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Baroness Carnegy of Lour: Before the noble Baroness sits down, did I understand her to say that the Government would be quite happy if a primary care trust was set up in an area where the majority of GPs in that area did not want it; that it would be imposed on the GPs. Did she say that?

Baroness Hayman: If I did, it was an error. It was not what I intended to say. We would have no intention of doing that. The example I was giving was the possibility of a majority of GPs wanting a primary care trust, but the organisation of the primary care group--or one of the groups which would be involved in creating the trust--might not be supportive and therefore stand in the way of the majority of GPs. I was trying to reassure the Committee that we look for local support for these organisations. A key to local support would be local professional groups, like GPs--but not exclusively--and primary care groups would have an important role. The noble Lord, Lord Clement-Jones, is right to say that they will be key players and that their views would be a key consideration. My point is that writing that into the Bill may, in very rare circumstances, be unnecessarily restrictive.

Lord Clement-Jones: I thank the noble Baroness for that response. It seemed to warm up as it went along; the language became stronger and more reassuring as we proceeded. It may be that the language at the end was added later--I do not know--but certainly something like "we would not envisage circumstances" is useful language. But it is slightly contradicted-- I obviously need to read Hansard--by the point the Minister made about the possibility of it being overridden. She gave the example of two PCGs going into a PCT, and so on. Therefore, I shall need to reflect on what the Minster has said.

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It is probably necessary--not only in terms of the Committee stage of the Bill but in terms of reassurance to PCG chairs and members--to amplify the letter of the 19th February. There are gaps in it and there has been some unhappiness concerning the language about,


    "It is our assumption that the support of the relevant Primary Care Group would be required".
The Minister's current language of "We do not envisage circumstances where the consent of the PCGs concerned will not be required" is stronger and better.

Baroness Hayman: It was my honourable friend's language rather than my own which was written down in the advice. I was not trying to draw a distinction. I was trying to rephrase for him, in a way that the noble Lord might find more comforting, the assumption that is clearly set out in that letter. I take the noble Lord's point about the need to in some way clarify exactly what is involved in this. Perhaps he and I can both reflect upon this in the days to come.

Lord Clement-Jones: I thank the Minister for that reply. That is certainly the case. I do not think that I am alone in interpreting what she has said as more reassuring about PCGs than the wording in the letter. We need to reflect and come back to it. The Minister has given various reasons as to why it should not be on the face of the Bill--that it might create circumstances where that could not be overridden where that might be desirable, and so on. We need to think about it and come back to it on Report.

Earl Howe: This has been a useful debate. I realise that, when I introduced Amendment No. 3, I was guilty of not making it clear that I was speaking also to my other Amendments Nos. 6 and 12.

I take the point made by the noble Lord, Lord Rea, and the noble Baroness, Lady McFarlane of Llandaff, among others, about inclusivity. It is, I am sure, the Government's intention, and indeed the wish of most of the Committee, that in the consultation arrangements there should be that inclusivity. There is no question about that. My purpose in putting down the amendments was to test the Government's receptiveness to the idea that there should be prior approval from a key group of professionals who would be most affected by a move to PCT status.

The issue for GPs, as distinct from any other group of professionals, however important their role may be, is that, by moving from a PCG to a PCT, they are deprived of one very important factor, which is hands on control of the PCG under the current arrangements. Those current arrangements are ones which the Government have themselves granted to GPs. It is not as if they inherited those arrangements or anything else. They have quite consciously given GPs control of PCGs if they want it. No other group of professionals is similarly affected.

With respect to the noble Lord, Lord Clement-Jones, it seems to me that under his amendment, Amendment No. 16, GPs could be delivered bound and gagged into a PCT unless there were some kind of formula in the voting arrangements. But that is a matter of detail.

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I am grateful to all noble Lords who have spoken. This has been a useful debate and no doubt we shall return to these matters at a later stage. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

5.30 p.m.

Lord Harris of Haringey moved Amendment No. 4:


Page 1, line 15, at end insert ("to provide goods and services for the purposes of the health service.").

The noble Lord said: I wish to repeat the declaration of interest I made during the Second Reading debate. I was formerly director of the Association of Community Health Councils and am currently a non-executive director of an ambulance service trust. In the interests of brevity, to which the noble Earl, Lord Howe, referred earlier, I intend to speak briefly. I will not repeat my declaration of interest at subsequent stages.

We are now dealing with Clause 2. I wish to raise the issue of defining clearly the functions of primary care trusts. The Bill does not contain any details of the functions and it does not provide for regulations to define what the functions should be. Therefore, the only way these functions can be specified will be by the establishment orders which will be in the hands of the Secretary of State for Health.

I am conscious that primary care trusts will be publicly funded, as is set out in Clause 3(1). It is also intended to transfer NHS properties and facilities to them, under Schedule 5A, paragraph 1(4) and paragraph 21. Furthermore, under Schedule 5A, primary care trusts will have powers to dispose of land and property and, under Clause 4(1), they will be permitted to treat private patients and to charge for those services. It is critically important that we build into the Bill safeguards to ensure that public moneys and NHS properties are utilised primarily for the benefit of the NHS. I therefore submit that limits on functions are necessary.

It is arguable that the Secretary of State would not have powers to detail proper limits and safeguards in an establishment order, as by so doing the Secretary of State would be detracting from the functions permitted in primary legislation without there being an express power in primary legislation to permit the Secretary of State to do so. In any event, it would be more open to have these details in primary legislation than in individual establishment orders.

What I am suggesting in the amendment is that it would be helpful to have functions specifically detailed in the Act along with safeguards to ensure that the primary care trusts operate for the benefit of the health service. Furthermore, it will be important to ensure that they do not operate in such a way as to disadvantage NHS patients or other bodies providing health or social services. It is also clear in this context that consultation

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issues will be important. No doubt we will return to that point when we come to discuss other clauses. I beg to move.

Baroness Thomas of Walliswood: I rise to speak to Amendments Nos. 5 and 24 and to Amendment No. 7 which stands in the name of the noble Earl, Lord Howe. Our amendments seek to put on the face of the Bill some description of what a PCT will actually do. They seek to set out not its powers but its functions. Amendment No. 5 amends Clause 2 and Amendment No. 24 amends Schedule 1. The two amendments are mutually supportive. Before I go any further, I should like to thank the Public Bill Office for ensuring that Amendment No. 24 was put in the right place.

Our objective is to make the purpose of primary care trusts plain on the face of the Bill. There is a prima facie case for doing that in such an important Bill which gives a totally new structure to the purchasing of care in the National Health Service. There is also the matter of transparency. Bills are there not only so that legislators and lawyers can understand what they are about. More and more ordinary folk and the people who stand in their interests want to know what Bills are about. Perhaps I may remind the Committee that the Bill is a series of amendments to an Act which is already almost 300 pages long. Every one of those pages has at least one explanatory note. Some of them have four or five. We are in very complicated territory. That is another reason for wanting to make the purpose of this new development clear on the face of the Bill.

Many pressure groups have seen the amendments and have written to support them for the reasons I have put forward. Perhaps I may also draw attention to the fact that in paragraph 15 of its report the Select Committee on Delegated Powers and Deregulation states:


    "If the House is of the opinion that Parliament does not have sufficient control over the creation of Primary Care Trusts, it may wish to consider amending the bill to include a statement of the purposes and objectives of PCTs".

The formula we have chosen is not the only formula one could choose. The noble Earl, Lord Howe, has approached this issue in a different way. We could have done so. We could have taken a number of different formulae in order to get the same point across. The formula is not what we are most interested in. We want to get a description of the purpose of a PCT on the face of the Bill. I very much hope that the Minister will be able to indicate that she has some sympathy for the purpose of the amendment, even if she does not think that the formula is the one we should have chosen.


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