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Baroness Andrews: My Lords, as I said, the tariff will be the same whether they are NHS or private providers. The additional costs will be essentially for start upwe have done this already for NHS providers in some cases. It covers the mobilisation of additional staff, extra equipment so that staff can start
The Earl of Onslow: My Lords, does the Minister recognise that the Government are departing from being the monolithic state provider of health? Is it not a good idea to provide healthcare from wherever it is best provided as opposed from only one sourcethe NHS? That is almost a damascene conversion that we on the free market, liberal part of the political spectrum should welcome and encourage.
Baroness Andrews: My Lords, I suspect that I am taking my life in my hands to agree in part with the noble Earl. I refer to the NHS plan 2000, which made it clear that we would be using private capacity to meet the real challenges within the NHS and the need to reduce waiting times. We are pleased to be able to do that, because of the extra capacity that we are delivering. However, I reiterate that these are NHS patients within the NHS framework. They will not pay for their treatment. They are provided for because they are in need and there is no compromise to the fundamental NHS principle of treatment that is free at the point of need.
Lord Hunt of Kings Heath: My Lords, does my noble friend agree that, in accepting that there can be up-front costs for new entrants into the provision of NHS care in the private sector, it could also apply to the voluntary sector? If we are to encourage more voluntary sector organisations to provide services to the NHS in the future, does she agree that we must provide stability and some financial incentive to enable them to set up the infrastructure to enable them to provide such additional services?
Baroness O'Cathain: My Lords, have the Government assessed the long-term effect on doctors' training if they do not have the opportunity to witness and, indeed, to perform eye cataract and hip replacement operations?
Baroness Andrews: My Lords, that is a good question. The DTCs, as we call them, are in areas that have extremely long waiting lists and need urgent action. We are examining the impact on doctors' training. However, we envisage that doctors will be able to do some relevant training in the DTCs. There will be no loss of accreditational training facilities within the hospitals, but
The Lord Bishop of Hereford: My Lords, will the Minister explain again why this additional investment, expenditure, recruitment, training and provision cannot be made within the NHS more efficiently, economically, simply and quickly?
Baroness Andrews: Yes, my Lords. We have gone down this road because, when the strategic health authorities examined the capacity of the NHS to deliver shorter waiting times by the target that we have set ourselves of six months by 2005, many of them realised that that could not be achieved within the NHS. Rather than give up and leave people waiting in pain, the decision was taken to try to expand capacity. That can only be to the benefit of NHS patients and the NHS.
We would all want to see capacity freed up within the NHS. Hospitals may be able to take other elective surgery in place of the high-volume work that they were doing or reform their A&E departments. We have no doubt that there will be additional value for the NHS.
The Countess of Mar: My Lords, where are these people to come from? Surely, doctors and nurses are all trained in this country, within the NHS. Does she envisage the DTCs bringing doctors and nurses from countries other than the United Kingdomin other words, poaching?
Baroness Andrews: My Lords, some of the teams will indeed come from overseas and will bring whole teams of clinicians with them. Others are from the UK and will bring their own staff. Some will use some NHS staff in strict agreement with the local PCTs and in circumstances that reflect local conditions, circumstances and need.
On the question of closure, we see the proposal not as a short-term fix but as a long-term investmenta new way of working for the NHS to deal with high-volume, complex and very painful conditions, which have condemned people for far too long to waiting lists of a year or more.
Baroness Andrews: My Lords, I am happy to give the noble Baroness, Lady Sharples, an assurance on that. I understand that we have asked the South African teams to ensure that they have the support and clearance of their Government to bring their teams over here. They see this opportunity as an investment, because the staff coming will be largely on short-term contracts. There will be investment in training and
Lord Hayhoe: My Lords, will the Minister reassure us about the patients treated in these centres? I accept what she said about the speed of dealing with painful conditions, but operations can sometimes go wrong and one needs the back-up facilities of major hospitals, intensive care and the like if such were to happen. What arrangements are being made to deal with that aspect of the matter?
Baroness Andrews: My Lords, on the broader question, the independent sector treatment centres will be registered with the National Care Standards Commission and, as from next year, with new CHAI, the regulatory body. They are staffed by highly-trained doctors. These are world-class organisations. All surgeons working in the centres will be registered with the GMC. Many of the centres will be physically based within the NHS and will have a close relationship. Obviously, we want to see the closest possible partnership between the NHS as a whole and the new centres.
Lord Grocott: My Lords, before we start the debate on the Second Reading of the Hunting Bill, perhaps I may offer the usual arithmetic to the House. As we know, there is a long list of speakers. Were the average Back-Bench contribution to be 10 minutes long, which is one possibility, the House would finish at 2 a.m. However, if it were possible for the contributions to be around seven minutes long, the House would then rise at about 11.30 p.m. By way of comparison, the last Second Reading debate was on the Health and Social Care (Community Health and Standards) Bill, when a time of eight minutes for contributions was suggested and was, broadly speaking, observed. The list of speakers was shorter, but we did rise at 10.34 p.m., so sometimes the suggestions work.
On the face of it, this is a simple, straightforward Bill. It has 17 clauses and three schedules and deals with only one subject. It provides for the prohibition of the hunting of all wild animals with dogs and all hare coursing events.
There are a few limited exceptions to the ban, but they relate only to stalking and flushing out in certain circumstances, terrier work in relation to protection of birds kept for shooting, falconry, ratting and rabbiting, the retrieval of shot hares, recapture or rescue and research. That encapsulates the Bill. It is a simple Bill, but we know that, regrettably, there are surrounding features that make it a bit of a contentious Bill.
Fox hunting is an issue that has raised high emotions on all sides for a considerable time. For as long as I can remember and, certainly, for the past decade, a majority of the people taking part in any reputable poll have wanted some form of restriction on fox hunting: they still do. For over a decade, Parliament has failed to resolve the issue. We still have not done so. Secondly, there has, in the past two elections, been a clear commitment in the Labour Party manifesto that the issue of hunting should be resolved by a free vote in another place. The Bill now before this House is the result of an overwhelming vote of the elected House, conducted on a free vote in all parties and with Members from all parties forming part of the majority.
Thirdly, it is clear that there remains a direct clash between the views of many in this House and those of Members of another place. The last Labour election manifesto referred explicitly and uniquely to the need, in the event of a disagreement between the Houses, to allow Parliament to resolve the matter. The issue of the use of the Parliament Act 1911 has therefore, as I understand it, led to many discussions in the bars and corridors of this House and elsewhere that would have taken place more logically at the end of the process of a Bill through the House, rather than at the beginning. I shall return to that matter.
Some would argue that there is another unique feature to the Bill, namely that the Bill that emerged from the Commons differs significantly from the one originally presented to the Commons by the Government. I understand that analysis, but that is hardly anywhere near being a unique feature. In any case, the Government's position, in line with the manifesto, has been to facilitate the views of the majority in a free vote in the Commons. The Bill must therefore be treated as a government Bill, and any contention to the opposite is not valid. The Bill should be dealt with in the normal way in this House. The Government will welcome constructive engagement on the Bill. We continue to hope for agreement between the Houses, but I must express a word of caution: underlying all of this, it must be obvious that your Lordships must take account of the views expressed very clearly by the elected House.
According to some of the whispers in the corridors and even on the "Today" programme, there may be a move by some in this House to revert to the original Bill or some variation of it. The Government continue to believe that that Bill had merit and could have been the best way of resolving the issue, but the House of Commons disagreed with that. Your Lordships should recall that the original Bill andeven more sothe version that emerged from the Commons Committee were vociferously opposed by most hunting organisations and many Members of this House. It would have banned stag hunting and hare-coursing events and imposed tight restrictions on all forms of hunting. It would have severely restricted hunting, and there would therefore still be deep conflict with those who believe that traditional hunting should largely continue. In any caseI say it againthe overwhelming majority of the elected House voted in favour of the alternative approach, which is now before your Lordships.
I also owe it to the House to explain two other matters. The first is the Government's position. We will, as ever, listen to arguments for amendments to the Bill in your Lordships' House, but our attitude to amendments must be that the Government's duty is to facilitate the will expressed in a free vote in the elected House. Radical or wrecking amendments will therefore not be supported from the Government Benches, although, of course, it will be, at all times, a free vote in this part of the House and, I believe, among other parties.
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