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National Health Service Reform and Health Care Professions Bill

House again in Committee.

8.37 p.m.

Clause 5 [Local Representative Committees]:

Lord Rea moved Amendment No. 54:

The noble Lord said: In contrast to some of the weighty matters that we debated before dinner, I hope that these amendments will be taken quickly. I hope to say only a few words about them.

The reason for Amendments Nos. 54 to 58 is to draw the Minister's attention to the importance of ensuring that consultation takes place between primary care trusts and local committees representing the health professions in their areas; namely, local medical committees, dental committees and those representing ophthalmic practitioners and pharmacists.

As it stands, the Bill states that recognition of such committees by PCTs is discretionary. The amendments make that recognition mandatory. My noble friend will doubtless say that that recognition is already given or will always be given by PCTs to local medical committees and the like. Such a statement, if he makes it, will be welcomed. However, it is important to note, as we discussed at some length a little earlier, that not all 300 or so PCTs are yet up and running. Some will have difficulty in becoming operational by the appointed day, and they may feel that consultation with local representative committees has a lower priority than many other conditions. On that I would value my noble friend's comments.

I speak also to Amendment No. 60, which is grouped with these amendments. This amendment enables regulations to be made requiring strategic health authorities rather than primary care trusts to consult with local representative professional committees about those functions that the strategic health authorities will retain and which have not been passed down to the PCTs in the current reorganisation. Those responsibilities and functions include the commissioning of specialist services—or some specialist services, I might say, after the debate that we had before dinner—as well as major capital developments and performance management of the PCTs. The Bill allows such consultations to take place regarding Section 28C schemes—that is, personal medical service pilot schemes—but it does not do the same for general medical services, which are those that concern the great majority of primary healthcare professionals. Decisions taken at strategic health authority level will be much more effective and widely accepted if they are informed by such consultations, preferably on a regular basis.

I shall be very interested to hear my noble friend's comments. I beg to move.

Lord Clement-Jones: I shall briefly support the noble Lord, Lord Rea, on all the amendments. The first amendments in the group concern the duty of

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PCTs to recognise the local representative committees. The Minister may well be reminded of our happy hours discussing "may" and "shall" on various health Bills in the past, but the situation in this case is rather different. It is all very well for there to be a convention that "may" can mean "shall" as far as the Secretary of State is concerned when it comes to making regulations, but when local bodies such as PCTs see legislation granting them discretion, they will inevitably treat the provision as something that they may do if they get round to it rather than something compulsory. It is important that the Secretary of State makes it clear in the Bill or in some form of guidance what is expected of the PCTs.

The situation is rather different for strategic health authorities. The noble Lord, Lord Rea, has put his finger on a gap in the Bill—if it is possible to put one's finger on a hole or a gap in legislation; I am not sure whether the metaphor extends that far—in relation to general medical services, which are not provided by the great majority of primary healthcare professionals. Amendment No. 60 would fill a gap in the duty of strategic health authorities to consult with local representative professional committees about their functions. I should be very interested to hear whether that has genuinely been thought about in the scheme of things, or whether the Minister has some other form of consultation in mind.

Lord Peyton of Yeovil: More years ago than I care to recall, I served on a regional hospital board. One of my less happy memories of those years is the plethora of committees that surrounded it. Ever since then I have cherished—perhaps that is the wrong word; I have tried unsuccessfully to suppress—a suspicion that there are far too many committees in the National Health Service. To compel one body to recognise another seems to me a mistake.

Not very long ago, I asked the noble Lord if he could give any estimate on this issue. I admit that it was rather a silly question, because I knew that he could not possibly have counted the number of committees that sat under the aegis of the National Health Service and did practically nothing useful, any more than he could oblige if I took him down to a nice sandy beach and asked him to count the grains of sand.

Perhaps I could venture this speculation—it is no more than that, because I could not prove it. I have always had more than a suspicion that half the membership of any committee ought to be spending their time on far more valuable activities and the other half ought to be on nothing at all.

The Minister has done nothing to deserve this, except that he has my entire respect, but I am offering him my support in rejecting the amendment, as I suspect that he will. That might possibly choke off very slightly the number of committees that strangle the National Health Service without ever benefiting a patient. Committees may do something for their own

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glorification, but as far as the patients are concerned they are of less value than face powder on somebody else's nose.

Lord Rea: I have a lot of sympathy with what the noble Lord, Lord Peyton, has said. I agree that there are far too many committees. However, they are in existence and they represent the local professional healthcare workers in each local health area. It is important for a health authority to consult the representatives of those who provide the services that the noble Lord thinks are so important.

Lord Clement-Jones: Provoked by the noble Lord, Lord Peyton, I should add that these are important committees. We may talk about structures not having much positive impact on morale, but they can have a negative impact on morale if they do not provide for consultation with those most closely affected by the decisions that they take. This is a classic example. As the noble Lord, Lord Rea, has pointed out, there are committees representing local healthcare professionals, so we are not creating a batch of regulatory or other committees. Those committees would benefit from having their views taken into account on the way in which PCTs and strategic health authorities carry out their functions. This is not a St Augustinian view—"Lord, give me deregulation, but not yet". Rather unusually, it has some good credentials.

Lord Filkin: I am very grateful to have the noble Lord, Lord Peyton of Yeovil, on my side. That does not happen very often, but it is deeply welcome.

Amendments Nos. 54 to 58 would change a power to recognise local representative committees into a duty. Local medical committees have been a feature of the health service since 1911 and pharmaceutical, dental and ophthalmic committees have been a feature since the inception of the NHS after the war. In all that time, we have yet to hear of any LRC being denied formal recognition.

I understand that, of the four professions, only the BMA has expressed some interest in changing "may" to "shall". I suspect that that interest is in the form of a probing amendment rather than anything more fundamental. The BMA has acknowledged that no committee has ever been denied recognition. Elsewhere it has spoken positively about Clause 5.

We have always wanted the NHS to work closely and co-operatively with front-line professionals. That is why we amended the provisions in the 1999 Act to make LMCs and LDCs inclusive of PMS doctors and deputies and PDS dentists.

Amendment No. 60 would oblige strategic health authorities to consult LRCs. We will require primary care trusts and strategic health authorities to discharge their functions inclusively. For example, the duty of partnership working introduced by the Health Act 1999 will apply to strategic health authorities and to primary care trusts. Similarly, we shall expect strategic health authorities routinely to involve and consult

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local stakeholder groups as they take forward their work. The Committee will recognise that that is good practice.

However, the proposals to place a specific statutory duty on strategic health authorities to consult LRCs is unnecessary and inappropriate. The matters which most directly concern LRCs are those relating to the services provided under Part II of the 1977 Act or their newer Part I locally managed equivalents—namely PMS and PDS. The Bill provides for all existing health authority functions in respect of Part II services to be conferred on primary care trusts. For Part II services, there is, therefore, no statutory function on which the strategic health authority could consult the LRC.

For PMS and PDS, the Bill already makes specific provision to continue the existing statutory requirements. Clause 5 provides for regulations to be made requiring strategic health authorities to consult LRCs on those limited PMS or PDS matters—under both pilot and permanent arrangements—for which the strategic health authority is responsible.

For these reasons, therefore, we find it difficult to understand why we should single out LRCs for special attention. Other groups, nurses, hospital doctors, patients, have at least as great a claim to be involved in the work of strategic health authorities as do GPs or other primary care contractors, however valuable their work is.

We could list all of these groups whom the strategic health authority should consult. But shopping lists of this type put on the face of the Bill are usually incomplete and cause offence to someone who gets overlooked in the process.

For all these reasons, we have to suggest that there does not appear to be any pressing practical benefits to the amendments. I hope, given what I have been able to put on the record, that the BMA and others will be fully assured of the importance we attach to consultation without the need for further statutory direction. It is clear that primary care trusts must and should consult without our needing to teach grandmothers to suck eggs by putting it literally into the Bill.

Government Amendment No. 59 is minor. It clarifies the definition of a Section 28C dental practitioner for the purposes of the section.

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