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Lord Clement-Jones moved Amendment No. 4:

Page 2, line 38, at end insert--
("( ) Appropriate arrangements shall be made with a view to securing that a Primary Care Trust's functions are exercised with due regard to the principle that every individual has a right to treatment according to individual need free of discrimination as to access to or the quality of service.").

The noble Lord said: My Lords, I mistakenly had a crack at this a short while ago. I should like essentially to move the amendment formally, as I have already made my speech on it. However, in the spirit of flexibility which the Minister has displayed in other parts of the Bill, and also in the interests of drafting speed, I should like to reiterate that I very much hope that that will be mirrored in subsequent stages of the Bill. I hope that the department will bring forward some robust amendments to the Bill which will ensure equal opportunities for those who have primary care treatment at PCT level, and that it will lay down those duties for the commission for health improvement. I beg to move.

4 p.m.

Lord Renton: My Lords, the noble Lord will have the right to reply to a debate on this amendment so that he can decide whether to withdraw the amendment or to ask the opinion of the House. When he replies I wonder whether he could amplify the concept that he has in mind as to the expression,

    "free of discrimination as to access".

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Does that mean free of discrimination as to access to a particular hospital, or form of treatment, or what?

Lord Skelmersdale: My Lords, I threatened to speak to this amendment, and so I shall. In his primary crack at this amendment, as I think he would describe it, the noble Lord, Lord Clement-Jones, referred to feeling a tinge of disappointment that nothing further had come from the Government on this extremely important matter which has run through all our debates on this Bill; namely, that,

    "every individual has a right to treatment according to individual need free of discrimination as to access to or the quality of service".
To answer my noble friend Lord Renton--of course, the noble Lord, Lord Clement-Jones, will be able to answer for himself--that means the individual has a right to treatment and to access to an appropriate hospital.

That causes me to don my hat as a PMM--as I described it on Report--that is, a parliamentary moaning minnie, in that I am surprised indeed that this amendment has not been grouped with that of the noble Baroness, Lady Masham. The words that I have just read out--I shall not repeat them--refer not only to local treatment but to treatment elsewhere. We all know that there are occasions when it is necessary to have out of area treatment. I shall not discuss that because no doubt we shall debate it a little later. However, I regard this amendment as taking precedence over those of the noble Baroness. I am more than a little surprised--in fact, I am slightly miffed--that the Minister has not done what I understood her to promise to do at Report stage; namely, to put similar words in the Bill by means of an amendment.

Baroness Carnegy of Lour: My Lords, I hope I am not quite as far off the mark as I was when I intervened on the previous amendment. I apologise to the House for wasting a moment of our time. The wording of this amendment worries me because I do not see how every individual can have the right to treatment in the way that is described. For example, one hospital may have a far more up-to-date scanner than another hospital. Therefore the kind of scans that can be carried out in a particular hospital are more limited, perhaps because it has an older scanner. I speak of the situation in my own area but I am sure that scanners vary across the country.

In some hospitals one has to pay for assisted pregnancy whereas in others that is free. In some areas and in some hospitals that provision is not available. That may impinge on the amendment of the noble Baroness, Lady Masham, but I am not sure that one can ask for the right that is described in the amendment. I do not know whether the Minister intends to put something in the Bill, and if so she will probably be able to meet this problem. It is not just a matter of rationing, but different hospitals have different abilities to carry out particular treatments.

Lord Walton of Detchant: My Lords, the intention underlying this amendment is totally praiseworthy but I share the anxieties that have just been expressed by the noble Baroness, Lady Carnegy of Lour, because it seems

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to me that as the amendment is framed at the moment it would give carte blanche to any individual in any situation to be able to demand any form of treatment, however difficult and however expensive. In a National Health Service where--whatever one's good will towards the care of the individual--resources are ultimately finite, it would be dangerous to put so clear a recommendation, or in fact so clear a statute, on the face of the Bill. I am wholly in favour of the principle that individuals should have access to healthcare irrespective of age, sex, or other forms of discrimination on political, ethnic or other grounds. That is an important principle, but as it is framed I believe this amendment would be impossible to implement in a health service which has finite resources.

Baroness Masham of Ilton: My Lords, I point out that my two amendments use the term "where appropriate".

Baroness Hayman: My Lords, the brief debate we have had on these issues is an illustration of some of the difficulties in drafting appropriate legislation in this area. First, I shall deal with the point made by the noble Lord, Lord Skelmersdale, when he suggested that I had not fulfilled my promise to the House. I refer the noble Lord to the record of our debates at Report stage where I stated,

    "At this stage it would be premature of me to give an absolute commitment to bring forward such an amendment because I do not yet have before me advice on whether we can properly legislate as the noble Lord would wish. However, I give the commitment that during the course of the Bill we shall return to the subject and report progress".--[Official Report, 15/3/99; col.496.]
That is the commitment I intend to fulfil this afternoon. Therefore, I do not believe that I misled the House in suggesting that we would be able to bring forward amendments at this stage.

Lord Skelmersdale: My Lords, I would not dream of suggesting that the noble Baroness had misled the House. I merely gave my interpretation of what she said, which I must admit was from memory because I have been away for the past three days.

Baroness Hayman: My Lords, I am grateful to the noble Lord for those comments. We discussed similar points both in Committee and at Report stage when I made clear the importance the Government attach to achieving fairer access to high quality healthcare. I welcome the opportunity now to restate the Government's commitment that access to the National Health Service should be on the basis of need and need alone, with no place for discrimination on grounds of gender, age, disability or ethnicity. Although I accept the points that have been made in debate, we are not at that point yet in that we have varying levels of provision and access to services in various parts of the health service. A major part of the Government's proposals and work programme concerns reducing inequalities in access to services. However, that is an ongoing process. It is not something that can be delivered overnight in terms of an absolute diktat.

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I also stated at Report that this was one of the areas on which we had not yet managed to reach a conclusion on the best way forward in legislation, but that it was important that we came back with appropriate solutions for the NHS as a whole and not simply for primary care trusts and the commission, which are the two areas to which the amendments of the noble Lord, Lord Clement-Jones, apply. I believe that was the spirit of the comments made by the noble Lord, Lord Skelmersdale; namely, that the provision should cover out of area treatments, which will not necessarily be offered by primary care trusts, but are most likely to be offered in specialist hospitals. This is still the case. I reassure the House that we are still considering the points that have been made. However, I believe it would be wrong to lay an amendment before the House before we have made a searching examination of the issues facing the NHS both as an employer and as a provider of services. The amendment is very wide and there are varying aspects to equal opportunity issues and to planning for change where necessary. That is particularly so in the light of the Macpherson report which has posed sharp challenges to the whole range of public services. We need to explore those in a thorough way. Any legislation should flow from rather than precede such consideration. I am sure that in that context the noble Lord, Lord Clement-Jones, will welcome the fact that your Lordships' House will have an opportunity to debate the Macpherson report immediately after the Easter Recess. At that point the issues of equality of access to public services will, I am sure, be debated at some length.

I hope that the noble Lord and others who have spoken will accept my assurance that, in saying that I cannot yet offer a substantive reply, I do not intend in any way to underplay the seriousness of the issues. I would suggest that not having an instant answer reflects the importance we attach to having a coherent and comprehensive approach to issues which deserve serious and careful attention. The noble Lord, Lord Clement-Jones, referred to the spirit of the amendments. I can assure him that we embrace the spirit of the amendments. I am certain that we will return to these matters during the passage of the Bill, although, in all likelihood, in another place. On that basis, I hope that the noble Lord will feel able to withdraw his amendment.

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