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Lord Hughes of Woodside: If these two professions were placed on the face of the Bill, would it not in future prevent other professions being added as directors?

Lord Mackay of Drumadoon: Not as I understand the current legislation, which was explained to us in the letter sent by the Minister for which we are grateful. But the fact that on the face of primary legislation it is necessary to have two types of health service professionals as executive directors does not preclude, as I understand the law, the Secretary of State or the First Minister bringing forward an order which also required chiropodists, dentists or whomsoever to be on the board; nor does it prevent such people being appointed, whether or not they are mentioned in primary or secondary legislation. Therefore I have to say to the Minister that I find his response unsatisfactory and I shall seek to test the opinion of the Committee.

1.27 a.m.

On Question, Whether the said amendment (No. 188A) shall be agreed to?

Their Lordships divided: Contents, 2; Not-Contents, 29.

Division No. 2


Henley, L. [Teller.]
Mackay of Drumadoon. L. [Teller.]


Addington, L.
Ahmed, L.
Amos, B.
Archer of Sandwell, L.
Bach, L.
Carter, L. [Teller.]
Clement-Jones, L.
Desai, L.
Donoughue, L.
Falconer of Thoroton, L.
Farrington of Ribbleton, B.
Gilbert, L.
Gordon of Strathblane, L.
Gould of Potternewton, B.
Grenfell, L.
Hacking, L.
Hardie, L.
Hayman, B.
Hoyle, L.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Macdonald of Tradeston, L.
McIntosh of Haringey, L. [Teller.]
Mar and Kellie, E.
Monkswell, L.
Pitkeathley, B.
Ramsay of Cartvale, B.
Sawyer, L.
Sefton of Garston, L.

Resolved in the negative, and amendment disagreed to accordingly.

1 Mar 1999 : Column 1532

Lord Mackay of Drumadoon moved Amendment No. 189:

Page 31, line 6, at end insert--
("(2) In section 12A of the 1978 Act (NHS trusts), after subsection (3) there is inserted--
"(3A) The chairman and trustees of every NHS trust shall, on appointment, be resident in or employed in the area covered by the trust."").

The noble and learned Lord said: Again I rise to move this amendment in place of my noble friend Lord Mackay of Ardbrecknish. It seeks to probe the

1 Mar 1999 : Column 1533

Government and elicit from them details of their policy as to how well connected with the local area covered by a particular health service trust, whether a primary care trust or an acute hospital trust, the non-executive directors of the trust--namely, the trustees, who include the chairman--must be. In replying to the previous amendment the Minister touched on the connection between the non-executive directors and the local community--not that they formally represent members of the community, but that they should have a connection with them.

As presently drafted, Clause 39 seeks to amend Section 12A of the 1978 Act in the terms to which I have drawn attention. It is obviously unnecessary that this amendment should cover executive directors; by definition they are employed by the National Health Service trust concerned and are therefore employed in the area for which the trust has responsibility.

I trust that the Government will not dispute the importance of non-executive directors being seen to act on behalf of the people who live and work in the area in respect of which a trust has responsibility. That is seen to be their primary role, as it were, rather than becoming too involved in the day-to-day management of the provision of healthcare services, which is a matter for the professionals who are employees of the trust, whether or not those professionals also be executive directors.

Such identification with the needs of the local people is important. Those who work or reside in an area are the potential patients of a trust. It is appropriate, and indeed necessary, to have on that trust people who will speak and argue on their behalf rather than take a particular position on behalf of the employees of the trust, whom other people are there to represent.

It seems to me, and it certainly seemed to my noble friend Lord Mackay of Ardbrecknish, that Section 12A of the 1978 Act, if it is to be amended as the Government propose by Clause 9, would benefit from an amendment which required the chairman and non-executive directors, the trustees, to be either resident in or employed in the area. I beg to move.

Lord Monro of Langholm: I support my noble friend in his amendment. So far as I am aware, the chairmen of area health boards would live in their own areas. That could, however, be difficult in the central belt of Scotland, where one is domiciled to the headquarters of one's health board. In the more rural areas that was always the case, certainly when I set up the original health boards.

Although 1st April is only about four weeks away, the Minister is not aware of how new members are to be appointed to trusts or to the board. I know from experience, as I am sure does he, that it sometimes takes months to obtain the appropriate appointments to boards and trusts, going through all the formalities and the careful and diplomatic soundings beforehand. It seems to me that if area health board chairmen or members of boards or trusts are about to be appointed, the Minister should have a great deal of information in the pipeline. Yet he is not aware whether or not he has to invoke the

1 Mar 1999 : Column 1534

Nolan recommendations. I hope that before we finish the debate tonight he can go a little further with regard to what the position will be in four weeks' time.

Baroness Carnegy of Lour: It may well be that in central Scotland, as my noble friend said, it is not very easy to keep membership to those living within the border of each trust. But the point is important. My research tells me that quite a number of current non-executive directors of trusts tend to "go native" and become so absorbed into the system that they begin to act like professional administrators and are therefore not as good a foil as they should be to those administrators. If they knew that they had to live in the area and therefore were speaking for the area and their minds were addressed to working entirely within the boundaries of the trust, that should help. I hope that the Government are interested in the amendment.

The Earl of Mar and Kellie: If this new statutory requirement were to be put on the face of the Bill, I should prefer it to say that the chairman and trustees should be "domiciled in" rather than "resident in". "Domiciled" means that it is their first and main home, whereas "resident" could refer to a convenient pied-a-terre, which would defeat the purpose of this statutory requirement.

Lord Macdonald of Tradeston: In reply to the noble Lord, Lord Monro, as I said earlier, I believe that the Scottish health boards have been something of a model for the noble and learned Lord, Lord Nolan. I can confirm that health boards and trusts are subject to Nolan and that people have been appointed to new trusts under the Nolan principles.

The noble and learned Lord, Lord Mackay, has explained his wish to ensure that there should be proper representation on all the boards. We accept that there should be strong links between those appointed to a trust board and the community which the trust primarily exists to serve. Geographical considerations such as this are already a fundamental part of the appointment process, as has been acknowledged. We have achieved much of what the noble and learned Lord wants without the need for legislation, and I am sure that that will continue to be the case in future.

However, a trust often provides services to a wider catchment population than lives in its immediate vicinity. That is particularly true where a trust provides services from a hospital located near the boundary of a health board. The amendment could have the effect of denying the trust the services of the best candidate for the job simply because he or she does not reside or work in the trust's area and is not prepared to take up residence there.

The example of the acute hospital trusts in Glasgow perhaps makes the point most clearly. From 1st April there will be two acute hospital trusts in Glasgow, one providing services primarily in the north of the city, the other providing services primarily in the south. In many respects they will be complementary. Patients from all over Glasgow and indeed from outside the city will be treated in both trusts. I am sure that the noble and

1 Mar 1999 : Column 1535

learned Lord does not want potential trustees in Glasgow--especially the original proposer of the amendment, who lives in the lovely, leafy south side of Glasgow--to have to uproot themselves from north of the Clyde to south of the Clyde or vice versa. I repeat that the Government have every sympathy with the principle behind the noble and learned Lord's amendment but, for the reasons I have given, I hope he will not feel the need to pursue it.

Lord Mackay of Drumadoon: Once again, I am very grateful to the Minister for his response. He clearly accepts the general principle which lies behind the amendment, but he makes the valid point that there are practical problems when a hospital is located near a boundary. My noble friend Lady Carnegy of Lour also has reservations as to whether it would be appropriate for such a provision to be on the face of the Bill. In those circumstances, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 39 agreed to.

Clause 40 agreed to.

1.45 a.m.

Lord Mackay of Drumadoon moved Amendment No. 190:

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