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Lord Campbell of Alloway: My Lords, as a matter of practicality, this is a frightfully important subject. The Select Committee meets on 22nd June and the Motion says that it, "shall report by 29th July". If the committee has to take evidence from outside interests, which it will have to do in order to do its job properly, how on earth can this be done in that time? Moreover, if members of that committee do not do it, what will happen to them? Will they be taken off and put into the Tower, or what? It seems totally impracticable to me.

The Chairman of Committees: My Lords, I understand that the time limit proposed to your Lordships is comparable with that which was set on the Financial Services and Markets Bill. Perhaps I may assure the noble Lord, Lord Campbell of Alloway, further and say that I also understand that the proposed chairman of this committee, if your Lordships decide to set it up now, is happy with the suggested time limit. I commend the Motion to the House.

On Question, Motion agreed to.

Health Bill [H.L.]

3.36 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman): My Lords, I beg to move that the Commons amendments be now considered.

Moved, That the Commons amendments be now considered.--(Baroness Hayman.)

On Question, Motion agreed to.

COMMONS AMENDMENTS
[The page and line refer to Bill 77 as first printed for the Commons]
COMMONS AMENDMENT

1 Clause 2, page 2, leave out lines 8 to 11.

Baroness Hayman: My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 1. We had extensive debates on the role of the primary care group in the process of establishing primary care trusts when the Health Bill was previously considered in your Lordships' House. Reflecting on what was said then, I am convinced that there is in fact little difference on this issue between the underlying aim of the Government and that of those on the Opposition Benches.

I have read the official record again, and I agree with much of what was said by the noble Earl, Lord Howe. We share a common objective that the establishment process should be locally owned and driven. We also agree that the voice of the PCGs is crucially important.

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My ministerial colleagues and I considered these debates very carefully and our decision to table an amendment in another place was not taken lightly. In our considerations, from whatever perspective we approached the matter, we always came back to the fundamental point of principle--whether or not the views of one local stakeholder, however important, could mean that the views of others are automatically set on one side or ignored. That would be the effect of the amendment that was made in your Lordships' House. It would give the primary care group a statutory right of veto over the views of all other local stakeholders. I believe that that would demean the importance of the views of partners in the local NHS, such as community trusts and their staff, and indeed patient groups.

We also believe that it would be unwise to set down such a rigid rule on the face of the Bill. Complex and difficult situations may well arise which require careful and sensitive handling. I recall that the noble Lord, Lord Clement-Jones, recognised on Report, in the form of what was then Amendment No. 5, that there might indeed be exceptional circumstances which needed to be considered. We are aware, for example, that in some places proposals are under discussion to establish PCTs which cover the area currently covered by several PCGs. While it remains to be seen whether such large PCTs could effectively fulfil the functions that we have set out for them, we would not wish to prevent such proposals from being considered at this early stage.

It is equally possible that such a proposal could have the support of all but one PCG--and perhaps be opposed by a very narrow majority of members of that individual PCG--and enjoy widespread support among clinicians and others in the local area. While very great care and sensitivity would be needed in deciding how to proceed in such circumstances, it is clear that a statutory PCG veto could mean that a very small number of people could potentially block an extremely beneficial development. It is precisely because we cannot fully anticipate all the possible scenarios that could develop, such as this one, that the Government brought forward this amendment in another place.

I would like to make it clear, however, that the Government attach the greatest importance to the successful establishment of primary care trusts. They offer unparalleled opportunities for local stakeholders--including family doctors, nurses, midwives, health visitors, the professions allied to medicine and social services--to shape services to provide better healthcare and to improve health. They will bring significant benefits to patients, clinicians and the local NHS as a whole. But a PCT will work only if it builds on local enthusiasm and local commitment, in particular of those working at the front line of patient care: GPs, nurses, midwives and other health and social care professions.

For this reason the Government have no intention whatsoever of establishing primary care trusts without broad local support from the very professions which will form them and give them the energy they will need to succeed. We believe that a voluntary approach is the only sensible way to proceed. I can be quite clear to the House today that we do not want, and are not

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encouraging, a headlong rush to primary care trust status. Instead we are looking for measured and evolutionary change. We want progression to trust status to be locally driven at a pace that suits local circumstances.

That desire is reflected in the Government's proposals for the establishment process. We have deliberately left it to the local NHS--the PCG board, GPs, nurses, other professions, a community trust or a health authority--to bring forward a proposal to develop a primary care trust. If a proposal has local NHS support--from a PCG or NHS trust providing community services--the health authority will be required to enter into a formal local consultation. This consultation process will be particularly important to hear the views of the wider community and local patients in particular.

Once the local consultation process is complete, the health authority will submit the proposal to the Secretary of State for his consideration. I can assure the House that we intend that the Secretary of State will not simply be sent a recommendation. We intend that regulations will require all the responses to the consultation to be attached to the recommendation so that the Secretary of State has the benefit not only of the views of the local health authority, but also those of consultees, and at first hand. The views of primary care groups, local GPs and other professions, as well as those of the wider community and the NHS locally, will be key considerations for the Secretary of State in deciding whether to establish a primary care trust.

I go further and say that the support of the relevant primary care group will be a critical factor in our consideration. The Government intend to establish primary care trusts in a way that is sensitive to local views, and primary care groups are key to that. For the reasons I have given and in the light of these assurances I hope that noble Lords will feel able to support the Government in this amendment.

Moved, That the House do agree with the Commons in their Amendment No. 1.--(Baroness Hayman.)

3.45 p.m.

Earl Howe: My Lords, the House will be grateful to the noble Baroness for the clear way in which she has spoken to this important amendment. I am reassured that she feels there is little that separates us on this issue. If I do not misread her, I think that the Minister has modified her position somewhat from that which she adopted on the previous occasion when this issue was debated in your Lordships' House. In particular she seemed to me to have moved away from the guarded form of words that she used several times both in Committee and on Report. She said then that a decision to establish a primary care trust would,


    "take into account all local views". She also said that it was the Government's "assumption" that the support of the primary care group would be required by the Secretary of State before he approved a primary care trust.

Those phrases did not seem to me to reflect one of the essential requirements in any transition to PCT status; namely, the need to have the prior, wholehearted

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backing of those who are most affected by such a change. The previous Minister, Mr. Milburn, spoke about putting doctors and nurses "in the driving seat". At the time I thought I knew what that meant, but in the light of the Government's antipathy to your Lordships' amendment I realised that I did not. However, hearing the noble Baroness speak in the way she has today, in terms--if I do not misquote her--that referred to measured, evolutionary change, locally driven, I am considerably reassured.

One of the arguments we debated at earlier stages was that it is pointless going out to wide consultation on a proposal to move to trust status if the health professionals themselves do not support it. But the important point is that the degree of support among health professionals should be established. Can the Minister say in what way this will be done? Would it, for example, make sense to involve the local medical committee in organising some kind of a ballot?

I agree with the noble Baroness that when a PCT is established it is in all our interests that it should be a success. Without broad support among GPs and the key professional stakeholders, the chances are that it will not be. But the Secretary of State should, I suggest, be looking for other indicators as well. He needs to ensure that there is competent management in place, with tight financial management and proper accountability. Can the Minister be a little more specific about the criteria that the Secretary of State will adhere to when making his decision? If there is a dissenting group of health professionals among those in the proposed PCT, will he ensure that that fact is made publicly available?

I have a further concern which the Minister may be able to help me with. We understand that the first wave of PCTs are expected to be in place by April 2000. In another place the Minister made it clear that the necessary orders to establish such PCTs would need to be finalised by about the beginning of December. Prior to that the Government are committed to consulting on the draft PCT orders. If that consultation follows the normal pattern it will be a three-month process. But prior to that, regulations will need to be laid, and they, too, will be subject to consultation, again over some three months. Working back from the early December deadline--when the PCT orders are to be laid--it is clear that the draft regulations will need to be ready shortly indeed. Are those draft regulations ready now and, if they are, can the noble Baroness say why neither your Lordships nor another place has had the benefit of seeing them yet? If we were able to see them, I have little doubt that they would inform our debates considerably. Can the Minister say whether the timetable I have outlined is roughly right, or have I got it wrong?

I thank the Minister for the added reassurances she has been able to give. They are important reassurances. It may be wishful thinking on my part, but in the light of what she has said I am inclined to conclude that we can be slightly more confident than once we were of the procedural safeguards that will be put in place. If the

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Minister is able to answer my questions satisfactorily I would not propose to recommend to your Lordships that the House's earlier amendment should be insisted upon.


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