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Lord Elton: I was very surprised when the noble Baroness sat down, because I thought that after her summary of our debate at Second Reading she would address the intentions within her amendment and tell us how they would work. In the absence of such an explanation, I assume that the principal intention is the one she briefly outlined and upon which the noble Baroness, Lady Robson, elaborated; namely, the substitution of a two-tier system for the one-tier system proposed in the Bill.

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The Bill passed Second Reading. Its sole purpose is to introduce a single-tier system. It seems to me that we should not waste too long discussing overturning the whole principle of the Bill by an amendment which the Opposition have not even taken the trouble to explain.

Lord Rea: One of the questions unanswered by the Bill concerning the proposed abolition of the regions is: what is to become of the organisation of postgraduate medical education? The regional postgraduate deans and the regional advisers in general practice have played, and do play, a major role in the organisation of postgraduate education for general practitioners, general practitioner trainees and junior doctors. I am familiar with the work of the regional advisers in general practice, who are responsible not only for postgraduate education, but also for the training, selection and supervision of the general practitioners who are to become trainers involved in the vocational training scheme in general practice. Without them the success story of raising the status and academic standards of British general practice over the past 25 years could not have occurred.

It was suggested that the contracts of junior hospital doctors, which are now held by the regions, should be held by the regional postgraduate deans. But where will they be based? Where will they obtain the infrastructure to carry out the job efficiently? If the regional postgraduate structure is to be maintained as it should be, the new health authorities individually, even if they undertake postgraduate eduction, will need to be co-ordinated nationally. Where will the offices of the postgraduate dean and advisers be situated? To whom will they be accountable?

I assume that universities will continue to play a major part. But that needs to be in the Bill. Surely it will be easier to continue this vital part of the National Health Service—that is, the system for postgraduate education—if the regional structure of the National Health Service remains, as the amendment allows.

Baroness Gardner of Parks: I take the technical point made by my noble friend Lord Elton and find it interesting that we are developing arguments on this amendment. I was amazed to hear the noble Baroness, Lady Jay, say that this was a case of the National Health Service being reformed "yet again"—that was her expression—when that is not at all the case. This is just the next stage in the present reform. I shall be opposed to any further reform. This is the end of the reform and in the Second Reading debate many of us said that it was time to allow the health service to settle down and start working because it has been reformed too often. This is not a new reform; it is a further stage in the reform about which everyone has known for a long time.

The noble Baroness went on to say that there was a large degree of uncertainty in regard to the changes. That may be true. But the staff in the regions are aware of what is happening and of what they expect to happen. Nothing could be worse than deferring any kind of decision on this matter in such a way that those people are thrown into a greater state of uncertainty. Many are already looking into what their position will be. The whole system is geared to the fact that staff come high

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on the list of concerns and are being carefully considered in the arrangements that are being made at the moment.

The noble Baroness said that health authorities make most of the decisions. She seemed to think that that was bad. I believe it is good. It makes the situation more localised and closer to those people receiving the service. The Cinderella services were referred to by the noble Baroness, Lady Robson. We are overlooking the role of the CHCs in this. The community health councils are aware of the Cinderella services and are active and efficient in drawing attention to any gap they see in the provision of services under the National Health Service.

When the noble Baroness, Lady Robson, was chairman of a regional health authority, nursing education was quite different from what it is now. Project 2000, which is the present system of training, meets her anxieties in that regard. I should perhaps say that I was vice-chairman of a regional health authority until a year ago when I became chairman of one of the large acute hospital trusts. But I am well aware of the Culyer Report on research. People do not need to worry. Everyone working within the National Health Service is aware of the emphasis that will be placed on research and on further postgraduate education. There is already a federation of teaching hospital trusts which meets regularly. The chairman of that body is based in Liverpool and I am convinced that there will be no problem as regards the future. The academic world of medicine is most concerned and interested to see that postgraduate education continues, as well as undergraduate education. The amendment is simply obstructive and I shall oppose it.

3.45 p.m.

Lord Stoddart of Swindon: Perhaps I should declare an interest in that I act as a consultant to Unison. I confess that I do not agree with the points of view just expressed from the other side of the Chamber. After all, the amendment seeks to ensure that further consultation takes place before a final decision is made. The noble Baroness, Lady Gardner, and the noble Lord, Lord Elton, believe that that is unreasonable. But in my view this amendment was tabled following the anxiety expressed by many people and organisations.

Why is it that we all receive briefings from such places as the Royal College of Nursing, from the BMA and all kinds of other organisations which are concerned that the measures at present dealt with by the regional health authorities should continue to be exercised in a proper manner, worthy of the service and suitable for the patient? I accept that it is entirely reasonable for the Opposition to seek to ensure that those people's views are taken into account, and that is exactly what the amendment seeks to do. Quite frankly, to try to abolish a tier which has worked extremely well over decades requires extra special attention and therefore, for myself, I believe that the amendment is reasonable and should be considered.

There is something else that I want to know. We are abolishing the regional tier and will have other regions of civil servants. How are they to be answerable to the patient? How are they to be answerable to the public? And

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how are they to be answerable to Parliament? At present the regional health authorities are answerable to the public and therefore they are not constrained in any way by any oath they take in relation to the Official Secrets Act. Will we find, because of that oath of secrecy taken by civil servants, that information we have hitherto received will not be given to the public and to Parliament? We want to know—certainly I do; I do not know about my noble friends—to whom the new bodies will be answerable and how they will exercise the power being given to them.

That is another good reason for accepting the amendment and why my noble friend should not be criticised for tabling it. It is important. We need to be sure that the people involved in the reorganisation are satisfied that it will be to the advantage of the National Health Service and that the reorganisation is not being done in a way that will injure the patient. That is entirely reasonable and I am surprised that there should be any criticism from the other side.

The other point which concerns me, and I shall make it my last, relates to staff. As the noble Baroness, Lady Gardner, said, the staff are important. They will lose 1,500 jobs within the regional authorities. They have already lost 1,300 jobs, so 2,800 jobs have had to be accommodated as a result of this reorganisation. It is entirely reasonable that we should ask that the staff receive proper treatment. They need to be reassured about their pensions for the future. They need to be reassured that they can be accommodated elsewhere within the National Health Service. They need to be given some assurance that those who remain in the service will have a career progression available to them. Those are all legitimate concerns.

Consultations with the trade unions in the National Health Service have taken place in a reasonable and friendly manner, and progress has been made. But Members of the Committee are entitled to raise these issues and to be given some reassurance that staff who have given their expertise and their service to the regional authorities will be treated well and will receive assurances about their pensions, their conditions of service and, if redundancy is involved, good redundancy terms. I hope that redundancy will not be involved. I hope that all the staff will be accommodated within the new arrangements. I trust that the Committee will agree that my noble friend has done a great service in putting down this amendment as it has enabled us to discuss these very important matters in detail.

Lord Carr of Hadley: It may be that all the subjects which the noble Lord and other noble Lords have mentioned should be discussed if they have not already been discussed. However, we have surely to look at the amendment on the Marshalled List. It seeks to insert into the Bill, to which your Lordships gave a Second Reading two weeks or so ago, an amendment which in another place we would undoubtedly have described as a wrecking amendment because it seeks to go back to the principle we decided against when we gave the Bill a Second Reading.

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