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Lord Prys-Davies: I wish to thank my noble friends Lord Stoddart and Lord Elis-Thomas for their staunch support of the amendment. In view of one remark of the noble Lord, Lord Elis-Thomas, I should make clear that I was chairman of a Welsh hospital board from 1968 to 1974. That was many years ago; it was an unpaid office. However, I have not moved the amendment out of some nostalgic loyalty for the integrity of the excellent staff of that old Welsh hospital board. My basic reason for moving the amendment is our profound belief that the Secretary of State is making a huge mistake.

The Minister, with her usual courtesy, has disagreed with the amendment, as I feared she would. But she really has not disagreed in detail with a number of the basic points we advanced. With deepest respect to the Minister I must say that I, for my part, am wholly dissatisfied with her general comments. The Minister has not given specific confirmation that she will place the information that we have requested in the Library before Report stage. In our submission we are entitled to know what options were considered. The Minister said that the three clinical services were asked to consider the options and to produce their schemes. However, they were under instructions to do so from the Secretary of State for Wales. I ask the Minister to ensure, if she can, that the options, the criteria and the weightings are set out in a document in the Library. May we also have full particulars of the parties who were consulted? The Minister used a general phrase. We are asking for further and better particulars of that statement.

I also trust that we can soon have a satisfactory reply to the question posed by my noble friend Lord Elis-Thomas. We want assurances that the use of the Welsh language will not be prejudiced in any respect by whatever decisions the Secretary of State, in his wisdom, decides to impose. We are entitled to that confirmation. If we do not get it, it appears to me that he is flying in the face of the principles of the Government's policy as set out in the Welsh Language Act 1993.

It may be our fault that the Minister has not fully understood our case, but we will have to consider carefully what has been said. The Chamber this evening can hardly be described as full. Nevertheless, we will consider what has been said. It is clearly inappropriate

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to test the feelings of the Committee this evening and therefore I do not propose to press the amendment. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 2 agreed to.

Schedule 1 [Amendments]:

The Deputy Chairman of Committees (Lord Lyell): I must advise the Committee that if Amendment No. 13 is agreed to, I will not be able to call Amendment No. 14. I now call Amendment No. 13.

Baroness Gardner of Parkes moved Amendment No. 13:

Page 5, line 18, leave out from beginning to ("persons") in line 20.

The noble Baroness said: The patients are the most important group in the health service. I think we would all agree with that. But, after the patients, no one is more important than the medical practitioners, the registered nurses and the registered midwives. Therefore my amendment in no way seeks to denigrate them or to reduce their importance. Paragraph 3 of Schedule 1 states,

    "Every Health Authority shall make arrangements for securing that they receive"

appropriate advice. I consider that to remove the reference to,

    "medical practitioners, registered nurses and registered midwives"

would not in any way damage the paragraph because the advice would then come from,

    "persons with professional expertise in and experience of health care".

Medical practitioners, registered nurses and registered midwives are all included in that phrase. Throughout today it has been said again and again that the Government do not wish to be prescriptive in the legislation. The three groups designated in the schedule seem to me an example of being prescriptive. Their inclusion in the Bill therefore seems contrary to the line taken on every other amendment moved today. If we are to retain the reference to those three groups of personnel, I believe there is every justification for the case put to me by pharmacists who have asked why they are not included. I notice that the following amendment seeks to include registered health visitors in the schedule. What about dentists, osteopaths and chiropractors? We could mention a great many groups of people who would like to be included in the schedule. They all feel that they are equally important as the three groups which are named.

Earlier this afternoon the noble Baroness, Lady Robson, suggested that those groups are closest to patients. That is arguable, and it is also variable depending on the individuals involved and the areas in which they work. We heard from my noble friend Lord Carr that in his area community pharmacists are very close to patients. Therefore, one cannot say that those groups are named because they are the only professionals who are close to patients.

I believe that either we should not refer to any category but limit the reference in the Bill to people with professional expertise in and experience of healthcare or

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we should enlarge the list of those named to cover each and every one of the health professions to make clear that we believe that they should all be included.

I do not believe that any further presentation on the amendment is required. The position is perfectly clear, particularly in the light of comments made earlier this afternoon. I beg to move.

9.15 p.m.

Lord Carter: This is a very ingenious approach to the problem, which the noble Baroness explained extremely well. It appears that the intention is to exclude some in order to please all. I should be interested to know what criteria the health authority would use to choose the persons with professional expertise in and experience of healthcare if subparagraph (a) is omitted. The noble Baroness has ingeniously used a very wide definition. I entirely understand and support the anxiety of pharmacists, and all the other professions which are not mentioned, because—to use a football analogy—they seem to have been relegated to the second division as the Bill is worded.

The Minister has a very interesting choice to make when responding to the amendment. Either she accepts the amendment and infuriates everyone referred to in subparagraph (a), or she rejects it and infuriates all those encompassed in subparagraph (b). I shall be extremely interested to learn how she deals with the amendment.

Lord Rea: I shall say the same as my noble friend, but in different words. In contrast to Amendment No. 20 which the noble Baroness will move later, I oppose this amendment. I have to declare an interest as a general practitioner. However, I feel that the amendment would weaken the influence of the main professionals working in the National Health Service, particularly those named in the Bill, who would be deleted by the amendment. However, I do not feel that the amendment strengthens the case of the other professionals to be consulted or to act as advisers since instead of having a subparagraph in the Bill to themselves, they would have to share the same line with doctors, nurses and midwives, who are more numerous.

Baroness Gardner of Parkes: I am grateful to the noble Lord for giving way. He has misunderstood the amendment. They would not share the same line; the line would be replaced.

Lord Rea: But they would be included in the same line in the end. I suggest that, being included in the same line as the nurses and doctors, there would be more chance of their being forgotten than if they had a line to themselves as they do now. I very much hope that the noble Baroness will withdraw the amendment or that, if she does not, the Minister will gently oppose it.

Baroness Eccles of Moulton: I should like to say a word about the amendment. The purpose of the amendment to the National Health Service Act is to ensure that health authorities take advice. When one considers the enormous range of duties of the health authorities it is clear that they have to take advice from a wide range of health professionals. I shall be interested

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if my noble friend the Minister can explain why the three categories of health professionals mentioned in the Schedule have been selected so that special attention is drawn to them on the face of the Bill.

Baroness Cumberlege: To respond to the noble Lord, Lord Carter, he will know that the training for every Minister takes place on a high wire and one has to perform a balancing act.

Lord Carter: They fall off occasionally.

Baroness Cumberlege: That is undisputed.

I understand my noble friend's anxiety. The provision she seeks to amend was added to the Bill in another place because of the concern felt across the professions that their involvement in health authority decisions should not simply be left as a matter of good practice. We had already made clear in draft guidelines which were circulated widely to the professions and the NHS that involving healthcare professionals was not an optional extra. The amendment which the Government tabled in another place added weight to the guidelines which outlined the areas where professional involvement will be needed. These include strategic development of services, developing primary care services and contracting decisions.

The Government's provision makes particular mention of doctors and nurses, including midwives, as do the draft guidelines. There is no implication here that health authorities will have fulfilled their statutory duty by consulting doctors and nurses. They must involve a whole range of professions. This point is stressed in the draft guidelines—they list 20 or so different groups—and is made clear in the provision itself which covers everyone with,

    "professional expertise in and experience of health care".

Doctors and nurses are the largest groups of healthcare professionals. They are involved in virtually every aspect of patient care in hospital, community and primary care settings. It is appropriate to give them special mention in this amendment but I repeat that other groups have an equally important contribution to make in their areas of special expertise. I urge my noble friend to reconsider and withdraw the amendment.

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