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Lord Hunt of Kings Heath: We must be very careful. I am prepared to go away and reflect on the matter and write further to the noble Baroness. Essentially, my understanding is that it depends whether the patients are funded by the NHS. That is the key. Whether they are being treated in the independent sector, the charitable sector or the NHS itself does not matter: they must be NHS patients.

As regards the question of whether a private or a voluntary establishment is properly regulated, of course we have legislation to cover those institutions as institutions. The question of the CHC rights must rest ultimately in the status of the individual being treated. Clearly, they must be NHS patients.

Baroness Finlay of Llandaff: I am grateful to the Minister for giving way. Perhaps we can discuss this matter outside the Committee. It would not be helpful to delay us now. I think that there are complexities in funding a service. In Wales we have achieved excellent integration of the voluntary sector with the NHS to the point that it is truly seamless. The patients perceive themselves to be fully NHS funded even when part of their care is paid for by the voluntary sector. It is terribly important that that integration is not undermined because it would be to the detriment of the seamless care that patients receive.

4.15 p.m.

Lord Hunt of Kings Heath: Of course I should be very happy to have further discussions with the noble Baroness. However, I enter a note of caution. We must be cautious about the rights of community health councils to inspect premises of independent organisations where the patients are not NHS patients. Ultimately, it must be a question of whether or not a patient is an NHS patient. Otherwise, there are problems for community health councils and their relationship with bodies that are outwith the NHS when that kind of responsibility ought to lie with regulatory bodies. Perhaps we could leave the matter there. I am happy to discuss it further with the noble Baroness.

Lord Roberts of Conwy: I was delighted to hear the trend in the Assembly's thinking about the

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composition of the CHCs. It is quite clear that there must be representatives, preferably of the highest calibre, from local authorities and voluntary organisations. The proposed quarter membership for each is about right. Similarly, I think there is scope for the competitive element. When I had some responsibility for health in Wales, I remember that we advertised. The response was astonishing. Some very good people came as a result of the advertising. I am sure that good people will put themselves forward for the community health councils.

I do not wish to be unnecessarily prescriptive, but someone has to be at the end of the day. I am quite happy to leave the matter to the Assembly. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Schedule 1 [Schedule 7A to be inserted in the National Health Service Act 1977]:

Lord Roberts of Conwy moved Amendment No. 6:

    Page 6, line 10, at end insert—

"( ) to publish an annual report on the level and quality of the health services in its area"

The noble Lord said: Amendment No. 6 concerns CHCs publishing an annual report. I think we would all agree that the public have a right to know what is being done by a CHC responsible for their area. It can be argued that its meetings are normally open to the public and the media and that that is sufficient to discharge its corresponding duty to inform the public of its proceedings. I do not think that that is adequate.

Paragraph 1 of the schedule spells out the CHC's dual duty. First, to represent the interests of the local public in the NHS; and, secondly, to perform such functions as may be conferred from among those listed in paragraph 2. Paragraphs 2(h) and 2(i) include:

    "(h) the preparation and publication of reports by Councils",

under regulations by the Assembly as to,

    "(i) the matters to be included in any such report".

The succeeding paragraphs appear to be more inhibitive than permissive and I question whether under the provisions of the Bill we, the public, will ever get a true account of the state of the NHS in a council's area and as its members perceive it. CHCs will be creatures of regulation, centrally controlled and with very little freedom. I may be mistaken. I hope that I am. One can understand why such bodies must be regulated to an extent, but CHCs which will have a role representing the interest of the public must surely have a corresponding duty to give an account of themselves to their public—and where better than in an annual report? The amendment prescribes the duty to report alongside the duty to represent the public interest, with the same self-standing independence.

I regard this as an important amendment, as I hope do other Members of the Committee. I hope that the Committee will support it. I beg to move.

Lord Prys-Davies: I fully understand the concerns voiced by the noble Lord, Lord Roberts. It seems to me that an annual report is almost a standard informational output of any statutory body. No doubt

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my noble friend Lord Hunt will correct me on that, but that is my impression. Such a report should be publicly available. That is one way in which a citizen can mark the progress that has been achieved during the preceding year and the obstacles that must be surmounted.

I have a great deal of sympathy with the amendment and can understand the reasons for it. Nevertheless, I do not support the amendment because, as a devolutionist, I believe that, ordinarily, it is not for us to encroach on the provisions of a Bill that has been agreed by the two Administrations. I shall be content if the Health Minister and the committee at the Assembly pay due regard to the worries voiced on behalf of the official Opposition.

Baroness Finlay of Llandaff: I have great sympathy with the spirit of the amendment, as it seems obvious that a public body must report, at least annually, on what it is doing. However, I have some concern about the wording of the amendment, because other agencies exist that will be examining,

    "the level and quality of the health services in its area".

I am worried that, as the amendment is currently worded, it might create a conflict with the roles of other inspectorate bodies.

The Commission for Health Improvement has been active in Wales in considering the quality of health services, and such inspections will continue. It is important that the CHCs work with, not in competition with, those bodies responsible for determining the level and quality of health services in the area. That includes the local health board, which will commission services. For that reason, I must express concern over the wording of the amendment.

Lord Hunt of Kings Heath: I am grateful to the noble Lord, Lord Roberts, for raising this question. I very much agree with my noble friend Lord Prys-Davies. No one would argue with the idea that a public body should regularly report on the discharge of its responsibilities. It should be in the minds of the members of those bodies that they have a public responsibility and that they need to be transparent about what they do and what their successes and concerns are. However, my noble friend is right to suggest that the National Assembly should deal with this matter.

I have looked again at the part of the schedule to which the noble Lord, Lord Roberts, referred. I read it in a very different way from him: he regards it as constraining, whereas I believe that it provides CHCs with a great deal of discretion and responsibility in their future functions. For example, sub-paragraph (f) refers to the,

    "consultation of Councils by Health Authorities, Local Health Boards",

and so on. Sub-paragraph (g) refers to the,

    "consideration by Councils of matters relating to the operation of the health service within their districts".

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Sub-paragraph (h), meanwhile, refers to,

    "the preparation and publication of reports by Councils",

and sub-paragraph (j) to,

    "the furnishing and publication by"—

NHS bodies—

    "of comments on reports of Councils".

Sub-paragraph (k) refers to,

    "the provision of information . . . to Councils by",

NHS bodies. Sub-paragraph (l) refers to,

    "the provision of information ... by Councils to other persons".

The schedule provides a satisfactory structure for the National Assembly to make provisions about the job that CHCs are to do in the future in Wales. I have no doubt that the ability is there for CHCs to report on the stewardship of their work and responsibilities.

I agree with the noble Baroness, Lady Finlay, that the wording of the amendment presents a problem. Other bodies are charged with reporting on the quality and standard of services that are being provided. One such inspection body is the Commission for Health Improvement. We must not duplicate functions. The role of a CHC is clear; it is its duty,

    "to represent the interests in the health service of the public in its district".

On the general point, I have no doubt that the National Assembly will charge CHCs to ensure that their activities are properly reported. At the end of the day, however, it is best left to the Assembly to make its own decisions in that regard.

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