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Lord Skelmersdale: In her answer to this group of amendments the Minister, quite rightly--if I may say so without sounding patronising--relied heavily on paragraph 17 of the schedule. It starts with the word

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"Regulations" which immediately makes my eyes open and my ears prick up. Surely to goodness, by now, with the experience of the NHS trust, the Government and the department know exactly what they want the organisations within the health service to put into their reports to publish and to publicise. Therefore, why are regulations needed?

Baroness Hayman: I think that the broad areas are clear. However, there is change in reporting and what we need to know about. Clinical governance, for example, is an innovation in the health service. It is important that we have proper and transparent reporting on clinical governance arrangements. In the same way, I believe that the broad areas to be covered will be similar to those for other NHS bodies. As has been pointed out, PCTs, particularly at level four, are a new animal. It may be appropriate to ensure that the reporting arrangements recognise that and provide for transparency in those circumstances.

I am sure that we are quite a long way along the learning curve, but I am not sure that we are 100 per cent. there.

9.15 p.m.

Baroness Fookes: If transparency is to mean anything, it must also be very important to be able to make comparisons between the various trusts and how they are working. Therefore, it is important, if there are to be regulations, that there is some kind of uniform format or presentation for the key factors. Otherwise, it will be extraordinarily difficult to make comparisons.

Baroness Hayman: I accept the noble Baroness's point. We need a stronger national framework against which local decision making can be assessed. The guidance that comes out of NICE, the national service framework, will be backed up with local clinical governance arrangements reporting back on how an individual institution can be compared against another. Together with the national performance assessment framework with its various criteria, we hope that that will help us to improve and to provide more consistent access to high-quality services. It will provide exactly the kind of material for real comparison that will assist local people involved in the provision of services to improve their own service as against other people's. It will also assist local communities to assess what is being done for their locality as opposed to others.

Lord Clement-Jones: I thank the Minister for that curate's egg of a reply, for that is, perhaps, the best description of it. There were some helpful aspects of what she said. As I understand it, the Minister undertook to re-examine the wording at the beginning of paragraph 17 of the schedule in terms of "must" versus "may". That will, to a degree, go some distance towards tightening up that paragraph.

I also thought that her clarification on Amendment No. 50 was helpful in terms of the split function. Perhaps I am being a little churlish, but when she said that she was sympathetic to the purpose, I wonder how many parsnips

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that will butter. It is good to have the sympathy of the Minister on this point, but it is the concrete outcome which is important--

Baroness Hayman: I hope that the noble Lord will forgive me for intervening. There are always nuances in "sympathy" and "looking at", as we discovered earlier in the day. The point I was trying to make to the noble Lord was not that I would give him kind words but nothing in reality, but rather that we believe that the purposes to which we are sympathetic are already covered by the Bill as it stands. That is the reason for not needing the amendment.

Lord Clement-Jones: With the greatest respect, that reply worries me more than the original reply. If the Minister believes that it is already incorporated in the Bill, perhaps my eyesight is failing me. However, I shall look at the reply in Hansard.

This is a problem because regulations will provide for the kind of information which is provided. However, I seek some assurance about the precise type of information without restricting flexibility. However, members of local communities will want to know what a primary care trust is obliged to provide by way of information, and in particular the type of information we were talking of as regards Amendment No. 50 in terms of their conflict of interest, which the Minister acknowledged.

I fully accept that the amendment itself may be flawed. The intention is that people can see clearly what the trust is providing internally, so to speak, as opposed to outsourcing. That is of considerable importance. However, I do not see this in concrete terms. I can well believe that the regulations may well provide for that in due course in some shape or form, but we shall read Hansard carefully as the Minister's reply had to be something of a double-decker of a reply. We may well return to this on Report. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 40 to 44 not moved.]

Earl Howe moved Amendment No. 45:

Page 45, line 12, at end insert--
("( ) An order approved by the Secretary of State shall be laid in draft before both Houses of Parliament and shall be subject to approval by resolution of each House.").

The noble Earl said: Schedule 1(19) relates to the powers of compulsory purchase which may be vested by the Secretary of State in a primary care trust. It is a very considerable power. I do not know--perhaps the Minister can tell us--what other types of body, apart from local authorities (that is, of course, outside central Government) have that privilege conferred by statute. I doubt whether there are many. I should like to hear from the Minister a clear set of reasons why the Government feel that it is appropriate for a PCT to have that privilege.

I fully appreciate that the Bill does not confer a blanket power to acquire land compulsorily and that any application would be subject to individual approval by the

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Secretary of State. I also realise that--in theory at least, if not in practice--the power is already available to NHS trusts under the 1990 Act.

Can the Minister say under what circumstances the Secretary of State would be likely to grant approval for a purchase to be made compulsorily, if that is not too hypothetical a question? Paragraph 1 merely contains the phrase,

    "for the purposes of its functions".
I cannot help observing that that is a bit of a joke because the Bill does not yet tell us what the functions of a primary care trust are! However, we do know that they could be very wide-ranging. The serious point is that by approving this part of Schedule 1 as it stands, we would be writing something of a blank cheque. That is why we need to hear something definitive from the Minister.

A fear that I have heard expressed by GPs is that compulsory purchase orders could be used by a primary care trust to purchase their surgeries if they did not want to agree to the proposals put forward by the PCT about the use of that surgery. That really would represent a significant threat hanging over the heads of GPs on virtually every decision that they made in their dealings with the primary care trust. That would be extremely regrettable. For all those reasons, I felt that it was right at least to throw into the ring the possibility that there should be parliamentary scrutiny if ever the question of a CPO should arise to ensure that those CPO powers are used both sparingly and responsibly. I beg to move.

Baroness Thomas of Walliswood: I am bound to say that I share the doubts of the noble Earl. Compulsory purchase is used by local authorities. If, for example, a highways authority wants to purchase a piece of land for the construction of a roundabout--or a cycle path, as would be more likely these days--it may do so, but only after that has been subject to the process of a public inquiry. The local authority has to go through a long process in order to ensure that the compulsory purchase is justified and that everybody has been satisfied in that respect. I await the Minister's answer with a considerable degree of interest.

Baroness Hayman: I think perhaps I can give an answer to the Committee. I hope to give some reassurance on the fears of some of the GPs to whom the noble Earl referred. We would not expect this to be used in any way as a weapon of coercion against general practitioners or as a threat to confiscate their property. I have more difficulty in trying to envisage exactly the circumstances in which it would be necessary for these powers to be used for a primary care trust, but the clause does provide that ability to the primary care trust.

I should like to make it clear that consideration of any PCT to go down this route should be very much a last resort. The Secretary of State would expect that any order submitted for his approval demonstrated that every other possible solution had been explored. This could include the purchase of an alternative suitable site in the usual way. As the noble Earl acknowledged, the power of compulsory purchase of land for National Health Service purposes is not new. Such a power was

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approved for NHS trusts in the National Health Service and Community Care Act 1990, and under that Act the Secretary of State is empowered to approve orders submitted to him by NHS trusts for the compulsory purchases of land. However, such orders approved by the Secretary of State are subject neither to affirmative resolution of your Lordships' House nor of another place.

This Bill does not seek to alter the existing arrangements for NHS trusts but to make the same provision for primary care trusts. It is not a power that would be used lightly. The use of compulsory purchase for land for NHS purposes is extremely rare but it is considered to be a necessary fall-back power to ensure that the NHS is able, where it is essential, to ensure that services are made available on a site that best meets the needs of the local population.

It is rare and perhaps may become even rarer now that we have set in motion other initiatives, such as health and education action zones, where partnership and working with other bodies is a key aim and where we seek to ensure that effective communications exist between all arms of local and central government. In this way primary care trusts and NHS trusts will perhaps earlier become aware of residual shared-land opportunities that can be accessed without the need for compulsory purchase. As the noble Earl pointed out, these powers are available to many government departments and to other public bodies.

Safeguards already exist to which objections can be made and which can culminate in the holding of a public inquiry. We do not believe it is necessary to subject primary care trusts' compulsory purchase orders to additional requirements. These would be powers that we think would be very rarely used. There are the back-up safeguards in terms of reference to the Secretary of State and that it would have to be demonstrated that every other possible solution had been explored. I suggest to the Committee that we do not need another layer of safeguard.

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