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Lord Clement-Jones: With the leave of the Committee, perhaps I may interrupt the Minister. One question that has not been answered is when the regulations will be published. The Minister's thesis is that these matters are best left to regulation, but the content and timing of the publication of the draft is of crucial importance if people are to accept that as a substitution for primary legislation.

Baroness Hayman: I am grateful to the noble Lord. Perhaps he will allow me to take some advice and soundings on that. I do not have the answer immediately. It is an issue to which we could return at a later stage, at which time I can give him a better idea about the timetable for regulations.

Lord Rix: Before the Minister sits down, perhaps I can say that, unfortunately, when the noble Baroness speaks "off-mike" the tinnitus from which I suffer drowns out the drop in the voice level. If my question has been answered, I apologise. It related to representation of people with learning disabilities on health authority boards and so forth. That was the promise given to us at our conference by the then Under-Secretary of State, Paul Boateng. MENCAP is in correspondence with the department and I would be glad if the Minister would look at that correspondence and write to me at some time in the near future.

Baroness Hayman: I am happy to give that assurance to the noble Lord, Lord Rix. I am aware that there has been correspondence; I am not aware as to exactly what stage it has reached. But I would rather deal with the matter by writing to the noble Lord than chance my arm at the Dispatch Box. I apologise for going "off-mike". One is always torn between trying to be courteous and look at

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people when replying and the knowledge that in so doing one may stop them hearing what one is saying. I shall try to address the microphone in future.

Baroness Sharp of Guildford: I thank the Minister for her response to our amendments. I also thank noble Lords who have supported us, particularly as regards Amendment No. 17. We are disappointed that she does not see a way of including in the Bill some broad obligation to consult which we, from these Benches, should like to see. However, we take courage from the fact that the Minister has given us an assurance that such an obligation will be mandatory within the regulations. I believe it is important that the regulations are published quite quickly. As the Minister has assured my noble friend Lord Clement-Jones, of that, we hope that it will be the case.

Amendment No. 15 was not covered in the Minister's response. I wonder whether she could deal with that now. That amendment concerns the process of transition between PCGs and PCTs and the readiness of PCGs to become PCTs. We should be grateful for a response.

Baroness Hayman: I shall attempt to do so. Perhaps the noble Baroness will let me flannel for a moment as I am trying to find the precise detail on Amendment No. 15. This is the issue about placing on the face of the Bill the criteria upon which the Secretary of State will base his decision of whether or not to establish a primary care trust.

We recognise the need for criteria for assessing the suitability of PCGs to progress to PCTs. We want a measured transition with proposals developed and taken forward in partnership with key stakeholders. We want to ensure that people progress to PCT status when they are ready to do so.

The amendment identifies suitable elements that we would clearly want to take into account when assessing the suitability of proposals for PCT status. They are all important issues. However, there may well be other factors which will need to be considered. We would expect to see, for example, a clear vision of how proposals to set up a PCT will benefit patients. The impact on existing services, both those that come within the remit of the PCT and wider services, would also be an important consideration.

Again, this is not a case of us trying to undermine the importance of the issues to which the amendment draws attention; but rather that we wish to retain a degree of flexibility. It may be, for example, that in the light of experience, over time, we shall need to bring in other criteria. It is for that reason that we suggest that we do not put the provisions on the face of the Bill.

Baroness Sharp of Guildford: I thank the noble Baroness for that response. Again, we are somewhat sorry that she does not see her way to include in the Bill something slightly more specific. By this amendment, and Amendment No. 17, we aim to give the Bill some teeth. I am sorry that the Minister cannot see her way to include them in the Bill.

Lord Harris of Haringey: I welcome my noble friend's comments about the importance of consultation

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with users, carers, and patients. It is important, in considering such arrangements, that there is a tendency not simply to consider consultation with the professional groups and the established organisations in an area, but also to recognise the need to have discussions with users' and carers' organisations. I am slightly disappointed by my noble friend's suggestion that it would be inappropriate to put such provisions on the face of the Bill.

I should like to comment on the point made by the noble Lord, Lord Clement-Jones, concerning publication of regulations. It would be helpful if we were able to see such regulations before the Bill finally leaves your Lordships' House. Again, I am learning the code words. "Advice" and "soundings" do not seem quite as strong as "some sympathy". However, I certainly hope that it will be possible for us to have sight of the regulations to enable us to understand exactly how the Government's thinking is developing on this matter.

I was concerned by some of the comments made by the noble Baroness, Lady Gardner of Parkes, regarding the speed with which consumer groups respond to consultation, and the fact that perhaps they need to get their act together in that respect. I believe it needs to be recognised that we are talking of small groups of people, who may be fairly vulnerable, operating in the community. It is simply not realistic to expect them to respond at the speed with which professional organisations or statutory bodies can, and expect to, respond.

Organisations of carers or patients may not meet more frequently than once every two months. It may be a complicated process for people to attend such meetings. Specialist care support and specialist transport may need to be arranged. It is simply not feasible for them to turn things round rapidly. Some of your Lordships may feel that three months is a fairly generous timespan in that respect, but it will not be adequate in some circumstances. I am conscious that the current Department of Health expectation, on many issues, is three months. It is remarkable how frequently those three months happen to cover the month of August or the Christmas period. That clearly makes it difficult for any organisation--even the more well-developed ones--to respond within the timescale concerned. I hope that my noble friend will be able to consider some of these matters again. However, in that context, and given the fact that perhaps we may be able to have sight of the draft regulations before we proceed much further, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 9 to 18 not moved.]

Lord McColl of Dulwich moved Amendment No. 19:


Page 2, line 12, at end insert--
("( ) Every Primary Care Trust, or other body exercising functions on behalf of the Primary Care Trust, shall make arrangements for securing that they receive from--
(a) medical practitioners, registered nurses and registered midwives, and
(b) other persons with professional expertise in and experience of health care,
advice appropriate for enabling the Primary Care Trust effectively to exercise the functions conferred or imposed on it under or by virtue of this or any other Act.").

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The noble Lord said: The purpose of the amendment is to ensure that there is a statutory basis to require primary care trusts, or indeed other bodies acting on their behalf, to take advice from doctors, nurses, midwives and other healthcare professionals before commissioning decisions are taken. Under Section 12 of the National Health Service Act 1977, health authorities have a clear duty to involve healthcare professionals in decision-making. The wording of the amendment reflects the wording in that section.

It is not clear in the Bill what mechanisms will be used to ensure that primary care trusts seek professional advice when they are deciding on the commissioning of medical services. Doctors, nurses, and other healthcare professionals have, of course, the kind of detailed knowledge necessary to advise on the clinical elements of the service. Their guidance and support is essential if the NHS is to work properly.

A nursing sister, who has been running a busy ward for some years, really knows what she is talking about. To fail to collect the advice of these professionals would be a great mistake. One splendid ward sister noticed that the paper towels available in her ward were so rough that the only way they dried the hands was to knock the skin off and take the water with it. She started to investigate and found that if paper towels which actually absorb fluid were used, only one towel would be required as opposed to three of the rough variety. That saved a great deal of money. She did not have a degree in economics, but she did have sound commonsense.

Primary care trusts will need to seek advice from experts on many issues, including on the public health services which are provided by clinicians, and on pharmacy services and services provided by the professions allied to medicine and many others. Primary care trusts will be charged in particular with building relationships with local social service departments. In the area of public health, primary care trusts will have a duty to contribute to the health improvement programme and to commission services for the benefit of the public health of their populations as well as for the health of individual patients. It will therefore be of great importance for primary care trusts to have access to high quality public health services at all stages of the commissioning process. I beg to move.


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