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Viscount Ullswater: My Lords, I am sure that that is an interesting question to the noble Lord, Lord Rochester. However, I believe that Warrington is rather a long way, both physically and metaphorically, from the Question on the Order Paper.

Lord Annan: My Lords, is this a case like the Newbury by-pass on which the Minister is unable to make up his mind for fear of criticism?

Viscount Ullswater: My Lords, no, I do not believe that to be the case. I have indicated that this is about reflecting convenient local government. The Government took account of local opinion and the case for unitary authorities in north-west Kent. The concept of a coherent community, identity and interest, the markedly different characteristics from the rest of Kent, and the community of interest in economic development, gave my right honourable friend considerable backing to ask the Local Government Commission, when reconstituted, to review those specific areas.

Lord Aldington: My Lords, is my noble friend aware that the representations made by the four MPs and

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others to his right honourable friend were also made to the Local Government Commission several times? The representations were bandied about in the press. Everyone has been aware of all the points. The commission found that 70 per cent. of the people consulted —a high percentage, and even more important than Members in the other House—were against the proposal. The Minister says that coherence is important. Does he not recollect that his noble friend Lady Blatch and the Secretary of State in the other place, as well as letters from Ministers including the Prime Minister, have constantly emphasised that the Government were not in favour of a national blueprint? Why is the Minister now suddenly saying that the Government have changed their mind?

Viscount Ullswater: My Lords, I believe that there is a world of difference between forcing local government to conform to a rigid blueprint—as my noble friend suggested—and asking the commission to look again at a small number of districts to ensure that the pattern which emerges from the review has an internal logic which will give it long-term stability.

Renewable Energy Sources

3.11 p.m.

The Earl of Buchan asked Her Majesty's Government:

    Whether they are encouraging the development of renewable sources of energy.

The Minister of State, Department of Trade and Industry (Earl Ferrers): Yes, my Lords. The Government's policy is to encourage the development of new and renewable energy sources wherever they have the prospect of being economically attractive and environmentally acceptable. The non-fossil fuel obligation is the principal vehicle for achieving that.

The Earl of Buchan: My Lords, I thank the Minister for his helpful Answer. Proverbs 15, verse 1, shall apply.

In cases of threatened wind farm turbine blight, as referred to in the authoritative Daily Telegraph article yesterday—one at Carno in Wales and another to come at Barningham on the Yorkshire/Durham border—who is supposed to hold the general interest between the profit-orientated power companies, the people living in the area and the general environmental effect of turbines?

Earl Ferrers: My Lords, before a wind turbine farm can be created, or any other type of generating capacity, it has to have planning permission. That is where the interests of the people in the locality are met, whether they are to encourage that form of electricity production or whether it would be too offensive for the locality. That is a matter for the planning authorities.

Lord Avebury: My Lords, has the Minister seen the reports that were published this week confirming the predictions of global warming which have been made in

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the past? Will the Government carry out a study on the implications of global warming for the United Kingdom? In particular, there is the predicted rise in sea levels around the United Kingdom by the year 2050. Would that not give the Government reason to encourage the use of renewable sources of energy to a greater extent, as well as putting more money into conservation?

Earl Ferrers: My Lords, I agree that global warming is a matter of anxiety. That is one of the reasons, but not the only reason, we encourage the generation of electricity by renewable sources. Quite a lot is being done.

Lord Campbell of Croy: My Lords, will the Government keep in mind the prospects of harnessing tidal energy or currents at sea, for example, in the Pentland Firth? That should not cause any disturbance on land or environmental objections. Although such projects have not so far proved to be economic, might they not become so as circumstances change?

Earl Ferrers: My Lords, that is certainly true. While something may not be economic at one time, circumstances may change so that it may well become economic. However, until it does, one cannot do anything about it.

Lord Stoddart of Swindon: My Lords, is the noble Earl aware that wind turbines are visually ugly and destructive of the landscape? Is he further aware that 1,000 wind turbines are needed to provide as much energy as one 2,000 megawatt power station and that they require hundreds of acres of land? They are, therefore, wasteful of land. Will the Minister agree that the best way of obtaining energy is to conserve it? Will the Government assist householders and industry to do just that?

Earl Ferrers: My Lords, that is a totally different twist to the Question. We encourage people to conserve energy. The noble Lord, Lord Stoddart, said that wind turbines are ugly and he does not like looking at them. However, we all sometimes have to look at things that are ugly, as we know. I cannot quite understand why noble Lords find that so funny.

Lord Graham of Edmonton: You are not sitting where we are!

Earl Ferrers: My Lords, the Opposition Chief Whip is becoming personal, but I was not. Beauty is in the eye of the beholder.

Lord Moyne: My Lords, is my noble friend aware that the noble Lord, Lord Stoddart, should not be allowed to get away with his statement on the waste of land? Sheep graze all around a wind farm and the only land used is the minuscule amount for each windmill. I find them attractive.

Earl Ferrers: My Lords, I am sure that that is an interesting question.

The Earl of Halsbury: My Lords, will the Government bear in mind that those sources of power are fitful and their availability is unpredictable? Unless they work in conjunction with pumped storage of some kind, they are merely toys.

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Earl Ferrers: My Lords, I do not like to disagree with the noble Earl, but I disagree totally with that comment. Vast quantities of renewable sources of energy are available. Under the non-fossil fuel obligation we are trying to encourage the companies and firms who are involved at the beginning of the enterprise to set it up so that it then becomes compatible with other systems. With the greatest respect, the noble Earl is not correct when he says that the systems are toys.

Lord Williams of Elvel: My Lords, would the noble Earl care to pass on his original Answer to his right honourable friend the Secretary of State for Wales? He said that the wind farms were acceptable if they were economically attractive as well as environmentally acceptable. Clearly, as the noble Earl rightly said, whether they are environmentally acceptable is a matter for the local authorities and planning procedure. Will he accept, however, that the renewable energy sources are only economically attractive if they are subsidised? Otherwise, they are economically wholly unattractive.

Earl Ferrers: No, my Lords. I do not entirely agree with the noble Lord. He asked a question and perhaps he will be good enough not to shake his head in dissent before I have even answered it. At the moment a certain amount of subsidy is given in order to enable those generating stations to compete and bring the price of electricity down to a competitive rate. When the period of subsidy is over, the stations may well reach a stage where they can contribute. The commercial market for renewable technologies in this country is estimated to be £3,000 million; throughout the world it is £30,000 million.

Health Authorities Bill

3.19 p.m.

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

Moved, That the House do now resolve itself into Committee.—(Baroness Cumberlege.)

On Question, Motion agreed to.

House in Committee accordingly.


Clause 1 [Abolition of RHAs, DHAs and FHSAs and duty to establish HAs]:

Baroness Jay of Paddington moved Amendment No. 1:

Page 1, line 11, at end insert:
("(1A) Before making any order under subsection (1) above, the Secretary of State shall consult such persons as he considers appropriate about the desirability of making the order and shall lay before each House of Parliament a report of the consultation.
(1B) If either House of Parliament resolves, in the light of the report made under subsection (1A) above, that the Secretary of State shall not make any order to establish a new health authority, the Secretary of State shall by order instead establish—

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(a) authorities for such regions in England as he may by order determine, and
(b) authorities for such areas in Wales or those regions in England established under paragraph (a) above as he may by order determine;
and orders determining regions or areas in pursuance of this subsection shall be separate from orders establishing authorities for the regions or areas.
(1C) The authorities established by order under subsection (1B) above shall be named as follows—
(a) an authority established for a region shall be called a Regional Health Authority;
(b) an authority established for an area shall be called a Health Authority and in addition by a special name signifying the connection of the Health Authority with the area for which it is to act.").

The noble Baroness said: The purpose of this amendment is to give the Government the opportunity to reconsider some of the very radical proposals for yet again reorganising the National Health Service which are contained in this Bill. It aims to persuade them to consult more generally and more widely, particularly among those who work in the NHS and those of us who use it, about whether or not the abolition of the regional health authorities—one of the structural changes proposed in the Bill—will enhance the National Health Service or detract from its services to all of us.

Noble Lords who took part in debates on the earlier reorganisation of the health service about four years ago, at the beginning of the so-called reforms, will remember that there were constant requests from all sides of this Chamber that the proposals should be introduced gradually; that there might be opportunities for testing, for perhaps piloting, some of the schemes that were introduced; and that the internal market should, as it were, be a gradual revolution. All noble Lords who took part in those debates and made those points were disappointed. As we all know, the whole reorganisation was introduced on one day and a nationwide revolution went ahead, and many noble Lords are aware of the results. In particular, those noble Lords who are members of health authorities or of trust bodies know that there has been a large degree of uncertainty and concern about those changes as they have been brought about. It is instructive to notice from the poll published at the end of last week that public concern about the NHS is at its highest for three years—that is, since the so-called reforms were introduced. This amendment is designed to try to learn the lessons of the past and to think again, steadily and clearly, about the way in which these new proposals are to be introduced.

It is interesting that the noble Baroness the Minister, in winding up the debate at Second Reading, herself drew the attention of the House to the fact that only four out of the 19 Members who spoke in that debate had given the proposals wholehearted support. A great deal of the specific concern that was raised in various different ways at Second Reading was about the abolition of the regions.

One of the problems about this particular Bill is that it is enabling legislation. A great deal of the detail is not contained on the face of the Bill and will be subject to later regulations. But, in general, my criticism of the

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regional abolition is perhaps best expressed by the Minister in her winding-up speech at Second Reading. She said:

    "The role of the regional offices will be quite different from that of the old regional health authorities. In the old NHS structure it was appropriate for RHAs to be separated from the Department of Health, but in the new system health authorities will be the main operators. They will take most of the decisions which directly affect local people".—[Official Report, 6/3/95; col. 68.]

That expresses my concern about the basic principle of abolishing the regional health structure within the health service: we achieve fragmentation of the national structure and centralisation through the regional offices at the same time.

At Second Reading I proposed a number of tests against which we should judge whether or not we felt that the changes to the NHS were ones that we should support. They included tests about the effectiveness of the service, its efficiency, its equity and its accountability. All of those points are addressed in separate amendments later on the Marshalled List; but if I could summarise them as they are on the principle of the abolition of the regions they would include these major points.

In abolishing the regions we shall lose some of the crucial functions of the strategic overview of the health service which the regional authorities were independently providing in the structure. We shall particularly lose the strategic overview of some of those so-called Cinderella services which are very important to the people who receive them but are not necessarily attractive in the internal market where, as we know, individual trusts and small local health authorities will be competing with each other for business, as it is now called.

I include in those strategic functions that we shall lose when the statutory regional authorities go, concern about mental health, and particularly about the programmes for looking after people with mental illness in the community; concerns about HIV and AIDS, which, again, have been issues addressed by regional bodies; and concerns about the areas of drugs and alcohol abuse. As noble Lords will see, none of those is the kind of subject that is necessarily attractive to small local health authorities which are competing with other small local authorities for business within the internal market. Nonetheless, they are extremely important. They are crucial elements of the National Health Service and in the delivery of services which are best looked at in the context of a regional overview and a regional provision of services.

The noble Lord, Lord Walton, who, sadly, cannot be with us this afternoon, was very eloquent at Second Reading about the importance of maintaining the tertiary services which are offered, and have been offered, by the regional services of the NHS. He spoke about the planning of expensive tertiary services, such as neurology and cardiology, which have previously been overtaken at the regional health authority level and on which there seemed to be very little guidance about how and where they will be effectively planned and organised in the future. As the noble Lord said, these were regional specialities which could be "glamour" specialities for individual trusts rather than the services

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that I mentioned before, in the sense that each trust might well want to compete to offer a neurology and cardiology service, for example, but that that might not be a very economic or effective way of offering those services, and was the kind of thing that had been handled best at the regional level.

The noble Lords, Lord Walton and Lord Dainton, and several other noble Lords with considerable experience in the field of academic medicine, were also concerned at Second Reading about the links with universities which had been maintained in the previous arrangements at the regional level. They queried the problem that there no longer seemed to be formal representation for academic medicine at the university level with the regions. I understand that there has been a suggestion that there will obviously be informal links. However, noble Lords who spoke at Second Reading were most concerned about the fact that there was no statutory provision for that level of input into the new regional offices of the Department of Health; and that meant that it would be unlikely that they would be involved in the management and strategic planning of the work of the NHS in the way that they had been before, which would indeed be a loss to the health service in general.

In that area, too, is the whole question of research and development. Noble Lords will be aware, because it was the result of an initiative by this House, that the research and development programme of the NHS was established some few years ago. Research and development has become a very important part of maintaining standards of excellence within the NHS. Up to now it has been largely directed and planned by the regional directors of research and development, who have themselves been attached to the regional health authorities.

These matters will perhaps be the concern of the regional offices—the regional outposts of the Department of Health. But one of the matters that is of concern, and was mentioned often at Second Reading, relates to independence and the separate arrangements for the input of academic medicine—the regional postgraduate deans, the regional directors of research and development—which has been so important in the past few years. There was concern that if those people were to become civil servants—that is, direct employees of the Department of Health through the regional outposts rather than being part of an independent statutory body as they had been as members of the regional health authority—then in a sense their academic and intellectual independence was to some extent under threat.

That brings me to the other major point of concern about the abolition of the regional health authorities; namely, accountability. As regards the regional health authorities with their independent chairmen, many points were raised at Second Reading about whether or not they were truly independent or were political placemen of the Government. Membership of the authorities will be addressed in later amendments. But the statutory independence of the regional health authority provided a very important step in the relationship between the Department of Health and the

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management executive of the health service and the very local concerns of independent health authorities and trusts.

The Government have often spoken of how this new Bill will reduce bureaucracy and levels of management in the health service. As we know, there has been much criticism from this side of the Chamber about the explosion in management in the health service over the past few years. But it is worth remembering that that explosion has not taken place at the regional level. In fact, at the regional level the number of managers and administrators has been reduced. It is at the lower health authority and trust level that the numbers of managers have increased so greatly; it is there that the operations of the internal market—the contracting system—have meant that more and more people have had to be involved.

In a sense, the notions of bureaucracy and accountability have to some extent been confused by the Government. It seems to me that accountability can be achieved through the lean structure of the RHAs as that has now developed. As I said, the number of bureaucrats and administrators at that level has been reduced. But one does not automatically achieve something good simply by sweeping away a number of officers. What is lost in terms of public accountability, which, as we know, has been under question within the health service, through abolishing that regional tier is much more than what is gained by reducing the number of officers.

Perhaps I may quote again from another expert in the field of health care, Professor David Hunter, who is director of the Nuffield Institute for Health at the University of Leeds. He recently wrote that the essential functions of the regional health authorities which seem to have no firm place in the new structure included,

    "arbitrating in local disputes; providing a challenge to local myopia in service development and commissioning ... encouraging innovation and new ways of doing things; promoting health strategy development, community care and priority services, and research and development".

All those suggest a very good reason for thinking again about the abolition of the regional health authorities and indeed for consulting further and explaining more about where those functions will reside under the Bill.

I was interested to note that yesterday, in answer to a question in this Chamber, the Minister said that she had learnt not to say "never, ever" in the health service. I hope that she will apply that judgment to this amendment. I beg to move.

3.30 p.m.

Baroness Robson of Kiddington: On behalf of these Benches I support very much the amendment moved by the noble Baroness, Lady Jay. She explained it in great detail. There is not much that I can add. I like the thought that it gives us the opportunity to think again.

In my view, the regions have served the NHS very well. We removed the area health authority at one point and that was perfectly correct because it should never have been there in the first place. But the region is a completely different animal. If we are to have a National Health Service which has some kind of uniformity, in the sense that everybody receives the same services

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wherever they happen to live in the country, it cannot be left completely to health authorities which just cover a small district. The regional health authorities have served us very well.

I wonder whether the noble Baroness the Minister will think back and consider how we would have dealt with the establishment of regional specialties and regional centres if there had not been the regional health authorities in the past. It certainly would not have been done by the district health authorities, as there is always a desire to have the maximum amount of services within one's own district, particularly under the present purchaser and provider system which is an encouragement to have the high-tech and expensive services with which more money can be earned.

The noble Baroness, Lady Jay, was perfectly right to say that there is another function for which the regions have been responsible and which would be lost if they were abolished; namely, the strategic overview they have taken of services which she called the Cinderella services. That role is of tremendous importance. It has become even more important since the new health reforms were introduced because they are not the glamorous services which attract a large amount of cash. I agree that the regions have also acted as a stopgap for arbitration in disputes.

Additionally, the regions have been responsible for medical training, strategic planning of nurse education, various health programmes, such as screening for cancer, and research and development. According to the new plans, some of those duties will be undertaken by the regional outposts. I agree with the noble Baroness, Lady Jay. I much prefer those responsibilities to be undertaken by people who are not civil servants but who represent us, the general public and the patients in the community. Other responsibilities will be taken over by the new health authorities which may not have the necessary expertise. They will frequently look at problems from a parochial point of view. If the responsibility for nurse training is spread to the health authorities, they will consider what is needed within each little area. They will not think about the matter from a national point of view. That could be very detrimental to the future of the health service. After all, we rely on the nurses and on producing enough nurses for the future. I feel that there is a great danger under the proposed alterations that that will not happen.

I sincerely hope that the Government will think again about the abolition of the regional health authorities. If they do not accept our proposal that they should remain, will they accept that the regional outposts must have a much bigger input from ordinary, independent people?

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