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Baroness Cumberlege: My Lords, the new regional offices will be an integral part of the NHS Executive and therefore part of the reporting arrangements already in place for the Department of Health through the departmental annual report. That report, which is a Command Paper, is laid before Parliament and is available to the public. It describes in detail the department's expenditure and activities across all its responsibilities. All major developments during the year are included. Further information about NHS Executive activities is made public through a wide range of publications, including the NHS annual report and a new series of quarterly reviews as well as a range of statistical bulletins and issues-based newsletters. We already publish extensive information on performance management of the NHS and will continue to do so.

The noble Lord, Lord Carter, expressed particular concern about the move from the regional health authorities to regional offices which will be part of the Civil Service. He felt that the move would mean a loss of openness. I can assure him and your Lordships that information held centrally, which is not of a confidential nature, is and will be available on request under the open government provisions. Regional offices are not the bodies which need to be independent. Their role will be different from that of the old regional health authorities. It is the new health authorities which will be taking decisions that directly affect local people. They will be independent in the same way as regional health authorities are now.

Regional health authorities are artificial entities in public health terms. There is no particular reason why public health should be dealt with in one geographical administrative area rather than another. The new health authorities will be much more appropriate

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places for public health work. Their areas will be smaller than the regions and they can be more sensitive to local variations in health and health care needs. They will have better links with local government which is an important public health role.

The shift in responsibilities for public health from regional health authorities to the new health authorities means that it will no longer be appropriate to produce regional health reports. But there will continue to be over 100 district directors of public health reporting annually on public health issues, who are wholly independent, as now. Those directors can also work together on issues of common interest, supported as necessary by the regional director of public health. Public health reports will continue to be a key and welcome feature of the work of health authorities. Therefore, I cannot accept that the amendment is necessary. I hope very much that the noble Lord will withdraw it.

Lord Carter: My Lords, before I decide what to do with the amendment and because the Minister was helpful in referring to the departmental annual report, may I ask her whether she can tell the House what aspects of those "appropriate" activities will be spelled out in that report as opposed to being lost in the raft of general information that will be given on the work of the whole department? I am sure that the Minister understands that there is concern about whether there will be any attempt in the departmental annual report to try to tease out and explain what has happened in terms of the responsibilities to be transferred from the RHAs to the new executives. We need to know that, at least in the early years, so that we can ensure that those responsibilities are discharged effectively.

Baroness Cumberlege: My Lords, there is in addition the Chief Medical Officer's annual report which deals specifically with the nation's health. That is produced yearly and receives wide publicity with a press conference and an explanation of it. It would also be possible to include in that report on the health of the whole nation the reports of the 100 or so health authorities which I mentioned. If the noble Lord is seeking much more managerial information, I can advise him that that is contained in the annual report of the NHS, which is produced by the chief executive, and in its quarterly reviews. There is also a range of statistical bulletins. Different types of information are available, and I can assure the noble Lord that there is no intention to be secretive.

Lord Carter: My Lords, that is extremely helpful. The purpose behind the amendment was to get on the record what the Government intend to do. In the light of the Minister's reply, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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4.45 p.m.

Lord Carter moved Amendment No. 5:

After Clause 2, insert the following new clause:

Provision of information

(" . The provision of information by Health Authorities established under this Act shall be in accordance with those Codes of Practice which shall from time to time be issued by the National Health Service Management Executive or the Secretary of State.").

The noble Lord said: My Lords, in moving Amendment No. 5, I should like to speak also to Amendments Nos. 11 and 17. Amendment No. 5 deals with the new Code of Practice on Openness in the NHS which has been published by the NHS Executive. It includes not only a number of welcome provisions, but also some puzzling ones with which I shall deal. It states correctly at the start that it,

    "reflects the Government's intention to ensure greater access by the public to information about public services and complements the Code of Access to Information which applies to the Departments ... including the NHS Executive".

We can all welcome that.

The introduction continues:

    "Because the NHS is a public service, it should be open about its activities and plans. So, information about how it is run, who is in charge ... should be widely available".

Under the heading "Aims", the code spells out the extremely important second aim that people,

    "are provided with explanations about proposed service changes and have an opportunity to influence decisions on such changes".

The fourth aim is that people should,

    "know what information is available and where they can get it".

Your Lordships will remember that in Committee I referred to something that happened in my area of Wiltshire, which seemed to show that the whole of the consultation process had broken down badly. It is important to realise what is happening in a number of areas around the country. Perhaps I may again describe what happened and ask the Minister whether she feels that what happened was correct and whether it fits the code of practice that is before us. The example goes back to 1989 when a number of plans were published for reorganising the health plans in the district. There were public meetings—I attended some—and all were helpful. Everything was open. All sorts of plans were produced. New community hospitals were mentioned and there were discussions about the right sites for them. There was good local consultation and everybody was reasonably happy.

Things then went into cold storage because the plan depended to a large extent on the sale of some property. That sale did not take place because of the slump in the property market. Everything went quiet. However, everybody was still convinced that what had been promised would take place, but perhaps more slowly. Without anybody in the district knowing what was going on, a secret business plan was produced in September 1994 which completely reversed all the previous ideas and proposals. The promise of new community hospitals for several areas was removed. Hospitals were to be closed, without replacement. My area, with a catchment of about 35,000 people, was to have virtually all its services removed. That seemed to be because of the possibility of a housing development on one of the sites.

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All of that was in secret, despite all the previous consultations. When the report was leaked earlier this year and people saw what was proposed, as you can imagine, all hell broke lose in the district and throughout the county. The authorities then hastily backtracked and started a consultation process.

As I have said, page 3 of the code states that people should be provided,

    "with explanations about proposed service changes and have an opportunity to influence decisions on such changes".

All of us who have been involved in business know about business plans and that you do not spend a lot of time and money making such plans and then put them on the shelf as a theoretical exercise. The health authority involved had decided what it wanted to do—and that was a complete reversal of all the earlier plans. It was only because that secret business plan was leaked that we were able to achieve the fourth aim of the code, which is that people should know what information is available and where they can get it.

That is not the only such example around the country. As I said in Committee, the business of consultation starting after the authority has made up its mind is a farce. I hope that the Minister will be able to spell out exactly how the code of practice is supposed to work.

Before I turn to Amendments Nos. 11 and 17, I should like to deal with another interesting aspect of the code. I refer to the business of charging for information. Paragraph 7(b) on page 5 states:

    "for requests from people not listed above"—

that is, press and other media; community health councils; MPs; local authorities and citizens' advice bureaux—

    "no charge for the first hour and a charge not exceeding £20 per hour for each hour thereafter",

may be charged for time expended. In the case that I have just described, a local organisation has been formed, called Save Our Local Hospital. It does not have any real money and if it is asked to pay about £20 per hour after the first hour for such information, it will find it extremely hard to do so.

We had a good debate on the provisions of Amendment No. 11 in Committee, so there is no need to repeat the argument at length. When moving his amendment, Amendment No. 23, in Committee, the noble Lord, Lord Tope, gave a full list of everything that has to happen in local government regarding the declaration of interests. About half a column of the Official Report is taken up with a list of all those things that members of local authorities are required to declare. When the Minister replied, she mentioned the implementation of the codes of conduct and accountability. The Government seemed to have to rest their case on that. However, she also said:

    "Having introduced the codes of conduct and accountability, we have begun the process of monitoring their implementation. An initial early check will be completed next month"—

that was said on 30th March, so I presume that the results are due in April—

    "and the results will be reported to Ministers shortly afterwards".—[Official Report, 30/3/95; col. 1734.]

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Can the Minister tell the House when those results will be available? Indeed, will that report to Ministers be in the public domain and published? It is important that we know the way in which the code of conduct has worked in the early stages. A test of the Government's view of openness will be whether they make that information public.

The Minister's other answer which I found extremely unsatisfactory was her explanation of why health authorities are different from local authorities. She said that it is because local authorities raise taxes. She also said that the Government did not have any objection to the principle of the amendment. That is extremely important because, if they have no objection to the principle of the amendment, why not accept it or table a similar amendment themselves? Big sums of money are involved. We all know what happened at Wessex Regional Health Authority. We need not go into that again—it has been mentioned often enough. That is not the only case where a declaration of members' interests was vital.

Amendment No. 17 deals with "gagging clauses", as they are known. Again I am afraid that in Committee we had an unsatisfactory reply from the Minister, which is why we have tabled the amendment again. All sorts of examples were given in Committee about where health authority employees have been gagged, in effect, when they have tried—to use the jargon or slang—to blow the whistle, and I shall not repeat them. However, perhaps I may repeat a point I made on this amendment in Committee. The terms and conditions of service of hospital medical and dental staff used to contain a clause in paragraph 330 which stated:

    "A practitioner shall be free, without prior consent of the employing authority, to publish books, articles, etc. and to deliver any lecture or speak, whether on matters arising out of his or her hospital services or not".

That is an absolute freedom. It is a safeguard for public health, the public good, and for the professionalism of medical staff which is the cornerstone of the NHS.

Another matter to which I referred in Committee, and to which I do not believe the Minister replied, was the concern relating to the additional financial incentive for trusts, as employers, to keep quiet matters which might have a negative impact on their marketing (these are customers, not patients, we should not forget) of hospitals to purchasers such as the GP fundholders, health authorities and the rest. For all those reasons, there is now real concern about the lack of openness about information.

There is a difference in ethos and approach between working for an NHS authority and working for the Department of Health. There are practical issues regarding the freedom of speech. We have had it confirmed that civil servants are responsible to the Secretary of State and are bound by the Official Secrets Act. Will concerns about standards and procedures be aired publicly? RHA staff have a strong commitment to the NHS. They consider themselves to be health service staff. While they currently work for an RHA, most expect their employment paths to cover the various parts of the service on both the provider and purchaser side.

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There is a qualitative difference in being a civil servant working directly to the Secretary of State, whose career path could lead to other parts of the Civil Service outside the health service. The NHSE wishes to see more fluidity between the department and the service, but will that happen to any significant degree?

What will be the significance of all that for the service and ultimately for patients? RHAs are often rightly criticised as being remote and not attuned to the needs of the service. Will not the regional offices, staffed by people (however efficient personally) answerable directly to the Secretary of State, be worse? Is that not another example of the Government's tendency to centralise and direct under the rhetoric of devolution and the granting of freedom?

Will the Minister comment upon the footnote to page 3 of the Code of Practice on Openness in the NHS? At the top under "Scope" it states:

    "The Code of Practice covers the following NHS organisations".

The first it quotes is the RHAs. There is then a footnote which states:

    "Under the Health Authorities Bill at present before Parliament, Regional Health Authorities would be abolished on 1 April 1996 and District Health Authorities would combine with Family Health Service Authorities to form a single local Health Authority. When necessary, this Code will be revised accordingly".

When is "necessary"? How will the code be revised? It is a NHSE publication, and so presumably the code, or parts of it, will apply to the new regional offices. It would be helpful if the Minister could tell us how the code will be amended to take account of the changes proposed in the Bill. I beg to move.

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