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Page 1, line 11, at end insert:
("( ) The Secretary of State may by order establish a Health Authority's membership to include representatives of—
(a) medical practitioners, registered nurses and registered midwives; and
(b) other persons with professional expertise in and experience of health care.").

The noble Baroness said: I hope that I shall be able to explain the amendment as clearly as possible to the Committee. It concerns the ability of the Secretary of State to prescribe the types of people who should be members of health authorities. That should not be an exclusive power but he should have the ability to prescribe who should be included on the new health authority boards.

It is an attempt to have written on the face of the Bill the necessity for professional involvement in the decision-making process of the new health service. The words relating to the people to be included are taken from Schedule 1 to the Bill. In Schedule 1 it is suggested that those are the people to whom health authorities should look for professional advice. That was as a result of an amendment proposed by the Government in another place on Report after argument on the subject in Committee. Therefore, the schedules make specific provision in relation to the advice of those people. My amendment is designed to ensure that there is a statutory

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duty on the new health authorities to obtain that advice by making that kind of professional expertise part of the authority.

Noble Lords who spoke on Second Reading will remember that several noble Lords wished, for example, to include nurses as members of health authority boards. This amendment seeks to provide a broader application of professional expertise involved at board level on the new health authorities. At present, such professional membership exists in family health authorities which will become, effectively, part of the new merged health authorities.

It is interesting to note that the draft guidelines which the Department of Health issued in January of this year on professional involvement in the work of the new health authorities refers to the:

    "need for closer and more effective involvement by doctors, nurses and other professional staff in the full range of the work of the authorities".

The guidance goes on to state:

    "Health authorities will need to demonstrate that their mechanisms are effective in terms of planning and decision making, good communication and professional understanding of local policies and strategies".

There are many examples in the draft guidance of areas in which it is intended that there will be professional input. Some of those areas appear in Annex C of the draft issued for consultation; for example, maintaining a district-wide view of healthcare purchasing; establishing ways of judging clinical effectiveness; planning health care services for people with disabilities; working on midwifery supervision and child protection measures; and looking at the whole area of mental health.

Those are obviously areas in which it is extremely important to have the right and appropriate level of input into decision-making from professionals of the type who are mentioned in the amendment. It seems to me that the simple way to achieve that is by making sure that the new health authorities are advised appropriately by precisely the people who the draft guidelines say will be extremely important to the work of the new health authorities. That can be achieved by making them members of the boards.

The amendment would not mean prescribing numbers. It may mean that the number of non-executive members may have to be increased slightly but I do not see why that is necessarily a problem. However, it slows down the process of the health authority boards being dominated, as many have been in the past few years, by people with very little practical involvement or interest in the health service.

I can speak to that from my own experience. The work of the district health authority with which I have been involved for many years has been slowed down by the involvement of people who have come in from outside with very little practical knowledge of the way in which the health service works and who show very little understanding of its mechanisms. At one stage, I asked people—I hope not in a sense of hostility—whether or not they were health service patients. It was

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surprising that several were not. It was surprising also that several were not involved in the local community which they were supposed to represent.

This is an attempt to try to redress the balance in that way. It is also my experience that one member of my local authority always referred to the fact that the papers and minutes were addressed in what she described as "NHS-speak"; that is, they were written in words which were often referred to and explained by the technical, medical and professional health-related issues which they were intended to cover rather than being written, as it were, for the local newspaper.

The proposal would not in any way affect the fact that the bodies which will run the local health authorities can have a broad concept of experience. It would not mean that there would need to be a prescribed number. When the Minister spoke on Second Reading in response to various noble Lords who raised the question of having people from individual professions represented on the authorities, she said that she did not like the concept of representation. I suspect that that may well be included in the Minister's reply this afternoon.

In the amendment, we are not suggesting representation of particular professional bodies; we are suggesting the inclusion of the voices of those from a professional background who can lend their expertise and experience to health authorities and who in any event, as the Bill stands, must statutorily be consulted for their advice. That is why I commend the amendment to the Committee. I beg to move.

Lord Boyd-Carpenter: Will the noble Baroness explain what she believes the legal effect of her amendment would be if it were accepted? As I understand it, it merely says:

    "The Secretary of State may by order establish a Health Authority's membership to include representatives"

of various professions. But surely the Secretary of State already has complete power to do so; indeed, he has power to include all those representatives in the membership of the health authority. As the amendment only purports to give the Secretary of State such authority if he so desires —"may" being the word used—surely it would have absolutely no effect if carried.

Baroness Jay of Paddington: I am sorry if I did not make myself clear in explaining the purpose of the amendment. The point behind the amendment is to put on the face of the Bill the necessity to include people who are already included in Schedule 1 as being appropriate advisers. If the noble Lord looks at line 23 of Clause 1 of the Bill, he will see that it says:

    "The Secretary of State may by order",

and then various indications are given as to the way in which the Secretary of State may behave in relation to the health authorities. The amendment is simply an attempt to add to those possibilities.

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Lord Boyd-Carpenter: But does that not amount to a statement in that all the amendment is doing is saying that the Secretary of State "may" do what in fact he can already do?

Baroness Gardner of Parkes: I oppose the amendment. In fact, it is rather in conflict with Amendment No. 13 which is tabled in my name. As the noble Baroness said, she has taken the wording from the schedule. Amendment No. 13 would alter that schedule and, consequently, the wording of the noble Baroness's amendment. I am not opposed to any of those people serving on such an authority. However, I have been approached by pharmacists who are very upset that "medical practitioners", "registered nurses" and "registered midwives" have been named in Schedule 1, whereas they are not. Therefore, I was asked to put forward an amendment which would add the word "pharmacists". I immediately declined and said that I could not do so, the reason being that the moment I did so I knew that dentists would approach me and make the same request. It seemed to me that we would then go on through all the health professions, including chiropractitioners and so on. Thus we would have ended up with a whole list of people.

Therefore, I have tabled Amendment No. 13 to Schedule 1 which would delete the whole of paragraph 3(a) as set out in the noble Baroness's amendment and the word "other" at the beginning of paragraph 3(b), so as to make representation on such boards open to any health professional. The pharmacists—and I know that the dentists would feel exactly the same—feel very much second-class citizens because doctors, nurses and midwives have been named, while they have not been. Even though, according to the terminology, they know that they would be able to participate under paragraph (b) of the schedule, they feel that preference would be given to those who are specifically named in paragraph (a) and that those people would believe that they had the right to be on the board whereas the others were just another option. For that reason, I cannot support the amendment.

I should like to see persons of professional expertise being included, but I believe that they will be appointed in any case. The noble Baroness said that many of those in trusts and in health authorities have no direct health experience. However, I heard just that question today from Charter 88, regarding today's "Quango Day" meeting. A quick calculation was made. On my trust, there is a direct national health experience of over 80 years in the non-executive members of the board. Therefore, it is certainly not general practice for those on trusts to have no health background.

4.45 p.m.

Baroness Robson of Kiddington: I support the amendment moved by the noble Baroness, Lady Jay. I have a certain amount of sympathy for the other professions. However, we could not possibly have an amendment that named all the different professions. The reason for "medical practitioners", "registered nurses" and "registered midwives" being specifically mentioned is, in my view, due to their close involvement with

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patients in hospitals and in the community. They are in a special class compared with other expertise that relates to the health service.

During her response to the first amendment, the Minister said that the purchasing authorities, in themselves, represent the patients in the community. One cannot imagine a health authority that did not include a member of the medical profession, especially a general practitioner. In the new pattern of health care that we now have with the emphasis being on community care, the general practitioner is most important. Moreover, the nurses are the people who give 80 per cent. of the care in hospitals. They know more about what patients feel; indeed, they know more about what patients need. They are perfectly capable of contributing enormously to the purchasing question of a health authority. I would very much welcome it if the Government were to accept the amendment.

I heard from the Royal College of Nursing that there could be a problem with having a nurse representative on the board of a health authority. The reason is that it is not really permitted for a member of a board of one authority to be working for another authority. It would be very difficult for nurses to be represented on such boards because most of them are working in hospitals. I hope that the Government will consider that point and make a special allowance to ensure that nurses can be represented on the boards.

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