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Baroness Jay of Paddington: I am grateful to the noble Lord, Lord Ezra, for reminding us that all those important decisions about private finance schemes should not be taken by politicians or bureaucrats locked away in ivory towers, without consideration for the public in whose communities they will be built and who will use the new hospitals. I very much take on board the specific points made by the noble Lord and my noble friend Lord Rea about the Norwich situation. But as my honourable friend Mr. Milburn, who has been referred to, made clear in another place in announcing the wider review of PFI in health, on 10th June, in future we must be satisfied that the projects have taken due account of the needs and wishes of local communities. I am sure that all Members of the Committee will wish to endorse those sentiments.

However, despite sharing the noble Lord's concern on this matter, I cannot agree that the right way to address it is by amending the Bill in this way, as there is already legislation in place which requires consultation on such matters.

It is not possible to consult every single member of the public on every single local health service issue. Instead, the Committee may be familiar with the expression that the community health councils are the "patients' watchdog.". Paragraph 1 of Schedule 7 to the 1977 NHS Act states that it is the,

We continue to acknowledge the pivotal role played by community health councils in articulating the views of local people, and they are required to be consulted on important changes to health services. Regulation 18 of the 1996 Community Health Council regulations state:

    "It shall be the duty of each relevant Health Authority to consult a Council on any proposals which the health authority may have under consideration for any substantial development of the health service in the Council's district, and on any proposals to make any substantial variation in the provision of such service".

I am sure your Lordships will agree that a major PFI development is precisely the sort of "substantial development" on which a council could expect to be consulted. Given the requirement for consultation which already exists, we cannot agree that the Bill should be amended to make yet further provision.

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But my honourable friend, Mr. Milburn, is looking at the whole prioritisation of PFI schemes. He has made it clear that in the future, that will be done on the basis of major capital schemes and their relevance to the health service. Service need will be paramount. These conditions build upon the existing, well-established framework for approving major capital schemes as set out in the Capital Investment Manual, which requires the Department of Health and the Treasury to give their approval for major projects. Those bodies are also able, at a stage in the approval process long before the certification point with which this Bill is concerned, to ensure that consultation has taken place and that the interests of all parties have been taken into account in deciding whether a scheme should progress. That is the general point of the amendment which has been put forward and which lies behind the contribution from my noble friend Lord Rea.

I understand that there are particular anxieties in Norwich in relation to the proposals for the building of the hospital there. But the health authority carried out a formal consultation along the lines of the general principles that I have discussed. Although I understand there is controversy about it, the people in the local community realise that it is the best possible solution to the local problem of where to build the hospital.

Perhaps I may quote from a letter to my honourable friend in another place from one of the Members of Parliament for Norwich, Mr. Charles Clarke. He said that when he was elected he reviewed the facts about the situation in Norwich in relation to the new hospital and had a series of meetings with Ministers and civil servants:

    "It became very clear to both myself and my colleague, Dr. Ian Gibson",
who is another Member of Parliament for Norwich,

    "that the real choice here was between the particular site which was being proposed and no new hospital at all".

Without in any way wishing to sound heavy-handed in relation to this matter, that really is the situation. As my noble friend Lord Rea suggested, there are particular problems in that community. The hospital has been given a high priority in my honourable friend's review of the PFI in the health service. There are many other competitors for immediate funding who are wanting to go ahead with their contracts and who have the interests of their local community at heart. I am afraid that it is the case that because of that prioritisation system, any project where there has been a problem, which has been properly reviewed and where discussion has been going on for many years, will find itself pushed back down the queue.

However, I hope that the noble Lord, Lord Ezra, will understand that the specific legislation which is in place will allow proper and appropriate consultation to be held on future schemes. Proper consultation has taken place on the specific matter that he raised, although I know that subsequent controversy has occurred. Given that it is also in the interests of the whole NHS building

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programme which lies behind this measure to go ahead as quickly as possible, he will find it unnecessary to press the amendment.

Lord Ezra: I thank the Minister for her full answer to the issues raised by the amendments. I am reassured by what she said: that there is already in place in other legislation an obligation to carry out full public consultation and to consider the interests of the local population and any wider areas which may be involved. Therefore, on those grounds I agree that it does not seem necessary to introduce such an obligation in the present Bill.

However, the second reason for moving the amendments was to relate them back to the Norwich case which seems to have been particularly long drawn out and complicated. I have done that. We referred to it on Second Reading and it has been referred to again now. The Minister must be well aware that there is continuing concern about that issue. Having achieved my two objectives, I beg leave to withdraw Amendment No. 2.

Amendment, by leave, withdrawn.

[Amendment No. 3 not moved.]

Lord Ezra moved Amendment No. 4:

Page 1, line 25, at end insert ("other than services provided by professional staff which have direct impact on patient care").

The noble Lord said: I move this amendment on behalf of my noble friend Lady Robson who unfortunately cannot be with us this afternoon due to other urgent commitments.

The purpose of the amendment is very simple and again relates back to the discussions that we had on Second Reading. The concern is that the reference to "services" in the Bill does not make it clear that that would exclude clinical services.

There seems to be general agreement by the Government and everyone else that clinical services should not be affected by any project by private investment; and that those should always be kept apart and fall within the public domain.

The wording used here to cover that point is proposed by the BMA. Having looked at the matter very carefully, that is what it proposes. I can read it out in full; but in summary the BMA defines clinical services as services provided by professional staff, whom it describes as doctors, dentists, pharmacists, nurses and other health professionals, which have a direct impact on patient care. Those are the words used in the proposed amendment.

The BMA then goes on to describe in full what it means by those services. I do not need to detain the Committee by going through those. Therefore, here we have the wording put forward by the BMA to support the views already expressed and assurances given by the Secretary of State for Health when he spoke to the Royal College of Nursing in May. He said that the Government would keep to their promise not to extend private finance to include clinical services. At a later date, Mr. Alan Milburn MP, Minister of State for Health, spoke in very much the same terms and in our debate

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on 3rd June the noble Baroness, Lady Jay, (at cols. 612 and 613 of Hansard) said very much the same thing. There is no doubt about it at all; that is the Government's intention. The purpose of the amendment is to put that intention on the face of the Bill. I beg to move.

4 p.m.

Lord Jenkin of Roding: I find the amendment as worded extremely obscure. The noble Lord, Lord Ezra, referred us to the brief of the BMA, but by merely excluding services,

    "which have direct impact on patient care",
he would render the subsection nearly meaningless. However, when one looks at the brief of the BMA, it makes specific reference, as the noble Lord said, to diagnostic services such as radiology, pathology and clinical biochemistry.

The only point that I should like to make at this stage is that I believe it would be a great pity if the Government were to rule out the possibility of a PFI scheme for those services. I say so for one overwhelming reason. There must be very few radiology departments and clinical pathology departments where the professionals involved could put their hands on their hearts and say that they have all the equipment that they need. My experience is that most departments have been calling for some years for an upgrading of their equipment to take advantage of modern technology, to be able to buy new machines and, therefore, provide a very much better and often--especially in the case of pathology--much quicker service.

There is a second angle to the matter. Both this Government and the previous one have been looking for more collaboration in such fields for trusts, and perhaps neighbouring trusts, to form consortia to provide a more effective and cost-effective service in support of the substantive clinical services. It would be quite impossible to achieve that aim on the basis of no additional capital expenditure. I say impossible, but that is perhaps an exaggeration. There may be cases where it could be done. However, in the majority of cases, the clinicians and the technicians who provide a great deal of those services--although I am not clear whether they have a direct impact on patient care--and the other clinical services, for example, medicine, surgery, gynaecology, and so on, that need diagnostic services, would be far more enthusiastic if they thought that a scheme of rationalisation, or of collaboration, between neighbouring trusts would bring with it the prospect of substantial additional equipment, such as might be provided under a PFI scheme, than would otherwise be the case.

Therefore, with the greatest of respect to the noble Lord, I believe that the BMA has got it wrong. By seeking to rule out any PFI for these diagnostic services, we would in many cases rule out necessary improvements in the quality and cost-effectiveness of such services. When the Minister replies, I hope that she will take full account of that view. If the Government are to follow through what may have been their

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intention when the Secretary of State spoke generally at the conference of the Royal College of Nursing--namely, that they were intending to exclude such services--I believe they will find the improvements that they seek to make much more difficult to achieve. I cannot believe that that is their intention.

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