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House of Lords

Thursday, 23rd October 2003.

The House met at eleven of the clock: The CHAIRMAN OF COMMITTEES on the Woolsack.

Prayers—Read by the Lord Bishop of Sheffield.

Human Rights

The Chairman of Committees (Lord Brabazon of Tara) : My Lords, I beg to move the first Motion standing in my name on the Order Paper.

Moved, That the quorum of the Select Committee appointed to join with the committee of the Commons as the Joint Committee on Human Rights be two.—(The Chairman of Committees.)

On Question, Motion agreed to.

Gambling

The Chairman of Committees : My Lords, I beg to move the second Motion standing in my name on the Order Paper.

Moved, That the order of the House of 9th September appointing a Select Committee to join with a committee of the Commons to consider and report on any clauses of a draft Gambling Bill presented to both Houses by a Minister of the Crown be amended by leaving out the words "within the United Kingdom".—(The Chairman of Committees.)

On Question, Motion agreed to.

Criminal Justice Bill

Baroness Farrington of Ribbleton: My Lords, on behalf of my noble friend Lady Scotland, I beg to move the Motion standing in her name on the Order Paper.

Moved, That the amendments for the Report stage be marshalled and considered in the following order—

Clauses 1 to 11,

Schedule 1,

Clauses 12 to 26,

Schedule 2,

Clauses 27 to 39,

Schedule 3,

Clauses 40 to 60,

Schedule 4,

Clauses 61 to 97,

Schedule 5,

Clauses 98 to 118,

Schedule 6,

Clauses 119 to 161,

Schedule 7,

Clause 162,

Schedule 8,

Clauses 163 to 169,

Schedule 9,

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Clause 170,

Schedule 10,

Clauses 171 to 175,

Schedule 11,

Clause 176,

Schedule 12,

Clauses 177 to 201,

Schedule 13,

Clauses 202 to 206,

Schedule 14,

Clauses 207 to 211,

Schedules 15 and 16,

Clause 212,

Schedule 17,

Clauses 213 to 221,

Schedule 18,

Clauses 222 to 247,

Schedule 19,

Clauses 248 to 254,

Schedule 20,

Clauses 255 to 256,

Schedule 21,

Clause 257,

Schedule 22,

Clause 258,

Schedules 23 and 24,

Clauses 259 to 261,

Schedule 25,

Clause 262,

Schedule 26,

Clauses 263 to 276,

Schedule 27,

Clauses 277 to 280,

Schedule 28,

Clauses 281 to 298,

Schedule 29,

Clauses 299 to 301,

Schedule 30,

Clauses 302 to 305,

Schedule 31,

Clauses 306 and 307,

Schedule 32,

Clause 308,

Schedule 33,

Clause 309,

Schedule 34,

Clauses 310 to 314.—(Baroness Farrington of Ribbleton.)

On Question, Motion agreed to.

Female Genital Mutilation Bill

Read a third time, and passed.

Health and Social Care (Community Health and Standards) Bill

11.8 a.m.

The Parliamentary Under-Secretarty of State, Department of Health (Lord Warner): My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.

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Moved, That the House do now again resolve itself into Committee.—(Lord Warner.)

On Question, Motion agreed to.

House in Committee accordingly.

[The CHAIRMAN OF COMMITTEES in the Chair.]

Clause 171 [General medical services contracts]:

Earl Howe moved Amendment No. 456:


    Page 90, line 13, leave out "suspending or terminating" and insert "as to the circumstances in which a Primary Care Trust or Local Health Board may agree with a contractor that"

The noble Lord said: In moving Amendment No. 456, I shall also speak to Amendment No. 457. Subsection (4)(b) of proposed new Section 28U provides for regulations to be made that would suspend or terminate a requirement in the GMS contract to provide services of a specified type. I have no difficulty with what I interpret to be the purpose of this provision; my only difficulty is with the drafting. It will surely not be possible for regulations on their own to achieve the intended purpose because, in reality, if a PCT or LHB wished to suspend or terminate an additional service, I should have thought that it would almost always be practice-specific. Surely, regulations would not want to provide for a blanket suspension or termination of a service, nor legally could they provide for a suspension or termination of that service by particular doctors. Will the Minister shed some light on that matter and reassure the Committee that the drafting is robust? I beg to move.

Lord Warner: I will try to explain the purpose behind the provision, and in the course of that explanation I hope to satisfy the noble Earl.

Proposed new Section 28U(4)(b) allows for regulations to make provision about the suspension or termination of a duty under the new GMS contract to provide services of the prescribed nature. It allows for GMS practices to be able to opt out of providing out-of-hours services and those services designated as additional services in the agreement between the BMA and NHS Confederation. The regulations will define those particular services and detail the procedures through which the option to opt out can be affected.

We believe that the wording does deal with the practice issue. Certainly, the agreement on the new GMS contract allows practices to be able to opt out of providing out-of-hours and additional services with or without the agreement of the PCT, provided that they follow the procedures that will be set out in the regulations. Only in exceptional circumstances—and provided that the PCC has been able to demonstrate to an appeal body that it is essential for the practice to continue to provide a particular service in order to guarantee patients' rights—will the PCT be able to prevent such opt-outs.

The effect of this amendment would be to undermine the opt-out process because it would give the PCT an absolute veto over a practice's right to opt

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out of a service. It cuts across one of the most important parts of the agreement with the profession. Being able to opt out of providing services is a fundamental plank of that agreement that builds on the existing flexibility. There is not a dramatic change here in terms of the areas of services covered, but they are expressed in terms of practices rather than individual doctors. Under the agreement, the practices need to be able to vary their workload according to their capacity to provide those services and, of course, to the income to which they aspire.

Maternity, family planning, child health surveillance and minor surgery have always been optional services for practices. Under the current arrangements, individual GPs can opt out in full or part when they do not have the necessary professional expertise or facilities, or, in the case of family planning, they cannot provide the services for reasons of conscience. Not all individual GPs currently provide those services. The new agreement provides for vaccinations, immunisations and cervical screening to be added to the list. However, those services are also voluntary because practices and GPs could currently opt out of providing them. Again, it is up to the practices. If they opt out of providing services, their income will be reduced.

I could develop those arguments further but I have sought to explain the purpose behind the clause and the effect that the amendment would have on it. We do not think that the drafting is deficient, but I am happy to arrange for the noble Earl, if he wishes, to talk to the lawyers about that outside the Committee.

Earl Howe: I am grateful to the Minister. He will realise that I was, essentially, asking a simple question through a probing amendment: how can regulations operate at the level of individual practices? I think that I understand what the Minister told me about opt-outs. I will read carefully what he said. For now, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 457 and 457A not moved.]

The Chairman of Committees: If Amendment No. 457B is agreed to, I cannot then call Amendments Nos. 458 and 459.

Lord Warner moved Amendment No. 457B:


    Page 90, leave out lines 18 to 26 .

On Question, amendment agreed to.

[Amendments Nos. 458 and 459 not moved.]

Clause 171, as amended, agreed to.

Clause 172 agreed to.

Clause 173 [Arrangements under section 28C of the 1977 Act]:

Lord Warner moved Amendments Nos. 459A to 459E:


    Page 92, line 4, leave out "or section 17C arrangements" and insert ", section 17C arrangements or Article 15B arrangements; or

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(iii) under section 19 or 25 of the 1978 Act or Article 56 or 61 of the Health and Personal Social Services (Northern Ireland) Order 1972 (1972 No. 1256 (N.I.14));" Page 92, line 24, leave out "an individual" and insert "a person"


    Page 92, leave out lines 27 to 37 and insert—


"( ) an individual who is providing services as specified in subsection (1)(bc)(iii) above" . Page 92, line 38, leave out from ""section 28C employee"" to end of line 39 and insert "for "an individual providing" substitute "a person providing or performing""


    Page 93, line 20, at end insert—


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