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Baroness Jay of Paddington: I apologise for interrupting but I wish to correct the impression about what happened in another place. An amendment very

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similar to this was discussed in Committee. It did not even include the words "to take back and consult on this issue". It simply did what the noble Lord is now suggesting constitutes a wrecking amendment. It asked for the paragraphs which come under subsection (1B) in my amendment to be reconsidered. I do not think that the noble Lord can draw on that analogy as a way of describing the impossibility of today's amendment.

Lord Carr of Hadley: I confess to being 20 years out of date with regard to what happens and to what is thought and felt in another place. It evidently has a more humane and tolerant attitude to these matters than it would have had 20 or 30 years ago.

What we have to do is not just discuss the matters which have been mentioned but look at what the amendment would do. It would insert into the Bill very complicated procedures which would take a great deal of time to bring to fruition. If they led to changes in the structure we would produce a health service which was an extraordinary pattern of different systems of organisation in different parts of the country. I cannot believe that that would be good for the development of better health services for the patients of this country.

It so happens that purely by chance I had to lunch today someone who was my personal assistant in industry during the latter part of the 1950s and much of the 1960s. She is now a widow living alone, of my kind of age. I shall not be more specific. We did not talk about the health service but at the end of lunch I suddenly looked at the clock and said, "I must hurry you away because I have to go to the House to talk about health". She said, "Before I go, may I just say to Parliament, 'Well done' about the health service. I now come under a budget holding practice and when I need to go to hospital I go to a trust hospital. I cannot tell you how much the health service has improved in my part of Kent since reorganisation." I believe that that is increasingly the feeling of many people in this country.

It is certainly the feeling in my part of Gloucestershire where more and more people are satisfied with the improvements they experience in the way the health service is working. I should be astonished if any government of any party substantially reversed the changes. They might trim them around the edges but the changes have come to stay. If they have not come to stay there will be a great revolt among the patients of this country who are seeing improvements month by month. If we were to insert into the Bill an amendment of this kind we would greatly reduce the speed with which our health services, both in general practice and in hospitals, are being improved.

Of course, not all is perfect. Of course, there are things wrong. But there always will be. And, of course, all the changes do not go right immediately; they go better in some areas than in others. But if one is looking, as we are in the case of the National Health Service, at an enormous organisation which employs about 1 million people and spends more money than any other organisation one can think of, one has to face the very difficult balance between what has to be centralised and what has to be decentralised. Anyone with practical

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experience of working in, let alone running, managing and directing a large organisation, has over the past 10 or 20 years come increasingly to understand that in order to make an organisation work humanely and efficiently some things have to be centralised. They need to be centralised effectively and they should be kept as few in number as possible. But other things have to be decentralised. They must be decentralised thoroughly. One must take some risks. If one puts in different layers of authority at the top and at the bottom, one gets delay, democracy, lack of speed in action and fuddled decisions.

No organisation as large as the National Health Service is perfect. It will always have faults which will need to be looked at. But I genuinely believe that results are beginning to show and that we are now on the right lines. Let us concentrate on getting those lines more right where they are not always straight at the moment rather than on trying to hold everything back and go backwards.

In moving the amendment the noble Baroness mentioned mental health, HIV and AIDS, drugs and alcohol abuse and so on, which she said would not be of attraction and interest to competing suppliers. But, with respect to the noble Baroness, that is standing everything on its head. She is not appreciating the crucial change that this service of ours is now becoming customer-driven rather than producer-driven. These things may not be of natural interest to specialised suppliers. But, my goodness, they are of prime interest to the purchasing authorities whose job it is to ensure that there are supplied in their districts the kind of services, including services for mental health, HIV and AIDS, drugs and alcohol abuse, and further education and training for all branches of the medical profession, which the patients in their areas will need. It is the purchasing authorities which increasingly have the power: they are the ones which represent the patients. That is a move in the right direction. It is because that is beginning to be felt by patients that my friend who had lunch with me a couple of hours ago said what she did on leaving.

4 p.m.

Lord Carter: Perhaps we may return to the interesting point made by the noble Baroness, Lady Gardner of Parkes. She said that this matter is not yet another reform of the health service but part of the seamless robe of reform which started in 1990. I was on the Front Bench team with my noble friend Lord Ennals during the passage of the Bill. I have looked through the Act and there is no reference in it to the abolition of the regions. In fact, all through that legislation the regions are built into the whole structure, including their functions. The idea that the abolition of the regions is part of the original reforms thought of at the time is plainly wrong. In fact, that is the reason why we have this Bill: to do away with them and their functions. It is reasonable to have a discussion on their functions and authority and the arguments which we shall produce for retaining them. But to imply that it is all part of the reforms that were thought of in 1990 is not correct.

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Lord Peyton of Yeovil: My noble friend Lord Carr, like the pioneer that he is, broke absolutely new ground in actually referring to the amendment. I want to follow his very distinguished example. I differ from my noble friends who describe the measure as a wrecking amendment. I believe that the first half of the amendment is just quaint and I wonder what it will achieve. In a moment I shall invite the attention of the Committee to the amendment in some detail. The second half of the amendment is undoubtedly calculated to do damage to the Government's proposals and with that I would not agree.

I invite the Committee's attention briefly to the first four lines of the amendment which states,

    "Before making any order under subsection (1) above, the Secretary of State shall consult such persons as he considers appropriate".

I do not believe that one would be assuming too much if one took it for granted that the Secretary of State has already consulted those persons whom she considers to be appropriate. I believe that that would go without saying. When she was consulting about the desirability of making the order under this section, I do not believe that she could have been in any doubt as to the advice she would receive from those persons whom she considered it appropriate to consult.

Then there is the proposal that the Secretary of State shall lay before Parliament a report on the consultation which has taken place. I wonder whether any of your Lordships would be so bold as to rise in his or her place this afternoon and assert that a detailed report on those consultations would be of any interest at all. I believe that it would be a great waste of time save to those who suffer from insomnia.

As I have already said, it must be apparent that the next part of the amendment is designed to make nonsense of the Government's proposals and to render them meaningless. The amendment continues:

    "If either House of Parliament resolves, in the light of the report made ... that the Secretary of State shall not make any order"

then certain things will follow. The report received would not put any fetter on the right of either House of Parliament to reject the Government's decision. Therefore, one must assume, as I have said, that the first part of this amendment is quaint, and the second merely wrecking.

Perhaps I may trouble the Committee for a moment or so with a recollection from my own past, a very long time ago—not all that long, it seems, after Noah landed in the Ark—when I found myself a member of a regional hospital board. I say nothing which reflects any disrespect whatever on the membership of the board—I would be taking great risks if I did—or on the quality of its officers. To put the matter very politely, it seemed to be yet another layer of administration. Its product was very large indeed when measured in terms of paper. It was a real paper mill.

I would just like to weary the Committee for a moment with one particular recollection. One day, having gone through a huge mass of paper, I inquired of one of the officers as to what value my opinion would be on whether Dr. So-and-So of Tewkesbury should have six months' sabbatical leave or on what a needle

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sharpener in Bodmin should be paid. I said that the knowledge and quality of my advice on both those subjects would be absolutely nil. The answer came clearly: "Sir, officials must be protected".

One needs to be very careful before one perpetuates the bureaucratic machines which spread paper and which ask people to pass opinions on matters as regards which they do not have any detailed knowledge.

My noble friend, Lady Cumberlege, is a most gracious lady and I am sure that she would be the first to acknowledge the generosity of the Opposition in offering her this opportunity to reconsider. But I suspect that, like so many gifts on offer today, this is not one that she will particularly value. It would not altogether surprise me if she triumphed over her habitual graciousness and actually turned it down flat. In fact, I shall go further and say that I very much hope that she will.

There is one further point that I should like to make. I recall in my distant days long past in the other place that the only weapons of Oppositions were time and delay. One of the ways to take up a little time when some particularly tiresome Bill was in the offing, was to propose a little more consultation: somebody else ought to be consulted for no very good reason, but they ought to be consulted because it would be a friendly thing to do. As a result we have the most elaborate machinery of consultation laid on us in this country which is time wasting and costly in terms of cash.

I was talking just now to my noble friend Lady Faithfull who has a very great knowledge of the social services. She was assuring me of how the social services would be relieved of an extremely tiresome duty if they had to consult only one level of administration instead of two. I am not always very friendly towards the Government's legislation, but on this occasion I find it a joy. I particularly admire my noble friend Lady Cumberlege. I find it a great joy also to support what I regard as a thoroughly sensible measure. I have no doubt that my noble friend will wish to throw out an amendment which, as I have said, is quaint in the first half and in the second just damaging.

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