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Lord Tope: I rise briefly to support this amendment, which in many ways speaks for itself. In the previous debate we were talking about the extent to which local and health authorities now work together, particularly in the field of community care. To me it seems inconceivable that the Minister or the Government would seek to vary, change or even abolish a health authority without consulting the relevant local authorities in that area who have been or would be working with that health authority.

But there is another reason why this amendment deserves to be supported. In part perhaps that is what the noble Lord who has just spoken was referring to. For better or worse, local authorities are now the only democratically elected bodies in the areas concerned. That is not to say that that is the sole and only way of consulting the public; nor should it be. Nevertheless, they are the only bodies that can claim legitimately to represent the whole of public opinion. That is another reason why they deserve to be consulted and indeed should be consulted before any such changes go ahead.

Similarly, the community health councils work closely with the health authorities and scrutinise them. It is hard to conceive that changes as envisaged in this clause of the Bill would go ahead without consultation with community health councils. If that is the Government's intention—I wish to believe that it is—I can see that it would do no harm. They would certainly give reassurance to those of us who need it by accepting this amendment.

Let me add a word about the nature of the consultation. Too often when local authorities are consulted, the time allowed for a response is ludicrously short. For matters of such importance, local authorities need time to be able to consult their communities, to get

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a proper response and not least to go through the inevitable committee cycle. The same is possibly even more true of community health councils, whose members are in every sense voluntary and where time is more limited. So, rather than simply pay lip service to this amendment if, as I hope, it is accepted, I urge the Government, in their consultation both on this measure and generally, to allow proper time for meaningful consultation and meaningful responses. If they do, I am sure that at the end the decisions will be very much better for it.

Lord Peyton of Yeovil: I welcome any opportunity that I have to agree cordially with the noble Lord, Lord Carter. I wrote down his exact words:

    "if we are going to have consultation, it should actually mean something".

I agree totally; but I should like to add a rider and ask whether he will co-operate with me in reaching agreement: the more consultation you have, the less it is likely to mean.

People become extremely bored with consultation. I wish that those who are constantly advocating more and more consultation would ask themselves this question: what would those who are taking part in the exercise be doing if they were not consulting? It is just possible that they might be doing something much more useful. Because I believe that to be very likely, I hope very much that my noble friend, despite the eloquence of the noble Lord opposite, will reject the amendment.

Baroness Gardner of Parkes: I find this a strange amendment in that it asks the Secretary of State to do all the consulting. A lot of consultation takes place now but it is not direct consultation by the Secretary of State. It is done by other people—tiers further down—who are in much more direct contact with groups.

Our trust has a "learning from patients" system, which we find immensely useful. The patients say what they find good and bad in the service that is being given and they say what they want to see. There are several meetings every year with community health councils. There are now consultations going on at all levels.

The noble Lord, Lord Peyton, mentioned that there was, perhaps, too much consultation. I usually agree with the National Consumer Council, but recently it wrote to me suggesting that we have a consultation about the form that consultation should take, which should be published in the newspaper. The extra layers that are being added and the times and delays are excessive. I cannot support the amendment.

Baroness Cumberlege: In the debate on the Second Reading of the Bill in another place my honourable friend the Minister for Health made it clear that the NHS will carry out consultation on the boundaries of the new health authorities. We believe that the public must be kept informed and given the opportunity to comment on any major changes that will affect the delivery of health services. My honourable friend also gave an undertaking that there would be no change in the requirement for health authorities to consult community health councils.

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Regulations will continue to require authorities to consult CHCs on proposals which would involve substantial changes in the provision of health services.

We—and the NHS—recognise that key local bodies such as CHCs and local authorities may have practical and constructive comments to make which will affect decisions on boundaries. I do not consider that it is essential for the duty to consult to be enshrined in legislation. We have already demonstrated our commitment to consultation by consulting on every boundary change since 1990 even though the 1990 Act removed the statutory duty to consult. It is our intention to continue to consult on boundary changes in most circumstances. That is sensible management practice.

I refute the suggestion made by the noble Lord, Lord Carter, that consultation is an empty process—I believe he described it as a "farce". I do not believe it is. I can reassure my noble friend Lord Peyton that plans have been changed as a result of consultation. The noble Lord, Lord Tope, was absolutely right in bringing us back to the purpose of the amendment, which is not so much about health services, but that,

    "The Secretary of State may, by order, vary a Health Authority's area, abolish a Health Authority or establish a new Health Authority".

It is looking at health authorities as an administrative entity.

We have made changes; for example, the consultation that we carried out when we were reducing the number of regional health authorities from 14 to eight and when the boundaries were changed in Cumbria before the orders were laid before Parliament. It is not therefore the Government's intention to ignore consultation.

My main objection to the amendments is not that they oblige us to consult; it is that they make no distinction between large and small changes. I take the point made by my noble friend Lord Peyton that it is important for consultation to concern serious issues and changes that really matter to people. There must be a distinction between those and others that make no difference at all.

I am fearful that we will lose flexibility if health authorities have to waste time consulting on every little change. They should be spending their time on more important things, like consulting the public on their purchasing plans and on proposals for service development. There is a real danger of overburdening people with consultation documents instead of focusing on what matters most.

Parliament agreed in the 1990 Act to remove the requirement to consult on health authority boundary changes. It did that to streamline procedures and to give us flexibility if we needed it. To give one example, a health authority may want to make a small change to its boundary to keep in line with its local authority. That is a sensible thing to do which avoids confusion. Very few people will be interested in that though the health authority will want to make sure that the handful of people affected—the local authority, the community health council, perhaps a couple of local GPs —know what is happening. A public consultation on such a change would be completely over the top and it would probably put the health authority off proposing the change at all.

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On that basis I am not able to accept these amendments which would remove necessary flexibility for no good purpose.

Baroness Gardner of Parkes: On a point of information, perhaps I can say to the Committee that I referred to the National Consumer Council. It may be that it was the Consumers' Association; I would not want to attribute the information to the wrong source.

Lord Carter: I am grateful to all those who have taken part in this short debate and particularly to the noble Lord, Lord Tope. As he emphasised, local authorities are now the only link with democratic election to show what people want to happen in the health service.

I was interested by the intervention of the noble Lord, Lord Peyton. He seemed to face both ways when he both accepted and rejected the amendment in the same sentence, which was very quaint.

Lord Peyton of Yeovil: I dislike the idea that I left the noble Lord in any doubt because that would be an extremely uncomfortable state for him to be in. In my most friendly desire to agree with him as far as I could, I said that I accepted what he said—that if we are to have consultation it must be meaningful. But I asked him to agree with me in certain other respects. In case the noble Lord is in any doubt, I reject totally his amendment and I hope that my noble friend will do the same.

Lord Carter: The support that the noble Lord gave me was similar to the support that he often gives to his own Front Bench. To be serious on this point for a moment, consultation goes badly wrong—I deliberately used the examples from my own locality—when people refuse to attend the consultation process because they feel that it is a waste of time. It was very badly handled in my area.

The amendment is worded in the way that it is because of the wording in the Bill, which says that,

    "The Secretary of State may by order (a) vary a Health Authority's area; (b) abolish a Health Authority; or (c) establish a new Health Authority".

That is a wide-ranging power and we felt that it was important that the organisations specified in the amendment should at least be given the chance to consult.

The Minister mentioned the undertaking in regard to boundaries, which is the least the Government can do, and also that it would be the Minister's intention to consult the community health councils where substantial changes are involved. But who decides what is substantial? Obviously it would be the Minister.

I did not say that consultation was a farce; I said that the people in my area now regarded it as a farce on account of what happened in the examples that I gave. The Minister made a fair point that the amendment makes no distinction between a small and a large change. But if she is prepared to accept the principle, we can easily come back with a reworded amendment.

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However, we have heard the words "streamlined" and "flexibility" before; they mean centralisation and quangos.

I do not think that I shall be able to change the Government's mind. I do not propose to divide the Committee on this amendment, but we shall return to the important point of consultation at a later stage of the Bill. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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