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Baroness Carnegy of Lour: While on these points, if we look at paragraph 15 of the recommendations of the report of the Select Committee on Delegated Powers and Deregulation and the preceding paragraph, paragraph 14, they state that Part II of the Bill makes similar provisions to those that we have just been discussing for Scotland.

I wonder whether the Government read it as the committee's intention that there should be a definition of the different primary care trusts for Scotland. I also wonder whether, in making the addition to the Bill which the Minister has just outlined, she would do likewise for Part II of the Bill. Perhaps the noble Baroness would consider it. I see the Minister sitting beside her. He may be able to help her in the matter.

Baroness Hayman: I will undertake to look at it. There is a parallel, as the noble Baroness rightly pointed out. If that parallel is one that ought to meet with an equal response, we will undertake to try to do so. Perhaps I may take it away and consider it in detail.

Earl Howe: Before the noble Lord, Lord Harris, decides what to do with his amendment, perhaps I may take this opportunity to thank the noble Baroness for giving constructive consideration to our debate at Second Reading and again in Committee today. I also thank her for offering to bring a government amendment forward at a later stage in the Bill. It is most helpful and I believe that the whole Committee will be extremely appreciative of the trouble she has taken to address the issues we have raised.

Baroness Thomas of Walliswood: I add my voice to that of the noble Earl. I thank the noble Baroness, Lady Pitkeathley, and the noble Lord, Lord Rix. We were delighted to see his signature on our amendment. It is always a great honour in this Chamber.

We accept absolutely that the solution put forward by the noble Baroness is correct. I am grateful to her for her compliment on our drafting. We are not entirely surprised because we did our best to ground it on papers provided by Her Majesty's Government so as to make it difficult to oppose. However, we accept the solution she offered and look forward to the forthcoming government amendment.

Lord Harris of Haringey: I am grateful to the Committee for a helpful discussion. It was clear that a consensus was emerging from all sides about the need to see something on the face of the Bill defining the role and functions of primary care trusts. It was interesting that no Member of the Committee who spoke seemed wedded to the forms of words before us in the group of amendments.

I am a novice at all this. I understand that if my noble friend Lady Hayman says that she has some sympathy for the proposal, it should be regarded as good news.

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I look forward to seeing the amendment that she hopes to bring forward at Report stage. On those terms, I beg leave to withdraw the amendment in my name.

Amendment, by leave, withdrawn.

[Amendments Nos. 5 to 7 not moved.]

6 p.m.

Lord Harris of Haringey moved Amendment No. 8:


Page 2, line 1, leave out ("If any").

The noble Lord said: I beg to move Amendment No. 8 which is inextricably linked with Amendments Nos. 10, 11, 14, 46, 47 and 48. Earlier today I had a conversation with my noble friend Lord Desai who was concerned to give me a lecture on grammar in case I did not make clear that all of these points were closely linked. This amendment brings us back to a discussion a few minutes ago about consultation. Clause 2 and Schedule 1 allow the Secretary of State to determine through regulation any consultation requirements on the creation of a primary care trust. The amendments in this group mean that clearer and more robust consultation requirements are written into the legislation to ensure that a thorough consultation process is followed whenever a primary care trust is created or--of equal importance--dissolved.

There may well be circumstances in which in a few years' time primary care trusts merge. That may turn out to be a controversial matter. It is important that the circumstances in which a trust is dissolved are also subject to proper consultation. The purpose of these amendments is to ensure that there is always a consultation requirement, and that consultations are thorough, inclusive and effective prior to the creation or dissolution of any primary care trust. In each area different local communities will contain different organisations with relevant interests. Despite the need for local flexibility, there is perhaps a core group of organisations which should be consulted in all circumstances: certainly, all NHS bodies whose areas fall wholly or partly within or adjacent to an area specified in the primary care trust order; all bodies who represent patients and NHS users within the specified area, including community health councils; all local authorities whose areas fall partly or wholly within or adjacent to the specified area; and relevant professional organisations and other bodies.

It is important to have greater clarity about the length of the consultation process. My experience over the years is that it is very difficult for local communities and organisations to be consulted properly unless there is adequate time for that consultation to take place. In particular, it is not simply a matter of small community organisations receiving a document and being able to respond very rapidly. They need time to consult their members. They may not meet very frequently. There must be an opportunity for proper discussion and understanding of the issues involved. This group of amendments provides that there should be a minimum of six months' consultation and that the outcome of that consultation should be published in all cases. The purpose is to ensure that there are equally robust

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consultation requirements in the event of both the creation and dissolution of a primary care trust. I hope that the Committee will accept the amendment.

Earl Howe: As the noble Lord, Lord Harris, points out, the Bill contains a provision for the Secretary of State to initiate consultation before a PCT order is made. What it does not do is make that consultation mandatory, unless I have misread the Bill; nor does it list those bodies which have to be consulted on a statutory basis. That is a cause for concern. In discussions that led up to the publication of the Bill complaints were made that significant bodies were not consulted at all or were simply informed of what would happen with no opportunity for participation.

I speak now to my Amendment No. 13 in conjunction with Amendment No. 25. The Committee will note that Amendment No. 25 contains a list of those bodies which appear to be right and proper statutory consultees. I accept the strictures of my noble friend Lord Skelmersdale (who is not in his place at the moment) that there is an antipathy to lists in any piece of legislation. But the list in Amendment No. 25 is not exclusive and contains those very major bodies which are unlikely ever to become superfluous to the consultation process. The key point is that the consultation process should be thorough and effective. Amendment No. 13 in my name will ensure that there must always be consultation. But other questions arise, one of which has been posed by the noble Lord, Lord Harris: how long should the consultation period last? That is an extremely important question. Will the outcome of the consultation be published? My amendment proposes that it should be.

Baroness Sharp of Guildford: I rise to support the amendment moved by the noble Lord, Lord Harris, and speak also to Amendments Nos. 15 and 17 to which I have put my name together with those of my noble friends Lord Clement-Jones and Baroness Thomas of Walliswood and the noble Lord, Lord Rix. We support the amendments that impose an obligation to consult. We very much support the amendment of the noble Lord, Lord Harris, which ensures that there is a minimum consultation period and that the outcome is published.

As to Amendment No. 25, we have some reservations about the listing. We do not see why bodies such as the BMA and the RCN at national level should be consulted on what is essentially a very local change, although it is important that their representatives at local level are consulted. We certainly believe that to be the case. Amendment No. 15 is linked to the earlier discussion about the process of transition from primary care groups to primary care trusts. We believe that it is vitally important that the Secretary of State is satisfied that the primary care group is ready both in terms of the medical provision that it makes within the area and in terms of its financial capabilities to take over the very much wider necessary responsibilities of a primary care trust. It is also important that it has sufficient maturity to take on the necessary accountability for that status.

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Amendment No. 17 makes clear that primary care trusts belong to their communities and should include other key partners in the consultation process in the delivery of health care services, such as universities which frequently train GPs and are also involved in the training of nurses and other professionals in the medical field. It is extremely important that they are part of the consultation process. Further, dentists appear to get only a very small look in. We believe that they should be consulted to a much greater extent than they are. As to other professionals allied to medicine, such as physiotherapists and pharmacists, it is important that when setting up a community body they are consulted. Finally, patients, carers and voluntary organisations should also be consulted. This underlies the rationale of our amendments. But in broad terms this is very much a question of whether, when one does something that affects the local community so intensely, there should be an obligation to consult widely within the area.


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