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Earl Howe: At Second Reading the Minister argued that to include a definition of primary care trusts on the face of the Bill was unnecessary and inappropriate. She argued that on two main grounds. The first was that it was inconsistent with previous legislation. The second was that it was undesirable because what the Government wanted to achieve was maximum flexibility in the way that PCTs could operate and develop in the future. I totally understand the argument about flexibility. But what I tried to convey at Second Reading was the simple point that it was right as a

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matter of principle for the House to be able to comprehend directly from the face of the Bill the broad structure of what it was debating; namely, primary care trusts. I still do not think that that is an unreasonable expectation for a measure of this importance.

Indeed, it is a view that is shared by the Delegated Powers and Deregulation Committee of this House, which suggested that,


    "the House may wish to explore whether the primary legislation might provide a general framework for PCTs which will provide a statement of the purposes and objectives within which the regulation-making powers can be exercised".
That was a more than usually gentle hint from the committee. We should do well to take note of it. The amendment that I have tabled attempts to achieve that objective. I am not wedded to the wording, but I hope that the Government will not be dismissive of the principle behind it.

It is worth reflecting on the background. As the Delegated Powers and Deregulation Committee said, this part of the Bill contains a wide set of powers. We shall debate their scope later. It is important for the primary legislation to place the order-making powers into a properly defined context.

The Government have made it clear that they wish to see PCTs develop in imaginative new ways. One cannot possibly take issue with that. I do not believe that the presence in the Bill of what is by any standards a basic definition would inhibit the development of PCTs in any way whatever. So the scope for flexibility is still there.

Lord Clement-Jones: The enclosure with the Minister's letter of 19th February contains a whole page on the role of primary care trusts. Then the document immediately goes on to talk about their benefits. It is rather like a sales pitch. It speaks of better support to practices, better support to individual clinicians, better integrated services and better access. You then ask yourself where it relates to the role of PCTs. I mention this point merely to illustrate the necessity of being much more explicit in relation to functions. You have to turn another three pages before reaching the point where the letter states, in rather runic terms,


    "The functions of level 3 Primary Care Trusts are similar to level 2 Primary Care Groups, although with more extensive powers and responsibilities".
We then refer back to the circular. My noble friend's amendment was drafted with reference to the circular, although in slightly more friendly and not such detailed language. It is that kind of issue that one is grappling with.

A provision is needed on the face of the Bill. The functions of the commission for health improvement are included in the Bill; surely it would be relatively straightforward to include the functions of the PCTs. The PCTs will have a far bigger impact on the lives of ordinary people than will the commission for health improvement, so there must be a double reason for including the functions of the PCTs.

Lord Rix: I am sure that the noble Baroness, Lady Thomas of Walliswood, and the noble Lord, Lord Clement-Jones, were surprised when they arrived

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today and found that I had added my name to Amendment No. 24. I hope that they will accept my apology for not informing them beforehand. The functions of primary care trusts have particular relevance to people with a learning disability. I therefore stress the importance of heading (e) in the suggested new draft. It introduces a new function for primary care trusts to develop,


    "particular services to improve the access to health of disadvantaged or vulnerable residents".

That function is important for two reasons. First, there is presently great confusion about responsibilities for local health services for people with learning disabilities. There is a danger that services may fall between primary care groups and mental health trusts. To that end I should welcome confirmation from the Minister as to where services for people with learning disabilities will be located in this tidal wave of reform. The foreseeable state of flux and uncertainty is a fragile basis for effective management of consultation, accountability and quality management over the next decade. This amendment would give greater priority to effective partnerships in services for people with learning disabilities, and indeed others who are disadvantaged by virtue of age, disability, ethnic origin or social factors.

5.45 p.m.

Baroness Pitkeathley: I am agnostic about how these functions are to be spelt out. However, I too wish to speak in support of Amendment No. 24, and particularly heading (f), which refers to,


    "The shaping of local health services to reflect local needs ... which ensures the support of users and carers".

It reflects the absolute necessity of spelling out information in what is to be a major change in health services. It will have the utmost effect on users of the health service. How we do it is of less concern to me, but we must be sure that it is done.

Lord Walton of Detchant: I strongly support the principles underlying the reasons for tabling Amendment No. 24. One of my concerns, however, relates to the extent to which it is proper in primary legislation to lay down a whole series of individual clauses when it may subsequently become apparent that a number of points of considerable importance have been omitted. For example, heading (c) refers to,


    "the promotion of healthier lifestyles".
Otherwise, however, the amendment says very little about preventive medicine and a whole series of other issues which might well be enshrined in such a statute.

Is it, therefore, right that such a complicated and detailed series of proposals should be on the face of the Bill? Or might not these definitions preferably be subject to secondary legislation? If I may be pedantic, in sub-paragraph (g) the phrase "best clinical practise" should have a "c" not an "s".

Lord Skelmersdale: Like the noble Lord, Lord Walton, I was wondering whether the Liberal Democrat Benches had perhaps been taking lessons from the Americans, but we shall leave that aside.

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I wish to make three brief comments on this series of amendments. First, I am sorry that we have lost our two professorial economists. When I was learning economics at a very junior level, one of the first things I was taught was to define the terms before mounting the argument. I therefore go along with the noble Lord, Lord Harris, in his amendment, and indeed the other amendments which seek to define exactly what we mean by primary health groups and primary health trusts on the face of the Bill as soon as we decently can.

However, one can go over the top. Ten years on the Front Bench opposite taught me to be very wary indeed of shopping lists; and what Amendment No. 24 provides is a shopping list. I am sure that, even if the Minister does not use those words, that is exactly what she will to tell the Committee.

Thirdly, I have the honour to be a member of the Joint Committee on Statutory Instruments. I like to think that I do my homework fairly well and I pore over the various instruments that come before the Committee before each Tuesday's discussion. The idea of including a purpose clause in every statutory instrument pertaining to trusts fills me with total horror. It would be far better to have the provision on the face of the primary legislation; then we could all take it as read.

Baroness Gardner of Parkes: A detailed list such that in Amendment No. 24 is not desirable. It would be even worse were it to include heading (j), which refers to,


    "any other activities and functions which, from time to time".
It is already wide-ranging. Having provided a long list from (a) to (i), the amendment then adds anything else that we might like to name. I cannot support it.

Baroness Hayman: The noble Baroness has given my reply for me on Amendment No. 24. Perhaps I should try to be helpful to the Committee. The amendments propose in different ways to set out on the face of the Bill the purpose or the functions of primary care trusts. The amendment in the name of my noble friend Lord Harris of Haringey and that in the name of the noble Earl, Lord Howe, attempt to define the purpose in broad terms. In contrast, the amendments proposed by the noble Lord, Lord Clement-Jones, and the noble Baroness, Lady Thomas, define the functions in more detail. In the contributions from the noble Baroness, Lady Gardner, and the noble Lords, Lord Skelmersdale and Lord Walton, we had illustrations of the difficulties of putting down lists.

On the broad principle of a statement of overall purpose of primary care trusts, I have some sympathy with the arguments put forward. We will have to try to define them in fairly broad terms, but we ought to try to ascertain whether we can bring forward a suitable government amendment at Report stage. It would allow the face of the Bill to show what we see as the broad purpose and role of primary care trusts. I believe we can do that.

However, we get into more difficult territory when we try to define the functions in primary legislation rather than in secondary legislation. There was a

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commendable effort from the Liberal Democrat Front Bench and it broadly reflects the role that we envisage primary care trusts exercising. However, at the same time it illustrates the problems inherent in trying to define functions of that nature by primary legislation. For example, subparagraph (b) in Amendment No. 24 refers to hospital services "other than specialised services". We envisage that PCTs will be debarred through directions from commissioning some highly specialised services such as those for HIV/AIDS, or cystic fibrosis, or a number of tertiary services for children such as paediatric intensive care.

However, there are other services such as blue light ambulance services and population screening services where we may want to direct PCTs on how they exercise their commissioning function. We might require them to commission services through joint arrangements with other PCTs or PCGs.

Clause 2 allows PCTs to enter into such arrangements. The problem of definition has been referred to: what is a specialised service? Another problem of definition is that we all know exactly what is meant by "disadvantaged or vulnerable resident", but if we put it into the hands of the lawyers, after enacting it in primary legislation, we might all find NHS money going down the drain.

I am not doing this in any way to try to nit-pick or challenge a very good statement of what primary care trusts will do. I suggest to the Committee that it might be a wiser course if we try to bring forward an amendment at Report stage that deals with the broad role that we envisage PCTs taking on. I hope that the Committee will find it useful.

Reference was made to this being an issue raised by the Select Committee on Delegated Powers and Deregulation in its report on the Bill. At Second Reading I indicated that we would want to look carefully and constructively at what the committee suggested. I welcome the committee's conclusion that the argument referred to by the noble Earl, Lord Howe, whereby I proposed that the approach we had taken mirrored that in earlier NHS legislation was appropriate for the Bill and that in some ways the broad divide was acceptable. I intend to try to bring forward something that meets the points made by both the Select Committee and the Committee today.

It might be helpful if I referred to two other broad areas on which the Select Committee on Delegated Powers and Deregulation made recommendations. One was in relation to pharmaceutical prices and profits. It stated that it would like to see an appeals procedure and also an affirmative rather than negative procedure for the powers in paragraph 36. We accept the underlying intention of that recommendation and will attempt to respond positively to it at a later stage in the Bill.

On the issue of self-regulation of the healthcare professionals, there was the comment that there might be a statement of criteria for the exercise of the power, and in addition to the arrangements already set out in the Bill for consultation, a summary of representations received on a draft order laid before the House before that order was considered. That is another

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recommendation that is positive and helpful. I hope I shall be able to bring forward government amendments on those two areas, as well as on the specific one at Report stage.


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