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Baroness Gardner of Parkes: I should like to take up the point made by the right reverend Prelate. I have put down an amendment to amend Schedule 1 to include a representative who is involved in primary care. However, Amendment No. 2 does not make clear that the people concerned should be involved in primary care. I do not believe that the amendment covers that point.

Baroness Cumberlege: I am grateful for this opportunity to debate how best we can ensure that professional healthcare experts are fully involved in the work of health authorities.

The Committee will be aware that the Government have recently published new guidelines on appointments to health authorities. My right honourable friend the Secretary of State made clear our approach when she said that:

Both professional and non-professional people can offer that skill and commitment. Those working in primary care have a particularly important contribution to make as we move towards a more primary care led NHS, and I agree with the comments of the right reverend Prelate. I am sure that many health authorities will have non-executive members with experience in primary care and, indeed, experience in the acute sector and in community care. Everyone who is suitably qualified will be welcome to apply for appointment, provided there is no conflict of interest.

There are, however, many other groups with a contribution to make. I make no apology for emphasising the value of members with financial and business skills with voluntary sector experience and with experience of representing consumers from a lay perspective.

My noble friend Lord Carr is right that it is important that the new authorities are effective decision-making bodies. For that, they must be compact and streamlined. It would not be possible, or desirable to include on every health authority a representative of all the different groups and organisations with an interest in health services. Not only would that make health authorities less effective as decision-making bodies, but it would

28 Mar 1995 : Column 1532

go against our aim of ensuring that health authority members are chosen for their personal skills and abilities.

No health authority can do its job properly without involving doctors, nurses, midwives, health visitors and the many other skilled professionals working in the NHS—and I include pharmacists and dentists. I fully accept the valuable personal contribution that they can make, as executive or non-executive members of authorities.

I can reassure the right reverend Prelate the Bishop of Liverpool that GPs and other primary care practitioners, will be free to apply for appointment to health authorities. That will include GP fundholders—who cannot currently be members of district health authorities, so we are widening the scope. However, it would not be appropriate for employees of trusts—including nurses—also to work for purchasers as members. We therefore agree with the Royal College of Nursing that as members nurses are more likely to make their contribution as executive members of health authorities. But of course, we welcome suitably qualified nurses as non-executives where there is no conflict of interest.

Membership is far from being the only way for professionals to be involved. That is why—in paragraph 3 of Schedule 1 —referred to by the noble Baroness, Lady Jay—the Bill now places an absolute, clear statutory duty on health authorities to secure advice from medical practitioners, registered nurses and registered midwives and other people with professional expertise in and experience of healthcare.

The noble Baroness, Lady Robson, and the noble Baroness, Lady McFarlane, quite rightly highlighted the contribution of nursing. They will agree that the Government have demonstrated in many ways their commitment to nurses, midwives and health visitors. It is relatively easy to praise the nursing profession, but we have given nurses added responsibilities and shown our trust in their professional skills. One example that I should like to highlight is nurse prescribing, an area in which I have taken a personal interest. As my noble friend Lady Gardner said when we debated the first amendment, we have made an enormous investment in nurse education and training through the introduction of Project 2000. My Changing Childbirth report acknowledged the central role played by midwives in the routine care of women during labour.

Purchasing healthcare requires innovation, understanding of health needs, sensitivity in relationships with patients and the wider public. We believe that there are many people who can bring those skills to purchasing.

My noble friends Lord Boyd-Carpenter and Lady Eccles quite rightly pointed out that the amendment before us has no practical effect. The Secretary of State is already free to appoint healthcare professionals to health authorities. She already has the power to appoint members of health authorities in general. We believe that by inserting a pointless provision there is a risk that a court might doubt the generality of the existing power.

28 Mar 1995 : Column 1533

We are committed to involving a whole range of healthcare professionals in the decisions of the new health authorities. However, I do not believe that the amendment is the best way to achieve that. Therefore, I hope that the movers of the amendment will be willing to withdraw it.

Baroness Jay of Paddington: I am grateful to the Minister for that reply. In some ways there is only a small distance between us. We both agree that it is vital that members of the various professions are involved, but I agree with the noble Baroness, Lady Gardner of Parkes, that there would be difficulty in having an all-embracing list of everybody who would wish to be involved and who would feel that they should rightly be involved.

The distance between us is that I want to see this representation on the face of the Bill. I take the point that it has been argued that this might create a position which was nonsensical. However, having taken advice, we are seeking—in the Minister's words—to achieve the "absolute, clear statutory duty" of the health authorities to receive the advice of these people as members of those authorities. I refer Members of the Committee again to the guidance issued by the Department of Health regarding examples where professional input will be "essential"—I cite the department's word—in the new authorities. If that input is to be essential, covering such a wide range of policy and strategic decisions, how can it be achieved simply through the mechanism of advice?

Unlike other noble Lords who spoke from the other side of the Chamber, I am not shy of the concept of representation. There is a difference between us on that issue. I was interested that the noble Lord, Lord Carr, referred to a size of authority or a decision-making body which was considerably less large than the present Cabinet as being the only effective body to take decisions.

There are some issues between us, in particular on the clear and statutory duty that we should like to see placed on the Secretary of State to achieve professional representation on the health authorities. We want to achieve such representation where decisions are taken and not simply in an advisory capacity. On that basis, I wish to take the opinion of the Committee.

5.11 p.m.

On Question, Whether the said amendment (No. 2) shall be agreed to?

Their Lordships divided: Contents, 94; Not-Contents, 139.

Division No. 2


Addington, L.
Archer of Sandwell, L.
Ashley of Stoke, L.
Avebury, L.
Banks, L.
Blackstone, B.
Bottomley, L.
Brooks of Tremorfa, L.
Bruce of Donington, L.
Callaghan of Cardiff, L.
Carmichael of Kelvingrove, L.
Carter, L.
Castle of Blackburn, B.
Clinton-Davis, L.
Cocks of Hartcliffe, L.
David, B.
Dean of Thornton-le-Fylde, B.
Desai, L.
Diamond, L.
Donaldson of Kingsbridge, L.
Donoughue, L.
Dormand of Easington, L.
Dubs, L.
Eatwell, L.
Falkland, V.
Farrington of Ribbleton, B.
Fitt, L.
Gallacher, L.
Geraint, L.
Graham of Edmonton, L.
Gregson, L.
Grey, E.
Hamwee, B.
Harris of Greenwich, L.
Haskel, L. [Teller.]
Hollis of Heigham, B.
Hooson, L.
Houghton of Sowerby, L.
Howie of Troon, L.
Hughes, L.
Irvine of Lairg, L.
Jay of Paddington, B.
Jeger, B.
Jenkins of Putney, L.
Kilbracken, L.
Kinloss, Ly.
Kirkhill, L.
Lester of Herne Hill, L.
Liverpool, Bp.
Longford, E.
Lovell-Davis, L.
Mallalieu, B.
Mar and Kellie, E.
Masham of Ilton, B.
Mason of Barnsley, L.
McIntosh of Haringey, L.
McNair, L.
Merlyn-Rees, L.
Meston, L.
Milner of Leeds, L.
Mishcon, L.
Monkswell, L.
Morris of Castle Morris, L.
Nicol, B.
Ogmore, L.
Peston, L.
Plant of Highfield, L.
Prys-Davies, L.
Rea, L.
Redesdale, L.
Richard, L.
Robson of Kiddington, B.
Rochester, L.
Russell, E.
Seear, B.
Sefton of Garston, L.
Serota, B.
Shepherd, L.
Simon, V.
Stedman, B.
Stoddart of Swindon, L.
Strabolgi, L.
Taylor of Gryfe, L.
Thomas of Walliswood, B.
Thomson of Monifieth, L.
Thurso, V.
Tope, L. [Teller.]
Tordoff, L.
Varley, L.
Wallace of Coslany, L.
Wedderburn of Charlton, L.
White, B.
Williams of Elvel, L.
Williams of Mostyn, L.


Aberdare, L.
Addison, V.
Ailsa, M.
Aldington, L.
Archer of Weston-Super-Mare, L.
Astor of Hever, L.
Balfour, E.
Bethell, L.
Birdwood, L.
Blaker, L.
Blatch, B.
Blyth, L.
Boardman, L.
Boyd-Carpenter, L.
Brabazon of Tara, L.
Braine of Wheatley, L.
Bridgeman, V.
Broadbridge, L.
Brougham and Vaux, L.
Cadman, L.
Caldecote, V.
Carnegy of Lour, B.
Carnock, L.
Carr of Hadley, L.
Chalker of Wallasey, B.
Charteris of Amisfield, L.
Chesham, L.
Clanwilliam, E.
Clark of Kempston, L.
Courtown, E.
Craigavon, V.
Cranborne, V. [Lord Privy Seal.]
Cranbrook, E.
Cross, V.
Cumberlege, B.
Davidson, V.
Dean of Harptree, L.
Denham, L.
Dilhorne, V.
Downshire, M.
Dundonald, E.
Eccles of Moulton, B.
Eden of Winton, L.
Elles, B.
Elliott of Morpeth, L.
Elton, L.
Faithfull, B.
Ferrers, E.
Fraser of Carmyllie, L.
Gage, V.
Gainsborough, E.
Gardner of Parkes, B.
Geddes, L.
Gisborough, L.
Glenarthur, L.
Goschen, V.
Gray, L.
Greenway, L.
Gridley, L.
Grimston of Westbury, L.
Hailsham of Saint Marylebone, L.
Halsbury, E.
Harding of Petherton, L.
Harmar-Nicholls, L.
Harmsworth, L.
Hayhoe, L.
Hemphill, L.
Henley, L.
Hives, L.
Hogg, B.
Holderness, L.
HolmPatrick, L.
Howe, E.
Hylton-Foster, B.
Inglewood, L. [Teller.]
Johnston of Rockport, L.
Kimberley, E.
Kinnoull, E.
Kintore, E.
Knollys, V.
Lauderdale, E.
Layton, L.
Liverpool, E.
Long, V.
Lucas of Chilworth, L.
Lucas, L.
Lyell, L.
Mackay of Ardbrecknish, L.
Mackay of Clashfern, L. [Lord Chancellor.]
Marlesford, L.
Merrivale, L.
Mersey, V.
Miller of Hendon, B.
Milverton, L.
Mottistone, L.
Mountevans, L.
Munster, E.
Nelson, E.
Newall, L.
Nickson, L.
Norrie, L.
Northesk, E.
Oppenheim-Barnes, B.
Orr-Ewing, L.
Oxfuird, V.
Perry of Southwark, B.
Peyton of Yeovil, L.
Pike, B.
Porter of Luddenham, L.
Rankeillour, L.
Rees, L.
Renfrew of Kaimsthorn, L.
Rodger of Earlsferry, L.
Savile, L.
Seccombe, B.
Sharples, B.
Shaw of Northstead, L.
Simon of Glaisdale, L.
Skelmersdale, L.
Slim, V.
St. Davids, V.
Stewartby, L.
Stodart of Leaston, L.
Strange, B.
Strathcarron, L.
Strathclyde, L. [Teller.]
Sudeley, L.
Swansea, L.
Swinfen, L.
Thomas of Gwydir, L.
Thurlow, L.
Trefgarne, L.
Trumpington, B.
Tugendhat, L.
Ullswater, V.
Vaux of Harrowden, L.
Wade of Chorlton, L.
Weatherill, L.
Wilson of Tillyorn, L.

Resolved in the negative, and amendment disagreed to accordingly.

28 Mar 1995 : Column 1535

5.19 p.m.

Baroness Jay of Paddington moved Amendment No. 3:

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