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Other things still have to take place. I hope that the BMRB survey will take place shortly. I take comfort also from the Ministers statement that the Government want to see live music flourishing. There clearly needs to be a balance. I am not suddenly suggesting that we have a de minimis exemption for venues of 500 people and for amplified music in those circumstances. It would be foolish of me to suggest that. But we need to let off the brake somewhat. We need to have a more sensible de minimis. I am sure that the BMRB survey will demonstrate that the abolition of the two-in-the-bar rule has had problems. I do not think that it is correct to say, as the Minister did, that there were not many instances where adverse effects have been found from the Act. He seemed to contradict himself.
This has been a useful way of flushing out the Minister and of finding out the Governments attitude towards live music and whether they are sympathetic to some re-looking at the Act. I have elicited some daylight during the course of the debate which did not constitute any form of onslaught. The Minister will have to get used to more bludgeoning of a different variety in the course of the next few weeks and months. No doubt he is rather tender after coming straight back from the Recess.
I am grateful for the Ministers words today. I hope that, along with other bodies and organisations, those who constituted the Live Music Forum can continue to take part in the debate, despite the fact that I and many others were dismayed to see that it was disbanded immediately after its report. In these circumstances, I beg leave to withdraw my Motion.
What is this all about? I think it is an attempt to exclude from the scope of any public consultation services that the Government decide they want to procure from private providers. We have seen this situation on a national scale with the introduction of independent treatment centres. ISTCs were imposed on PCTs from the centre, whether they liked it or not. New subsection (1E) is designed to give Ministers a reserve power to introduce services top-down in a similar way in the future. Is that right?
If so, why is there no provision for consultation at a national level for any top-down decisions that Ministers choose to take? National consultation would be no less important in those sorts of circumstances than local consultation about other service issues. I say again, as I did in Committee, that if the spirit of the Bristol inquiry is to be honoured and kept alive, an equivalent form of consultation and involvement at a national level has to be provided. I do not see that anywhere.
Most of us accept that the world of healthcare provision has changed from 10 years ago. Plurality of providers is a concept that is here to stay. Given that, would we not want public involvement in both procurement and changes in procurement in situations where there may be a question of a private provider being brought in or indeed dispensed with? On the contrary, patients and the public need to know about these things and make their contribution, because that is one vital way of ensuring that services are patient-focused. We need to hear from the Minister whether she agrees with that and, if she does, what she proposes to do about it. I beg to move.
Baroness Neuberger: My Lords, I have one addition to what the noble Earl has said. He and I are as one in thinking that the intention must be as he stated. On the issue of national representation, the Minister will know about National Voices and that we will have a national user bodyor at least we hope we will in the near future. One thing that worries me is that, as the noble Earl outlined, there is no reference anywhere here to any role that such a national body might play. There is a gap where one might expect
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Baroness Morgan of Drefelin: My Lords, I hope I can offer some reassurance. I do not accept the noble Earls analysis of the question of consultation around a provider. The whole policy remit of the Bill is about providing for consultation around the provision of services. New duties are introduced, for example, for strategic health authorities to consult on their role and the frameworks for which they are responsible. Some of the concerns that the noble Earl has raised in this amendment might legitimately be answered in those clauses if one is looking at the general thrust of policy towards the delivery of services in an area. I do not accept the noble Earls analysis, although I accept the point made by the noble Baroness, Lady Neuberger, about the importance of developments outside the terms of the Bill, such as the National Voices initiative. Additionally, a level of scrutiny exists over and above the Bill through bodies such as the Health Select Committee, which holds the Government to account. That is equally important.
We do not accept that the change proposed by the amendment makes good sense. Involvement and consultation should be meaningful and have some relevance to patients and the public. The clause provides specifically for consultation to relate to services received by patients and the public, because that is relevant and meaningful to them. I do not want to repeat our discussions in Committee.
The clause relating to services supplied has the effect of requiring involvement and consultation of patients and the public on matters where they would have no ability to judge the effect of any change, except possibly through any preconceptions they might have about a provider. It makes more sense for consultation to be about the services that a patient receives rather than the nature of the provider supplying them. If a change in the nature or name of the provider results in a change to the service, the duty to involve and consult remains. I am happy to put that on the record. We are quite clear that there should be appropriate consultation whenever there is a change to services, and where that change has an impact on the nature of services and the manner in which they are provided.
I am comfortable that the existing provisions are right, in that they ensure that consultation requirements kick in when there is a meaningful impact on the people who use or may use services. I understand the concerns that noble Lords have raised, but the additional measures in the Bill will, I hope, encourage them to withdraw the amendment.
Earl Howe: My Lords, that was a helpful and largely reassuring reply. I accept that the insertion in the Bill of provisions relating to strategic health authorities makes a difference in so far as wholesale changes to services are concerned, because they would necessarily have to be dealt with at that level. Nevertheless, I still have an uneasy feeling. I always come back in my mind to health inequalities and marginalised groups in a community, whose voice is less often heard than that
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Baroness Morgan of Drefelin: My Lords, the point that I am trying to make is that if the patient notices any difference or is concerned that there might be a difference, the consultation duty kicks in. If there is no difference, surely there is no matter.
Earl Howe: My Lords, that begs the question of who decides whether there is going to be any difference, and I would have thought that it was for patients groups to be afforded that opportunity. But I note what the Minister said. I shall leave it there and reflect carefully on this matter between now and Third Reading. I beg leave to withdraw the amendment.
(1) The Secretary of State must by regulations require each Strategic Health Authority to make arrangements which secure that health service users are, directly or through representatives, involved (whether by being consulted or provided with information, or in other ways) in prescribed matters.
(1) The Secretary of State may make regulations enabling a Strategic Health Authority, in circumstances mentioned in subsection (2), to direct a Primary Care Trust that persons who would otherwise be involved in a particular matter under arrangements made by the Primary Care Trust under section 242 are not to be involved in that matter under those arrangements.
(2) The circumstances referred to in subsection (1) are where the persons concerned are to be involved (whether by the Strategic Health Authority, by the Strategic Health Authority and the Primary Care Trust acting jointly, or otherwise) under arrangements made or to be made by the Strategic Health Authority.
(2) In subsection (1) commissioning decisions, in relation to a Strategic Health Authority, means (subject to any directions under subsection (5)(e)) decisions as to the carrying-out of functions exercisable by it for the purpose of securing, by arrangement with any person or body, the provision of services as part of the health service.
The noble Baroness said: My Lords, government Amendments Nos. 219ZB and 219ZC amend Clause 237, which currently imposes a duty on PCTs to report on their consultation activity in relation to their commissioning decisions. The noble Earl, Lord Howe, proposed in Committee that this duty should be extended to strategic health authorities. We agree that this is an important addition and, because SHAs have responsibility for the commissioning of specialised services on a national basis, although currently that is carried out by NHS London, it is appropriate for the PCT duty to report on consultations to be mirrored for SHAs. However, in view of the important new duty to involve and consult on the strategic plans for an area, which we discussed earlier, we think that the duty to report should also be extended to reporting on other consultations carried out by an SHA and their outcomes.
I am sure that noble Lords will recognise that these amendments are significant. I thank the noble Earl, Lord Howe, again, for identifying these important issues and giving us the opportunity to strengthen the voice of patients and the public in this particular context.
Amendment No. 219ZBA, tabled by the noble Earl, seeks to extend the duty to consult to other commissioners. We think that the amendment is based on the misunderstanding that PCTs will be able to contract out their commissioning function either to the pre-approved list of suppliers published as part of the FESC or that this extension could apply to practice-based commissioners. The point we are trying to make is that we do not expect PCTs to be able to contract out their commissioning function in this way.
This is not the case, PCTs will remain ultimately accountable and responsible for commissioning, both in terms of practice-based commissioning as well as FESCI shall put that out in full in a momentwhich merely provides PCTs with a pre-approved list of suppliers with specialist expertise to support them in carrying out their commissioning function to supplement their own capacity and capability.
The duty is being placed on PCTs because not only do they have responsibility for the vast majority of commissioning decisions, they also hold the vast majority of money in the health service. It is because of these huge responsibilities that this important duty is being imposedto ensure that PCTs are accountable to local communities in a transparent way. What the amendment seeks to do is rather out of proportion in relation to the PCT duty. While I accept that a small number of services are commissioned by trusts these are certainly exceptions and I do not believe that the duty to report on consultations in relation to those services is proportionate. It is not that the information pertaining to a trusts consultation in relation to its commissioning activity would be inaccessible to patients and the public. Indeed, a local involvement network could very well request this information from the trust concerned and overview and scrutiny committees could do the same.
I am trying to make it clear that it is essential that PCTs report. I appreciate the amendments point about the level of delegation that PCTs might make but they
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Earl Howe: My Lords, the noble Baroness correctly anticipated the points that I would have made in speaking to Amendment No. 219ZBA. Those were precisely the concerns that she outlined. I am reassured by her reply and there is no need for me to speak to the amendment further.
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