Lords Sitting of 18 March 2002

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

Teachers: Performance Pay
Baroness Walmsleyasked Her Majesty's Government:
How they expect school budgets and teacher morale to be affected by the under-funding by the Department for Education and Skills of the teachers' performance-related pay scheme.
The Parliamentary Under-Secretary of State, Department for Education and Skills (Baroness Ashton of Upholland): My Lords, rewarding effectiveness should improve teaching morale, and there is no question of under-funding. In the coming year we are increasing education standard spending by £1.3 billion to nearly £24 billion. In addition, we expect to provide about £600 million in direct support for performance-related pay, of which £100 million will be new special grant for the upper pay scale and related reforms.
Baroness Walmsley: My Lords, I thank the Minister for her Answer. However, she is aware that only about 50 per cent of the teachers who are above the threshold will be able to receive that money. Is she aware that at the beginning of the school year—in the absence of any indication from the Government as to how much money would be available, and in the absence of any criteria—in order to be fair to their staff, some head teachers set their own criteria and gave a commitment to those staff who met such criteria that they would be rewarded? is not the Government's under-funding of this performance-related pay a good way to demoralise the teaching profession by setting teacher against teacher and head teachers against their staff?
Baroness Ashton of Upholland: My Lords, I must make clear that the payments are not increments but incentives to teachers. My right honourable friend the former Secretary of State for Education and Employment, David Blunkett, announced last March that there would be a special grant. We have set minimum criteria but we believe that it is within the gift of head teachers working with their governing bodies to ensure that they look for and reward improvements in standards and that they set their own criteria. They are used to doing that. They have been giving responsibility points for some years.
Lord Pilkington of Oxenford: My Lords, can the Minister respond to a head teacher's comment to me last week that government grants have not allowed for incremental drift? His school has a number of teachers at the higher end of the salary scale and he has found
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himself considerably reduced in resources. Can the Minister assure the House that no school where the staff have remained stable and are at the higher end of the salary scale will suffer as a result of incremental drift?
Baroness Ashton of Upholland: My Lords, I am happy to give the noble Lord the understanding that we have here the ability for teachers to apply to go across the threshold. Where such teachers are able to go through the threshold, that is a demand-led funding, which is fully funded. Beyond that point, on the four remaining points it is for schools to make decisions about the rewards they want to give to their teachers and the criteria for so doing.
Baroness Perry of Southwark: My Lords, does not the Minister agree that an incentive which is given permanently for the remainder of a teacher's career hardly guarantees that it will remain in 10 or 20 years' time?
Baroness Ashton of Upholland: My Lords, it is important to understand that the incentives we are trying to bring into the system are on, top of the basic increases we have given to teachers. Noble Lords will be aware that teaching salaries have increased by quite a lot; by up to 30 per cent since 1997. The incentives we are additionally bringing in are designed to allow head teachers who are managers to make the right kind of decisions to incentivise their staff and their schools to continue to improve.
Baroness Carnegy of Lour: My Lords, is the Minister aware—I am sure she is—that the National Association of Head Teachers is very angry indeed about this matter? That association seldom complains in public, although I am sure it talks often to the department about its problems. It is being asked to do something which makes running schools difficult. We all understand that crossing the threshold is fully funded; the Government agree that. However, this is another matter altogether, setting teacher against teacher. That is not the right way to proceed. The Government never said that only 50 per cent of the proposal would be funded. It seems very unwise. Cannot they do something about that?
Baroness Ashton of Upholland: My Lords, we have funded £100 million for the rest of this financial year, and £150 million for the year 2003–04. As I have said before, my right honourable friend the former Secretary of State made clear last March that there would be a special grant. We should be careful of the assumption that all teachers who pass the threshold automatically increase on this scale. It is not an incremental scale. It is designed specifically to incentivise schools and teachers to improve, to set criteria and to reward. That practice is used in all areas of management and is one we should encourage.
Lord Rotherwick: My Lords, can the Minister tell the House whether "new" government money is being

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made available for the performance-related pay scheme or is it money that was allocated in another year? Do the Government intend to make that new money available or do they expect local authorities to do so?
Baroness Ashton of Upholland: My Lords, the Government are providing £600 million in direct support for performance-related pay in 2002–03. As I said, £500 million of that will be a special grant to cover the extra salary cost—noble Lords will be aware that that is around £2,000 per teacher—to go through to point one on the upper pay scale as a result of passing the performance threshold. As I said, that grant is demand-led. The additional money which is available is for movement under the other points of that scale. This is money available. Decisions about future funding are subject to the Comprehensive Spending Review.

Crop Improvement: Transgenic Technology
2.42 p.m.
Lord Taverneasked Her Majesty's Government:
What is their policy for funding research into the transgenic approach for improving crops.
The Parliamentary Under-Secretary of State, Department for Environment, Food and Rural Affairs (Lord Whitty): My Lords, the Government recognise that the use of transgenic technology for crop improvements could have the potential to produce benefits if applied safely and responsibly. The Government have supported and support research and development programmes which utilise genetic modification approaches for crop improvements and are aimed at providing the underpinning science and developing responsible GM approaches.
Lord Taverne: My Lords, do the Government recognise the glaring contrast between the importance of agricultural biotechnology—a technology in which we have special expertise in this country and which has enormous potential in the fight against hunger and disease and for a better environment—on the one hand, and, on the other hand, the gradual decline over the years in government support for that field? Is it not particularly important that there should be public support for this field of research rather than letting it all be done by multinational companies or other countries? Could they perhaps not divert some of the millions which are spent on organic farming, the claims for which have no scientific basis, and invest that money in proper science instead?
Lord Whitty: My Lords, I think that the House has heard the noble Lord's opinions on both sides of the argument. The Government believe that there is benefit in developing technologies in biotechnology, including GM approaches. We also believe that there
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is benefit in helping the development of what many farmers and many consumers regard as the benefits of organic farming. We support both. But we also recognise that there is public concern in this area. Therefore, we support technology on GM approaches, which help speed up, for example, hybridisation, and for the use of GM technology which is to the benefit of mankind in food, medicine and other fields. However, the development of products in this area is primarily a matter for commercial concerns and not for government.
Baroness Byford: My Lords, does the Minister accept that if the research is left to individual companies there will not necessarily be public confidence in that research? Sadly, we have seen an example of that over the past year or so. Will the Government therefore consider increasing their research funding to make sure that it is linked to good-quality, accessible and relevant science which is based throughout the world on a similar basis? That should include risk assessment as a major part of that funding. Can the Minister clarify where the money is going at the present time?
Lord Whitty: My Lords, the Government spend nearly £60 million in total in these areas. Of course only part of that total is spent on GM technology. The expenditure by my own department, which is about half of that, is mainly concerned with the development of GM techniques. Those are geared to doing exactly as the noble Baroness suggests—looking at what is being developed, assessing it and helping to use such approaches in areas that will be of benefit to the community as a whole.
The point I was making to the noble Lord, Lord Taverne, is that government money is not primarily directed to product development. It is directed at helping to improve the Government's ability to assess products and assess the way in which science is developing.
Baroness Hayman: My Lords, does my noble friend agree that the debate in this country on GM crops has been disproportionately focused on the risk rather than on the potential benefits of such crops? Given the point that has already been made by the noble Lord, Lord Taverne, that the fear of control of technologies being in the hands of multinational corporations is a large element of that, is it not important to those of us who are concerned that the potential benefits in terms of health and agriculture in the developing world are supported by research expenditure that is not commercial? That means from government.
Lord Whitty: My Lords, it is precisely on those noncommercial areas where we can assess development that the Government are focusing. That includes, as my noble friend indicates, supporting developments within the developing world, within medicine and within the safe and responsible development of crop and food technology. The argument has perhaps at times not been entirely rational on this issue on either

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side. That is why the Government have very heavily invested in ensuring that the farm-scale trials of GM crops are completed before we take any further decision. We need to allay public concern in this area. It is not just a question of media stories; there is substantial consumer concern. We need, therefore, to have proper science and a proper assessment of the actual production risk, which is what the farm-scale trials are directed at.
Baroness Gardner of Parkes: My Lords, does the Minister agree that the degree of public scare about genetically modified foods is disproportionate? Not many people realise that the early hybridisation and first studies on this issue go right back to the monk, Mendel. People have been breeding improved crops ever since that time. Could not a little more publicity be given to that fact? Could it not be made clear that this is really modern science progressing on from that early work?
Lord Whitty: My Lords, to a degree I agree with the noble Baroness. One can regard genetic modification as being the next stage of a programme of hybridisation that has been going on for a long time. But there is also an element of step change in this, which is why it is right to recognise that there is a degree of broader concern than there would be in just one more intensification of a process. That underlines the need for us to have the science correct and to ensure that the basis on which we are informing the public is an informed, controlled and detailed assessment of the effects of commercialisation on crop growing in this country.
Lord Hylton: My Lords, the Minister was quite right to use the words "step change". It is a step of the order of many magnitudes. Does he agree that while genetic modification may look scientifically desirable or beneficial, the practical difficulties are very great indeed? Will the Government take the greatest possible care over such things as volunteer plants, escapes, hybridisation and wind pollination?
Lord Whitty: My Lords, the likely controls on any commercialised growing would indeed be directed at minimising and, so far as possible, eliminating the risks on those counts. We are taking the matter carefully, but we are also taking it on the basis of sound science and sound agriculture.
Baroness Sharp of Guildford: My Lords, the Minister indicated that the money that the Government are investing is not in the close-to-market area but in research. Is he confident that enough money is going into research in what is an important area of science?
Lord Whitty: My Lords, as I said, a substantial amount of money is going into research of (IM techniques. Of course, substantial commercial money is also being invested in these areas, including within the UK and within Europe. The Government must
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address the balance between ensuring that we understand the science and can assess proposed developments and dealing with widespread public anxiety within the UK and within Europe as a whole.

A400M Aircraft Project
2.51 p.m.
Lord Burnhamasked Her Majesty's Government:
What revised plans have been made for the future of heavy lift aircraft in the light of the partial withdrawal from the A400M project by the German Government.
The Parliamentary Under-Secretary of State, Ministry of Defence (Lord Bach): My Lords, I can reassure the noble Lord that there ha; been no partial withdrawal from the A400M project by the German Government. The German commitment to proceed with the A400M programme is subject to Bundestag funding approval, which the German defence ministry is working to obtain by the end of March. There is therefore no present need to revise our plans for acquiring that capability.
Lord Burnham: My Lords, I thank the noble Lord for that reply. However, are not the vibes strong that the German Government will not provide the money for the project? Is it not time that Her Majesty's Government exercised the right that they rightly reserve to themselves totally to abandon the A400M programme and plan for an aircraft that has the lift, capacity and range that the services require?
Lord Bach: No, my Lords, it is not lime to abandon the A400M. It is the best deal for the taxpayer and for British industry. I remind the noble Lord that it has a 50 per cent greater payload than the ageing Hercules C130K that it replaces, with the flexibility to operate in both strategic and tactical roles. As a joint programme with our European partners, it also delivers clear benefits in interoperability, sheer development and through-life costs. Finally, I remind the noble Lord that it can create or sustain thousands of British jobs.
Lord Redesdale: My Lords, while supporting the A400M, does the Minister agree that there may be a gap between the decommissioning of the ageing Hercules fleet and the date on which the A400M comes into service? If so, what will fill the gap? If it is the American heavy lift aircraft, will we have to buy it, or will we lease it?
Lord Bach: My Lords, we will not have to buy it. We have leased four Cl7s—I think that that is the aircraft to which the noble Lord refers—and will continue to do so until the A400M is on-stream. We expect that to be in 2010.
Lord Jones: My Lords, how many jobs will be created in the now hard-pressed aerospace industry by the A400M project? As the American President now

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aims to put steep tariffs on Britain's steel exports, why should we contemplate the leasing or buying of further C17s? Mighty Boeing is mighty enough.
Lord Bach: My Lords, I shall not answer any questions about steel tariffs; I am looking forward to hearing the Answer to be given by my noble friend Lord Sainsbury in a few minutes. Airbus UK, which is the company responsible for the aircraft, estimates that the programme will directly create up to 2,500 high-quality jobs, notably in design and advanced manufacturing. Indirect employment could bring that figure to more than 8,000.
Noble Lords: My Lords—
The Lord Privy Seal (Lord Williams of Mostyn): My Lords, perhaps we may hear from the noble Baroness, Lady Strange. She has risen three times, I believe.
Baroness Strange: My Lords, I thank the noble and learned Lord. Is the Minister aware that last week the defence study group visited the C17 at Brize Norton and was impressed not only with the charm and morale of the three-man crew but with the speed with which the aeroplane could be emptied—30 minutes flat—and its capacity? It could take a Tornado or a Chinook or two Pumas as well as heavily loaded lorries and pallets and 50 passengers.
Lord Bach: My Lords, the noble Baroness is quite right: the C17 is a superb aeroplane—I have had the good fortune to see inside one myself. But that does not take away from the need for the capability of the A400M. Although the C17 is a fine aircraft, it is not an answer to our needs in the field.
Lord Vivian: My Lords, what contingencies are in place for the survival of the A400M project should programme approval not take place by 31st March? What are the implications for the European rapid reaction force if the project does not proceed?
Lord Bach: My Lords, if only partial German funding were to be achieved by 31st March—that is, for the first 40 of the 73 aeroplanes that they would still require—the contract could become effective. However, partner nations would expect the German Government to secure balance of funding for 73 aircraft at the earliest opportunity and—this is important—to compensate them for their additional cost, in other words, increased unit price, if that funding were not secured.
Lord Watson of Richmond: My Lords, is not the A400M essential to the heavy-lift capability of any European rapid reaction force, so that the credibility of such a force hinges on the project continuing? Will the Minister confirm that that is fully understood by the German Government and that he is confident that the in-service date of 2010 can and will be met?
Lord Bach: My Lords, I have no doubt that the German Government are in favour of the A400M
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project. They have done nothing to suggest that they are not. It is an essential part of our defence project, both at home and abroad.
Lord Gilbert: My Lords, it is not the case that only a Liberal Democrat Peer could think that the A400M was essential for our heavy-lift capability when it will not carry a modern main battle tank, our AS90, tank transporter equipment, heavy bridging equipment and so on? But leaving that aside—it is of course a joke of a plane as it exists only on paper at present—can my noble friend tell us what was the initial full unit cost of the A400M, what it was after the Italians sensibly cancelled their order for 20, and what it will be after we have the new engine that we are told we suddenly need, which is not even at the design stage, and after the Germans have failed to pay any of the development costs until they have received the plane?
Lord Bach: My Lords, I have the highest opinion of my noble friend. He has been extremely good and generous to me since I took on this job and it is rarely that I disagree with him, but I do so profoundly with regard to this aeroplane. I shall try to answer his questions briefly.
The original unit cost of the A400M falls under commercial in-confidence rules, so I am unable to give my noble friend the information. I should like to, but I am unable to; my noble friend should understand that better than most. The withdrawal of Italy from the programme occurred during the latter stages of price negotiation. While it is fair to say that such a reduction in overall aircraft numbers would have had a negative cost impact, it was one of many changing factors—some of which were positive in their financial effect—considered at the time. The company, which, as I said, is responsible for the project, did not identify any specific cost impact of that withdrawal.

US Steel Tariffs
2.59 p.m.
Lord Razzallasked Her Majesty's Government:
What steps they propose to take in view of the imposition of steel tariffs by the Government of the United States.
The Parliamentary Under-Secretary of State, Department of Trade and Industry (Lord Sainsbury of Turville): My Lords, steps have already been taken through the European Union to respond to this unjustified American action. A decision is expected within days on measures to protect UK and EU industry from diversion of steel products to the EU as a result of the US measures. In addition, the European Commission has sought formal consultations with the US under both the World Trade Organisation safeguards agreement and the dispute settlement understanding.
Lord Razzall: My Lords, I thank the Minister for that Answer. I am sure he will accept that it is a somewhat

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Kafkaesque situation when, for example, the Democratic Party in the United States is in favour of even higher tariffs on steel and Corus, I understand, has made a significant financial contribution to the campaign for US steel tariffs. Does the Minister accept that, in those circumstances, the danger is that we in the European Union will engage in tit-for-tat measures, leading to a trade war in which the only people to suffer will be the British consumer and the British worker?
Lord Sainsbury of Turville: My Lords, the Government have so far taken four actions. The EU Trade Commissioner, Pascal Lamy, has requested immediate WTO dispute-settlement action. That will, of course, take some time, even if we win—possibly 15 months. With Commissioner Lamy, we are already considering what safeguard action we can take to protect British and European steel producers and workers against a flood of steel imports. The action that we take will be WTO-compatible; we will act within WTO rules. We are also supporting UK exclusion requests and compensation. Only if we pass through the compensation stage can we, under WTO rules, move towards retaliation. The first action will be to press the Americans on compensation.
Lord Barnett: My Lords, does my noble friend the Minister accept that tit-for-tat retaliation on that scale would not be helpful to the UK or anyone else? Would he not rather bring pressure to bear on our "friends"—in quotes—in the United States for them to withdraw what they are doing on tariffs? Retaliation is in nobody's interests—neither those of the US nor those of anyone else.
Lord Sainsbury of Turville: My Lords, in the year since the action was started by President Bush., we have, on numerous occasions, made our views clear. We are not taking any kind of tit-for-tat action at this stage. We are doing something different: protecting our industry from a flood of imports. That is what the safeguard action under the WTO rules is specifically about.
Our argument with America is that the Americans have not seen a flood of imports in the past few years. On the contrary, there has been a substantial decline in the volume of imports into America. They are 'very much down on two years ago—I think 28 per cent down compared with 1998. In this case, we are within our rights to take action to protect our steel industry from floods of imports.
Lord Howell of Guildford: My Lords, does the Minister agree with the sentiments expressed in the previous two questions that, in this case, the European Union should move cautiously and avoid rushing into any impulsive retaliation? As he rightly said, the WTO and its procedures are the right mechanism with which to sort the matter out. Also, it is clear that the Bush Administration is in a complex political mode whereby this unhelpful and unwelcome move could be a precursor to more trade liberalisation and stronger emphasis on trade freedom. President Bush has indicated that that is still the way he wants to go.
Lord Sainsbury of Turville: My Lords, I am not sure that I understand what a complex political mode is. We can be certain that the British Government will stand by the steel producers and steelworkers in this country in dealing with what many of us regard as a piece of straightforward protectionism. We will take action to defend our industry. We will do so in a measured and considered way, within the WTO rules, but we will stand by it.
Lord Hardy of Wath: My Lords, given the experience of unfair trading within the EU during the 1980s and 1990s, which greatly affected the engineering steel industry, especially in south Yorkshire, one can sympathise with the United States if it can prove that there has been dumping. Have the Government taken any action to assist the engineering steel industry to maintain its traditional, long-established export of engineering steels to the United States? That trade has gone on for a long time, and the Americans expected it to continue. Have the Government made representations and what was the response?
Lord Sainsbury of Turville: My Lords, there is the issue of exclusions. We are working with the steel industry to make certain that if a case can be made for exclusions, it will be made. That is what we are working on.
Lord Acton: My Lords, the Minister mentioned a 15-month period required for the WTO to take action. That seems a long time. Is there any thing the Government can do to speed up the WTO machinery?
Lord Sainsbury of Turville: My Lords, the process will take 15 months, including the different stages of making representations, appeals and so on. There is nothing that we can do in these circumstances, although it is desirable in such situations that the process be speeded up.

Business
Lord Carter: My Lords, at a convenient moment after 4.30 p.m., my noble and learned friend Lord Williams of Mostyn will, with the leave of the House, repeat a Statement which is being made in another place on the European Council at Barcelona. After that, my noble friend Lord Bach will, with the leave of the House, repeat a Statement which is being made in another place on Afghanistan deployments.
Marine Wildlife Conservation Bill
Brought from the Commons; read a first time, and to be printed.
Consolidated Fund (No. 2) Bill
Read a third time, and passed.

National Health Service Reform and Health Care Professions Bill
3.8 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 resolve itself into Committee on this Bill.
Moved, That the House do now resolve itself into Committee.—(Lord Hunt of Kings Heath.)
On Question, Motion agreed to.
House in Committee accordingly.
[THE CHAIRMAN OF COMMITTEES in the Chair.]
Clause 2 [Primary Care Trusts]:
Baroness Noakesmoved Amendment No. 36:
Page 3, line 5, leave out "It is" and insert "From 1st April 2003, it shall be"
The noble Baroness said: In moving the amendment, I shall speak also to Amendment No. 52. Both amendments concern the readiness of primary care trusts for the responsibilities envisaged for them in the Bill.
Amendment No. 36 is a simple one. It defers the responsibility of the Secretary of State under Clause 2 to create PCTs covering the whole of England until 1st April, 2003. The Government's current intention is to ensure that all PCTs are in place by this October. Many of them will, in fact, exist by this April, only a couple of weeks from now.
The Minister may well say that, as most PCTs will exist legally next month, the amendment is of no practical effect. However, there may be a small number of PCGs that will not have completed the transition to PCT status next month. I remind the Minister that his predecessor, the noble Baroness, Lady Hayman, assured the House that no PCTs would be imposed and that progression to trust status would be,
"driven locally, based on local views".—[Official Report, 25/2/99; col. 1268]
We know that most of the conversions have not been made in that way. They have been driven by the centre, with a fig-leaf of local involvement.
Will any PCGs not have been converted to PCT status on a so-called voluntary basis by the beginning of April 2002? If so, will the Minister say how many, and where they are located? Will conversion to PCT status be enforced under this Bill, if it becomes law, even if local views—including, importantly, the views of local health professionals—are against it? Will he say whether enforced conversion represents an adequate foundation for a PCT to take on the major new functions envisaged in the Bill?
We on these Benches do not agree with the policy of forced conversion of PCGs to PCTs but we recognise that the Secretary of State is hell-bent on reconfiguring the NHS to his own design. Amendment No. 36 at least seeks to provide a more dignified timetable to allow the hard-pressed NHS to adapt.
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Amendment No. 52 is more complex and, in practical terms, more important. It requires the Commission for Health Improvement to investigate the preparedness of PCTs, both before a PCG becomes a PCT and, importantly, before the PCTs are given the new functions envisaged for them in the Bill. If in either event CHI believes that a PCG or a PCT is not ready, it must make a special report which would defer the creation of the PCT or the transfer of functions for one year. In that way, even if there are no PCTs still to be created when the Bill becomes law, the amendment would require a report from CHI on all PCTs' readiness to receive their new functions.
This will be particularly important given the continuing concerns about the ability of PCTs to cope. I am sure that the Minister has listened to the concerns of organisations such as the British Medical Association as to whether, for example, the necessary clinical and managerial staff have been recruited for the role envisaged for future PCTs. I am sure that he will also be aware of the King's Fund tracker survey last year which reported many problems in commissioning, in health improvement and in partnership working, as well as concerns about managerial capacity and information deficiencies.
I am sure that the Minister is aware of the findings of district audit during its visits to PCGs and PCTs during 2001. Unsurprisingly, it found a marked variation in the degree to which those bodies were prepared for their new roles. It found specific risk areas in corporate governance, in information management, in partnerships, in commissioning, in control of prescribing costs and in arrangements for personal medical services.
The Minister may also have read an article in the Health Service Journal last week about a survey of primary care groups and primary care trusts in the south-western region. That found that many were still relying heavily on their health authority for commissioning. It concluded that the proposal to allocate 75 per cent of NHS funds to PCTs by 2004 will be unrealistic in some areas.
Can the Minister say whether the 300 or so PCTs that will be operational next month currently have a chief executive who has the competencies required for the new PCT responsibilities and an appropriately qualified finance director who will be able to cope with the new financial requirements involving 75 per cent of total NHS spending? In this connection, the King's Fund tracker survey found last year that one in seven had no finance staff at all. A cursory glance at the recruitment pages of the Health Service Journal will show that many, many posts remain to be filled.
Will the PCTs have an appropriately qualified public health specialist capable of pursuing the public health agenda that the Government envisage for PCTs, including the development and delivery of health improvement plans? Will they have appropriately qualified staff to handle the whole range of functions, including, most importantly, commissioning and the new revalidation and regulatory requirements in relation to primary care? Will they have adequate

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information systems? And last but not least, will they have adequate budgets to pay for all of this? These requirements are not in the "nice to have" category; they are essential if the planned additional functions are to be delegated to PCTs.
Does the Minister accept that there are major gaps in readiness among PCTs—gaps so great that it is unrealistic to think of a commencement date of October this year? If he does accept that there are gaps, what do the Government intend to do about them?
We on these Benches are profoundly concerned about the preparedness of PCTs, on whose shoulders so much of the burden of delivering the Government's aspirations for the NHS will rest. That is why we believe that the implementation of the new PCT functions should not take place until there has been an independent examination by experts. The Commission for Health Improvement seems to fit that Bill but an alternative could be to use the Audit Commission, which is even more independent.
We urge caution until it is clear that the requisite capabilities demonstrably exist. It may well he that some PCTs are, in the Government's view, ready to proceed, but I hope that the Minister will not claim that that is the position of all PCTs because all of the available evidence is against that. If the Government insist that the change must be on a 100 per cent basis rather than a more cautious, phased approach, we believe that the pace of the slowest must prevail. Will the Government now consider a phased approach? I beg to move.
3.15 p.m.
Lord Clement-Jones: We on these Benches support the two amendments, particularly Amendment No. 52, to which I have put my name. As the Minister knows, in an ideal world we would prefer a scheme whereby, as agreed under the Health Act 1999, health authorities would determine the point where PCGs had enough capacity to become PCTs. It would be a local decision and the duties would be assigned to PCTs according to their capacity at the time. Under the Bill, there will be an almost compulsory changeover to PCT status and then an assignment of duties to those PCTs in a completely nondiscriminating way in terms of whether or not they have the resources and the capacity to take them on.
The Minister will he well aware that there is considerable doubt and uncertainty as to whether PCTs across the board will be in a position to assume those roles and responsibilities. It is particularly notable how common that view is in the area of commissioning. Later this week, seven all-party groups will gather to talk about this issue—the All-Party Parliamentary Groups on AIDS, on Cancer, on Health, on Maternity, on Men's Health, on Mental Health and on Primary Care and Public Health. A fairly considerable degree of concern is being expressed by all those involved in those all-party groups. The Minister would have to be insensitive not to understand that there is great concern about the capacity of PCTs in these circumstances.
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We on these Benches agree with the BM A that PCTs are new organisations and the demands being placed on them by the Bill may be beyond their existing capacity. Indeed, as the noble Baroness, Lady Noakes, pointed out, the reorganisation is virtually there in advance of the Bill. Whether or not they have the capacity and resources, the Secretary of State has, in effect, anticipated the outcome of the Bill. He has shown a degree of confidence that Ministers do not normally possess.
As the noble Baroness, Lady Noakes, explained, PCTs are already experiencing difficulties in recruiting clinical and managerial staff who are able and willing to participate in the roles to which they will be assigned. It has been explained in the Commons that PCTs will be up and running by October this year or next spring, but even that date is ambitious given that there are many primary care groups which were insufficiently prepared in the first place for the move to PCT status.
PCTs will be responsible for assessing the health needs of their local communities and for preparing plans for health improvement, and a strengthened public health function will be needed for PCTs to provide this needs assessment function. As the Minister is aware, the public health function is an area where there is grave uncertainty about whether PCTs will have the capacity, resources or expertise to handle their new functions.
In addition to the public health function, the Government want PCTs to be the lead NHS organisation in joint working with local authorities and others as part of local strategic partnerships. Together with the BMA, we are concerned that while advances in health may not be related to the healthcare system, the primary responsibility of PCTs must be to provide a proper and adequate healthcare service. The emphasis of PCT activities must be on that core activity. But what we now see happening is that the Government are loading them with other functions which may mean that those core functions are not going to be properly carried out.
There is the national PCT development programme. I should like the Minister to give an absolute assurance that PCTs will be in a position to carry out their functions and that they will have the resources and the expertise. That requires a considerable degree of confidence from the Minister. I very much look forward to hearing what he has to say.
Baroness Carnegy of Lour: When the Minister replies, will he specifically answer the question of my noble friend Lord Howe? Can he assure the Committee that each primary care trust will have a competent chief executive in post and a competent finance director, somebody who is a specialist in public health and also other professionals who are able to deal with the various functions? The Committee needs a precise answer to that question because it is quite clear to anybody. whether they know about the detail of the trust functions or not, that without such people the changeover should not be made.
Lord Hunt of Kings Heath: I find myself somewhat disappointed by the tone of the remarks made in this debate so far about primary care trusts. In our very enjoyable debates on Clause 1 for the whole of last Thursday, the theme of the criticism of the Government was that we were adopting an over-centralist approach. Before us this afternoon there is evidence of the Government's decentralist approach and our aim to ensure that primary care trusts decision-making is as close as possible to GPs, primary care and the patient. Here we come forward with exciting ideas to get decision-making down to that level and the reaction of Members of the Committee who have spoken is shock, horror and, "You can't do this. We are very worried".
I make no apologies for being an absolute enthusiast for primary care trusts. Of course, I accept that there are tremendous challenges for them to take on and that there are those who are expressing some uncertainty about the ability of PCTs to do that. In the main they are not primary care trust themselves, but various pressure and interest groups which normally seek to influence the Government to take a highly centralist approach and wish the Government to continue to do so.
I say right at the outset that my experience in meeting primary care trusts and talking to general practitioners and the staff involved leads me to believe that they are very well able to take on the extra responsibility which they have been given. It is worth remarking that the first primary care trusts were established on 1st April 2000. Subsequent waves of primary care trusts have been established. In April 2001 we had 164 primary care trusts delivering healthcare to 47.7 per cent of the population.
The fact is that there is a great deal of enthusiasm out there for becoming primary care trusts and that is why we have received over 150 proposals from primary care groups and others who wish to become operational on 1st April 2002.
As regards the question asked by the noble Baroness, Lady Noakes, at present it is anticipated that only one primary care group will remain as at 1st April 2002. From that date we expect that there will be 303 operational primary care trusts. The one primary care group which we believe will remain at 1st April 2002 is Braintree which proposes to become a care trust from October 2002. There is one other primary care group, Crosby and Maghull, which is part of proposals to create a South Sefton primary care trust. That is currently subject to a submission to Ministers. If that were not to approved it would become a subcommittee of Bootle and Litherland primary care trust. Therefore, there would be two primary care groups left as at April 2002.
I completely deny that primary care groups have been dragooned into becoming primary care trusts. I have visited any number of such groups and trusts over the past few months. I am absolutely convinced that there is enthusiasm for getting on with the task and being given the enormous responsibility that they have. I am sure that primary care trusts will enable this
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crucial inter-relationship between the decisions of GPs and primary care to be pulled together in the work they will do on commissioning, which I am convinced will lead to a much better balance of services between primary care, secondary and tertiary care.
To suggest that those primary care trusts are incapable of managing these changes underestimates enormously the calibre of managers, primary care leaders and clinicians within the National Health Service. Already within PCTs which have been established we are seeing better support practice, better support to individual clinicians, better integrated and effective services and better access and design.
As the noble Lord, Lord Clement-Jones, has suggested, we have established a very good development programme to help primary care trusts prepare for operation. They include a co-ordinated development programme, a comprehensive self-assessment toolkit, an integrated whole systems package of development for each strategic health authority community and a robust infrastructure for all key stakeholders to have appropriate influence and to ensure that PCTs are equipped to deliver on the Government's objectives.
At local level, primary care trusts are being encouraged to develop and work collaboratively, to pool knowledge and to share capacity and expertise. I make no apology for that. For some particular functions primary care trusts will need to work together with others. But that does not detract at all from the individual ability of each primary care trust to work effectively. No one has ever suggested that each primary care trust would be totally self-sufficient. But I have no doubt whatever that co-operative arrangements which we determine locally will work effectively.
I was asked about the position of executive appointments. My understanding is that as of 11th March, chief executive appointments had been made in all except six primary care trusts. Clearly, they are crucial appointments. Once the chief executive has been appointed it will then be possible to get on with the appointment of other senior officers. No one could say that as at 1st April every primary care trust will have every senior officer position filled. However, I expect the NHS to have the arrangements in place to ensure a seamless process of transition of responsibility from health authorities and primary care trusts and that health authorities will support primary care trusts to ensure that there are no particular gaps.
Having said that, I turn to Amendment No. 52. It would require the Commission for Health Improvement to investigate whether primary care groups are properly prepared to become primary care trusts and whether they are ready to take on functions under this Bill. While I understand why the noble Baroness, Lady Noakes, makes this proposal, I do not believe that it is a proper function for the commission. CHI's responsibilities are quite specific. It may already carry out investigations into the management,

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provision or quality of healthcare, for which primary care trusts have responsibility under the Health Act 1999. Under this Bill we are extending the responsibility of CHI, particularly to carry out general reviews of any aspect of NHS services.
The independent review of services by the CHI is of a different order from that proposed in the new clause. It is not appropriate for the CHI to make the decisions envisaged in the new clause. The decision on whether a primary care group should become a primary care trust or whether a primary care trust should take on functions is surely for the Secretary of State to make. In making that decision, the Secretary of State needs to be satisfied in four key areas: the benefits of what will be achieved, the degree of support for the proposal, the fitness of the proposed organisation to deliver and the impact on other organisations.
Having been involved in approving a number of applications for organisations to become primary care trusts, I can confirm that the decision is taken only after the fullest consideration. Careful analysis is undertaken and Ministers ensure that the key questions that need to be asked are posed. We have to be satisfied that the proposed primary care trust can take on the responsibilities that it is to be given.
I understand why questions have been asked about the preparedness of primary care trusts. They are being given an enormous responsibility. However, I am confident that they can take on that role. I have been impressed in my visits to primary care trusts. They do not need delay and uncertainty; they need to press on. I am confident that they can do so.
3.30 p.m.
Baroness Noakes: I thank the Minister for that response, which was not a big surprise. We on these Benches are not against the proposals to devolve functions to primary care trusts; we are against the premature delegation of functions and transfer of responsibilities before those trusts are ready. That was the purpose of my questions to the Minister.
The Minister has said that he has met a lot of enthusiasts. That often happens to Ministers. They do not necessarily meet a representative selection of opinion in the NHS. I am afraid that that is a fact of life.
Lord Hunt of Kings Heath: Health Ministers meet all shades of opinion. I assure the noble Baroness that I have met health authorities, in particular, that have expressed concerns about the transition of power to primary care trusts. However, there is self-interest in some of those concerns. My whole experience of the NHS is that at the end of the day it always rises to the challenge.
Baroness Noakes: I do not doubt the sincerity of the Minister's views, although he has taken an unnecessary swipe at those organisations that have reported lack of preparedness. One would not suspect the King's Fund or district auditors of having a particular agenda.
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I asked the Minister whether each of the 300 or so bodies would have a chief executive w ho had the competencies for new PCT status. He replied that there would be a chief executive in all but six. Will they all be chief executives selected for the competencies of the new PCTs, or will they be chief executives who were in post under the old arrangements, who were not expected to have the competencies of the new roles of PCTs? I understand that there has had to be a reappraisal of those already in post to see whether they are capable of undertaking the role for the new PCTs. However, that deals only with chief executives. I understood the Minister to say that we would then move on to other posts. I asked about qualified finance directors, public health specialists and the staff who will handle functions such as commissioning, as well as the underpinning requirements of money and information systems. I must press the Minister on what progress has been made on those posts. It is all very well to say that chief executives will come in and see to the rest, but there is an awful lot to do if all those posts are not in place or substantially in place by now. Perhaps he will comment on that.
Lord Hunt of Kings Heath: It is difficult for me w say the extent to which each of the 303 primary care trusts has filled each position. I can make two specific points. The chief executives, who will be in place in all but six primary care trusts, will be a combination of those who were already in post in the existing primary care trusts and chief executives who have been appointed as a result of the new primary care trusts coming into being on 1st April.
I certainly accept that we now envisage PCTs taking on a great deal of responsibility that might not have been envisaged by some primary care trusts when they appointed their chief executives. It will be for each primary care trust to consider those responsibilities and assess the strength and calibre of its existing management team. Equally, the development programme that we have put in place will enable the NHS to give support and encouragement to existing post holders as well as new post holders.
The chief executive is the key appointment to be made for primary care trusts that come ini o being on I st April. Once the chief executives are in place in the new organisations, they can work with the chairs and the non-executives to get on with filling the other senior positions. We hope that that will be done as quickly as possible. My point in my original response to the noble Baroness was that I expect there to be interim arrangements in place to ensure that primary care trusts are ready to go live on 1st April. That is one aspect of the responsibilities of health authorities in providing the support required by PCTs in the interim period.
Baroness Noakes: I thank the Minister for that. Who determines whether a PCT is ready? The Minister said that it was for PCTs to consider whether their chief executives were strong enough for the roles that they would have to carry out. Is he saying that at the time that the Secretary of State makes the delegation of

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functions to primary care trusts, he will not have carefully considered the preparedness of the individual trusts? The Minister explained the process and the matters that were considered in the creation of PCTs. I am sure that he accepts that there will be a lot of gaps in the capabilities needed on day one, when the functions are delegated. I am very unclear as to what information flows will be coming to the department before the button is pressed on the responsibilities falling on the shoulders of PCTs. What processes does the department have—or is it expecting to leave the matter entirely to the PCTs?
Lord Hunt of Kings Heath: In the assessment that is made in agreeing to the establishment of new primary care trusts, the department takes a number of factors into account before Ministers are asked to make a decision. One of the criteria for making a decision is whether there is sufficient evidence to indicate that the proposed primary care trust is fit for the purpose. That includes consideration of whether the application identifies effective governing and leadership arrangements and whether those arrangements will deliver the local primary care trust's vision.
The noble Baroness also asked about existing primary care trusts. That is a matter for local decision. If a primary care trust is taking on more responsibilities, the board of that trust needs to see whether the management arrangements and the calibre of its leadership cadre are up to new responsibilities. The same would apply to any other NHS organisation.
In addition, we debated the role of strategic health authorities last Thursday. It is also the case that strategic health authorities will want to ensure that leadership within primary care trusts is effective, and that is also part of its performance management function. I should be surprised if the noble Baroness were suggesting that the Secretary of State should adopt a highly centralist approach to judging the capability and performance of each primary care trust chief executive. We have in place a sufficient process to ensure that judgments can be made about leadership capability as well as development programmes to help those leaders show just what they are capable of.
Baroness Carnegy of Lour: Before my noble friend continues—I apologise to her for confusing her with the noble Earl: I do not know why I did it, but I do know the difference—what the Minister is saying will not do. I am very shocked at this, as I am sure others are. In order for the Government to be able to say that they are decentralising and how enthusiastic they are about it—some of us are doubtful about the extent of this decentralization—they are prepared to let bodies take on enormous responsibilities when their chief executives may or may not continue at the moment. It is impossible to say when the finance director will take over, because he does not at present exist in a number of trusts. The Health Service cannot be asked to do that just to get political will across to the nation. The Government should ask themselves whether we need
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to hurry so much. People will accept a short delay until the whole matter is put in order. They are making a great mistake, and I should have thought that politically it will be disastrous for the future.
Lord Hunt of Kings Heath: If the noble Baroness were to ask primary care trusts whether they would like another year to potter around trying to reach the state of preparedness that she suggests they have not yet reached, they would say that that would be the worst possible thing that could happen to them. They know that they have to take on the challenge of major responsibilities, but they want to get on with the job.
The assessment criteria under which we have judged the effectiveness of primary care trusts to take on their responsibilities, combined with a development programme and the overseeing role of health authorities to ensure that things are done correctly, that there are no gaps, that the infrastructure is in place, give me confidence that the NHS is well able to take on the new structure from 1st April this year, and I believe that it should be allowed to get on with it.
Baroness Noakes: Having listened to what the Minister has said, I am left profoundly unconvinced. We are told that an assessment is made of leadership. That is all very well, but leadership does not necessarily deliver a fully functioning organisation on the ground. There is a big gap between an assessment of leadership over the past few months and knowing, when the Secretary of State comes to make the delegation, that these organisations are ready and able to take on those functions. I do not believe that it is centralist to have a proper assessment of the new organisations. The new organisations may be jumping up and down, saying that they are ready, but that does not mean that they are ready. That is why Amendment No. 52 was designed to put an independent assessment into the process.
I had expected the Minister to inform me of the comprehensive and robust procedures that the Department of Health will adopt to ensure that PCTs are not given their new functions unless they are sure that they are completely ready. When referring to this amendment, the Minister said that he thought the CHI was not up to the job, which I found rather surprising—
Lord Hunt of Kings Heath: I am grateful to the noble Baroness for giving way. I hesitated to read out to the Committee the criteria for assessment because I thought it would extend our debate for many more minutes than that. Perhaps it would help the noble Baroness if I were to write to her, setting out the criteria for assessment. If she sees the extent and range of those criteria, she may feel somewhat reassured.
3.45 p.m.
Baroness Noakes: I should be most grateful to receive that information. However, at this stage I remain sceptical about whether or not anything that has been said today has met the point of whether or not, first, PCTs are currently ready for their new

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functions and, secondly and perhaps more importantly, anyone in the Department of Health will know in October, or whenever the new functions are delegated, that that is the case. I am sure that we shall want to return to that matter at a later stage. Meanwhile, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 37 to 40 not moved.]
Clause 2 agreed to.
Schedule 2 agreed to.
Baroness Northovermoved Amendment No. 41:
After Clause 2, insert the following new clause
"DUTY OF PRIMARY CARE TRUSTS REGARDING TEACHING AND RESEARCH
Primary Care Trusts shall have a duty to foster and safeguard teaching and research."
The noble Baroness said: Amendment No. 41 requires primary care trusts to foster and safeguard teaching and research. This amendment should hardly be necessary. It should, of course, be a "given" that teaching and research should be integral to the Health Service at every level. However, with the pressure to meet targets, deadlines and budgets, it has become clear that teaching and research can too often be squeezed out. Therefore, only by enshrining in the Bill a duty to foster research and teaching will it be protected. The NHS has an outstanding record in both, yet we know that both are currently under threat.
The noble Lord will doubtless recall that on 21st November 2001 the noble Lord, Lord Walton of Detchant, introduced an important debate on the issues now confronting medical teaching and research. That debate highlighted most acutely the problems facing those areas. If we are to have joined-up thinking, we need to remember those problems as we consider this Bill. As we heard then, the requirement to teach students, treat patients and conduct research means that clinical teachers have impossible demands made on their time. For a number of years the recruitment and retention of clinical academics has been a major problem.
According to a recent BMA survey, the heavy pressure of NHS work leaves little time for vital research. Comments in the survey include:
"The NHS has turned its back on research",
and,
"the clinical work runs away with the show".
Until the serious problem of recruitment and retention of medical teachers is addressed, the Government's plan to educate and train extra doctors for the NHS will not succeed. But that is not just a problem at secondary or tertiary level. The ethos of teaching and research must run right through the NHS. The public has much greater contact with primary care than with secondary care. There is a role for the PCTs in a wider teaching brief—teaching public awareness. PCTs should have a key role in preventive care. They should also play a part in promoting research among the public, helping to
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persuade people that it is in the wider public interest to participate in research and trials. If they do not take such a lead, distrust of research may well become unstoppable.
In teaching future doctors and other health professionals, PCTs clearly have a vital role to play. Those working in this sector must not be so overburdened that they cannot do that. Therefore, it has to be clear to those in administration, government and the Department of Health that they need to look to the wider picture. Much research would be better carried out at primary level if only the infrastructure were there. For example, in programmes such as screening, GPs often play the key role in compliance—hence those instances in which letters sent to patients supposedly from the GP are in reality drafted and sent by the hospital co-ordinating the trial. The poor GP has no time to play much of an active part. That is surely in no-one's interest.
If we are to see a shift of emphasis within the National Health Service to PCTs, it is vital that their aims should be clear. Teaching and research should be integral to those aims. Given that PCTs are still in their infancy, it is important that this is written into their brief. I would like to be sure that it is and I would like to know how we can be sure that research and teaching will not be squeezed out as currently happens. I beg to move.
Lord Walton of Detchant: I am very grateful to the noble Baroness and to the noble Lord, Lord Clement-Jones, for tabling this amendment to which I give my warm support. I do not wish to go over the ground covered in the debate last December, to which the noble Baroness referred. However, from the inception of the National Health Service, there has been an agreement, never fully enforced, that clinical academics, appointed and paid by the universities, should be able to devote six sessions weekly—six half days a week—to clinical service in the National Health Service. Five sessions should be devoted to teaching and research. Under the old knock-for-knock agreement, that was co he compensated for by the teaching given by National Health Service consultants, who were not employed by the universities. That particular agreement has been breached to a remarkable extent.
The BMA survey, to which the noble Baroness referred, has demonstrated that there is a massive recruitment problem of clinical academics. Over 70 chairs and more than 200 clinical lectureships or senior lectureships are vacant for lack of suitable applicants. At a time when the Government are committed to training 6,000 medical students annually, rather than the present 4,200, it is absolutely vital that this sector should be expanded and increased and that the time available for teaching and research should be preserved.
The same survey found that practically no clinical academic was spending less than 40 hours a week in service commitments to the National Health Service. Some were spending as much as 48 to 50 hours a week, leaving little or no time available for teaching and research. This is a huge disincentive to recruitment of

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clinical academics. In many instances, it has been due to managerial pressure on clinical academics to see ever more patients and help fulfil the Government's commitment to bring down waiting lists for outpatient appointments and inpatient care. Therefore, it is absolutely vital that a clause with this kind of intent should be included on the face of the Bill.
Baroness Pitkeathley: I understand that some primary care trusts have teaching responsibilities which would address some of the concerns raised by Members of the Committee who have already spoken. When my noble friend the Minister replies, he may be able to give figures.
Baroness Cumberlege: I believe that to be the case. The Minister will tell us the definitive answer. As I understand it, there are designated primary care trusts that are specific for teaching. The amendment of the noble Baroness, Lady Northover, is to try and get teaching throughout the whole of the National Health Service. I very much support that.
In Committee, probing amendments are sometimes put down. Other amendments can be teasing or have a wider aim, but some are very serious. This is a serious amendment to which I give my full support.
I chair the medical school council of St. George's Hospital. Much of the research in primary care there is conducted by GPs. Despite the pressures, they do carry out research. The British Medical Journal devotes a complete section to research carried out by general practitioners. I hope that that continues.
I should like to look at undergraduate education and how that currently works. If we are to do ever more in the community, it is essential that the people who provide that service have teaching built in at an early stage. Fifteen to 30 per cent of the experience of undergraduates is in primary care. Around 203 practices are involved. It is a huge commitment from general practice.
The graduate entry programme that St. George's undertakes is for graduates with any degree—50 per cent have a science degree, 50 per cent other degrees. This is a marvellously innovative way of educating doctors for the future. We shall have better doctors as a result. In the first week, their entire experience is in general practice. That is important if we are to reshape the way we give clinical care in the future.
In both adult and paediatric nursing courses, 10 to 25 per cent of time is spent in placements. In mental health, it is 20 to 35 per cent. This will be an enormous commitment on behalf of primary care and community services. Placements, teaching and research are all going on in primary care.
There are enormous pressures on the National Health Service. The spirit of this amendment is absolutely right. We are not asking for rights; we are asking for information and discussion. We are asking for an awareness of the responsibilities needed in primary care if we are to deliver this new curriculum.
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A deep concern of researchers is that if PCTs decide they wish to change their placement of future contracts, it could derail an entire research project. That could have a disastrous impact on new research that is coming forward. It is essential that PCTs, in their commissioning, recognise what those contracts will do.
We know that the Minister has exemplary skills in avoiding amendments and skirting round them. I hope that he will reconsider this amendment and make it a duty of primary care trusts to have regard to teaching and research.
Baroness Finlay of Llandaff: I strongly support the amendment. I declare my interest as a vice-dean of an undergraduate medical school. The noble Lord, Lord Walton of Detchant and the noble Baroness, Lady Cumberlege, have outlined many issues. I shall not repeat them.
It is crucial that we look at the benefits of teaching and research from direct patient outcome. There is good evidence that all patients entered into clinical trials, even those on the placebo arm, do better than patients not entered into trials at all. There is good evidence that standards of clinical care in teaching practices rise—even in those practices which might be considered to be providing care at a slightly suboptimal level. The standard of such practices can be pulled up by their becoming involved in teaching. They become involved in reflective practice; they audit what they are doing. A questioning student will often provide as much teaching as a so-called teacher.
Duties of a doctor, a GMC document, outlines teaching and research as a core duty of every doctor; but such duties do not exist for managers. There is presently no obligation on managers to ensure that teaching and research take place in the area over which they have responsibility. Time needs to be allocated to clinicians; but they also need rooms, facilities, computers, and a library online. Those who teach and those who receive teaching need to be able to access simple things such as paper, photocopying and secretarial support. Those must be built in to the ethos of the system that is delivered.
Research evidence is needed on the patterns of healthcare delivery. The Health Services Management Centre considers that there is no research evidence to support the changes currently proposed in the reorganisation of the NHS. We are desperate for good research evidence for different systems of management within the NHS, quite apart from clinical research and clinical teaching.
If we are to recruit healthcare professionals into primary care in the future—and there is present evidence that people are walking away from primary care—we must ensure that the teaching and research environment is valued and that that becomes a statutory duty of managers.
4 p.m.
Baroness Emerton: I support the comments of the noble Baroness, Lady Finlay. I suggest that we also

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extend the requirement to other healthcare professionals. Teaching in the community is much more difficult than it is within the environs of a hospital. Clinical supervision is yet another difficulty that is experienced in the community. It is important to ensure that teaching and research is included for all healthcare professionals in the primary healthcare field, particularly when new patterns of care are being experienced. I refer to hospitals such as the one near my home, where there is a multi-professional team approach. That is where research comes in and can prove that this is essential. I support the amendment.
Earl Howe: I, too, am pleased that the noble Baroness has tabled the amendment. I fully share the concern that underlies it. I shall not repeat what has been said, except to underline one of the main worries that have emerged from this short debate. The difficulties currently being experienced in medical teaching and research as a result of the acute shortage of clinical academics are of the highest importance for the health service. So important are they, that we must not for one minute allow ourselves to lose sight of them amidst the upheaval in the NHS that is heralded by the Bill.
PCTs are new creatures. Even those which exist have not been going very long. Others have yet to come into being. Much of their expanded remit is new territory for them. Many of the staff will be new, and systems will be bedding down. While I worry about the burdens of acclimatisation that the Government are imposing on NHS staff, I worry also that, without great care being taken, functions that are not central to the delivery of healthcare to local communities will simply fall out of view. The money will be directed to where it is most urgently needed.
No one is saying that PCTs should suddenly be granted a vastly enhanced role in the commissioning and delivery of medical teaching and research. That responsibility lies elsewhere. I dare say that the strategic health authorities will have a duty to oversee medical teaching and training at a local level. But it will be the PCTs, with 75 per cent of the NHS budget, that will have the financial muscle and will play a key role. There is a need to ensure that that element of the teaching and research budget currently being shouldered by health authorities and trusts and by general practice is not squeezed out by other, more immediate and visible pressures. Indeed, there is a need to ensure that it is valued. I particularly identified with the noble Baroness's remarks about maintaining the ethos associated with research and making sure that GPs and clinicians in the community are fully on board.
I hope that the Minister will be able to reassure the Committee and tell us that the Government have these concerns very much in mind. I hope that he will be able to explain how they are being addressed.
Lord Turnberg: I must apologise for entering the Chamber too late to hear the noble Baroness, Lady Northover, introduce her proposal. However, as an ex-dean of a medical school and as vice-president of
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the Academy of Medical Sciences, I am desperately keen to see research and teaching fostered and safeguarded. It is in desperate need of that. The Academy of Medical Sciences is about to produce a report which highlights many of the difficulties facing academic medicine, teaching and research. These activities are under great threat at a time when we are keen to enhance them.
The principle behind the amendment is entirely laudable—were it not for the fact that primary care trusts will have a big load on their shoulders. It is important that they are involved in research and teaching in the ways described. However, to expect them to have a prime responsibility in this area may be going a little far. This is not necessarily just a local problem; it is a matter of national importance. The responsibility for ensuring that research and teaching are fostered should lie not only with PCTs but also with strategic health authorities in particular, which will be in place in areas where there are medical schools and universities and will have an important role in encouraging relationships with the universities. To that end, I hope that when my noble friend responds he will consider how the functions of research and teaching can be encouraged, perhaps by members of the university and the medical school becoming members of strategic health authorities to ensure that there is a link at that level. This should foster what goes on at PCT level.
Although I like this idea, I am not sure that this amendment will meet the bill. Nevertheless, I hope that my noble friend the Minister will take it on board.
Lord Rea: As a former primary care physician, I strongly agree with the points made on all sides of the Committee. However, I am not absolutely sure that such an amendment is necessary on the face of the Bill or is the right way of doing things. I hope that my noble friend's response will reassure all Members of the Committee who have spoken as to the importance that the Government place on research and teaching in primary care.
Baroness Masham of Ilton: Drugs are one of the biggest items of cost in primary healthcare. Therefore, to find out which drugs are most effective, there must be research. The pharmaceutical industry needs that data. Primary healthcare is having more and more put on to it. It is vital that areas of the profession work together. Therefore, I support the spirit of the amendment.
Baroness Carnegy of Lour: In replying, will the Minister tell the Committee what the spread will be under the new arrangements of research ethics committees? Will there be an ethics committee in each strategic health authority which will look at research in the local area?
Lord Hunt of Kings Heath: This has been an extremely interesting debate, and one with which I have a great deal of sympathy. Clearly, it is very important that we have effective arrangements in place

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for teaching and research functions within the National Health Service. Indeed, I would argue that it has been one of the great strengths of the NHS since its foundation that we have built up such strong links. I also accept that there are concerns about the recruitment of clinical academics and more generally about the pressures on clinicians within our teaching hospitals in terms of the amount of time that they have for teaching and hard clinical practice.
The Department of Health is very much apprised of the challenges and issues that we face. Some months ago, the noble Lord, Lord Walton, introduced an interesting debate on those issues. At the time I talked about some of the proposals that the Government were taking forward, particularly in partnership with the Department for Education and Skills, such as the individual higher education institutes and the higher education funding councils. At a time when we see a massive expansion in the number of medical school places in our universities, it is important to ensure that we are able to attract clinical academics who can provide the kind of teaching and research that is evidently required. We must also ensure that the medical schools, in their expansion of places and the development of new medical schools, are able to attract people of the highest calibre. I assure noble Lords that it is in the interests of the National Health Service and the Government to ensure that we address some of the problems that noble Lords have raised in the debate.
Having said that, I am entirely sympathetic to the general comments made by noble Lords, although I am not sure that the amendments tabled by the noble Baroness are necessarily the right approach to this issue. The Secretary of State already has powers to support teaching research activities that have been delegated to health authorities and, through them, to primary care trusts. Primary care trusts also have their own directly conferred powers to conduct research and to make offices and facilities available to universities. By keeping that as a function of the Secretary of State, we are allowing maximum flexibility to involve all health service bodies
My noble friend Lord Turnberg raised a number of important issues. He asked whether a university representative would be appointed to a strategic health authority board. The Health Authorities (Membership and Procedure) Amendment (England) Regulations 2002 were laid before Parliament on 11th March to come into force on 1st April. They state that in relation to health authority membership,
"One of the non-officer members to he appointed to an Authority shall be a person who holds a post in an institution within the higher education sector which provides education enabling students to fulfil criteria necessary for".
It then lists professions, including the medical profession, the dentistry profession, the pharmacy profession, the nurses and midwifery profession and professions covered by the Health Professions Council.
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That appointment will be an extremely important one in terms of the role of the strategic health authority in ensuring that some of the issues raised by noble Lords are, in effect, carried out. I remind noble Lords that strategic health authorities will have the role of performance-managing primary care trusts and so they will be in a position to ensure that primary care trusts contribute what is necessary to enhance teaching and research within the National Health Service.
We have developed what we describe as work-force development confederations. Their responsibility within each local health community is to decide how money on education and training should be spent. Primary care trusts will be constituent members of those confederations and the performance of the confederations will be managed by strategic health authorities. As part of the strategic role of each strategic health authority, I see a particular responsibility for ensuring that the conditions are right for enhancing teaching and research.
The noble Baroness, Lady Finlay, pointed to the positive impact of teaching practices. I echo that. The experience of the NHS is that the teaching practices that are connected to university medical schools have an enormously positive role to play in the training of medical students and specialist registrars who are attracted to primary care. They also have a positive impact on the development of high quality practice within primary care.
In Birmingham the links between the medical schools and teaching practices in the inner city areas are seen as one positive way that we can overcome some of the recruitment and retention problems in inner city primary care practices. In the future we will want to enhance and to encourage that. I would expect primary care trusts themselves to see the value of much stronger links between constituent primary care practices within their primary care trusts and universities.
Part of the responsibility for ensuring the right conditions for teaching and research is having the right research governance framework so that research can be conducted properly. In March 2001 the Department of Health published a research governance framework that recommended framework agreements between organisations that collaborate on research work. The NHS Regional Research and Development Forum, the Medical Research Council and the Department of Health are co-ordinating discussions to develop a model framework agreement by April 2002.
It sets out that each primary care trust will have responsibilities related to research governance for research and development in primary, community and social care. By April 2003 there will be a national network of primary care trusts to act as host for shared research governance and management capacity.
Clearly, it is important that we are as encouraging as possible to research and to clinical trials. My work in the joint task force between the Government and the research-based pharmaceutical industry has identified a number of issues that need to be addressed to ensure that one has robust research governance, and that the

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arrangements whereby clinical trials and research can take place are as straightforward and as non-bureaucratic as possible. Within that I would expect primary care trusts to play their full part.
The noble Baroness, Lady Carnegy of Lour, asked me about research ethics committees. They will remain until October 2002 at health authority level and we are still discussing how, after that date, they can effectively be brought under primary care trust responsibility. A suggestion that may emerge is that one lead primary care trust within each strategic health authority area takes on a lead responsibility, but we are still working on those arrangements.
The noble Baroness, Lady Masham, asked me about drugs. Of course, we are keen to ensure that the most effective drugs are used within primary care. That is one reason that we have prescribing advisers who have been successful in advising individual. GPs on their prescribing responsibilities. We also set up the National Institute for Clinical Excellence to give advice on what are the most cost-effective and clinically-effective drug treatments.
My noble friend Lady Pitkeathley asked about the development of teaching primary care trusts. In March 2001 my right honourable friend the Prime Minister announced that £25 million over a three-year period had been made available to develop a number of teaching primary care trusts across the country. That is a very exciting development. Those teaching primary care trusts will provide teaching and clinical opportunities for primary and community care professionals to support and improve the delivery of services for the local population. Their importance relates not only to individual primary care trusts; they will also stress to primary care generally the importance with which we regard teaching and research.
4.15 p.m.
Lord Walton of Detchant: if the Minister ultimately feels unable to accept this amendment, is it possible that, with his characteristic ingenuity, he could at least find a way of including the words "teaching and research" somewhere in the Bill? It is remarkable that a Bill of this magnitude and scope does not even mention those particular words of great importance to the future of the NHS.
Lord Hunt of Kings Heath: I am not as yet convinced that the words "teaching and research" need to be included in the Bill, partly because the reference to teaching and research is already fully included in other NHS legislation. For example, Section 5(2)(d) of the National Health Service Act 1977 provides the Secretary of State with the power to conduct or assist others to conduct research into any matters relating to the causation, prevention, diagnosis or treatment of illness.
Under Paragraphs 14 and 15 of Part III of Schedule 5A to the 1977 Act, primary care trusts are empowered to conduct, commission or assist the conduct of
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research and to make officers and facilities available in connection with training by a university or any other body providing training in connection with the health service. Under Paragraph 11 of Schedule 2 to the National Health Service and Community Care Act 1990, an NHS trust may undertake and commission research and make available staff and facilities for research by other persons.
Under Section 51 of the 1977 Act, the Secretary of State has a duty to exercise his functions so as,
"to secure that there are made available such facilities as he considers are reasonably required by any university which has a medical or dental school, in connection with clinical teaching and with research connected with clinical medicine, or as the case may be, clinical dentistry".
Paragraph 11 of Schedule 2 to the 1990 Act states:
"An NHS Trust may provide training for persons employed or likely to be employed by the trust or otherwise in the provision of services … and make facilities and staff available in connection with training by a university or any other body providing training in connection with the health service".
Earl Howe: I cannot help but notice that, in that very helpful list which the Minister has just react out, many of the powers, apart from those that he related to the Secretary of State, are permissive only. They are not duties. I think that that is the concern that has been expressed. There may be the power to do all these things at a local level, but will this function in practice be squeezed out?
Lord Hunt of Kings Heath: The short answer to that is no, because the NHS and the Government cannot allow teaching research to be squeezed out.
Baroness Finlay of Llandaff: I am grateful to the Minister for giving way, and I should like to build on the previous comment. As the dates of the legislation which the Minister cited demonstrate, the desire to incorporate teaching has existed for well over 10 years. A paper from Freeman & Sweeney is entitled, Why general practitioners do not implement evidence: qualitative study, and an article in this week's BMJ calls for primary care organisations to create learning environments that capitalise on the wealth of knowledge. I fear that, unless the Government seriously consider including these requirements in legislation, they will continue drifting on the matter as they seem to have done for many years.
Baroness Cumberlege: What is very good about this amendment is that it uses the words "a duty", and therefore imposes an obligation. I n his reply, the Minister seems to have rested his case on the fact that the strategic health authorities will do the monitoring. However, is that not trying to put right something once it has happened? It is very difficult to do that in research because research has to be continuous and, in research, one is working with a defined patient population. I think that, in research, the danger lies in the PCTs' contracting and commissioning work. In teaching, I think that the danger lies in the pressure on the service, in that, as I explained, so much of teaching today has to be done in primary care.
Lord Hunt of Kings Heath: I fully accept what the noble Baroness has just said. However, it does not

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seem to follow that simply including this amendment in the Bill would necessarily lead to any specific change.
The question surely is this. Is teaching research important to the National Health Service? If it is, how can we ensure that due recognition is given to that fact not only at government level but at the NHS local level? I believe that teaching research is critically important: it is important to the quality of services and to the quality of research in this country. Moreover, it is important not only to the National Health Service; it is important also to UK plc in terms of our science base and future investment in research and development. I do not believe that the House should have any doubt at all that the Government regard the proper support of teaching research as critically important. I am simply saying that amending the Bill as proposed would not be helpful when the powers that I have read out are clearly available for use by the NHS. I do not expect strategic health authorities to interfere and inhibit the role of primary care trusts.
Primary care trusts have a prime role to play in ensuring—first through the workforce confederations—that sufficient teaching places are commissioned and that the conditions are right for research and teaching. The point about the strategic health authorities is that they are there to check and to ensure that things are not going wrong. As I said last week in ourdebate on strategic health authorities, if there were a specific case in which an individual primary care trust was not prepared to play ball, we would have the lever of performance management as a means of intervening.
My general expectation, however, is that primary care trusts will wish to support teaching research. The impact of the increasing number of training practices has in itself had such a beneficial impact on the overall performance of primary care and the quality of services that I believe that a great swathe of primary care and primary care trusts will see the benefit of supporting teaching and research. As I said, the establishment of teaching primary care trusts is in itself a visible sign of primary care commitment to teaching and research.
I have no doubt that all the points raised by noble Lords are extremely important. They are important to the Government. We wish to ensure that effective teaching research does take place. However, I doubt whether the amendments in this group really would lead to a difference in approach or a real improvement in the way in which teaching research is dealt with. Although it is a major challenge for the NHS, it has to be dealt with effectively by means of the type of mechanism I have discussed.
Baroness Masham of Ikon: Before the Minister sits down, perhaps I may point out that Amendment No. 41 is not grouped with other amendments but stands on its own. Does it not emphasise the need to include research in the Bill. What harm could that do?
Lord Hunt of Kings Heath: The noble Baroness is quite right: the amendment is not grouped but
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separate. Surely there are three points here. First, even if that were in the Bill, it would have to be interpreted by the department in terms of its meaning for individual organisations. That is no different from the current position. Secondly, it would apply only to primary care trusts. Although one may wish to go down that path, I doubt that there is any specific reason to single out primary care trusts. Thirdly, as I have made clear, current NHS legislation already very comprehensively covers the issue of teaching and research.
Baroness Northover: I thank the Minister for his reply and noble Lords for their contribution to this mini-debate. I seem to have struck a chord. I may not have written this amendment quite as it should be. No doubt I shall have to revisit it, but revisit it we will need to do because there is clearly a lot of concern about this.
What has motivated me is what we have seen happen at secondary and tertiary levels in terms of teaching and research. They are not a key priority for those who are trying to fill financial black holes. The noble Earl, Lord Howe, hit the nail on the head. If this is a duty, then in a way that gives a power to those who are trying to ensure that teaching and research at PCT level is given its due emphasis. If it is not, then when the question is raised as to how resources are to be spent it will simply be pushed aside. I therefore disagree with what the Minister has said. There is a purpose in having something like this built, as a duty, into the list of priorities of PCTs.
I am very struck by what noble Lords have said about the situation at all levels of the health service: for example, the fact that we do not even have ethics committees in place. No decision has been made about that. Clearly there has been a decision within the Department of Health that it is not a key priority; that they need not address it yet; that other things have to happen first.
Lord Hunt of Kings Heath: I am most grateful to the noble Baroness for giving way. I thought that I had said that we have decided to keep the research ethics committees based at health authority level up to October this year. They will then be picked up by primary care trusts. We are now holding discussions on how best those arrangements might then be conducted at primary care trust level. I do not see how it follows that the Government regard it as an unimportant issue.
Baroness Northover: It seems to me that, if it were a high priority, and given that the PCT has to play such a key role in the health service so very soon, it would have been taken somewhat further forward.
Lord Hunt of Kings Heath: I am grateful to the noble Baroness, but I must confess that I find myself somewhat confused. Last Thursday the Government were accused by the Liberal Democrat Benches of taking a far too prescriptive, centralist approach; yet, in the debates this afternoon, I am being invited to take

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a centralist, prescriptive approach by those very same Benches. It would be interesting to know which hat the Liberal Democrat Benches are now wearing.
Baroness Northover: I have heard this argument before. What the Minister has said, however, is that he will be laying down guidelines from the department as to how PCTs should play their full part; that decisions should follow on from that. What he has not done, therefore, is to devolve this to local level. He has not set down the framework within which PCTs have then to carry forward that duty.
I would consider it appropriate that this should be part and parcel of drawing up the guidelines for PCTs. PCTs then have a duty to implement and carry that out; not the Department of Health, if they feel like it, advising that they might.
The very fact that extra money has gone to some PCTs in order to take this forward shows that the Government do not have the confidence that, without it, research and teaching would be taken forward. That seems to belie what the Minister has said about this happening automatically.
I agree, as I think everyone does, that teaching and research are vital for the NHS and that the future of the NHS depends upon them. Just wishing that to be the case, however, is surely not sufficient. More needs to be done to ensure that PCTs play their full part in this matter and that it is therefore given to them as a duty to carry this out, not simply as a power.
I have listened to what the Minister has said. I am sure that we can revisit this matter and we undoubtedly need to do so, in order to draw up something which would gain some consensus. At present, I beg leave to withdraw this amendment.
Amendment, by leave, withdrawn.
Lord Filkin: I beg to move that the House he now resumed.
Moved accordingly, and, on Question, Motion agreed to.
House resumed.

European Council, Barcelona
4.35 p.m.
Lord Williams of Mostyn: My Lords, with the leave of the House, I shall now repeat a Statement made earlier in another place by my right honourable friend the Prime Minister. The Statement is as follows:
"With permission, Mr Speaker, I should like to make a Statement about the European Council which took place in Barcelona on 15th and 16th March.
"Two years ago at Lisbon the European Union set out to become the world's most competitive and dynamic economy by 2010. Since that date the European Union has created five million new jobs. There are now nearly three million more women in work. Tax rates on low wage earners have
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been falling. We have agreed a new framework for competitive telecoms markets. Telecoms liberalisation has cut the price of calls across the EU by almost a half. As a result of the EU Action Plan, Internet access has doubled across the EU.
We have cut red tape for small firms so that a private limited company can now be set up in under two weeks in 10 EU member states. We have recently agreed proposals to deliver a single EU securities market and cheaper capital for small firms.
"The recent difficulties faced by the world economy mean we cannot rely on cyclical growth to deliver the employment Europe's citizens need. We must push ahead with the structural reforms to Europe's economies.
"At Stockholm a year ago, progress stalled. Barcelona had to recover momentum. There is no doubt that, after Barcelona, we are moving again, though there is still much ground to be made up by 2010. Such progress as there is is a tribute to the Commission and the leadership of the Spanish presidency, and I pay tribute to the excellent chairmanship of Prime Minister Aznar.
"Here is what was achieved. We set a timetable under majority voting to complete the single market in financial services, itself capable of boosting EU GDP by half a percentage point. No fewer than 25 different liberalising measures have already been agreed. Seven more key measures will be agreed by the end of the year. Most of all, we made a breakthrough in opening up the European energy market. All member states have now agreed fully to open up the non-domestic market by 2004 with free and fair competition. This represents over 60 per cent of the total market in gas and electricity. In addition, it is clear that the overriding majority of EU countries are now ready to open up their domestic markets as well. We agreed that a decision on the relevant directives will be taken by majority vote, at the latest by the end of 2002. This means that a single market in energy is now attainable.
"We agreed to deliver broadband technology across the European Union by 2005. That means Internet access at 10 times the present speed. We agreed to boost our commitment to research and development towards a target of 3 per cent of GDP by 2010. The new Research Framework programme will spend 17.5 billion euros to this end. New industries, like the growing biotech market, will benefit significantly.
"We have agreed to implement by the end of 2002 proposals to reduce regulation on business and a new system for consultation with business before new regulation is introduced.
"These steps go hand in hand with a social policy which seeks to encourage more and better jobs for all. The record of the British Government is strong. We have guaranteed fair rights at work. We have a national minimum wage. Our disability, gender and race equality legislation is among the most advanced

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in Europe. We have introduced a new system of tax credits to make work pay. Our New Deal has got over 300,000 young people into work.
"Since we came to power unemployment in Britain has fallen to its lowest level for 25 years. We have one of the highest employment rates in Europe overall, including for women and for older workers. Europe agreed that the enlargement agenda must focus on measures targeted at jobs, enterprise and moving people off benefit into work, rather than heavy-handed regulation—the British approach and increasingly the European one. As the Barcelona conclusions say,
"employment is the best guarantee against social exclusion".
"The enlargement countries came to Barcelona and, for the first time, participated in policy debates. We also discussed how to make our decision-making more streamlined and efficient once we become a European Union of 25, 27, and more. I welcome the proposals of the Secretary General of the Council, Javier Solana, which will now be taken forward by the Spanish presidency. In many respects, these echo the ideas that Chancellor Schroeder of Germany and I put forward in a recent paper on Council reform.
"The Council also addressed a range of pressing international issues. The EU committed to increase its average development aid to 0.39 per cent of GDP by 2006. This achievement owes a lot to the lead given by my right honourable friends the Chancellor of the Exchequer and the Development Secretary. It is worth an extra 7 billion dollars a year. If delivered, it means another 80 million children in Africa and elsewhere in schooling—up for the first time.
"On the Middle East, we underlined the extreme gravity of the present situation and called on both sides to take action to stop the bloodshed. We welcomed the resolution adopted by the UN Security Council last week and the initiative taken by Crown Prince Abdullah of Saudi Arabia offering full normalisation of relations with Israel in return for full withdrawal from Occupied Territories. There must be an immediate ceasefire all round to give the peace process a chance to work again.
"On Zimbabwe, the European Council accepted our judgment that these elections were neither free nor fair. It agreed to take forward specific measures through Foreign Ministers.
"On the Balkans, the Council warmly welcomed the agreement brokered by the EU's High Representative Javier Solana between the authorities in Serbia and Montenegro for a new relationship within a single state. This agreement underlines just how far the countries of south east Europe have come in the past four years. A democratic government is in place in Belgrade. Milosevic is on trial in The Hague, and Kosovo has held successful elections for its provisional government. Moderates are in power in Croatia and Bosnia. The noose is tightening around Karadzic. In Macedonia, active diplomacy last year stopped what could have become another Balkan war.
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"All this progress came about in large part through Britain acting in alliance with others. Prior to the summit, we took initiatives with no fewer than seven different countries—the Netherlands, Germany, Sweden, Denmark, Italy, Belgium and Poland. Five years ago, such alliances would have been unthinkable. Under the previous Conservative government, Britain was marginalised, without influence appropriate to our weight and size, in the isolation room. Now, from the economy to defence to institutional reform, Britain is in there shaping Europe's future, making Europe work in a way that is better for Britain and Europe. The policy of constructive engagement is right. Britain's proper role is as a leader and partner in Europe. We shall continue to get the best for Britain in Europe. Under this Government, the days of weakness and isolation will not return".
My Lords, that concludes the Statement.
4.43 p.m.
Lord Howell of Guildford: My Lords, I am most grateful to the noble and learned Lord the Leader of the House for repeating the Statement. As I believe the noble and learned Lord is aware, I have been asked to respond to the Statement due to the unavoidable absence of my noble friend Lord Strathclyde.
To begin with, putting aside the party political cadences in the final paragraph of the Statement, is it not the objective view of most observers that the Barcelona meeting has been a bit of a disappointment? I suppose that that is not really surprising because previous EU summits in recent times have also been disappointing. Indeed, no one could claim that it matched the hype and the rather extravagant claims that it would be a "make or break" affair, which would determine whether or not the momentum for modernising Europe was going forward.
We certainly support the rather modest liberalisation of energy trading that was achieved. It is very minor, but we support it. It still leaves Electricite de France in a complete monopoly position, both inside France and in its operations on this side of the Channel. However, it is better than nothing. We strongly support the Prime Minister and the Chancellor of the Exchequer in their firm rejection of the protestations of Mr John Monks, and others. Protecting workers' rights is very important, but when that is really a code for protecting the rights of those in jobs at the expense of those who are unemployed, and when it really means promoting unemployment, we believe that the Prime Minister and the Chancellor are right. Those who argue another line are totally wrong, unfeeling and selfish.
Having said that, it is the universal view—one that appears to be shared by the Prime Minister—that the Barcelona event was not very entertaining. In fact, the Prime Minister came very near to saying that it was a bit of a bore, and that he would rather have been elsewhere. One can see his point. The Government recently produced a vast White Paper on the subject of realising Europe's potential, which set out all sorts of

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high hopes; but these do not seem to have reached Barcelona. In practice, as we learnt from the Statement. the results that emerged are very thin. Indeed, if one is to judge by what was actually achieved, it looks as though the reform process is running into the ground throughout the euro zone.
Why do I make that comment? I do so because energy liberalisation in the larger sense has been blocked, although we have the small concession. We should remember that the Lisbon process was supposed to be a matter of catching up with the United States—admittedly, over a period of years—but we are two years into the system and all the statistics show that the US is still further ahead in per capita income, in technological advance, as well as in other areas. The Lisbon process was supposed to achieve a lighter and more targeted regulation on business. Coming from this Government, that would have been a shade more credible if they had not been the Government who, last year, imposed 4,642 new regulations on small business—which works out at one every 25 minutes of the working day.
Then there is enlargement, which many people believe to be the central ideal of the Union today. But that is bedevilled by disputes about second-class status for the central European applicant states, and there does not seem to be much about that in the communique. As for certain defence issues not mentioned in the Statement, but featured in newspaper reports, it seems that EU countries are still at sixes and sevens as to what relationship the rapid reaction force should have with NATO. In the end, I believe that reality will force it back into the NATO pattern as a strong European subsidiary of the organisation, and not as an autonomous force.
Newspaper reports have mentioned the same kind of disagreements over what Europe should do on the second phase of the war on terrorism. We know that there are disagreements rather nearer to home on what to do about Iraq, but none of that was covered in the Statement. Can the noble and learned Lord say whether anything was actually debated at Barcelona in that respect? Was there any discussion on common agricultural policy reform, which is very important? Was anything decided on the blocked take-over directives, or on pension reform, which is now becoming a critical issue for the Italians? Generally, we believe that Barcelona took place under a delusion—a delusion that governments create jobs. They do not.
On the foreign side, there is a hint of firmness as regards Zimbabwe. However, it would be helpful if the noble and learned Lord could tell the House what the Foreign Ministers will now consider, and what their next move might be. Menacing reports have appeared in newspapers about Gibraltar; but, again, nothing was mentioned in the Statement. We need the assurance that the Gibraltarians will not be put under intolerable pressure if they turn down the joint sovereignty deal—which, of course, they will. They must not be forced to renege on their own democratic wishes.
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Noble Lords on this side of the House are constructive Europeans: we want new measures to defeat the euro malaise, and to restore democracy and accountability. We see very little constructive corning out of Barcelona. The Prime Minister said that the achievements were limited and solid. They are limited; indeed, they are so limited that one would almost need to use a microscope to see them. They are so solid that they appear to be on the verge of being immobile. In our view, it is high time for a fresh approach. Nothing that was done or said at Barcelona by this Government seems to reflect that urgent need.
4.50 p.m.
Baroness Williams of Crosby: My Lords, I. too, thank the noble and learned Lord the Leader of the House for repeating the Statement made in another place. I begin by saying that it is perhaps a little churlish not to pay considerable respect to the remarkable achievement of the turnover from national currencies into the euro. Whether or not we are part of that process at present, it has been a remarkable achievement and extraordinarily successfully carried out. Whether one is pro or anti membership of the European monetary union, one should recognise that that has been, and is recognised throughout the world as being, a remarkable achievement.
Perhaps I may mention, with approval from these Benches, two other achievements of the Barcelona summit. One is the impressive resolution to increase development aid and to bring about a more rapid move towards debt relief. In that context we on these Benches congratulate the Chancellor of the Exchequer and the Minister for International Development on what has been a steady and consistent attempt to address the huge inequities in our global economy, for which they deserve considerable praise. We are pleased to see further measures being taken on the environment and moves towards an energy tax, although the dating of that is somewhat distant.
Having said that, and having also said that it is encouraging that there is some move towards liberalisation of the electricity market, we have to agree to a limited extent with the noble Lord, Lord Howell of Guildford, that, even given the extraordinary ability of the Prime Minister to burnish almost anything to a very high glow, this was not a particularly impressive summit. First, as we all know. there was no substantial move towards completing the internal market. Frankly, a figure of 98 per cent for seven countries so long after the Single European Act was passed is not impressive by any standard. To say that it will be another four years before we get anywhere near 100 per cent is to say that we are moving at a tortoise-like pace.
Secondly, to speak of research and development expenditure increasing to 3 per cent by 2010 is slow progress. That is hardly what one might call a wildly ambitious target. We are disappointed by the fact that the financial services action plan, which is vitally important to the development of the European economy, is still mired in indecision, and equally that

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the attempt to create a European patent is still subject to long delays because no one can agree on the languages into which it should be interpreted.
On some of the key areas of creating exactly the kind of modern, information technology-conscious economy of which the Prime Minister and some of his colleagues have spoken on many occasions, we are not making what one might describe as rapid progress. That is a pity because there is no doubt that Europe's potential is much greater than its achievement. In that respect, I ask the Leader of the House three questions. First, can he tell the House more about the financial services action plan, the Lamfalussi proposals, and what prospects there are of that being implemented within the next four or five years in line with some of the reforms that are being made globally? Secondly, can he say something about the European charter for small and medium enterprises, which is again a vital part of modernising the economy of Europe and creating more job opportunities? Finally in this respect, can he say a word or two about the proposals with regard to patents?
I turn to the international annex attached to the Statement. Again, we congratulate the Prime Minister and the Government on the steps that have been taken to create a new federation between Serbia and Montenegro. It is hoped that that will be one which will provide for more autonomy for Montenegro than was the case in the old federation. It is obvious that Montenegro is tugging in the direction of having a greater say in its own future. I have suggested already that we are pleased by some of the steps towards environmental improvements, including at a global level.
However, again I must ask the Leader of the House a serious question. The summit Statement has much more to say about the Middle East than has the Prime Minister's Statement. It is clear from the visits being paid to the Arab states by Vice-President Cheney that the message has come through loud and clear from virtually every moderate Arab capital that it is the war and growing escalation of violence and tension in the Middle East that is perceived by all those governments—Egypt, Jordan, Bahrain, Qatar, and Saudi Arabia—as being the central threat they face. Against that threat they will not get engaged in giving help for an attack on Iraq because they do not believe that that is the first priority in saving the peace of the world. It is interesting that Mr Cheney has begun to change his tune somewhat and, in the past couple of days, speak as if he too thinks that perhaps the Middle East crisis should take priority.
In that context perhaps I may ask the Leader of the House specifically about two matters the Prime Minister did not mention, and welcome one which he did. We welcome the commitment of the Prime Minister and the European Council to call on Israel to withdraw from the occupied territories. However, there were two other things said by the Council which the Prime Minister did not say. The first was to call again on both sides to respect United Nations resolutions, including the most recent resolution 1397,
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calling upon both sides to respect the sovereignty of the other, the ultimate setting up of a Palestinian state and the withdrawal of both sides from violence in the other country.
But, secondly, and perhaps even more important, the European Council called for there to be monitors sent from the European Union to oversee and monitor any attempt to try to create a peace agreement between the two sides. Many of us in this House regard that as being perceived to be more neutral between the two sides than, with great respect, American monitors. It is vitally important that we know the view of our own Prime Minister on that European Union proposal. I therefore conclude my questions by asking the Leader of the House to tell us as precisely as possible whether the Prime Minister supports that conclusion and whether he would agree to co-operate by sending British monitors along with European monitors to supervise the peace process desperately needed in the Middle East.
4.57 p.m.
Lord Williams of Mostyn: My Lords, I am grateful for the contributions of the noble Lord, Lord Howell, and the noble Baroness, Lady Williams. I confirm that the noble Lord was courteous enough to indicate the reason why the noble Lord, Lord Strathclyde, could not be in his place.
I do not believe that it is right to say that Barcelona was a disappointment. It would be deeply disappointing if one thought that one was going to change the world on every such occasion. Such processes are bound to be incremental. We cannot have "big bang" solutions on every occasion, particularly in a community, a union, which is expanding quickly and introducing countries at different levels of economic, political, cultural and social development. In the view of the Government, that is the key to the future of the European Union.
It was said, for instance, that the Prime Minister and the Chancellor had repudiated Mr Monks on the rights of workers. I do not think they did. He is a thoughtful, careful and, if I might say without presumption or appearing to patronise, most intelligent trade union leader. He might well be putting forward the point of view, which I recognise as having legitimacy, that if one is a worker in a company one has certain rights in the same way that one has certain duties to one's employer. He might have had in mind what sometimes strikes some of us as the grossly disproportionate outcomes one has if one is a worker in a firm which fails as opposed, perhaps, to being a director in a firm which fails. That sometimes seems to some of us to be a necessary pre-condition to receiving a multi-million pound payout.
It is right that one cannot have an endlessly static labour market. It is also right in my experience and belief that we will never have a satisfactory labour and employment market unless people who work and thereby contribute to the profit of the company have their rights properly and decently regarded. I believe that the noble Lord, Lord Howell, said that the Prime

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Minister appeared to be bored in Barcelona. In my experience such a thing is not possible. One may go to bed very late but one is certainly not bored.
What have we brought about? It was said that Barcelona was supposed to be make or break. As regards the energy markets, for instance: 60 per cent, non-domestic, to be followed promptly by the remainder of the energy market being opened up, with every prospect that that will be done by this time next year; the progress in telecommunications and broadband by 2005; the research and development budget up to 3 per cent; the Secretary General's proposals for reform on institutional change; the desire to achieve 0.39 per cent of GDP in terms of international aid and development; the communiqué on the Middle East; and the progress on Zimbabwe. None of these could be said to be disappointing. They are not perfect outcomes because, as I said earlier, this is a continuing incremental procedure.
The noble Lord, Lord Howell, asked in particular about CAP and about Iraq, Gibraltar and Zimbabwe. The noble Baroness certainly asked about the Middle East and the war against terrorism. On Gibraltar perhaps I may repeat again—I know that your Lordships are perfectly reasonably concerned about Gibraltar—that the Government's position has not changed at all since a few days ago when my noble friend Lady Symons yet again unambiguously stated the Government's position, which is that there will be no constitutional change in the Gibraltarian context without the consent of the people of Gibraltar.
I shall make plain the Government's precise position yet again because I know that your Lordships are concerned about the matter. We will not enter into arrangements in which the people of Gibraltar would pass under the sovereignty of another state against their freely and democratically expressed wishes. I know that the noble Lord, Lord Waddington, has on a number of occasions pressed my colleague. I repeat that formulation which I hope is important to the people of Gibraltar.
Questions were asked about the Middle East. Perhaps I should deal with that matter at more length. I believe that on the Middle East there was significant progress made. We said in terms that we absolutely support the United Nations Security Council's Resolution 1397, to which the noble Baroness, Lady Williams, referred. Your Lordships will know that Resolution 1397 deals with the rights and legitimacies of Israel and the Palestinians.
The Arab summit will take place on 27th March. I entirely take the points which the noble Baroness made about the dangers of the Middle East situation at the moment. We have supported the proposals made by Crown Prince Abdullah. On behalf of the Government I entirely agree with the noble Baroness that there can be no resolution of wider matters without a determined attempt to resolve the Middle Eastern question.
I agree with the noble Baroness that it is necessary that all sides—whoever they are and whatever their historic grievances—should respect UN Security Council Resolution 1397.
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The noble Baroness, Lady Williams, asked a number of questions about the financial services action plan. Its deadline for implementation is 2005. There are about 45 measures needed to complete it. Twenty-five of those have already been agreed. There is a continuing review of the progress of the financial services action plan available on the Internet. It is frequently updated. I have a large number of pieces of paper in my hand. I should be more than happy to circumvent the operation of the Internet, because, on this occasion, I think that the human hand will be quicker than the Internet. I am more than happy to provide the noble Baroness with a copy later today.
The noble Baroness also asked about the small firms charter. That has been agreed. Barcelona called for full implementation of the charter. I know that the conclusions contain quite an amount of material. The reference is paragraph 15 of the conclusions.
The noble Lord, Lord Howell, asked whether there had been any discussion of a takeover directive. In January of this year the high level group of experts on company law produced a report on how to take forward the idea of a takeover directive. The Government welcome that report and hope that the Commission will come forward with a new proposal as soon as possible. That is the up-to-date material that I have on the matter.
It cannot be said that Barcelona was a disappointing conference. I know that the noble Lord very gently chided me about reading out the more "partisan", as he described them, last two paragraphs. I cannot really disagree with that adjectival description. What seems to me absolutely critical is what was said earlier in the Prime Minister's Statement. Five years ago many of these steps would have been inconceivable. It is extremely sobering and humbling to go around Europe and see what hopes are placed on the progress of the United Kingdom in playing a full part in Europe. We are seeing countries now about to enter the European Union which have had a century of dismal history—no democracy, overborne by neighbouring countries, often totalitarian, and With the idea of human rights absent not simply from their constitutions but from their hopes, dreams and thoughts.
We are capable of exercising a substantial moral as well as political energy in the European Union. It will damage the European Union, as well as us, if we do not take our opportunities.
I hope that I have dealt with the specific points that were put to me. I repeat that this has not been a disappointing conference, except among those who believed that two days in Barcelona would change the world.
5.6 p.m.
Lord Tomlinson: My Lords, does my noble and learned friend agree that the Barcelona conclusions contain not only some welcome agreements but also some points of serious warning? Perhaps the most serious warning at a time when we are concentrating on how better to connect Europe to the citizen is not to

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start too many new initiatives until we have completed some of the existing ones. Therefore, should not the now more than 10-year old initiative of completing the single market be put as an absolute priority until we have got the single European securities market, the full completion of the telecommunications markets, a full single market in financial services and a single energy market? Should we not therefore be encouraging an attitude of mind that doing less and doing it better involves a self-denying ordinance on new initiatives until we have completed the agenda that we have already committed ourselves to?
Lord Williams of Mostyn: My Lords, I think that there is a good deal of virtue in what the noble Lord says. That is why I was seeking to say that these are incremental processes. We are making quite significant progress towards the conclusions of which the noble Lord speaks. I know that the noble Lord has referred to this matter in your Lordships' House on other occasions. In addition, if we are to make these changes we need to make sure that those who are involved—that is, the citizens of every state in the European Union—fully know what we are doing and the purposes we hope to obtain by bringing them about.
Lord Waddington: My Lords, the noble and learned Lord did not really answer the question put by my noble friend about Gibraltar. What was said at the Council meeting about Gibraltar? Are the press reports correct that money was offered to Gibraltar conditional on it accepting whatever is agreed between Britain and Spain? Surely, the development envisaged is either economically justified or not? If it is economically justified but cannot take place at present because of obstruction by Spain, the duty of the countries in Europe is to tell Spain to stop being obstructive rather than offering a bribe to the people of Gibraltar and telling them that they had better accept any arrangement arrived at between Spain and Britain—whether or not they think it right—because if they do not agree to it they will not get the money.
Lord Williams of Mostyn: My Lords, I am not sure what newspapers the noble Lord is referring to. I enjoy reading newspapers but I do not always accept their entire accuracy on every occasion. What happened at Barcelona was that the Council welcomed the United Kingdom and Spanish efforts under the Brussels process, which I remind the House—I hope not tediously—was a communiqué issued in November 1984 to overcome our differences over Gibraltar. I repeat: any proposals on sovereignty would be put to the people of Gibraltar in a referendum.
I am advised that no sum of money has been agreed. The Commission has been asked to make proposals and we look forward to reading them in due course. There is no question of a "bribe"—to use the noble Lord's word. If agreement can be achieved, it would not be inappropriate to provide some financial underpinning for it. That is not a bribe if—I repeat—
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we make it plain that we will not enter into arrangements under which the people of Gibraltar would pass under the sovereignty of another state against their freely and democratically expressed wishes.
Lord Sheldon: My Lords, my noble and learned friend mentioned discussions on the Middle East. Was any comment made about the danger of our acting against Iraq in the absence of any settlement of the Israeli-Palestinian situation? That is a most dangerous matter. There must surely have been some discussion of that important matter in Barcelona.
Lord Williams of Mostyn: Indeed, my Lords, there was. First, I am happy to tell my noble friend that the Council issued a strong declaration warmly welcoming UN Security Council Resolution 1397, which, as I said—I know that I was paraphrasing it—is not limited to the rights of Israel alone; it also deals with the rights of the Palestinian people.
The Council made perfectly plain that the Palestinian Authority must have full responsibility for fighting terrorism, but that Israel must withdraw its forces from Palestinian-controlled areas, stop extra-judicial killings, lift restrictions and closures and freeze settlements. Both parties—I underline this—must respect international human rights standards. As my right honourable friend the Prime Minister said in the Commons this afternoon, if Israel is exercising a state's undoubted right in law, any response must be proportionate.
I repeat, as the Prime Minister has said on many occasions, no decisions in respect of Iraq have been made. Plainly, no one would seek even to contemplate any action in respect of Iraq without bearing in mind the possible consequences on an already deeply troubled area. On that I agree with my noble friend.
Lord Ezra: My Lords, I should like to ask about the liberalisation of the energy market. It is welcome that the liberalisation of the commercial part of the market has now been agreed. Can we also take it that when the appropriate directives are discussed at the end of the year, they will include extending liberalisation to domestic markets? Furthermore, as the other important issue facing the European Union is security of supply—because of its increasing dependence on imported sources—will that be urgently considered at a future conference?
Lord Williams of Mostyn: My Lords, I cannot give the noble Lord a cast-iron assurance on his second question, although I imagine that all governments will have the concerns that he mentioned well in mind. However, I can give him an assurance on his first question. As he rightly says, the breakthrough at Barcelona deals with more than 60 per cent of the gas and other energy markets, so they will be open to full and fair competition by 2004. The noble Lord's important supplementary question was: what will happen to the remaining part of the market? Within a year, a decision will be taken on full liberalisation, as

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the noble Lord spoke of it. It will be taken by qualified majority voting in the Council of Ministers. Barcelona showed that there was a clear majority in favour—14 to 1—so we should have agreement on the further step described by the noble Lord by about this time next year.
Lord Clinton-Davis: My Lords, does my noble and learned friend agree that there was a marked difference of tone between what the noble Lord, Lord Howell, had to say about the summit and what was said n the House of Commons by the Leader of the Opposition? What was the reaction of other members of the European Union at the Barcelona summit to those positive achievements of the British Government—the national minimum wage, fair rights at work and so on?
Turning to the Middle East, would it not be better if the Palestinian Authority, which controls television and radio, was far more positive about the existence of the state of Israel? Whatever one's views of Prime Minister Sharon, does my noble and learned friend agree that the state of Israel is there to stay?
Lord Williams of Mostyn: My Lords, there is no question in the Government's mind that the state of Israel is there to stay, for all sorts of moral, historical and legal reasons. There is no future for either the state of Israel or the Palestinian people unless they are able to live together. That is a truism, but it none the less needs to be recognised.
As for television coverage of the conflict in the Palestinian media, I imagine that criticism could be made of all sorts of media coverage. It is not for outside governments to seek to interfere with media coverage in other parts of the world, any more than they should seek to interfere with media coverage here, even though sometimes one may regard it as wrong.
The tone of the response of the noble Lord, Lord Howell, was indeed different. Of course, that comes as no surprise to your Lordships, as the quality of debate in this Chamber is normally higher than one finds elsewhere—I did not say in another place. Indeed, the noble Lord is free of mummy in a way that perhaps Mr Duncan Smith is not.
Lord Brooke of Sutton Mandeville: My Lords, why do the Government run the risk of confusing our European colleagues by claiming that the New Deal has generated 300,000 new jobs when the National Audit Office, which is a far from partial witness, states that only 20,000 are attributable to the New Deal?
Lord Williams of Mostyn: My Lords, I know that there are different views about that figure. I do not think that the fact of that extraordinary improvement is itself disputed. Personally, I prefer to accentuate the positive by pointing out that between 250,000 and 300,000 people now have good prospects of settled, long-term employment. That benefits not only them and their families but, critically, the operation of our society, not least in the incidence of youth crime.
Lord Pearson of Rannoch: My Lords, does the noble and learned Lord agree that in at least two important
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areas the Statement is factually incorrect? One is where the Statement claims that proposals are emerging to reduce regulation on business. Does that mean that some existing regulations will be withdrawn? The flood of such regulations continues unabated. One need only consider the vibration and end of life directives, the new regulations on nitrates for farming, the reversal of burden of proof in discrimination cases, the part-time workers directive, dietary requirements for sedentary workers and even the ladders directive, which will make it an offence to climb a ladder unless someone is holding the bottom of it. Surely it is simply untrue to say that we are winning the battle against European regulation.
Nor is it true to say—this is the second prong of my question—that the United Kingdom is winning the argument in Brussels. That is clearly untrue. Did not the European Parliament vote last week to give the European Union legal personality? If that is passed, does not the whole picture fall into place—with the charter of fundamental rights, the army, corpus juris for the legal system and even the ant hem and the flag? The flag is not legal at the moment—it is advertising—but it will be when the European Union gets legal personality.
To a Euro-realist such as myself, the Statement simply does not stand up. The Prime Minister himself said that Barcelona would be make or break. Clearly, it is break. So why do not we confess that, or, at least, talk about it at greater length than we can in a debate such as this?
Lord Williams of Mostyn: My Lords, my memory is quite short-term, but I do not think that one can find the phrase "the battle against European legislation" in any sentence of the Statement.
Lord Pearson of Rannoch: My Lords, at the end of the Statement, it says that all thanks are due to the Labour Government's wonderful new policy.
Lord Williams of Mostyn: It does not say that either.
Lord Pearson of Rannoch: My Lords, it says that Barcelona would not have been possible under the previous Conservative government, that then we were "without influence" and that we are no longer "in the isolation room". We jolly well are in the isolation room, unless we want to go along with the things I have just mentioned.
Lord Williams of Mostyn: My Lords, the noble Lord, Lord Pearson of Rannoch, sounds like a politician. He put forward his proposition, but, when I gently asked whether it was to be found anywhere in the text, he said, "No" and quickly side-stepped the question. In fact, he did not say, "No"; he just side-stepped it.
I shall repeat what was said towards the end of the Statement, because it is worth a guinea a word:
"Under the last Conservative Government, Britain was marginalised, without influence appropriate to our weight and size, in the isolation room".

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As a proposition of descriptive fact, that is correct. That is a continuing reproach to how feeble we were. We now have the opportunity to go forward under a Prime Minister who wants to do the best for Britain, knows where our future lies, wants to do the best for Europe and knows where its future lies.
There is, sometimes, too much legislation, but many of the regulations about which the noble Lord complains periodically are nothing to do with Brussels. They are, in fact, domestic statutory instruments. If the noble Lord wants to talk about people standing at the bottom of ladders, I respectfully invite him to examine the regulations made pursuant—as they say in my old trade—to the Factories Act 1961. He will find lots of regulations about people having to foot ladders. Why will he find such regulations? Because, if someone goes up a ladder that is not footed, they are liable to fall off, injure themselves and sue their employer.
Not all regulations are wrong, and I shall give one illustration. The sheep are baa-ing all over the world, not least in the United States Congress, about how Enron could have been allowed to be brought to the point of collapse. What reason is given? It is that there was not enough regulation.
Lord Harrison: My Lords, can my noble friend the Minister advise us whether there was any support at Barcelona for the views expressed by the noble Baroness, Lady Thatcher, as published today in The Times?
Lord Williams of Mostyn: My Lords, not only was there not much support for them in Barcelona, there is not much support for them in the sane tendency of the Conservative Party.
I am pleased to see the noble Lord, Lord Hurd of Westwell, in his place. In 2001, he usefully pointed out:
"Until six weeks ago, Mr Duncan Smith was known to students of politics as a one-issue man. He had built a reputation by undermining the last Conservative Government's policy on Europe and resisting all appeals to loyalty".
It is a pity that the noble Lord, Lord Brittan of Spennithorne, is not in his place. He has encapsulated the views of the noble Baroness, Lady Thatcher, far better than I could ever attempt to do, saying that,
"her suggestions are unrealistic, undesirable and dangerous—the present leadership of the Conservative Party is so closely associated with her that unless they unequivocally and immediately repudiate those ideas, they will be assumed to have them as a hidden agenda".
As the Prime Minister said in the House of Commons this afternoon, the present Conservative policy on Europe seems to be one of total silence.
Lord Wallace of Saltaire: My Lords, I am glad to see that this is a much less partisan House than the other place.
I press the Minister to answer the question asked by my noble friend Lady Williams of Crosby about EU observers in the Arab-Israeli dispute. I did not hear him respond.
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I also want to know what plans the Government have to help the broader public—and, indeed, some of us in this House—to understand some of the deeply obscure and technical negotiations that go on under the name of the EU. There is the Lisbon process. I was not aware that the Gibraltar negotiations were called the Brussels process. I am familiar with the Tampere declaration, the Dublin convention and all the other things that one tries desperately to understand.
As we approach the next inter-governmental conference, we have a convention already under way on which the British Government have not attempted what, I gather, is now called in Whitehall domestic public diplomacy beyond the Schröder-Blair letter, which is itself written in fairly turgid, technical language. I must be one of the 155 people in Britain who have read it from start to finish. Do the Government intend to try to explain to a broader public—perhaps through a Green Paper—what the issues for the convention are, beyond the occasional multiple bilateral alliances to which the Statement refers? It is important to make sure that the British people have a deeper understanding of the issues.
Lord Williams of Mostyn: My Lords, the noble Lord has a valid point, but I cannot commit myself to a Green Paper. However, I can say, without an excess of self-congratulation, that it is something that we have discussed many times in your Lordships' House. I know that the noble Baroness, Lady Williams of Crosby, has raised the matter many times. It may well be that we ought to be able to have more defined structures and mechanisms in this House not only for debate but for the elucidation in our debates and Select Committees to which the noble Lord, Lord Wallace of Saltaire, referred. It is an extremely important point.
I confess that, until it was necessary to point the finger of scorn in the context of Gibraltar, I was unaware of the Brussels process. The only reason that I stressed 1984 was that I seemed to recollect dimly that there might have been a Conservative government in power at that time.
The noble Lord is right. I did not mean to be discourteous to the noble Baroness, Lady Williams of Crosby. She put a wide range of questions, and my note to myself did not pick up the answer to her question, for which I apologise. Our stance was that we urged both parties to consider the proposals for monitors and stressed that we were prepared ourselves to participate in such a mechanism.

Afghanistan
5.29 p.m.
Lord Bach: My Lords, with the leave of the House, I shall now repeat a Statement made in another place by my right honourable friend the Secretary of State for Defence. The Statement is as follows:
"I would like to bring the House up to date by making a Statement about the continuing role of the British Armed Forces in Afghanistan. It is just over

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five months since the global coalition, assembled in response to the terrorist attacks in the United States, began military action in Afghanistan. At that time we set out a number of specific short and longer-term campaign aims. These included preventing Osama bin Laden and A1'Qaeda from posing a continuing terrorist threat, breaking the links between Afghanistan and international terrorism and reintegrating Afghanistan as a responsible member of the international community.
"Five months later, it is clear that this action has been remarkably successful. Afghanistan is now a very different country. The Taliban Government, who harboured the A1'Qaeda terrorists, are no more. Terrorist training camps have been put out of action. The first steps towards creating a functioning state have been taken. Aid agencies operate with increasing freedom. Refugees are beginning to return to their homes.
"I am particularly proud of the vital part that British forces have played in this success. I have set out, on a number of occasions, the contribution that they have made to the international coalition—reconnaissance and air-to-air refuelling flights; troops on the ground engaged in operations against A1'Qaeda and Taliban elements; and Royal Navy participation in submarine and interdiction support operations in the Arabian Sea.
"Britain's Armed Forces have also played a significant role leading the International Security Assistance Force in Kabul, with some 1,800 British troops currently deployed with the force. Full operating capability was achieved on time on 18th February, bringing together more than 4,600 troops from 18 different countries in a harsh and demanding environment at a considerable distance from home. I pay particular tribute to General John McColl for his role in this.
"The ISAF is helping the Afghan Interim Authority to provide a secure and stable environment in Kabul. Life in the city is at last beginning to return to some kind of normality, as I was recently able to see for myself.
"The ISAF is already training the first battalion of an Afghan National Guard—about 600 strong and with an ethnic make-up that reflects that of Afghanistan itself. It is also providing advice to the Afghan police. Where it can, the ISAF has helped with much-needed physical reconstruction work—projects that range from repairs to schools to getting the city's dust carts back on the road.
"British forces deployed with the ISAF include troops from the Second Battalion of the Parachute Regiment. It was always planned that they would return to the United Kingdom at the end of March to prepare for their deployment to Northern Ireland later this year. They are now in the process of handing over their responsibilities to the First Battalion of the Royal Anglian Regiment.
"Germany has agreed to provide a new headquarters for the Kabul Multinational Brigade, the ISA F.'s subordinate headquarters, which has,
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until now, been provided by the Headquarters of 16 Air Assault Brigade. A Bundeswehr brigadier will formally assume command tomorrow. This will enable us to withdraw a number of British troops from theatre and is a real demonstration of genuine international co-operation. So too is the Czech Republic's offer of a field hospital for the ISAF. Following my discussions with my Czech counterpart earlier this month, the Czechs signed the ISAF Memorandum of Understanding last Thursday. Their contribution is very welcome indeed.
"The House will also be interested in the hand-over of the United Kingdom's responsibilities as lead nation for the ISAF. Our talks with Turkey, which has expressed an interest in taking this on, continue. It would not be appropriate to say too much before those talks are concluded, but certainly the atmosphere in the high level discussions between the UK, the US and the Turks in Ankara last week was very positive.
"We are still working, therefore, to transfer the leadership of the ISAF. We are working hard to tie down the details, with the reassurance that Prime Minister Ecevit of Turkey has told my right honourable friend the Prime Minister that he strongly supports his country taking on the role.
"But for all the progress that we have made in Afghanistan, the threat of attack from A1'Qaeda and Taliban-related groupings and individuals across the country remains high.
"The recent operation, Anaconda, in the Paktia province, lead by the United States, tack led one group of A1'Qaeda terrorists and Taliban fighters. They showed that these people are still in Afghanistan in large numbers and that they are heavily armed. Left alone, these groups would threaten all that the Afghan people and their supporters in the international community have achieved so far and would strive to retain Afghanistan as a base for training and organising terrorism. They do not recognise the Afghan Interim Authority and will work to destabilise the situation across Afghanistan. A1'Qaeda and its supporters continue to pose a direct threat to states outside Afghanistan, including to the United Kingdom.
"I know that the House will join me in offering its sympathies to the families of the Afghan and American soldiers who died during Operation Anaconda and in paying tribute to all the coalition forces who were involved, including the crews of the RAF Tristar tankers and Sentry AWACS aircraft which supported coalition air strikes during the operation.
"The United States has now formally requested that the UK provides forces to join in future military operations against other remnants of A1'Qaeda and the Taliban elsewhere in Afghanistan. I have therefore authorised the deployment to Afghanistan of a full UK infantry battlegroup, built around

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45 Commando, Royal Marines. This group will join a US-led brigade—forming a potent force ready to undertake such operations.
"We have held 45 Commando ready for offensive operations in Afghanistan for precisely this purpose. The lead elements of 45 Commando—its Headquarters Company and "Whisky" and "Zulu" Companies—are already in theatre, embarked aboard HMS "Ocean".
"Arrangements are now in hand to deploy these elements to Afghanistan, where they will be joined by the remaining companies of 45 Commando—held at high readiness in Arbroath—and the Combat Support and Services Support elements integral to the Commando Group. These include: 7 Battery of 29 Commando Regiment, Royal Artillery, equipped with 105 millimetre light guns, from Plymouth; 59 Independent Commando Squadron, Royal Engineers; and elements of the Commando Logistics Regiment.
"There is already a versatile range of helicopters aboard HMS "Ocean" to support 45 Commando Group. To increase the Commando Group's operational capabilities still further, we are also deploying a further three Chinook helicopters of 27 Squadron, RAF.
"This is a powerful force, in total up to 1,700 strong. We will ensure that it is ready to take part in operations as quickly as possible. The force will go initially to Bagram, with the first members of 45 Commando Group on the ground within days, and ready to commence offensive operations by mid-April.
"The deployment of 45 Commando Group is not a decision that has been taken lightly. It is our largest military deployment for combat operations since the Gulf conflict. It is important that the House is under no illusion about what this might mean. These troops are being deployed to Afghanistan to take part in warfighting operations. We will be asking them to risk their lives. Their missions will be conducted in unforgiving and hostile terrain against a dangerous enemy. They may suffer casualties.
"No government ever take such decisions without reaching the absolute conviction that it is something that must be done. The appalling events of 11th September demonstrated very clearly that A1'Qaeda and Taliban elements have the ability and the desire to launch attacks right into the heart of nations like ours.
"Both the deployment of the Commando Group and our deployment to Kabul as part of the ISAF contribute to our overall objectives of ending the threat posed by international terrorism and restoring Afghanistan. Both are entirely consistent with the campaign objectives that we set out last October. But the troops with the International Security Assistance Force in Afghanistan have their own difficult and demanding job to do; 45 Commando Group will have theirs.
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"By deploying 45 Commando Group we shall make a new and important contribution to defeating the remnants of A1'Qaeda and the Taliban. And by our continued commitment to the ISAF we are helping Afghanistan regain her place as a stable and prosperous nation. I have no doubt that our Armed Forces will succeed in both tasks".
My Lords, that concludes the Statement.
5.38 p.m.
Lord Vivian: My Lords, I am most grateful to the Minister for repeating this detailed Statement. At the start may I congratulate all our Armed Forces in Afghanistan on the outstanding job they are doing and wish 45 Commando Group every success in their new deployment? They have all displayed their customary professionalism and their usual efficiency.
On these Benches, we have fully supported the decision of the United States of America and Her Majesty's Government to share the Afghanistan burden in destroying Al'Qaeda, but we have been concerned about our contribution to ISAF. The Chief of the Defence Staff, in his speech to the Royal United Services Institute for Defence Studies, RUSI, last November warned of getting our hands trapped in the mangle and that we would have to face the fact that our ability to run concurrent operations will be affected. Something will have to give, he said.
For ISAF, mission creep is exactly what is happening—the period for our deployment has been extended from three months to six months. Is the Minister able to say when we shall be able to withdraw from ISAF? I have noted that the Germans will provide a new headquarters for the Kabul Multinational Brigade, but does that mean that all of 16 Air Assault Brigade, which is currently doing the job, will be withdrawn? However, can the noble Lord also say whether a battalion has been warned to take over from the Royal Anglians when they are due to be withdrawn or replaced in Afghanistan?
With the additional deployment of some 1,700 personnel of 45 Commando and around 1,800 in ISAF, the British force now numbers somewhere in the region of 3,500. This is a large commitment to provide and sustain. It is not helped by the fact that we are still deployed in Northern Ireland, Bosnia, Kosovo and Sierra Leone. It is an added commitment for our logistical troops and to sustain this new force will be a heavy burden on our already over-committed logistical organisations.
The mission for the British troops in ISAF and 45 Commando must be carefully defined. Our goals and how we are to achieve them should be set out in a statement. For instance, will the United Kingdom troops in ISAF operate outside Kabul?
Let me ask the Minister some additional questions. How long will British troops be involved in ISAF? Can he clearly define the mission of 45 Commando and ISAF? Under whose command will 45 Commando be placed once it has deployed? What are our goals for ISAF and 45 Commando and how will they be achieved? For what guarantees are the Turks waiting

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before they will agree to take over command of ISAF? If they are guarantees of USA extraction, should this be necessary? Can we be assured that the other countries contributing to ISAF will remain? If financial support is required for Turkey, why are such funds not provided by the UN? Why have we been unable to give Turkey the assurances it seems to require? Finally, what pressure is being exercised to ensure that more Afghans join their new army? Six hundred is not very many and, presumably, it will be difficult for ISAF to withdraw until the new army has sufficient numbers and is properly trained.
5.42 p.m.
Lord Redesdale: My Lords, we on these Benches value the work that ISAF is undertaking and we take pride in the fact that Britain has taken a lead role in commanding ISAF. Obviously the search to find successor to take over that lead role is under negotiation and we welcome the talks that are taking place in Turkey, especially as Turkey is suffering from such a turbulent economy at the moment.
I have only one question in regard to ISAF. Is the UN mandate, which is due to expire in June, currently being renegotiated? If so, how far have those talks developed?
The Minister said that this will be our largest deployment since the Gulf conflict. Our thoughts are very much with the men of 45 Commando and their families because, for such a large deployment to take place, the strength of the current resistance must have been severely under-estimated in the reports in the press. Obviously the Minister will not be able to give the House detailed information about deployment and strengths, but perhaps he can tell us the strength of the remaining resistance in the mountains of Afghanistan.
As the noble Lord, Lord Vivian, pointed out, we are talking about 3,500 troops in Afghanistan. Will this lead to a degree of overstretch outside the commitments that we are already undertaking?
Britain has been asked to take part in this operation. Can the Minister give an indication of whether the Americans have requested the support of any other nation? He said that this was to be a US-led operation; can he say whether 45 Commando will come directly under the command structure of CENCOM? If so, to what extent will British command be subsumed by the American command structure?
This very large commitment raises the question of cost. Obviously the cost of ISAF has depleted reserves set aside for such issues—we will return to this subject at a later date—but can the Minister give an indication of the Treasury's position in regard to funding this extra commitment if it falls outside the contingency reserve?
We support the Government's commitment in Afghanistan and the roles being undertaken by the British Array—not only in the forthcoming combat situation but in the rebuilding of Afghanistan in areas such as the training of police forces and making Kabul safe for the civilian aid workers. However, with such a destabilising influence in Afghanistan showing further
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resistance, is it feasible at this point to consider any future action against Iraq in the short term? If the figure being bandied around in the press—which obviously has little foundation—of 25,000 men being necessary, where would these men come from?
5.46 p.m.
Lord Bach: My Lords, I am grateful for the contributions of the noble Lords, Lord Vivian and Lord Redesdale. I shall do my best to answer their questions. But, first, I thank them for their congratulations and good wishes for the British Armed Forces. They will be very well received. Secondly, I thank them for their support for the decision taken by the Government. The support of all parties in this House and the other place in regard to this conflict has been most impressive. I am grateful to noble Lords for repeating that support in such fulsome terms today.
A number of questions were raised by both noble Lords and I shall do my best to answer them. So far as concerns ISAF, at present 20th June is the end of its six-months' existence. It is true that there may be an extension of that time if the United Nations decides that that is what it wants to do—it would be foolish to pretend that that might not happen— but, as I speak today, no decision has been taken to extend ISAF's six months beyond 20th June.
The noble Lord, Lord Vivian, used the cliché "mission creep" unfairly. As matters stand today, we are to be the lead nation until 30th April. We hope very much that Turkey will succeed us on that date. If it does not, we shall not run away from our responsibilities, but it is our desire that Turkey should succeed us then.
As to what is holding up Turkey's agreement to being the next lead nation, I would rather not go into any details today. But negotiations are at an advanced stage and I repeat that we very much hope that Turkey will take on that important role.
As to the question of the noble Lord, Lord Vivian, about whether a successor battalion to the Royal Anglians has been named, the answer is no. The Royal Anglians themselves are not yet fully in Kabul.
Let me now deal with a number of questions which were common to both noble Lords. First, the issue of overstretch. As regards overstretch, we know that there are problems which have been admitted before in both Houses. But we are comfortable that this particular deployment can be managed alongside our existing commitments. Out of the 1,700 or so personnel involved, some 400 are already in theatre. It is important to remember that when numbers are being bandied about. The remainder have been held at high readiness in the United Kingdom against just such a contingency as this. We believe that this is a realistic and sustainable deployment.
As regards the question asked by both noble Lords as to who will be in command, obviously clear command and control arrangements are essential to the success of any force. As part of our deployment, Brigadier Lane, the commander of 3 Commando

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Brigade, and his headquarters will also deploy to Bagram. The brigadier and his staff will join the American headquarters from Central Command who are already there. The commando group itself will join with its American counterparts now in Afghanistan and it will benefit from the support of coalition forces now at Bagram.
On the question of costs, our initial estimate is that the additional cost of this deployment will be in the region of about £65 million. I know that noble Lords will not hold me to that figure in time to come, but that is the best estimate that we can give in trying to be as frank as we can with the House.
I was asked whether any other countries were part of the deployment. No doubt the Americans are negotiating with other countries as we speak. It would be wrong of me to take in advance any decisions which might be made on that matter. I thank both noble Lords for their support.
Lord Hurd of Westwell: My Lords, as the noble Lord said, this is a serious commitment which has been announced to Parliament today. Does it arise from a revised assessment by the Americans and ourselves following Operation Anaconda or was it always envisaged that after the earlier and brilliant successes in kicking the Taliban out of positions of power there would be, in a way rather reminiscent of Afghan history, a long and difficult follow through such as the noble Lord is now describing?
Perhaps I may raise another issue where we have a national and a European interest which the Americans do not seem entirely to have. If it is true that 90 per cent of the heroin which reaches Europe comes from Afghanistan, what steps are our forces or agencies taking to check that flow? Would it not be a bitter paradox if, as a result of all this energy and new commitments, the flow of heroin which can poison so many of our children were increased?
Lord Bach: My Lords, with his great experience in this field, the noble Lord is absolutely right. The Statement I have repeated this afternoon is indeed a serious one. I am not in a position to say whether such an event as I have announced was forecast months ago. As the noble Lord will know, these analyses change with time. As he rightly said, there were great successes which were perhaps achieved more quickly than some anticipated last autumn. It may be that the Anaconda campaign has affected both the United States and its allies in realising that the A1'Qaeda and Taliban would not just disappear. The United States has always said that it was going to be a long haul as regards the Afghanistan part of the warfare against terrorism. I do not believe that it is true that the coalition has been caught by surprise. But what is absolutely vital is that the battle against A1'Qaeda and terrorism is finally won in Afghanistan because if it is not, then why have we bothered to risk the lives of our troops and those of the coalition?
I am grateful to the noble Lord for having given me advance warning about his last question concerning drugs. That is a very important issue. It has not been
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the task of British forces to destroy opium crops. We do not specifically target heroin stockpiles. Some may have been destroyed during coalition military attacks on terrorist targets. It is impossible to say how many. But the Afghan Interim Authority is planning to destroy this month the Spring opium crop. ISAF is not strictly responsible for the areas of Afghanistan where these crops are largely grown. The interim authority has put on record its determination to stamp out opium production and the signs are encouraging. That is the latest information. The prediction is that this year's crop will be about one-third of what it was under the Taliban, which is one-third too much. But it is an improvement. We are working hard with the Afghan interim administration and the rest of the international community, with the funding that was promised at the Tokyo conference, as the noble Lord will recall. Some of that money will be used for crop substitution and other schemes to help wean Afghan farmers from their opium production, which was basically the result of Afghanistan being a failed state. I am grateful to the noble Lord for his questions.
Lord Swinfen: My Lords, can the noble Lord say when the Czech field hospital is likely to be deployed? Will that mean that our own field hospital, currently there in support of ISAF, will return home or will it be used in support of 45 Commando?
Lord Bach: My Lords, I cannot tell the noble Lord when the Czech hospital will be deployed and neither can I answer his second question. I shall write to the noble Lord with the answers when they are available.
Lord Rogan: My Lords, I shall be brief. I welcome this afternoon's Statement and offer my support and that of my noble friends of the Ulster Unionist Party, for those additional troops who will now be deployed in Afghanistan. Having spent some time with Brigadier Lane and 45 Commando, Royal Marines, in the Omani desert towards the end of last year, I know that they are well equipped, that they have high morale and that they can deal with any challenge that they may face. I, and I am sure all the Members of this House, wish them well.
Lord Bach: My Lords, I thank the noble Lord for his party's support for this undertaking.
Lord King of Bridgwater: My Lords, the Minister has made a very serious Statement committing our forces to a war-fighting role. There was reference by the noble Lord, Lord Vivian, to the speech of the Chief of Defence staff as to whether we were going to be caught in the mangle. It certainly does not look like a short engagement, but a long haul. The issue of overstretch is not just whether 45 Commando can go there now, but who may replace them and who is going to undertake this continuing assignment in the future.
I do not think that the noble Lord responded to one question from the noble Lord, Lord Vivian; namely, what was the total commitment now of British troops to theatre? I am referring not just to the Royal

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Anglians or 45 Commando, but the total commitment we have now of forces to this theatre of operations, which will have to be sustained by further planning about which there appears to be no commitment at present.
The dates which the noble Lord has given to the House sound rather extraordinary. As I understand it, he is hoping that the Turks will take over ISAF by 15th April—
Lord Bach: My Lords, 30th April.
Lord King of Bridgwater: And then that ISAF itself is due to wind up because its commitment runs to 20th June, as I understand it. I have some experience of Turkey. While I am delighted that Prime Minister Ecevit is supportive of the Prime Minister, everyone knows the power of the armed forces in Turkey and that they are unlikely to take on anything unless they are persuaded that they are going forward on a proper basis. It does look as though the commitment may stay with us and that with those we are taking on now, for what looks like a much more difficult undertaking than it might appear in the initial stages, they present a significant military commitment. We clearly have to deal with the terrorists, but we should not underrate the scale of the commitment that we are taking on.
Lord Bach: My Lords, it is difficult to give a precise answer to the noble Lord's first and important question about how many of our Armed Forces are involved. If one includes the large number at Tampa Central Command, those working on this issue in London, those on our ships in the Arabian Sea, the troops who are already in Afghanistan and the troops in Britain who are ready to go, the figure of about 9,000 would not be wildly wrong. That is a frank answer to the noble Lord at present.
I take the point made by the noble Lord about the 30th April and 20th June dates. We hope that the Turks will soon make a decision and will take over shortly after, if not on, 30th April.
Lord Bruce of Donington: My Lords, will the Minister give the House an indication of when these grave matters will be discussed by Parliament? Until recent months, it has long been the tradition for affairs of national moment to be laid before Parliament and for Parliament to give its views. Successful military and political leaders in the past have always insisted that Parliament must reign supreme and that parliamentary consent on behalf of the nation is an indispensable condition to the successful prosecution of any course that the country finally decides to take.
Lord Bach: My Lords, I am grateful to my noble friend, with his vast experience. However, I must gently point out that we are making this announcement in Parliament at the first available opportunity. The country first knows of it as a result of my right honourable friend's Statement in the
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House of Commons and my repetition of it here. I think the House will agree that that is the appropriate way to announce a decision of this kind.
My right honourable friend was asked in the Commons exchanges a short time ago about the matter of debate. His reply—the one that Ministers make on all these occasions—was that it would have to take place through the usual channels. However, I find it difficult to believe that these serious matters will not be debated very soon.
Lord Inge: My Lords, first, I thank the Minister for that statement and endorse what the noble Lord, Lord King, said about the importance of this commitment.
Touching on the remark that has just been made, I should like to add how important it is for the Armed Forces to feel that the nation is behind them when they are deployed. That is an enormously important point, which is sometimes underestimated by those who send them on these kinds of difficult missions.
I should also like to ask the Minister whether it is right that 45 Commando will be commanded by the Americans rather than by ISAF. For what length of tour of duty does he expect 45 Commando to be deployed in Afghanistan? Was it considered—it would be the usual practice—that a force deployed on a dangerous operation such as this would take with it its own air support? I assume that we shall be relying on the Americans for that close air support. However, will the Minister tell us whether consideration was given to sending our own close air support and, if not, the reason for not doing so?
Lord Bach: I am grateful to the noble and gallant Lord for his contribution. As far as command is concerned, I must draw the distinction sharply between ISAF and 45 Commando. 45 Commando has nothing to do with ISAF. We are now talking about Operation Enduring Freedom and Operation Veritas, which are part of the coalition forces in the continuing struggle against A1'Qaeda and the Taliban. They will be under the same command as other British Armed Forces have been in the four or five months of this conflict thus far.
With regard to the timescale, we hope that this tour of duty will last for three months. I make no promises to the House about that. That is the intention as I speak today.
I have no separate knowledge of air support. I suspect that the RAF has played an important role in air support in its most general terms during the course of Operation Enduring Freedom and will no doubt continue to do so. Air support for 45 Commando and the work that they do with their American colleagues, and any other country that takes part, will no doubt be under American escort.
Lord Tebbit: My Lord, first, was the implication of the Minister's last answer that 45 Commando will in fact be under American control but that he could not quite bring himself to use the words?

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Secondly, does he agree that the implication of his Statement is that we have now entered into an open-ended commitment in Afghanistan? Will he say whether the Treasury has entered into an open-ended commitment with the Department of Defense?
Lord Bach: My Lords, let me be explicit. I hope I was fairly explicit previously. Under Operation Enduring Freedom, the command of the coalition forces has been by the Americans from Central Command at Tampa. That continues. It will apply to 45 Commando, as it has to other British Armed Forces that have previously been there. This is not an open-ended commitment, but we are determined that A1'Qaeda and the Taliban should be destroyed in Afghanistan before Operation Enduring Freedom ends. Otherwise, I repeat, what would have been the point of entering into this difficult task in any event?
With regard to questions about Her Majesty's Treasury, the noble Lord will have more experience than I of those.
Lord Gilbert: My Lords, my noble friend has quite understandably said that he cannot give the House any commitment as to how long our troops may find themselves in Afghanistan. However, will he tell us whether Her Majesty's Government have made a decision about the size of our contingent? Will it permanently be capped at the number to which he has referred at the Dispatch Box today, and, if so, have Her Majesty's Government told our allies that?
Secondly, although I understand the Minister's reluctance to identify other countries that have been invited to make contributions to this war-fighting force in Afghanistan, will he at least tell us how many other countries, without identifying them, have been invited to participate?
In conclusion, perhaps I may comment on the remarks of the noble Lord, Lord Hurd. However worthy his objectives, I can think of nothing more disastrous than having British troops sent on a war-fighting expedition being asked to take part in policing operations that are the responsibility of the civil authorities in Afghanistan.
Lord Bach: My Lords, I have no doubt that we have discussed the matter of numbers with our allies, as we discuss everything with them. The number in our ISAF force is presently down on the original number. It makes up part of the total number that I gave in my answer to the noble Lord, Lord King. He asked me for a figure in the round and my figure represented ISAF as well as Operation Enduring Freedom. That is the position so far as concerns numbers.
I regret that I am not in a position to answer the question about who else the Americans may ask to join in.
Lord Gilbert: My Lords, have the Government capped the number of British troops who are going in a war-fighting ro?
Lord Bach: My Lords, I do not believe that the British Government have, but the decision to send in 45 Commando, with the logistics and other forces that it needs to make it operational, comes to between 1,500 and 1,700. If that is a cap, then they have.
Baroness Park of Monmouth: My Lords, I should like to ask the Minister three questions. First, may we take it that we can now forget any British commitment to the new EU army's plans for Macedonia? Secondly, is there any truth in the press statements that a major training exercise in Canada had to be cancelled? Thirdly, how is that in any way consonant with keeping our troops properly prepared and able to rotate?
Lord Bach: My Lords, the noble Baroness is cleverly trying to lead me down the road to Macedonia, but I shall not be tempted on that. I have enjoyed talking about Afghanistan this afternoon, but I am not going to answer questions about Macedonia. I do not know the answer to the noble Baroness's question, but, with the greatest respect, I do not think that it is relevant to today's Statement. The issue of Canada is relevant. I do not have the answer, but I shall write to the noble Baroness as quickly as I can on that.
Baroness Dean of Thornton-le-Fylde: My Lords, I, too, welcome the Statement and endorse the comments of those who have pledged full support for our Armed Forces in Afghanistan. I should declare an interest as chairman of the Armed Forces Pay Review Body. I have listened to the questions and answers about operational issues. One of the best manifestations of support for our troops is to ensure that their welfare is taken care of. The terrain and climate in Afghanistan are very difficult. Like other Members of this House, I have read the reports about the field accommodation and the quality of the reconstituted food that our troops are receiving. I know that some noble Lords may not regard that as a priority, but I do, having met service personnel. Will the Minister give me an assurance on this important issue, particularly as it appears that, while we may be hoping for a three-month operational deployment, the task may well take longer?
Lord Bach: My Lords, I am grateful to the noble Baroness, who plays an important role. Of course welfare and accommodation are crucial, even more so in hostile terrain such as Afghanistan. I can give her the assurance that she is seeking.
Lord Mayhew of Twysden: My Lords, is it not essential that the operation is funded by the MoD, with full indemnity from Her Majesty's Treasury? I have not given the Minister notice of this question, but perhaps he can answer it anyway. Is it not the case that counter-productive penny-pinching in the recent Gulf exercise, in which Challenger tanks were sent to the desert without desert air filters, has been found to have

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resulted in significant damage to their engines, for which spares are being delayed, with consequential harm to our ability to deploy those vital units?
Lord Bach: My Lords, the Treasury has not been lacking in the war against Afghanistan. The noble and learned Lord will know that there was a debate in the other place on defence funding last week. Extra money has been paid out of the consolidated fund to cover the money that was expended by the Ministry of Defence in relation to Afghanistan. The figures are available. I do not believe that there has been any penny-pinching on Afghanistan. I speak on behalf of the Government, not just on behalf of the Ministry of Defence.
Lord Mayhew of Twysden: My Lords, what about the future?
Lord Bach: My Lords, the noble and learned Lord is pressing me on the future. My view is that the Government will make sure that the important decisions that I have restated today will be properly funded.

National Health Service Reform and Health Care Professions Bill
House again in Committee.
6.14 p.m.
Earl Howemoved Amendment No. 42:
After Clause 2, insert the following new clause—
"DUTY OF STRATEGIC HEALTH AUTHORITIES: PUBLIC HEALTH
Strategic Health Authorities shall have in place systems of surveillance to—

(a) monitor changes in the health of members of the public within the area of the Strategic Health Authority; and

(b) identify trends arising from the activities of the Primary Care Trusts within the area of the Authority."

The noble Earl said: One of the major questions begged by the Bill is its implications for public health. Public health doctors, including directors of public health, will have to transfer from existing health authorities to PCTs. Strategic health authorities will each have a doctor with responsibility for public health, but not necessarily experience in that discipline. The precise way in which the roles and responsibilities at each tier of the NHS will 'work together is as yet unclear. My purpose in tabling the amendment is to ask the Government to clarify their plans in this extremely important area, on which they have rightly placed a great deal of emphasis.
So far, the plans for NHS reorganisation have not yielded up any clear operational guidance on how the three essential elements of public health—planning, surveillance and service delivery—are to he run and co-ordinated. Ministers have referred in outline to public health networks, but there has been no indication of how such networks will relate to the statutory entities within the NHS. I am worried that, if
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the PCTs are to be charged with shouldering the lion's share of planning and delivering health protection and health improvement to local communities on top of what is already a huge and in part unfamiliar remit as providers of health services, we could be in a serious situation.
I am also worried that in some strategic health authorities there may be no one with the expertise of a public health doctor and that the person with responsibility for public health will not have the necessary independence that the role demands.
We then look to the regions. Regional directors of public health are to be created. Those directors will address the wider determinants of good health in the regions and will co-ordinate the design of the new public health networks. The new role for regional offices and regional directors of public health lacks a great deal of clarity. In particular, there is concern that the staff working to those offices will be working as employed civil servants, not as professional independent advocates for patients, as consultants work in the NHS.
In their recent document, Getting Ahead of the Curve, the Government have proposed a new national agency,
"to act as a source of national expertise and to provide key services at national, regional and local level in a range of specified areas of health protection".
My noble friend Lady Noakes will have more to say about national co-ordination of public health when she speaks to Amendment No. 99 later. I am not at all clear how the functions of this new agency—yet another new agency—will differ in practice from the functions of the public health networks. How will the agency relate to the regional directors of public health and the strategic health authorities? Where will accountability lie for the success or failure of public health services? It appears at the moment to lie nowhere.
As far as we can understand it, the approach to public health in this reorganisation is piecemeal. It needs to be cohesive. At the least, we ought to have a codified plan from the Government setting out how public health services are to be delivered through the various local and national bodies, as well as a clear idea of where the duties and responsibilities lie. I did not necessarily expect to see anything on the face of the Bill in that regard—although that would have been a bonus—but it is regrettable that at this very late stage in the planning for a far-reaching reorganisation of the health service there is still almost no detailed knowledge within the NHS of how precisely and in practice the priorities for public health are to be addressed across the country. I beg to move.
Lord Clement-Jones: I shall speak to Amendments Nos. 43, 45, 49 and 51, which fall into two categories. Amendments Nos. 45, 49 and 51 are probing amendments to ascertain whether the PCTs are ready for the role that is being thrust upon them.
I must correct the Minister's earlier statements. He seems to believe that if one states that PCTs are not ready for a particular role, that is centralist. The noble

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Baroness, Lady Noakes, made that point. I should like to reinforce it. The Minister is developing a mantra about centralisation, which needs to be killed at the first possible moment. It is not centralist to query whether such a body is ready. It is not centralist to place a duty on a PCT if the responsibility is performed at that level. However, it must be properly performed, and a PCT must have the resources and expertise necessary to fulfil that responsibility.
There are major implications for public health services in this Bill. There is very little explicit reference to them. Public health directors will soon move from area health authorities to PCTs—on 1st April 2002. Who will fill all these roles? Will they be filled in time? What qualifications are necessary? How will PCTs deal with public health specialisms which have been built up over a number of years? What consultation has there been with public health professionals over these changes? As the noble Earl, Lord Howe, said, how does this fit in with the proposed new national agency?
In a speech which seems to be the one point of reference most public directors have, the Minister plays a considerable role with regard to how reorganisation will take place. That is perhaps flattering for the Minister, but not totally helpful for all the public health professionals affected. It is far from clear what resources PCTs will have.
The King's Fund, in its helpful way, is producing some valuable work, showing the problems that PCTs will have in taking on new public health responsibilities. Its document, launched on 26th March, is entitled Public Health in the Balance. We await that with bated breath. The King's Fund makes a hefty contribution to whatever it espouses. The title alone sounds as though it intends to publish some fairly formidable conclusions.
Devolution of public health functions has been uneven. There are concerns about specialisms being lost. Staff vacancy rates may hamper PCT efforts to deliver public health. Responsibilities for different aspects of public health are blurred, as the noble Earl, Lord Howe, has mentioned. All these difficulties need to be overcome if PCTs are effectively to discharge their public health functions.
I offer the Minister two solutions. First, for a while, exclude public health from the duties of PCTs, so we can get it right in a proper fashion. That would be my preference. Secondly, place on PCTs the kind of duties suggested in Amendment No.43 which is cognate to the amendment put forward by the noble Earl, Lord Howe.
Amendment No. 43 arises from the fact that the arrangements are by no means clear to ensure that health protection and health improvement duties are fulfilled and that the necessary resources allocated. The Government have failed to articulate how these public services should be organised to ensure coordinated delivery of programmes for health improvement, health protection and prevention programmes by the National Health Service at each level.
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Who will be the lead public health officer where one local authority is served by two or three PCTs? The current reorganisation of the National Health Service has yet to produce clear operational guidance on how the three key public health functions should be run and be connected with regional and national tiers. Public health networks have been mentioned, but their formal relationship to statutory entities in the National Health Service and local authorities is not clear.
Some key questions remain on public health duties and on how this reorganisation will work. How will the Government ensure that a cohesive and balanced public health service will deliver its challenging policy commitments? How will they ensure that all these components are integrated at local, regional and national levels? The collaborative arrangements between local government and National Health Service bodies are archaic. How and when will the law be updated? What will be the relationship between public health networks and PCTs and how will they be funded?
Baroness Masham of Ilton: It is very important to have the expertise of trained doctors in public health in primary health care trusts and strategic health authorities. Are there enough trained personnel in place to deal with the rising number of cases of tuberculosis in various parts of the country and the worrying rise of the many sexually transmitted diseases, such as chlamydia, gonorrhoea, HIV, AIDS, variant CJD, food poisoning, and water-borne infections such as cryptosporidium, together with an increase in alcohol and drug abuse?
We need an increase in health education, and public health needs should be pushed up the health agenda, not fragmented within inadequate departments with too much responsibility piled on them. There are not enough experts to deal with some of these very difficult and important public health matters. I hope that the Minister will give us some positive assurances tonight that public health will be adequately financed and organised to do its job.
Lord Turnberg: One of the key elements of a public health agenda is to protect the public against infectious diseases: food poisoning, meningitis, HIV, AIDS. TB and so on. A large number of different professionals are involved in that activity, including GPs, primary care trusts, environmental health officers, consultants in communicable disease control and regional epidemiologists. There is also the Public Health Laboratory Service through its local microbiological laboratories, specialist reference laboratories, the Centre for Disease Surveillance and Control, as well as the National Health Service trust laboratories. I declare an interest as chairman of the Public Health Laboratory Service.
Primary care trusts clearly have to have a role. They are right in the middle. But they will have their work cut out to deliver what to them are relatively new activities. My anxieties increase when we know there will be considerable change in the way the PHLS

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network will run as the new health protection agency takes over in April 2003. The PHLS will cease to exist and the laboratories will be largely handed over to individual local National Health Service trusts.
There will be two almost simultaneous changes in the surveillance for communicable disease; in the primary care trusts taking up their new role and in the laboratory services as these trusts take over. Some degree of caution is required and special attention must he paid to this potentially hazardous transition period. I am encouraged that my noble friend the Minister is acutely aware of these difficulties and that there will be opportunities to discuss how they may be obviated. I very much look forward to that.
6.30 p.m.
Baroness Finlay of Llandaff: Perhaps I may quote the remarks of the president of the Faculty of Public Health Medicine, London, Sian Griffiths. She refers to concern among public healthworkers from multidisciplinary backgrounds and states:
"Since last April they have not known where they will be working on 1 April 2002. Working in public health requires a long term view".
Difficulty arises in relation to the long-term strategies to ensure equity in health and health prevention issues in the nation; and there are the infection control issues that have been referred to. There is also the problem of acute infection, in relation to which public health laboratories must form part of our national defence. We have already had scares about threats to our national defence through infection, so the coordination of these services is crucial.
As Sian Griffiths has said,
"if this reorganisation is not to weaken the public health function a sustained input of energy, time, and resources will be needed from the government to promote [the agendas required of the service]".
Baroness Pitkeathley: For the avoidance of doubt, I should state that I occasionally act as an adviser to a company providing healthcare. I am also chair of the New Opportunities Fund, which is investing £300 million in about 300 healthy living centres which are examining public health in its widest sense.
I am fully supportive of the idea of making public health central to the NHS. However, I do not believe that the amendments are necessary. It seems to me that the Government have demonstrated their commitment by ensuring that each primary care trust has a director of public health. We must also remember that public health goes far wider than what we normally think of as healthcare. It includes such issues as access to transport, access to information, and the environment, as well as issues of neighbourhood. Having a regional director of public health in each government office reminds us of the much wider agenda on the public health issue.
The duties of PCTs in relation to public health are clearly stated—and I believe that they are understood. Indeed, I am impressed by the number of primary healthcare trusts which are already taking up those responsibilities, and taking them very seriously in
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terms of being responsive to the health needs in the widest sense of their local community—which is, after all, why they were set up in the first place.
Lord Hunt of Kings Heath: This has been an interesting and important debate. I welcome the opportunity to discuss the amendments. Although I do not recommend that the Committee accept them, I recognise the importance of ensuring a cohesive public health system which enables us to tackle ill health, inequalities, surveillance and public protection. My belief is that our proposals in relation to public health will do just that.
First, the distinct advantage of the organisations that we propose is that there will be a strong public health team in every primary care trust, engaged with its own community, with local authorities and with non-governmental agencies—one that is very much focused on improving health, preventing serious illness and reducing health inequalities in the population that they serve. I believe that the combination of primary care and public health will ensure that they become powerful agencies for public health in the community.
Every PCT will have a director of public health on its board. This will be a high-level appointment. We expect the new posts to be taken up by public health professionals of the highest calibre. Regional directors of public health will have a key role in the selection process for the posts, to provide the necessary quality assurance.
For the first time, the director posts will be open to all suitably trained public health specialists, both medical and non-medical. In relation to the questions raised about the workforce and the numbers, my department is working at national level to strengthen the public health workforce and ensure that high-quality training programmes are in place to deliver the next generation of public health professionals.
As I have said, the new role of public health in primary care has enormous potential. The new directors of public health up and down the country will be the engines of public health delivery. The focus of their activity will be on local neighbourhoods and communities, leading and driving programmes to improve health and reduce inequalities.
It will be the job of the public health teams in primary care trusts to ensure that maximum health improvement is brought about by prevention and other interventions. In addition, the director of public health will be accessible to the local media to explain health inequality issues. The DPH will have a team whose composition will be a matter for local determination. They will seek to ensure that the public health role of the primary care workforce—including health visitors, school nurses, health promotion and other community workers—is fully realised by encouraging practitioners to lead specific programmes.
A number of speakers mentioned the public health networks. I agree that these are of importance. Essentially, the public health networks will provide the specialist expertise which cannot be provided in every

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single primary care trust. The idea of the networks will be to pool expertise and skills in specialist areas of public health which can then be available to all primary care trusts, to share good practice, to manage public health knowledge and, importantly, to act as a source of learning and professional development.
I want to make it clear that this will not be an additional tier of NHS management; nor will it adhere to rigid professional boundaries. The networks will be flexible and responsive, and they will change and evolve over time. For example, a network will be able to respond to cities for public health advice and action programmes. New NHS structures will not be able to match every local authority boundary, but a flexible, responsive network will, for example, be able to support the Health Cities initiatives, so vital in many parts of the country.
This country has a long and highly respected tradition in academic epidemiology and public health. It has been vital in contributing to the knowledge base for disease prevention. Academic departments of public health in the universities, with and without medical schools, have also played a vital part in education and training. We want to ensure that those academic strengths are preserved and maintained in the changes.
It is important that the existing public health research and development funding by health authorities continues to be spent on public health R&D, and we are considering the most appropriate management arrangements to enable that to happen. Public health networks will also include non-governmental organisations which have a key role to play in improving health and reducing inequalities, and also in dental public health.
One question that is apposite to public health at the primary care trust level—a question asked by the noble Earl, Lord Howe—relates to the lead public health officer in an area where two or more primary care trusts cover the area of one local authority. My understanding is that the directors of public health serving that area, working within the local public health network, decide and agree on the best arrangements for ensuring the high-quality advice to each individual local authority. That will include named lead public health officers.
At the strategic health authority level, there will be a senior public health doctor in every health authority as a member of its top team. They will have a distinctive performance management role in relation to the constituent NHS organisations within their boundaries, including, of course, primary care trusts and the public health role of those primary care trusts.
While not duplicating the work of directors of public health in primary care trusts, strategic health authorities will have responsibility for performance management of public health action within primary care trusts. In order to discharge that, each strategic health authority will need a medical director/public health doctor with the appropriate strategic management skills to undertake this function as a member of its top team.
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From April 2002 at the regional level there will be a regional director of public health and a support team in each of the regional offices of government to provide the Department of Health's public health function. The senior officers and the teams will have a wide-ranging role: they will manage and co-ordinate the health protection and emergency planning functions in their regions; they will design, develop and maintain public health networks; and they will tackle the root causes of ill-health inequalities through the health component of cross-government policies in the regions. Overall, regional directors of public health will be accountable for ensuring that appropriate high quality health protection arrangements covering infectious diseases and other risks to health are in place in all locations in their regions. They will also be accountable for managing and co-ordinating the health aspects of the Government's response to emergencies and disasters.
In addition, I refer to the Chief Medical Officer's proposals, which were announced on 10th January and which are designed to streamline the services involved in the prevention and the control of infectious diseases. The proposed health protection agency will provide an integrated approach to all aspects of health protection, including chemical and radiological hazards as well as infectious disease control. The agency will take over functions that are currently performed by the Public Health Laboratory Service to which I pay great tribute. I hope my noble friend Lord Turnberg will convey that to the PHLS. The National Radiological Protection Board, the Centre for Applied Microbiology and Research and the National Focus for Chemical Incidents will also assume responsibility for employing consultants in communicable disease control.
The new agency will work closely with regional and local services and the expert government advisory committees. The new agency will also work with CHI where there are serious deficiencies in standards of infection control in hospitals, primary care or other health service premises.
I recognise the crucial importance of surveillance. The CMO's strategy makes that clear as regards infectious diseases and environmental hazards. We envisage that the new health protection agency, proposed in the CMO's strategy, will have a key role in surveillance of infectious diseases and environmental hazards and, as part of that, will work through the NHS to decide what role other players should have in surveillance.
I do not believe that it is desirable to write the requirement to carry out surveillance into primary legislation. It can be dealt with through secondary legislation, which will allow more flexibility over the precise form that the requirement should take. The responsibility for systems for monitoring the health status of the public is much wider than the role of strategic health authorities. As I have indicated, there is a crucial role to be played at the primary care trust level and at the regional level.

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The public health functions of PCTs are set out clearly in the Next Steps paper. To set them out in statute is neither necessary nor appropriate as the achievement of health improvement and reductions in health inequalities cannot be accomplished by PCTs working alone.
I hope that noble Lords will recognise from what I have said that the Government consider that a cohesive integrated approach to public health is important and essential, and that each part of the new public health system, whether at the primary care trust level, in networks, at strategic health authority level or the regional level, or in the new health protection agency, as announced by the Chief Medical Officer, will ensure that we have a safe integrated function.
As my noble friend Lord Turnberg has said. I recognise that a great deal of detail needs to be talked through and developed. I am happy to meet him, and other noble Lords who are interested, between now and Report stage to fill in some more of the details. I am confident that the approach that we are taking will provide a strong public health element at every level of the NHS and the required protection that the public so richly deserve in what I accept is an important area.
6.45 p.m.
Baroness Cumberlege: I thank the Minister for such a clear exposition of how this matter will work in terms of the public health function. However, I am concerned about one point. The Minister said that at the PCT level the public health officer may not be a doctor—it could be anybody. Obviously it would be someone with a good qualification, but not a medical qualification. Is that a wise move? I understand that all kinds of people—geographers—may have an interest in looking wider in terms of public health, but I wonder about the credibility of such people among other medics whom they will have to lead and influence. We know that at times the medical profession can be chauvinistic. I am anxious that the system is robust and that we do not have a woolly social scientist who will have no credibility with the medical profession.
A new agency will be set up and my heart warms to that in terms of the debate that we had earlier in Committee. But I wonder how the Health Development Agency, which was the successor to the Health Education Authority, will work with the health protection agency and all the other bodies that will be set up. Can the Minister tell the Committee what the Health Development Agency has achieved, if anything?
Lord Hunt of Kings Heath: The Health Development Agency has made a good start. The particular focus of its work is in producing evidence-based research in the area of public health. That will be available for public health professions, NHS authorities, local government and other agencies at local level to inform them as to what is likely to work best in terms of public health intervention. I believe
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that that agency has made a good start. We would expect it to work alongside the grain of these new arrangements.
I was disappointed that the noble Baroness raised the issue of non-medics performing the role of public health specialists. I would have thought that she, of all people, would have welcomed this move—indeed the Faculty of Public Health Medicine has welcomed it—as she was passionate about nurse-prescribing and about developing the skills of non-medics in the health service. I believe that it will enrich the public health profession.
I accept the implication that the people appointed must have the highest public health skills. My understanding is that the non-medical public health specialists who are likely to be appointed would have either a Masters or a PhD in a public health discipline and would have years of experience behind them in the area of public health. In appointing a non-medic to that post a primary care trust would clearly have to take account of the kind of issues that the noble Baroness has raised. I would not cast aspersions on social scientists, as the noble Baroness did. I am convinced that this will be a way of bringing in new people and giving proper career development to people who have gone into public health but are not medically trained. However, I believe that they will receive support from many in the medical profession.
Lord Clement-Jones: Perhaps I can elicit further information from the Minister. I thank him for his initial statement that set out the broad pattern. However, it is regrettable that he has to set it out in that way, whereas on the face of the Bill it would not have been difficult to set out the strategic health authorities, primary care trusts and—
Lord Hunt of Kings Heath: Earlier I said that I would be happy to meet with noble Lords between the Committee and Report stages. If it is helpful to the Committee, I shall set out in some detail how we see the public health arrangements developing and I shall be happy to send that to the noble Lord and to other noble Lords who have spoken in this debate.
Lord Clement-Jones: That would be helpful. I was going on to ask the Minister whether, in addition to the statements made in Next Steps and what he has said today, there would be a clear statement of accountability. I believe that the accountabilities and the responsibilities at each level will be so important in determining who has the lead role on particular matters. Some will be national; some will he regional; and some will be extremely local with the involvement of the health protection agency as well. I welcome the creation of that agency, but one wants to be sure that that scoops up all the current activities in the effective way in which the PHLS has operated. So I think that that would be helpful.

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One matter that the Minister did not touch on is the funding of public health networks. How will they be funded? Will it be a matter of PCTs effectively chipping in to the pot, or will there be another source of funding?
Lord Hunt of Kings Heath: I think that it will be very much a matter of PCTs pooling their budgets together. PCTs are deciding that, in some parts of the public health function, it would be better to work together with a number of other PCTs. It therefore seems eminently appropriate that that should be funded from their own budgets.
Earl Howe: This has been a helpful debate. I thank the Minister for filling in a number of the blank spaces that existed in my mind before we began this discussion. It is not so much a matter of including in the Bill anything relating to public health as of setting out for the National Health Service and those who work in it how these arrangements will work. I am aware that, until very recently, many have been ignorant of how in practice these functions are to be distributed and how accountability will work. However, the Minister has explained, in more detail than we have had to date, how in practice PCTs will take responsibility for their public health function. There has been helpful clarification of the role of public health staff at strategic health authority level and in the regions and the role of the health protection agencies.
The Minister used the word "integrated". Although I am sure that that is what the aim should be, going back to those three headings of the public health—planning, surveillance and delivery of services—I would welcome further clarification of how those functions are to be parcelled out across the tiers of the health service. Perhaps between now and Report the Minister can copy me in on whatever he distributes to Members of the Committee.
Workforce planning is a very difficult exercise in the field of public health, especially in a city such as London. I am aware that the King's Fund report which was referred to by the noble Lord, Lord Clement-Jones, will specifically focus on London. The noble Lord, Lord Turnberg, was absolutely right to draw attention to the wide range of professional expertise to be found in public health, from the very specialised expert to those working in the community. This is certainly not a matter of re-arranging in some simple way the roles and the jobs that are currently being performed. The restructuring will deeply affect the way in which public health is delivered.
I am not clear in my mind what the Chief Medical Officer's role will be in terms of the ultimate accountability for public health. I imagine that, in broad terms, that will remain as it is now. However, if there is any change in substance or in nuance, perhaps the Minister could tell me.
Lord Hunt of Kings Heath: The regional directors of public health will have a performance management responsibility in relation to the strategic health authority public health person, who in turn will performance
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manage the primary care trust. The regional public health directors will be managerially accountable for their public health and health protection functions to the Chief Medical Officer as well as to the relevant director of health and social care. So the Chief Medical Officer is at the pinnacle of those levels, and I think that he or she will keep a pivotal role in ensuring that the overall arrangements work effectively.
Earl Howe: I am grateful. I rather deduced that that would be the case from the Minister's earlier remarks. We may see fit to return to this subject at a later stage, but I think that it is now time to move on. I thank all noble Lords who have taken part. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 43 not moved.]
Clause 3 [Directions: distribution of functions]:
[Amendments Nos. 44 to 51 not moved.]
Clause 3 agreed to.
[Amendment No. 52 not moved.]
Baroness Noakesmoved Amendment No. 53:
After Clause 3, insert the following new clause—
"PROVISION OF SPECIALIST SERVICES
(1) The Secretary of State may not make directions to a Primary Care Trust as to his functions under section 13 of the 1977 Act unless he has made arrangements for the provision of specialist services.
(2) The Secretary of State must consult health professionals who have an interest in the provision of specialist services before making the arrangements referred to in subsection (1) above.
(3) Specialist services for the purposes of this section are those services which are not provided within the territory covered by the Primary Care Trust."
The noble Baroness said: This amendment inserts a new clause after Clause 3 and is designed to ensure that the Secretary of State does not delegate his functions to primary care trusts unless he has made arrangements for the provision of specialist services. Furthermore, the Secretary of State will be required to consult health professionals who have an interest in those specialist services before making the arrangements.
The roots of this amendment lie in concerns that have been expressed not only by many doctors, but, on Second Reading, by the noble Lords, Lord Turnberg and Lord Walton of Detchant. Those concerns centre on whether PCTs will be effective commissioners of tertiary services and other highly specialised services such as neurosurgery, renal dialysis, transplantation cardiac-thoracic services, and many more. The concerns are on several levels. The first is that the new PCTs will simply not be ready for such complex commissioning. The Committee has already debated the readiness of PCTs. Although I for one am not confident that they will be capable of handling the full range of their responsibilities from October 2002, I shall not labour the point in speaking to this amendment.

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Secondly, on Second Reading, concerns were expressed by the noble Lord, Lord Turnberg, that specialist services will be "relatively neglected" by PCTs. It is a question not simply of technical readiness for commissioning, but of attitude and orientation. Indeed, I have heard concerns that the acute sector generally could be neglected by PCTs, which have a natural primary care orientation. If there are fears about the acute sector in general, those fears exist in spades for specialist services.
Thirdly, on the first day of consideration in Committee, concerns surfaced about how commissioning will work in practice. The Minister told us that he expected one PCT to take the lead in commissioning within an area covered by strategic health authorities. However, he also said that it might be possible that a PCT would not buy into what he described as the,
"agreed programme for the commissioning of specialist services".
He then said that if a PCT was,
"not prepared to play ball … the strategic health authority would have the opportunity to intervene and bang heads together". [Official Report, 14/03/02; cols. 1024–25.]
It cannot be satisfactory for the commissioning scheme for vital specialist services to depend on the head-banging abilities of strategic health authorities.
I know that some would have been reassured if responsibility for commissioning specialist services were given to strategic health authorities—much as when, in the good old days, regional health authorities were responsible for funding specialist services within their region. However, the Government seem to have an unbending view that they will place responsibility on the least appropriate tier, and then clear up any messes through intervention—or head banging—by the next tier. It is far from self-evident that those arrangements will work effectively.
'The document Shifting the Balance of Power does provide for the continuation during 2002–03 of the existing regional specialised commissioning groups. Will the Minister say what will happen if PCT capacity to take these responsibilities one year hence has not matured sufficiently? Will the Government be prepared to reconsider and keep these regional groups in place?
On our first Committee day last week the Minister said that the Government intended to continue with national specialist commissioning arrangements. Will the Minister say what those arrangements are, and will he say why they could not be extended to provide a more secure commissioning route for a wide range of specialist services?
It would be folly to proceed with the delegation of functions to PCTs if it was not clear beyond peradventure that the commissioning of specialist services would be fully effective. They are vital services and must be protected. I beg to move.
7 p.m.
Lord Clement-Jones: The noble Baroness, Lady Noakes, has very succinctly put the case for her amendment, with which I and these Benches wholeheartedly agree.
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The Minister will remember that. I expressed fears about the current pattern proposed by the Government for specialist commissioning when we debated a regional health authority proposal versus a strategic health authority proposal. I could tell that the Minister's mantra was coming on when the noble Baroness, Lady Noakes, proposed the strategic health authority option, and I am sure that it w ill come on again when I mention the regional: health authority option. The point of devolution, however, is that the service is devolved to the point at which it can be best delivered. There is a considerable fear that these proposed consortia are not the most appropriate way of delivering specialist services.
To remind noble Lords, the Department of Health has recognised 35 treatment areas which are considered as specialist areas, ranging from cancer, to heart disease, to haemophilia, to HIV. They are some of the most serious and important conditions that need to be treated by the health service, and certainly require their own commissioning arrangements. There is no guarantee, however, that the consortia envisaged will have a sufficient number of local PCT members to provide for viable services. This could lead to a new postcode lottery for specialised services—something which the Government dedicated themselves against on coming into office—where the availability of treatment for these serious illnesses is decided not on clinical need but on geographical location.
Shifting the Balance of Power: The Next Steps, which seems to be the Bible for this part of the Bill, sets out how PCTs are expected to commission local services. Despite being billed as the definitive expression of government policy, the document does not contain any mechanism for guaranteeing that local commissioning consortia will have a sufficiently large membership to be viable. This system could lead to substantial disruption in the provision of specialised services, as PCT boards decide that local, relatively low-cost, high-volume services are a greater priority for investment than membership of consortia for high-cost, low-volume treatments.
The Government's response to these concerns has been to commit themselves,
"to maintain service continuity and allow co-ordinated service development",
for specialised services. This policy principle is to be delivered by the proposed system of PCT consortia. Although the health service circular guidance states that PCTs,
"with significant service agreements with the same provider will work together to ensure consistency in the core elements of the service agreements",
and that,
"PCTs will work in consortia to ensure that specialised services continue to be effectively commissioned at StHA and supra StHA levels",
they remain unclear how this will in fact operate on the ground.
The Government have committed themselves to a steady state of funding in 2002–03—whatever that means—with PCTs obliged to honour the service

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contracts of their parent local health authorities and regional specialised commissioning groups. Welcome though that is, it does not guarantee an extra year of funding if service agreements expire next year. There is no clear transitional process to cover circumstances where local health authority service agreements run out and existing consortia do not effectively cover specialised commissioning needs.
The existing regional specialised commissioning groups will continue for an extra financial year, as the noble Baroness, Lady Noakes, has explained, until April 2003 and,
"will have a specific role in developing PCT capacity to commission specialised services as part of a planned transition to successor arrangements".
The regional commissioning groups, however, will have no power to compel PCTs to join consortia. With a large proportion of PCT chief executives still to be appointed, it is not clear how many PCTs are likely to participate actively in their work.
This is rather a confused picture and it is no wonder that there is cause for concern. Local health authorities, who do have the tradition and personnel with experience of commissioning specialised services, will be replaced under the new arrangements with groups led by general practitioners and others, who may well have little experience or indeed familiarity with the priorities for these treatments. Although some personnel will transfer between the two, there is no guarantee that local health authority funding priorities will be shared by their successor PCTs once existing service agreements expire.
Although the existing consortia have had mixed success in attracting health authorities to their membership, even though local health authorities have a tradition of strategic planning for specialised services, this problem is likely to be exacerbated by devolution to PCTs—who will of course have a fairly steep learning curve—for commissioning across the board. It is likely that, under these conditions, the number of opt-outs from consortia will increase and this could undermine the effectiveness of specialised commissioning agreements.
I have painted a fairly bleak picture and I hope that the Minister will be able to dispel some of that bleakness, but those are the fears that many have about the current arrangements and I look forward to his reply.
Lord Turnberg: The problem that PCTs have in being responsible for commissioning specialist services may not be insurmountable but nevertheless will be a problem. The problem is that, by and large, the number of patients requiring specialist care is fairly small in the population for which they are responsible, of something like 100,000.
It poses particular problems for an individual PCT when there are so many more patients requiring its attention and having more pressing problems. For example, two or three patients with a rare, expensive disease such as haemophilia, moving into a new GP's
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practice can cause enormous problems and havoc for its budgeting. Patients needing renal dialysis or transplantation, for example, may be ill served in this system and such services may become threatened in the process.
The proposal that a lead PCT will act for several PCTs may work, but only if each PCT is willing to fund it. I have spoken to one or two non-executive PCT members and they tell me that there is considerable reluctance to fund in this way. I am not yet convinced, therefore, that specialist services should be the responsibility of PCTs, but rather should be the direct responsibility of strategic health authorities. At least there the population of a million or more provides enough patients with specialist services for them to take a particular interest.
Although I am not in favour of these particular amendments, I would look to a separate system for commissioning those services, which I think would be very much welcomed by the PCTs and by the NHS trusts. There may of course be other ways in which we can ensure that these important services are not damaged and are protected. I very much look forward to hearing how the Minister will reassure us on this.
Baroness Masham of Ilton: I would like to declare an interest. I would not be here today if I had not been treated in a specialised unit—a spinal unit which was classified as a supra regional unit, that is, going beyond the region. I was very grateful to the Minister, who came down to see one of the spinal units when it was experiencing some difficulties.
What will be the national overview with regard to these specialised units? Will Ministers still be able to be involved? I believe that some of the very complicated neurological conditions must be treated in specialised units. Can and will the patients be able to be sent anywhere in the country for treatment? Sometimes their needs are very unique, and there are but a few specialists dealing with such conditions.
I should like to tell the Committee how important it is to get the correct treatment quickly, and how cost effective it is. I had seen so many disasters in the spinal injury field with people receiving the wrong treatment and suffering from horrific pressure sores that I founded the Spinal Injuries Association. Some years ago, we undertook a survey on pressure sores, which cost the country millions of pounds of extra money that could be avoided. We found that the worst pressure sores arose in the intensive care units of teaching hospitals. That may seem surprising, but, while everything is monitored, the basic skin is forgotten. It is often the basic treatment that is so important. Therefore, the expert doctors, nurses, physiotherapists, and all the ancillary staff, have an important role to play.
I believe that such amendments are very significant. It will be interesting to hear what the Minister has to say, because many people throughout the country are worried about these very specialised services. I look forward to hearing his response.
Baroness Finlay of Llandaff: Perhaps I may express my concern over the lack of protection of secondary and tertiary services, as outlined in the Bill at present. The problem is that tertiary services are integrally linked with secondary care services: they cannot be separated. We do not have enough resources to separate tertiary care completely from secondary care. Therefore, within the hospital sector and the specialist sector of the NHS we have the full range of services, of which I should like to give the Committee some specific examples. I should declare an interest here as I am married to a dermatologist. Building on the example of skin, as used by the noble Baroness, Lady Masham, I should point out that dermatologists function as generalists, but within that service there are also highly specialised fields, such as paediatric dermatology, surgery, viral disease, inflammatory diseases, and occupational dermatology clinics, as well as cancer clinics.
I should also declare an interest as I have just been a patient and been in receipt of Mohs surgery, which, until I was on the receiving end of it, I did not know existed. There are a handful of specialist dermatological surgical centres around the United Kingdom, as well as a few photo-dermatology centres; yet there are general services everywhere. The difficulty with not protecting the whole of the secondary care sector in commissioning is that you may well find that you are simply buying a generalist service, and losing the highly specialised expertise that is required in the process.
I also have a concern that we might return to some of the nightmares that occurred under fund holding. At that time, it was an administrative nightmare to find that some fund holders had contracted for certain services while other fund holders had not done so. Therefore, you would have two patients from different areas under separate GPs who, under the commissioning arrangements, were able to access different parts of services. That inequity was terrible for those functioning in the secondary care or tertiary care service sectors.
My other concern is that there may be a misguided view that primary care trust commissioning will somehow act as a form of rationing and control expenditure in secondary and tertiary care. However, there is evidence to show—although it is anecdotal—that unmet needs are revealed where GPs and those in primary care are better educated about conditions. The result is more appropriate referrals, not fewer referrals. There is a need to ensure that the spectrum from high quality primary care into secondary care and on to tertiary care is protected right the way through, thereby securing the highest standard of care for patients who need it at the time that they need it; in other words, not too late when problems have to be undone. I look forward to hearing the Minister's reply.
7.15 p.m.
Baroness Northover: When the internal market was first proposed, I remember a high level civil servant from the Department of Health being asked how the new arrangements would ensure that specialist services
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would be preserved. She replied that she did not know, and that 15 years would show whether or not they would go to the wall—by which time, of course, it would have been too late. It struck me then, and still does now, that that was a most cavalier approach. Indeed, since the NHS was introduced, specialist services have often sat uneasily in a service that tries to provide everything everywhere and ends up by not doing so. Unless this area of concern is properly addressed in the way outlined, yet again, a civil servant at the Department of Health might, truthfully, be able to say that he or she does not know; and, indeed, such services might well go to the wall.
We all know how important it is to retain specialist units given the huge variation of outcomes according to whether or not people are treated in such units. I was not reassured during the briefing meeting before the Committee stage, which was otherwise most helpful, when the Minister seemed quite unsure as to how decisions would be taken as regards which PCTs would lead in each specialist area. I trust that the Minister will be able to give more concrete guarantees today.
Lord Hunt of Kings Heath: The matter of specialist services is one that has always been of great interest to noble Lords, and rightly so. I am the first to accept that it is important not just to patients but also to the NHS—and to the wider issues of teaching and research in this country—that we support our specialist services with the right kind of resources, and the right kind of agreements, in terms of ensuring that there is appropriate patient referral.
I echo a point made by the noble Baroness, Lady Finlay. My general view on the matter is that part of the approach of getting this right is to recognise the inter-relationship between primary, secondary and tertiary care rather than treating specialist services as an isolated service to be resourced and dealt with in a completely different way from that applied to other services that will be commissioned by PCTs in the future. The care networks under development in a number of important areas involve an integrated approach through from primary to secondary and then to tertiary care. They are very often roughly aligned with the strategic health authority boundaries. I certainly hope that they will provide the sensible approach in terms of commissioning, funding, and the referral of patients that we all seek.
By their very definition, specialist services are those with small patient numbers. Quality can be achieved only by bringing together a critical mass of patients in each specialist centre. Inevitably, relatively few centres will be able to offer treatment, and there will not be a specialist centre in every locality. By concentrating specialist services in a few centres, we hope to achieve the best outcomes, maintain clinical competence, sustain the training of specialist staff, support high-quality research programmes, and ensure that services are cost effective, while making the best use of scarce resources, including expertise, high technology equipment, research and development.

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As the noble Lord, Lord Clement-Jones, suggested earlier, typical specialised services include drug treatments for HIV and AIDS, rare cancer services, children's intensive care services, neuro-surgery, secure mental health services, renal services, and so on. Where those services are for exceptionally rare conditions, and where service provision would otherwise be vulnerable, the National Specialist Commissioning Advisory Group will be asked to commission the services on behalf of the whole country. I have a list with me of the designated national services in 2001, which includes over 20 services. Again, I shall be very happy to place a copy of this list in the Library of the House for the convenience of noble Lords.
It is important to stress that national commissioning can and should occur only where local solutions are impossible to achieve. That is why under Shifting the Balance of Power, which contains the principles under which the Bill is brought before the Committee, primary care trusts will be responsible for commissioning health services for their local populations. That principle applies also to specialist services.
However, we recognise that where it makes sense to organise services on a larger population base, so those services will be organised on a larger population base. That is why primary care trusts will be expected to work together on a consortium basis to secure specialised services, except for that list of highly specialised services which will continue to be commissioned at national level.
The noble Baroness, Lady Northover, felt that I was not explicit enough on how a PCT would be selected at local level if it was decided that one PCT would undertake specialist commissioning in relation to one service and another PCT would take on specialist commissioning for another service. I do not believe that I should be explicit, nor that it is my position to be. The point is that this is the kind of arrangement—
Baroness Northover: I thank the Minister for giving way. I was concerned at the briefing meeting about what would happen if no PCT wanted to take a lead in this matter. I would be happy if a PCT wanted to take a lead. That would obviously show an interest and an incentive to do that. However, it seemed to me in the briefing meeting that it was not clear what would happen if no PCT wanted to take a lead.
Lord Hunt of Kings Heath: That is where my "banging of heads" comes together. I shall come to that in a moment in response to the noble Baroness, Lady Noakes.
A number of noble Lords asked about the existing agreements. Perhaps I may state clearly that primary care trusts will be expected to honour existing agreements, financial and otherwise, negotiated by regional specialised commissioning groups and current specialised service commissioners. In future, specialised services will continue to be defined by
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reference to the national specialised services definitions set. I shall place that information alongside the designated services information in the Library.
In the financial year 2002–03, regional specialised commissioning groups, which will continue in existence for the moment, will have a specific role in developing primary care trust capacity to commission specialised services as part of a planned transition to successor arrangements. We are retaining for the moment the regional specialised commissioning groups to ensure that their capacity and skills can be handed over to primary care trusts as part of a planned transitional arrangement. Although continually in our debate today doubt has been passed on both the capacity and willingness of PCTs to take up that challenge, that is not my experience. From speaking to many primary care trusts, I know that work is already taking place in terms of deciding which PCT will take on a particular role on behalf of other PCTs in developing the specification and in the commissioning of such specialist services.
We expect primary care trusts to work together to ensure that specialised services will be effectively commissioned. If appropriate, that might cover the population size of the strategic health authority or involve going across one strategic health authority boundary to another. I understand the concerns being expressed. I can assure noble Lords that it will not be a question of a haphazard approach with some primary care trusts clubbing together and others staying out. We shall expect primary care trusts to form consortia to take collective decisions about the commissioning of specialist services, and that consortia decisions will be binding on all parties.
My noble friend Lord Turnberg spoke of non-executives who said, "We are not really interested in funding specialist services". However, the reality is that the whole structure we are putting into place will not work if that "head in the sand" approach is taken. Seventy-five per cent of the budget of the National Health Service will be at PCT level. The quid pro quo of that kind of resource being devolved to that level is for primary care trusts to accept that they have a wider responsibility than simply their own primary care trust.
In our debate last Thursday, I said to the noble Baroness, Lady Noakes, that if ultimately a particular primary care trust refused to go into such a consortium arrangement—I do not expect that to happen—I would expect the strategic health authority to call it to order. Perhaps I may say to the noble Baroness that her doubts about the effectiveness of banging heads surprised me. Her reputation in the department as a most effective banger of heads is still as strong as ever within the walls of Richmond House. Surely, the new leadership skill of the strategic health authorities is not to second-guess primary care trusts nor to attempt to micro-manage, but to have an ability to intervene where necessary if there is a problem.
Perhaps I may say to the noble Baroness, Lady Masham, that I am well aware of the issues concerning spinal injury units. Indeed, I would regard the well-being of such units as a test of the new commissioning

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arrangements in two ways. First, it is to show that PCTs have the ability to commission such specialist services. Secondly, I took the point she made about patients who may have been cared for in such units being further treated in local general hospitals where their specialist needs may not be fully understood. One of the great advantages of primary care trusts is that they can leverage pressure at local level on those district general hospitals.
I have spoken at some length. I am confident that the new arrangements can work effectively. I do not agree with my noble friend Lord Turnberg that to top-slice specialist service commissioning at strategic health authority level is a good thing. I believe that it detracts from both the competence and authority of primary care trusts. I believe that the arrangements I have described with the performance management role of strategic health authorities is the best way to get us through this issue.
Baroness Noakes: I thank the Minister for that response. Indeed, I thank all other noble Lords for taking part in the debate on the amendment. I hear the Minister explain how this will work in practice, but we keep coming back to the fact that he has one view of the world—that is, that there will be PCTs which will do these things and strategic health authorities which will do certain things, largely called "performance management"—and that he seems unwilling to accept that there may be better ways to do things at different levels. He said, for example, that where it would make sense to organise commissioning on a larger population base than for PCTs, the answer—which most of us would think logical—would be to say, "Let's do it at the strategic health authority level or with a group of strategic health authorities, if necessary"—
Lord Hunt of Kings Heath: I am grateful to the noble Baroness for giving way. That was not quite what I said. The responsibility would still be with primary care trusts, but the specialist commissioning might go across strategic health authority boundaries and therefore engage a wider group of primary care trusts.
Baroness Noakes: I thank the Minister for that. I was aware of it. The point was that if the noble Lord was saying that commissioning should be done on the basis of a larger population area the logical answer is to say that several PCTs should do it. The logical answer is to ask whether there is another tier in the service that more naturally can fit with the commissioning need. Yes, there happens to be another layer called the strategic health authority. So it is logical. The Minister starts from the proposition that everything must be put down to PCTs and then be lifted back up again. Some of us see the matter as being much more logical, secure and safer in terms of commissioning coherence and robustness if it was not pushed down and then brought up but was left at a higher level.
7.30 p.m.
Lord Clement-Jones: Will the noble Baroness agree with me that we are now in the second of two debates where we get these rather precarious organisations. We have this consortium of PCTs in the case of commissioning and with regard to public health we have these rather amorphous public health networks. It seems to me that we are building rather a lot of responsibility into organisations which are highly precarious.
Lord Hunt of Kings Heath: Could I—
Baroness Noakes: I completely agree, but the Minister may want to say more than that.
Lord Hunt of Kings Heath: That is why I rose, to try to deal with the issue before the noble Baroness felt that she had to respond. The point is that as dedicated de-centralisers the Government are investing a great deal of faith in primary care trusts. I make no apology whatever for that. Of course there are some areas where commissioning needs to go wider than primary care trusts. I agree with the noble Baroness that we could have taken a different approach. We could have said to strategic health authorities, "You do all the difficult things. Top-slice the money and leave primary care trusts with the routine stuff". But that would have detracted from what we are really trying to do, which is to get decision making down to the primary care level. If one goes down the Government's route, you do—
Baroness Finlay of Llandaff: I express a grave concern. The Minister has expressed that he has great faith. I would call for evidence to support the changes, and evidence that patients' care will not be jeopardised. I have a real concern that while the changes go through—we know that it takes two years for organisations to bed down and find new ways of working —there will be ill patients who miss out on the services they need. There will be arguments between who is commissioning what. In the process of that, services will be destabilised. Destabilised services do not function well.
Lord Hunt of Kings Heath: The evidence that I would pray in aid is: first, I have already described how the current regional specialised commission arrangements will hold for another year while the regional specialised groups work with primary care trusts to ensure that in the future they have the capacity to undertake specialised commissioning.
Secondly, we are working already with primary care trusts which have been in existence for some time. The evidence I have to hand is that they have worked very well indeed. They have delivered improvement to patients. They have not led to huge gaps, risks or failures to commission certain services. In Fact, they have shown that it is perfectly possible to deliver and commission services at the primary care level while at the same time recognising that they are part of a fully

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integrated national system. It is that balance that gives me a great deal of confidence that primary care trusts will rise to the challenge being set for them.
Baroness Noakes: That, while an admirable expression of faith in whether or not the system will work, is not much more than that. It does not constitute evidence that the system will work. Most Members of the Committee who have spoken in the debate have raised concerns about whether or not these arrangements will work in practice; whether all the PCTs will be ready, able and/or willing to participate in specialised services commissioning, as the noble Lord wishes they would; and whether within a strategic health authority area they will agree on the same things—such as whether there will be effective commissioning or whether there will be a lot of dispute. As the noble Baroness, Lady Northover, said, we really cannot wait until the specialised services have fallen apart to say whether or not this approach is right.
The hour moves on. We have had a good exchange. I thank all noble Lords who have taken part in the debate. I think that this subject will not go away. We shall reflect carefully on what the noble Lord has said. We look forward to the items that he will table for us to read in the Library. I anticipate that we may well return to this matter. I beg leave to withdraw.
Amendment, by leave, withdrawn.
Clause 4 agreed to.
Schedule 3 agreed to.
Lord Filkin: I beg to move that the House do now resume. Perhaps I may suggest that the Committee stage be resumed not before 8.36 p.m.
Moved accordingly, and, on Question, Motion agreed to.
House resumed.

Northern Ireland Human Rights Commission
7.35 p.m.
Lord Lairdrose to ask Her Majesty's Government whether they are satisfied with the activities of the Northern Ireland Human Rights Commission.
The noble Lord said: My Lords, I am most grateful for this opportunity to raise a topic in your Lordships' House, which is of great interest to many in Northern Ireland, and which is an important part of understanding the complex picture of the Province today. The issue is the vital one of human rights and, in particular, the activities since the formation of the Northern Ireland Human Rights Commission.
At the outset I pay tribute to the noble and learned Lord the Lord Privy Seal, Lord Williams of Mostyn, who is widely respected in Northern Ireland and elsewhere. He is currently travelling so much to the Province that I believe that he may be in line for
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support from the tourist board. None of my remarks reflect on him. Since June of last year, I know that he has taken an interest in this topic.
I should like to think that those who know me accept that I hate criticism for its own sake, rather I look to the best in most things and peoples and am dedicated to the concept of positive thinking. As an Ulster unionist, I feel that over the past four years I have exhausted all my abilities in that direction and am forced to move to the area of attack and outright criticism. I take no pleasure in that task.
Much has been made of the Secretary of State's warning that Ulster has become a cold house for unionists. So tonight we shall examine one of the central factors that has contributed to the chill felt by unionists.
The concept of a Northern Ireland Human Rights Commission, the consideration of all issues against human rights requirements and the possibility of a Bill of Rights specifically for Northern Ireland was welcomed by all on the unionist side. But the applause soon faded away when the reality of what had been created became clear.
The right honourable Mo Mowlam's contribution to events in Northern Ireland will be the subject of much debate by future historians. Those of us who have to live with the reality have made our own judgment. To be kind to the former Secretary of State for Northern Ireland, I would explain her appointment of the members of the commission initially as being clearly designed to appease Sinn Fein. As a body required to reflect the community balance as laid down in the Belfast agreement and promised by the right honourable Paul Murphy in another place, it failed from day one.
The community balance was just not there. Where, for example, were the representatives of the evangelical community or the Ulster Scots community, each with a substantial section of the population? Indeed, who was appointed to represent the 25 per cent of the community who rejected the Belfast agreement? It was even worse than that. The republican representatives appointed were robust in nature, most were linked to the so-called Committee on the Administration of Justice, and, in several cases, had a very suspect record of human rights activities.
In the appointment process well-known figures from the unionist community with excellent human rights credentials were not even considered. In a glaring oversight, a former Queen's University law lecturer in European human rights and author of a work on the topic did not even get an interview.
From day one the commission was off to a bad start. Then things got worse. I want to underline that there are many honest and decent people who are members of the commission and who have done, and continue to do, their best as they see it. However, my concern relates to the republican cabal that proceeded to consider the commission as its vehicle into power and to operate as it wished. During the following few years,

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an ongoing chapter of events positioned the commission as having, crudely and openly, a one-sided agenda.
I reject out of hand the concept that human rights apply only to republicans and nationalists and not in equal measure to unionists and others. The qualification for human rights is to be human, not Irish republican. In evidence of the attitudes of the chief commissioner, Professor Brice Dickson, I shall cite from Human Rights Law and Practice, the general editor of which is the noble Lord, Lord Lester of Herne Hill. Professor Dickson said in 1999 that the commission's role includes,
"convincing people, especially those perhaps of a unionist disposition that human rights are for all, not just for one particular community".
There we have a candid insight into the non-unionist thinking of the chief commissioner from the start.
I can list many problems with the commission and its work, but I shall point only to a few tonight. First, there is the highlighting of areas of interest to republicans, almost ignoring the rest. Worse is misrepresenting the position of official bodies—for example, suggesting that the police used plastic baton rounds for crowd control and not just for the preservation of life. Another is funding the challenge to Belfast City Council over the possible reduction of resources for a nationalist parade, yet failing to support the families of the Omagh bomb victims.
One of the largest abuses of human rights, which I have raised in the House before, is the enforced relocation of populations. A year ago, I supplied a detailed file on the enforced movement of 250,000 unionist people from towns all over the province. That controversial issue has to my view been ignored. Why?
The extra powers sought by the commission are excessive and unwarranted. They include the power to,
"enter and search premises",
and to require people,
"to attend before the Commission to answer fully and truthfully any question put to him or her by the Commission".
The SS would have been proud of such powers.
The most evident example of the commission's hunger for power is its manipulation of the Belfast agreement. It has disregarded the Secretary of State's request for advice on the scope for devising a Bill of Rights specific to Northern Ireland. Instead, it has actually drafted a form of Bill of Rights. The consultation period for that draft Bill was only three months. First, we were informed that ideas could be added to the draft but that none could be taken out. Worse, the contents were clearly directed to aid republicans—and, in my view, those involved in terrorism. The commission spent public money on areas of activity not required of it by legislation.
Even the groups that it constructed and then consulted on areas of interest for the draft Bill were clearly weighted to the non-unionist advantage and so subject to considerable controversy. The outside groups listed in the commission's document, entitled Making a Bill of Rights and published on 4th September 2001, demonstrate a clear lack of
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unionist input. In several cases, I have identified organisations on the list that have not made submissions. What credibility has that document?
If we should expect one feature of a human rights body, it is openness. Perhaps that is one of the commission's greatest failings. Against a background of open hostility from the unionist community, the commission has seemed to go about its business in as much dark as possible. The only way to obtain so much information about its activities is that I and others drag it out line by line in parliamentary Answers. I resent having to do that; it is a waste of my time and of public money and makes it look as if I have a vendetta. As far as I can see, that is the only route by which the commission is held to account.
When a review of the working of the commission was due after three years, what did it do? It refused to accept £25,000 from Her Majesty's Government, so that it could run its own review by picking its own investigator, creating its own terms of reference and even supplying the investigator with a list of "suitable" organisations to contact for opinions. The investigator, Mr Peter Hosking—a man of outstanding reputation, I have no doubt—has been uncontactable by e-mail to allow the input of critical views.
If another organisation—let us say the police, for example—had organised an inquiry into its own workings and picked the judge, the jury and the witnesses, the first organisation to explode in anger would be the Northern Ireland Human Rights Commission. Is not sauce for the goose sauce for the gander?
Having outlined only a flavour of the discontent felt by many groups in Northern Ireland, not just unionists, perhaps I may suggest what may be the only way out of the problem. First, a full, impartial investigation into the running and procedure of the commission is vital. The main area to be addressed is openness. A code of conduct on the timescale for reply to letters must be introduced. Monitoring of all considerations with equal balance must take place. All information must be available as soon as possible on the Internet. That includes minutes and correspondence that is not private.
The terms and conditions of the consultation process, the supply of money to individuals and the selection of working parties must be reviewed and made available to all. The commission must be asked to stick to its remit without excesses. I acknowledge that the letter from the Minister of State to the commission of 22nd November 2001 goes much of that distance.
Unless the commission is publicly brought into line, the aim of some republicans of making their Bill of Rights a vital part of the peace process—not open to change, like Patten—may be achieved. We want a commission that is not out of control. Added to its membership must be those who would redress the balance and allow the commission to become that which was promised in the Belfast agreement—a balance of the total community—and so become part of the solution, not part of the problem.

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Failure to act will ensure that the cold house for unionists outlined by the Secretary of State will maintain indeed a frosty climate.
7.47 p.m.
Lord Archer of Sandwell: My Lords, it is not often these days that I venture to participate in debates about Northern Ireland. That does not reflect any diminution in my interest nor in my regard for the people of Northern Ireland. It is simply a recognition of the fact that I have fewer opportunities to inform myself. My reasons for speaking today are twofold. First, my noble friend Lord Dubs, who was anxious to participate, is unable to be here. He asked me to convey his apologies and, in effect, to be his messenger—particularly as, as it transpired, his views and mine are very much in accord.
My second reason for speaking is that I have had some discussion with the commission on the possible content of a Bill of Rights, although I hasten to add that my contribution was minimal. To that extent, I declare an interest, but my interest is essentially in peace and justice in Northern Ireland.
I listened with care to the speech of the noble Lord, Lord Laird. I regret that we do not have more time to examine some of the detail in his speech. I have noted the Questions that he has asked in recent months, but in the brief time available today, I should like to clarify what I believe to be a misconception that is fundamental to what he said. I hope that I have established my credentials as a friend of both the noble Lord and Northern Ireland, and that he will forgive me.
There are two possible approaches to democracy. One is to say that the voice of the people is the final arbiter on all issues and that the voice of the people is ascertained by counting votes. The alternative is to say that majorities may sometimes be wrong—in particular, they may sometimes be unfair to minorities or individuals—and that there should be some machinery to adjudicate between them. That may consist of giving the majority—I mean the majority on any specific issue, not a permanent majority—an opportunity to think again. It may provide scrutiny of detail in order to expose the impact of a particular provision on an individual or group. It may go further to provide that a specific right should be entrenched or subjected to a process of conditional validation, so that no one has power to infringe that right.
Those two approaches go back far into history. They have been debated since Socrates said, "The majority has voted that I shall die; therefore, I shall remain in the city and drink the hemlock". I believe that Socrates was wrong and that he would have served posterity better by upholding the principle of free speech and declaring that the right to free speech did not depend on the counting of heads, just as the rights to due process of law, equality of esteem and humane treatment in places of detention do not depend on the counting of heads and should not be left starkly to electoral politics.
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The concept of human rights is a contribution to that debate. It seeks to provide a filter between the vote of the majority—the product of the electoral process—and those who are exposed to what has been decided. Of course, as the noble Lord, Lord Laird, said, the rights are for all, irrespective of beliefs or traditions. The concept consists in trying to secure agreement on certain general principles, so that when a specific question arises, emotions run high and the argument becomes an argument ad hominem, so that it becomes a dispute between their side and our side, there must be general guidelines that have already been agreed and which can protect us from ill considered and, sometimes, Pavlovian reactions.
As I understand it, those who concluded the peace agreement had those considerations in mind when they provided for a human rights commission. I believe that they were wise and that the whole of the United Kingdom may draw on that experience when, at some time in the future, we must consider whether to follow the precedent. Of course, the winning of confidence depends largely on the wisdom and judgment of those who are chosen as commissioners and officials. I may be prejudiced. A number of them I regard as friends, including the chairman, Professor Brice Dickson. They are trying to exercise their remit fairly and sensibly. They would do more if they had access to greater resources, but their annual reports provide ample evidence of a serious and thoughtful approach. They have a difficult remit. In their annual reports, they have included recommendations designed to encourage a balance in appointments and the independence of those who are appointed. That is not an issue; they want those things too.
In passing, I pay tribute to British-Irish Rights Watch, which can supplement the functions of the commission, as its remit is not restricted by statute. It has monitored the human rights dimension with commendable objectivity and has shown equal concern for Billy Wright and Patrick Finucane. I hope that in the future we will continue to see mutual co-operation and respect between statutory bodies and NGOs.
The commission represents an attempt to remove certain fundamental principles from electoral politics. The purpose was to help bring confidence and, with it, peace, justice and reconciliation to Northern Ireland. I suspect that that process would be set back, if the commission and its work, so far from being protected from electoral politics, are dragged into electoral politics. I hope that the noble Lord, Lord Laird, will reflect further on what, I am sure, is his ultimate objective, as it is mine.
7.54 p.m.
Baroness Park of Monmouth: My Lords, the only human rights commission project of which I have knowledge is the proposed Bill of Rights. I understand, however, from the commission that it has established a victims' rights project and a committee for victims and closely examined the possibility of taking further legal action on behalf of families who feel that the killing of their loved ones has

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not been thoroughly investigated. I do not know whether it also intends to require the IRA to investigate the murder of Jean McConville, whose body is still missing.
I also know that, according to the evidence that the commission gave to the Select Committee on Northern Ireland Affairs last year, it had not, until then, conducted any research into the extent of paramilitary intimidation, especially the permanent exile, on pain of death, of whole families. Nor had it, according to its own testimony, compiled information on the steps being taken by government and law enforcement agencies to eliminate the activity, or the measures adopted by government and public bodies to assist the victims of such intimidation. It had met the Maranatha community to learn more but felt that it had no authority to grant practical assistance to individual victims of intimidation other than to help with court proceedings they might wish to pursue.
The draft Bill of Rights speaks of victims of the conflict. With the exception of one reference in chapter 6, citing some submissions highlighting concerns about the protection and safety of individuals' physical well-being, home and neighbourhood, there is no explicit reference to the greatest single current abuse of human rights, which has continued unabated and indeed enhanced ever since the Belfast agreement, namely, the merciless oppression of their own communities by the paramilitaries. It is simply not mentioned. The Bill of Rights sees the state as the only threat and speaks repeatedly of the tragedies of the past and of the need for,
"an independent and public process with international involvement for dealing with the past".
The commission is concerned to preserve the Irish and Ulster Scots languages—that is good—sign language and the language of travellers. It wants to abolish the Diplock courts and believes that the improved political and legal circumstances in Northern Ireland now negate the justification for non-jury trial. The noble Lord, Lord Carlile of Berriew, does not share that opinion. Nearly the whole of the section on criminal justice is aimed at curbing the powers of state, which is the target of most of the proposals. The state is a villain, seen throughout as the potential oppressor and source of violence. The commission is concerned with the right of prisoners, once released, to have as much right to enter society as a law-abiding citizen. That is very proper, but, in Northern Ireland, the hidden agenda is to ensure that they may serve in the new community police units, representing those worthy citizens.
In the section on the rights of children and women, there is no word of the real source of violence, the threat from the paramilitaries. The Government have consistently refused to recognise that many of the citizens of Northern Ireland, since the signing of the Belfast agreement, have been living under the heel of the paramilitaries. The then Secretary of State spoke of,
"an acceptable level of violence"
and said:
"the peace we have now is imperfect, but better than none".
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Would it be acceptable on the mainland? No. Would it be tolerated here as a price worth paying if it were a case of racist violence? No. The Government, despite the explicit assurances that there would be no more violence, given by the Prime Minister when the agreement was signed, are determined to do nothing to inhibit the so-called peace process, which allows the political representatives of the paramilitaries to sit at Stormont, allegedly involved in the democratic process while the paramilitaries remain in sole control of their unfortunate communities. Having destroyed an effective police service, they now refuse to recognise the new one, which wholly conforms to the requirement of 50:50 composition. They never intended to cede control of their communities to any legal force. The complete control that Sinn Fein, at least, exercises over its paramilitaries was twice demonstrated when they turned off the tap of violence completely when they wished to do so.
I find the priorities of the commission, in the light of the daily violence and the growing desperation and despair of the people, difficult to understand. Of course, I respect the members of the commission, but it is still extremely difficult. Many—not all—of the commission's priorities would certainly coincide with those of Sinn Fein/IRA, which wisely encouraged sympathisers to join many of the new bodies created following the Belfast agreement. That was wise, and it was their right. Their agenda, however, is, naturally, to diminish the power of the state and to advance their own green agenda. Sinn Fein/IRA, with its Marxist roots, is naturally entryist and foresaw the value of infiltration and control. It saw that power would lie with the new institutions and focus groups, many of which are lavishly funded by the EU. In some, they have quietly taken control and, at the same time, demonstrated their democratic credentials.
Unfortunately, serious recommendations such as those in Sir Kenneth Bloomfield's major report on victims have been ignored by the Government. He advocated the appointment of a victims commissioner: none was appointed. A Minister for Victims is no substitute, as the Government are determined to see no evil and hear no evil, and is part of the problem. The Government will not recognise that neither participation in power in the Assembly by political leaders nor restorative justice schemes, which are often infiltrated by the paramilitaries who wish to encourage and control any alternative to formal justice, have in any way reduced the brutal punishment and killings of young people or exilings. The guns have not been silenced, and, in the past two years, assaults have increased.
Kenneth Bloomfield also argued strongly for a senior public servant to be responsible for championing victims, co-ordinating the relevant public expenditure and enforcing the need for an understanding approach by public agencies. It is only too clear that the various agencies, from NIACRO and Victim Support to the social security agency, the compensation agency and the housing executive, do not treat the innocent victims of paramilitary violence, often political, as people in a special category needing

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special care and understanding. There appears to be no central machinery to co-ordinate their actions and their approach. The agencies either minimise the problem or remain indifferent to it, or think the victims must have done something to deserve it. Conversely, the victims are too terrified to seek help from any state-sponsored institution, especially the police, for fear of retribution by the paramilitaries.
I urge the commission to make it a priority to get the Government and the Assembly to co-ordinate the state-funded bodies and require of them an active and immediate plan to tackle the needs of the victims, not of the state but of the paramilitaries. I would hope to see it urging the Government to require the political parties to take immediate action to end the violence, as it is in its power to do. Next, I would hope it would call the Government to account on the total absence of coordinated support for exiles in the UK and the lack of any focal point to which the lost and frightened may turn. Finally, I urge the commission to implement the recommendations for action made to it by the Maranatha Community over a year ago.
8.1 p.m.
Lord Rogan: My Lords, I begin by congratulating my noble friend Lord Laird on securing this important debate. The Northern Ireland Human Rights Commission was created as a result of the Belfast agreement. As such, the Ulster Unionist Party supported its establishment. Indeed, I believe that unionists in general shared with me high hopes and expectations for it. Up to the present point, however, I regret to inform your Lordships that those hopes have not been fulfilled.
The first major challenge for the commission was that posed by the Police (Northern Ireland) Bill and, in particular, the so-called 50:50 recruitment policy contained therein. Shamefully, the commission took the decision to support this measure which, in effect, legalised religious discrimination in Northern Ireland. I simply ask the question: since when was the ability to discriminate against an individual on the grounds of their religion a fundamental human right?
Next for the commission was its draft Bill of Rights. Under the terms of the Belfast agreement, it was,
"invited to consult and to advise on the scope for defining, in Westminster legislation, rights supplementary to those in the European Convention on Human Rights, to reflect the particular circumstances of Northern Ireland".
Bearing in mind that the draft Bill was to include only rights "supplementary" to the European convention, why on earth did the commission include in it voting rights, rights for the disabled and rights for women? Did it even read the European Convention on Human Rights? If it had done so, of course it would have seen that those rights are already there.
Also on the subject of the draft Bill of Rights, the commission made great play out of the fact that it had attempted to draw on the South African experience. However, the South African Charter of Rights took six long years to put together with the aid of some of the
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best legal minds in that country. Yet the Northern Ireland Human Rights Commission felt able to cobble together its version in a matter of months, obviously fearful that most of its members were not to be reappointed for a further term; a fear which in the end did not transpire.
I must tell noble Lords that I was completely opposed to the decision to reappoint the original commissioners en bloc. However, in addition to the reappointments, the Government also took the step of appointing another four commissioners. Your Lordships might not be aware that one of those who applied was my noble friend, and colleague of your Lordships, Lord Maginnis of Drumglass.
I am told—I am sure that noble Lords will have no difficulty in believing me—that my noble friend Lord Maginnis performed admirably, indeed, if I can spare his blushes, perhaps brilliantly at his interview for the position. However, despite his vast experience and the high regard in which he is held across both traditions in both Northern Ireland and Southern Ireland, he was not successful. Why was that? I suggest that it is generally known that the Northern Ireland Office effectively blackballed his appointment as it believed that it would have been deemed "offensive" to Catholics. That episode simply reinforces the current impression across the Province that proper human rights now appear to be considered important for only one tradition that resides there.
Finally, I have serious difficulties with the huge amount of public money being wasted by the commission on what I would regard as self-promoting and, indeed, vain activities. Just over two weeks ago, for example, the commission sent a weighty and detailed document to all Members in another place. The document centred on a number of suggested amendments for Members to table on Report. Unfortunately, the document arrived too late for those amendments to be tabled. In other words, the exercise was a complete waste of time and, more importantly, of taxpayers' money.
Then this morning I received a glossy background briefing pack which I understand has been sent to each noble Lord. Given that we have a list of only seven speakers this evening in what is a one-hour debate, can that really be regarded as a proper use of public funds? Further, the detail enclosed in the pack had obviously been put together to put the best possible slant on the work of the commission. To use a term which has become popular with the media in modern times, it was nothing more than a "spin exercise".
I have to confess that I am no fan of Professor Brice Dickson. However, I will give him credit for one thing: he is able to manipulate reality in a manner that even our Prime Minister would be proud of.
8.7 p.m.
Lord Smith of Clifton: My Lords, this brief debate has, I am afraid, moved along the usual lines when we debate Northern Ireland matters. There is not too much redress from people who hold a different opinion from that of the noble Lords, Lord Laird and Lord Rogan.

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I thought that the noble Lord, Lord Laird, began with a scatter-gun approach which in a sense was altogether disproportionate and lacking in balance. Had he focused his criticisms of the Northern Ireland Human Rights Commission rather more narrowly, and prioritised them, one might have been able to grasp more than the general drift of his views.
Perhaps I may say that the noble and learned Lord, Lord Archer of Sandwell, gave a very considered speech which demonstrated a great understanding of human rights. The noble Baroness, Lady Park, spoke of a hidden agenda and, again, we heard more a general criticism of government action or inaction rather than a focus on the human rights commission in particular.
The noble Lord, Lord Rogan, wondered why the noble Lord, Lord Maginnis, had not been successful. I should have thought that anyone who had recently been a Member of Parliament would rather have blurred the boundary referred to by the noble and learned Lord, Lord Archer; that is, that on the one hand in safeguarding democracy elections are held, while on the other hand agencies are in place to ensure that the elected democracy attends to the interests of minorities at any one time.
The noble Lord, Lord Rogan, went on to complain that in its recent publication, the human rights commission had put forward the best possible slant on its work. I do not believe that the noble Lord, Lord Laird, as a distinguished practitioner in public relations would advise a client to put the worst foot forward.
The human rights commission plays a vital role in a very difficult milieu. It is under-resourced to take on all the tasks with which it has been charged, and the nearly 60 Questions about it tabled by the noble Lord, Lord Laird, have drained limited resources. If a civil servant rather than the staff of the human rights commission had had to prepare the Answers, the Government would have said that his Questions were disproportionate in terms of cost and would have sought to reduce them. The Government should do more to protect such an important agency in this way.
As the noble and learned Lord, Lord Archer, said, the human rights commission is without precedent in the United Kingdom. As we develop our culture of rights throughout the United Kingdom, it will provide a valuable pilot study when the other three nations of the kingdom move along this path. It is learning as it goes and it is doing its very best in the circumstances. It is terribly easy to criticise an agency in its formative year or two—and, as I said, it has a very wide remit.
I declare an interest in that I employed Professor Brice Dickson when I was vice-chancellor of the University of Ulster. He was a distinguished colleague and I can say without contradiction that he is a man of extraordinary integrity. He is fighting a very lonely battle against a historical context which has required this kind of agency to be created in order to produce a fairer and more democratic society.
Lord Laird: My Lords, I agree with the substance of much of what has been said by noble Lords today, but
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would not the noble Lord, Lord Smith of Clifton, be prepared to say that it is better for the human rights commission to have an open agenda where people can receive information about it, rather than to have to drag information out of it line by line in Parliamentary Questions? Does he agree that it is important that the human rights commission should look after both sections of the community, not one?
Lord Smith of Clifton: My Lords, I believe that it should look after both sections of the community and those citizens who are members of neither. I also believe that it should work with openness. The noble Lord, Lord Laird, would have been better advised first to approach the commission with his questions rather than to ask formal Parliamentary Questions. That is using a sledgehammer to crack a nut. It would have been more appropriate to approach the commission in the first instance and, if he was unhappy, then to ask Parliamentary Questions.
I am not despairing about the work of the commission. It is one of the many agencies which is still finding its way in Northern Ireland. We could have a debate about all kinds of shortfalls in terms of the pure canons of democracy in Northern Ireland, but there is no particular merit in singling out the human rights commission at this stage.
8.14 p.m.
Lord Glentoran: My Lords, I thank the noble Lord, Lord Laird, for introducing the debate and all noble Lords who have contributed to it.
The Conservative Party has opposed the 1998 Act since it was first introduced into Parliament. We do not believe that the incorporation of the European Convention on Human Rights is the best way to protect British citizens. We believe that Parliament rather than unelected judges are best placed to protect our rights and that the Human Rights Act will drag the judiciary into the political arena. Having said that, we recognise that human rights and equality lie at the heart of the Good Friday agreement. We should be concerned to ensure that that is where they stay.
It is a pity that the Northern Ireland Human Rights Commission started life in the way it did. It was not unlike another organisation which was in a parallel situation. I do not need to name the organisation; we all know what I am talking about—a brilliant academic in charge but consisting of a group of people less than ideally suited to do an immensely difficult task who were chosen by someone similar to that description.
We very much welcome the fact that Her Majesty's Government have now acknowledged some shortcomings and that they have altered to some extent its constitution and those people who serve on the commission. I am not certain that it was wise to completely reappoint the whole commission. I am not here to knock the Northern Ireland Human Rights Commission, even though I may sound as if I am doing so, but it is impossible to argue against the fact that it has received a serious amount of criticism.

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The commission has brought some of that criticism upon its own head because of the tactless and insensitive way in which it has set out to do its job. For example, it has not shied away from controversial issues. It tried to prevent the BBC "Panorama" programme about Omagh; told unionists that they had no absolute right to parade; unsuccessfully tried to intervene in judicial proceedings; criticised the Northern Ireland schools transfer system for breaching human rights; called on the Police Service of Northern Ireland to stop using plastic bullets; and claimed that British security forces colluded with loyalist paramilitaries to murder Belfast lawyer, Pat Finucane. What a wonderful way to make itself popular and win the confidence of the people. Would I set about it that way? I would not. All of its jobs needed to be done, but what an unfortunate way to go about it.
Let me turn now to the question of the Northern Ireland Human Rights Commission's Bill of Rights. Sadly, coming from a number of eminent people, this should have been a serious work. It should have taken a considerable amount of time to produce because, however brilliant you are, you cannot put together a Bill of Human Rights in a short space of time. However, I welcome the fact that an extension to the consultation period has been agreed and that we now have until December 2002.
It is useful to have these debates. Most noble Lords in the Chamber know the facts fairly well. I hope and believe that Her Majesty's Government know them equally well and realise how important it is to correct a number of matters.
I should like to ask the noble and learned Lord a few questions. Do Her Majesty's Government propose to legislate fora Bill of Rights for Northern Ireland in the near future? If so, do they see a Bill of Rights for Northern Ireland as being different from one for England and Wales? Or do they believe—as I hope they do—that a Bill of Rights should incorporate all parts of the United Kingdom? If there were to be a Bill for Northern Ireland, what part would Her Majesty's Government see the Government of the Republic playing in drafting a Bill of Rights for Northern Ireland?
Finally, do Her Majesty's Government consider that those who constitute the Northern Ireland Human Rights Commission are the right people to draw tip a Bill of Rights for Northern Ireland?
Lord Smith of Clifton: My Lords, before the noble Lord sits down, I believe I heard him criticise the human rights commission for declaring that loyalists had no absolute right to march. In the noble Lord's view, does anyone have an absolute right to march?
Lord Glentoran: My Lords, I thank the noble Lord for that. I agree that nobody has an absolute right to march. The point I was making was that it was a tactless, unnecessary and provocative statement at the time.
8.20 p.m.
Lord Williams of Mostyn: My Lords, I am grateful for this opportunity to discuss these matters. I want to make it quite plain that the human rights commission in Northern Ireland is an independent body. It is not subject to approval or disapproval by me, nor to any control by any of my colleagues. That is the key to it. After all, what was the Belfast agreement about? In paragraph 5 on human rights there was an undertaking that a new commission would be set up to include keeping under review the adequacy and effectiveness of laws and practices, making recommendations to government as necessary, providing information and promoting awareness of human rights, considering draft legislation referred to it by the new Assembly and in appropriate cases bringing court proceedings or providing assistance to individuals doing so. As noble Lords have said, that was put into effect in the Northern Ireland Act 1998 by virtue of Section 68 and following and Schedule 7 to that Act.
The noble Lord, Lord Glentoran, asked me whether the Government intend to legislate to bring a Bill of Rights for Northern Ireland into effect. I make it quite plain that we shall not make any policy decision on that until advice is received from the commission and we have considered it with great care. There is one matter which needs clarification. The draft Bill of Rights in the consultative document is exactly that. It seems to me to be a tenable stance that if one wants consultation about a Bill of Rights it is very difficult to do that in the abstract. I may be wrong, but as I understand it, what the commission has done is to put out for full consultation a draft model which might serve as the basis for discussion. It seems to me, whether one agrees with the draft or not, that is a rational and prudent way of approaching this problem.
It was said that a background briefing had been sent out and that is so. I received one myself. I glanced through some of the correspondence. On 16th August 2001, Professor Dickson wrote to the noble Lord, Lord Laird, saying,
"Could I please remind you of my letter of 4 May 2001. I offered an invitation at the end of that letter to which I have not yet received a reply".
Following through the correspondence, on 24th October 2001, Professor Dickson wrote again to the noble Lord, Lord Laird, saying what they had been doing. A number of questions were raised this evening about what support had been given to various victims. If one casts an eye quite briefly—I know that my time is limited—at that letter, it states that the commission,
"helped the relatives of the Omagh bomb in the following ways:"
I am having to be selective and I will go to some highlights:
"providing advice, at a specially organised meeting in Omagh, on what rights the relatives would have at the inquest … by advising HM Coroner that it was consistent with international human rights standards for him to make available to the relatives in advance of the inquest information supplied to the police about the killings".

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That is quite an important step forward from what relatives normally have, or used to have, before the rules were changed in coroners' courts in England and Wales. The letter continues,
"by applying to intervene in the inquest to make known the Commission's views on what the scope of the inquest should be … by applying for judicial review"—
this was mentioned—
"to stop the BBC from broadcasting … Panorama in which the Commission (and some-but not all-of the relatives) felt individuals were being improperly tried by the media rather than by a court of law; … considering whether to grant assistance for a civil action in relation to the atrocity".
That is something which is very much alive at the moment. The commission said,
"(a step we have not been able to take given our limited resources)".
That does not display to me an indifference towards the suffering of victims.
There were other steps. I stress that I have been selective, but not unfairly so, by way of assistance. It seems to me that if these letters are accurate—I see no counter to any of these assertions in any of the correspondence that is capable of disputing some of the allegations made this evening: but it is a matter for others to judge, not me, because it is an independent commission.
Baroness Park of Monmouth: My Lords, I have not received that document. I took very great care to quote from the one letter which I had from Professor Dickson. I simply want to make that clear.
Lord Williams of Mostyn: My Lords, I do not dispute that for one moment. I stress again that these are letters sent to the noble Lord, Lord Laird, not to the noble Baroness. But in the question to which the noble Baroness rightly returns on these occasions, she deals with those who have been expelled. Other noble Lords said in a sense, I believe, that the commission ought to be even-handed. I could not agree more with what the noble Lord, Lord Laird, said. Human rights are not only for republicans and nationalists.
The letter of 24th October last year condemned the murder of Rosemary Nelson by the Red Hand Commandos. It called for a judicial inquiry into the murder of Mr Finucane, it is said, by loyalist paramilitaries. The commission investigated the circumstances surrounding the murder of Billy Wright by members of the Irish National Liberation Army.
I refer in particular to the questions put by the noble Baroness. The commission had been,
"meeting with a large number of victims' groups in Northern Ireland and discussing with them what more can be done through legal channels to ensure, for example, that the investigation of relevant killings has been thorough, that the proper level of compensation has been paid and that appropriate recognition has been given to the great hurt suffered by the relatives of persons killed by republican and loyalist paramilitaries; by holding meet ings"—
which is more to the noble Baroness's point—
"for representatives of voluntary and community organisations, and of local political parties, on the phenomenon of "punishment" attacks; by discussing with a number of people from within and
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without Northern Ireland how best to acknowledge the victimhood of those who have suffered at the hands of republican and loyalist paramilitaries in Northern Ireland".
I shall continue with just a sentence or two from some of the rest of the correspondence. There is a letter dated 3rd January 2002. The allegation has been made that the commission was secretive and unwilling to share with members of the public any appropriate information. The letter is from Professor Dickson to the noble Lord, Lord Laird. It says that,
"you might find it quicker to contact us directly if you require information. We will endeavour to respond as fully and as speedily as possible in all cases".
That is rather than the device, which the noble Lord is perfectly entitled to use, of Parliamentary Questions waiting for Written Answers, which have to go through the Northern Ireland Office.
There is also the letter of 7th March, which is almost bang up to date. Professor Dickson writes to the noble Lord, Lord Laird:
"Finally, could I please once again extend to you a cordial invitation to visit the Commission to see at first hand the work that it conducts? I would be happy to buy you lunch on that occasion".
Those are the documents that I have looked at as an outsider with no responsibility for the commission. It does not seem to me, as a fair reading of those letters, undisputed as they stand in my hand, that some of the criticisms can be made out.
Of course, all organisations say that their budgets are too small. The baseline funding was set at £750,000. This year the funding has been over £1.3 million.
Perhaps I ought to turn to the membership because there has been criticism. I am not making comment, but reciting what I believe to be fact. It is alleged that it is a hopelessly partisan body. The new members were Lady Eames, the wife of our colleague, the noble Lord, Lord Eames, the Primate, and outgoing president of the Mothers' Union; Dr Christopher McGimpsey, UUP councillor, with wide-ranging business and community interests; Mr Kevin McLaughlin, regional development manager for Leonard Cheshire Homes and member of the Civic Forum, who has a strong interest in rights for disabled persons; Mr Patrick Yu, director of the Northern Ireland Council for Ethnic Minorities, former member of the Commission for Racial Equality, Northern Ireland, with extensive community experience. Those are all matters for judgment and individual taste. I would find it very difficult to describe any of those as improper candidates for membership of a commission such as this.
Lord Laird: My Lords, in discussing the composition of the commission, will the Minister explain why there are no representatives on the commission of the evangelical community, the Ulster-Scots community or the approximately 25 per cent of the people of Northern Ireland who do not accept the Belfast agreement? I accept the Belfast agreement; they do not.

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Will the Minister also take note of the fact that at one stage I offered Professor Dickson my total support for everything he did in relation to human rights, if he involved us as a human rights organisation and involved the Unionist section of the population? I further suggested to him that I would be quite prepared to appear on his platform at the launch of the Bill of Rights. I never heard another word about my offer.
Lord Williams of Mostyn: My Lords, I cannot comment on conversations at which I was not present and of which I have no knowledge. The noble Lord asked me why various persons were not on the original commission. It was an open competition and all the rules were scrupulously abided by. I shall be quite happy, if it is considered useful, to go through every one of the nominees on the original commission. Perhaps I should do so.
They were: Professor Brice Dickson, Professor of Law and Head of Legal Studies at the University of Ulster; Winston Churchill fellow on Bills of Rights in Southern Africa, 1994; Professor Christine Bell, Director of the Centre for International and Comparative Human Rights Law since 1997; Margaret-Ann Dinsmore, QC, active on advisory and supervisory bodies such as the Northern Ireland Commission for the Rights of Trade Union Members; Torn Donnelly, Justice of the Peace since 1985, patron of the Belfast Charitable Trust for Integrated Education and former SDLP councillor; Reverend Harold Good, superintendent minister of the Belfast South circuit of the Methodist Church in Ireland; Professor Tom Hadden, part-time professor of law at Queen's University, Belfast, since 1985; Patricia (Paddy) Kelly, director of a children's law centre, election observer for the United Nations and the European Union; Inez McCormack, regional secretary of the trade union, UNISON; Francis (Frank) McGuinness, regional manager of Trocaire, Northern Ireland, former English teacher and education officer.
It is for your Lordships to come to your own conclusions—not for me to suggest them—that, on the face of it, that list represents a reasonably reflective balance of a community as diverse as Northern Ireland.
The noble and learned Lord, Lord Archer of Sandwell, with whom I entirely agree, said that majorities may sometimes be wrong; so may governments, officials, departments, and even some of your Lordships on occasions. The purpose of having a commission such as this is so that it may challenge and make itself disagreeable and uncomfortable. On the basis of my experience, such a commission would be unlikely to do its duty if it pleased everyone on all occasions. If the commission pleased governmental organisations on every occasion, my immediate instinct would be to wonder whether its time was not somewhat overdue.
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As I understand it, the commission's agenda is not to diminish the powers of the state. In so far as I have been able to deal with the point raised by the noble Baroness, Lady Park, it is not fair to say that it has not attended to the issues with which she has concerned herself. It is true that it has not solved the problems, but I do not think it can fairly be said that it has closed its eyes to them.
I have dealt with the point raised by the noble Lord, Lord Rogan, about the draft Bill. It is a proposal, a skeleton outline as it were, on which everyone can have his or her view, on which the Government will come to their conclusions.
The noble Lord, Lord Glentoran, fully set out his stall—that he does not agree with the Human Rights Act in this country. He and I will never agree on that. I believe that it was a triumph of this Government—I did not say "the only triumph"; I see the noble Baroness, Lady Park, smiling—but it is the most significant act of devolution of power from the Government to the individual that has ever occurred.
I shall give one example in the context of Northern Ireland. Bitterly contested has been the question whether or not those against whom assertions have been made in respect of Bloody Sunday ought to have anonymity. The courts, I stress, have given anonymity to the soldiers against whom, on the one hand, allegations have been made and about whom, on the other hand, it is said they were servants of the state carrying out their proper duties. The inquiry will decide that matter. I very much doubt that they would have been given the anonymity they wanted, were it not for the fact that they were able to say, "My human rights include the right to life, which will be imperilled if you give me no anonymity". It is quite useful to bear in mind that the Human Rights Act protects everyone, without fear or favour, prejudice or ill will.
I have spent a little time going through the correspondence. I am not commenting on it; I am simply pointing to fact, which I know is sometimes disagreeable.
I am grateful to the noble Lord, Lord Laird, for letting in the light on something that has perhaps caused trouble and distress. I respectfully suggest that he might find it helpful to take up the invitation of the human rights commission—it did not invite me, but I went anyway on Friday of last week—immediately following a meeting with the Police Federation and the Prison Officers' Association. Both those organisations have done very significant public work and discharged public duties in Northern Ireland for a long period of time. I was impressed by the comment of the Chairman (soon to retire) of the Police Federation that although things are not perfect, they may have got better. In the past several years he has followed no coffin to the funeral of any of his comrades.
We should sometimes reflect that although things are not perfect, there have been some distinct improvements. I am obliged to the noble Lord, Lord Laird, for giving me that opportunity to say a few words.

National Health Service Reform and Health Care Professions Bill
House again in Committee.
8.37 p.m.
Clause 5 [Local Representative Committees]:
Lord Reamoved Amendment No. 54:
Page 5, line 1, leave out "may" and insert "shall"
The noble Lord said: In contrast to some of the weighty matters that we debated before dinner, I hope that these amendments will be taken quickly. I hope to say only a few words about them.
The reason for Amendments Nos. 54 to 58 is to draw the Minister's attention to the importance of ensuring that consultation takes place between primary care trusts and local committees representing the health professions in their areas; namely, local medical committees, dental committees and those representing ophthalmic practitioners and pharmacists.
As it stands, the Bill states that recognition of such committees by PCTs is discretionary. The amendments make that recognition mandatory. My noble friend will doubtless say that that recognition is already given or will always be given by PCTs to local medical committees and the like. Such a statement, if he makes it, will be welcomed. However, it is important to note, as we discussed at some length a little earlier, that not all 300 or so PCTs are yet up and running. Some will have difficulty in becoming operational by the appointed day, and they may feel that consultation with local representative committees has a lower priority than many other conditions. On that I would value my noble friend's comments.
I speak also to Amendment No. 60, which is grouped with these amendments. This amendment enables regulations to be made requiring strategic health authorities rather than primary care trusts to consult with local representative professional committees about those functions that the strategic health authorities will retain and which have not been passed down to the PCTs in the current reorganisation. Those responsibilities and functions include the commissioning of specialist services—or some specialist services, I might say, after the debate that we had before dinner—as well as major capital developments and performance management of the PCTs. The Bill allows such consultations to take place regarding Section 28C schemes—that is, personal medical service pilot schemes—but it does not do the same for general medical services, which are those that concern the great majority of primary healthcare professionals. Decisions taken at strategic health authority level will be much more effective and widely accepted if they are informed by such consultations, preferably on a regular basis.
I shall be very interested to hear my noble friend's comments. I beg to move.
Lord Clement-Jones: I shall briefly support the noble Lord, Lord Rea, on all the amendments. The first amendments in the group concern the duty of
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PCTs to recognise the local representative committees. The Minister may well be reminded of our happy hours discussing "may" and "shall" on various health Bills in the past, but the situation in this case is rather different. It is all very well for there to be a convention that "may" can mean "shall" as far as the Secretary of State is concerned when it comes to making regulations, but when local bodies such as PCTs see legislation granting them discretion, they will inevitably treat the provision as something that they may do if they get round to it rather than something compulsory. It is important that the Secretary of State makes it clear in the Bill or in some form of guidance what is expected of the PCTs.
The situation is rather different for strategic health authorities. The noble Lord, Lord Rea, has put his finger on a gap in the Bill—if it is possible to put one's finger on a hole or a gap in legislation; I am not sure whether the metaphor extends that far—in relation to general medical services, which are not provided by the great majority of primary healthcare professionals. Amendment No. 60 would fill a gap in the duty of strategic health authorities to consult with local representative professional committees about their functions. I should be very interested to hear whether that has genuinely been thought about in the scheme of things, or whether the Minister has some other form of consultation in mind.
Lord Peyton of Yeovil: More years ago than I care to recall, I served on a regional hospital board. One of my less happy memories of those years is the plethora of committees that surrounded it. Ever since then I have cherished—perhaps that is the wrong word; I have tried unsuccessfully to suppress—a suspicion that there are far too many committees in the National Health Service. To compel one body to recognise another seems to me a mistake.
Not very long ago, I asked the noble Lord if he could give any estimate on this issue. I admit that it was rather a silly question, because I knew that he could not possibly have counted the number of committees that sat under the aegis of the National Health Service and did practically nothing useful, any more than he could oblige if I took him down to a nice sandy beach and asked him to count the grains of sand.
Perhaps I could venture this specuilation—it is no more than that, because I could not prove it. I have always had more than a suspicion that half the membership of any committee ought to be spending their time on far more valuable activities and the other half ought to be on nothing at all.
The Minister has done nothing to deserve this, except that he has my entire respect, but I am offering him my support in rejecting the amendment, as I suspect that he will. That might possibly choke off very slightly the number of committees that strangle the National Health Service without ever benefiting a patient. Committees may do something for their own

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glorification, but as far as the patients are concerned they are of less value than face powder on somebody else's nose.
Lord Rea: I have a lot of sympathy with what the noble Lord, Lord Peyton, has said. I agree that there are far too many committees. However, they are in existence and they represent the local professional healthcare workers in each local health area. It is important for a health authority to consult the representatives of those who provide the services that the noble Lord thinks are so important.
Lord Clement-Jones: Provoked by the noble Lord, Lord Peyton, I should add that these are important committees. We may talk about structures not having much positive impact on morale, but they can have a negative impact on morale if they do not provide for consultation with those most closely affected by the decisions that they take. This is a classic example. As the noble Lord, Lord Rea, has pointed out, there are committees representing local healthcare professionals, so we are not creating a batch of regulatory or other committees. Those committees would benefit from having their views taken into account on the way in which PCTs and strategic health authorities carry out their functions. This is not a St Augustinian view—"Lord, give me deregulation, but not yet". Rather unusually, it has some good credentials.
Lord Filkin: I am very grateful to have the noble Lord, Lord Peyton of Yeovil, on my side. That does not happen very often, but it is deeply welcome.
Amendments Nos. 54 to 58 would change a power to recognise local representative committees into a duty. Local medical committees have been a feature of the health service since 1911 and pharmaceutical, dental and ophthalmic committees have been a feature since the inception of the NHS after the war. In all that time, we have yet to hear of any LRC being denied formal recognition.
I understand that, of the four professions, only the BMA has expressed some interest in changing "may" to "shall". I suspect that that interest is in the form of a probing amendment rather than anything more fundamental. The BMA has acknowledged that no committee has ever been denied recognition. Elsewhere it has spoken positively about Clause 5.
We have always wanted the NHS to work closely and co-operatively with front-line professionals. That is why we amended the provisions in the 1999 Act to make LMCs and LDCs inclusive of PMS doctors and deputies and PDS dentists.
Amendment No. 60 would oblige strategic health authorities to consult LRCs. We will require primary care trusts and strategic health authorities to discharge their functions inclusively. For example, the duty of partnership working introduced by the Health Act 1999 will apply to strategic health authorities and to primary care trusts. Similarly, we shall expect strategic health authorities routinely to involve and consult
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local stakeholder groups as they take forward their work. The Committee will recognise that that is good practice.
However, the proposals to place a specific statutory duty on strategic health authorities to consult LRCs is unnecessary and inappropriate. The matters which most directly concern LRCs are those relating to the services provided under Part II of the 1977 Act or their newer Part I locally managed equivalents—namely PMS and PDS. The Bill provides for all existing health authority functions in respect of Part II services to be conferred on primary care trusts. For Part II services, there is, therefore, no statutory function on which the strategic health authority could consult the LRC.
For PMS and PDS, the Bill already makes specific provision to continue the existing statutory requirements. Clause 5 provides for regulations to be made requiring strategic health authorities to consult LRCs on those limited PMS or PDS matters—under both pilot and permanent arrangements—for which the strategic health authority is responsible.
For these reasons, therefore, we find it difficult to understand why we should single out LRCs for special attention. Other groups, nurses, hospital doctors, patients, have at least as great a claim to be involved in the work of strategic health authorities as do GPs or other primary care contractors, however valuable their work is.
We could list all of these groups whom the strategic health authority should consult. But shopping lists of this type put on the face of the Bill are usually incomplete and cause offence to someone who gets overlooked in the process.
For all these reasons, we have to suggest that there does not appear to be any pressing practical benefits to the amendments. I hope, given what I have been able to put on the record, that the BMA and others will be fully assured of the importance we attach to consultation without the need for further statutory direction. It is clear that primary care trusts must and should consult without our needing to teach grandmothers to suck eggs by putting it literally into the Bill.
Government Amendment No. 59 is minor. It clarifies the definition of a Section 28C dental practitioner for the purposes of the section.
Lord Peyton of Yeovil: I cannot easily find words to express my gratification at being able to give such valuable support to the Minister in making such a wise decision.
Lord Filkin: I shall treasure Hansard for many years to come.
Lord Rea: I thank my noble friend for giving the attention that he has to these two amendments. I cannot agree with every word that he has spoken, particularly with regard to Amendment No.60. We shall look at his words in Hansard and decide whether

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to take it further. It may require further discussions. For the moment, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 55 to 58 not moved.]
Lord Filkinmoved Amendment No.59:
Page 6, line 7, after "services" insert -in the area of the Primary Care Trust"
On Question, amendment agreed to.
[Amendment No. 60 not moved.]
On Question, Whether Clause 5, as amended, shall stand part of the Bill?
Lord Peyton of Yeovil: I hate to disturb such rapid progress and to break into the harmony. I have long objected to this habit of putting two Bills into the same sausage skin. A new Bill is pushed rather rudely into the old Act of Parliament. The result is something which is not always easy to understand.
I do not know whether the noble Lord, Lord Hunt, or the noble Lord, Lord Filkin, will reply but I would just ask them to explain, in simple language, so that I and other of your Lordships can understand what I am now going to read out.
I would not dream of trying to inflict indefinite pain on the Committee, so perhaps two lines will suffice. Subsection (11) reads:
"In subsection (1C) for 'subsection (A1)(b) or (c) or (B1)(b) or (c)' there is substituted 'subsection (ZA1)(b) or (c), (A1)(b) or (c), (A2)(b) or (c) or (B1)(b) or (c)".
I call for a moment's silence of mourning over such disgraceful garbage being put on the face of a Bill. I recently complained about this same habit when it was practised by the parliamentary draftsman at the Home Office. My punishment was to see produced out of a conjuror's hat a fair copy of the Bill as it was hoped it would emerge from Committee. I visited the Printed Paper Office this evening to inquire whether, hidden away, there was to be a repeat of such a phenomenon. No one had heard of it. Your Lordships' House is faced again and again with this revolting habit of putting something plainly unintelligible—not even meant to be understood—on the face of one Bill after another.
The noble Lord, Lord Hunt, is someone for whom your Lordships have great respect. I hope he will justify that feeling of respect by taking this garbage away and saying it will not do.
Lord Hunt of Kings Heath: I am grateful to the noble Lord for allowing me to explain Clause 5(11)(a). I thought it would be abundantly clear to your Lordships. In essence, the clause is simply consequential on renaming health authorities strategic health authorities. It removes the need for local representative committees to be coterminous only with the relevant health authority and it provides for local representative committees to establish themselves at the level of one or more primary care trust area.
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I recognise that amended wording is difficult to follow. The noble Lord is right to point that out. The only crumb of comfort I can give is that work is in hand in the department on a consolidation Bill bringing together within a fairly short period of time all relevant health service legislation. This will make life easier, both for the legislatures and, more importantly, for the National Health Service.
Lord Peyton of Yeovil: The last comment is astoundingly good news. Only recently, when the Police Reform Bill was before your Lordships' House, I inquired at the Public Bill Office whether anybody had any thoughts about further consolidation measures. There were, I was told, European measures which were due for consolidation but otherwise nothing at all—a bleak nothingness between us and the horizon.
I am grateful to the noble Lord for what he said in his tribute to me, but I had hoped that he would produce a simple summary of this gibberish. In so far as he has succeeded in doing so—and one would need hours to check up on the matter—it entitles me to ask why he did not place it on the face of the Bill.
Baroness Fookes: I do not want to depress my noble friend too much, but I serve on the Select Committee which examines the consolidation of Bills. I have to tell him that the committee does not meet very often.
Lord Hunt of Kings Heath: All I can say is that work on such a measure has begun within the department. I do not know when it will be completed and when the matter will come before the noble Baroness's committee. All I would say is that I very much understand the need for a consolidation measure on health service legislation.
Clause 5, as amended, agreed to.
9 p.m.
Earl Howemoved Amendment No. 61:
After Clause 5, insert the following new clause—
"THE HEALTH INSPECTORATE
(1) There shall be a body corporate known as the Health Inspectorate, which shall take effect from 1st April 2004.
(2) The Health Inspectorate shall assume at that date the functions undertaken prior to that date by—

(a) The Commission for Health Improvement, and

(b) The National Care Standards Commission.

(3) The Secretary of State may by order make such amendments of the legislation relating to the health service in England and Wales as in his opinion facilitate, or are otherwise desirable in connection with, subsections (1) and (2)."
The noble Earl said: With the proposals in the Bill to widen the functions of the Commission for Health Improvement, an opportunity has arisen for us to examine CHI's role in the round. In particular, we have an opportunity to revisit a matter that was first considered by this House during the passage of the Care Standards Act 2000.
During the passage of that legislation, we debated—at some length, and not without some fairly energetic exchanges—the respective roles of the Commission for

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Health Improvement and the National Care Standards Commission, which the Care Standards Act brought into being. At the time, many noble Lords, including myself, urged the Government to consider whether the demarcation line that they were seeking so firmly to draw between the NHS and the private acute sector for the purposes of inspection and monitoring was really in the best interests of either sector, and, more particularly, of patients.
I believed then, as I still do, that for quality control purposes the distinction between the two sectors is, and should be, academic. The Secretary of State has a duty to ensure that wherever patients are treated, no matter who is paying for the treatment, standards of care are both uniform and of the highest possible quality. The doctors who treat patients in the NHS are the same doctors who treat patients in private hospitals.
That position begs the question of whether we need two full-blown inspectorates. Two years ago, the Government stuck firmly to their line, "Yes, we do", on grounds which I confess I have never fully understood; namely, that the NHS as a managed service, and the independent sector as a regulated service, should not be subject to the same quality control regime. I do not believe that it is unfair to say that behind that policy stance there lay a deep-rooted antipathy towards the independent sector in the minds of certain Ministers at the time. What we emerged with at the end of the day was Section 9 of the Care Standards Act, which provided for co-operative working between CHI and the NCSC, whereby each regulatory body could delegate functions to the other.
To be fair to the Government, a great deal has happened since the Care Standards Act was passed. There has been a tangible warming of relations between the Government and the independent sector. A concordat has been signed under which many NHS operations and procedures are being carried out in private hospitals. We have a target, I believe, of 100,000 such operations being performed in the private sector over the next year. As recently as last June, the Secretary of State was saying to Parliament:
"by and large, we thankfully have one monopoly provider and that is the NHS. As long as a Labour Government are in power that will remain the position".—[Official Report, Commons. 26/6/01: col. 500.]
It was striking that only a few months later, in December last year, he should be saying completely the opposite:
"Where we need to get to is a position where the NHS is no longer a monopoly provider of care, but it does become a monopoly funder of care".
That U-turn is to be welcomed because it recognises reality. However, it again opens up the issue of how quality standards should best be monitored. The more there ceases to be a meaningful distinction between the NHS and the private sector, the less one can justify the overlap and duplication inherent in having two inspectorial bodies, each imposing its own burdens on doctors, nurses and managers, each having to observe fairly artificial demarcation lines, and each separately
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staffed. It has to be said that the pool of expertise available for such monitoring work across the country is not that large in the first place. A single body would not only ensure consistent standards between the NHS and the private sector; it would also capitalise on the expertise gained in CHI as a result of work that has been done there to date.
I felt emboldened to table this amendment when I read the Secretary of State's response in another place to the Bristol report, when he said:
"There will be greater co-ordination among those organisations responsible for assuring the quality of care in the NHS. That will necessitate closer working and, over time, organisational integration between the CHI. the Social Services Inspectorate, the National Care Standards Commission and the Audit Commission, so that health and social care services are subject to a common set of standards, irrespective of whether they are provided by public, private or voluntary organisations".—[Official Report, Commons, 17/1/02; col. 456.]
What a difference from a couple of years ago! The energy expended by the Government in putting up fierce resistance to exactly that argument from these Benches could have been more usefully directed elsewhere. But if the Government are now serious about organisational integration, why not make a start now, using this Bill? It is a golden opportunity. I beg to move.
Lord Peyton of Yeovil: I want to make two points. First, I acknowledge the generosity that we always expect from my noble friend on the Front Bench. On this occasion he has rather exceeded himself. He might have challenged the Government by saying, "Let us bury, alive or half dead, the Commission for Health Improvement and the National Care Standards Commission". That would have put the Minister on the spot: he would have had to explain what useful functions these two bodies had ever performed and what degree of skill they had shown in doing so. Can the Minister tell the Committee whether their functions are so important and so well performed that they should be taken over by the health inspectorate?
My noble friend puzzled me. Subsection (3) of his amendment contains the words,
"The Secretary of State may by order make such amendments of the legislation relating to the health service in England and Wales as in his opinion facilitate".
I wonder whether one should voluntarily make such an offer to Secretaries of State, a genus for whom I am not soaked with respect. They need to be carefully checked. I am more than conscious of the fact that, given the power to do something by order, they almost always generate more bureaucratic activity from which patients are the last to benefit, if they benefit at all.
It grieves me deeply that in the first two subsections of the amendment my noble friend did not see fit to go a little further and question the usefulness of the two bodies, and whether their functions should be taken over. I appreciate that it is better to have one body rather than two. I also feel slightly uncomfortable

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about the prospect of inviting a Secretary of State to do something by order. That does not appear to be appropriate.
Baroness Carnegy of Lour: Out of kindness to my noble friend, I am bound to say that I believe that this is an extremely good idea. The battle appears to have been won and the Government appear to be persuaded that the private sector can be extremely useful in the National Health Service. They appear to have dropped their doctrinaire dislike of it. Perhaps that is dire necessity. The battle having been won, it appears to be pointless to have two bodies carrying out roughly the same task in two different parts of the service.
I agree with my noble friend Lord Peyton, who objects so much to subsection (3). However, my noble friend Lord Howe did not draft an amendment that he expected to be put on the face of the Bill verbatim. Many other amendments would have to be made to the Bill should this extremely good idea be adopted by the Government, so I am not too worried about subsection (3). In this Bill so many matters will happen by order that this particular requirement may disappear into oblivion.
I do not believe that the Minister should launch into an endless description of the system as it now stands. Perhaps he will tell the Committee why, given the fact that the battle in relation to the private sector has been won, we need two bodies. Why not have a single inspectorate?
Baroness Pitkeathley: I confess to a certain wry amusement on seeing this amendment. Earlier today and last week, we heard a great deal from the Opposition Benches about delay, about the state of unreadiness in PCTs and so on. Now we hear the opposite: that we should hurry to merge the functions of two bodies, one of which is not even yet in existence.
However, I am in sympathy with the spirit of the amendment. As the noble Earl, Lord Howe, has told the Committee, the Secretary of State has committed the Government to further integration of inspection services in the future. As your Lordships know because I go on about it endlessly, I am also in favour of anything that promotes further co-operation between health and social services. The commitment to that cooperation already exists in the bodies mentioned in the amendment, as I have reason to know from my role as interim chair of the General Social Care Council.
We have to ensure that there is an ongoing review of the functions of each body and of the relationships between them, as the Secretary of State and the Kennedy report have suggested, and that those bodies should be given the utmost importance as we proceed, together with their relationships with the Audit Commission and the Social Services Inspectorate. Please let there be no merger of the General Social Care Council before it has had an opportunity to put into practice its wide-ranging and significant powers,
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and to capitalise on the welcome support that it will command among all those who work in the area of social care.
Baroness Masham of Ilton: Recently, there was an example of a mother who had given birth to twins in a private hospital and died because she had not had her blood pressure monitored. Patients are patients wherever they are treated. Surely they should all have the same minimum standards and Parliament should try to ensure their protection. I therefore support this amendment.
Baroness Fookes: I, too, support this amendment. In fact, I think that it is very important that there should be one common standard, and I saw no reason for having two sets of regulatory bodies when the legislation was first brought in. Now, I believe that it is even more important that the situation should be simplified: one standard for all. I therefore support the amendment.
9.15 p.m.
Baroness Northover: I, too, support the amendment, which proposes a health inspectorate that includes both CHI and the national care standards commission. As my noble friend Lord Clement-Jones explained on Second Reading—perhaps he has said this so often that he is blue in the face and it is now my turn to say it—we have long supported these proposals. We welcomed CHI when it was established in the Health Act 1999 and gave a general welcome to the Care Standards Act 2000, but we feel that the national care standards commission should he incorporated with CHI. This is a good time do that, before the National Care Standards Commission comes into effect and we have two bodies working in parallel.
In the other place, in relation to this Bill, we urged that the time had come to put the two bodies together. We also disagreed with the Conservative Party in the other place that the merger should include NICE and the proposed council for the regulation of the professions. We felt that the latter two bodies are expected to perform different functions and should remain separate. We therefore welcome the fact that, speaking for the Conservative Party in this House, the noble Earl, Lord Howe, has accepted the proposal that it is CHI and the care standards commission that should be merged. We are happy that we are speaking with one voice on this side of the House—a point which I am sure will not be lost on the Minister.
We are fully committed to the objectives of ensuring the highest possible quality of care for all patients. Patients deserve the best possible protection regardless of whether they are being treated in the NHS or the private sector. A single inspectorate should help to achieve uniform high-quality patient care across both those health sectors, avoiding, as we have heard, unnecessary duplication. If we merged these two organisations, we would ensure consistent standards between the NHS and other sectors. As the noble Earl, Lord Howe, has pointed out, CHI would be in a

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position to use the expertise it has gained from inspecting the NHS and the same limited pool of expertise could be used.
It should also be clear that we are certainly heading down that road. We on these Benches have noted what Mr Alan Milburn said in his response to the Bristol report—which the noble Earl, Lord Howe, has quoted—when he spoke of the,
"organisational integration between the CHI, the social services inspectorate, the National Care Standards Commission and the Audit Commission".—[Official Report, Commons, 17/01/02; col. 456.]
That is precisely what we are talking about. Therefore, as I said, it looks as though we are pushing at an open door.
The BMA has produced a chart showing the multiplicity of organisations that check on the various sections of the health service. Surely anything that streamlines the arrangements must be welcomed—although that does not seem to be the Government's intention, as demonstrated by their proposals to replace CHCs. I trust that the Minister will see the sense of this proposal. Nevertheless, even if he does not, I think that he will find that this type of arrangement is coming down the track.
Lord Hunt of Kings Heath: I should like first to say what a joy it is to welcome the noble Lord, Lord Peyton, back to our debates on the National Health Service. I was particularly struck by his reminiscences of the work of regional health authorities. Earlier, while looking wistfully back at regional health authorities, the noble Baroness, Lady Noakes, expressed her wish that they should speed on and be reintroduced. I suspect that the noble Lord, Lord Peyton, might have something to say about that.
As for the general point made by the noble Lord, Lord Peyton, on the accomplishments of the Commission for Health Improvement and the purpose of the National Care Standards Commission, I believe that they perform very important functions. The Commission for Health Improvement provides a means of reviewing the way in which clinical governance is undertaken within the National Health Service. I think that, in its first reports, it has shown its mettle and been very helpful in identifying issues to be raised and problems to be tackled within the NHS.
The National Care Standards Commission starts its work this April, and it will lead to a much more uniform, consistent quality of legislation within the private health sector, the care homes sector and various other care sectors. It will take responsibility from both health authorities and local authorities, and I am sure that it will lead not only to a much higher inspection standard, but, as importantly, to greater consistency. That is why care homes and other parts of the independent sector were so welcoming of the establishment of the National Care Standards Commission.
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As far as the general principles raised in this debate are concerned, there is very little between us. The Government are certainly sympathetic to the thinking behind the amendments but consider that they are somewhat premature. At the moment, the Commission for Health Improvement and the National Care Standards Commission have discrete and distinct functions in relation to the inspection and regulation of health and social care in this country, but they already plan to work collaboratively where their respective roles impact on each other. This cooperation will also be assisted by, and extended to, other bodies through the new council for quality that we announced in our response to Professor Sir Ian Kennedy's report on Bristol. Noble Lords may well recall that the Bristol inquiry response referred to:
"in the short term, a strengthened inspection role for the CHI working with the Social Services Inspectorate and National Care Standards Commission as appropriate to give the public an independent assurance that each provider of NHS services has proper quality assurance and quality improvement mechanisms in place".
The Government said:
"We will take further steps at the earliest opportunity to rationalise the number of bodies inspecting and regulating health and social care".
As the noble Earl, Lord Howe, has already suggested, my right honourable friend the Secretary of State for Health, in a speech to the new health network, said:
"The Commission for Health Improvement will take responsibility for the independent publication of information about clinical and organisational performance. It will have a greater inspectorial and reporting role over the health system's performance that will necessitate closer working and, over time, organisational integration between the CHI, the Social Services Inspectorate, the National Care Standards Commission and the Audit Commission, so that health and social care services are subject to a common set of standards whether they are provided by public, private or voluntary sector organisations".
There is nothing between us on this matter, therefore. Our intention is that there will be a convergence between the activities of these four bodies, including CHI and the National Care Standards Commission, drawing together their expertise in joint work where appropriate, and sharing best practice.
To give an example of how we will develop this, as the National Care Standards Commission starts its work in April and as the Commission for Health Improvement develops its inspection function, we will be looking for the development of common methodologies, where appropriate, and the coordination of visiting programmes. We have made it clear, however, that we believe that it would be premature to seek to rationalise the functions of CHI and the National Care Standards Commission, or indeed other relevant bodies, in the current Bill. These issues and possible legislative requirements are complex and they need to be given full consideration before we act.

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We have, however, already made provision in the Care Standards Act 2000 for CHI to exercise functions of the National Care Standards Commission in relation to the independent sector. When we enacted the Care Standards Act, we considered it right that the regulation of private healthcare should be different from arrangements for the independent review of NHS bodies by CHI. But life has moved on. We have gained a lot of experience with CHI, and the Bill before us now gives CHI a new function of inspection, which will be against published standards.
While we are clear that private and voluntary health care must remain under a system of regulation or licensing of service providers, we believe that CHI should now act on the National Care Standards Commission's behalf to inspect independent hospitals. We will therefore be bringing Section 9 into force shortly and making regulations so that the Commission for Health Improvement may exercise the National Care Standards Commission's function of inspection in relation to independent hospitals.
I hope that in the immediate future that will go some way to meeting the points raised by noble Lords tonight. In the rather more long term, work will continue to look at how we can rationalise the different inspecting organisations I have mentioned. We will have to come back to that at a future stage. I hope, however, that in my remarks noble Lords will see that we are very much with the thrust of the points being put forward. We believe that this amendment is premature in terms of legislative action to bring the bodies together but, in bringing into action Section 9 ill relation to CHI and the National Care Standards Commission, we are showing, I believe, that we are moving down that route.
Lord Peyton of Yeovil: The Minister's response was most interesting. However, in case I gave the wrong impression, I should like to stress that I did not intend any criticism of the Commission for Health Improvement or of the National Care Standards Commission when I spoke earlier. It seems to me that bodies established to look at the work carried out in hospitals, and elsewhere, should also be inspected. I am not making a flippant point.
I was recently in a very major hospital, which is not in London. I shall not mention the name, but the chairman of the group said to me, "What we are suffering from here is death by a thousand visits". I hope that the Minister will take that message on board. Let us face it, most of those who visit and inspect hospitals do not make patients any better; they are made better by physicians, surgeons and nurses. If such people are over-inspected and over-examined, their morale may suffer.
Baroness Hanham: I am tempted to rise to my feet at this moment on the subject of the inspection of inspectorates. I should declare an interest now, and in respect of any further interventions that I may make, in that I am chairman of an NHS trust.
So far, CHI has been well received, except by those who have borne the brunt of its remarks. I support what my noble friend Lord Peyton has just said about
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the multiplicity of inspectorate regimes. Indeed, far more than that, there is the amount of information that is required both in advance and at the time of such inspections. I assume that the information required for the first visit will not subsequently be required when the overall picture has been grasped. But if that is not the case, we are talking about a week's visit to the whole trust involving many people's time and, prior to that, something like four weeks during which information from all sorts of sources must be collected. It is not a terribly useful way of serving patients because it is time-consuming.
As I said, I hope that such information would be required only once. Thereafter it should be available on computer records. Indeed, the information obtained for CHI could very reasonably be passed on to the National Care Standards Commission, which would mean that it does not have to be requested again. It is a question of trying to rationalise what the inspection regimes are doing. I am not quibbling about the fact that this work has to be done, but it seems to me that such inspections take up an awful lot of people's time that could otherwise be used more effectively.
Lord Hunt of Kings Heath: I do not disagree with the points made by the noble Lord, Lord Peyton, and the noble Baroness, Lady Hanham. The noble Lord is right to say that it is important to keep one's eye on the activities of these bodies. We agree a work programme with CHI and Ministers have regular meetings with the commission. We also listen to comments and criticisms about CHI's performance from the NHS, which we then discuss with the commission. I am sure that the same arrangements will be put in place in relation to the National Care Standards Commission when it starts its work.
I very much share the concern about a multiplicity of organisations inspecting hospitals. My right honourable friend the Secretary of State started the process of looking at the regulatory inspection regime to assess whether we can rationalise it. Therefore, although I am sympathetic to the thrust of the arguments put forward tonight, I feel that the proposed amendment is a little premature because we have not yet completed the process.
The noble Baroness, Lady Hanham, raised the question of the amount of information required to assist such inspections. I accept that the task of providing it can be quite onerous. However, I should point out that CHI has undertaken many reviews. When considering the performance of the board of some trusts, the CHI was surprised at the paucity of information at its disposal in terms of judging the performance of its organisation. It was clear to CHI that, in many of those organisations, the board of the trust was not getting enough information from which to judge overall performance. It is to be hoped that CHI focusing on information will help boards to ensure that they are able to judge their own performance, benchmark it with other organisations and, through that, improve standards overall.
9.30 p.m.
Baroness Hanham: I think I accepted that that was what I said; that in the initial stages the collection of information was necessary. I hope that it will not be necessary to require quite so much in future.
Earl Howe: I am inwardly distraught that my amendment does not commend itself to my noble friend Lord Peyton, whose approval, when I get it, I unfailingly cherish. I have to say to him that I do not regret tabling the amendment. I am and will remain an unashamed supporter of what is termed "the quality agenda" across the NHS and the private sector. I believe that an efficient inspectorate is an integral part of that.
I fully agree with my noble friend that those bodies should have to justify their existence. However, that is perhaps a separate question to the one I sought to raise. I also agree with him about death by a thousand visits. If he is good enough and patient enough to wait for Amendment No. 96, to which my noble friend Lady Noakes will speak at a later stage in Committee, he will find that the issue is brought into even sharper focus.
The noble Baroness, Lady Pitkeathley, chided me for proposing the merger between the two bodies with, as she thought, undue haste. I enjoyed the point she made. However, the fact that PCTs are, in the view of some of us, not ready for the big changes that are about to engulf them, has nothing to do with the fact that CHI and the National Care Standards Commission may be ready. The fact that the Secretary of State has spoken of organisational integration and, indeed, the fact that the Minister has tonight confirmed the department's intention is, at least to me, a hopeful and promising sign that I am on the right track. Perhaps I may say to the noble Baroness that the amendment was not that hasty in that it proposed a two-year delay before we plunge into the merger. I was struck by the comment of the noble Baroness, Lady Northover, that this was a good time to consider the merger immediately prior to the National Care Standards Commission being up and running for the first time.
I do not want to prolong the debate. I thank the Minister for his sympathetic response. I am glad that he acknowledged that life has moved on from a year or two ago. There is little between us on the issue. We wait with interest to see how the convergence of the four regulatory bodies is brought about in practice over the months ahead. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 7 [Funding of Strategic Health Authorities and Health Authorities]:
Baroness Noakesmoved Amendment No. 62:
Page 9, line 11, leave out subsection (3) and insert—
"(3) Subsection (3C) is omitted."
The noble Baroness said: Amendment No. 62 is a probing amendment which would amend subsection (3) of Clause 7 by deleting the current subsection (3) and replacing it with a new subsection deleting subsection (3C) from Section 97 of the 1977 Act.
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Subsection (3C) of Section 97 of the 1977 Act was inserted by the Health and Social Care Act 2001. It gives the Secretary of State power to pay additional amounts to health authorities if they satisfy objectives or perform well against criteria. We debated those powers last year. Subsection (3) of Clause 7 amends that to replace health authorities with strategic health authorities while Amendment No. 62 deletes the power altogether.
When we come to Clause 8 of the Bill we shall deal with the financial arrangements for PCTs and the creation of a similar power for the Secretary of State to pay additional amounts to PCTs. The Secretary of State has said that he intends to allot at least 75 per cent of the funds available to him to PCTs. Strategic health authorities will not have significant functions other than performance management of PCTs and NHS trusts and so it is difficult to see why the Secretary of State needs these performance payment powers over strategic health authorities.
Can the Minister give any explanation of why in reality these powers created over health authorities are needed for strategic health authorities, given that the vast majority of the functions will now be taken over by PCTs?
As far as I can see, the only possible reason why the Secretary of State would require the powers is because he cannot bear to see any tiny part of the NHS over which he has less than a complete set of powers for use one day when the mood takes him. I shall be interested to hear whether the Minister has any substantive reasons for these powers over strategic health authorities. I beg to move.
Lord Peyton of Yeovil: I should like to congratulate my noble friend on having given us as lucid an explanation of what she was after as the Bill which she seeks to amend allows. I am just a little sorry that she allowed her natural good nature to get the upper hand of her and did not try to turn the knife slightly in the wound which I tried to inflict on the Minister just now about this awful habit of superimposing a Bill on an old Act of Parliament. No one just coming to look at the amendment could possibly understand without a certain amount of research what it intended to do. My noble friend moved her amendment very well, but I do think that she allowed herself to be a little more merciful than the situation caused her to be.
Baroness Finlay of Llandaff: The noble Lord, Lord Peyton, has given me the courage to stand up to ask a question. I am a novice on legislation. I find some of this rather gobbledegook to follow. But I had understood from Clause 1 that the term "strategic health authorities" applies to England and that the term "health authorities" applies to Wales. Yet the wording within Clause 7 appears to relate to England and not to Wales. Therefore, I fail to understand why the heading of this clause includes "health authorities". Have I missed something and does the clause in some way apply to Wales as well as England.
Lord Hunt of Kings Heath: First, I thank Members of the Committee for comments that they have made

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about the amendment. Essentially, the subsection as currently drafted means that the Secretary of State could give performance-related payments to strategic health authorities for meeting certain objectives notified to them. It does not compel him to do so. The amendment proposed by the noble Baroness, Lady Noakes, would take away the power of the Secretary of State to make such performance-related payments to strategic health authorities.
The noble Baroness, Lady Noakes, asked why we needed this part of the Bill when we have stated that it is not our current intention to make performance-related payments to the new strategic health authorities out of the NHS performance fund. The intention is that we shall not make performance-related payments to strategic health authorities, but it may be that in the future, and as we see how the new arrangements develop, there may be an opportunity to make such payments.
Perhaps I may give an example. In relation to the way in which we judge and make payments in accordance with performance, while much performance relates to the work of an NHS organisation, working across boundaries and in partnership is also one of the ways in which one can ensure good quality performance. It may well be that strategic health authorities may be incentivised in future for partnership working by being given money to use to encourage partnership working between primary care trusts. We may wish to make payment to health authorities for that purpose. We have no current intent to do so, but we want to allow for that possibility in future.
Baroness Noakes: I thank the Minister for that reply. Perhaps I may tell my noble friend Lord Peyton how much I appreciate his kind comments. Those of us on the Front Bench always look to my noble friend for kind comments; this is the first time that I have received some from him, and I hope that it is the first occasion of many.
Turning to the Minister's explanation, what he said demonstrated that there is no need for the power to make performance payments. The Government have no current intention to make such payments and the examples that the Minister produced sounded somewhat thin. He said something about working in partnership and across boundaries. I could not see the substance of that. However, in the interests of moving on, I shall consider what the Minister said and I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 7 agreed to.
Clause 8 [Funding of Primary Care Trusts]:
Baroness Noakesmoved Amendment No. 63:
Page 9, line 35, at end insert—
"( ) In determining the amount to he allotted for any year to a Primary Care Trust under subsection (1)(b), the Secretary of State shall consult with health professionals, local authorities and other interested parties as to the health needs of the population served by that Trust."
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The noble Baroness said: In moving Amendment No. 63, I shall by leave speak also to Amendments Nos. 68, 73 and 81, which are grouped with it. Amendments Nos. 63, 68, 73 deal with consultation and taking account of the health needs of the population in determining allocations to primary care trusts by amending new Section 97C of the 1977 Act, which is proposed in Clause 8. Amendment No. 81 deals with taking account of health needs in the amounts allocated to local health boards by the National Assembly for Wales.
Amendment No. 63 seeks to insert a new subsection into new section 97C. It would require the Secretary of State to consult health professionals, local authorities and other interested parties about the health needs of the population served by the PCT. Amendment No. 68 would insert a new subsection after subsection (2) of new Section 97C, which would require the Secretary of State to take health needs into account when determining the amounts allotted. Amendment No. 73 is a narrower amendment, and would attach the same requirement to have regard of the health needs of the population to the powers in subsection (6) of new Section 97C, which allows the Secretary of State to reduce allotments already made to PCTs in certain circumstances.
I am sure that the Minister will say that the amendments are redundant because the Secretary of State already takes into account the health needs of the population when assessing how moneys are to be allotted, but the health Acts do not require him to do so. More importantly, whether or not in practice the Secretary of State takes into account the population's health needs, there is no requirement on him to consult anyone. I am aware that in practice there is an advisory committee on resource allocation, but that is a central body and I am not aware of locally based debates on health needs feeding into that committee. In any event, the advisory committee does not advise on all aspects of the allocation methodology. In particular, it does not advise on the subjective pace of change and health inequality adjustments.
Amendment No. 63 is therefore designed to ensure that there is more openness in each allocation process so that there is greater public confidence in the process. Although the Department of Health releases copious notes on allocation methodologies after it has announced allocations, those methodologies are not the subject of public debate—certainly not in advance of the Secretary of State's allocation decisions. The department's figures per weighted head of population for health authorities, based on allocations for 2002–03, show that the highest spending authority spends 15 per cent more than the lowest. That is on a weighted basis, so why the differences? That space cries out for more public debate.
Amendment No. 73 is important because it qualifies the Secretary of State's power to claw back moneys allocated under subsection (3) of Section 97C on the basis that the PCT has failed to meet some conditions imposed. It might be good business management theory to impose penalties for failure to meet a condition, but the NHS is not a business. Penalties can

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have only one target: the patients. Less money means less patient care. If the Secretary of State wants to use business-world penalties—we are far from convinced that that is an appropriate mechanism—the amendment would require him to have regard to the health needs of the population. If the health of the population would be harmed by the withdrawal of funds, the amendment would make it difficult, if not impossible, for the Secretary of State to proceed.
9.45 p.m.
Lord Clement-Jones: This may be the opportunity to talk more generally about the funding of PCTs, which has raised concerns in several quarters. The way in which the allocation of funds is devolved to PCTs is of particular concern.
There is concern that PCTs could be saddled with the outstanding deficits of health authorities, as part of the devolution process, leaving PCTs without the resources to implement their devolved responsibilities and achieve the Government's targets. Arguably, there could be no additional resources and, therefore, little opportunity to improve the provision of healthcare over and above that provided by the authorities from which the PCTs have taken the responsibilities.
It is also unclear whether PCTs' funds will be protected from the revenue consequences of any major building projects. It is understood that discretionary capital will be allocated to the new strategic health authorities. If PCTs are not protected from the revenue consequences, there will be particular concerns in areas in which boundary changes following the establishment of strategic health authorities mean that PCTs may become retrospectively liable for the revenue consequences of a major building project.
Baroness Hanham: I endorse the fact that there is concern about the resources being given to PCTs and about the way in which they will be allocated. I speak from the point of view of the acute sector, although this probably affects the primary sector as well.
As has rightly been said, resources have been secured for 2002–03. They are not secured for 2003 onwards. There are only a few pilot primary care trusts in existence, and those that are coming into existence will not really be operational and taking a strategic view of how they will spend their resources for at least six months. There is a concern about the allocation of resources and how it will be carried out, particularly in 2003–04 when the ground will hardly be secure under the PCTs' feet.
Stability of funding is vital in the short term, if not in the long term, in the health service. The amendment is important as it begins to show a way of discussion and consultation about how services should be provided. My noble friend Lady Noakes would agree that that cannot happen in the short term, but it could happen in the longer term. However, I would be interested to know how the Minister sees 2003–04 progressing in the light of the fact that PCTs will
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probably not be able to make serious and informed decisions about funding and the continuation of or changes to services within that timescale.
Lord Hunt of Kings Heath: Stability of funding is extremely important. Noble Lords will know that by 2004 we intend that some 75 per cent of the budget should be devolved to the primary care trusts. The Advisory Committee on Resource Allocation, to which I shall refer in more detail in a moment, is currently developing a formula for primary care trust allocations alongside a decision that will then need to be taken by the Government with regard to any pace of change policy in relation to movements from target on the part of primary care trusts.
As a point of interest, I understand that the current figures in relation to primary care trusts and distance from target reveal a range from minus 14 per cent to plus 14 per cent. Some 46 per cent of primary care trusts are within 2 per cent of target, while 83 per cent are within 5 per cent. My right honourable friend the Secretary of State will give great consideration to deciding what pace of change should be introduced for PCTs when they receive the full allocation.
However, there are always counterbalancing forces. If you are in a part of the country where the primary care trust is greatly under target, you will want the pace of change to move as quickly as possible. That has to be balanced against the need for stability in general across the NHS. That summarises the nature of the decision which my right honourable friend will have to reach.
The national resource allocation formula that is used to determine fair shares for health authorities and primary care trusts reflects the fact that different locations around the country have different health needs. The formula takes account of the age structure of the local population. Patterns of morbidity vary by age group. The very young and the elderly, whose populations are not evenly distributed around the country, make more use of health services than the rest of the population. Even when differences due to age are taken into account, populations display different morbidity characteristics, so the formula includes a wide range of health and socio-economic indicators associated with the need for healthcare.
The formula is already used to establish targets, or fair shares, for primary care trusts. While allocations are still made to health authorities, they are required to pass on resources to primary care trusts in accordance with national guidance. As I have already pointed out, we are asking the Advisory Committee on Resource Allocation to review the operation of the formula at primary care trust level. I listened with interest to the comments made by the noble Baroness, Lady Noakes, but she will recognise that the advisory committee has serving on it NHS management, GPs, academics and clinicians. Of course one would always welcome contributions from the NHS towards more general discussions on the way in which the formula is developed.
Lord Roberts of Conwy: Would the Minister be kind enough to clarify a point for me? He will have noted

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Amendment No. 81, which is grouped with Amendment No. 63. It relates to the local health boards to he established in Wales. Can the noble Lord give me an assurance that the formula to which he has just referred will apply equally in Wales? Alternatively, will there be different principles of allocation?
Lord Hunt of Kings Heath: I cannot answer the noble Lord's question because it will be up to the National Assembly for Wales to decide how resources are to be allocated to the health service in Wales. I hope that I am not going outside my brief if I suggest that many of the principles which govern the allocation to the health service in England will be the kinds of issues of which the National Assembly will also wish to take account when developing its own formula. However, ultimately it must be a formula that is developed by the National Assembly for Wales and not the Department of Health in England. I am reliably informed that officials of the National Assembly and of the Department of Health hold regular meetings to discuss the intricacies of resource allocation. We will allocate resources direct to primary care trusts through a national formula. That will take into account the health needs of a primary care trust's population.
Amendment No. 63 would undermine that process. If the Bill was enacted with the amendment as drafted, we would face applications from each of the 300 primary care trusts. That would be an arduous and heavy duty for both the primary care trusts—which, as we have heard, will be hard pressed to get on with the job of commissioning services from April—and for the Department of Health. The present arrangements whereby the advisory committee advises the Secretary of State about improvements to the formula is the best approach and one which has general acceptance.
As the noble Lord, Lord Roberts, suggested, the formula in Wales is different from the one in England, but it takes account of a whole range of health and socio-economic indicators associated with the need for healthcare. My understanding is that the Assembly is committed to ensuring that there is more equitable access for the entire population in accordance with their health needs. At the moment, the Welsh Assembly is considering the outcome of a major resource allocation review.
As to Amendment No. 73, Clause 8, in essence, mirrors the existing powers in the Health and Social Care Act 2001 which enable us to recover sums from health authorities if they have not met the conditions set. I listened carefully to what the noble Baroness, Lady Noakes, said about that. I hope that the power will not have to be used, but it is necessary to have a discipline in the system to prevent abuse.
It is unnecessary and misleading to single out health needs as the one particular factor to be considered when the Secretary of State makes a decision as to whether to recover funds. In practice, the Secretary of State will take into account a range of factors. These may include health needs but could also include
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matters such as the performance of the organisation in general, the leadership of the trust and the chief executive, and any other number of matters.
Overall, the amendments are not required. It would be best if we put our trust in the very sensible national formula which has broad acceptance within the health service. It is as appropriate for primary care trusts as it is for health authorities.
Lord Clement-Jones: Will the Minister answer the two sets of questions that I referred to in my short contribution?
Baroness Noakes: Perhaps the noble Lord, Lord Clement-Jones, would care to wait until we gel to Amendment No. 66, which deals specifically with deficits. I realise that the Minister has not answered the noble Lord's points, but he will have another opportunity to do so when we reach later amendments, to which I am sure he is looking forward.
I thank the Minister for his reply. He appears to be wedded to the processes of allocations being shrouded in some secrecy or, at least, confined to a small group of people at the centre. I would not necessarily he horrified by the prospect of up to 300 PCTs having their say about how they thought the process worked for them. That would seem to be an entirely sensible and rational debate for them to have, although I take the point that they must have the capability to handle their other functions before they move on to demanding the money that is rightfully theirs. I was disappointed by the noble Lord's answer to that.
I was even more disappointed with his answer to Amendment No. 73, which was about clawing back moneys. The Minister said that the Secretary of State might want to take into account performance in general or leadership. I suggest to him that that misses the point, that whenever moneys are taken away they are going to harm patients. Performance in general and leadership are just abstract concepts, but money taken away from primary care trusts will affect patient care. That is the inevitable arithmetic of the NHS.
As I say, I am disappointed by the Minister's responses. I shall consider them further. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
10 p.m.
Baroness Noakesmoved Amendment No. 64:
Page 9, line 35, at end insert—
"( ) From 1st April 2004 the total amounts paid to Primary Care Trusts in any financial year under subsection (1) above shall be not less than 75 per cent of the total moneys available to the Secretary of State for distribution to all NHS bodies for that year."
The noble Baroness said: The aim of the amendment is to require the Secretary of State to distribute 75 per cent of NHS money direct to PCTs. In the document Shifting the Balance of Power and in the earlier announcement on the reforms, the Secretary of State committed himself to 75 per cent of the total budget being passed to PCTs. We have no problem with that

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in principle, but with the readiness of PCTs to accept all that money being passed down to them at this time. There is no point in revisiting those discussions.
For the purpose of this amendment let us assume that all PCTs are up and running and have the capability to handle the money coming down. On that basis we completely welcome the allocation of the majority of the resources for decision-making at the lowest possible level. Indeed, we wonder why it is as low as 75 per cent. I shall be interested to hear from the Minister why 25 per cent needs to be kept back from the decision-making powers of the PCTs.
As I have said, this amendment has the simple aim of enshrining in legislation the stated distribution policy. I have no doubts about the integrity of the current Secretary of State and have no reason to believe that he will not do what he has said he will do. But as we know, Secretaries of State come and go, as indeed do governments. This amendment will at least hold any future Secretary of State to the current intent of putting the majority of the purchasing power of the NHS in the hands of PCTs.
In replying, I ask the Minister to confirm that when moneys are allocated to PCTs they will not be ring-fenced, earmarked or have any restrictions placed on them. Otherwise it would be a complete sham if the moneys were allocated on the basis of restricted local decision-making. I beg to move.
Lord Hunt of Kings Heath: The 75 per cent of the NHS budget going directly to primary care trusts is intended to cover the unified allocation for the provision of hospital and community health services, the costs of prescribing by general practitioners and GP practice infrastructure. The remaining 25 per cent of the NHS budget includes items such as funding for capital projects and for research and development, and the education and training of doctors and nurses which is not spent by primary care trusts.
The noble Baroness, Lady Noakes, said that Secretaries of State come and go as do governments. None the less, I believe that there is an interesting debate to be had as to whether it would be right to enshrine the 75 per cent in law or whether it is properly a matter for Ministers to decide what the resource allocation for the health service should be. They are accountable to Parliament.
The Government's view is that at the end of the day it is a matter which should properly fall to Ministers, who are accountable to Parliament, to make a decision as to the broad allocation of resources to the health service and the proportion that should be allocated to different tiers. On that basis, I do not believe that we are justified in going for a formulated approach enshrined in legislation.
What is not in doubt is that we are determined to ensure the commitment that by 2004 PCTs will control 75 per cent of the total NHS funds and that that will be put into practice. We also believe that primary care
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trusts will have the capacity to accept that challenge. But I do not believe that a case has been argued persuasively that one needs to enact that in legislation.
Baroness Carnegy of Lour: Would the 25 per cent include the amount mentioned in Clause 8(3), which is the reward to primary care trusts for doing well?
Lord Hunt of Kings Heath: I believe it would.
Baroness Hanham: Perhaps I may revert briefly to the previous amendments on which I spoke and ask for some clarification. I was specifically referring to when these allocations would start and when the primary care trusts would be in a position to deal with them. I have two questions. First, is the 75 per cent due to be passed to the PCTs in the year 2003, or will it start in 2004? Secondly, does the Minister believe that the PCTs that will not be up and running until probably October or November this year be ready and able rationally to make the kinds of decisions they will be required to make so as not to affect the stability of funding around their trust areas as they start up?
Lord Hunt of Kings Heath: The commitment made by my right honourable friend the Secretary of State is that the 75 per cent will be directed to PCTs by the year 2004. We have some flexibility in relation to whether that will be done in the 2003–2004 or 2004–2005 financial year. Final decisions still need to be made.
With regard to the specific issue raised by the noble Baroness, Lady Hanham, we intend that every primary care trust shall be in position to accept the responsibilities laid upon them. Whatever the vesting date, we want the new primary care trusts to be in a position to do so.
I made it clear earlier in the debate that we believe that there are, at most, only two primary care groups that will not become primary care trusts by 1st April this year. In relation to October, therefore, we are talking at most about two such organisations.
Baroness Noakes: I thank the Minister for his replies. I heard him say what are to be retained—capital projects, certain developments, certain training. It appears to me that that does not amount to 25 per cent of total NHS spending. There is, therefore, perhaps a lack of ambition in the target to put 75 per cent of the funding into PCTs.
Perhaps more important is the Minister's unwillingness to accept that the Secretary of State's intention should be enshrined in the legislation. That should put a chill in the heart of every primary care trust in the land. They cannot rely on the statements already made, because the legislation will be in such a form as to allow the Secretary of State to decide how allocations are to be made, which can be changed by Ministers at will, and the primary care trusts will have nothing on which to rely. I regret that. However, for the moment, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Noakesmoved Amendment No. 65:
Page 9, line 38, leave out ", in whatever way he thinks appropriate".
The noble Baroness said: In moving Amendment No. 65, I shall speak also to Amendments Nos. 67, 78 and 80, which are grouped with it. These amendments concern the discretion of the Secretary of State in relation to PCTs in England and of the National Assembly for Wales in relation to health boards in Wales.
Amendment No. 65 removes from subsection (2) of Section 97C, introduced by Clause 8 of this Bill, the words,
"in whatever way he thinks appropriate".
Amendment No. 78 is the equivalent for Wales under Clause 9. Amendment No. 67 deletes the two closing lines of subsection (2) of Section 97C, which allow the Secretary of State to consider any period or elements of expenditure he thinks appropriate. Amendment No. 80 is the equivalent for Wales under Clause 9. These are probing amendments to discover why the Secretary of State might possibly need to rely on those words.
Section 97C(2) specifies what the Secretary of State may take into account—general Part 2 expenditure and items that would have been general Part 2 expenditure but for an order under Section 103. The same provisions are made for Wales under Clause 9.
I am sure that the Secretary of State or the National Assembly would want to take those items into account only in a reasonable way. If that is the case, the words,
"in whatever way he thinks appropriate"
and,
"during any period he thinks appropriate"
are not necessary. However, if the Secretary of State does not want to act reasonably, he may need to rely on those words. I am sure that the Committee would be chary of facilitating the unreasonable acts of a Secretary of State. I hope that the Minister will place on record why the Secretary of State or the National Assembly for Wales might want to use the discretion conferred by those words. I beg to move.
Lord Hunt of Kings Heath: Section 97C(2) confers a general power on the Secretary of State to take into account a primary care trust's non-cash-limited expenditure when determining its cash-limited allocation. Under the existing provisions for funding health authorities, contained in Section 97 of the National Health Service Act 1977, the formula, process or mechanism by which the Secretary of State determines the allocation of each health authority is left to his discretion. It has always been for the Secretary of State to decide what each health authority should receive and how that is determined, subject to the usual constraints of being answerable to Parliament and the funding process being monitored by the National Audit Office. Of course, he must also exercise his powers in accordance with the principles of administrative law. In other words, as the noble Baroness implied, the power must be exercised rationally. It cannot be exercised in a way in which no
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reasonable Secretary of State would exercise it. That allows the allocation process to evolve over time, in line with policy changes. We have simply adopted the same approach in Clause 8.
The alternative to a general power would have been to take a very narrow power to allow the Secretary of State to introduce a particular scheme to take into account an authority's non-cash-limited expenditure when determining its cash-limited allocation. Such an approach might limit the ability to modify our approach over time—for example, as new information or research becomes available—and could reduce Ministers' ability to determine the pace of change policy on an annual basis. A narrower power might limit a future administration's ability to make allocations in line with their policy.
The words that Amendments Nos. 65 and 67 would remove simply make it clear that it is the Secretary of State who exercises that power and that he has a wide discretion to determine precisely how the primary care trusts' non-cash-limited expenditure is to be taken into account. The same arguments are also true for Amendments Nos. 78 and 80, as they relate to the funding of local health boards in Wales. Clause 9 as it stands allows the Assembly to take into account all healthcare resources that are available to meet the needs of a local health board's population when determining allocations. That philosophy is part of the National Assembly's determined drive to close the gap between the worst off and the better off in health terms. If those words were deleted, as the amendments suggest, the Secretary of State and the Assembly would retain a general power. The amendments would simply remove wording that helps to clarify the intention of the clause that the Secretary of State and the National Assembly for Wales should have a general discretion as to how they take account of a primary care trust's and local health board's non-cash-limited expenditure. We would not want to agree to any amendment that made the provision less rather than more clear.
Baroness Noakes: I thank the Minister for that clear and comprehensive reply, which I look forward to reading carefully in Hansard. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
10.15 p.m.
Baroness Noakesmoved Amendment No. 66:
Page 10, line 2, at end insert "; and
(c) any deficit inherited from a predecessor body,"
The noble Baroness said: The amendment deals with deficits, which the noble Lord, Lord Clement-Jones, referred to earlier. It would add a new paragraph to Section 97C(2) of the 1977 Act, as inserted by Clause 8. It may be convenient if I also speak to Amendment No. 79, which is grouped with Amendment No. 66, because it is in virtually identical terms but deals with the Welsh equivalent under Clause 9.
Amendment No. 66 allows but does not require the Secretary of State to take into account deficits inherited from a predecessor body m determining

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allotments to PCTs. The noble Lord, Lord Clement-Jones, has already referred to the concerns that have been expressed about this area, in particular by the BMA.
There was a time, which I am sure the Minister recalls, when I seemed to spend all of my time on National Health Service deficits. That might sound sad, but it is the truth. In the back end of the 1980s, deficits were spiralling out of control. As the then director of finance of the National Health Service Management Executive, it was my job to get them under control.
Health service deficits never go away. You may think you have them under control, but they pop up again. There are various levels at which deficits can exist. What we used to call income and expenditure deficits were met by brokerage at the year end—borrowing from other health authorities to get by. Nowadays, the language is more complicated with the introduction of resource accounting, but the basic principles remain the same.
Deficits do appear to be a topical issue. We heard earlier this year about a potential deficit of £60 million emerging in the south east region. The story was that brokerage would cover that, so the National Health Service overall would remain in balance. But there would still be deficits in some authorities and surpluses in others. That £60 million is a lot of money in patient care terms, although not a big percentage of the overall money in the National Health Service.
This is not confined to the South East. The Health Service Journal at the end of January said that other parts were struggling to the tune of £150 million. I see from a Written Answer given by the Minister on 25th February that the Department of Health's expenditure limit for 2001–02, has been increased by £230 million, of which £120 million relates to the take-up of flexibility for health authority allocations. If I understand the code correctly, it means that the National Health Service has borrowed £120 million from next year's allocations. There is a deficit of £120 million to start the new financial year.
I ask the Minister to say what the deficits for health authorities for 2001–02 are expected to be. I would ask him to state that on a gross basis and not net off the surpluses in those authorities that are fortunate enough not to be facing financial pressures.
If there are any which start with deficits, I repeat what the noble Lord, Lord Clement-Jones, asked. What will be done in respect of allocations to PCTs taking over the functions of health authorities with deficits? Will the new PCTs be starting with a clean slate?
I have talked about the simplest kind of deficits—the GCSE of deficits. The noble Lord, Lord Clement-Jones, is clearly on to the advanced levels of deficits. He talked about the revenue consequences of capital schemes which is of particular concern where funding does not exist to meet the revenue costs of capital schemes once commissioned. Underlying deficits occur when income and expenditure are in balance or
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resource limits are met, but non-recurrent moneys have been used to fund recurrent expenditure. There are hidden deficits which occur when spending commitments are deferred in the hope that money will emerge from somewhere before the project can be delayed no longer.
These advanced forms of deficits are likely to be even more important than the basic levels of deficit which get recorded year by year. Will the Minister say what the Secretary of State intends to do about these areas? They are just as important to PCTs starting life with a clean slate as anything else. I look forward to the Minister's comments. I beg to move.
Lord Hunt of Kings Heath: This is an important matter. We start from a position where the NHS is in receipt of record sums of resources as a result of the Government's policy on the NHS. That certainly provides a very good foundation on which we can discuss the issue of the transfer of resources to primary care trusts.
In the last financial year, all but one health authority achieved a balanced financial position. I know that the noble Baroness, Lady Noakes, asked me about the current position. She will understand that we are not yet at the conclusion of the financial year. We are in discussions with trust health authorities and PCTs about managing their end-of-year positions, but we cannot speculate about the year-end financial position before those discussions are complete.
By the end of this financial year we expect all health authorities to live within their agreed resource limits. Where they require support at the year-end, this will be provided principally through brokerage from elsewhere in the NHS. As the noble Baroness suggested, that is normal practice in managing the year-end financial position of individual bodies for the NHS overall.
In practical terms, one accepts that while brokerage can assist an organisation to manage its end-of-year position and avoid a breach of its statutory duty, it does not of itself cure the cause of the financial problem; it essentially rolls the issue over into the next financial year. In practical terms, that means that borrowing organisations must have plans in place not only to fund the replacement of brokerage the following year but also to ensure that the problem does not repeat itself—so the underlying cause of the financial overspend needs to be addressed.
Inevitably, that means that although there may have been high levels of growth, a greater proportion of it will be used to meet the cost of the previous year's over-spending and the recurrent effect in forward years of spending above the levels allocated. There is no getting away from that.
Where a health authority has been involved in a brokered situation and its responsibility then devolves down to a primary care trust, clearly the PCT has to pick up the consequences of that. It would not be feasible simply to say that we should wipe the slate clean so that primary care trusts can start from a position as if, within a local health community, there

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has not been a financial issue to be dealt with and there has not had to be brokerage. That would not be fair to the NHS as a whole, and it would not ensure that the proper disciplines were in place. The overall position is that, given the overall strengths of NHS finances, primary care trusts in general will have an immensely strong foundation on which to build in the future.
So far as concerns the general point, it is clear that in a situation where brokerage has had to be entered into to deal with some specific funding problems within a local health community, the primary care trust involved will need to take forward those issues when it takes over major responsibility for the budget of the local health service.
Lord Clement-Jones: Before the noble Baroness, Lady Noakes, replies—and she will no doubt have a far more penetrating set of questions—what information will the PCT have on the actual state of finances regarding the services that it will be assuming from the health authority? It seems to me that the state of the knowledge of the PCT in the circumstances described by the Minister is of crucial importance.
Lord Hunt of Kings Heath: Of course, the noble Lord is absolutely right, but the books will be open. I do not believe that there should be any situation where information is not available to primary care trusts taking on new financial responsibilities. I know of no reason why full information should not be available to those primary care trusts.
Lord Clement-Jones: If the strategic health authority retains certain functions carried out by the health authority, but the primary care trust assumes other functions, how transparent will the accounts of the former health authority be? How will the deficit be allocated between the strategic health authority and the primary care trust?
Lord Hunt of Kings Heath: Such matters will be as transparent as they can be. I am talking about a situation where financial pressures have been experienced, and brokerage has had to be entered into so as to enable a particular health authority to fulfil its statutory duty. I have already said that the point of brokerage is to allow time to enable the individual health authority to get its financial situation back into a viable position. Inevitably, as strategic health authorities come forward, and as primary care trusts have to take on the major responsibility for funding services at local level, they will have to take on their share of the brokerage arrangements.
Lord Clement-Jones: Is the brokerage allocated by function which is devolved to the primary care trust: or retained by the strategic health authority?
Lord Hunt of Kings Heath: It is a matter of the NHS as a whole ensuring that we meet statutory obligations and it will enable the funding to be transferred from
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one part of the NHS to another. In essence, the money will have to be paid back. That would not he done by function; there would be a totality of a figure.
Baroness Noakes: I raised the matter of the £120 million. Can the Minister clarify whether that £120 million that is included in the additional expenditure limit for 2001–02 relates to deficits that are carried forward; for example, £120 million borrowed from next year?
Lord Hunt of Kings Heath: I may have to write to the noble Baroness as I do not have the information about the specific figure that she has raised.
Baroness Noakes: I look forward to receiving that. This is an important area.
The questions raised by the noble Lord, Lord Clement-Jones, are extremely important. The Minister has suggested that it is in some way easy to parcel up a deficit and to attribute it to a primary care trust. I put it to him that there is no logical way of allocating a deficit that exists in one health authority between, say, three or four primary care trusts. Do the primary care trusts share equally in the deficit? Are some allocated larger amounts than others? If a health authority has a deficit at the end of the year, there is no logical way to allocate it to any one particular activity and to say which activity has borne the deficit. The noble Lord, Lord Clement-Jones, has raised some extremely important questions on that.
I ask the Minister to consider the matter again. He may like to write to us before Report stage about how that provision will work in practice as we have concerns about it. The noble Lord said that this will he a record year for resources, but I put it to him that the signs emerging from the NHS are that next year is already looking extremely tight. I understand that the early cut of the planning framework—nowadays called "SWAFF"—is showing almost as many tensions as there were this time last year. That round was regarded as an extremely difficult and bloody round of financial planning. That may not be a good basis on which to go forward into next year.
10.30 p.m.
Lord Hunt of Kings Heath: This is the time of year for noises and squeals from the health service, because this is the time of year when the health service is trying to reach agreement on the SWAFF round. I suspect that, whatever amount of resource one might give to the health service, there will always be squeals at this time of year. I think that the noble Baroness herself will remember the process all too clearly.
Baroness Noakes: I do remember the process. I was merely remarking that people in the NHS are not saying, "Oh, what a lot of money we've got!" Until we see the end of that process, I think that we might have to take with a pinch of salt the Minister's assertion that there will be so much money sloshing round next year that a few deficits will not make much difference.

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Basically, however, the Minister has confirmed to us that PCTs will have to pick up the sins of their forebears. I know that that will be a considerable disappointment to PCTs, who will find it difficult to know how to start their life with a deficit, even if they do not know how that deficit is to be calculated.
Lord Hunt of Kings Heath: Surely this is no different from any other restructuring in the health service when successor bodies take on the assets and liabilities of their predecessors. This is a normal process of structural change in the health service. Moreover, it seems to me that it would be wrong to wipe the slate clean. If we were to do that, surely we would be rewarding areas that have benefited from spending in excess of what we regard as their fair share. It would also send out the wrong signals to primary care trusts about the need to exercise financial discipline in the future. Surely this is the only sensible way in which to go forward.
Baroness Noakes: There are two ways forward. The first is to say that we shall give these new organisations a clean slate to begin with, and the second is to attribute a history from the previous organisation. Each is logical, and each has advantages and disadvantages which have been considered in previous reorganisations. There are two ways to proceed, and some PCTs will be disappointed at the Government's line.
We would like to think again about the issue. We should be grateful if the Minister will provide the additional information that he has undertaken to provide. Meanwhile, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 67 and 68 not moved.]
Baroness Noakesmoved Amendment No. 69:
Page 10, line 7, leave out "may" and insert "must"
The noble Baroness said: In moving this amendment, with leave, I shall also speak to Amendments Nos. 70, 71, 72 and 82. This group of amendments generally concerns payments to primary care trusts under the powers in Section 97C of the 1977 Act as inserted by Clause 8 of this Bill, while Amendment No. 82 deals with the corresponding amendment for Wales to Clause 9.
The effect of Amendment No. 69, which replaces "may" with "must" in subsection (3) of Section 97C, is to convert the Secretary of State's option as to whether he makes an extra payment to a PCT if it has satisfied its objectives or performed well against criteria. If the PCT has fulfilled its side of the bargain and satisfied its objectives and so on, why should the Secretary of State have the option to renege on his side of the bargain?
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Amendment No. 70 deletes the words "if it appears to him" from subsection (3). The effect of that is to turn the question of whether a PCT has or has not satisfied its objectives or performed well against criteria from a subjective test to an objective one.
Amendment No. 72 inserts a new subsection after subsection (3) which provides that the Commission for Health Improvement will supply the answer as to whether or not a PCT has passed the performance tests. The Commission for Health Improvement is fairly independent and so can provide the required objectivity.
The sum of those three amendments is to turn a subjective set of tests into objective ones. We on these Benches are far from convinced that the micro-management of PCT budgets via additional payments for achieving the Secretary of State's latest set of requirements is the right route. These provisions are a part of the Secretary of State's determination—as we have discussed before—to hang on to as much power as possible over the PCTs despite his decentralisation rhetoric. In our view, if these powers are to exist and to be held at the centre, they should be operated as rigorously and objectively as possible.
Lastly, Amendment No. 71 leaves out the words,
"(whether or not the method of measuring its performance against those criteria was also notified to it)".
Amendment No. 82 does the same for Wales. This removes a particularly nasty element of the performance payment regime contained in Section 97C. It is not new to your Lordships' House and we debated it in the context of the Health and Social Care Act 2001. The words allow the Secretary of State to move the goalposts or, even worse, erect goalposts after the game has been played.
PCTs can be rewarded for performing well against criteria notified to them as criteria relevant to the satisfactory performance of their functions. Under the terms of Clause 8 it is not necessary to tell PCTs how their performance will be measured. In management terms that is complete nonsense. There is a massive library of literature on rewarding performance, and I do not believe that there is one respectable page of it which would recommend setting measurement rules separately, let alone not notifying measurement rules. But, of course, the Secretary of State may not be interested in sound management practices because we know what he wants to do is to retain as many levers as possible over his NHS. It is not decentralisation. It is old-fashioned command and control.
These amendments are modest changes, designed to give PCTs more of a chance to manage their affairs within the Secretary of State's framework, without the arbitrariness of the powers as drafted. I beg to move.
Lord Roberts of Conwy: I am particularly interested in Amendment No. 82, which is very similar to Amendment No. 71 relating to England. I am not sure whether these two gratuitous lines that we seek to eliminate do not indicate a somewhat slipshod approach towards financial allocations.

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I am bound to say that subsection (3) as a whole reads very oddly in this clause. It says in effect that the Assembly may add to the initial amount allocated to the local health board if (a) the board satisfies notified objectives and (b),
"it performed well against any criteria notified to it as criteria relevant to the satisfactory performance of its function".
Then, as an afterthought, come the two gratuitous lines that the amendment seeks to delete.
My question is how on earth can a local health board perform well if it does not know the criteria against which its performance is to be measured?
I note under subsection (6) that the Assembly may also take away money from boards in the event of failure, wholly or in part, to meet any conditions imposed. What if the money has already been spent in trying to meet the conditions?
The arbitrary subtraction of moneys could in these circumstances have a seriously detrimental effect on the board's services. These arrangements are hardly reassuring so far as the local health boards are concerned, therefore, and seem to confirm our view that this clause gives the Assembly absolute discretion and very considerable latitude in financial matters.
Lord Hunt of Kings Heath: This is indeed happy, familiar territory and I hope that I shall be able to convince the Committee, as I am not sure I did last time we debated the matter, that there is a perfectly reasonable explanation as to why the particular words the noble Lord, Lord Roberts, mentioned should be in the Bill.
What subsections (3) to (6) of Clause 8 to the Bill do is simply to mirror, for primary care trusts, existing powers to make payments to health authorities. Essentially the Secretary of State is here taking power to determine how much to allot each primary care trust based on their performance. He may consider a whole range of factors and we believe it is right that he has the flexibility to determine if and on what basis those payments should be made.
The Secretary of State may want to increase the allocation to a primary care trust for a number of reasons —either as a reward for good performance against challenging targets, or perhaps to assist those PCTs that have under-achieved against certain targets and, therefore, need extra assistance. For example, the Secretary of State might want to reward PCTs to meet challenging waiting-list targets, as in the former performance schemes in operation in 2000–01. Primary care trusts might also take part in pilot schemes, in conjunction with the Modernisation Agency, or others, to develop new ways of delivering healthcare. It would be wrong to tie our hands and remove the ability and flexibility to respond to opportunities to improve local services for people
In 2001–02 all NHS organisations have received their fair share of the new performance fund, regardless of star ratings. High-performing, three-star organisations have, however, the freedom to spend the fund as they want. Organisations with unsatisfactory levels of performance have received their funding with
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strings attached. The Modernisation Agency signs off their plans and oversees the implementation and spending of the fund. That will also be the case in 2002–03.
Amendments Nos. 69 and 70 would take away the flexibility of the Secretary of State to consider whether performance payments were warranted in the light of other information. I believe that these amendments rather contradict Amendments Nos. 71 and 72, which seek to make payments dependent on reports by the Commission for Health Improvement. Amendments Nos. 71 and 72 would take away the flexibility of the Secretary of State to take into account such factors as CHI reports.
The Secretary of State should specify the precise measures used to assess performance. Indeed. I do not believe that there is any doubt in that respect. However, for important reasons, he might not be able to do so before the start of the financial year in question. Planning guidance published in autumn 2001 will affect the financial performance for the year 2002–03, which, in turn, will influence the performance ratings that are due to be published in July 2003. It would simply not be possible to commit ourselves to the precise measures and thresholds to be used 18 months in advance of the star ratings being published.
I know that the noble Baroness, Lady Noakes, and the noble Lord, Lord Roberts, said that this was like moving the goal posts. However, perhaps I may give the Committee an example of how this provision would apply. The recently published mortality indicator for all deaths within 30 days following an operation now includes subsequent deaths in hospital and at home. This is clearly a better indicator than using only the deaths-in-hospital statistic which was previously used. Many patients are discharged from hospital and die elsewhere. If, however, we tied ourselves to the old measure purely because hospitals knew about it 18 months ago when the planning and priorities guidance was issued, that would mean using an inferior indicator of hospital performance.
In terms of the integrity of the process, perhaps it would be helpful if I inform noble Lords that in 2002 CHI will publish the performance ratings, and in 2003 will take full responsibility for the process. It will still be for the Secretary of State to determine the priorities for the NHS, but CHI will have an active role in overall assessment. As CHI is an independent inspectorate, this seems to be an appropriate division of responsibilities as opposed to the Department of Health, which is accountable through Ministers to Parliament for the management and performance of the NHS.
Indeed, the department may well act on the recommendations of CHI, as was the case last September when the star ratings of two NHS trusts were downgraded to zero stars because of adverse CHI reports. However, I believe that it would be wrong to put CHI in the driving seat when determining if and how to make specific payments based on performance. Surely that is a proper function of the Secretary of State.

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As I have said, the Secretary of State may want to increase the allocation to a primary care trust for a number of reasons, either as a reward for good performance against challenging targets or, as I have said, to assist those primary care trusts which have under-achieved against certain targets and need extra assistance.
Amendment No. 82 concerns Clause 9, which deals with the funding of local health boards in Wales. The National Assembly is currently considering a new framework to promote continuous improvement in health and health services in Wales. That is based on a "balanced score card" approach. The Welsh approach will be to look at the situation in the round—the resources and pressures locally as well as the current performance—and will have a future orientation. It will not simply give good or bad marks but will look at capacity, processes and results and provide a strong steer to every health organisation to sustain good performance and make improvements over time where needed.
If performance were to be measured solely on numerical indicators, it would be straightforward to specify the exact methodology for measuring performance. Although numerical indicators will play a key role in performance assessment, they cannot illustrate every aspect of performance. To give an example, one element of taking a balanced view of overall performance would be to assess whether the healthcare system is in touch with patients, its staff and partners both in terms of expectations and satisfaction. For such an area, performance will be more appropriately assessed against statements and standards. To set out exactly how performance will be measured in advance might be counter-productive and restrict the autonomy of the Assembly to take into account all the information available in reaching that judgment. The approach being taken by the National Assembly is innovative and will need to be fine tuned to best accommodate nuances in assessing performance. I hope that noble Lords will accept that a straitjacket would not be helpful in the early stages of performance funding.
I hope that my example illustrates why it is important that the amendment should not be accepted and that some flexibility must be allowed in order to arrive at a balanced view of local health board performance.
10.45 p.m.
Baroness Noakes: I thank the Minister for that extremely comprehensive reply. He made a bid for flexibility. One man's flexibility is another man's lack of certainty. If we look at the arrangements for performance payments through the other end of the telescope, the primary care trust end, we might find that the view from there is that the Secretary of State does not want to give certainty to primary care trusts about how the performance regime will operate for them. He wants to retain as many controls over it as
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possible, including using indicators that were not even relevant when the PCT set out its plan for what it was to achieve and went ahead.
These are complex matters and the hour is late. I shall read the Minister's comments in Hansard with interest. Meanwhile, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 70 to 73 not moved.]
Baroness Noakesmoved Amendment No. 74:
Page 10, leave out line 42.
The noble Baroness said: In moving Amendment No. 74 I shall speak also to Amendment No. 75. With Amendment No. 74 we return again to the theme of the powers of the Secretary of State over primary care trusts. The amendment deletes paragraph (a) of subsection (8) of Section 97C of the 1977 Act as inserted by Clause 8 of the Bill.
Paragraph (a) allows the Secretary of State to give directions to a PCT with respect to moneys paid to it as allocations or as additional allocations for performance. The Secretary of State cannot have it both ways. He cannot say that on the one hand he is committed to decentralisation, to devolving decision-making to the front line and to freedoms and autonomy for PCTs while at the same time retaining massive powers to intervene in their affairs.
Paragraph (a) would give the Secretary of State carte blanche to tell PCTs what to do. This is not about strategic direction at a high level. There is no limitation on this power. It potentially attaches to every last penny paid to a PCT. The Minister may say that the Secretary of State needs these powers for when things go badly wrong and that he would not use them all the time. However, we are all well aware that statutory powers of direction, even though rarely used formally, are used often and significantly by way of background threat and inducement to achieve things. I believe that the power is grossly disproportionate and wholly out of keeping with the Government's stated intention to decentralise.
Amendment No. 75 is rather different. It inserts the word "reasonable" into subsection (9) of new Section 97C so that when the Secretary of State sets conditions as to records and certificates they must be reasonable conditions. I am sure that the Secretary of State would only act reasonably and therefore that the noble Lord will find it easy to accept the amendment. I beg to move.
Lord Roberts of Conwy: Amendment No. 83 relating to Wales is grouped with these amendments. It is an indication of general public concern in Wales that there should be equitable distribution of funds between local health boards in different parts of the country. That is a very sensitive issue in Wales. Ministers may have noted in Committee last Thursday that the noble Baroness, Lady Finlay of Llandaff, in her proposed new clause, ascribed to the national

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agency that she proposed, the function of overseeing "the equitable distribution of funds" to local health services. It is a very important issue.
We are all familiar with the fact that, for example, similar operations do not cost the same in different parts of Wales. There are tremendous variations in cost for fairly standard operations. I am sure that the Assembly will do its best to reduce those differences. There are similar variations in England.
We also have postcode prescribing in Wales. Certain drugs are available in certain areas and not in others. There are also variations in waiting times for hospital treatment. In these circumstances, there is a strong temptation to concentrate resources on the worse affected areas at the expense of the best served. The result is often to reduce the level of service overall.
Of course it is certainly not easy to define, and even more difficult to provide equity where funding is concerned. All sorts of factors have to be taken into account. There is the nature of the population, levels of morbidity, the NHS inheritance and so on. Nevertheless, in a country like Wales, some regard must be paid to the equity principle; otherwise people soon sense that one area is being unduly favoured at the expense of another and discord ensues.
I am bound to tell the Minister that I am not reassured by the fact that there are going to be different formulas operating in England and Wales. I do not see why we should not have the same formula operating in, both countries if there is any objective criterion which that formula must meet.
Lord Hunt of Kings Heath: I have noted with interest the suggestion of the noble Lord, Lord Roberts, that we operate the same formula. I suspect that many of the broad principles will be the same, but I think that there is some advantage in looking at how different approaches work out in practice. Obviously, it will be interesting to compare how this works through over the next number of years.
The effect of Amendment No. 74 would be that the Secretary of State could not impose any conditions on any of the allocations to a primary care trust. As we devolve power to the local level we clearly want to get as much resource as we possibly can to primary care trusts. But we also want to be able to set the general course for the NHS and to set national priorities. On occasion—I stress "on occasion"—we might want to ring-fence part of the allocation to ensure that funds are spent on the purpose for which they are allocated. We do that at present for out-of-hours development funds for GPs, and we must retain that facility.
On Amendment No. 75, under existing provisions for funding health authorities and primary care trusts, it has always been for the Secretary of State to decide what records each health authority and primary trust may keep, subject to the usual constraints of parliamentary accountability. So far as reasonableness
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is concerned, power must be exercised rationally. It cannot be exercised in a way in which no reasonable Secretary of State would act. On that basis, the wording of the amendment is superfluous. Obviously, the Secretary of State would always act in a reasonable way.
On Amendment No. 83, I listened with great interest to the comments of the noble Lord, Lord Roberts, about the issue of equity in Wales. That is a matter for the National Assembly, but I understand that the Assembly is committed to ensuring more equitable access for the entire population in Wales. As I said earlier, the Assembly is currently considering the outcome of a major resource allocation review, which is an attempt to close the gap between the worse off and better off in health terms.
The problem with Amendment No. 83 is that if it were accepted, the Assembly would be prevented from pacing the introduction of a new formula. Pacing is important. In any move to a new formula that could lead to large differences in the new allocation compared to the old one, we must ensure that the rate of introduction is paced. The problem with Amendment No. 83 is that it would inhibit the National Assembly's ability to pace that introduction. The National Assembly for Wales is exercised by the production of a fair formula. On that basis, I hope that the noble Lord will not press that amendment.
Baroness Noakes: I thank the Minister for that reply on both my amendments and that of my noble friend Lord Roberts. I cannot say that I am surprised by the Minister's views on Amendment No. 74. Of course, the power allows the Secretary of State to direct the smallest amount of activity in a primary care trust, because he is allowed to attach a power of direction to any tiny amount paid to a primary care trust. The Minister said that he may want to use that for ring-fencing to set direction for the NHS.
Of course, if it were simply a question of direction and balance, that would be much easier to understand. Perhaps at present we are lacking the words to give that sense in the Bill. In the light of the Minister's comments, I shall reflect further and see whether we can include in a direction-giving power something of a higher level to give sufficient freedom for primary care trusts. However, at this late hour, I shall not labour the point further. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 75 not moved.]
Clause 8 agreed to.
Lord Filkin: It is nearly 11 o'clock and I am aware that the House is sitting early tomorrow. I therefore beg to move that the House do now resume.
Moved accordingly, and, on Question, Motion agreed to.
House resumed.
House adjourned at eleven o'clock.