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Baroness Pitkeathley: My Lords, I very much welcome the changes which the Government have proposed to the Bill, particularly Amendments Nos. 4

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and 8. Your Lordships will remember that many of us were concerned about which carers would be included in the Government's arrangements. Amendment No. 4 will ensure that carers are part of the members of the public benefit corporation. That is hugely welcome. Amendment No. 8 then defines "carer" and protects that definition by ensuring that carers are neither employed nor volunteers. In other words, they are the informal carers, the family members, who are caring as a result of a pre-existing relationship. They are not in either a voluntary or a financial arrangement. What my noble friend has done essentially is to ensure that there is clarity around the definition of "carers", which is extremely welcome, while ensuring that they also have a place at the table and therefore an opportunity to use their expertise and knowledge to support the new body. The amendments are welcomed by Carers UK and will be welcomed by carers everywhere.

Lord Hunt of Kings Heath: My Lords, I very much welcome all the amendments in this group save Amendment No. 256 which relates to the conduct of elections. This follows the passage of, I believe, an opposition amendment in Committee. Although Amendment No. 256 states, "Regulations may make provision", I take it to mean that regulations are required to be made. How long will that delay the establishment of foundation trusts? Subsection (3) of the new clause in Amendment No. 256 states:

    "An NHS foundation trust must secure that its constitution is in accordance with regulations under this section".

I assume that it will take some time to put those regulations in place. They have to be written, consulted upon and come before Parliament under the affirmative procedure. I believe that my noble friend mentioned the affirmative procedure in relation to these particular regulations.

If foundation trusts are now consulting on their constitutions with their own scheme of elections, what is the impact on that if we now have an amendment accepted which states that the constitution cannot be decided upon until it is,

    "in accordance with regulations under this section"?

Will that delay the matter by, say, six months? Alternatively, I hope that it is my noble friend's intention and that of his colleagues in the other place to get rid of this section when the Bill goes back to the other place. I certainly hope that that is the intent.

Lord Lipsey: My Lords, my noble friend Lord Hunt welcomed all the amendments in the group with the exception of Amendment No. 256. However, in welcoming all the amendments in the group I particularly welcome Amendment No. 256. It is an important gesture on the Government's part in response to the Opposition's concern not to have an electoral system that makes it particularly easy for all the adverse consequences that the House discussed earlier to occur. After the previous debate on the subject I thought about electoral systems. You can design perfectly plausible electoral systems that will give a large range of results, particularly with regard to

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the threshold which extremists would have to pass to get in. This is an admirable amendment. If, as my noble friend fears, it has the coincidental advantage of delaying the setting up of some of the trusts while we sort out the rest of the governance, that is an additional argument in its favour.

Baroness Noakes: My Lords, the noble Lord, Lord Lipsey, tempts me to say how much I support what he has just said. I wish to speak briefly to the amendments in this group. In general we are either indifferent to them or we are pleased that the Government have listened to the points that we made in Committee. I wish to raise just one point. Amendment No. 76 adds an officer of the Audit Commission to those auditors who can be appointed. We have no problem with that. However, I remain concerned that the remaining elements of paragraph 22 of Schedule 1 allow persons to be appointed as auditors even if they are not qualified to carry out audits under the Companies Act, which is the only properly approved set of processes available to test the competence of those who hold themselves up as auditors. I believe that is unfortunate. I hope that if the schedule ever sees the light of day again, the Minister will reconsider that matter.

Baroness Carnegy of Lour: My Lords, I ask the noble Lord particularly about Amendment No. 68 and the register of interests of members of the board of governors. I know that there has been a great cry for this in another place. I think that noble Lords on the Liberal Democrat Benches asked for it before and they have tabled Amendment No. 69 today. Have the Government thought about this? It is very important that the right people should be available to be governors. They will have a key role. It will be important to think out what sort of interests people are expected to declare. They must surely be relevant interests, not just any interest. To be asked to be a governor may be a great honour or it may be something that people are not frightfully keen on and need to be persuaded to do. But if they have to declare all their interests, I believe that many people will be put off this job.

It occurs to me that one relevant interest might be that a member, or a member's family, had a propensity to some sort of illness and was going to need acute treatment, perhaps frequently. Would that be something someone would be expected to declare? I do not necessarily expect the Minister to give a detailed answer on that but I believe the Government must have thought that relevant interests must be identifiable and written down somewhere so that people who should be governors are not put off that job.

Lord Clement-Jones: My Lords, like the noble Baroness, Lady Noakes, I believe that some government amendments which the Minister introduced today are ones that we on these Benches would prefer to draw a veil over. A kind of triple decker public constituency is not something that we would wish to see incorporated in any schedule.

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However, I do not think that now is the time or the place to debate the detail of a number of those government amendments.

I welcome government Amendment No. 50. I believe that members of the Royal Colleges of Nursing and of Midwives, the BMA and a number of professional organisations will very much welcome it. We on these Benches had tabled an amendment to include three such people as executive directors but to bank two will be perfectly respectable.

Government Amendment No. 68 sprang directly from a debate that we initiated in Committee on the interests of members of the board of governors. As regards government Amendment No. 76, the solution is not quite as mandatory as we would have argued for in Committee but the fact that it opens the way for the Audit Commission either to specify the auditors or to have its staff audit foundation hospitals would be an advance if such a creature were ever created. The amendments in this group constitute a mixed bag but some are to be welcomed.

I am rather torn whether or not to agree with the noble Lord, Lord Hunt, or the noble Lord, Lord Lipsey, but the Government's drafting as ever is extremely cunning. Paragraph 6(5) of Schedule 1 states—this is an insertion at the behest of the Conservative opposition in Committee:

    "If contested, the election must be by secret ballot using an electoral system to be specified in regulations made by the Secretary of State".

However, government Amendment No. 256 now specifies:

    "The regulations may in particular provide for . . . systems and methods of voting, and the allocation of places on the board of governors, at contested elections".

That is some very fancy footwork by the Government. If this had a greater measure of reality and if we were discussing a real Schedule 1 as opposed to a virtual Schedule 1, I would prompt a Division on Amendment No. 256. Clearly, the Conservative amendment referred to an electoral system. The set of regulations that the Government propose in Amendment No. 256 refers to "systems". That is exactly the nub of the argument that was made both on these Benches and on the Conservative Benches; namely, that a plethora of systems is exactly what we do not want. To have different bases for election in different foundation hospitals is absolutely not what we want.

1.30 p.m.

Lord Lipsey: My Lords, I disagree with the Opposition for once on the issue. There is a case for different systems in different areas. It makes sense to have geographical constituencies in an area that is geographically dispersed, such as the Scottish Highlands. It probably makes no sense at all in an inner-city area where there is a much greater geographical concentration and other matters are of more importance. I hope that the noble Lord will not

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slam the door on the possibility of variety. It is a question of horses for courses. The noble Baroness nods her head. Some systems will not work anywhere.

Lord Clement-Jones: My Lords, the noble Lord knows all about horses, so naturally I would not dream of disagreeing with him at this stage, particularly as we are in a virtual debate. However, I caution the Government that the drafting could give rise to problems and fractiousness from these Benches.

Baroness Finlay of Llandaff: My Lords, I place on record my sincere thanks, and I believe those of my noble friend Lady Emerton, to the Minister for a very helpful discussion that we had that I think helped him bring forward Amendment No. 50, which we support. It improves on the amendment that we tabled.

It is extremely important for the professions to have the strong declaration of confidence in their role on the board that has come from the Government through Amendment No. 50. It means that the Government recognise the importance of the clinical directives from medicine and nursing in developing strategy and business plans; providing professional advice; communicating professional views and the trust's views to clinicians; being responsible for operational aspects of clinical governance and maintaining clinical standards; clinical risk management; safeguarding confidentiality; and research and development on information that the Government issue. The amendment will also allow a board to work with primary care colleagues, another important role in its liaison to primary care.

As a doctor and nurse, or a dentist if it is a dental trust, will be on the board there will be a huge responsibility on them to liaise with all the allied professions throughout the trust, to ensure that there is true multi-professional working and that all the issues of governance and strategy are filtered out, with information gathered from the whole multi-professional team. I am sure that I speak for my noble friend in saying that we have every confidence that the people in that position on the board will be able to discharge such duties. It is crucially important for any service to have that input at board level.

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