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Lord Dubs: Perhaps I may briefly make a further comment. I thank the Minister for clarifying the position regarding the auditors. He has confirmed that the Bill as drafted means what the amendment is intending to achieve, so I am happy to have that assurance. However, I am less happy about the Minister's comments in relation to the question of how the accounts should be kept.

The Minister said that the Housing Corporation would not require accounts to be presented in a different form from those normally required by the Accounting Standards Board but that the corporation might in some respects want more detailed information to supplement the normal Accounting Standards Board requirements. That is fairly clear. If the amendment to which I was speaking is accepted, the Bill would say:


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I should have thought that those words would actually meet what the Minister said and clarify the position beyond doubt so that we would not run the risk of having accounts presented in two different ways by the same social landlord. It would have the other advantage that all social landlords, whether or not they come under the Companies Act, would present their accounts in a similar way and conform to similar standards. I should have thought that the Minister's argument leads to the outcome which the amendment would achieve. I wonder whether he would think again about the merits of the suggestion in Amendment No. 33.

Lord Lucas: What paragraph 16 of the schedule achieves is that all social landlords will produce their accounts in the same format. It also says that the format will be determined by the Housing Corporation alone. We think that is right. It has its own requirements and it should be able to insist on accounts which show what it wants in the way that it wants.

I am sure that the Housing Corporation is made up of sensible people. It certainly is at present and it probably will be in the future. It will wish to work as far as possible with the grain; and that will mean, as far as possible, with accounting standards recognised for companies and in general for other bodies. That is why the Housing Corporation at the moment says that in practice all it would expect to be needed is a certain amount of supplementary information presented with the accounts and reported on by the auditors. We think that the powers should be there to enable the Housing Corporation to get what it wants in the way that it wants without being forced to comply with the wishes of some other body which has a different set of interests.

Lord Dubs: I see that the Government are not to be persuaded. I still regret that that is the Minister's position. We may well find that those social landlords who come under the Companies Act, if they wish to avoid producing two sets of accounts, may, in conforming to the Housing Corporation requirements, be departing from the requirements of the Accounting Standards Board. The Minister said that the Housing Corporation will be sensible and that--I am paraphrasing what he said--it will take account of the standards of the Accounting Standards Board in order to achieve a satisfactory outcome. In other words, the Minister is saying that he will not put it in the Bill but the Housing Corporation had better do what the amendment says. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment Nos. 34 and 35 not moved.]

Lord Lucas moved Amendment No. 36:


Page 125, line 40, after ("with") insert ("the").

The noble Lord said: This amendment corrects a drafting error. It inserts the word "the" between the words "with" and "consent" in paragraph 19(4) of

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Schedule 1. While "with consent" may make sense in certain circumstances, in this one it does not. I beg to move.

On Question, amendment agreed to.

Lord Lucas moved Amendment No. 37:


Page 126, line 7, at end insert ("or persons").

The noble Lord said: In moving this amendment, I wish to speak at the same time to Amendments Nos. 38 to 45. These amendments are necessary because the current wording of paragraph 20(7), which deals with the conduct of an inquiry by more than one person, is ambiguous and unclear. Paragraph 20(7) was introduced as an amendment at Commons Report, consequent on another amendment providing that more than one person can be appointed by the corporation to conduct an inquiry. These amendments therefore represent a certain amount of polishing that is required. I beg to move.

On Question, amendment agreed to.

Lord Lucas moved Amendments Nos. 38 to 45:


Page 126, line 8, leave out ("considers") and insert ("consider").
Page 126, line 11, after ("person") insert ("or persons").
Page 126, line 11, leave out ("he thinks") and insert ("they think").
Page 126, line 12, leave out ("him") and insert ("them").
Page 126, line 14, after ("person") insert ("or persons").
Page 126, line 15, leave out ("and in such form").
Page 126, line 15, at end insert--
("( ) An interim or final report shall be in such form as the Corporation may specify.").
Page 126, leave out lines 16 to 20.

The noble Lord said: I have just spoken to these amendments. I beg to move.

On Question, amendments agreed to.

Lord Mackay of Ardbrecknish: I beg to move that the House do now resume. In moving this Motion, perhaps I may suggest that the Committee stage begins again not before 8.15 p.m.

Moved accordingly, and, on Question, Motion agreed to.

House resumed.

Healthcare 2000 Report

7.17 p.m.

Lord Hacking rose to ask Her Majesty's Government what is their response to the issues raised in the Healthcare 2000 Report.

The noble Lord said: My Lords, my purpose in tabling this Unstarred Question is to draw attention to the Healthcare 2000 Report and to seek the considered response not only of Her Majesty's Government but of Her Majesty's Opposition to the report. I am therefore delighted that the noble Lord, Lord Rea, a general practitioner in London, is speaking from the Opposition Front Bench and, although I am sad that my noble friend

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Lady Cumberlege is unwell and is unable to participate in the debate, I am delighted that my noble friend Lady Miller is replying on behalf of the Government.

Lord Graham of Edmonton: Hear, hear!

Lord Hacking: My Lords, I am glad to have support from the noble Lord, Lord Graham. Perhaps I may also say that I am delighted that a dental practitioner in London, the noble Lord, Lord Colwyn, is taking part, as indeed is the noble Lord, Lord Butterfield, who has held a number of very distinguished appointments both in hospitals and in academia. Although this report was published in September of last year, this is the first occasion that either House of Parliament has considered it. When the report was published there was comment from the political parties which, alas, was more political than constructive in its response. Perhaps, in fairness to my noble friend the Secretary of State, I should state that he was asked questions somewhat early in the morning on the "Today" programme and probably at a time before he had had an opportunity to give the report full study. Comment from the media was also more of the hysterical than the thoughtful kind. The so-called informed press was more hysterical than other organs of our other press. Indeed, to a leading article in the Independent of 20th September 1995 there was the heading, "Faulty diagnosis ... dangerous".

This is not the only report that has been recently issued which expresses concern about the future of healthcare in this country. The Royal College of Physicians published a recent report. In a press release the report is described as saying:


    "The criteria and procedures for determining priorities are inadequate and rationing in the National Health Service should be more openly discussed".
The British Medical Association and the NHS Consultants' Association also issued reports.

Therefore, I shall be arguing in my short speech that this is a thoughtful report that deserves and merits a thoughtful response. There have been enormous changes in the needs of patients and in the services of the National Health Service since it was founded in 1947.

The report has been funded by a number of leading pharmaceutical companies based in this country. The composition of the steering committee, chaired by Sir Duncan Nichol, was of very wide composition, consisting of doctors, clinicians, patients associations, academia and healthcare directors. There was also the widest consultation including not only critics of the National Health Service but also of the pharmaceutical industry. No fewer than 50 healthcare organisations were consulted. I make it plain that I have no interest whatever to declare under the rules of the House, including the latest resolutions, but I am most willing to tell your Lordships, as some noble Lords know, that I am in practice as a lawyer in the City of London and among my clients there are pharmaceutical companies.

The thoughtful report begins in Chapter 2 with an analysis of the challenges that face the National Health Service now and in the years ahead. The major advances in surgery and in treatment, computing and information technology have resulted in a widening gap between the

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provision of resources available to the NHS and the ability of National Health Service patients to receive those resources.

In Chapter 3 there is a very careful evaluation of the purposes and values of the National Health Service. As regards Chapter 2, I draw to your Lordships' attention one very important matter; namely, the analysis of demographic changes. The report identifies the fact that there are 9 million people currently over the age of 65 and 900,000 persons in the United Kingdom over the age of 85. By the middle of the next century, in the year 2050, there will be 15 million persons over the age of 65 and 3 million over the age of 85. A rather graphic way of describing this demographic change is that when Her Majesty first came to the Throne in 1953, I believe that she sent 270 telegrams to those who had reached the age of 100 years. I understand that Her Majesty is now sending nearly 3,000 telegrams, faxes--perhaps she is even using E-mail--to those who have reached the age of 100.

Similar demographic changes have been identified in the United States of America where there are 6,000 more Americans celebrating their 65th birthday as every day passes. By the year 2030 it is calculated that in the United States of America there will be more persons over the age of 65 than there will be persons under the age of 18 years.

Chapter 4 of the report deals with patients' need and the great need for better information passing from the health carer to the patient. Chapter 5 analyses the healthcare professions. Page 32 gives a very interesting example of a patient scenario, which I shall read to your Lordships because it describes how, with better integrated healthcare, the patient's position is greatly improved:


    "Alan Christie had been depressed for most of his adult life. He had not consulted his doctor for a few years--not since he had a course of pills that didn't work. When the practice nurse was taking his blood pressure one day it all came out, how he couldn't concentrate, sleep or experience any joy from life. She referred him to the clinic run at the practice by the community psychiatric nurse. Alan attended the clinic and the nurse soon arrived at a diagnosis of clinical depression which needed active treatment. She assessed Alan's case with the family doctor. The doctor saw Alan within twenty four hours and decided, in consultation with the psychiatric nurse, on a plan of shared care. For the first time in years, Alan feels at ease--he no longer feels divided between the inner pain he felt and the mask he always wore to hide it".

Chapter 6 of the report analyses the funding of healthcare. Chapter 7 deals with the purchasing and provision of healthcare. It was those chapters that received the most publicity in the media because the report bravely grasped a number of nettles and asked central questions. As I said to your Lordships earlier, it identifies an increasing gap between resources and demand, which naturally brings into place proper questions that should be asked about the future funding of healthcare in the United Kingdom and whether we can continue still just to rely on general taxation as the major source of income for the National Health Service.

The plain facts are that the increasing cost of healthcare goes up year by year. I give noble Lords the figures: in 1970 the cost of the National Health Service was just under £2,000 million; in 1980 it was, in round

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figures, £11,600 million; in 1990 the figure was £27,760 million. The latest figure for 1996 estimates is that the cost will be £41,427,000. So in the past five years the cost of the National Health Service, despite a number of steps that have been taken to reduce it, has almost doubled in size.

The other fact is that from the outset of the National Health Service every government have had to seek more resources for it. As I have said, the NHS was introduced in 1947 and there were no prescription charges. However, within three-and-a-half years Hugh Gaitskell, who was then the Chancellor of the Exchequer, sought to introduce a prescription charge, which resulted in him being called, if I recollect correctly, "a desiccated calculating machine". That issue also caused the resignations of Aneurin Bevan, John Freeman and Harold Wilson. However, the Labour Party was driven to introduce a modest prescription charge of 5d within three-and-a-half years of the foundation of the NHS and, although the Labour Party abolished the prescription charge when it came back to power in 1964, by 1968 Kenneth Robinson, the Secretary of State for Health, had to reintroduce prescription charges.

An example from the other side of the political divide is that the Conservative Government have recognised the need for other funding within the National Health Service in terms of private health funds and in their NHS reforms. The trouble is that the debate about the NHS has always had a political cloud over it. That point was made by Dr. David Green in his dissenting opinion on page 60 of the report--


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