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Lord Rix: I rise to support Amendment No. 17, and in particular paragraph (d) which seeks to involve patient and carer associations and voluntary organisations which are involved in health care delivery. As president of MENCAP I am concerned to ensure that people with learning disabilities are adequately represented on the boards of local healthcare bodies so that their needs are not overlooked in the planning, commissioning and delivery of services and the development of strategies to improve public health.

At MENCAP's conference last September the then Under-Secretary for Health Paul Boateng gave MENCAP assurances that people with learning disabilities would, with appropriate support, be represented on health authority boards throughout England and Wales. I shall therefore welcome today assurances from the Minister that this commitment will be honoured when the new structures are put in place, and that all the relevant consultation processes will be accessible to members of the community with a learning disability.

On a matter of information, in December, in conjunction with the Royal Society of Medicine, we are holding a major conference of universities, schools of medicine, the dental profession and allied professions--nursing and so on--to look at the delivery of healthcare for people with learning disabilities. I am happy to say that the response from all the bodies taking part has been encouraging.

Baroness Pitkeathley: While sharing the reservations of many Members of the Committee about lists, I add my support for the general principles of consultation. As we have heard, the consultation must be thorough and real and the outcomes reported back.

I remind noble Lords that consultation with user, carer, patient and consumer groups is different from consultation with well established statutory organisations. The requisite support in the form of

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proper information, through radio programmes, respite care or expenses, must be considered if the consultation is to be meaningful.

Lord Crickhowell: I rise to ask a question which I suspect will not be answered until we reach Clause 51. However, it seems appropriate to ask it now.

I confess that I have only recently considered the Bill in detail. I was abroad at Second Reading. I cannot see that the issue was addressed at that stage. I am genuinely puzzled as to why the transfer of responsibilities to the Welsh Assembly starts only at Section 13. It is a little strange that the power to set up trusts, and for consultation, is given to the Secretary of State and not to the Assembly. If one sets out a list--I refer to Amendment No. 25--one would be bound to add the Welsh Assembly. If the Assembly is not to set up the trust and organise the consultation, clearly it will have to be consulted.

It seems curious that we are in this situation. I may be wrong, but I do not believe that an explanation has been given on the selection of those powers which go to the Assembly and those which do not. They do not appear in the Explanatory Notes. I pose the question now in the knowledge that I may receive some brief indication. I shall return to the matter on discussion of Clause 51.

Lord Walton of Detchant: Having been critical of lists a few moments ago, I believe that the list set out in Amendment No. 17 is wholly appropriate. It seems to me crucial that those bodies should be consulted on decisions about primary care trusts.

The quality of general practice in this country has risen steadily since the institution of vocational training for GPs many years ago. While there is inevitably some unevenness in the quality of provision, the standard of general practice, I believe, is now the highest of any country in the world. I pay tribute to those who have been involved in this transformation.

The universities play a crucial part in the training of doctors. Through the academic departments of general practice, they play a crucial part in training future GPs, in contributing to vocational training and to the postgraduate and continuing training of those in general practice. The medical schools have become increasingly aware of the crucial importance of teaching medical students in the community in association with general practitioners and not just in the hospital environment. For that reason alone, I believe that it is absolutely vital that university participation should be written on the face of the Bill.

At Second Reading I referred to the parlous state of clinical academic medicine. That embraces the problems that are being encountered by academic departments of general practice. For that reason, I strongly support Amendment No. 17.

The same problems relate to Amendment No. 25 as to the list which attempted nobly to define the functions of primary care trusts. If the BMA is to be consulted, why not, for instance, the Medical Women's

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Federation? If the Royal College of Nursing is to be consulted, why not the Royal College of General Practitioners? One could add infinitely to the list.

Having given us an assurance that on the functions of primary care trusts she will come back with a government amendment at Report stage, I believe that the Minister and her colleagues are equal to the task of producing a satisfactory amendment to embrace the principles set out in Amendment No. 25. I hope that it is a matter she may be able to concede.

6.15 p.m.

Earl Howe: Before the Minister rises, perhaps I may say to the noble Lord, Lord Walton, that I deliberately made the list non-exclusive. He will note that the amendment refers to,


    "such other relevant bodies as the Secretary of State shall determine".
Therefore it does not exclude other bodies.

Baroness McFarlane of Llandaff: I have difficulty with Amendments Nos. 17 and 25. Although I agree with the intent of Amendment No. 17, I believe that there are a number of important omissions. For instance, where would nursing be classed in the list which refers to,


    "key partners in the delivery of NHS health care"?
Nursing is not technically classed as a profession allied to medicine. The listing in Amendment No. 25 falls into the trap that we have so often mentioned.

A robust requirement for consultation to take place would be preferable. Bodies such as the Royal College of Nursing are asking how long the consultation process will last and how local communities and organisations should be informed about the outcomes. They suggest a six-month period for consultation. That may seem somewhat long. They also suggest a requirement for the outcome to be published in all cases. They also inquire about the consultation before a PCT is dissolved.

Lord Rowallan: We must have a requirement on the face of the Bill that the voluntary sector is consulted before any PCT is set up. They were not involved in the setting up of PCGs.

I speak on behalf of the mentally ill. I declare an interest. I am a director of SANE and patron of Depression Alliance. I am concerned that only 33 per cent. of GPs have mental health training, and much of that is brief. The voluntary bodies do an enormous job in this field. Whatever else happens, we must make certain that they are involved in the setting up of a PCT.

Baroness Carnegy of Lour: I apologise to the Committee that when I raised the subject of universities I had muddled my groupings. I had not realised that the subject would be raised now. The noble Lord, Lord Walton of Detchant, has introduced the matter in a more authoritative and able manner than I can.

Perhaps I may add what the Committee of Vice-Chancellors and Principals has said; I expect that other noble Lords have received the information. It points out that in addition to their teaching

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responsibilities, university staff, including senior clinical academics, contribute substantially to patient care. It is university employees who provide 30 to 40 per cent. of consultant patient care in teaching hospitals. That is an important additional point, with which the noble Lord, Lord Walton, would probably agree. Those people do most of the science of clinical research which is essential to improvements in healthcare, as well as being major contributors to postgraduate training and continuing professional development.

I therefore believe that an amendment such as No. 17 is important, although I do not know whether that is the way in which the Government would wish to include the provision in the Bill. The CVCP points out that major implications for medical education and research arise from changes in service delivery. The way in which the trust will operate will be different and that will affect universities enormously. I do not believe that the committee should be regarded as just another group of people to be consulted. It is part of the system and I hope that the Government will take that on board, regardless of whatever they wish to do about Amendment No. 17.

Baroness Gardner of Parkes: It is sad that my noble friend's amendment does not mention the dentists, but that Amendment No. 17 does. I am pleased that Amendment No. 17 specifies dentists. For too long there has been too big a division between the British Dental Association and the General Dental Practitioners Association, which represents many National Health Service dentists and should be consulted on a more regular basis. I was pleased that the noble Baroness, Lady Sharp, made that point about dentists.

I was impressed by the comment made by the noble Baroness, Lady McFarlane, that nursing is a huge omission from Amendment No. 17. I believe that that must be corrected.

I am all for consultation, but I believe that a general power for consultation should be built into the Bill. The noble Baroness, Lady Pitkeathley, said that consumer groups are the most important, but everyone considers their interest to be the most important. Everyone is important. The noble Baroness stated that some authorities are well geared to sending their replies quickly. I believe that consumer groups and voluntary organisations must become better geared so that the consultation process does not take so long as to hold everything up. I heard six months mentioned, and I would be horrified by that. When I had a position with a regional health authority, I saw years wasted in consultation, after consultation, after consultation. I should like to see a general obligation for consultation and to have a time limit. I do not know whether that should be set by regulation or appear on the face of the Bill, but procedures should not be held up for ever.

I was interested in the comment made by the noble Lord, Lord Rix--we are always interested in his comments--because dental healthcare for people with learning difficulties is a major issue. It is even more so now that dentists are not allowed to give general anaesthetics. Many of the patients he described are

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suitable only for treatment under general anaesthesia. They do not understand the treatment and that can be upsetting and frightening. There is therefore a requirement for consultation and for all special needs to be taken into account. I should like to see a more general power rather than it being spelt out in individual lists.


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