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Baroness Cumberlege: I also support my noble friend Lord Peyton. One of the advantages of a Bill having several days in Committee is that one can think about the previous day's debates and how they will play into some of the later amendments put before us. This amendment is trying to achieve some structure around what the Government are proposing.

I have very serious reservations about handing over governance to an elected body. My earlier amendments, as the Minister has said, tried to get the necessary politics, the necessary accountability, into a rightful place with Parliament and the Government, freeing up the NHS from day-to-day political interference.

In discussing earlier amendments, the noble Lord, Lord Lipsey, who I am very pleased to see in his place today and who is an authority on electoral matters, argued the case against these reforms. At our previous sitting, he said,


My answer to that is, "No, that is what many of us do not want". If noble Lords will indulge me, I shall do as the noble Lord, Lord Walton, has done in previous debates, and refer to past experience. Personal experience is one of the things that noble Lords bring to this

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Chamber. When I was first involved in the NHS, we had elected members. Mine on the whole were fairly reasonable, when they turned up; on the whole, they did not turn up. In Lambeth, the elected members were totally unreasonable. I remember these events very distinctly, because I was part of the same region. Those members fought their political battles within the governance of the NHS and in that particular health authority. They left in the middle of meetings for press briefings. They took the chairman to court and fought legal cases against the chair. They brought in their supporters to disrupt the meetings. They actually locked members of the board out of the boardroom and, in the end, the police had to come and attend regularly to ensure that there was some discipline in the governance of the NHS. The governance disintegrated and the commissioners were brought in. That did not happen overnight but took months and months and, as a consequence, no decisions were reached. The authority incurred enormous debts and the rest of us in the region had to bail it out. The staff were demoralised, and it took the local service years to recover. I am not exaggerating—I was there, and I saw that happen.

I accept that Lambeth may be one of the very worst examples of that happening, but it is easy to forget, in these arrangements, what politicising the health service is going to mean. As the noble Lord, Lord Lipsey, rightly said, we will then have party factions and Whips. We will bring in the party political system right down to ward level and into primary care trusts, and so on. That is dangerous, and it is not what the health service is about. The health service is about treating individual patients. We should reconsider the system that is being proposed.

In a previous debate, the Minister said that he was trying to get a system that was "fit for purpose". This is not fit for purpose; it is dangerous, and it has fundamental flaws. The Minister said that he would listen carefully to good arguments. Throughout the Committee stage of the Bill we will be putting forward good arguments. The Minister should listen well; in fact, he told us that he was going to. Perhaps he could tell the Committee, "We as a government have decided to think again". I hope that he will surprise us, will take account of what we are trying to do throughout the Committee stage and rethink some of the proposals.

Lord Warner: It would be a masterpiece of understatement to say that very few people in this Chamber would want to use the experience of Lambeth at a particular point in history as the basis for public policy. There is a fundamental difference, on the question of participation, between the position of noble Lords in some parts of the Chamber and the Government's position. We are concerned here to introduce a set of changes to enable communities and patients to participate more in the running of the health service locally. That is what we are about. We are trying to create a governance structure that achieves that objective. As I said, we will be prepared to listen to well thought out changes and proposals, but they must be proposals that do not deflect us from

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that particular key objective. Later on in our discussions, noble Lords will see the Government being very flexible and responding positively to some amendments. I do not want to anticipate that, but I wish to whet noble Lords' appetites so that we can make good progress towards those amendments.

We shall consider the issues carefully, but I should like to say what the downside is of the two amendments. Before I go on, however, I should put on record what I saw in the Daily Telegraph this morning. At a fringe meeting of the Conservative conference, Greg Clark, the head of policy at Conservative Central Office, said that one of the key principles for any future Conservative government was being committed to promoting more choice for communities and citizens. That seems to me to involve a participative approach. It is good to see that the news has travelled to Blackpool, as it suggests that we are getting support for the measures in this Bill.

Amendment No. 24 would require fixing a maximum membership in each constituency. That would risk excluding potential members, solely because of an arbitrary cap. We stated in A Guide to NHS Foundation Trusts that,


    "there will be no limit on the number of people who can register as members if they meet the eligibility criteria".

That quote is from paragraph 2.10.

It would be totally unfair to exclude people who wanted to get involved in their local services because membership was limited. There is nothing to be gained from setting a maximum figure for membership. Amendment No. 24 is not well founded.

Amendment No. 25 would require a minimum membership of 50. Here, the arguments are slightly different. It would be wrong to set any arbitrary figure for local membership, as proposed in the amendment, as the circumstances of each NHS foundation trust will be different. We will discuss that matter when we arrive at the debate on governors and non-executive directors, so I shall not rehearse all the arguments. Many of the same arguments occur.

It is eminently more sensible, as the Bill provides in paragraph 4 of Schedule 1, to require individual foundation trusts to set their own minimum membership numbers as part of their constitutions, which are subject to the approval of the independent regulator. That would take into account the diversity of trusts. Classically, trusts range from those such as Rotherham, which has a single provider, a single commissioner and a clearly defined geographical territory, and places such as Moorfields, which draw their patients from an extremely wide geographical area. The same arguments apply to governors as to membership, in not being arbitrary in setting particular limits from Westminster and Whitehall.

Specifying a minimum of 50 members would not ensure a genuinely representative membership. Fifty is too low a number of members for NHS trusts which become NHS foundation trusts and is likely to be too low for an NHS foundation trust that is established as a new organisation. We can tell from the work done by the first-wave trusts that there is a huge response from

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people wishing to be governors of trusts. In one case, well over 1,000 people came forward just to be governor, offering their services in that role. We are seeing a much more positive response than many noble Lords suggest. Some noble Lords are being too pessimistic about some of the public responses in some parts of the country. The amendment suggests an arbitrary requirement for a minimum membership, and we suggest that noble Lords rethink their proposal.

11.30 a.m.

Lord Peyton of Yeovil: I am grateful to those noble Lords who have participated in the debate on my modest amendment. I was reminded in the course of the discussion of a question that I once asked the noble Lord, Lord Hunt of Kings Heath, who used to speak for the Government on this subject. I asked him how many committees there were sitting under the aegis of the National Health Service. I realise that that was a terribly unfair question. I might as well have asked him to count the grains of sand on the seashore. He had no idea how many committees there are. However, I do not want to dwell on that painful subject.

I do want to say this. I have come to believe that keenness to serve on a committee perhaps ought to be considered as a very serious disqualification. The noble Lord, Lord Hunt, will be familiar with this thought of mine, although it did not persuade him. My feeling about committees is that they are almost always too large. Half of those sitting on them would be much better employed using their very important knowledge on much more important things, and the other half probably ought not to be released anywhere. When the Government say rather baldly, as the Minister did just now, that their aim is to have more participation, I hope they will bear in mind that they could get participation from all sorts of people who would produce only confusion and delay. Therefore, as the discussion went on, I began to think that my amendment was more and more worth attention. While I should be happy to withdraw it now, I must tell the noble Lord that certainly my present intention is to return to the subject later. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 25 not moved.]


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