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Baroness Miller of Hendon: My Lords, your Lordships will be aware of the Codes of Conduct and Accountability for NHS boards, issued by my right honourable friend the Secretary of State on 28th April 1994. Your Lordships will also be aware of the Code of Practice on Openness in the NHS which the Secretary of State issued on 5th April 1995.

The Codes of Conduct and Accountability were warmly welcomed when they were issued last year, not least by your Lordships, and by the noble Lord, Lord Carter, a few moments ago. They were also welcomed by the Audit Commission, the Public Accounts Committee and Sir Adrian Cadbury himself.

There is wide acceptance that those codes have done much to ensure that the public service values of openness, probity and accountability remain at the heart of the management and operation of the NHS. They introduced new measures to enhance the accountability to their local communities of authorities and NHS trusts. All trusts and authorities now hold publicly available registers of board members' interests and those demonstrate to the public that the pursuit of private gain plays no part in any member's service to the board and to the organisation. Health authorities now produce annual reports. All boards have audit committees. All boards have remuneration and terms of service committees. Those are real steps forward in ensuring that the board is held accountable for the stewardship of public funds.

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Your Lordships have previously drawn comparisons between the requirements placed on local authority councillors and what is required of health authority members. That is not comparing like with like. Local councillors are elected. Health authority chairmen and non-executive members are direct appointees of the Secretary of State and are accountable to her. They can be more easily moved if necessary. For example, the current regulations governing membership make it clear that the Secretary of State can terminate an appointment if a member has failed to comply with the requirement to disclose financial interests. The codes are very specific about the requirement on chairmen and board members to declare any interest that may be relevant to NHS business, and that such information should be made available to the public in a register.

The Codes of Conduct and Accountability do not need to have legislative force to achieve their objectives. Current evidence is that NHS trusts and authorities are complying with the codes and that they are proving effective. To underline the importance of the new codes, my right honourable friend the Secretary of State for Health has made compliance with them a condition of appointment for all board members. There is therefore no suggestion that the requirements of the codes are not taken seriously by NHS boards. The noble Lord, Lord Carter, asked whether the results will be published. I shall have to write to him on that, because I am afraid that I do not know the answer.

The Code of Practice on Openness in the NHS was issued on 5th April and will be implemented throughout the NHS on 1st June. That code builds on the success of the Patient's Charter in making information available to the public. It aims to ensure that the public are well informed about the health service they fund; that they know what information is available and where they can obtain it.

The Code of Practice on Openness in the NHS is the first of its kind in the NHS. It is a code for the public: to help them understand what the NHS does for them and to enable them to hold their local NHS organisations to account. It sets out statutory requirements on publishing information and describes good practice in publishing other information. To give legislative force to that code would not enhance its effectiveness. My right honourable friend the Secretary of State has said that she is introducing the code of practice in order to promote a climate of openness, to foster a culture of co-operation and confidence. We believe the code of practice, as a flexible and non-statutory code, will help to achieve that in the health service.

I note what the noble Lord, Lord Carter, said about matters that happened in his area. I should like to refer to part of Section 5 of the code of practice which states:

    "details about important proposals on health policies or proposed changes in the way services are delivered, including the reasons for those proposals. This information will normally be made available when proposals are announced and before decisions are made; details about important decisions on health policies and

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    decisions on changes to the delivery of services. This information and the reasons for the decisions, will normally be made available when the decisions are announced".

That is, apart from exemptions later in the code, NHS trusts and authorities must publish or otherwise make available in the following information the matters that I have just discussed.

With regard to the rights of the regional office staff to speak out, the regional offices will have a different role to that of the RHAs. The new health authorities will be the operators in the new system. They will be taking the decisions that will directly affect local people. There will be no reduction in the rights of health authorities to represent publicly the needs of their populations.

The regional offices will contribute to the development of central policies for the National Health Service, monitor the health authorities and trusts in their areas and intervene managerially where this is needed. Those are responsibilities appropriate to the Civil Service and therefore it is right that the regional office staff should be civil servants.

The noble Lord, Lord Carter, was anxious about the charges for information. The code recommends that charging for information should be absolutely exceptional and that no charge should be made in the majority of cases. It also sets out where information must not be disclosed; for example, where details of other people are requested.

Clearly, the change in the rights of regional office staff to "speak out" is a change of status but it gives them more influence over central policies. As civil servants in the new order, they will have greater opportunities to shape central policies by offering advice to Ministers.

I hope that in the light of that explanation the noble Lord, Lord Carter, will feel a little more satisfied and will not believe it necessary to press the amendment.

5 p.m.

Baroness Jay of Paddington: My Lords, with the leave of the House, I was a little unclear about what the Minister said about the way in which the Code of Practice on Openness in the NHS applied to the new regional offices. It states in the introduction that this builds on:

    "and complements the Code of Access to Information which applies to the Department of Health, including the NHS Executive".

How will that apply to the regional offices?

Baroness Miller of Hendon: My Lords, as I said, the regional offices will have a different role from that of the RHAs. Under those circumstances, the regional offices will contribute to the development of central policies for the NHS and will monitor the trusts. Their responsibilities will therefore be appropriate to those of the Civil Service, so it is right that the regional office staff should be civil servants.

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Perhaps I may comment on a point made by the noble Lord, Lord Carter. He asked how the codes of practice will be amended. I do not have that information but I shall write to the noble Lord.

Lord Carter: My Lords, I hope that the Minister will not object if I say that that was not a very satisfactory answer. I am glad that she has spelt out the information which must be provided under Section 5 of the code. In the example that I gave, almost everything was done in complete breach of what has been suggested and we shall want to follow that up.

The arrangements for direct appointees by the Secretary of State to the various bodies raise anxieties about the declaration of interests and we hope that the new code will help to prevent the recent bad examples. I am surprised that the department has not taken a policy decision on the publication of the results of the survey as regards the Code of Conduct and Accountability. I hope that it will not be described as an imputed motive if I suggest that perhaps the department is waiting to see what the survey says before deciding whether to publish it. That is not exactly the openness of government that we should all like to see.

Charging for information was mentioned as exceptional but presumably it will be left to the trusts and authorities to decide what is exceptional and what is not. That will be a considerable disincentive to the small local groups that are set up to try to save a hospital or to protest about a closure. They will be discouraged by the charge for information, which I believe is excessive.

We have heard about civil servants at the regional offices being able to influence central policies and so forth. I wonder what will happen to the civil servant who does not believe in the internal market and how far his or her career will progress under the change of responsibilities that we have discussed.

The answer is not satisfactory but it is the kind of answer that I expect from the Government when we are discussing openness and accountability. I do not intend to press the amendment at this stage but we may wish to return to the matter on Third Reading. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Cledwyn of Penrhos moved Amendment No. 6:

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