan and the widespread public consultation that we held, there is no doubt that we had a lot of comments coming back saying that the NHS was poor at dealing with complaints on the spot; that people did want the option of independent advocacy to support patients wishing to make formal complaints against the NHS; and that they did want to have an input and influence over local decisions about NHS services. It is my contention that the proposals we are putting before the Committee will enable us to do that more effectively than community health councils.
I suspect that Mrs Archibald will be with us for quite some time today. I do not believe that it is possible to say that under the current arrangements Mrs Archibald would be well served. Surely it is a reflection of the problem of getting the NHS sufficiently user conscious and involved that the noble Baroness was able to raise this example. I agree that the new arrangements need to be able to deal with the
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kind of issues that Mrs Archibald faces; I believe that they will do so in the first place when it comes to patient advocacy and liaison services.
This is an exciting proposal: a new, trust-based, front-of-house customer service for patients and their families. I came across this kind of service in the US some 15 years ago. There are compelling reasons why we need it in the NHS as soon as possible. The record of the NHS is that very often people come into hospital or into our community health services and find that there are problems. However, they feel inhibited from raising them or they raise them only through a formal complaint some weeks later. If we had a mechanism which enabled us to deal with those kinds of issues on the spot as they arise, surely we would have a much more effective healthcare system. That is what PALS is all about and why we are implementing PALS from April this year, starting with the major hospitals and rolling out the service during the year to cover all NHS and primary care trusts. It will be a new core service for trusts. It will guide people through the system, provide information about the services of the trust, and help to resolve problems as they happen rather than after the event.
As part of that service, PALS staff will have direct access to the chief executive of a trust, with the ability to facilitate the swift resolution of problems. I cannot stress too strongly the importance of that. The people who are charged with trying to sort out problems as they arise will have access to the top management of an organisation.
But it will not always be appropriate for PALS to be the body that deals with patient complaints. Clearly, some people—perhaps after dealing with PALS, and others who may not wish to use PALS at all—will feel much more comfortable with independent help. That takes us to Clause 17, which places a new duty on the Secretary of State to arrange the provision of independent advocacy.
We have not been prescriptive about who should provide that advocacy. We want as much flexibility as possible, and we want to build on many of the excellent advocacy arrangements that already exist throughout the country. What is not in doubt is our assurance that this will be an effective, independent service, and one that will be able to deal with the different issues raised by Mrs Archibald.
At trust level, we are also setting up patients' forums. They will be the local route into the decision-making processes for patients and the public. They will be made up of patients, carers and representative organisations through a process that will be agreed by the independent NHS Appointments Commission. In addition, these patient forums will be able to appoint a member to the trust board to which they relate. That will give a voice to patients at the top level of their local national health service.
Again, I make the point that patient forums will be independent. They will be responsible for monitoring and reviewing the services to which they relate. They will also have a duty to seek the views of patients and carers in their area and will report them to the local

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NHS trusts. They will be able to make recommendations to NHS bodies about services, basing these on an inspection of services that they have conducted and what they have heard from people who use those services.
The noble Lord, Lord Clement-Jones, accused me of wanting to proliferate patient forums. But surely this is the whole benefit: for every NHS trust there will be a patient forum which will be able to bring the concerns of patients to the attention of senior managers and the trust board. Because those forums are basing themselves on the services of a particular trust, they will be able to focus very much on the concerns of patients using those services. That will be a great advance. It will enable forums to exercise a great deal of influence over the NHS.
In addition, another key role of the forum will be to report on how the NHS is fulfilling its duty under Clause 11, dealing with arrangements for consultation and the involvement of patients, their carers and representative organisations in the decisions that the NHS makes and in proposals for changes in the way in which services are provided.
I understand and hear the concern that because patients' forums will relate to each individual trust they might become isolated and might not relate to patients' experience across the range of local health services. I certainly accept that there is a need to co-ordinate the work of patients' forums to ensure that they take what might be described in the jargon as a "whole systems" view of services for patients.
That is why we accepted an amendment on patients' councils in another place. These are made up of members from each of the local patients' forums. The council will make reports to the health authority, to trusts, to the local authorities and to their overview scrutiny committees. Their role will help the forums to co-ordinate their work, to share experience and to consider the views of patients across the range of services. They could even provide independent advocacy services and will certainly be consulted on the best arrangements for providing independent advocacy in their local area. To make all this work in a co-ordinated way, the patients' council will share a secretariat with local patients' forums, strengthening their links.
This is a real and useful role for patients' councils. However, I do not believe that it supersedes the role of the patient forum. We see the patients' forum as having the crucial relationship, bringing the NHS and patients together. The patients' council will necessarily have a more distant relationship. It will deal with many trusts and will take an interest particularly in the health authority's strategic decision-making process.
That is why I do not find myself in sympathy with amendments which seek to make the patients' council the pre-eminent body for representing patients, with the forums as sub-committees. I believe that it is much better that the key body in all these arrangements at local level is that of the forums, which are very much based at the patient care level. The patients' council
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can pull together views and can co-ordinate the forums, but the forums themselves should be the key building blocks.
The noble Lord, Lord Peyton, asked me to discuss overview and scrutiny committees, and we shall debate amendments on the subject in due course. They provide another piece of the jigsaw. It has always been a criticism of the NHS that at local level it has had what has sometimes been described as a democratic deficit. It is often proposed, particularly by local authorities, that the NHS should be run by them so that decisions may be made through the ballot box, legitimised by local councils.
Governments of both parties have always rejected that proposal because of the essential national nature of the National Health Service. But there is no doubt that local government has an important role to play, both in putting forward views about the health service and in ensuring good co-operation between the NHS and local government.
The overview and scrutiny committees will be committees of the principal local authority in an area. They are consistent with what is happening in local government generally in the establishment of such committees to monitor the normal local authority provision. I believe that they will be very powerful in ensuring that what happens in the NHS is very much open to public scrutiny and examination by local authority councillors. If one were looking for an example of where the proposals we are placing before the House are much more powerful than those that currently exist, that is surely it.
The test of all these proposals is whether, at the end of the day, there will be more effective patient and user representation within the NHS at local level. I have no hesitation in believing that the answer to that is yes.
Baroness Masham of Ilton: Before the Minister sits down, perhaps I may ask him about delaying the closure of hospitals. Will any of these bodies be able to do this?
Lord Hunt of Kings Heath: I apologise to the noble Baroness for not responding to the specific point that she raised. The role of community health councils in relation to major changes in services will be transferred to the overview and scrutiny committee of the local authority. If a proposal for a major change is made with which the overview and scrutiny committee disagrees, it will be referred to a panel, or an advisory committee, that we are establishing at national level called the national reconfiguration committee, which will then make recommendations to the Secretary of State. Therefore, in essence, the new local authority overview and scrutiny committee will have that responsibility in the future.
5.30 p.m.
Baroness Masham of Ilton: Would those at national level know the nature of local needs?
Lord Hunt of Kings Heath: At present, if a CHC objects to a major service change, such an objection is

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referred directly to the Secretary State. The new provision will establish an advisory committee to enable the Secretary of State to receive the advice of experts on such a proposal before he reaches a decision on the matter.
Lord Harris of Haringey: Perhaps I may intervene before my noble friend sits down. He started his response by giving us a fairly lengthy account of the strength of PALS. I am well aware that my noble friend has been a long-term advocate of such arrangements. However, does he accept that the PALS arrangements, which, I am sure will be a very valuable part of "customer relations" for a local trust, are not the same as independent advocacy?
I believe that my noble friend said that it would not always be appropriate for the body dealing with patients' complaints to be the PALS. I am quite worried by those remarks. I should be grateful if my noble friend could further clarify them. We must be quite clear that the handling of complaints, and advising and supporting complainants, must be independent of the trust concerned.
My noble friend also said that the Government did not wish to be prescriptive about who should provide advocacy. Would my noble friend think it appropriate to place some residual duty on the patients' councils to satisfy themselves that appropriate advocacy arrangements are in place and are strong enough so that, if they are not satisfactory, the patients' council can provide the service?
My further point relates to the relationship between patients' councils and patients' forums. My noble friend said that patients' councils should not be pre-eminent in terms of patient representation at local level. I believe him to be wrong in that respect. Given the fact that my noble friend has acknowledged that there is a danger that patients' forums might be subject to isolation—indeed, almost subject to "agency capture", which I think is the jargon for it—can he tell us what form the arrangements will take? Who will be responsible for the performance management of patients' forums, who will set the budgets for them, and who will appoint and manage their staff?
Lord Hunt of Kings Heath: Perhaps I may respond—
Lord Peyton of Yeovil: As we are in Committee, I should point out that there is absolutely no reason to worry about whether or not the Minister has sat down.
I do not believe that I explained myself adequately when I spoke a short while ago. I am concerned with the ever-lasting business of inspection and scrutiny. Patients are mainly concerned with the ability of doctors and nurses to get them better. They are not so concerned with the cogs of administration. I hope that those at the sharp end of the NHS will not find themselves too much tortured by a machinery of complaints that requires them to spend an inordinate
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amount of time protecting themselves against all kinds of contingencies, and every possible complaint, no matter how unreasonable.
Lord Hunt of Kings Heath: I understand the noble Lord's concern; and, indeed, I have some sympathy with it. At the end of day, we need to have a proper complaints system, as well as a health service that is sensitive to the needs of the public and patients. That is the purpose of many of the Bill's mechanisms. Equally, if by prompt action—this is where the PALS come in—we can deal with problems as they arise, it may well mean that patients do not always wish to go through a formal complaints process because the problem has been resolved.
However, if patients wish to go through a proper complaints process, I can reassure my noble friend that the options will be open to them in the future, as they have been in the past: they can go directly through a formal complaints system, or, if they wish to have help to do so, they can go directly to the independent patients' advocacy service. There is no question about that. I believe that the PALS service will provide a very straightforward and easy route in many cases, thereby allowing problems to be put right as soon as possible.
My noble friend also asked about the secretariat for the patients' forum and the patients' council. Some of these issues will need to be developed because neither the forum nor the council will be able to employ staff directly. We shall need to find a mechanism through which such staff can be employed. That is not unusual because CHCs have found themselves in the same position. The intention is that the funding will come from the Secretary of State through regional offices. I do not believe that I can reassure my noble friend that I have a robust system of performance management at my finger tips. However, we shall be debating a number of these issues later. I can tell him that we shall wish to support the patient council and the forum and that we shall enable them to be as effective as possible in their work. Some of the work carried out by my noble friend in that area would be apposite to that aim.
Baroness Cumberlege: I do not want this Committee stage to be haunted by my fictitious patient, but the Minister said he felt that she would not be served well in the current situation. I should like the noble Lord to explore that comment. We need to know exactly what we are jettisoning, and what we are gaining in its place.
Lord Hunt of Kings Heath: The litany of failure outlined by the noble Baroness was a breakdown both in terms of services provided by different parts of the NHS and in terms of co-ordination between them. I should point out to the noble Baroness that there are examples of that happening at present. The existence of CHCs per se does not seem to me to have had an impact on the situation. Under the new arrangements, it is important to note that when, for example, the relatives of Mrs Archibald confront a problem they would have an avenue through which to raise it

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immediately. However, if that is not effective, there would be a way to ensure that all the different issues with which they have problems would be dealt with.
In the first instance, PALS comes into play in dealing with problems as they arise. However, if that does not work out and if, say, Mrs Archibald's relatives decide to go through a formal complaints process, that would undoubtedly be co-ordinated by seeking the help of the independent advocacy service.
Lord Harris of Haringey: I shall not make the mistake again of saying that I wish to comment before my noble friend sits down. Perhaps I may clarify a few points about independent advocacy. Clause 13(3)(c) refers to patients' councils carrying out,
"such arrangements as may be made with the Council under section 19A of the 1977 Act (independent advocacy services)".
I presume that that will enable the Secretary of State, if he so wishes, to contract with the patients' councils providing independent advocacy services. However, in the light of what my noble friend said, can he say whether he expects that to be the normal arrangement—namely, to contract with the patients' councils to provide those services—or whether he expects that to be the exception to the rule?
Lord Hunt of Kings Heath: It is very difficult at this stage to say what will happen in practice. It is clear that the independent advocacy services could be provided in the way suggested; alternatively, they could be provided by another public organisation. Indeed, they could even be provided by a voluntary organisation. It is important to ensure that we have a robust, independent and effective service for the public. Of course, that responsibility rests with the Secretary of State. But before making any arrangements he will need to consult any relevant patients' council and such other persons as he considers appropriate. Whatever the arrangements are for the provision of those services, there will be an opportunity for patients' councils to express their views.
Lord Harris of Haringey: Would it not surely be better for the patients' council with local knowledge to have the residual responsibility for deciding where the contract should be placed locally to provide the most effective service for local people?
Lord Hunt of Kings Heath: Given the importance of ensuring that there is an effective service of consistent high quality throughout the country, that responsibility must rest with the Secretary of State.
Lord Harris of Haringey: I make one final point on a slightly separate issue. My noble friend said that he did not think it was possible at this stage to have a robust performance management system for patients' forums. I have some sympathy with that view. However, can we be clear that he accepts the principle that the performance management of patients' forums and, for that matter, patients' councils, must be independent of the local health service? If that is not
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the case a successful patients' forum and a successful patients' council may well be considered to be the one that gives the quietest life to local health service managers. However, it might well be argued that a more effective patients' forum or patients' council would sometimes give local health service managers a difficult time.
Lord Hunt of Kings Heath: I understand the point that my noble friend makes. That is why I emphasised the support that should be given to patients' councils and patients' forums when they are established to ensure that they do their job properly and to ensure that there is exchange of good practice between different parts of the country to enable them to draw on the best practice available.
Baroness Masham of Ilton: The Minister, who is an expert, sounded rather confused just now as to who to approach. I just wonder how on earth the poor patients will be able to find a way through the network.
5.45 p.m.
Lord Hunt of Kings Heath: I am sorry that the noble Baroness thinks that I sounded confused. The matter is very straightforward. If you go into a hospital and there is a problem in the outpatients department, you will have immediate access to the patient advocacy and liaison service within the relevant trust. I hope that that will sort out the problem there and then. However—
Baroness Cumberlege: Even at night?
Lord Hunt of Kings Heath: Of course, we shall have to make arrangements to ensure that there is access to patient advocacy and liaison services. That is an issue and a challenge to which every trust will have to face up. If that does not work out, or if an individual does not want to use PALS because he or she feels that it is more appropriate to make a formal complaint, the system will operate as now. He or she will make a complaint and that will be dealt with through the formal process. At the moment if someone seeks assistance, he or she can approach the community health council. In the future if someone seeks assistance to make a complaint, he or she can approach the independent advocacy service. As I say, I believe that the matter is straightforward. The individual will be given more leverage and power than he or she has had hitherto.
Lord Clement-Jones: This has been an extremely useful and important debate, as was demonstrated by the fact that so many Members of the Committee took part in it. The more Members of the Committee gave examples and teased out situations where certain provisions might come into effect, the more the doubts in my mind (which were already considerable) grew. Certainly those who have spoken have been sceptical about those provisions, to say the least.
The amendments tabled by the noble Earl, Lord Howe, and myself seek to join up the disjointed. I believe that the story of Mrs Archibald will live on

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in folk memory. It illustrated the situation well. The noble Lord, Lord Harris of Haringey, valiantly tried to illustrate that the CHCs did not have the help and assistance that it appears that some of the new services to be established under the Bill will have. The budget of the CHCs is something in the order of £20 million at present. The budget required by the new services may he over £100 million. That is outrageous. How effective could they have been if they had had the necessary powers? Will Hutton's commission on the health service—it was sponsored partly by ACHCEW—concluded that CHCs had inadequate powers.
There is not a great deal between us in terms of agreeing an effective outcome but there is a great difference between us in terms of mechanics. I fully accept that the amendments are rather à la carte, but we have given the Minister a chance to select out of that à la carte menu the provisions that he might consider attractive or at least those which fit in with his general approach. I suggest to the noble Lord, Lord Harris of Haringey, that the table d'hôte will come later if we are permitted a Report stage.
However, I am disappointed in the Minister's response. He said that we were debating a matter of principle. I disagree. As I made absolutely clear, we are debating the details of the powers and the joining-up of the different bodies. The Minister showed no willingness to effect more joining-up than has been evident heretofore. The Minister is aware of the need to be as public and patient friendly as possible and as public and patient oriented as possible—there are all kinds of different ways of saying the same thing. I am sure that we agree with that. We want more powerful public involvement in the NHS. However, we do not believe that that will be achieved at present. The Minister went into enormous detail over PALS. That demonstrates some of the difficulties. We had to clarify whether that was to be the normal way of proceeding with independent advocacy. Will patients' councils deal with that on a usual basis or an exceptional basis?
The noble Lord, Lord Harris of Haringey, teased out some interesting answers from the Minister to the effect that the Government do not appear to know at the moment how the system will work. However, if the system really hung together, the Government would know how it worked. Patients' councils should be able to plug into the complaints system.
Lord Hunt of Kings Heath: I do not have a blueprint for saying what proportion of independent advocacy services might be run by patients' councils in the future or might be run by other voluntary organisations as decisions have to be made as to what circumstances suit every locality. That is the responsibility of the Secretary of State. In fulfilling that responsibility he will seek the views of local patients' councils. Surely that comprises the taking account of local circumstances for which the Committee has asked.
The Earl of Listowel: I hope that the noble Lord, Lord Clement-Jones, will forgive me for interrupting
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him. However, what if a mother who does not speak English wishes to access the independent advocacy service? She tries to call NHS Direct but there is not an Urdu speaker to hand. Under the old system she would be able to go to the CHC—the shop front—with her child who perhaps can speak English and gain access to whatever service she needs. How will her need be met under the new system?
Lord Hunt of Kings Heath: It is interesting to note that the noble Earl assumes that in those circumstances every CHC in the country will be instantly accessible and able to respond to those demands. I think that that is most unlikely. With the availability of NHS Direct, and efficient, independent advocacy services, where the views of the patients' councils expressed to the Secretary of State that certain services need to be included are taken into account, one is more likely to have a mechanism for responding to those demands than at present.
The Earl of Listowel: I am sorry to persevere. Perhaps I have not understood the Minister correctly. It seems to me easier for a person to go to an office, perhaps with someone who can speak the English language, than for him to contact a disembodied person at the end of a telephone line in order to gain access to a service. However, perhaps I misunderstood the Minister.
Lord Hunt of Kings Heath: I think that there are four CHCs in Birmingham. Does the noble Earl seriously suggest that it is easier to find those offices, in a city of about a million people, than to have direct access to NHS Direct and then contact with an independent advocacy service?
The Earl of Listowel: I thank the Minister. I shall consider what he says. I am sure that we shall have an opportunity to discuss the issue later.
Lord Clement-Jones: In many respects, that illustrates clearly the total difference between the mindset of those who tabled the amendments on this part of the Bill and that of the Minister and his colleagues in the Department of Health. To me, local decision making involves local decision making: a patients' council has the ability to determine the kind of independent advocacy services it wishes to run, subcontract, commission and so on. To the Minister, it is the Secretary of State, with perhaps some consultation with the patients' council. That is decentralisation. It is extraordinary.
Lord Hunt of Kings Heath: I do not wish to prolong this debate. I am sure that we could carry on all night on these issues. The point is this. At present, support for the public in making complaint is too variable and patchy. Therefore, the Secretary of State needs to take the power to ensure that a consistent, high quality, independent advocacy service is available throughout the National Health Service. However, in doing so, he

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will take account of the views of local organisations, including patients' councils. Surely that is a sensible approach which involves the best of both worlds.
Lord Clement-Jones: We shall have to differ on that. The Minister's view is that no action is good unless the Secretary of State takes it himself. That seems an extraordinary view. Aneurin Bevan warned against the rattle of bedpans in the Department of Health. We are now faced with that situation. It seems extraordinarily centralist.
I warn the Minister that during its next stages these Benches will judge the Bill on whether it is clear where independent advocacy lies, or whether patients' councils and patients' forums have sufficient independence. The Minister asserted the independence but I have not seen chapter and verse of it.
The Minister made a virtue of proliferation of the various forums. However, he then said that they might become isolated. Why do we not cure that problem before it arises rather than building in mechanisms in case those bodies become isolated.
Lord Hunt of Kings Heath: A moment ago the noble Lord accused me of being over-centralist. With the patients' forum we are placing the key responsibility for patient involvement at NHS trust level. The noble Lord seeks to move that to a patient council which is one level removed from the patient.
Lord Clement-Jones: The Minister knows his constitution. Having considered centralisation or federalism, he knows that the great trick about devolution is to ensure that decisions are taken at the appropriate level with the right mechanism. We believe that the most coherent point at which that can be done is at the patients' council level. It can then be the coordinating factor. If we are not careful, patients' forums will lead to forum shopping. The experience of Mrs Archibald, cited by the noble Baroness, Lady Cumberlege, was telling.
I do not disagree with the Minister's aim regarding more effective patient and user representation. Indeed, we shall probably quote those words back at him when judging whether or not the Bill meets that criterion. We shall consider the total package. If it does not meet what we believe are necessary criteria, we shall act accordingly in later stages of the Bill. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 7 [Functions of overview and scrutiny committees]:
Lord Clement-Jones Lord Clement-Jones moved Amendment No. 37:
Page 6, line 16, after "section," insert "the strategy for health improvement and action to address health inequalities"
The noble Lord said: The posture of suspended disbelief probably applies as much to this part of the Bill, which precedes the provisions on the patients' council, as to the previous amendments. We wish to test whether the Minister is flexible about the way in which scrutiny will operate.
My local government colleagues in the party believe that these scrutiny provisions may work. As the Minister pointed out, the overview and scrutiny committee has become a central plank of the way in which local government now operates. With the institution of cabinet government at local government level, it is a different animal from a few years ago. Nevertheless, some issues need to be resolved. I suggest that conflict of interest may well need to be resolved as these scrutiny powers take hold.
However, I wish to note a few key gaps in the powers of the overview and scrutiny committees. Amendments Nos. 37 and 53 deal with overview of strategy for health improvement. That is an important area. The issue of making information available to patients' councils arises from scrutiny. CHCs were able to take a view about a pattern of behaviour or circumstances which informed the way in which they did their job. It is important to have that link between scrutiny and patient representation, and patients' complaints and patient advocacy.
The committees should be able to refer to other NHS bodies such as CHI and NICE, and to set up local inquiries. There should be the ability to co-opt observers from patients' forums on to scrutiny committees. Above all, there should be procedural standards for the scrutiny committees. That seems to be one of the weakest areas. It is important to have transparency about the operations of the committees. We need to know, for instance, whether the party whip will operate in these circumstances. I understand that planning committees have clear guidelines about the use of the party whip. I believe that it would be wrong for the party whip to operate where scrutiny of the local health service takes place. These are important additional issues which need to be dealt with. In moving the amendment, I speak also to Amendments Nos. 38, 41, 45, 46, 49, 50, 51 and 53. I beg to move.
6 p.m.
Earl Howe: Clause 7 is the first in a series of clauses that give effect to the arrangements outlined in the NHS Plan to introduce better local accountability for health services and to enhance the voice of patients and the general public. The Minister will not be surprised to hear that I still hold the view that I expressed on Second Reading that the arrangements are a mish-mash, despite everything that he has said on the previous group of amendments. I cannot make complete sense of the Bill as it stands. The Minister may be able to illuminate some of the dark corners of the Bill as we proceed, but I doubt that he can dispel my concerns entirely. Like the noble Lord, Lord Clement-Jones, I shall wish to return to these matters with vigour.
I hold that view because Ministers have approached the issue from the wrong direction. They have asked what structures might be invented to perform certain functions, whereas they should have asked what they were trying to achieve. The end result is a pile of structures. It was seven at the last count, although

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someone has told me that it might be nine if we include bodies such as the Secretary of State's reconfiguration panel.
Let me restate our objective. It is to examine the structures that the Bill proposes, look at what they are intended to do and then suggest ways of rationalising them so that they are more user-friendly and less bewildering than they are at the moment.
Clause 7 relates to the role of local authorities in enhancing local accountability. My problem with the idea of greater local authority involvement is not so much with the theory as with the practice. Local councillors are already stretched. They have limited time to do what they are required to do. That means that the real work on Clauses 7 and 8 will have to be done by the officers, who are already dealing with a host of other social services and health-related issues—not only the co-called Section 31 arrangements under the Health Act 1999, which permit local authorities and health bodies to collaborate, but also the arrangements adumbrated under the Bill for the formation of care trusts.
Many councils already find it difficult to fulfil their statutory child protection and adoption services in anything like a satisfactory way. In that context, the issue of resources rears its head almost immediately. Amendment No. 47 addresses that. Local authorities cannot do what the Bill asks of them unless they are given the financial wherewithal to do it. If they are not properly resourced, the whole exercise will fall down in a heap because it will not command confidence. If it does not command confidence, it will be useless. The first thing that the Minister needs to tell us is how he will ensure that this particular bird will fly. Not only do there need to be officers in place dedicated to servicing OSCs, there also need to be resources made available directly to those councillors who sit as scrutiny councillors.
Those new duties come hard on the heels of other scrutiny functions laid down in the Local Government Act 2000. Even before Part 2 of that Act has bedded down, scrutiny councillors will be required to extend their purview into non-local authority functions. That is a tall order.
The Explanatory Notes attempt to put a small amount of flesh on the bones of the clause, which is pretty skeletal by any standards. However, there are a number of important lacunae. What are OSCs there to do? If they are to count for anything, they must talk to the outside world a bit. They must talk to patient groups and, if they wish, to national bodies such as the Commission for Health Improvement and the Audit Commission. They must be able to set up local inquiries with the power to call for evidence. Those are functions that CHCs have at the moment.
The danger as the Bill is drafted is that OSCs will be cut off from everybody except the NHS. Unlike CHCs, they will not have the benefit of inspections to inform their scrutiny work, because inspections will be carried out by patients' forums. Unless patients' councils and forums have a duty to pass on relevant information, the OSCs will operate in a vacuum, or will at any rate
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have a very one-sided view of the world. When they have passed that information over, patients' councils should be able to call for OSCs to take action on whatever concerns they may have. All that is set out in Amendment No. 52. I expect such joined-up arrangements.
What happens once the OSC has reached a conclusion on a matter? Presumably, although the Bill does not say so, it will be able to make its views known to the local NHS body in question. When that happens, what is the NHS body obliged to do? Does it have to do anything? In Amendment No. 48, I suggest that it should.
All those matters should be the subject of advance consultation by the Secretary of State. Despite the smokescreens and bluster of various kinds, there has been no consultation on the detailed proposals for local authority functions, but there has to be consultation if the regulations are to prove work able and effective.
Amendment No. 43 relates to the effective use of time and skills. Subsection (3)(f) would require any officer of a local NHS body to attend before the committee to answer questions. My noble friend Lord Peyton referred to that provision earlier. I am worried about that on several counts. Obviously the OSC will need to be able to question the chief executive of a health authority or trust on occasions. It may also need to question other officers, but those officers cannot be made subject to the beck and call of the OSC every week of the year. The OSC is a lay panel. The officers of the health authority, trust or PCT are busy professional people. In most ordinary circumstances they must be allowed to get on with doing their job. The OSC should not consider that it has the right to summon officers of the trust willy-nilly without there being a good reason for doing so and without first being satisfied that the officer concerned can represent the trust or health authority at the most appropriate level. Even worse than summoning an officer for a trivial reason would be—I hesitate to say this—to have a scrutiny committee agenda for party political reasons rather than for the purpose of improving local NHS provision.
I hope that the Minister can reassure me that the tail will not be allowed to wag the dog in that sense.
Lord Harris of Haringey: I am an enthusiastic supporter of the clause, because it provides an important means of strengthening the role of local government. Providing for scrutiny committees to look at the health services in an area adds to the range of oversight and scrutiny committees in local government and is a valuable part of building the community advocacy role of local government. That role is contained in proposals for local government, but this is the first tangible sign that it will affect and impinge on other public services.
I was slightly concerned about the contributions of both the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones. I suspect that, so far as concerns

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this matter, they have not quite come to terms with some of the changes that are already taking place within local government.
The noble Earl, Lord Howe, suggested, for example, that councillors would not be able to take on such an onerous responsibility. I believe that he may not have recognised the enormous change that is occurring within local government. A distinction is now being drawn between the, perhaps, 10 members of a local authority who will sit on a cabinet and run the local authority by carrying out the executive, decision-making functions, and the role of the remaining—perhaps 50—members of a local authority, who will be involved in scrutiny arrangements. Not only will they be concerned with what their own local authority's executive—the cabinet—is doing; they will also have responsibility for reviewing and taking a policy view of what is happening elsewhere in their area. They will act as genuine local representatives. That change in the role of most local councillors will represent a valuable part of the work that they do. It will not be squeezed out by executive responsibilities because the nature of local government work has changed.
Similarly, the noble Lord, Lord Clement-Jones, conjured up a fantasy that overview and scrutiny committees would be dominated by the party whip system. I appreciate that he is probably not as steeped in the rules of the Labour Party as I am. The Labour Party has adopted rules which state clearly that it is not possible to whip councillors who sit on scrutiny committees. He may be telling us that the Liberal Democrats or, for that matter, the Conservative Party allow rampant whipping to take place on scrutiny committees and that, therefore, they distort the whole operation. However, if all the major parties took the view, as the Labour Party has done, that it is not appropriate for whipping to take place, that issue would not be so serious.
Having said that, I believe that, by and large, the Government should consider seriously the amendments that have been put forward. There are risks in relation to scrutiny of the health service by local government. One such risk is that the process could be extremely antagonistic, with local authority councillors spending their time effectively attacking what takes place in the local health service and pursuing matters in relation to closures, cleanliness, waiting times, or whatever, to the exclusion of the wider picture.
That is why I believe that the amendment in the name of the noble Lord, Lord Clement-Jones, which seeks to ensure that part of the scrutiny process involves the consideration of health improvement programmes, and so on, and the strategy required in that respect, is sensible. It seeks to ensure that discussions held by scrutiny bodies are focused on the wider picture and do not become antagonistic.
I believe that an approach which ensures that scrutiny committees listen to the viewpoints expressed by other agencies and call evidence—perhaps in the same way as parliamentary Select Committees are able to do—will make certain that the relationship between
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local authority scrutiny committees and the local health service is constructive rather than antagonistic. We should certainly all be working towards that. Therefore, I hope that my noble friend will consider the amendments carefully and ensure that the spirit behind them is embodied in the final legislation.
The Earl of Listowel: I also welcome the amendments in the name of the noble Lord, Lord Clement-Jones, and I welcome the extra patient focus that the Government are introducing. Recently, at a Centrepoint conference, two young, homeless 20 year-olds made a presentation. What they said was far more powerful and constructive than anything said by any other contributor, including chief executives and the local mayor.
In his opening remarks, the noble Earl, Lord Howe, made clear that a balance needs to be struck between individual representation and the whole picture or the whole community. Therefore, I am concerned about what will happen to the former function of CHCs, which, to a large extent, involved reaching out to the local community and looking out for local health needs.
Therefore, I welcome the amendment and would appreciate some reassurance in the Minister's response as to how proactive the replacement for CHCs will be in reaching socially excluded groups. As an example of what CHCs have achieved in the past, perhaps I may quote from a newsletter:
"Health Action for Homeless People has had a long association with Community Health Councils. They were instrumental in establishing the organisation and managing it for many years. London CHCs in particular have an understanding of the difficulties experienced by homeless people in accessing good health care and are effective in lobbying for improved access and for good quality specialist services".
Perhaps I may give another example. At a recent meeting of the All-Party Parliamentary Group on Maternity, its members heard about research currently taking place in Islington. That research indicates that a surprisingly large number of single mothers are living in temporary accommodation and that they have very few friends. They have no contact with one another. There may well be a need for a health initiative in relation to that situation. Perhaps a local centre is required to bring the mothers together, or something along those lines. Again, I hope that the Minister will address those concerns in his response.
6.15 p.m.
Lord Hunt of Kings Heath: This large group of amendments probes the functions of local authority overview and scrutiny committees. Perhaps I may refer to the original question raised by the noble Earl, Lord Howe. He asked what we are trying to achieve. First, as my noble friend Lord Harris said, such committees are a recognition of the leadership, or advocacy, role which local authorities play in the community. In addition, their establishment recognises that the National Health Service is an important part of any local community. It is absolutely right that local authorities should wish to take a view on the progress

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and key decisions of the National Health Service. I believe that the committees will lead to an enhanced relationship between the NHS and local government.
Over the past 10 or 20 years we have seen the problems that arise when the NHS and local government do not work well together. In recent years, there has been a tremendous improvement in that relationship. In the winter planning undertaken over the past few months, local authorities have been absolutely vital partners in the planning and provision of services. The enthusiasm with which they took part in discussions with the NHS at local level showed a much more positive relationship than there has been for many years.
I understand the concern expressed by the noble Earl, Lord Howe, that that relationship may become adversarial and destroy the good work that has taken place. However, I believe that the scrutiny committees will lead to local authorities having a greater understanding of the issues and priorities faced in the health service. I believe that, just as importantly, they will help the NHS to understand local authorities' core issues of concern which affect the whole community.
From discussions that I have held with members of many local authorities, I understand that they welcome the proposed new role. They believe that they will have the capacity to undertake it, and they will use it as a constructive approach towards better relationships with the NHS overall.
In response to a number of amendments, perhaps I may reiterate that I believe that, in time, the committees will develop an expertise which will add value to the process of NHS scrutiny. We are providing a new function for an existing body. Therefore, the overview and scrutiny committees will continue to be bound by the procedural requirements set out in local government legislation, which is a part of the local authority's responsibility. That is why making the power in Amendments Nos. 51 and 52 is unnecessary. They will also draw on their existing resource arrangements for the funding of those OSCs.
We expect the OSCs to have a wide-ranging role and to take their own decisions as to the key areas for scrutiny in their local areas. We also intend the OSCs to have real teeth. Therefore, I should say to the noble Earl, Lord Howe, that the function of referring contested service change proposals to the Secretary of State by an independent reconfiguration panel, currently with CHCs, which will pass to OSCs, will be a very important indicator of the importance of the scrutiny committees.
Clearly there will be other matters which do not come within the definition of a contested service change. But it would seem to me unlikely that the local NHS would not take account of the views expressed by the OSC on a whole range of matters.
I certainly accept that the OSCs cannot operate in a vacuum. They will have shared interests with patients' forums and patients' councils. We expect those bodies to work together locally. But it is important that we recognise that they have different functions. The OSCs are there to represent the interests of the public.
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Patients' forums and councils are set up to have a specific patient focus. Both perspectives are important but they are different and there is a risk of mixing the two so that one becomes drawn into—I use the noble Earl's expression—a mish-mash. It is extremely important that we clarify and separate those different roles. That is why we do not agree with the suggestion that OSCs, patients' forums and councils should be obliged to share members or that there should be formal partnership arrangements.
I have mentioned already that we want OSCs to develop their own priorities for scrutiny. I certainly agree with the noble Lord. Lord Clement-Jones, that the local HImP and actions to address health inequalities are likely to be high on the agenda. Amendments Nos. 37 and 53 would provide specific powers to allow the Secretary of State to require OSCs to look at those issues.
I do not believe that those amendments are necessary. Those issues relate to the health service. The current regulation-making powers in the Bill would enable the Secretary of State to provide that such issues are considered. I for one should very much welcome OSCs focusing on those issues because if we are talking about health inequalities, we shall certainly not achieve all we wish to achieve unless health and local government are working together.
I turn now to the issue raised by the noble Lord, Lord Peyton, who is no longer in his place, to which the noble Earl referred; namely, the risk of tying, up the NHS in bureaucracy in responding to the information requirements or the summoning of NHS officials before the OSCs.
I understand Amendment No. 43. We anticipate requiring NHS chief executives to appear before the OSC once or twice a year. That is a reasonable requirement. We do not believe that we need further protection on the face of the Bill. I should much prefer to leave this matter to the good sense of people locally to operate sensibly. I really believe that the great majority of local authorities will behave sensibly and will call NHS officials before them when that seems appropriate but will not over-egg that and cause a huge bureaucratic burden for them.
It is worth saying that OSCs are developing ground in local government. Experience so far shows them to be effective. And so councils will not be coming to this with a fresh piece of paper. They will have had experience in operating the system.
Our proposal to make local social services authorities the lead on NHS scrutiny will certainly help to ensure effective and consistent scrutiny and will reduce the number of OSCs directly scrutinising the NHS.
I do not agree with Amendment No. 38, which would give all district councils scrutiny rights. There is a part for district councils to play in NHS scrutiny and the provisions in Clause 8 allow that to happen. But if each of the large shire counties with a large number of non-metropolitan district councils had scrutiny powers as of right, there would then indeed be the bureaucratic problem to which the noble Earl referred.

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We believe that the OSCs should look at all services, including those delivered in partnership with the local authority. I know that some Members of the Committee have expressed concern about that but it is worth making the point that within the OSC role within local government, that happens now in relation to scrutiny by the committee of local authority directly provided services. On those grounds, I would not support Amendment No. 56.
Amendments Nos. 46, 49 and 52 deal with the powers of OSCs to call for inquiries or involve CHI, the Audit Commission or the Secretary of State. As regards inquiries, I do not believe that it is necessary for the OSCs to be able to call inquiries, particularly not with powers to summon evidence. That would be a power on a par with that of the Secretary of State under Section 84 of the National Health Act 1977. The Bristol inquiry is an example of the use of that power. It seems to me that that is going too far. But, of course, OSCs have every right to decide what issues to look into and the right to ask people to come to give evidence.
On the submission of OSC reports and concerns to other bodies, if it is unhappy with the way that the local NHS has responded to it, the OSC will be able to refer its concerns to the Secretary of State or the regional office. I confirm also that the Commission for Health Improvement is already empowered to investigate concerns raised by other bodies so that no new powers are needed to allow CHI to respond to requests from an OSC. Therefore, those amendments are unnecessary.
Amendment No. 41 seeks to change "may" to "shall". That would mean that the regulations on OSCs would have to make provision for all the matters set out in paragraphs (a) to (f). It may not always be appropriate, over time, to make provisions on some of those matters. In addition, the extent to which the Secretary of State would have to make such provision is unclear. So I firmly come down on the side of "may" in this debate.
However, I assure the Committee that it is our firm intention to make regulations to define fully the role of OSCs, as it is clear that regulations must be made if the scheme is to operate properly.
As regards taking account of the views of those who have an interest, we shall consider and welcome any views given to us by relevant organisations, such as the Local Government Association, before making the appropriate regulations.
Lord Smith of Leigh: Perhaps I may seek clarification on some of my noble friend's comments. While I agree with him that overview and scrutiny committees should help to strengthen the relationship between the NHS and local authorities, they should not be seen as replacing relationships which exist already between the executives of local authorities and the NHS. Those bodies deal with those matters on which my noble friend commented; for example, the problems in relation to winter planning. They will also
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help to develop the care trusts and so on. As my noble friend knows, in my own authority there is a well-established health partnership board which involves ourselves, the local NHS trust and the health authority. Indeed, I had to tender my apologies in relation to that today in order to attend your Lordships' Committee.
6.30 p.m.
Lord Hunt of Kings Heath: Perhaps I can respond to my noble friend. I agree with the point. I was simply trying to say that I believed that overview and scrutiny committees would be but one aspect of the developing local government/NHS relationship. I certainly accept that, in terms of ensuring that collaboration and the provision of services works, including the involvement of the local authority in major NHS strategic change, the role of the executive of the local authority would be important.
Baroness Cumberlege: Much of this has merit. I understand the democratic deficit argument that has taken place for decades. Where the overview and scrutiny committees are good they will be very good; but where they are bad they will be perfectly horrid. Where there is a danger that the OSCs become a griper's charter, where they do nothing positive at all, but in fact destroy the trust and the good relationships that have built up, what action can be taken? Secondly, how will the committees be judged in relation to their performance? What criteria will be set against which they can be judged?
Lord Hunt of Kings Heath: That must be a matter for the local authority concerned because that will be part of the scrutiny role of the local authority. The scrutiny committee will not operate on its own, but it will operate alongside a number of other scrutiny committees. I would expect the local authority—as it will when it reviews the performance of the scrutiny committees from time to time—to monitor, to review and to take account of any views that the NHS may express when considering whether any changes need to be made.
On the issue of areas where the relationship is difficult, I do not want to dwell on that too much because I am positive about the developing NHS/local government relationship. I believe that it has changed fundamentally in the past few years. Now it is rare to find a place where the relationship is as bad as those to which the noble Baroness has referred. I also believe that it takes two to tango. It is not just a matter of a local authority being excessive in its demands; it is also a matter of the NHS being prepared to share information, time and officials with the scrutiny committee to take that committee through the issues that they are debating. At the end of the day, I believe that ensuring that that works out as effectively as possible should be left to the local level.
Earl Howe: Before the noble Lord, Lord Clement-Jones, responds perhaps I could ask the Minister about the purview of an overview and scrutiny

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committee. The lines on a map that delineate the boundaries of health authorities do not always reflect real life. Will a local authority overview and scrutiny committee have powers to examine proposed health service changes in adjacent local authority areas if such proposals are thought likely to have an impact locally?
Lord Hunt of Kings Heath: I would expect the focus of the OSC to be related to services provided within its boundaries. I accept that the NHS does not necessarily organise itself around local authority boundaries; sometimes perversely hospitals are built just within a borough boundary, and London has classic examples of that. That is why in Clause 8 we allow for regulations to make provisions for two or more local authorities to appoint a joint committee. Through those arrangements we shall be able to deal with issues such as a hospital that is on one side of a boundary providing services to those on the other side of the boundary. We would hope to deal with the general principles through regulations, but much will come down to good common sense as well.
Lord Clement-Jones: I thank the Minister for his response to this set of amendments. The noble Lord, Lord Harris of Haringey, lowered the tone of the debate by referring to "rampant whipping" and I confess that despite having lived in Lambeth for 30 years I had not realised what pussycats the Labour Chief Whips have become under the new regime!
The noble Lord, Lord Harris, made an important point that we need to design into this set of proposals the opportunity for constructive discussion between the NHS and local government. I believe that that is the cardinal aim set out by the Minister. He referred to enhancing the relationship between the NHS and local government, that the scrutiny committees would have real teeth and that they will not operate in a vacuum.
Since 1974 there has probably been a democratic deficit in the health service that requires amendment. As I said earlier, we have suspended disbelief in relation to this matter, but if these proposals go some way towards curing that democratic deficit, they should be welcomed. The Minister was extremely tentative in his approach to some of the amendments, which is to be regretted. In some areas he was a little vague; for instance, on the ability to scrutinise health improvement plans and health improvement strategies—they were welcomed by the noble Lord, Lord Harris—which I believe would be a cardinal function, he said that the Secretary of State would have power to require overview and scrutiny committees to do so and that he, as a Minister, would welcome a focus on those issues by OSCs. To me that did not quite add up to the Minister saying, "Yes, we will definitely place a duty on and give a power to OSCs to do so". A little more clarification from the Minister would be helpful.
Lord Hunt of Kings Heath: I do not believe that there is any doubt at all that the OSCs will have the ability
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to question the local health service about HImPs and their future strategies. That is the whole purpose of the committees.
Lord Clement-Jones: I assume from that that the Minister is saying that the Secretary of State will make regulations that allow them to do so and to have that as a principal part of their duties. In the Bill as currently drafted, that does not spring from the page.
Another aspect is that as we go through the Bill clause by clause at one point the Minister is a great centraliser and at another point he becomes the great decentraliser, except in relation to district councils: "We are the great decentraliser; this is the way we do things; we devolve to the lowest point and when it comes to representation it goes to patients' forums which are at the right level, close to the patient, close to the public and close to the NHS trusts and so on. But when it comes to scrutiny, I am very sorry that the ordinary district or borough council is not to be allowed anywhere near this set of proposals". On that point the Minister's response was not particularly adequate.
Lord Hunt of Kings Heath: I am grateful to the noble Lord for giving way. My first experience as a member of a local authority was in Oxford, in a non-metropolitan district council. I understand why non-metropolitan district councils would want to be scrutiny committees in their own right, but perhaps I can take Kent as an example. Kent has a population of 1.3 million; it comprises 12 district councils and one unitary authority. With the best will in the world, unless the principal local authority—the social services authority—is the OSC, one would run into the kind of bureaucratic issues that have been raised by noble Lords in Committee.
Of course, there will be an ability for the county council scrutiny committee to co-opt a member of a district council; it will also be able to delegate its roles perhaps in relation to a particularly local service. However, in practical terms, I believe that it will be difficult to allow the amendment.
Lord Clement-Jones: I thank the Minister for that extra elucidation, which was genuinely helpful. Although we found his response more unhelpful than we originally anticipated, having heard it I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
The Deputy Chairman of Committees (Lord Geddes): I must advise the Committee that if Amendment No. 38 is agreed to I cannot call Amendment No, 39.
[Amendment No. 38 not moved.]
Lord Clement-Jones Lord Clement-Jones moved Amendment No. 39:
Page 6, line 25, at end insert—
"( ) the GLA"
The noble Lord said: Fuller amendments on a similar theme remain to be discussed in this group. In the light of the experience of Members of the

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Committee who have tabled them, I know that they will be most interesting and I shall therefore be brief in introducing Amendment No. 39. It is tabled in order to draw the attention of the Committee to a major gap in the provisions.
We debated the GLA Bill at some length. Although it was not as full as it might have been as regards the duties of the authority to have responsibility for certain public health matters, as a result of work carried out by the King's Fund and other bodies, it was possible for the other place to insert provisions relating to the GLA's assessment of its health policies on the capital. It seems to us on these Benches and to many organisations involved in health in London that the position of the GLA must be recognised to a greater extent.
Indeed, one could draw a parallel much more broadly. The future role of regional government should be recognised. After all, the GLA is a strategic body and such health scrutiny is precisely the kind of activity it should be carrying out. Unless it is brought into the net—and I speak as a Londoner—London will be the poorer and we shall not have the precedent that we should have for future regional government. I beg to move.
Lord Smith of Leigh: In speaking to Amendment No. 58, I want to add to what was said by the noble Lord, Lord Clement-Jones, about the missing elements in the Bill. I welcome in principle the fact that Clauses 7 and 8 increase local authorities' accountability for the health of local people. However, at regional level in England, particularly in London, that element is missing in various proposals.
As the noble Earl, Lord Howe, said, issues relating to health do not fit neatly into the boundaries of local authorities, either singly or collectively, effectively to organise scrutiny. For example, public health for the region; the work of the regional health authorities; tertiary care provision; and health performance indicators, both inter-regional and intra-regional, could be subject to scrutiny by bodies at the level of the region.
Throughout England, there are in existence organisations which are capable of handling such matters. They are the regional assemblies and chambers which exist in all regions throughout England. They are selections of local authorities and other key social partners.
Unfortunately, the Department of Health does not always recognise the way in which the regional agenda is moving in England. On Friday, I attended a seminar held at the DETR examining the way in which the regional agenda is developing. All the key departments of state were represented, with the exception of the Department of Health. Even the Treasury was represented.
Health has a major role to play at the regional level in driving policy forward. I commend to my noble friend the social inclusion policies, which are most important for the Government, and also regional
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economic development. We need to get the health of people right. In my area, levels of unemployment may not be as high as they once were, but the level of incapacity is exceedingly high.
The work of the regional assemblies and chambers is being recognised by other parts of the Government. The Deputy Prime Minister and the Chancellor attended a meeting in Middlesborough on Friday 9th March. The Chancellor then said that he was making £5 million of new resources available to regional chambers to help them establish a substantially expanded scrutiny role within regions. He deliberately did not say that that was to be scrutiny only by the RDAs but left it open for them to examine across the region issues which matter to that region.
Regional assemblies are on the agenda. They have the means and the ability to effect scrutiny at the regional level and I hope that my noble friend will consider that most carefully.
6.45 p.m.
Lord Harris of Haringey: I want to speak to Amendment No. 65 standing in my name. I declare an interest as a member of the Greater London Assembly. The amendment is designed to rectify what I can only assume to be a mental aberration by civil servants in failing to recognise the existence of London. Recognition is given to the City of London, which has its own special clause, but the other 7 million people in London might wonder why no arrangements within the Bill would permit the London Assembly to take part in the overview and scrutiny arrangements in respect of London's health services.
We may be told by my noble friend the Minister that that is not a problem because the London Assembly's terms of reference are so broad. However, I am concerned that it is not made clear in the Bill that the London Assembly has a role in respect of the scrutiny of London's health services. Part of that role must be fulfilled in collaboration with the London boroughs and I can see circumstances in which provisions for joint committees of local authorities to scrutinise pan-London health issues will not involve the London Assembly because it is not included on the face of the Bill.
In referring to a particular anomaly, I should declare an interest as a non-executive member of the trust board for the London Ambulance Service. Such trusts are responsible for delivering pan-London services. I understand that twice a year the chief executive of the London Ambulance Service might be required to attend meetings of the overview and scrutiny committees of all 32 London boroughs and of the Corporation of the City of London, perhaps making some 66 visits to such committees. Given that he has an extremely busy role, that is not necessarily the best use of his time.
The most sensible outcome would be for the Bill to reflect clearly the role of the London Assembly; to reflect the fact that the most appropriate scrutiny body for the London Ambulance Service and any other pan-London service will be the London Assembly; and to

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ensure that the provisions of the Bill cover that. I am sure that the amendment tabled by the noble Lord, Lord Clement-Jones, has the benefit of simplicity but I suspect that it is technically flawed. I suspect that my attempt, which is rather more verbose, is also technically flawed. However, I hope that my noble friend will assure the Committee that at a later stage he will bring forward proposals which will cover London and the role of the London Assembly.
Lord Hunt of Kings Heath: I am grateful to both my noble friends and the noble Lord, Lord Clement-Jones, for raising an interesting question. I recognise the role of the GLA and the regional assemblies and chambers and I am encouraged by their interest in healthcare issues in the wider sense. I am responsible for the eastern and north-western regions of the health service and I encourage both chairs to become involved in the regional chambers. It is very important that regional. chambers understand, for example, the effect of the NHS on the regional economy which can be quite profound. I begin by being positive about constructive relationships at that level.
There are two issues in the context of the Bill. Clearly, we are endeavouring to promote scrutiny at local level, because in the end it is the connection between the health service and local services which has more impact on the quality of the services to the patient and the public. That is why in terms of scrutiny of the NHS we have made local social services the lead authority. I believe that the case for that is as strong in relation to whatever be the regional structure as in relation to the issue raised earlier by the noble Lord, Lord Clement-Jones, who referred to district councils. We need clarity.
I am convinced that the principal local authority which accepts the role of scrutiny should be the local social services authority, but I accept that there are circumstances in which scrutiny on a regional basis is appropriate. The powers in Clause 8 of the Bill enable that to happen through a joint committee of the OSC with NHS scrutiny right across the region. I believe that that approach provides a practical basis for working with the GLA without taking any further powers. I am wary of further powers which in the end make unclear who is responsible for scrutiny of the NHS. I believe that to provide powers to the GLA or regional assemblies on the face of the Bill could lead to confusion o f scrutiny responsibilities unless there is clarity as to which authority is absolutely responsible. The Bill already provides for joint committees and will enable a pan-London committee to be established with co-opted GLA members.
I accept the point made by my noble friend Lord Harris that we want to avoid the need for the chief executive of the London Ambulance Service Trust to make 66 visits. We want a sensible arrangement and we believe that the Bill allows for that. I point out to my noble friend that officials of the department are working with the GLA to develop a protocol about the involvement of the GLA in the development of London-wide health strategies. I should be very happy to meet my noble friend to discuss that further.
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It is very difficult to accept Amendments Nos. 141 to 143 because it is our policy that CHCs should be abolished. On that basis, those amendments fall.
Lord Harris of Haringey: Can my noble friend clarify how Clause 8 applies to the London Assembly?
Lord Hunt of Kings Heath: In a number of ways. Clause 8(2)(a) provides that,
"two or more local authorities may appoint a joint committee of those authorities".
Therefore, it would be possible for the London boroughs to come together to organise a joint committee and for co-options to take place.
Lord Harris of Haringey: First, does my noble friend suggest that Clause 8(2) operates on the basis that the Greater London Authority is a local authority, which on occasions is subject to some doubt? Secondly, can the Committee be clear that Clause 8(2) does not require the operation of subsection (1) as far as concerns the GLA? Clearly, that authority cannot fall within the purview of Clause 8(1) because it does not have executive arrangements under Part II of the Local Government Act.
Lord Hunt of Kings Heath: I said to my noble friend that I was very happy to meet him to discuss this further, particularly in the light of the protocol arrangement that we wish the Department of Health to develop with the GLA. Clause 8(2) makes provision for two or more local authorities—which I take to mean London boroughs—to appoint a joint committee, but it would be open to that joint committee to co-opt members from the GLA.
Lord Smith of Leigh: Is the Minister saying that Clause 8(2)(a) applies also to the regions outside London?
Lord Hunt of Kings Heath: I require a little more persuading of that. The specific case raised by my noble friend Lord Harris related to the area of the London Ambulance Service which, if not coterminous with the GLA boundary, is fairly close to it. If one looked at other regional assemblies one might find it difficult to identify a service which neatly fitted into the regional boundary. I want the NHS and regional chambers and assemblies to have a close working relationship and I am very happy to discuss that further with my noble friend.
Lord Harris of Haringey: I apologise for labouring the point. Can my noble friend say where in Clause 8 there is a power for a joint committee to co-opt?
Lord Hunt of Kings Heath: I am trying to find it myself. There is no question but that the committee can co-opt. Perhaps I may write to my noble friend on

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that matter. The key point of Clause 8(2) is the ability of local authorities themselves to appoint a joint committee.
Lord Clement-Jones: I thank the Minister for his response. As I anticipated, the noble Lords, Lord Smith and Lord Harris, made rather better arguments than I managed to muster because of their knowledge of the regions and the GLA respectively. They made rather telling points, particularly the quotation of Ministers in support of their arguments. The Minister responded more positively than at many other times today by describing this as an interesting debate. We must be making progress if this is interesting, no doubt in contrast to some of the previous debates.
I recognise the Minister's genuine belief in a constructive relationship at regional level, but when he went on to describe what that consisted of they were really crumbs from the legislative table. It is a very unsatisfactory situation if we are to stitch together the joint committees under Clause 8, when clearly the GLA for that purpose does not appear to be a local authority, with the possibility of co-option under a provision of the clause which is extremely well hidden, to say the least. We must then fall back on the formation of a protocol between the GLA and Department of Health, which in a sense gives the DoH the whip hand in all those circumstances. It would be far more satisfactory to recognise the strategic role of regional government, starting with the GLA. I give way to the Minister who appears to be about to tell the Committee the reference to co-option.
Lord Hunt of Kings Heath: It is not surprising that I cannot find it in the Bill because it is not there. The power is in Section 21(10) of the Local Government Act 2000 whereby a local authority may co-opt any persons who are not members of the authority. That would relate to the establishment of the joint overview committee which could cover London.
Lord Clement-Jones: I thank the Minister for his reply, which emphasises that we must pray in aid other bits of existing legislation and stitch them together to come up with a solution that is in any way satisfactory. Clearly, the Bill would benefit enormously from an addition which recognised the role of the GLA and future regional assembles. We may well wish to return to this amendment in various forms at a later date. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
7 p.m
Earl Howe Earl Howe moved Amendment No. 40:
Page 6, line 25, at end insert—
"( ) Where a county authority comprises district councils, it shall, where appropriate, include in the membership of the scrutiny committee representatives of each or all of the district councils within the authority's area of responsibility for health services."
The noble Earl said: I was contemplating not moving this amendment. However, I hope that the Minister will allow me to return to the subject raised
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by the noble Lord, Lord Clement-Jones, in Amendment No. 38, because I think that there perhaps is a broader dimension to the question than he suggested.
Clause 7 seeks to enhance patient and public influence in the development and operation of the NHS by introducing democratic scrutiny of the NHS through local authority overview and scrutiny committees. As the Committee will know, the clause provides for scrutiny by county councils, county borough councils, unitary authorities and London borough councils. Amendment No. 40 seeks to extend the scrutiny rights to district councils.
To back up the thought behind the amendment, it may be helpful to remind the Committee of a few key points. The NHS primary care reorganisation into primary care groups, evolving into primary care trusts, was devised so that decision making on primary care services could be devolved to communities of approximately 100,000 people. Many of the boundaries of primary care groups, and hence PCTs, are exactly those of their district councils. For rural communities, the county council may seem fairly remote and be located quite some distance away. This amendment seeks to honour the local accountability objective of primary care reorganisation; and it may prove particularly valuable if there is an important local issue such as the closure of a community hospital.
There is a further issue. A primary care group acts as a sub-committee of a health authority. Primary care groups are encouraged to become primary care trusts independent of, but accountable to, their health authorities. The next stage of the evolution, as we shall debate in later amendments, is to become care trusts under the provisions of this Bill. The care trust will probably provide its services within the same boundary of the PCT, if it has evolved from a PCT.
The budget of a care trust for social care is to be delegated from the authority providing social services. It may be worthy of consideration by the Government that that combined role should be democratically accountable to the community that it serves. The Minister said that he thought that this proposal would lead to some unwelcome bureaucracy. I am all for getting rid of unwelcome bureaucracy. However, I should like to suggest that there are all sorts of good reasons relating to democratic representation and the contribution of local knowledge that serve to recommend it. I beg to move.
Lord Hunt of Kings Heath: I understand the noble Earl's point. I have already made it clear that I have sympathy with non-metropolitan district councils and that I would certainly encourage the NHS locally to develop as strong a partnership as possible with those councils. Their housing and other roles make that doubly important.
My concern is that unless it is absolutely clear which local authority in any given area is the overview and scrutiny committee, there will be many problems and potential disputes. That is why I consider that the way

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in which it is expressed in Clause 8 provides a satisfactory way through. Clause 8(2)(b) makes it clear that,
"a local authority may arrange for relevant functions in relation to that authority to be exercisable by an overview and scrutiny committee of another local authority".
I can assure the noble Earl that in relation to Clause 8 that could be a non-metropolitan district council.
To take the noble Earl's example, if a matter arose concerning a primary care trust, it would be perfectly appropriate and possible for the county council to arrange for that oversight function to be exercisable by the overview and scrutiny committee of a non-metropolitan district council which covered the area of the PCT; but the decision whether or not to do it would be a matter For the county council. I believe that we have the capacity to make it abundantly clear that within any locality one local authority has that overall responsibility.
Earl Howe: I am grateful to the Minister. I shall reflect on what he has said. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 41 not moved.]
Lord Clement-Jones Lord Clement-Jones moved Amendment No. 42:
Page 6, line 27, at end insert—
"( ) as to the composition of the committee so as to include representatives of the voluntary sector and the Patients' Council,"
The noble Lord said: This amendment relates to scrutiny committees, which we have discussed at some length. But we have not discussed the composition of the scrutiny committees as set out in the Bill. This is another provision designed to join up some of the current proposals. It seems to us that it would be very important to have on the scrutiny committees, as of right, representatives of the voluntary sector and patients' councils—not simply co-optable under the provisions outlined by the Minister but as an integral part of the scrutiny process. I beg to move.
Lord Astor of Hever: I rise to speak to Amendments Nos. 59 and 61, which are designed to ensure that there is fair political representation on local authority overview and scrutiny committees. That would mean that they reflect as closely as possible the aggregate representation of the different political groups of the local authorities and ensure that the Secretary of State cannot, by regulations, change this balance.
We have two concerns. First, while the powers and changes to local government in England and Wales, as created by Part II of the Local Government Act 2000, are in their infancy, this clause of the Bill proposes to extend the role of scrutiny councillors into non-local authority functions. No doubt many scrutiny committees will contain a number of able councillors. However, against the background of continuing doubts about the executive/scrutiny split and the likely experience of scrutiny members, we are concerned that the necessary time, scrutiny and weight given to these functions may be lacking.
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Our second concern is to ensure that each scrutiny committee's membership reflects the political make-up of the area for which it is responsible. That is of particular importance, as health authorities' boundaries do not always correspond with those of local authorities. In addition, each local authority is likely to have a different political composition.
Section 21(11) of the Local Government Act 2000 brings into force Section 15 of the Local Government and Housing Act 1989—the duty to allocate seats to political groups. However, under powers in Sections 20(e) and 24 of the 2000 Act, the Secretary of State has the power to modify any arrangements made by local authorities.
We would therefore be grateful if the Minister could confirm what arrangements will be put in place to ensure a fair and equitable settlement of political representation between authorities.
Lord Hunt of Kings Heath: I deal first with Amendment No. 42, which would require membership of OSCs to include representatives of the voluntary sector and the patients' council. I firmly believe that that should be a matter for the local authority to decide. I am also very clear that the OSC must be in the hands of elected councillors, because that is the whole purpose of having an OSC. It is very important that that should not be dissipated by having too many other people on those committees. It must speak with the authority of the local authority.
As I have made clear in my reference to Section 21(10) of the Local Government Act 2000, it is already possible for OSCs to co-opt, as non-voting members, members of the voluntary sector, or, indeed, members of the patients' council. However, it is preferable for that matter to be left to each individual local authority to decide.
Perhaps I may turn to the issue of reflecting the balance of OSCs to ensure that there is a proper distribution of seats to political groups among appointing local authority members. Under Clause 8(3)(b) of the Bill, the Secretary of State is already allowed, in making regulations, to apply with modifications Section 15 of the Local Government and Housing Act. That is relevant to ensuring that we get an appropriate balance. I accept the points that the noble Lord makes. It is important that one gets a political balance. That enhances the credibility of the work of the overview committee. That may be more difficult when joint committees are established. But, as far as possible, our aim is that, when making regulations, the Secretary of State will try to ensure that OSCs are as representative as possible.
Lord Clement-Jones: I thank the Minister for his response, particularly to Amendment No. 42. Clearly, that was a disappointing response. It would be understandable if the whole mechanism was so clearly thought through that there was no further room for representation, and so on, but, as this scheme is still very inchoate, it seems disappointing that valuable additions to it, in terms of binding together the scrutiny and representation functions, have not met

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with any positive response from the Minister. Nevertheless, we shall ponder on what he has said. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 43 not moved.]
Earl Howe Earl Howe moved Amendment No. 44:
Page 6, line 40, at end insert—
"( ) requiring any member of an oversight and scrutiny committee who is also a member of the Health Authority, NHS Trust or Primary Care Trust not to take part in the discharge by the committee of the functions described in subsection (1) above"
The noble Earl said: In moving Amendment No. 44 I shall speak also to Amendment No. 56. This is a straightforward but important issue which I have taken separately. My concern is twofold. There is a danger that OSCs may find themselves acting somewhat incestuously. It is one matter for them to be scrutinising NHS bodies and providers; it is another for them to be scrutinising local authority services provided under joint care arrangements. There is an obvious conflict of interest in the offing there.
It would be better to entrust the overview and scrutiny of joint care arrangements to patients' forums, with the help of patients' councils. Those bodies will be quite independent of the arrangements under scrutiny and well-placed to exercise their functions in a manner that will command public confidence.
The other conflict of interest that might arise relates to scrutiny councillors themselves. It would be a total nonsense if particular members of local authority scrutiny committees were required to scrutinise the responsibilities that they had discharged as board members of trusts or health authorities. I beg to move.
7.15 p.m.
Lord Hunt of Kings Heath: I have some sympathy with Amendment No. 44 in the name of the noble Earl. The Department of Health is already working with the Department of the Environment, Transport and the Regions on the development of a code of conduct for the membership of the OSCs. The appropriate place for any guidance on matters concerning the possible interests of OSC members involved in scrutiny in the NHS would be in that code of practice. I certainly take on board the substantive point that the noble Earl makes.
So far as concerns the other issue, I do not agree with the noble Earl. I believe that OSCs should look at all services, including those delivered in partnership with the local authority. The noble Earl and other noble Lords perhaps have concerns about the independence of the OSC in that respect, but, if one looks at the role of these scrutiny committees within local government as a whole, that is precisely what they do: they scrutinise services provided by their own local authority. The real distinction is that drawn by my noble friend Lord Smith, who reminded us that the
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OSC members have no executive role within the local authority. It is their core function to scrutinise local authority services. Therefore, I do not believe that this is a particular problem. On that basis, I urge the noble Earl to withdraw his amendment.
Earl Howe: I thank the Minister for his comments. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 45 to 53 not moved.]
Lord Clement-Jones Lord Clement-Jones moved Amendment No. 54:
Page 6, line 44, at end insert—
"( ) Before making such regulations the Secretary of State shall consult Community Health Councils, patients' and carers' organisations and the wider community."
The noble Lord said: I was heartened to hear what the Minister said earlier when we were discussing the scrutiny clause. Perhaps he can correct me if I misheard him, but I think that he said, "And of course patients' councils and others will be consulted on the regulations made". That was in relation to Clause 7 and the scrutiny provisions. I hope that is correct. I also hope that that would be the reality with regard to consultation over the regulations relating to patients' councils—for example, that they would be consulted on the regulations which applied to them. If that is the reality, which the Minister appeared to be expressing earlier, then why can we not reflect that on the face of the Bill? In addition, could we not include carers' organisations into the bargain? That would be best practice. In a sense, the Minister was saying, "Yes, we will follow best practice". If that is the case, I would very much hope that we could include that, both in relation to scrutiny and patients' councils and forums. I beg to move.
Lord Hunt of Kings Heath: Actually, I do not believe that that is what I said. I said we would consult on the regulations concerning OSCs with relevant organisations. I mentioned the local government association as a particularly relevant organisation. It is not necessary to specify on the face of the Bill with which organisations the Secretary of State should consult. What is clear, and has been the practice of the Department of Health over the years, is that when considering regulations we consult with the appropriate bodies. We shall very much take account of the views expressed to us. But I do not think that it is necessary to put that on the face of the Bill.
Lord Clement-Jones: I hear what the Minister says. I agree that one does not want a great long list. But it is always good at this stage of the proceedings to get some kind of assurance. If there were to be a national patients' council—for instance, if that transpired as a result of the Bill—would the Minister believe that that would be an appropriate organisation to consult over both sets of regulations?
Lord Hunt of Kings Heath: There are a good many "ifs" in that question. If a national patients' council were to be established and if it were established in time

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before the regulations for other parts of the Bill had to be prepared, I should have thought that it would be an excellent organisation to consult. However, perhaps the noble Lord's question relates more to the future than to the immediate present.
Lord Clement-Jones: If that is the case, I can only hope that the regulations take some time in the making. However, we shall hang onto the lifelines thrown by the Minister at this stage of the proceedings. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 55 to 57 not moved.]
Clause 7 agreed to.
Clause 8 [Joint overview and scrutiny committees etc]:
[Amendments Nos. 58 and 59 not moved.]
Lord Hunt of Kings Heath Lord Hunt of Kings Heath moved Amendment No. 60:
Page 7, line 42, after "Act" insert ", or section 9 of, and Schedule 1 to, this Act"
The noble Lord said: In moving Amendment No. 60, I wish to speak also to Amendments Nos. 62 and 63. Amendment No. 60 is a minor amendment that applies exempt information arrangements to joint overview and scrutiny committees as well as to OSCs established by Clause 7. Amendments Nos. 62 and 63 are technical amendments which ensure that arrangements in Wales for overview and scrutiny committees are consistent with arrangements in England. Essentially, they both have the effect that the National Assembly for Wales may make regulations enabling the Assembly to direct local authorities in Wales to enter joint scrutiny arrangements. That gives the Assembly the same powers as the Secretary of State in England. I beg to move.
On Question, amendment agreed to.
[Amendment No. 61 not moved.]
Lord Hunt of Kings Heath Lord Hunt of Kings Heath moved Amendments Nos. 62 and 63:
Page 7, line 43, leave out "Secretary of State" and insert "relevant authority"
Page 7, line 47, leave out "Secretary of State" and insert "relevant authority"
On Question, amendments agreed to.
Clause 8, as amended, agreed to.
Clause 9 [Overview and scrutiny committees: exempt information]:
Baroness Northover Baroness Northover moved Amendment No. 64:
Page 8, line 24, leave out subsection (4).
The noble Baroness said: The overview and scrutiny committees are of vital importance if there is to be transparency and accountability in the NHS. We have serious concerns about whether the committees will be able to achieve all that we would wish. Subsection (4) of Clause 9 rather illustrates our concern. Our amendment seeks to delete subsection (4) because it runs counter to the declared function of the
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committees. If retained, subsection (4) would allow the committees to restrict in whatever way they wished the information that they disclosed to the public, with no debate over that locally or nationally. If the committees are indeed to have a function of overseeing the NHS, it is clear that the public must know and be a party to decisions that are made about their services. What role can an overview and scrutiny committee fulfil if it operates in an unaccountable and secretive way?
The amendment therefore proposes the deletion of subsection (4), which seems to us to confer too much power without accountability. The operation of such a subsection would reduce transparency from the current standard. That would be unacceptable. Given the views and recommendations of the 12th report of the House of Lords Delegated Powers and Deregulation Committee on Clause 67 of the Bill, we ask the Government to reconsider subsection (4) of the clause, which we conclude gives an inappropriate power to the committees. I beg to move.
Earl Howe: The noble Baroness, Lady Northover, covered the ground very well in what she said. I should just like to add one or two points. Subsection (4) raises immediate questions because it contains a Henry VIII power. I should like to ask the Minister about that. As I read it, the subsection confers a great deal of power with precious little accountability. It effectively allows the Secretary of State and the Welsh Assembly carte blanche to restrict the information that may be disclosed to the public without, as the noble Baroness said, any prior debate or consultation. I question whether that is needed. The current standard of transparency in matters of this kind is one which, as far as I know, operates perfectly well. As a general rule, we should strive for a situation that provides the public with as much transparency as possible. It is right that the public should know about and be party to decisions made about their services. I hope that the Minister can clarify the background to this part of the clause.
Lord Hunt of Kings Heath: I certainly agree that we wish to have OSCs operating as openly as possible. Clause 9(4) enables the Secretary of State and the National Assembly for Wales to amend Schedule 1 by adding to it, varying it or deleting its provisions. But I hope that I can reassure the Committee as to the extent to which that is likely to take place.
Clearly, we are in a shifting environment. The NHS as an organisation needs to change from time to time. The provision in the clause to amend Schedule 1 by order allows the flexibility necessary to ensure that the public disclosure of information in the course of the scrutiny of the NHS is kept in line with the changing nature of the NHS and local government legislation. There is a specific situation that we already know may require this provision. For instance, during the passage of the Local Government Act 2000 Ministers undertook to conduct a review of the categories in Schedule 12A to the Local Government Act 1972 on which Schedule 1 to this Bill is based. Schedule 1 has

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some additional categories to reflect its health service focus. The review is being carried out by the Department of the Environment, Transport and the Regions. The intention of the review is to examine whether the list of exempt categories may be restricted. If the DETR changes the list, the department will also be able to take action to revise Schedule 1 accordingly.
It is worth explaining why we need exempt information. Where an OSC meeting is perhaps discussing NHS matters, it is possible that discussions will involve the disclosure of information relating to the NHS which should not be disclosed to the public at large. The obvious examples of that are personnel information or medical information about individual NHS patients. That is why Clause 9 and Schedule 1 make the additional provision for overview and scrutiny committees that are scrutinising the NHS which corresponds to the existing provisions of the Local Government Act 1972.
The reason for adopting a similar approach to that contained in the 1972 Act is so that, as circumstances change—for example, where changes are made to the NHS structure or legislation relating to the NHS is amended—Schedule 1 can be brought up to date or be otherwise adapted. I believe that the undertaking given by Ministers during the passage of the Local Government Act 2000 to see how this power could be further restricted provides the comfort required by the noble Baroness. Furthermore, we shall take account of any decisions that are made by the DETR at the end of its consultation.
Baroness Northover: I thank the Minister for that reply. I draw some comfort from it, but I am not fully convinced by what he has said. Nevertheless, for the moment I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 9 agreed to.
[Amendment No. 65 not moved.]
Schedule 1 agreed to.
Lord Burlison: I beg to move that the House do now resume. In moving this Motion, perhaps I may suggest that the Committee stage begins again not before half past eight o'clock.
Moved accordingly, and, on Question, Motion agreed to.
House resumed.

Imports from Developing Countries
7.30 p.m.
Baroness Young Baroness Young rose to ask Her Majesty's Government what is their view about the European Union initiative "Everything but Arms ".
The noble Baroness said: My Lords, I make no apology for raising once again the important issue of the EU Initiative, "Everything but Arms". I speak in my capacity as president of the West India Committee
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and, as the House knows, I have long taken an interest in the Caribbean. I am delighted that so many speakers are taking part in the debate today.
The initiative will have a profound effect for the worse on the economic, social and political stability of those Caribbean countries, especially Guyana, Jamaica and the eastern Caribbean, which are dependent on commodities such as bananas, sugar and rice. But let there be no misunderstanding: the initiative will also affect us here in the United Kingdom.
Little has been heard about the initiative because of the speed with which it has been rushed through. It started in September of last year, barely six months ago, and was agreed by the European Council on 26th February last. It will come into effect at the end of March; that is, in around two weeks' time. The initiative is driven by the EU Commissioner, Pascal Lamy, and is a response by the EU to its desire to meet its WTO commitments to the world's poorest countries in such a way that the Americans and Japan will make similar offers. However, the more one looks at the initiative, the more one can see that it is not a good example of an ethical foreign policy.
What does the initiative say? It grants duty-free and quota-free access for all least developed country products, except arms, from the end of March. While this may help the world's poorest nations, it has the effect of setting aside existing regimes like those in the Caribbean and the more developed producers among the ACP of sugar, bananas and rice. It will have a serious impact on employment in all the more developed ACP nations producing those commodities. For example, 70 per cent of the population of Guyana is employed in sugar and rice. The initiative will erode rapidly the present arrangements in many Caribbean nations, just as they are starting the gradual process of economic transition out of preference and into free trade.
We all welcome the principle that help should be given to the world's poorest countries. Clearly, trade is much better than aid. But the way that this initiative is to work changes unilaterally existing preferential arrangements. It does so by extending duty and quota-free access immediately for all products entering the EU from the world's LDCs. Only in the case of sugar, rice and bananas will full implementation be delayed, until 2006 for bananas and 2009 for sugar and rice. The purpose of this, however, is not to benefit the Caribbean, but to help the producers of bananas, sugar and rice in the EU countries themselves. But of course prices will fall and the special quotas for all these three sensitive commodities will be opened immediately at levels which suggest that, from the end of this year, the Caribbean and other ACP producers will lose a significant share of their European market.
Not surprisingly, the Caribbean and the ACP have protested that, under the terms of the Cotonou Convention, signed only last June, they must be consulted. However, this has not happened. The convention seems to have been overruled. Indeed, in the debate that took place, EU states demanded

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concessions in order that their own agricultural producers would not be disadvantaged. The result is that the more developed ACP nations, for example, those of the Caribbean and Mauritius, now have to try and salvage what they can by arguing that, after the implementation of the initiative in two weeks' time, impact studies must be undertaken to measure the effect of the initiative on these producers. These must be undertaken by the EU and debated. This is, after all, the wrong way of dealing with this whole matter, which has been extremely disturbing, in particular to Caribbean countries.
The Prime Minister of Mauritius has told the Prime Minister and other European leaders that the initiative will initially transfer highly needed benefits from small, vulnerable island states to the least developed countries. Then, at a later stage, markets will be disrupted with serious consequences for more ACP nations and the French departments d'Outre Mer. ACP sugar producers have amplified this and have argued their own case. They suggest that the way in which the EU decision is structured means that the negative impact will be borne wholly by more ACP sugar producers and that,
"it will be the poor, not the rich, who bear the brunt of an initiative to help the poorest".
I regard that as an extraordinary outcome for an initiative.
So far as concerns rice and bananas, the situation is little different. In both cases, the market will be progressively disrupted as the new market arrangements, again largely designed to protect European producers, result in less competitive ACP producers being displaced from the EU market.
Britain has long had close ties with the Anglophone Caribbean countries and the 500,000 people from the Caribbean who now live in this country should make us recognise that fact today. The Caribbean was once known as the "Jewel in the Crown" and I believe that we cannot, and should not, neglect the interests of these small, vulnerable but important states. No one is arguing for preferential access in perpetuity. Indeed, I support the principles of free trade. But small island nations that are heavily dependent on commodities require a reasonable period of time in which to adjust. They cannot simply go out of preference and into free trade in a matter of two weeks, such is the timetable of this initiative.
I believe that the United Kingdom will ignore their interests at its own peril. Nations such as those in the eastern Caribbean, Jamaica and Guyana, are already major sources of drugs, centres for transhipment, money laundering and organised crime, including arms trafficking. The sudden collapse of sugar, rice and bananas in already weakened economies will have a direct impact on the United Kingdom, as the temptation will be for those countries to turn to drugs. What a policy, to take away from countries those commodities which help poor people to survive and stand on their own feet, and to put in front of them something much less desirable.
When the Minister comes to reply, I hope that he will say, first, that the treaty obligations under the Cotonou Convention must be met: there must be an impact statement. Secondly, any EU decision to undercut or to shorten the agreed eight-year preparatory period—that is, from 2001–2008—before the sugar, rice and banana industries can undertake a measured transition to World Trade Organisation compatible arrangements, would be quite unacceptable.
Finally, I hope that the Minister will accept that financial compensation is not an alternative. These three industries are the employers of most of the labour in much of the Caribbean. A gradual, integrated process of transition away from older industries to newer industries—such as tourism, financial services and information technology—is required. If this does not happen, the resultant instability will damage the future prospects for tourism and the newer industries.
All this transition will require a great deal of help from the private sector; it will require investment and it will require training. None of these things can happen overnight. I return to my original point: we have an obligation to these small, vulnerable countries, which are part of the Commonwealth.
I accept that the new WTO round is desirable, but it is not desirable at any cost. Special and differential treatment is desirable for small and vulnerable states such as those in the Caribbean. We were prepared to recognise this in the past; we recognised it when we entered the EU and we have recognised it on other occasions. Why have we forgotten it now? Should we not reconsider this policy, even at the eleventh hour.
7.41 p.m.
Lord Faulkner of Worcester: My Lords, we are indebted to the noble Baroness, Lady Young, for initiating the debate today. I am happy to support her plea for more sympathetic treatment for the banana, rice and sugar producers of the Caribbean. She has a distinguished record as a champion of the interests of the West Indies, and I am sure that the governments of that region will be grateful to her for securing the debate.
Why is there such concern in the commodity producing ACP states over the "Everything but Arms" initiative when, on the surface, it appears to offer such a great step forward for the world's 48 least developed countries? The problem is that one man's meat may be another man's poison. While the EBA initiative will help the LDCs, and is indeed a huge advance for them—I do not dispute that—it will in its present form do untold damage to every Caribbean economy that is dependent on commodities.
David Jessop, the executive director of the Caribbean Council for Europe, wrote on 13th October:
"It is no exaggeration to say that it could result in the destruction of much of the Caribbean's sugar and rice industry, do serious damage to the rum industry's last remaining chance to compete in the EU market, and diminish further the prospects for Caribbean bananas in Europe".

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In November, the Guyanan Foreign Minister—I was interested that the noble Baroness referred to Guyana on two occasions in her speech—said that the proposals were a knock-out blow which his country could not sustain. If the proposals went through, he said, it would become virtually impossible for Guyana to export rice, sugar and rum. As those commodities account for 44 per cent of Guyana's total exports, this would force Guyana into becoming one of the world's poorest countries. This must not be allowed to happen.
The Ministers of the ACP states held a council meeting last December. They produced a very interesting report afterwards. They started by warmly welcoming the EBA initiative—an act of generosity on their part, I feel. They went on to say that they had considered the implications for the stability of the banana market. The report said:
"Ministers noted that the EU market is attractive because of the effective limitations on supply from all sources. Measures which remove this limitation will inevitably lead to oversupply and the consequent further decline in prices".
My noble friend Lady Amos last week kindly sent me a briefing paper from the Department for International Development which explains why DfID supports the EBA initiative. It points out that following the passing on 26th February of a compromise regulation proposed by the Swedish presidency, there are now extended transition periods of five years for bananas and eight years for sugar and rice. The note goes on to say that the legitimate concerns of the Caribbean and other non-LDC ACP producers must be addressed, and talks about how the increased transition periods,
"allow a reasonable time for Caribbean producers to adjust gradually to the increase in competition".
That is fine provided that it is matched by action, and there are some clear indications of how that help with transition will be given. My worry, which I know is shared by many noble Lords, is that the rural economies of the Commonwealth Caribbean face absolute ruin, and that farmers who are exhorted to diversify will see that advice as simply giving them the green light to grow illegal crops for the drugs trade. We must do much more to support the process of diversification and steer it into legitimate directions.
Governments of both parties have stood solidly by our friends in the Caribbean. The contribution that their people have made to our economy and society in peacetime, and their bravery and sacrifice in times of war, means that we must continue to do all that is within our power to ensure that they are not disadvantaged as global trade is liberalised. It would be a terrible irony if the EBA initiative removed millions from poverty in the 48 least developed countries and, at the same time—perhaps unwittingly—caused terrible hardship in the ACP states.
7.46 p.m.
Baroness Byford: My Lords, in a debate on the EU sugar regime moved by my right honourable friend Mrs Gillian Shephard on 21st November last year,
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concerns were expressed by many MPs about the impact that the "Everything but Arms" proposals would have upon both the countries concerned in the Caribbean and our UK sugar producers. Tonight my noble friend Lady Young has given us the opportunity to look at these matters again.
While I understand very well the issues about which she has spoken, I hope that she will forgive me if much of my contribution centres upon our UK producers. I understand the difficulties and the economic and social needs of the Caribbean countries—I share my noble friend's concerns—but it would be remiss of me not to reflect on the impact that that will have on our producers here.
In her reply to the debate in the other place, the Minister, Joyce Quin, said:
"it is our responsibility to ensure a non-discriminatory effect as far as the UK is concerned".—[Official Report, Commons, 21/11/00; col. 23WH.]
Perhaps I may remind your Lordships that UK farmers are facing their lowest incomes for some 50 years, an average of just over £5,000 per annum; they are struggling against lower prices caused by the weak euro; and, in addition, since 1996, although sugar prices to the producer have gone down—they, the producers, are being paid less—the price of the product has risen.
In addition, it is not only the prime sugar producers who will be affected. A depressed sugar industry has implications for other local industries in the area—such as companies which supply the equipment used on the farms or in factories—and for those who work in sugar beet factories, whose jobs are threatened. In East Anglia, where sugar beet is grown in large amounts, farmers have had to cope with the down-turn in farming trade shared by every farmer throughout the country. They have also had the additional difficulty of swine fever and now—although it has not yet, fortunately, affected the two counties—we are in the depths of a foot and mouth epidemic which is running out of control.
The EBA proposals could result in a 25 to 40 per cent sugar quota cut, affecting both the EU and ACP producers. In the UK, some 23,000 jobs are at risk. I believe that the UK should not accept any quota cut as we have a deficit in our production. We produce about 50 per cent of our country's sugar needs. If any quota cuts are agreed, they should fall first on countries within the EU which have sugar surpluses.
As my noble friend suggested, the two proposals we are discussing today are contradictory and completely incompatible. Instead of tinkering with the sugar regime, this matter should be delayed and considered with the fundamental reform of the CAP. In the meantime, a full impact assessment should be undertaken to evaluate the effect of the EBA proposals on UK sugar producers. Perhaps I may ask the Minister why such an in-depth impact study has not been undertaken. Will the Minister not acknowledge that, if the EU is expected to reduce domestic sugar beet quotas, the UK would be unfairly disadvantaged?

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I again thank my noble friend for raising this very important issue. Although I have concentrated on the effects that these proposals will have on the UK, I am deeply concerned about the Caribbean countries. While I, like others, accept that there will have to be changes in the future, I think we are unnecessarily rushing through this matter. We should stop and rethink even at this late hour.
7.50 p.m.
Lord Judd: My Lords, I join other noble Lords in thanking the noble Baroness, Lady Young, for having provided an opportunity to debate this important subject. I declare an interest as a member of the Oxfam Association and a trustee of the Overseas Development Institute.
The 48 least developed countries to which the European Commission's proposal would apply include 32 of the 35 countries in the lowest category of the United Nations development programme's Human Development Index. Just imagine what that means in terms of human misery, suffering and wasted human potential. Aid alone can never provide the answer. There has to be a genuine opportunity to gain access to the markets of the world. Anything that inhibits this is indefensible.
Increasingly, free trade and the benefits of trade liberalisation have been preached to the developing countries as the route to their salvation. What, frankly, is deplorable is when too often from exactly the same quarters as those from which the sermons on market principles are preached comes the pressure for protectionism when self-interest is perceived as threatened. Northern protectionism currently costs developing countries an estimated 700 billion US dollars a year. Against that background, what the Commission proposes is very modest.
Research by the Institute of Development Studies has, I gather, indicated that the immediate impact of the new scheme will be limited to frozen beef, cheddar, sweetcorn, bananas, maize, long grain rice—husked and wholly milled—raw cane sugar, white sugar and molasses. There is not much prospect of the volume of exports of most of these products increasing significantly over the next few years. The 48 countries in question account for only 0.003 per cent of European Union imports and 0.4 per cent of world trade. They do not have the capacity rapidly to increase the volume of their exports.
However, in the case of beef, maize, rice and sugar there could be an increase in exports to the European Union as a result of diversion from other markets with less favourable terms of trade. But it seems likely from the research carried out by the IDS that the only significant such diversion would be sugar from Malawi, Mozambique and Sudan. Of these, the country most likely to gain is Mozambique. Even this increase would be small in absolute terms, although very important for Mozambique, whose global sugar exports in 1997 were only 59,000 tonnes. We should do well to remember that 40 per cent of Mozambicans live below the poverty line on less than one dollar a day.
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One in five children in Mozambique is dead by the age of five; it is one of the most educationally deprived countries in the world; and the country is still reeling from devastating floods both last year and earlier this year. Improved access to the European Union could help a great deal; and, of course, Mozambique happens to be a member of the Commonwealth.
Of course, there are real anxieties about the implications of all this. Sugar and bananas are the principal concern. They are of great value to vulnerable communities in the Caribbean. Convincing transitional arrangements will, therefore, be essential, as will real help in improving competitiveness and diversification. This cannot be left to chance. But what will no longer be acceptable is that historic accidents should debar equally poor or even poorer countries from their right to access.
The Everything but Arms initiative could prove a valuable, if modest, contribution by the European Union to generating confidence that the multilateral trade system can be made to look to the needs of the poor as well as of the rich. There will then be the ability—which is desperately needed—to say to the United States and to the World Trade Organisation not merely "Do as we say" but "Do as we do". However, in taking this road, it is essential to remember that every bit as important as the level playing fields themselves are the tailor-made arrangements to bring countries to the point at which they can play on them, for no two countries in the developing world and their needs are ever exactly the same.
7.54 p.m.
Lord Haskel: My Lords, this initiative is but one part of an international movement to reduce third world poverty. The movement is led by Great Britain, and especially by my right honourable friend the Chancellor of the Exchequer.
We have recognised that the least developed countries are stuck in a vicious cycle of debt, poverty and under-development because they are excluded from world trade and are unable to develop their economies. We have realised that by our actions we can turn this vicious cycle into a virtuous circle of debt relief, poverty reduction and sustainable development. No single change will make a greater contribution to fulfilling that virtuous circle than opening the markets of prosperous countries to the goods produced by poor countries.
However, I am not entirely carried away with euphoria. I listened with great interest to the careful words of caution of the noble Baroness, Lady Young. I agree that there need to be safeguards against corruption and exploitation. The legitimate concerns of the Caribbean producers must be addressed. But equally, there must be no clumping of subsidised food crops or other products in the 48 poorest countries. I am sure that my noble friend the Minister will be able to reassure us on this point.
The point that I want to explore is how long these kinds of arrangements are sustainable. Let me explain. Take the sugar industry, for example. The price of

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sugar in Europe is three times the world price. An elaborate system of quotas, subsidies and price guarantees has provided Europe's sugar industry with a profitable, protected, captive market. I simply ask: for how long will consumers allow this to go on?
This business is operated by companies. Today, companies are as heavily judged by image and reputation, by brand quality and by business ethics as they are by economic or financial factors. All these factors are very vulnerable to the bad publicity of profits from artificially maintained high prices and protected markets. Some say that corporate citizenship is just a matter of clever public relations. That may be the case. But it also makes for good business. It enhances the brand, it encourages staff loyalty by making employees feel good about the company and it pleases customers because today consumers have ethical commitments too.
Once consumers begin to target well-known brands with ethical demands, the brands react very quickly. That is why Nike shoes and Levi jeans are now made only in factories where there are adequate standards in wages and working conditions. It is why suppliers to McDonald's have to maintain high environmental standards; and it is why the major pharmaceutical companies are offering discounted drugs to help combat HIV in some of the world's poorest countries. In addition, thanks to such developments as cheap solar power and micro-credit, these poor countries are starting to become profitable markets for major companies.
Surely what the increasing liberalisation of world trade means in practice is that, instead of relying on quotas and subsidies, we all have to lift our performance. That is why consumers can make a difference. I congratulate the European Union on having taken this step.
7.59 p.m.
Baroness Trumpington: My Lords, I applaud my noble friend Lady Young for initiating this short debate. It is very important that the interests of the Caribbean islands are supported by the United Kingdom. That is not only in their interest; it is also in ours.
Poor countries such as the small Caribbean islands have to grow what is possible. I suggest to the noble Lord, Lord Haskel, that ethical consumers might buy Caribbean bananas. If the market is adverse, regrettably such countries turn to narcotics production and transhipment, money laundering and trafficking in arms. The relationship of these activities to organised crime and terrorism was pointed out by my noble friend Lady Young.
When the European Council agreed to the Everything but Arms initiative, it recognised the plight of the poorest countries, which, of course, was right. But at the same time it ignored the effect that it would have on the future economic, social and political stability of any Caribbean nations dependent on commodities. The Caribbean and the ACP countries
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have protested that, under the terms of the Cotonou Convention signed in June 2000, they must be consulted. However, the EU chose not to see this as an issue. As a result, more developed ACP nations—for example, the Caribbean and Mauritius—now have to try to salvage what they can through arguing after the event that impact studies on the effect on ACP commodity producers must be undertaken by the EC and discussed.
Surely the Minister will agree that treaty obligations under the Cotonou Convention must be met. ACP sugar producers have suggested that the way in which the EU decision is structured means that, in effect, it will be the poor, not the rich, who bear the brunt of an initiative to help the poorest.
It is now some time since I had the privilege of visiting some of these beautiful islands. I am probably out of date, but I cannot believe that their difficulties have lessened with the passage of time—rather they have worsened. I add my plea to that expressed by my noble friend Lady Young, that the British Government should seek partners with a vested interest in the outcome; in other words, that they should establish a position of leadership in the EU and with the United States in relation to the Caribbean and build a new vehicle with the private sector that is able to foster the delivery of rapid results.
8.1 p.m.
Lord Tomlinson: My Lords, when looking into the World Trade Organisation and the EU mandate post Seattle in June of last year, the Select Committee of your Lordships' House on the European Union made two comments in its report that I should like to quote. First, at paragraph 159, it said that,
"the EU must change its agricultural policies both to prevent the dumping of its surplus production on to world markets in a way which is damaging to developing countries, and to allow access to its markets for the agricultural exports on which developing countries depend".
Then, at paragraph 290, the report quite specifically said:
"While the EU procrastinates on the Common Agricultural Policy, and thus continues to impose restrictions on agricultural imports, it weakens its bargaining power in persuading others to go further in the concessions they offer to developing countries. We think that the EU should seriously consider giving a lead by allowing duty-free access for all imports"—
the committee emphasised the word "all"—
"from least developed countries, without waiting for other developed countries to follow suit".
When the report was debated in your Lordships' House, no one took issue with either of those points.
Originally, Everything but Arms was a proposal to allow duty-free, quota free access to the European Union for all goods from the world's least developed countries, except arms and munitions. We are now debating a proposal that has been changed—essentially changing the current generalised system of preferences in order to extend duty-free access without the quantitative restrictions to all commodities from the least developed countries, but with a recognition of the specific problems of three sensitive products:

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bananas, rice and sugar. There are very clear proposals now before Her Majesty's Government, which are not yet agreed but which the Government appear to be supporting. They are being brokered by the Swedish presidency in order to get a timetabled arrangement for dealing with those three sensitive products.
At present, this House should be encouraging the Government to encourage the Swedish presidency in the arrangements that it is seeking to make for those sensitive products, while at the same time bearing in mind the very clear cautionary words that are expressed Al the Government's Explanatory Memorandum on the policy issue. Paragraph 15 of that memorandum, which talks about policy implications, says—and I welcome this—that the,
"UK Government strongly supports the original Commission proposal. The 48 LDCs have become increasingly marginalised in the world economy, their peoples are amongst the world's poorest, and they are desperately in need of assistance to stimulate their own development and growth. The LDCs are characterised by their exclusion from international trade, accounting collectively for less than 0.5% of world trade".
That is the Government's own statement of policy implications. I believe that they are right. I hope that this compromise succeeds, because I believe that it will achieve improved access to EU markets by the LDCs, while giving sufficient time for the countries that are affected to adjust to change—an adjustment that I hope will be fully supported by the ACP, the European Union and the DfID. If they support and encourage the process of transition and change, I believe that we shall have a truly free international economy.
8.6 p.m.
Lord Roper: My Lords, I am most grateful to the noble Baroness, Lady Young, for having raised the subject this evening. It is obviously important that proper attention should be paid to this important advance of the European Union to improve access to its markets by the least developed countries. I am especially glad that the noble Lord, Lord Tomlinson, has just referred to the report last year of your Lordships' Select Committee on the European Union which welcomed such proposals.
Among those of us on these Benches there is a strong belief in the advantages of free trade. Therefore, we welcome the Everything but Arms agreement, not only in its own right but also as a confidence-building measure that increases the chance of starting a further major trade round of the World Trade Organisation at Qatar this November, and restarting a process which went so seriously wrong in Seattle last year. However, as the noble Baroness, Lady Young, and the noble Lord, Lord Faulkner, rightly said, this presents problems for the other ACP countries. I shall return later to that issue.
Some people would criticise the relatively limited concessions and the very long transitional periods as far as concerns bananas, sugar and rice, which, as the noble Baroness said, are primarily designed to protect the interests of the European producers rather—I fear—than those of the ACP countries. This proposal shows a need for an aggregate strategy towards the
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least developed countries and the ACP countries. I hope that the Everything but Arms agreement will shame the other wealthy countries into making similar concessions. We need to pursue debt relief, as has been advocated by the current Government. However, we also need to structure bilateral aid to the ACP countries to ensure that they will be able to diversify. as has been recommended.
In conclusion, I should like to make one further point. There seems to me to be a need for the Government to spend more effort in making the case for free trade so as to give the developing countries market access. The curious coalition that we saw last year at Seattle must be countered by the powerful arguments that exist and which, I believe, are shared in many parts of your Lordships' House. In that respect, these Benches would certainly not wish to claim any monopoly on the term "liberal". We hope that everyone will be liberal, as far as concerns the liberalisation of international trade.
Those arguments were made most effectively last year in the DfID White Paper, which pointed out the value that can be achieved in this way. We have seen the need for this in much of the discussion in the negotiations taking place in Geneva this week on the general agreement in trade and services. Once again, we have heard alarmist arguments that freer trade in services would merely be advantageous to large enterprises from developed countries to the cost of the less developed countries.
In spite of the problems which have rightly been pointed out by the noble Baroness, the Everything but Arms initiative which we are considering is, I believe, a credit to the European Union. I hope that it will take us forward to the further liberalisation of world trade which, if it is introduced properly and with the other measures, including the structural aid for diversification for the Caribbean countries, could only be to the great advantage of the least developed countries.
8.10 p.m.
Baroness Miller of Hendon: My Lords, I thank my noble friend Lady Young for introducing this debate so well. The Conservative Party believes in free trade and compliance with the rules of the WTO and in assisting the most disadvantaged third world countries.
However, I must point out to your Lordships that there is no such thing as free free trade. The least developed countries (LDCs) have no industrial base and the only way to boost their external trade is through agriculture. But what we are looking at is a see-saw. As there is a finite demand for such products as sugar, rice and bananas, if one group of countries is given preferential treatment, inevitably another area will suffer. Then that already struggling group will be dragged down the economic ladder—a classic case of robbing Peter to pay Paul.
The aims of the Everything but Arms initiative are to provide help to the LDCs, but the way that it has been written and the way that it is intended to be

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initiated have not been thought through. The timing of the initiative turns on its head the Cotonou agreement which gave limited preferential trading arrangements to ACP states but would be totally negated by the EBA initiative. The agreement was signed as recently as June 2000 and the EU Commission announced the Everything but Arms initiative before the ink had time to dry on 22nd September. Under the Cotonou agreement there should have been consultation and an assessment of the effect on the Caribbean economies. There was none.
Also, before the initiative can be brought into effect, there should be an examination of the problem of countries of origin; otherwise, we are in danger of creating the potential for fraud and deceit. Nepalese rice is a good example. Rice can enter Nepal from another country and be subjected to minimal processing as there will not be an army of inspectors to check what is going on. Then that same rice will qualify for lower tariffs to the detriment of other rice producers, some of them only marginally less poor.
The initiative will have a serious negative effect on every ACP country exporting the three important products I have just mentioned and will erode the arrangements in many Caribbean nations just as they are beginning the process of transition out of economic preferences that they have hitherto enjoyed. The measure has the effect of unilaterally modifying existing preferential arrangements by extending duty and quota free access to the EU from the LDCs, although in the case of bananas, sugar and rice the implementation will be delayed. Even then the special quotas given to LDCs for those three sensitive commodities will undoubtedly result in ACP producers, and especially those in the Caribbean, immediately losing significant shares of the European market.
The UK should have a special concern about the Caribbean. Some 56 per cent of the workforce in the five Commonwealth countries in the Caribbean work in preference-dependent industries. These countries will remain stable only as long as the region is stable. We have substantial export and investment interests in the area. If we impoverish this area, which is already targeted by criminal elements because of its proximity to the US, there will inevitably be an upsurge in the production and transhipment of drugs, trafficking in arms and money laundering. The UK, the EU and, indeed, the US have a vested interest in not upsetting the delicate balance of trade by sudden changes in the regime. Private sector involvement and capital are essential to the future growth of the area. Such investment will not be available if the area is deemed to be unstable, thus pushing it into a rapidly descending spiral of new deprivation.
What is needed is a far more gradual and tapered process rather than the uncontrolled upheaval that is projected. The initiative will, to begin with, transfer much needed benefits from highly vulnerable island states to the least developed countries. Markets will be distorted and disrupted with dire consequences for other countries as well as the possible destabilization
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of the areas that are prejudiced. The Government should use their influence in the corridors of Brussels to adopt a more gradualist approach. If they do not, the poor, not the rich, will bear the brunt of a good initiative designed to help the very poorest.
8.15 p.m.
The Minister for Science, Department of Trade and Industry (Lord Sainsbury of Turville): My Lords, I welcome the opportunity given by the Unstarred Question of the noble Baroness, Lady Young—to ask Her Majesty's Government what is their view about the European Union initiative Everything but Arms—to explain the Government's position on this important recent agreement in the European Union.
There seem to me to be three issues here which have to be carefully balanced: free trade, the reform of the common agricultural policy and our moral duty to the poorest people in the world. I hope that Members of this House can accept all three of those issues and that they also agree that the most difficult aspect is balancing those three conflicting issues. Our moral duty to the poorest people in the world was well expressed by your Lordships' Select Committee on the European Union's important report of last June, The World Trade Organisation: The EU Mandate After Seattle. That stated,
"We think that the EU should seriously consider giving a lead by allowing duty free access for all imports from least developed countries, without waiting for other developed countries to follow suit".
Let me start with some facts. Some 98 per cent of tariff lines covering the EU's imports from the 48 least developed countries in the world have been free of tariffs and quotas for some time. I note in passing that these products have never proved disruptive to EU markets.
Last October the Commission produced a proposal for the abolition of tariffs with effect from 1st January 2001 on all the remaining 900 or so tariff lines still subject to import duties, except for arms. The sole exceptions to this proposed early removal of tariffs were around 12 tariff lines covering raw sugar, rice and bananas where a three-year transitional period to phase out tariffs was suggested as a recognition of the relative sensitivity of these agricultural products.
As the Government explained in their Explanatory Memorandum submitted to your Lordships' Scrutiny Committee on European Legislation on 13th November, we believe that the proposal would benefit the poorest countries in the world. It would open to their relatively early stage industries and primary producers the largest market of consumers in the world.
Among these 48 poorest countries of the world, whose citizens—as the noble Lord, Lord Judd, rightly pointed out—subsist on less than one dollar a day, are Commonwealth countries such as Tanzania, Mozambique and Zambia. Their current state of economic development and poor infrastructure means that they are only likely relatively slowly to be able to take advantage of this new market access. But the EBA

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initiative gives them the certainty that our markets are open to them which should help them to attract the investment and development they so desperately need. Of course, it is not possible to be certain about either the speed or volume of their supply response to the opportunity of the EBA initiative. The Commission's impact study, finally published in February—but largely irrelevant as it was based on the superseded initial proposal—suggested EU imports of sugar from LDCs of between 900,000 and 2.7 million tonnes in the short to medium term. Oxfam's study estimated only 100,000 tonnes of sugar in the short term. Another study suggested 1.9 million tonnes in the medium term and the International Sugar Organisation suggested 900,000 tonnes after 10 years. The variables in all this are huge, not least the current attractiveness of an EU internal sugar price at over 2½ times world market price—a differential which the imminent reform of the sugar regime will probably reduce.
Indeed, the rightness of the EU's wish to help the poorest has been recognised by developing countries themselves. Before Christmas at the regular meeting of parliamentarians from the EU and its African, Caribbean and Pacific counterparts under the auspices of the Cotonou Agreement the EBA initiative was welcomed. The Prime Minister of Barbados in writing to the Prime Minister endorsed the objective of helping the least developed countries in order to draw them into the wider globalised marketplace. While noting with concern the possible negative impact of the Commission's original proposal, the Prime Minister of Barbados said,
"We therefore have no hesitation in expressing our fullest support for the implementation of such an objective".
We therefore supported a presidency proposal made on 19th February, finally agreed at the 26th February General Affairs Council, which committed the EU to removing all remaining tariffs (except on arms imports) from the LDCs. Already tariffs have been removed on nearly 900 tariff lines. They remain now only on the three sensitive products of bananas, rice and sugar. I do not think, therefore, that it is true to say, as did the noble Baroness, Lady Trumpington, that the interests of ACP countries were not taken into account. Perhaps I may say to the noble Lord, Lord Tomlinson, that the transitional arrangements have now been put in place.
For bananas, tariffs will be reduced by 20 per cent a year from 1st January 2002, becoming completely tariff free on 1st January 2006. This aligns these arrangements with the recent agreement on the EU banana regime, which will move from a quota system to a tariff only system from 1st January 2006. For rice and sugar, tariffs will be reduced at the beginning of their relevant marketing years (1st September for rice and 1st July for sugar) by 20 per cent in 2006, 50 per cent in 2007 and 80 per cent in 2008. They become completely tariff free during 2009. But meanwhile in order to phase-in access, tariff quotas are to be introduced based on the best figures for LDC imports during the 1990s, plus 15 per cent. That is a considerable period of time.
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The noble Baroness, Lady Young, said that she did not argue for protection in perpetuity. But in the light of these arrangements we have protection which runs for some considerable time into the future. This is designed to smooth the adjustment, particularly for other EU suppliers. This also aligns the graduated entry for LDC sugar and rice to the EU market with the period envisaged under last year's Cotonou Agreement with the ACPs for the setting up of new regional economic partnership agreements which arc due to come into effect by 1st January 2008.
The Government approach to this complex subject was laid out in last December's important White Paper from the Department for International Development, Eliminating World Poverty: Making Globalisation Work for the Poor. This committed the Government to working to improve the access of developing countries to EU markets including duty and quota free access to EU markets for all least developed countries.
The UK has therefore been supportive of the Commission's proposal throughout. We believe, as does Oxfam, that the adjustment costs from this change, which will accrue in part to long-established non-LDC ACP suppliers, should be dealt with sympathetically through EU and bilateral aid. Indeed, many Caribbean countries, even though they retain a guaranteed market for 80 per cent of their sugar exports to the EU under the terms of the Sugar Protocol, have already begun to diversify their economies away from too great a dependence on a single crop and a single market. Some 80 per cent of their sugar sendings are guaranteed under the Sugar Protocol, which is not affected by the EBA arrangements.
For bananas there is little risk of competition from the LDC before 2006. These costs should not, and did not, deter us from seeking to aid the very poorest. For EU suppliers of sugar and rice, we believe that the impact of tariff-free access for LDC suppliers will be relatively small, not least since the Government and EU are committed, well before full access for the LDC suppliers in 2009, to reforms of the EU regimes for both these products. It is right that consideration of the impact of the Everything but Arms initiative should be taken into account in discussions on reforming those regimes.
The noble Baroness, Lady Young, raised the question of consultation on Cotonou. The Commission proposal was first sent to the ACP secretariat at the same time that it was transmitted to member states, in October 2000. The EU ACP Trade Sub-Committee met in November 2000 to discuss the issues. Both sides welcomed the proposals. The joint EU-ACP parliamentary assembly met in October 2000 and welcomed the proposals. Do not let us forget that Article 37(9) of the Cotonou Agreement explicitly commits the EU to providing duty and quota free access to the LDCs for essentially all the products by 2005 at the latest.
The noble Baroness also raised the spectre of the ACP countries turning to drug production. I do not think that there is evidence to support that claim. Even with guaranteed access to EU markets at some high

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prices, some countries already have drug problems. Other poorer countries which do not have preferences do not have drug problems.
The noble Baroness, Lady Byford, raised the question of the impact on British sugar beet farmers and producers. I believe that the current sugar regime is unsustainable. It will be increasingly difficult to defend in the WTO. Enlargement will make it impossible to maintain in its current form. The EBA agreement will have no impact on British beet farmers while transitional quotas are in place. By the time they are removed, other factors such as enlargement and reform of the CAP sugar regime will have necessitated change anyway.
The noble Baroness, Lady Miller, raised the question of fraud. Safeguard action can be taken if substantial quantities of LDC products over and above reasonable expectation from previous statistics start coming into the EU; and safeguard measures allow all trade preferences to be suspended. That is a significant deterrent against fraud.
The Government believe that the EU's commitment to the Everything but Arms initiative represents a very good outcome for the least developed countries. It proves that the EU is serious in its commitment to putting the needs and priorities of developing countries—and particularly the poorest—at the centre of its approach to global issues.
The Government believe that the Community agreement strikes a reasonable balance between the interests of the least developed countries, those of the non-LDC, African, Caribbean and Pacific producers and those of our own domestic producers.
Your Lordships' Select Committee Report on The World Trade Organisation: The EU Mandate After Seattle rightly noted that,
"If the developing countries are to be persuaded to continue to co-operate in the multi-lateral trading system, they will need to be convinced that the system has the ability and the will to understand and address their problems".
The Government believe that the EU has, through the Everything but Arms initiative, demonstrated its commitment to putting the needs of the world's poorest people at the centre of its trading policies. The Government will be urging the EU to continue down this road, focusing on development in the next world trade round. This is the best way to ensure that the benefits of free trade are shared more equitably so that every citizen of the world can hope to enjoy the benefits that we too often take for granted.
Viscount Waverley: My Lords, before the Minister sits down—I am sorry to trouble him on this point—does he realise that he has undermined the concerns of his officials in Jamaica in matters relating to drug issues in the Caribbean?
Lord Sainsbury of Turville: My Lords, I made a general point. There is no evidence that where preference has been withdrawn it leads to drug taking; and there are drug problems in countries which have
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had preference. Therefore, the easy assumption that if preference is withdrawn it will lead to more drug taking cannot be substantiated by fact.
Baroness Ramsay of Cartvale: My Lords, I beg to move that the House do adjourn during pleasure until 8.30 p.m.
Moved accordingly, and, on Question, Motion agreed to.
[The Sitting was suspended from 8.29 to 8.30 p.m.]

Health and Social Care Bill
House again in Committee.
Clause 10 [Application to City of London]:
Lord Hunt of Kings Heath Lord Hunt of Kings Heath moved Amendment No. 66:
Page 8, line 41, leave out "(6)" and insert "(5)"
On Question, amendment agreed to.
Clause 10, as amended, agreed to.
Clause 11 [Public involvement and consultation]:
Lord Clement-Jones Lord Clement-Jones moved Amendment No. 67:
Page 9, line 18, after "representatives" insert "including Patients' Councils, patients' and carers' organisations, ILAFs, Patients' Forums, overview and scrutiny committees and the wider community"
The noble Lord said: I shall speak also to Amendments Nos. 69, 72 and 73. Clause 11 provides for health service bodies to involve and consult the public in the planning and development of their services. The amendments are straightforward. Amendment No. 67 is intended to clarify what is meant by "representatives" in subsection (1) so that it includes the new ILAFs, which are not specified elsewhere in the Bill, patients' forums, patients' councils, overview and scrutiny committees and the wider community. I am not a great fan of lists, but that seems reasonably short and to the point. There is currently a lack of clarity about whom the health service bodies should consult in the performance of their duties. It is not possible formally to consult everybody who may have an interest in health services, but one should have a pretty good idea of the principal players. The amendment carries out that purpose admirably.
The second main purpose is carried out by Amendment No. 72, which would add special health authorities, the NHS Executive—by that we mean the regional offices of the NHS Executive, which have an important planning and development function—and care trusts, which are set up by the Bill and will have an increasing importance over the years. It is important that those bodies should be included and should have consultation duties. I do not understand why they were not included originally. It may have been an oversight by the draftsman. The amendment fills a gap. It would be inappropriate for special health authorities and care trusts not to be subject to the same requirement as other health authorities to consult persons to whom their services are provided. The regional offices of the NHS Executive are responsible

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for many decisions that impact on service delivery. Amendment No. 72 would open up those regional offices. That is long overdue.
Amendment No. 73 relates to annual reporting. I note that the noble Earl, Lord Howe, has tabled a very similar amendment. This is an important issue. The bodies concerned should state publicly how they have consulted and in what form. The purpose of the first part of the amendment is to require health service bodies to explain in their annual report how they have involved and consulted patients, carers and the wider community and what they have done about what they have learned as a result. The second part of the amendment would provide for an appeals and referral procedure by which contested decisions would be scrutinised and adjudicated on. That would enable patients and local communities to express their concerns about contested decisions and have those concerns considered by the Secretary of State. I beg to move.
Earl Howe: I shall speak to Amendments Nos. 68, 72 and 74A. Clause 11 gives effect to one of the Government's main aims in this part of the Bill—to enable patients and the public to contribute in an appropriate fashion to the planning and decision-making of health authorities, PCTs and trusts. We fully share that aim. Patients and the public generally will be able to have their say in a reactive sense through a variety of different channels. The combination of patients' forums, patients' councils, advocacy services, ILAFs and, to an extent, overview and scrutiny committees will provide a conduit for the views of patients on the standard of services delivered locally and problems that may arise. However, equally important will be the ability of the local community to have a voice in the big decisions on issues such as the planning of new services or major changes in service provision.
The clause is not specific about who will be accorded the right of consultation and involvement in those decision-making processes. At some point in every Bill we reach what my noble friend Lord Skelmersdale has in the past described as a shopping list. Amendment No. 68 is framed as a catch-all shopping list, but its main purpose is to act as a probe. If it is a sin to try to insinuate a shopping list into a Bill, it is equally sinful to go to the other extreme and fail to give any indication of who is being referred to. There is a genuine risk that the Bill will fail to be clear about who the consultees are meant to be.
It is impossible formally to consult everyone who may have an interest in health services. At present, the statutory duty to consult is limited to consulting CHCs. However, unless the clause is fleshed out, I fear that legal challenges could be mounted by individual patients and groups who were not specifically consulted but who consider that they should have been. One can well imagine threats of legal action being directed at health bodies carrying out the consultation. CHCs have found themselves on the receiving end of complaints and solicitors' letters from community groups who believe, fairly or unfairly, that
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their views have not been reflected in the CHC's recommendations or responses. I shall be interested to hear how the Minister proposes to square that circle and to find out who will be included in the consultation process that the clause proposes.
As I said, the purpose of the clause is to place a duty on health authorities, PCTs and trusts to involve patients and the public in planning and decision— making. Amendment No. 72 would add to the list of health service bodies on which that duty was conferred. It would provide for special health authorities and care trusts to consult the public. It would also ensure that if proposals for changes in health services were under consideration by the NHS Executive, it, too, would be obliged to consult before reaching final decisions that may impact on service provision.
When a similar amendment was debated in another place, the Minister, Mr Denham, rejected the inclusion of special health authorities on the ground that by 2002 no special health authority would be providing services directly to patients. I ask the Minister to think again on that. The issue should not be whether services are provided directly. What matters is that the decisions of the authorities—for example, the National Institute for Clinical Excellence, which is a special health authority—can have a real and discernible impact on health service delivery.
In the case of care trusts, Mr Denham's argument stands up to even less scrutiny because it is clear that a care trust will provide services directly to patients in as full a sense as will an acute hospital trust. There may be a legal objection to that. The Minister may say that a care trust is simply an NHS trust or a PCT in a different guise. However, I am not sure whether I consider that to be a strong enough argument and I shall be interested to hear what the Minister has to say.
That brings me to the NHS Executive, to which the noble Lord, Lord Clement-Jones, referred. Again, I recognise fully that the NHS Executive does not provide services directly to patients. However, in indirect terms, its role is of course extremely important. Regional offices of the NHS Executive are responsible for a number of decisions which impact on service delivery. Those range from resource allocation to decisions about reconfiguration of health bodies and supra-regional services. Regional offices are often the place where final decisions rest. Therefore, one could argue—and I do—that any process of consultation that confines itself to the bodies which merely implement regional office decisions is a fairly worthless exercise.
Finally, one theme to have emerged from our debates on the Bill thus far is the need for transparency. With the exception of one or two notable provisions, there is precious little on the face of the Bill in the way of transparency. The purpose of Amendment No. 74A is to apply, as it were, a little more window-cleaning fluid to the procedures to which the legislation gives rise. Its simple purpose is to require health service bodies to explain in their annual

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report how they have involved and consulted patients. carers and the wider community. In my view, it is important not only that such consultation takes place but that everyone should be made aware that it has taken place and in what way. I hope that that idea will commend itself to the Minister.
The other amendment in this group provides for an appeal for referral procedure whereby decisions that are controversial can be scrutinised and adjudicated upon by the local OSC. In that way, patients and the local community will be able to express their concerns about contested decisions and, where necessary, have their decisions considered by the Secretary of State. A provision of this kind would mirror Regulation 18.5 of the CHC Regulations 1996 under which CHCs have the statutory right to refer contested decisions to the Secretary of State. At present, the Bill does not provide for any type of appeals or referral procedure. I believe that that is an omission which should be rectified.
8.45 p.m.
Lord Hunt of Kings Heath: This has been an interesting debate, and I believe it is worth acknowledging that this is a very important clause. It sets out the responsibilities of the NHS in fulfilling its duties to involve and consult the public. However, I have reservations about the amendments that have been put forward.
Clearly, our intention is that comprehensive patient and public involvement will take place at all levels of the NHS. Clause 11 is explicit about that. However, I do not believe that it is necessary to list on the face of the Bill all the bodies that we would expect to be consulted, as is suggested by Amendments Nos. 67 and 68. I believe that the list is too prescriptive and it runs the risk run by all lists—by naming some, almost inevitably others are excluded.
The important point is the intent. The intent is quite clear. I believe that it would be fairly obvious to every NHS organisation that patients' councils, patients' forums, OSCs and patient and carer organisations would be critical of the delivery of the duty set out in that clause. The NHS has had extensive experience in consultative processes. We want to make that bite still further. I believe that this general duty does so effectively without the need to list a particular organisation which specifically should be consulted.
Nor do I believe that it is necessary to specify in the clause that patients' councils should monitor the implementation of Clause 11, as is suggested by Amendment No. 69. One of the duties of the patients' forum will be to prepare annual reports that will be submitted to health authorities and, indeed, to the Secretary of State. Those reports will include an assessment of how local trusts consulted and involved the public in their decisions. I believe that that will also be a powerful tool in the armoury of those who, quite understandably, wish to hold the local NHS to account in ensuring that the clause is put into effect properly.
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I turn to the comments made by the noble Earl, Lord Howe, in relation to special health authorities, care trusts and the NHS Executive. He seems to have anticipated my answer, which is always rather disturbing. With regard to SHAs, my right honourable friend Mr John Denham was right. We do not envisage that any of the SHAs which currently provide health services will be special health authorities by April 2002. At present, Rampton, Ashworth and Broadmoor are covered by the terms of the clause as special health authorities. However, by the time that Clause 11 comes into force, they will have been made into trusts.
The noble Earl believed that some of the remaining SHAs which provide a service to the NHS may be covered by the proposal. It is worth recalling that the current SHAs include the Prescription Pricing Authority, the National Blood Authority and NICE. Although I accept that it is important that those organisations always focus their services on the impact on the public and patients, I am not at all convinced that the mechanism that we have set out here, which essentially concerns the provision of local NHS services, is the path down which one should go in relation to such institutions as NICE or the National Blood Authority.
It is also worth making the point that, for example, the Secretary of State has required NICE to set up a 50-strong Partners Council, made up of members representing the health professions and patient and carer interests, which it consults on a regular basis. In addition, a new citizens' council will be established to advise NICE on its clinical assessments.
So far as concerns the NHS Executive, I do not agree with the points that have been put forward. It is worth stating that the NHS Executive is part of the Department of Health. Therefore, the question of scrutiny and accountability must rest on Ministers' accountability to Parliament for the performance of their responsibilities, including the performance of the NHS Executive.
I turn to the question of care trusts. Perhaps I may explain in fairly outline terms that a care trust will be either an NHS trust or a primary care trust. If, for example, a care trust was formed out of a primary care trust and services were delegated to it by the local authority, in statutory terms it would be a primary care trust. Another example might be an acute mental health trust to which the local authority delegated services. That would be a care trust, but in statutory terms it would be an NHS trust. Therefore, I am convinced that care trusts will be covered by the terms of the Bill as it now stands.
So far as concerns Amendments Nos. 74 and 74A, I am not persuaded by the arguments put forward. Our proposal for a patient prospectus will require all trusts to say how they have taken into account the views of patients.
In addition, Clause 12 refers to the reports which patients' forums will be making to trusts and health authorities. Of course, those forums will also be able to make reports to the overview and scrutiny committees

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and, indeed, to the Secretary of State, if they are so minded. I do not believe for one moment that patients' forums will be inhibited from making their views known to anyone in the system whom they think is relevant.
The system that we are creating has any number of safeguards to ensure that as many people as possible are involved and consulted by the NHS. We do not need to go further. The clause as it stands is a very powerful guarantee of the way in which the NHS will behave in the future.
Lord Clement-Jones: I thank the Minister for that response. It was admirable in the way that it dealt with all the issues raised. There is considerable food for thought in what the Minister said. I believe that he has answered the point raised in relation to care trusts.
One always has those philosophical debates about lists, prescription and so on. I should not wish to set a precedent by having the Minister accept any amendment in that respect. I shall consider what the Minister said and meanwhile, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 68 to 74A not moved.]
Clause 11 agreed to.
Baroness Northover Baroness Northover moved Amendment No. 75:
After Clause 11, insert the following new clause—
"LOCAL MEDIATION SCHEME
(1) The Secretary of State shall, by regulation, set up a local mediation scheme to be operated by Patients' Councils.
(2) Regulations under subsection (1) shall provide for

(a) petitioning of Patients' Councils by local stakeholder groups;

(b) the broad criteria by which requests for mediation are to be decided;

(c) the bodies and office holders that Patients' Councils will have the power to call to a mediation meeting;

(d) the time period within which mediation meetings must be arranged;

(e) reports to be provided by the Patients' Council to the Commission for Health Improvement, the Commission for Mental Health, the Audit Commission and the Secretary of State.

(3) Before making regulations under this section, the Secretary of State shall consult Community Health Councils, Patients' Councils, Patients' Forums and such bodies currently providing mediation schemes and the wider community, as the Secretary of State shall consider appropriate.
The noble Baroness said: In moving this amendment, I shall speak also to Amendment No. 98 and Amendment No. 98A which stands in the name of the noble Earl, Lord Howe. These amendments are designed to introduce a local mediation service operated by patients' councils. The purpose of that arrangement is to make provision for the local resolution of problems concerning the planning and delivery of local services.
The resolution of problems at an early stage locally would reduce the need for problems to be directed through the courts or referred to the Secretary of State. The amendment ensures that the results of such
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mediation are to be reported to the Commission for Health Improvement, the Commission for Mental Health and the Secretary of State so that any lessons that can be learned from that particular conflict can be picked up by those bodies and good practice disseminated elsewhere in the service.
This provision ensures also that there is an accountable and transparent system in place and seen to be in place. That seems to us a very sensible provision with which I hope the Minister will sympathise. I beg to move.
Lord Hunt of Kings Heath: I was interested in the speech of the noble Baroness. I have severe doubts about the amendment because, in a sense, she is proposing that patients' councils act as a mediator between different NHS organisations within a particular locality.
There is a fundamental problem of principle in that regard in that we see patients' councils as having a specific focus based on patients. Their role, alongside the patients' forums, is surely to represent the interests and views of patients as regards local services.
In view of that, one wonders to what extent they could then act as a neutral observer in being able to mediate between the different interests of the health service or, indeed, between the health service, local government and voluntary bodies.
It seems to me that if there is a dispute, there are two ways in which it can be dealt with. First, if it is a concern about major service changes, it must be the role of the overview and scrutiny committee of the relevant local authority to scrutinise the proposals and, if it disagrees with them, it can refer the matter to the independent reconfiguration panel which we shall establish to advise the Secretary of State. If it is not so much a question of a major service change but is in a sense a spat between different NHS bodies and organisations, it is for the NHS regional office to sort that out.
I understand what the noble Baroness seeks to achieve but I have reservations about giving patients' councils a role which in some ways may detract from their focus on patients and their interests.
Baroness Northover: I listened with interest to what the Minister said. It rather illustrates the problems which we are having, in the sense that on this side of the Committee we are looking for a unified approach to those matters, whereas it seems from the list which the Minister has just given that the Government are looking for a diverse and varied approach to all the different parts. That is reflected in the amendment In looking for a unified, independent and informed overview of what is happening, we are seeking to tie together the different parts, and that does not seem to be the Government's approach.
However, I shall wait with interest to see what follows on from these debates and where we can move to. Therefore, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 12 [Patients' Forums]:
Earl Howe Earl Howe moved Amendment No. 76:
Page 9. line 40, at beginning insert "Before the commencement of section 18,"
The noble Earl said: In moving this amendment, I shall speak also to Amendments Nos. 11 and 138. I need not tell the Minister that there is a fundamental difference of view between the Government and ourselves on the future of community health councils. I want to raise an issue which relates to the implementation of the Government's proposal to abolish CHCs.
If the Government have their way, Royal Assent for the Bill will be granted some time in advance of 1st April 2002 when the new bodies proposed in the Bill become fully operational. During Standing Committee in another place, the Minister, Mr Denham, indicated that the Government would continue to fund CHCs and ACHCEW until 2002. That assurance, although welcome, leaves open the question of exactly when CHCs will be abolished. To my mind, we need to make absolutely certain that, as far as possible, there is a smooth transition between the existing regime and the new one. That can happen only if the new systems are fully operational and bedded down before CHCs cease to exist. That in turn means that the statutory powers and responsibilities of CHCs should continue in being alongside the new structures for a period of time.
There is uncertainty about the Government's intentions as a result of a letter circulated recently to CHCs by the Chief Nursing Officer, Sarah Mullally, in which she said:
"CHCs will remain in each area until the new system is in place".
Taking those words literally, that could mean that different abolition dates will be set for different CHCs according to how well advanced the implementation of the new systems is in each area. On the other hand, it could mean that there will be one cut-off date for all CHCs, regardless of how firmly established or not the new arrangements may be.
The fact is that that uncertainty exists and it reflects quite badly on the Government. As I said before, there was a total absence of consultation on those proposals when they were announced originally. Even if I accepted, which I do not, the view expressed by Ministers that ACHCEW had no legitimate expectation of being consulted, it seems to me a matter of courtesy to keep ACHCEW informed of the timetable for the demise of the CHCs and to give some indication of how plans should be made for that.
The way in which ACHCEW has been treated by Ministers is highly regrettable. I hasten to add that I have received no whinging from ACHCEW in relation to this at all. That is purely my own view and, therefore, I would be grateful for reassurance from the Minister. How do the Government see the transition process working? Will they undertake to keep all parties properly informed of the timetable? Above all, will they ensure that as far as possible the transition to the new regime will be a seamless one?
It would also be helpful to have clarification on what will happen to the employees of CHCs. Will they be offered the opportunity of applying for positions in, say, patients' councils and, if so, will their terms and conditions of employment be protected? Can the Minister tell the Committee what will happen to the records maintained by CHCs? The records represent a valuable resource, but issues of confidentiality will need to be considered. It would be helpful if the Minister could provide clarification on those concerns. I beg to move.
9 p.m.
Lord Rea: Amendment No. 138, in this group, stands in my name. I can do no worse than remind my noble friend of a paragraph in my Second Reading speech to which he did not have time to reply. I expressed more or less the same sentiments as those produced by the noble Earl, Lord Howe, although perhaps not in as elegant a fashion. I said:
"Can we be assured that the new organisations will be up and running before the community health councils are abolished? If, as I hope, many of the community health councils' paid and voluntary staff are transferred to one or other of the new bodies, can they continue to function under the aegis of the CHCs while the new arrangements are being brought into being? How are the phasing out and phasing in to be managed so that the experience of the CHCs' staff and volunteers is not lost?".—[Official Report, 26/2/01, col. 1022].)
There is already much disquiet among CHC and ACHCEW staff about the future and I believe that some of them have already taken other jobs. Perhaps my noble friend can tell the Committee what the Government's thinking is on this matter.
Lord Clement-Jones: I support what has been said by the noble Earl, Lord Howe, and the noble Lord, Lord Rea. Clearly, we need to inject some certainty into the situation. It would be grossly unsatisfactory if any gap were allowed to develop between the passing of the Bill and the appointed day for the relevant clauses, and indeed the setting up not only of scrutiny committees but also of patients' forums and patients' councils. I hope that the Minister can accept the amendments or dispel any uncertainty about the way in which the transition will take place, so that those who are employed and those who have a considerable interest in the effective development of patient representation at heart will be able to understand what the future holds.
The Earl of Listowel: On the continuity between the two services, can the Minister make an apology to the 5,000 volunteers of the community health councils for the handling of the CHCs and a statement to the effect that the new arrangements, if they are to be up and running quickly and effectively, will greatly benefit from the experience that the volunteers in the previous organisation have to offer? That would be most welcome.
Lord Hunt of Kings Heath: I hope that I can reassure noble Lords that I accept the point that we should have no intention of abolishing CHCs before the new

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arrangements are up and running. We intend there to be a well-managed transition between the existing system and the new system. The NHS has experience of restructuring so we understand how the process operates. We would seek to ensure that good, administered principles operate in relation to the phasing out of CHCs and the introduction of the new arrangements. Our intention is that the bulk of the new arrangements will have to be up and running before the existing arrangements are taken out of play.
The Secretary of State has a commitment to provide alternative services to those of CHCs before they are abolished. CHCs in an area will not be abolished until all the following arrangements are established: the OSCs, the patients' forums and patients' councils, which we intend should be established from April 2002. We want to ensure that PALS are established in every trust and primary care trust by April 2002. We also intend that the transition should be handled effectively so that there is no gap in relation to support for patients who need it from CHCs as of now and in the future from the new arrangements.
The noble Earl, Lord Howe, raised the matter of records. We shall need to consider carefully what should happen to those records. Clearly, it is important that the valuable work that has been undertaken should be passed on to successor organisations. We shall also have to reflect on how to deal with the paperwork in relation to individual members of the public who have raised issues with the CHC and which the CHC is pursuing so that such matters can be handed over in an orderly fashion. Support given now by CHCs would be given in the future through the new arrangements one way or another.
In relation to the members of the CHCs, I pay tribute to their voluntary and dedicated work. From personal experience I know how hard CHC members have worked over the years. I am anxious that we should be able to use that commitment and talent in the future. I have no doubt that when it comes to the appointment of patients' forums we shall look closely at the contribution that CHC members may have to make. It is also worth making the point that many of our current non-executive directors on the boards of health authorities and trusts have undertaken service with CHCs, which has proved to be valuable.
Employees of CHCs will be dealt with in a similar way to NHS staff who are the subject of a reorganisation or restructuring. However, I believe that the bulk of CHC staff will find that there are greatly increased opportunities for their expertise in the new arrangements. One has only to think of the possibilities in relation to PALS, to the secretariat which will support the patient forums and patient councils, to the establishment of independent advocacy services and to the servicing role of the local authorities' overview and scrutiny committees in order to recognise that there will be many opportunities for the highly skilled staff of CHCs. They will also find that there is a more effective career pattern for them. In the past, on becoming a chief officer of a CHC one reached a glass ceiling unless one moved into a
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different part of the NHS. The new arrangements will bring many more opportunities to move into different jobs in the area of patient and user involvement. Some Members of the Committee will be aware that a trust in Southampton has already advertised for the chief of its PALS at a salary of around £40,000, which is considerably more than chief officers earn.
Baroness Cumberlege: Will the Minister reply to the question asked by the noble Earl, Lord Listowel? There are many bruised people who feel they have been treated most shabbily.
Lord Hunt of Kings Heath: I paid tribute to the work of CHC members. However, the Government have decided that CHCs should be replaced by the new arrangements. I do not believe that in reaching that decision and making these proposals we are causing offence to the current members of CHCs. I believe that we shall use many of their skills in future. Equally, government have the right to make such decisions.
Baroness Cumberlege: I accept that. However, it is a tradition within the health service that on the whole one consults with people before one goes forward with a scheme. Problems have been caused because, although the proposal appeared in the NHS Plan, there had been no consultation as there had been with other measures. The element of surprise hurt people, so perhaps the matter could have been dealt with a little more graciously.
Earl Howe: In supporting the comments made by my noble friend Lady Cumberlege, perhaps I may add another dimension. CHCs and ACHCEW are still in being and they need to know what is happening. I am conscious that they feel that they do not know what is happening and it would be advisable for the department to institute a little more regular communication so that they know how to plan for the exit.
Nevertheless, I am grateful to the Minister for his comments, which were largely reassuring. They filled in a number of important gaps. The fear expressed to me was that CHCs might be left nominally in being but with none of their statutory powers. That would be a waste of time for all concerned and, more to the point, detrimental to the public interest.
I shall read carefully what the Minister said but I believe that it largely dispelled the doubts. With that, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 77 not moved.]
Earl Howe Earl Howe moved Amendment No. 78:
Page 10, line 6, after "carers" insert "and such other organisations as the Secretary of State considers appropriate"
The noble Earl said: In moving Amendment No. 78, I shall speak also to Amendments Nos. 79 and 83. They are designed to replicate one element of the status quo with regard to community health councils; that is, their duty to represent not only patients but also the

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wider community. I believe that patients' forums should be required to canvas the views not only of patients and their carers, although those groups must be a prime focus, but also potential patients; in other words, the community generally.
It is a matter not only of breadth of vision but of balance. The perspective of patients and carers is vital, but it is inevitably confined to a subjective viewpoint. Others who are not so closely bound up with local health services but who could be have an equal claim to be heard. I hope that if nothing else the Minister will recognise that there is an important point of principle at issue; that is, whether the remit and purview of patients' forums should be relatively narrow or a broad one like that of the CHCs. I beg to move.
The Earl of Listowel: I raised this point earlier. I remind the Committee of the past work of the Community Health Council for the City, East London and Hackney with groups dealing with the homeless, sufferers of sickle cell disease and members of ethnic minorities who have difficulties with English. That work is perhaps not concerned with particular complaints but the requirement for special services which the CHC has helped to obtain.
Baroness Barker: I add my support to the noble Earl, Lord Howe. I listened with interest to the Minister's words about CHCs a few moments ago. From conversations that I have had, perhaps the greatest blow suffered by people in CHCs is the devaluing of their strategic work on health, which is extremely important to the remainder of the Government's plans to make sure that health and social services become integrated. This is a forum in which one is not just talking about patients. Therefore, I echo the comments of the noble Earl about community involvement, which is very important.
9.15 p.m.
Lord Hunt of Kings Heath: Surely the point here is that much of the wider community role passes to the local authority in terms of the overview and scrutiny committee. That is the whole point of the changes that we are making. In gaining a wider community perspective, what better vehicle is there than the democratically elected local authority? That is the whole point of setting up the arrangement. As the noble Baroness, Lady Cumberlege, said earlier, we are dealing with the problem of the democratic deficit which has affected the health service for so long. That does not mean that the forums will not bring to the table at trust level concern for patients and the public. I believe that that will be a very forceful vehicle to take those views right to the heart of trust board decision-making machinery.
But there must be a focus on the patients and public who are served by that trust, informed by the very membership of the patients' forum itself, which will include representatives of local voluntary and patients' organisations. That will ensure that the forum activities are informed by the wider view to which the
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noble Earl referred. But it is very important to focus on the prime purpose of the patients' forum, which is concerned about the activities of the trust. At the same time, we must not discount the major leadership role which the local authority will play in future in the arrangements for the NHS.
The Earl of Listowel: I see great value in the Minister's emphasis on focusing on the patient and his or her experience, but something is being lost. Here one has an institution with a shop front in the community that processes complaints but also can take a broader view of strategy and thinking and the needs of the community. I do not believe that that asset is being replaced by the oversight and scrutiny committee. I do not have experience of local government, but I have worked with socially excluded people. It is easy to lose touch with that experience. When one deals with people who do not speak English, or perhaps are illiterate, or have difficulty connecting with the system, they are more likely to fall between those patients who are recruited to the new forum and council and the local authority group. I should be very grateful if the Minister could reassure me on that matter.
Earl Howe: I am grateful to all noble Lords who have taken part in this short debate. The difference of view between us underscores what I see as one of the shortcomings of the network of structures created by the Bill; namely, its fragmentation. Overview and scrutiny committees are designed to fill a democratic deficit, which I thoroughly applaud, but their remit is not the same as that of patients' forums. I believe that the latter have their own roles to play in reflecting the views of the locality and trying to represent them on a day-to-day basis in the health service. Not to have a broader compass, as my amendments suggest they should, would be a shame. It may be that, in practice, their role will broaden out because people inevitably come to talk to you if your door is open. I am sorry not to see something more formally reflected in the wording of the Bill. But I am, as ever, grateful to the Minister for the trouble that he has taken to answer my points, and I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 79 to 81 not moved.]
The Deputy Chairman of Committees (Viscount Simon): Before calling Amendment No. 82, I must advise Members of the Committee that, if it is agreed to, I cannot call Amendment No. 83 due to pre-emption.
Lord Rea Lord Rea moved Amendment No. 82:
Page 10, line 32. at end insert "and shall act independently, so far as practical, from each establishing NHS trust or Primary Care Trust as the case may be"
The noble Lord said: This amendment is conveniently tabled at this point because we are considering in this clause the general functions of patients' forums.
One of the main worries about the new arrangements is that the independent status of the CHCs will be lost. The patients' fora will be set up in association with one NHS or primary care trust. Therefore, it already appears that they will not have the independence of the CHCs. My noble friend may differ. He may say that they will operate under a different structure and will be able to take a completely independent position. I am not so sure about that; nor are many people who are rather critical of the whole thrust of the Government's reforms. Perhaps my noble friend will clarify how far the patients' fora will be removed from their parallel trusts, and the mechanisms by which they will be seen to be independent. I beg to move.
Lord Hunt of Kings Heath: In response to my noble friend. I say that there will be no point in having patients' forums unless they are to be effective; and, to be effective, they need to be independent. I restate to the Committee that the intention is that patients' forums will be provided with the independence required to fulfil their functions. They will be independent from the trusts for which they have responsibility—just as independent as community health councils are from the health authorities with which they have a relationship.
Forums will be established by the Secretary of State, not by trusts. The trusts will have no power to control how a forum carries out its functions. Members of the forums will be appointed independently through the auspices of the NHS appointments commission, which comes into operation on 1st April this year. Regulations will determine the criteria under which those appointments are made. Forums will be not be based in the trust, as in the case of the patient advocacy liaison service (PALS), but will be supported by a common secretariat shared with other local forums and the patients' council to whom they appoint representatives. Funding will be determined in regulations but will be received independently of the forum's trust.
I wish to state to my noble friend that the link between forums and their trust is central to making these new arrangements work effectively. To ensure that their views are effective, forums will appoint a non-executive director to the trust board. The forum will have the opportunity to build in the patient view at an early stage of the trust decision-making process. To make sure that all are aware of the forum's activities and the trust response, a patient prospectus will be published each year, detailing what patients think of services and how the trust is addressing those issues.
The patients' forum will sign off the patient prospectus as well as publishing its own annual report. I believe that these arrangements ensure that the forum will be independent of the trust and will prove to be a robust ally of the patients and the public concerned with that trust.
Lord Rea: I thank my noble friend for those reassuring words. I have a certain sympathy with him
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in that these words will now be in Hansard; they will be read countrywide and studied in considerable depth. The Government will be held to them. With those remarks, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 83 not moved.]
Clause 12 agreed to.
9.30 p.m.
Lord Clement-Jones Lord Clement-Jones moved Amendment No. 84:
After Clause 12, insert the following new clause—
"ASSOCIATION OF PATIENTS' FORUMS
(1) The Secretary of State shall establish an independent national body, known as the Association of Patients' Forums. with a duty to provide a national overview of the patient experience to the Secretary of State and National Health Service bodies, on a regional and national level.
(2) The Secretary of State shall make regulations for the purposes of subsection (1) above.
(3) Before making regulations for the purposes of subsection (1) above, the Secretary of State shall consult such bodies as represent the interests of persons likely to be affected by the regulations."
The noble Lord said: In moving Amendment No. 84 I shall speak also to Amendments Nos. 134A and 145. It is common ground on all sides in the Committee that ACHCEW has played an extremely valuable role over the years, not only in co-ordinating the activities of CHCs nationally and in spreading best practice, but in giving information to members of this House and the other place; for example, its snapshot surveys of accident and emergency departments. They have played a valuable role in keeping us abreast of what is happening in our hospitals.
The major gap in the Bill is the failure either to retain ACHCEW or to put another body in its place. A letter from the National Consumer Council is typical of many representations made to me and my colleagues on these Benches and no doubt to many other noble Lords. The NCC stated:
"Despite the various local structures, the Bill still leaves a gaping hole, in that it omits a national body for patient and public representation".
One hopeful development was that the Government in another place recognised the case for a national body to bring together the various patient representation bodies, the forums and councils. The Department of Health proceeded to fund a short feasibility study to explore how such a body could work in practice. I understand that the results of the study will be produced by 31st March.
There is general consensus about the likely functions of such a body. First, it would bring together the evidence from the patient forums and councils about the general issues arising for patients at the local level and ensure that it is used to influence future policy developments at a national level; secondly, it would provide support training and development for the patient and public representatives; thirdly, it would ensure quality by monitoring that all the patients' councils and forums' services are delivered to agreed standards; and, fourthly, it would shape best practice on a national basis. That is an extremely important

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agenda for such a body. However, by the time the conclusions of that feasibility study might be published, the Bill could have finished its parliamentary journey through this House or a general election might have been declared. Therefore, it is important that we put down a marker and, if possible, come to an agreement on an amendment while the Bill is in Committee.
It is important that the national body should be statutory and not simply one set up through cooperation between the councils. We believe that it should be a body corporate with powers defined in the Bill. It may be that one should not be over-prescriptive, but certainly the broad outline of the powers and duties of the body should be included.
There are various different ways of achieving what we seek. The noble Lord, Lord Harris, will notice that we are back to an A. la carte process with a series of amendments that have different impacts and may have different fan clubs in the ways they operate. Amendment No. 84 contains a fairly broad power to enable regulations to be made, but it sketches out only the broad outline of the kinds of duties that such a national body would have. Amendment No. 134A sets out considerably more of the powers and duties of such a body. It does not go into as much detail as many would like. For instance, it does not state that the new body will be responsible, in the same way as ACHCEW is, for funding patients' councils or patients' forums or that it should be a conduit for such funding. However, it allows regulations to be made that may or may not provide for that in the future.
Amendment No. 145 is perhaps the most comprehensive of all the amendments. It provides not only for a national body but also for regional patients' councils. That is certainly a preference of many in the CHC movement who would like to see the creation of those forms of regional councils. It would also have a resonance with regional government to be set up in the future.
I hope that one of the amendments will commend itself to the Government. I suspect that Amendment No. 134A is probably most to their taste. All the amendments would allow for developments to take place in the future. We need to have a provision that gives reassurance that this body will be set up. Therefore, the word "shall" in the first line of Amendment No. 134A is extremely important; otherwise, there might be a feeling that this would be nice to have—an optional extra—but might not happen once the Bill is enacted.
I trust that the Minister will be able to give a fairly good indication as to exactly what is acceptable in this collection of amendments and certainly give hope that we can start planning for the future and that a national body will indeed be set up. I beg to move.
Lord Astor of Hever: I rise to support Amendment No. 145, which was spoken to so eloquently by the noble Lord, Lord Clement-Jones, and to support the spirit of Amendment No. 134A. If I were dining a la carte, I would definitely go for Amendment No. 145.
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Although my noble friend Lord Howe has put his name to Amendment No. 134A, we on these Benches feel that it is not yet perfect. Further drafting is needed in order to ensure that the views of bodies representing a wider group than just patients and carers are taken into account and also to consider how the body should be linked to advocacy service providers.
At Second Reading in the other place, the Secretary of State announced that the department would be funding work to look at the feasibility of establishing a national patients' organisation to act as an umbrella body for NHS patients. However, as the noble Lord, Lord Clement-Jones, pointed out, that study has not been completed. Can the Minister tell the Committee what is the progress to date on that initiative?
We agree with the noble Lord, Lord Clement-Jones, that the national patients' council should be put on a statutory basis to ensure its independence and protection from changing opinion within the Department of Health, otherwise it will be liable to abolition or loss of funding without parliamentary debate. The political debate that has taken place over the past few months with regard to the abolition of CHCs shows how statutory status ensures that governments have to account to both Houses of Parliament when seeking to abolish bodies that represent the public interest.
The group overseeing the scoping study passed a statement on 7th March which stated:
"The advisory panel agreed, after consideration of the interim findings, based on consultation with a wide range of patient bodies and detailed feedback from over 60 organisations, that a national statutory body is needed to fulfil the key functions identified".
We hope, therefore, that the Government will now make a commitment on the face of the Bill that they will introduce a national body. If they do not do so, we feel that they will be riding roughshod over the wishes of the scoping study that they themselves established.
Lord Harris of Haringey: I rise to speak briefly in support of Amendment No. 144. Since tabling the amendment, I realise that, given the propensity of the NHS to use acronyms, this body might find itself being called "NATPUC" which is not the most appropriate name for a health service body.
It is worth noting the wide degree of consensus expressed on all sides of the Committee on the principle that some form of statutory status is needed here. So wide is that consensus that I note that the noble Lord, Lord Clement-Jones, has put his name to four different versions of the body. No doubt this develops the style that is typical of the Liberal Democrats in the run-up to elections: they are all things to all people. However, perhaps that is a cheap jibe which I shall withdraw instantly.
The importance of statutory status should not be underestimated. I know that government thinking appears to have moved on this, in that the principle of any reference on the face of the Bill was one that was rejected in another place. However, I understand that this concept may now be acceptable.

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I shall draw on my experience of serving as the director of the Association of Community Health Councils for almost 12 years. During that period, I gathered together a fat file of denunciations of my actions and those of the association by successive Secretaries of State, some of whom are now Members of your Lordships' House, although thankfully they are not present tonight. It is the function of consumer bodies and bodies representing the public interest in many spheres to make waves and to cause difficulties. On occasion, that goes against what Ministers wish to hear. Indeed, my file of denunciations concludes with what is probably the most vitriolic attack of all; it came from my right honourable friend Frank Dobson, who was then Secretary of State for Health. It was clear that he believed that anyone associated with the Labour Party, like myself, should not have been making the kind of comments we were issuing when a Labour Secretary of State was in office.
However, the point here is that every organisation along the lines of a CHC will, on occasion, need to be critical of government Ministers. If it is made too easy for governments of either complexion to say, "Let us abolish this organisation by removing its funding stream", then that is an extremely unsatisfactory situation. Statutory status matters a great deal and would be appropriate on the face of the Bill.
I still believe that, with one exception, my amendment is the best of the bunch. I take the point made 'by the noble Lord, Lord Clement-Jones, that it would have been better had the proposed new clause stated,
"The Secretary of State shall by regulations provide".
rather than,
"may by regulations provide".
There are a number of elements in my amendment which I hope, even at this late stage, the Government will consider. The first element concerns the question of whether or not the new national body should have explicit responsibility for dividing and allocating funds and resources to patients' councils around the country. My noble friend the Minister suggested earlier that the proposal was that funding would come through the regional offices of the NHS. That is the arrangement that currently applies to CHCs.
However, it is not always a happy relationship. The regional office of the NHS is there to ensure that the NHS region functions as it thinks appropriate, and there are sometimes stresses and strains between the regional office and CHCs, particularly those CHCs which are the more effective and perhaps create more waves on the issues which need to be addressed by the local health service. A system whereby the funding stream came through a body which was clearly established for the purpose of representing the patients' and users' interests at a national level would be an appropriate way to handle that issue.
Similarly, issues arise about who employs the staff—again a point referred to earlier. I think that the current arrangement—which is very complicated—whereby staff of CHCs are employed by health authorities, paid through a trust and managed by and accountable to
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the regional office is a very messy one. There have certainly been instances where perhaps inappropriate pressure has been applied to staff of CHCs by regional offices. There has also been ambiguity caused by the question of who is the employer and who pays the salaries. Again, arranging for staff to be managed and appointed through a national organisation would provide arm's length support for the principle of independence, which I believe is extremely important.
The final point that I consider critical is that the national body should have responsibility for quality control and performance management of patients' councils. That is something that has been lacking in the past. On occasion, regional offices have taken on that responsibility and, again, it has not always been a happy arrangement. Under such a system it would be clear that all patients' councils across the country were being performance managed by the national body.
That leads on to the question of what will be the governance arrangements for this national body. The current Association of CHCs is, of course, run by a standing committee which is elected from CHCs. That cannot be the appropriate way of doing things if the organisation is responsible for the performance management of individual CHCs and for some of the funding issues. It would be much better if the governance body contained representatives of patients' councils and various bodies around the country but also other people with an interest and belief in representing the interests of health service users and carers. By having that balance between people who are involved in patients' councils and those who are involved in representing the interests of health service users and carers through other mechanisms, you provide, if you like, a non-executive function which ensures that the performance management of local patients' councils is done in an effective and fair fashion and in a way which is not seen externally as self-serving.
The balance of membership is extremely important. and that is why I have reservations about Amendment No. 134A—which, rumour has it, is the favoured amendment today. The reason for this is that there is no reference at all within that amendment to the questions of staffing and funding. There are provisions in it which may allow staffing and funding to pass through the national patients' body, but it is not specifically prescribed.
There is nothing said in Amendment No. 134A about what are the Government's arrangements for the national patients' body. That could lead to all kinds of problems. You could end up with a national patients' body, the membership of which consisted entirely of hand-picked cronies—after an appropriate "Nolanesque" process—who would simply be there to ensure that what the Minister wanted to happen would happen in respect of patient representation. I am sure that that is not the intention of the Government. But it would be helpful if they made it clear that it is far removed from their intentions. It would be helpful to make clear on the face of the Bill the arrangements for the governance of the organisation, how it will be run and how it will relate to patients' councils.

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A further point which is omitted from the proposed new clause in Amendment No. 134A is any reference to the new body's relationship with independent advocacy services. That is not a problem if the view that I expressed earlier prevails; namely, that patients' councils are responsible for organising or making sure that arrangements are made for independent advocacy services in their area. If that is the case, it does not matter that no reference is made to independent advocacy services in respect of the national patients' body.
However, if the view expressed by my noble friend the Minister prevails—namely, that there will not necessarily be any prescribed form for the provision of independent advocacy services—it is important that there is a clear linkage between the independent advocacy services and the national patients' body, however that body is constructed.
I hope that we shall receive a clear signal from my noble friend the Minister that the principle of statutory provision for a national patients' body is accepted but that the specific reservations expressed in relation to Amendment No. 134A have also been taken on board by the Government.
9.45 p.m.
Lord Hunt of Kings Heath: This has been an extremely interesting debate. I was particularly interested in my noble friend's fat folder of anguish expressed by Ministers at his activities and those of his organisation. I am not sure that my file is quite so fat as his; however, I recall being called in by a deputy secretary some years ago to be told that if I did not stop criticising the Government they would instruct health authorities not to pay any further subscriptions to the NHS Confederation, its predecessor organisations—a point to which I may return in relation to devolution in future discussions in Committee.
This is an important issue. The Government are sympathetic to the concept of a national body. We are backing a study by patient organisations into the feasibility of a national body to represent patient interests at national level. We have seen an early draft of the recommendations and we feel that Amendment No. 134A goes a long way to meeting the broad thrust of those recommendations. It is our intention to accept the new clause proposed in Amendment No. 134A.
In accepting the amendment, we shall be creating a new independent statutory body to advise the Government on the effectiveness of the new arrangements for patient and public involvement. What is significant in relation to a number of the questions raised regarding how the new national body will operate—particularly those raised by my noble friend—is that the new clause will place a duty on the Secretary of State to consult on all the regulations made in regard to the new national body.
I want to make it clear that the Government are committed to wide consultation on how exactly the body should operate. This will include some of the issues raised by my noble friend, including the
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appointment of members—we shall want to see a rigorous, high-quality membership—the funding of the body and the provision of information to it. We shall have the final benefit of the recommendations resulting from the feasibility study soon. We shall examine them closely, together with any other suggestions put to us, before framing the regulations.
It is worth discussing briefly the kind of role that the new national body might occupy—first, importantly, in providing advice to government and NHS bodies on the arrangements for patient and public involvement in the health service. No doubt it will fulfil that role by gathering information from the NHS and the public about the development of these arrangements, by obtaining the views of staff involved in the patient advocacy liaison services and of members of patients' forums and patients' councils. Once these arrangements are fully in place, the body will then be able to advise the Government on the future development of processes for involving patients and the public. The body will have a duty to advise the Government through publishing an annual report, and to report to Ministers separately on its operations and its view on the effectiveness of the arrangements in the NHS.
The body will also be able to represent to the Secretary of State the views of patients, carers, and patients' forums and councils. In doing so, it will provide the opportunity for collaboration between the different patient organisations. It is to be hoped that that will allow for the co-ordination of patients' views from different organisations. I believe that it will also lead to somewhat more cohesive arrangements than are currently in place. Most importantly, the body will be able to support and advise patients' forums and councils. I am sure that that will be enormously effective in spreading good practice and in encouraging those bodies to be as effective as possible. I can give the Committee an example of how that might work. The body might draft a code of conduct for members of patients' forums, suggest service standards for the provision of advocacy services and provide advice on how the forums should relate to the board of the NHS trust, or the primary care trust, to which it relates.
I was interested in the comments made by the noble Lord, Lord Clement-Jones, and by my noble friend Lord Harris about some of the roles of a national organisation in relation to the funding and staffing of local patients' forums and councils. It is worth pointing out that, at present, CHCs are funded by the Secretary of State via a lead health authority in each region, whereas the Association of Community Health Councils is funded by CHC subscription, and also, I guess, by some income revenue raising activities.
I turn to the question of whether or not those arrangements should be replicated. I have great reservations about pulling the funding of the forums and councils up to the centre and using this proposed national body as a way of allocating those moneys. I do so for two reasons. First, if resources were allocated from this central body, and if staff were employed by it, I suspect the people working at local

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level would inevitably look to the national body as a fount of wisdom and accountability to the detriment of their work at local level.
Secondly, if this national body were concerned with the allocation of resources to patients' forums and councils, I suggest that it would be sucked into enormously difficult arguments about the formula to be adopted to ensure that it reached a fair-share position. The one issue that I always avoided at the NHS Confederation was any debate about RAWP, and any other allocated process that followed. I did so because I knew that we could never win. If the new patients' body were to employ all the staff and allocate all the money, I cannot help but wonder whether it would become sucked in by such difficult details to the detriment of its over-riding power.
I can assure my noble friend that we shall listen most carefully to what he and other noble Lords have to say about the proposed new patients' body. However, I believe that Amendment No. 134A most closely fits the Bill. That is why I urge Members of the Committee to accept it.
Lord Harris of Haringey: I understand what my noble friend said about the complications of resource allocation. It will no doubt be an interesting exercise for whoever has to undertake that task. In the future, the Secretary of State will undoubtedly have to explain the position that has been taken, rather than just saying that it was an historical accident arising from the original allocations to CHCs back in the 1970s.
However, I am not sure that I fully understand my noble friend's arguments about staff being employed by the nation al body and the concern that they would look to the national body rather than to the local body for guidance. The corollary of that argument is that if in effect staff are employed by the Secretary of State through a health authority or regional office, they will look to the Secretary of State for guidance and direction. Surely that is even less satisfactory in terms of independent effectiveness at local level than their looking to a national body which seeks to protect the interests of patients and health service users.
Lord Hunt of Kings Heath: I am not sure that I agree with that. I know that my noble friend can point to some areas where there have been problems with the current arrangements where he feels that some CHC staff have not been accorded the degree of independence by the employing authority which he considers they should be accorded. However, I believe that overall the system has worked well. It has comprised an employing organisation for staff which is reasonably removed from their work locality. I consider that if we were to have a national patients' body, as is suggested in the proposed new clause, and if it were to hold all the money and to employ all the staff, it would simply become a national service. I believe that that could detract from the essential element of all this work at the local level.
Baroness Noakes: Will the Minister consider funding and the employment of staff as separate
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issues? One could free staff from any residual concerns about who the paymaster is by having the direct contractual nexus with the new national body, but by having funding dealt with separately if issues of resource allocation are deemed to be too difficult, as my past experience indicates that they may well be. I believe that we can treat those two matters as quite separate issues. There is a serious issue as regards creating sufficient independence from the rest of the NHS for staff who are allocated to these functions.
Lord Hunt of Kings Heath: I accept that point. However, we intend that there should be an independent secretariat which supports both patients' forums and patients' councils. But because the forums and councils will not employ bodies in their own right we have to find another vehicle to do so. Inevitably there will be debate as to whether that is entirely satisfactory. As my noble friend has pointed out, there have been some problems in that area. I believe that on balance it is better that the secretariat, which will be independent, has an employer which is situated as close as possible to the relevant locality. A national organisation with a national employer would remove many decisions away from the locality where people work.
Lord Clement-Jones: We have had a significant debate in the past half hour. It is significant that the Minister has accepted an important principle tonight. It is welcome that he has accepted an amendment, although I realise that many Members of the Committee consider that it needs further development. I also welcome the fact that the Minister said that there will be consultation on how the body will operate.
Although one amendment has been accepted, in a sense we are still subject to work in progress. I say to the noble Lord, Lord Harris of Haringey, that he can make as many cheap jibes as he likes when he makes the good points that he does. I believe that he made four criticisms of Amendment No. 134A which I hope that the Minister will take on board as the Bill progresses. It is possible to correct by regulation the perceived holes in the amendment. For instance, a great deal was made, I think validly, of funding, employment of staff, responsibility for quality control and the nexus with the independent advocacy service. The noble Lord, Lord Harris, raised those points, rightly I believe. Despite the fact that the Minister is somewhat sceptical about how the funding may operate, in particular as regards membership and staffing, I hope that as the consultations progress, it may be possible for the various interested parties to come to an accommodation.
I believe that Amendment No. 134A has the flexibility for appropriate regulation to be made in due course. I shall move the amendment when we reach that point. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 85 to 95 not moved.]
10 p.m.
Baroness Northover Baroness Northover moved Amendment No. 96:
Page 11, line 27, at end insert—
"( ) The Secretary of State shall by regulations make provision for a unified health and community care complaints procedure.
( ) Before making regulations under this section the Secretary of State shall consult Community Health Councils, Patients' Councils, Patients' Forums, patients' organisations and the wider community."
The noble Baroness said: In moving the amendment, I speak also to Amendments Nos. 126, 129 and 133. I may earlier have inadvertently encroached on an amendment of the noble Earl, Lord Howe; I shall try not to do so again.
Underlying these amendments is the determination on our part that there should be a unified, effective and independent complaints procedure. That theme came out strongly at Second Reading and earlier today. Patients and the public have always deserved the best from the NHS. Today, unlike in 1948, they also expect the best. They understand if resources are limited but they do not accept that access to high quality provision depends on where they live, to whom they are referred and what arrangements have been made locally to facilitate or otherwise a good service.
When things go wrong, most patients are savvy enough to know when they are being fobbed off, whether the body to whom they complain has an interest in simply muzzling them, or they have a suspicion that that is so, and some will simply never find their way through the Byzantine system that awaits their complaints. It is no doubt clear that we on these Benches are not optimistic that the Bill will achieve improvements in this area. The amendment seeks to do just that.
Amendment No. 96 states that the Secretary of State must provide for a unified health and community care complaints procedure, given that the two arms are being brought closer together. We would like the term "unified" to run throughout the complaints procedure. It is plainly ridiculous that one patient suffering from different problems at different stages of his treatment should need to find out about, and proceed to, complaints systems in bits and pieces. As we have heard, that is looking at complaints from the service's point of view, not the patient's.
Amendment No. 129 seeks to include independent hospitals, clinics, medical agencies, care homes and domiciliary care under the umbrella of what we are discussing here. Across all the amendments, we are discussing a unified, independent, transparent and easy to use approach. No part of the complaints procedures should be, or be seen to be, answerable to trusts. Those procedures have to be, and have to be seen to be, independent. They must not depend on the whim of the Secretary of State. They must be seen to be robust. As litigation in medicine increases, this is the time not to weaken and fragment, but to anticipate, strengthen, unify and make more independent the complaint and advocacy procedures so that when something seems to go wrong, the cause can be quickly
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and easily established with the full confidence of the patient in how they are being treated in the system. I beg to move.
Earl Howe: I shall speak to Amendments Nos. 125, 127, 128, 130, 131, 132 and 134. When speaking to my amendments to Clause 13 on patients' councils, I explained my view that advocacy services would sit most logically as an integral function of a patients' council. That view met with some agreement around the Committee. I shall not rehearse those arguments, but I should like to raise some issues surrounding the provisions of Clause 17.
Amendment No. 125 would remove the words,
"to such extent as he considers necessary"
from new Section 19A(1). There is too great an overtone of subjectivity and discretion in Clause 17 on what the Secretary of State is enjoined to do. If he were so minded, the Secretary of State could set up a minimalist advocacy service, perhaps even as an adjunct to PALS based in NHS trusts. That would not do. The clause would be strengthened by the removal of those qualifying words.
Perhaps less provocatively, I have suggested in Amendment No. 127 that the remit of advocacy services should be extended to assisting individuals who wish to make a complaint under a procedure operated by a social services authority. At the moment some CHCs support such complaints. There is often an overlap between health service and social service complaints. If we are trying to break down the barriers between the NHS and social services, it makes sense to remove those barriers to help people find their way round the system.
In the same vein, I have suggested in Amendment No. 128 that apart from complaints made to the two health service commissioners, it should be possible for advocacy services to help someone whose complaint is directed towards the local government commissioner. Again, I am uneasy about the words, "so far as practicable" in subsection (5) on page 14. Perhaps the Minister would care to comment on them. Once one accepts that advocacy services need to be independent—I welcome that provision—it ought to follow that the arrangements are established as an independent service for all. I do not understand what is meant by practicability in that context. The subsection merely requires the Secretary of State to have regard to the principle of independence. It does not seem to fetter or compromise him in any way to insist that the arrangements have to be made everywhere or that they should be made in the form of an independent service.
Following on from that, the Bill should specify that, apart from being independent of the person complained of, the advocacy service should also be separate from any NHS or other body that may be involved in the complaint or that may have an interest in its outcome. That is the purport of Amendment No. 132. Amendment No. 130 continues that theme. If the advocacy service is to be truly independent, the way in which it is resourced should match that principle. There should also be some means of ensuring that the

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output of any given advocacy service is of an acceptable minimum standard and that the data gathered as a result of complaints work should be made available by way of anonymised reports to inform the work of other health bodies. Once again, we ought to ensure that there is information transfer if we wish the new bodies to perform a watchdog function.
Subsection (6) deals with the consultation process that would precede the setting up of an independent advocacy service. The noble Baroness, Lady Northover, has spoken to Amendment No. 133. I agree with her that consultation should take place with all bodies and groups which may be expected to make a contribution to the debate prior to the drafting of regulations.
Baroness Hanham: I apologise for intervening rather late in the process of this Committee. As I do so, perhaps I may remind Members of the Committee that I am the chairman of a National Health Service trust. I rise to speak on the question of consultation, to which my noble friend has just referred. I note that all the way through the debate on the amendments reference has been made to this clause, which recommends that regulations should be consulted upon with the community health councils and patients' councils. I have absolutely no objection to that; it is perfectly proper.
However, the organisations that will be the subject of the proposals are not being mentioned. Therefore, I should like to put down a marker that presumably the National Health Service trusts, care trusts and primary care trusts will be involved in such consultation, as well as the wider community.
Earl Howe: I realise that I failed to speak fully to my Amendment No. 134. Perhaps I may do so quickly. It is an amendment which I drafted as a clause on its own and it concerns complaints. Its purpose is to unify the complaints procedures for health and social services. Increasingly, complaints are made about issues that involve both health and social care provision. That trend is likely to continue because health bodies and local authorities are working together more closely, as has been said throughout today's proceedings. Indeed, they are being encouraged to do so.
It would be easier for complainants if their complaints could be investigated by a single body. That would save them having to disaggregate what may often be complex components of a complaint in order to lodge them with the appropriate bodies.
10.15 p.m.
Lord Hunt of Kings Heath: Clearly these amendments concern the arrangements for independent advocacy under Clause 17 and the complaints process for the NHS. The Bill places a new duty on the Secretary of State to arrange for independent advocacy services to be made available specifically to support people who wish to pursue a complaint against the NHS under the NHS complaints procedure. It is the first time that such a duty has been placed on the Secretary of State and I believe that it is a
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very welcome development. It means that patients who wish to complain will receive the support that they need both to understand the complaints process and to resolve the complaint itself. I believe that it represents a significant improvement over the current arrangements.
Having said that, I have concerns about the amendments that have been spoken to in this debate. Perhaps I may turn to Amendment No 125, which seeks to leave out,
"to such extent as he considers necessary".
Clearly, that would take away the Secretary of State's discretion over funding the new independent advocacy service. I cannot agree to that because, finally, it is a matter which I believe must fall to the Secretary of State.
However, what is not in doubt is that the new service must be resourced appropriately to enable it to respond to the demands placed upon it. It is certainly in everyone's interests to ensure that the independent advocacy service is as effective and efficient as possible.
Amendment No. 126 relates to the question of medical practitioners. I do not agree with the aim of the amendment. Medical practitioners have access to support through their professional bodies. I believe that those bodies are particularly effective in representing the views of medical practitioners. I do not believe that it would be appropriate to make independent advocacy available to them.
Amendments Nos. 127 and 128 aim to extend the Secretary of State's duty to arrange independent advocacy services to people who wish to complain about the services provided by a local authority. I understand the reasons for that proposal but there are genuine difficulties with it. The purpose of the new independent advocacy services is to assist complainants against the NHS. We have a different statutory arrangement and framework which applies to local authority services. It would be very difficult to extend the scope of an NHS independent advocacy service in that way.
However, I accept that similar issues arise as to how to help service users take up concerns about the services that they receive. We know that there are already many examples of advocacy in social services and particularly in relation to social services for children. We debated that matter in particular in our discussions on the Children (Leaving Care) Bill. I can tell the noble Earl that, following a recent consultation exercise on social services complaints procedures, we are looking at the possibility of a statutory right of access to advocacy as part of those procedures.
Amendment No. 129 seeks to extend the provision of independent advocacy services to those making complaints against independent providers, including independent hospitals, medical agencies and care homes.
Again, I see difficulties in that. The independent advocacy service is there to support those making complaints under the NHS complaints procedure. While that will apply to independent providers who

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are contracted by the NHS to provide health services to NHS patients, it will not extend to services provided by independent hospitals. Those organisations should make their own arrangements as they see appropriate to provide advocacy for patients who complain about their services.
The Government intend that independent advocacy should be just that, as set out in detail in subsection (5). That subsection already requires the Secretary of State to have regard to the principle that the provision of services should be independent from the person against whom the complaint is made, or who is investigating or adjudicating on the complaint.
Independence arises from a number of different factors. Clearly, funding is one such factor. If the service were resourced by the person making the complaint, that provision would not be independent and the principle set out in the clause would have been breached. We intend to respect the independence of funding already provided in the clause, and so separate provision is not required.
We have said also, in subsection (6), that we shall consult the relevant patients' council about the arrangements for providing the independent advocacy service. That will ensure the relevant local element of independence which the amendment seeks to enforce. For that reason, it is not necessary to legislate for a monitoring and accreditation scheme.
On Amendment No. 131, it is the Government's intention that independent advocacy services should be provided by a source entirely independent of any person or body that is the subject of or involved in the complaint. We shall seek to ensure that as far as possible.
Amendment No. 132 would have no effect because a reference in an Act to a person also includes a body. That is a reference to the Interpretation Act 1978.
Amendment No. 133 demonstrates the risk associated with lists. The amendment would limit whom the Secretary of State could consult about arrangements for independent advocacy. By listing the relevant patients' councils, community health councils and national bodies involved in advocacy, it confines the persons to be consulted to those organisations. It would have the effect of narrowing the scope of the clause. Of course, we wish to have the widest possible involvement by organisations from whom we shall seek and welcome views. I should say to the noble Baroness, Lady Hanham—and she would certainly expect me to say it—that the views of trusts and health authorities will be especially welcome, as will the views of the NHS Confederation.
On Amendments Nos. 96 and 134, I return to the issue of a unified complaints procedure covering both the NHS and social services. Last year we consulted on social service complaints procedures and we intend to propose changes to them in due course. Noble Lords will probably be aware that we also funded a two-year UK-wide evaluation study of the NHS complaints procedure. Now is not the time to discuss or to legislate for a unified NHS and social services complaints
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procedure ahead of those particular activities, but I certainly accept that to ensure—particularly in relation to services that are to be run together—that there is an easy way for the public to make complaints about those services is a challenge to the NHS and to social services.
Baroness Cumberlege: I support the Minister on the matter of lists. I believe that they are a snare and a delusion, except when my husband goes to the supermarket and then they are absolutely essential!
On the matter of the independent advocacy service, the Minister said that it is a significant improvement, which I would endorse. I believe that it is a great move forward. If it works really well, it will reduce litigation towards which we should all work. However, there is some timidity in terms of the unified advocacy service. Earlier today my noble friend Lord Howe described some of the approaches of the Government to this Bill in terms of looking at the functions and then looking at the structures to support those functions. This is another part of that. If we were to put patients first we would not worry about this. We would ensure that we worked out the structures to enable the patients to use a unified service. I am afraid that we have shades of Mrs Archibald back again because we know that many patients become trapped between the social services element, the care element and the National Health Service element. Of course, later we shall go into that in relation to nursing services and care services.
In relation to Amendments Nos. 127, 128 and 134, proposed by my noble friend Lord Howe, I urge the Minister to meet with his colleagues. I know some work has taken place, but the role of government is to ensure that such structures are set up so that patients are aided in what can be a stressful, difficult time when they are often fobbed off by one agency or another.
Lord Hunt of Kings Heath: From what I have said I believe that the noble Baroness will understand that I am fully sympathetic to the need to ensure that there is a consistency of approach between the NHS and social services, particularly where joint services are provided. However, I cannot go any further tonight in terms of what I have said. There are some genuine difficulties in taking the independent advocacy service that we suggest for the NHS and saying that it should apply to social services. I understand that the noble Baroness is saying that we should be brave and that we should knock away the statutory barriers, but some issues would have to be confronted. Also in relation to complaints, we should see the outcome of the work that is being undertaken at the moment.
The noble Earl, Lord Howe, asked about the issue of independence as far as is practical in relation to advocacy services. That rests on the possibility that patients' councils could provide independent advocacy services. As such a council would be formed of representatives of the patients' forum, it may be argued that it has a relationship with a trust in the area from which a complaint has come. We would not want to rule that out as being insufficiently independent. In those circumstances, we would want to have some room for manoeuvre.
Baroness Northover: After six hours of sustained battering, perhaps the Minister might like an advocate or perhaps a CHC or two to assist his case. I was comforted by some of his comments and would welcome the movement that has been suggested. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 97 not moved.]
Clause 13 agreed to.
[Amendments Nos. 98 and 98A not moved.]
Earl Howe Earl Howe moved Amendment No. 99:
After Clause 13, insert the following new clause—
"EXTENSION OF OBSERVER STATUS
( ) Health Authorities shall extend observer status, with voice but no vote, to representatives of Patients' Forums, Patients' Councils and overview and scrutiny committees for its area."
The noble Earl said: This is a short, simple amendment. Its purpose is to give the patient involvement bodies which are to be established the right to observer status at health authority meetings. I find it odd that the Bill does not make provision for patient representation at health authority meetings. At meetings of health authorities, CHCs currently have observer status with a voice but no vote. It would therefore seem to be logical to extend that right to the new patient representative bodies. I beg to move.
Lord Hunt of Kings Heath: There is a simple answer. Health authorities, like trusts, are obliged to conduct their meetings in public. At present, health authorities and trusts are encouraged to extend speaking rights to CHC members. That is very much down to local arrangement. We believe that it works well in practice and believe that there is no reason to assume that the best practice will not continue in respect of members of patients' forums and patients' councils.
I do not believe that it is necessary to enshrine the procedure in legislation. I believe that health authorities will do the sensible thing and that in the spirit of decentralisation we should allow them to do that.
Earl Howe:' I am grateful to the Minister. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 14 [Entry and inspection of premises]:
Earl Howe Earl Howe moved Amendment No. 100:
Page 11, line 29, leave out subsection (1) and insert—
"(1) Authorised members of a Patients' Forum shall be permitted (subject to subsection (2) below) to enter and inspect for the purposes of any of the Patients' Forum's functions, premises owned or controlled by—

(a) a Health Authority,

(b) a Primary Care Trust,

(c) an NHS trust, or

(d) a person providing services under Part II of the 1997 Act or under arrangements under section 28C of that Act."

The noble Earl said: In moving Amendment No. 100, I shall speak also to Amendments Nos. 101 to 106. This group of amendments is designed to effect some subtle changes to Clause 14, which relates to the powers of entry granted to members of patients' forums into NHS premises. Instead of permitting the Secretary of State to make regulations with regard to rights of entry, the amendments would place that right on the face of the Bill and require the Secretary of State to make regulations governing the way in which the powers could be exercised.
My reason for proposing this buttressing is simple. I believe that the right of patients' forums to enter the premises of NHS trusts, PCTs and so forth is essential to the proper performance of their functions. For that reason it needs to be enshrined in primary legislation rather than relegated to a statutory instrument.
It is then important to ensure that the regulations pursuant to those powers are framed correctly. Perhaps the key issue, which we debated during the passage of the Care Standards Bill, is the extent to which the powers should be exercisable without prior warning.
Unannounced visits, as CHCs have often found, are an excellent way of uncovering a picture of how the NHS is really performing. However, it must be said that even where there is prior warning, such as happens with casualty watch, what emerges can be immensely revealing. I should be glad of the Minister's confirmation that, subject to there being no risk to the clinical effectiveness of the premises being visited, unannounced visits by patients' forums will be possible.
I want to raise another issue. When the matters were debated in another place, the Minister, Mr Hutton, resisted the suggestion that powers of entry into GPs' premises, as something which might appear on the face of the Bill, would pose human rights difficulties. I should like to ask the Minister why that should be when under the Care Standards Act the right of the National Care Standards Commission to enter freely any care home in the middle of the day or night did not pose any human rights problem. In any case, my amendment explicitly leaves it to regulations to determine the precise rule which would govern the powers of entry. I shall be interested to receive a rather clearer explanation from the Minister as to why this particular part of my proposal does not find favour with him or the Government's lawyers, if that is the case. I believe that the NHS should be subject to no less stringent requirements for inspection than private sector care homes. I beg to move.
10.30 p.m.
Lord Hunt of Kings Heath: Amendments Nos. 100, 101, 103 and 104 would confer a right of access directly on authorised members of patients' forums rather than leave it to regulations. I start by assuring the Committee that the Government fully intend to make such regulations as are provided for within Clause 14. We are determined that wherever NHS patients go there should be a means by which those services may

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be monitored and reviewed by patients. It was made clear in the NHS plan that patients' forums should be able to visit and inspect any aspect of care provided to patients, and this clause is a vital part of the framework which enables us to meet that commitment. Health services will be placed under an obligation to allow patients' forums to visit their premises and, in the case of GPs, right of access will be made a term of service.
I believe that the issue whether these matters should be on the face of the Bill or in regulations is a clear one. The noble Earl, Lord Howe, said in his introductory remarks that we needed to ensure that we had got it right. Access arrangements are surely best left to regulations so that we can be as flexible as possible and learn from experience in relation to the issue of unannounced visits. I agree that that is something which must be allowed to happen under the new arrangements. In relation to GPs, we wish to have satisfactory agreed arrangements under which, as far as possible, such visits, unannounced as they may be, may take place. But that will have to be agreed with general practitioners.
We envisage that protocols will be produced for access arrangements which patients' forums may agree with health providers locally. Where access is denied, the forum would report that refusal to the relevant body. The regulations will set out the exact conditions and circumstances under which access will be permitted. They will include notice of a visit and a requirement to provide identification and the number of members who may participate. These matters were debated during the passage of the Care Standards Bill. The intention is not to create an adversarial system. Clearly, we want this to work in a constructive way. We must also ensure that the dignity and privacy of patients would not be overlooked in the arrangements. Hence the need for a protocol under which these visits would take place.
Amendments Nos. 105 and 106 would require the Secretary of State to make regulations requiring patients' forums to publish reports of inspections. I believe that these amendments are unnecessary. Provisions for regulations for the publication and distribution of reports by patients' forums are made in Clause 16 of the Bill. The forum has a duty to make reports and recommendations to its trusts and health authority and to make information on its activities available to the public and other organisations. In doing so, it clearly will be informed by the finding that it makes during inspections.
The response from the body inspected will be contained in the patient prospectus, which trusts will publish each year, detailing what patients think of their services and how the trusts are addressing those issues. The forum will be required to sign off the patient prospectus as well as publish its own report. Under Clause 16, the Secretary of State may already make regulations regarding patients' forums to prepare and publish reports.
I turn to Amendment No. 102, which I shall move in due course. This is a minor amendment to ensure that patients' forums have access to all family health
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services by extending their remit, as presently described in the Bill, to local pharmaceutical services as well. I suspect that we shall be debating local pharmaceutical services tomorrow. We want patients' forums to have the facility of scrutinising and inspecting any service used by patients. It is important that the forums should be able to scrutinise local pharmaceutical services as well as any other services. I hope that the Committee will agree to this amendment when I come to move it.
Earl Howe: I am grateful to the Minister for those very useful observations. I take the point about unannounced visits and the need to have flexibility through regulations, rather than tying ourselves down to the wording on the face of the Bill. Nevertheless, I am a little frustrated that we cannot find a way of doing both: guaranteeing a satisfactory assurance about the right of entry and leaving the way open for the modus operandi to be set down in regulations. However, I accept the Minister's assurances in the spirit in which they were given. I shall reflect carefully on what he has said. Meanwhile, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 101 not moved.]
Lord Hunt of Kings Heath Lord Hunt of Kings Heath moved Amendment No. 102:
Page 11, line 34, at end insert ", or
(e) persons providing services under arrangements made under Schedule 8A to the 1977 Act or section 35,"
On Question, amendment agreed to.
[Amendments Nos. 103 to 106 not moved.]
Clause 14, as amended, agreed to.
Lord Astor of Hever Lord Astor of Hever moved Amendment No. 107:
After Clause 14, insert the following new clause—
"INDEPENDENT LOCAL ADVISORY FORUM
The Secretary of State shall establish for each Health Authority a body to be known as an Independent Local Advisory Forum."
The noble Lord said: This amendment establishes a framework within which the Secretary of State may set up an independent local advisory forum for every health authority. On page 94, the NHS plan states:
"Patients and citizens have had too little influence at every level of the NHS. As a result of this plan, each health authority area will be required to establish an independent local advisory forum, chosen from residents of the area, to provide a sounding board for determining health priorities and policies, including the health improvement programme".
Those independent local advisory forums are conspicuous by their absence.
At Second Reading the Minister said:
"the most important barrier which the Bill seeks to address is that between patients and the health service. The radical changes in this Bill will underpin the involvement of the patient and the wider public in the NHS, will give patients real influence in the way that the NHS is run, and ensure that there is independent support available when they need it".—[Official Report, 26/2/01; col. 988.]

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Independent local advisory forums were to be the conduit for this wider involvement in the NHS. They, we believed, were to be the body to represent the wider community. Why, unlike patients' councils, patients' forums, PALS and all the other bodies feeding into the health service provisions established within the statutory framework, have these forums not been included? Without a statutory framework it is not certain that they will be established. Moreover, they may be established only sporadically and may operate to varying standards and responsibilities. I beg to move.
Lord Clement-Jones: I rise to support the amendment of the noble Lord, Lord Astor. In the Bill we have had to get used to a whole range of new creatures—ILAFs, PALS, patients' councils and patients' forums, and the list goes on. Some are statutory and some are not. Therefore, some are susceptible to abolition at the will of the Secretary of State and others are not.
The noble Lord, Lord Harris, said earlier how awkward CHCs could and indeed should be on occasion. I am sure that the temptation to abolish one's CHC may have been fairly strong in some health authorities, if only they were able to do so. Therefore, I should very much like to hear from the Minister why the interesting distinction has been drawn between ILAFs and, for example, patients' forums and why ILAFs do not appear on the face of the Bill. Certainly Amendment No. 107 is designed to elicit that response.
The Earl of Listowel: Perhaps the Minister in his response will elaborate on how these ILAFs will work; what their membership will be; how they will be facilitated; and, what is their agenda?
Lord Hunt of Kings Heath: ILAFs are a useful mechanism far helping health authorities obtain views from citizens about strategic decisions that they have to make. The reason that ILAFs are not on the face of the Bill is simply that they do not have to be because they can be set up through guidance that we can give to the health service. Secondly, we very much want ILAFs to evolve and develop locally. We do not want to be too prescriptive about how they should develop.
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Their function will be to help with the HImP and strategic planning process. The intent is that they might have a core panel of patients and citizens. some representatives of the patients' forums and, perhaps, a wider group of people from the locality involved. We know that some health authorities have developed citizens' juries as a way of getting public involvement and views about the overall strategic direction of the local health service. That technique could be used by ILAFs. Many health authorities have developed well-planned techniques for involving the public. They are not called ILAFs, but we can certainly build on that. We will certainly encourage health authorities to share and develop best practice.
I can reassure the noble Lord, Lord Clement-Jones, that the Secretary of State will be issuing directions to each health authority requiring the establishment of ILAFs and ensuring that appropriate mechanisms are in place to ensure effective and meaningful public involvement. We do not believe that we need to be prescriptive about how that should happen.
Lord Astor of Hever: I am grateful for the Minister's response, and even more grateful for the support from the noble Lord, Lord Clement-Jones. We are disappointed that the Minister is not prepared to put ILAFs on the face of the Bill. We feel that would have ensured that all health authorities would have them. Placing responsibility for establishing them with the Secretary of State means that health authorities will not be able to decide how effective they want the voice of the local community to be in this matter. However, I shall read carefully Hansard. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Burlison: I beg to move that the House do now resume.
Moved accordingly, and, on Question, Motion agreed to.
House resumed.
House adjourned at fourteen minutes before eleven o'clock.