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Baroness Jay of Paddington: Perhaps I may ask the noble Baroness a logistics question. Is she saying that the Government will bring forward amendments which encompass the proposals in the document published today on the second day of Committee stage of this Bill or will they be left to a later stage?

Baroness Cumberlege: When we come to the amendments, I shall be able to explain more fully the safeguards that we propose to enable these contracts to be held by trusts. At the moment, the proposal is that the contracts should be split: educational contracts to be held with the postgraduate medical deans and the normal employment contracts to be held with the trusts. I shall go into this matter much more fully. I appreciate that the Committee has not had a chance to see the consultation document, which is the key to much of this debate.

Baroness Jay of Paddington: I am sorry to pursue this matter, but does it therefore mean that this will be discussed in detail on Report?

Baroness Cumberlege: As I understood it, it will be at Committee stage on Thursday.

Lord Rea: What the noble Baroness said is extremely interesting. I am sure that her words will be read with great care by all the Royal colleges, the British Medical Association, many universities and all those practitioners in the field concerned with postgraduate medical education. As I said, we shall also study this document in greater detail. I am sorry if I misinterpreted some of its recommendations, but we shall come back, having digested the document more fully. I also hope to discuss the matter with the colleges and the British Medical Association before we debate it again in Committee. At this time, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Dean of Thornton-le-Fylde moved Amendment No. 16:


Page 7, line 17, at end insert:
("(c) of responsibilities exercised prior to the passing of the Health Authorities Act 1995 by Regional Health Authorities in respect of public health initiatives requiring that those responsibilities should continue to be provided on a regional basis.").

The noble Baroness said: The issue of the present structure of regional health authorities, the duties and responsibilities that they carry and how they will be transferred to the new health authorities form a theme that has run through the whole of our debates on the Health Authorities Bill. It came up at Second Reading and has come up today as well.

There is a lot of concern that many of the regional features of the present regional health authorities will go by the board. In fact, they will no longer be carried out at a regional level. This amendment will have the effect

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of ensuring that the best key features which are currently carried out at regional level will continue to be carried out.

At the moment regional health areas, and particularly the regional director of health, has a standing in the community on a whole range of issues. For instance, if there was a factory being built that was going to create a lot of pollution, the regional director of public health could be brought in and express a view on behalf of the people in the community. He could be consulted on new developments and general health issues in the region. The regional director of public health is currently required also to commission an independent report for the regional health authority on the population in the region. That report is drawn together from the districts. It assesses the need for regional specialist services—an area about which we have expressed concern during the discussions on the Bill—the development of teaching facilities and links with universities.

A question that we raise in relation to the provisions of the Health Authorities Bill is that, when one sees the transfer of regional staff, including the executive person, into the national health executive as an employee, thus becoming a civil servant, it is difficult to understand how that person can be accepted in the eyes of the local community as a person of independence; someone whose voice speaks purely from the health point of view and not necessarily from the fiscal point of view with all its usual constraints. It is not simply a matter of implementation therefore; it is also anxieties about the enactment of the responsibilities of the regional public health director.

Perhaps the Minister will address a number of questions when she responds to the amendment. Will the regional director, while a civil servant, continue to publish the annual reports? Will he have independence or be required to conduct himself as a civil servant with the obvious understandable constraints on him as an individual that that implies when carrying out the job? Will constraints be placed upon him in carrying out how he sees what is a wide-ranging remit?

At first glance it may appear that there will not be a great deal of difference; it will still be the same people. But in fact the functioning of this responsible area of work may be considerably different. It is that, linked with the specialist services, linked with what is needed in the region in relation to teaching facilities, technology and links with universities, that need to come from regional level and which themselves will feed into a national policy directorate. How will the Bill address those concerns? We do not believe that the Bill as it stands addresses them. I beg to move.

Baroness Cumberlege: Today and earlier in our Second Reading debate we heard a great deal about the crucial role played by regional health authorities in public health, leading the way in new policies, taking the strategic overview of the so-called Cinderella services, spearheading specific health of the nation projects, supporting health promotion, creating health alliances, leading local purchasers in creating a knowledge-based, effectiveness-led NHS. It has been a record of highly creditable achievement.

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The public health role of the new regional offices will continue to be crucial, but it will be different in character. The role was spelt out last summer in the NHS executive document, Public Health in England: Roles and Responsibilities of the Department of Health and the NHS. That report emphasised that, subject to our deliberations on the Bill, regional directors of public health and the new regional offices of the NHS executive will be responsible for ensuring that public health considerations drive the work of the new regional offices and ensure that public health functions are discharged effectively in each of the regions.

Some public health functions previously undertaken by regional health authorities can safely be devolved to the new health authorities with their larger resident populations. An important example is the purchase of breast cancer screening services. However, we recognise that a number of the present regional public health functions are more efficiently organised for populations larger than even the biggest of the new authorities.

An executive letter issued to the NHS on 10th March of this year identified four such functions. Those are: work associated with a confidential inquiry into stillbirths and deaths in infancy; the purchase of cancer registry services; the purchase of quality assurance services for breast and cervical cancer screening; and the appointment of doctors under Section 12 of the Mental Health Act 1983. Subject to the passage of this legislation, responsibility for these four functions will pass to a lead health authority which will undertake the work on behalf of all health authorities in the region, supported and monitored by the regional office. We believe that this approach allows decisions to be taken, as far as possible, at the local level where they can be influenced by the professional staff with most knowledge of the relevant health needs and healthcare services. It allows the necessary strategic view to be taken and permits more effective monitoring. Public health staff in the regional offices will have an important responsibility to ensure, through close liaison with a range of healthcare professionals in primary and secondary care, that health needs are properly assessed, outcomes reviewed and appropriate responses put in place.

The noble Baroness asked me whether the regional director in future will publish annual reports. I would expect them to contribute very heavily to the chief medical officer's annual report which covers all England and Wales. But in the future we would expect local health authorities to publish their own annual reports, part of which would, of course, take into account the public health aspects. It would be inconceivable for a health authority to publish a report without that important underpinning of expertise and knowledge. In the light of what I have said, I hope that the noble Baroness will withdraw her amendment.

9.45 p.m.

Baroness Dean of Thornton-le-Fylde: I regret the fact that the Minister's answer does not give me much comfort. It goes no way towards meeting the questions

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and points that I raised. However, I recognise that it would not be very constructive to divide the Committee at this stage. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Robson of Kiddington moved Amendment No. 17:


Page 7, line 44, after ("area") insert ("provided that no such council shall be a council for an area larger than the area of the council for the area of the Area or District Health Authority which that Health Authority has replaced").

The noble Baroness said: This amendment seeks to ensure that community health councils are not overburdened under the reorganisation. Where two district health authorities are replaced by one new health authority it is essential that both those community health councils are preserved. One cannot demand of a community health council that it should cover an area twice the size that it has previously covered. The members are all volunteers. They give an enormous amount of their time. As the Minister agreed, they have given invaluable service, advice and help to the health service. They are the main statutory bodies representing the general public. It is important that they should not be given too much to do where they cannot possibly fulfil the demands which the general public will make on them. Where two district health authorities are put together, I ask the Minister to agree that there should be two community health councils serving that health authority or that the number of people on the community health council should be doubled. I beg to move.


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