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Lord Rix: I thank the noble Baroness for her kind words which are singularly appropriate. However, perhaps I may ask her a question. When I was young I was told that dentists wanted to be called "dental surgeons". I was told that "dentists" were people who just pulled out teeth--that was before the requisite qualifications were introduced. Perhaps the noble Baroness will clarify that point.

Baroness Gardner of Parkes: A new Act was passed in 1921, after which dentists had to be qualified. Therefore, people wanted to call themselves "dental surgeons" in order to differentiate them from those who just put up a barber's pole and practised. I do not believe that any survive--certainly none still practises as far as I know! For that reason, we are all now proud to be called "dentists". The fact that dentists are also allowed to use the title "Doctor" has added a great deal to the professional standing.

Baroness Hayman: I am tempted to share with the Committee the fact that my grandfather was a dentist, but I am sure that he was properly trained. He changed his name by deed poll not when he first came to this country as an immigrant, but as a result of the 1921 Act when he had to register in order to give proof of the name under which he practised as a dentist. I am sure that such people have passed with the passage of time and no longer account for any difficulties.

We have had an interesting and useful debate which has highlighted some of the difficulties in drawing up, particularly in primary legislation, lists of those who must be consulted in any circumstances. If we added to the list the Welsh Assembly, as suggested by the noble Lord, Lord Crickhowell, we would go even more broadly than the RCN or the BMA as consultees on what are essentially local proposals.

As regards the Welsh Assembly, I understand that Clauses 2 to 12 amend the 1977 and the 1990 Acts. The Secretary of State's powers under those Acts will therefore be transferred to the assembly under the Transfer of Functions Order made under the Government of Wales Act. Therefore, the only provision which will be required in this Bill is one to the effect that the references in the Transfer of Functions Order to relevant provisions of the 1977 and 1990 Acts must be read as amended by the Bill. We will be introducing appropriate provisions to ensure that. Oh goodness, the noble Lord is going to ask me for even more detail!

Lord Crickhowell: I wish merely to express gratitude to the Minister. It shows the importance of such explanations being included in the Explanatory

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Notes because the situation is not otherwise obvious. It is the kind of explanation we will need in Bill, after Bill, after Bill, so perhaps a precedent can be set.

Baroness Hayman: I am grateful to the noble Lord. I thought that he was going to ask a supplementary question that I would be quite incapable of answering. We are on the case, so to speak, and the appropriate provisions will be introduced at a later stage.

In terms of the establishment of PCTs, consultation is mandatory. Clauses 16(4) and (5) have that effect. We must pay attention to two separate issues in tonight's debate. The first is the exception to consultation in certain cases of dissolution rather than establishment. Those are paralleled in other legislation. It will be undertaken only in cases where patient safety is at risk and would not be invoked in normal circumstances around merger or dissolution. It is important.

Although we want to have local consultation in the case of a dissolution, it would be wrong not to allow for exceptional circumstances, say, to vary an order. It might be amended, for example, from being a commissioning only Level 3 PCT to a commissioning and providing Level 4 PCT. We will make clear regulations as regards the responsibilities of the PCT if it proposed any significant change in the provision of services. Those would mirror the responsibility for the consultation which takes place when a significant variation of service is proposed for other NHS bodies.

We intend that the regulations will provide for exceptional circumstances when the requirements for consultation may need to be waived. It might, for example, appear to the Secretary of State to be necessary to dissolve a PCT as a matter of urgency. A similar power exists in connection with NHS trusts and is designed as a safeguard if patient safety is at risk. On the other hand, where a proposed change of a PCT order is a minor change--for example, a name or boundary change--we feel that full consultation is not necessary either.

We would not like to have an absolute requirement on the face of the Bill; it would limit the flexibility. It is argued that placing a requirement for consultation on the face of the Bill is too prescriptive. And specifying the bodies which may be consulted neither takes account of the fact that those who must be consulted may change over time nor that different bodies may need to be consulted for different PCTs, depending on the functions they propose to exercise. Requirements go beyond even who must be consulted, to the period of consultation and a requirement to publish results.

Clearly, we want there to be an adequate period of consultation--no one is suggesting that it should be a rushed and underhand process. However, as the noble Baroness, Lady Gardner, pointed out, we cannot extend that period ad infinitum. The current usual period is three months and I suggest to my noble friend that that may be more satisfactory than six months. It is also another reason why setting out in regulations the requirements for consultation is the most appropriate and practical approach. It mirrors the approach for NHS trusts. It avoids raising a large amount of procedural and

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administrative detail on the face of the Bill. And it allows for some flexibility for consultation procedures to develop and change over time in response to changing circumstances.

The other amendments grouped with Amendment No. 8 indicate equal difficulties. I should like to make clear to my noble friend that we recognise the importance of patient and carer groups in terms of the consultation that should surround the creation of primary care trusts and the fact that they may not be geared up to respond as some of the professional bodies are that have full-time staff. But their views are crucial if these bodies are to respond appropriately to the needs of the communities. It is exactly the same argument put forward by the noble Lord, Lord Rowallan, in regard to voluntary organisations and their specific role and interest in seeing the proposals go forward.

Equally, I recognise the fear that dentists are sometimes left out of the consideration when the contributions that they make--for example, to the care of those with learning disabilities--are considerable. I apologise to the noble Lord, Lord Rix, that I did not pick up his question earlier. There is no simple answer. Depending on the pattern of service locally and the services required by an individual, they may be of a specialist nature and therefore be regionally commissioned because there are regional specialist services available, or they may be at a primary care level, in which case a primary care trust that provided community services would do exactly that. We must look to the pattern of service being locally determined. I take the noble Lord's point that somebody at the commissioning level must make sure that the full range of provision is available for those with learning disabilities.

Perhaps I can say also that the contribution and importance of the interest of academic medicine and the universities is well acknowledged. We are not suggesting that, by omitting their names from the face of the Bill and the list of people who have to be consulted, they are not key players; that they do not have an important contribution to make. From my experience in central London, it would be inconceivable not to look to the academic perspective.

Lord Walton of Detchant: With the leave of the Committee, perhaps I can ask the noble Baroness a question which is of relevance to the universities. We had a great deal of debate when the National Health Service and Community Care Bill was under consideration in this Chamber. Eventually the government of the day conceded the right of universities to nominate members of health authorities and trusts. Do I take it that there is no such provision, following the repeal of certain sections, for university representation on primary care trusts?

Baroness Hayman: My understanding is that we are not talking about representation in terms of membership of trust boards. There is a recognition that not all the appropriate professional interests will be able to be represented at board level. It is important that at the executive committee level of the trusts and in their

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wider interactions with the local health community, account should be taken of other health service and academic bodies which are crucially important in the provision of both healthcare directly and in the training and education of staff. My understanding is that, because we are not talking about representatives on the boards, we are not in an analogous position to NHS trusts.

A significant number of interests need to be considered and balanced when we look at the consultation that will take place before the setting up of a primary care trust. We talked earlier about the negative possibilities of people being able to stop a primary care trust from going forward. Here we are looking at the positives and how we ensure that there has been proper consultation. Nothing that has been said in the course of our debate runs counter to the views of the Government as to how this should be approached locally. Our difference lies in the fact that we do not feel that it is helpful or possibly satisfactorily to put all the variations on the face of the Bill; that those are best left to regulations that will be laid. That is the established way in which this has been done in the past and I suggest that it is an appropriate way to go forward.


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