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Baroness Gardner of Parkes: Before the noble Baroness sits down, perhaps I may refer back to the matter of the pharmacists. The noble Baroness said that the three groups mentioned in the amendment are those most closely connected with the community. However, I met a number of pharmacists today. They assured me that the role of the pharmacist in the community is greatly increasing. Indeed, the aim is for many patients to go first to the pharmacists before they visit their GP. That would lighten the load for general practitioners. In fact, the pharmacists ask why the regulations cannot be such that eventually the GP, through information technology, can input prescriptions directly from the practice to the pharmacy. All those measures would save time for GPs.
We have had debates in this Chamber on the increasing role in the community of pharmacists. Therefore, we must accept that they are very much a group which is directly involved with the community and, indeed, are probably more readily available to patients as regards their hours of working than is the case with most surgeries.
Baroness McFarlane of Llandaff: I have a personal interest in supporting this amendment as a registered nurse and midwife. If I have a criticism, and if I must be pedantic about words, it is the words "representatives of" because the schedule states,
the stated professions. I think that is rather different. My contention is that this matter of health authority membership is not a matter of narrow sectional interests or professional sectional interests. In the discussion in the Committee today we have heard that many different
Baroness Eccles of Moulton: It is important to rememberas my noble friend Lord Boyd-Carpenter has saidthat the Secretary of State is of course presently empowered to appoint any health professional to a health authority. It would be interesting to know how many are serving on health authorities at the present time. However, the difficulty we have here is the representative aspect of this proposal. It is important that health authorities are made up of people from as wide a range of experience as possible, and also that they are tailored to suit the needs of the particular area that the health authority serves. In my view, I do not think that it would be at all helpful to be prescriptive in this matter.
Before 1991, health authorities had a number of representatives. These comprised doctors, nurses and trade union representatives and it was difficult for them, having been appointed, to leave their professional hats outside and not to allow their special interests to influence the policies that were being debated. Under the present arrangements we have a health professional on our authority; but they are not there as a representative and in no sense do they feel under any obligation to promote the interests of their own sector because they are appointed in their own individual right, and of course the professional knowledge and expertise that they bring is valuable. But as they are not a representative, they do not feel they are under any obligation.
At present, as regards advice, we take advice from a wide range of professionals, and this is extremely helpful. But that is quite a different matter to selecting an individual to sit on a health authority representing a particular profession. Incidentally, as regards the size of authorities, if a body is to be able to take decisions in an effective way, I believe that it should not comprise more than about a dozen persons as above that number the body's effectiveness immediately becomes restricted. I fully support the inclusion of health professionals on health authorities. They are of great value in an independent capacity and if they are appointed where appropriate. However, I do not support the proposal that such a requirement should be specified in the Bill.
Clearly a health authority will have a chairman. However, in any health authority with which I have come in contact, the officers of the health authority to a large extent include the professionals which are described in this amendment. Therefore I believe that to a great extent this amendment would duplicate what is already in the Bill in paragraph 59.
Lord Rea: I hesitate to engage in discourse with the noble Lord, Lord Boyd-Carpenter, on terminology in a Bill because he has such vast experience; but I should like to see the word "may" replaced by "shall". As the noble Lord knows full well, "may" is frequently used in legislation and allows a certain amount of leeway. I see it as a flagging up of the fact that the Minister may appoint these categories of people, so that if he does not appoint them, it can be pointed out that he was entitled to do so. If it is not on the face of the Bill, he might be able to smooth that over and it would appear that it is not within the range of possibilities that he can appoint those categories of people.
Lord Carr of Hadley: We must never lose sight of our main objective in discussing these matters, and that, surely, is to produce the smoothest working, most effective, health service that we can from the point of view of the patientsall our fellow citizens of this countryand to use every penny we possibly can on patient care out of the £30 billion-odd we devote to it, and to save every penny we can on administration, provided we get an efficient, smooth service.
As regards the functions of any board of directors or authority of this kind, there are two limiting factors. One is the size of the membership. If a body is too large, it is not a good policy-making body. I do not think I need enlarge on that. People have different ideas as regards ideal numbers. However, a figure any higher than 15 is getting dangerously high. I think anything over 10 is probably getting dangerously high. However, one must decide on a number.
As regards implicating professionals in this matter, if we are to appoint them as representatives, as my noble friend Lady Gardner of Parkes and others have already pointed out, there is no end to the number of people whom we could appoint as representatives. There are different aspects to the profession and people involved in these aspects all have a great role to play in this matter, not least the pharmacists. I live in a country area and I know of the role played by pharmacists in advising people who live in a country district with a dispersed
Secondly, there is also the matter of whether it is rightin my view it is not right in principleto have any board or committee packed with too many experts. I am not saying for one moment that we should exclude from membership a doctor, a nurse or a pharmacist. It would be mad not to include people with that sort of background. However, I submit that they should not be representatives. Many years ago now I had some years' experience as a member of a board of governors of one of our large London teaching hospitals. It was an admirable body but its membership was so large and so diverse that from a management point of view the body was useless. It served other purposes but it was a poor directional body. The governing body's main committees were also large and had all sorts of representatives on it. There were also some small sub-committees.
I remember very well serving on a small sub-committee which was charged with looking at rough specifications for the new St. Mary's which we hoped might be built some time in the next few decades, if not sooner. That small committee of eight people included two doctors. They were distinguished members of our staff, but because they were so busy they were seldom able to attend meetings every month. One or other might attend, but rarely both. They were highly dedicated menboth now, sadly, long since deadwho had different views. We reached the ridiculous position where we listened to one doctor one month, and the next month the other doctor attended and proposed the exact opposite of what his colleague had proposed. When we finally produced a report for the main sub-committee of the board the doctors and nurses argued about it because they could not accept that those members of our committee had the power to represent the medical view or the nurses' view.
Therefore, we must have people with relevant experience, but above all we must be free to ask such people to give evidence and to talk to us. If one has official representatives of doctors and nurses others are shy of coming. However, they must be free to come and give evidence. Once one has an official representative one is going down a very dangerous path leading to long delay and uncertainty of decision.
As I understand it, the purpose of the amendment is to ensure that there is a balance. I understand that the drafters of the amendment want to see that a balance is maintained between primary and secondary healthcare. With my longstanding interest in urban priority areas, I have taken a special interest in the health divide, ever since the Black Report and much else. I am clear that if we want to remove that health divide then primary healthcare is the place where principally that has to be
In a city like Liverpool one can draw health on the map very easily and predictably, showing dramatic differences. Better take up of healthcare, better education, better diet and better hygienethe issues which primary healthcare addresseswill shift the ground infinitely more than what happens in hospitals.
It is very important that the membership of the boards should be balanced and should include sufficient interest in primary healthcare in order to fight that corner.
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