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Page 1, line 14, at end insert ("and those areas shall, so far as is practicable, be of equivalent population size and coterminous with local authority boundaries").

The noble Baroness said: This amendment stands in the names of the noble Lord, Lord Tope, and myself. It addresses the issue of the size of the new health authorities and is designed primarily to try to obtain information from the Government about how they see the organisation of the health authorities, particularly in relation to their coterminosity with local authorities and councils.

As we know, the mood within the health service is to achieve what is becoming known as primary care-led purchasing. It will obviously include a great deal of community care which involves local social service bodies and other organisations, particularly in the voluntary sector. Previously, they often related more to local authorities than to local health authorities.

The amendment is also an attempt to address the issue raised by the right reverend Prelate the Bishop of Liverpool on the previous amendment about the so-called health divide. The question is whether it will no longer be the case—if we can achieve relative coterminosity both in relationship to local councils and local population sizes—that what you obtain in terms of

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some services, particularly community care, can sometimes depend on where you live and not on what you need.

Members of the Committee will remember that at Second Reading many of us were concerned with the issues which relate inequality of wealth to inequality of health. Difficulties occur when health authorities are simply related to a particular type of population; they may have problems in addressing the broad spectrum of healthcare. At the moment there are 111 district health authorities and 90 family health service authorities. As I understand it, in the end, when reorganisation has gone through, there will probably be 80 or 90 health authorities—the new HAs. These will have no regional responsibilities, only responsibility for the local area.

It is of great importance that the health authority areas should be roughly of the same geographic and population size. As the amendment says, that can only be done,

    "so far as is practicable".

I hope that that will be more practicable, particularly in some wider urban areas, than in the past.

It is easier to arrange the kind of community care we all hope to see if there is a close relationship between the areas which are organising social care and those which organise healthcare. Later, under a further amendment, we shall discuss the National Health Service responsibility for continuing care. Noble Lords who took part in our earlier debates on the subject will know the clear necessity for close co-operation between social services and health authorities if community care is to be successful. That is particularly important in dealing with problems which reflect the health divide in terms of population income and population health.

When we discussed the matter on earlier occasions, there was general agreement around the House that the so-called healthy alliances, very much underlined in the policy in The Health of the Nation, are much easier to organise if they are carried out at a local level with health, social services, voluntary sector bodies, charities and education bodies all working towards the same end. We see that clearly when we consider the issues which relate to questions of poverty and health. But they also relate clearly to issues related to health education and health promotion.

If we end up with health authorities which are variable, both in the size of their population and their relationship to local authorities, it seems that the objectives of achieving equity and effectiveness, particularly in the areas of primary and community care, will not be achieved. I hope that the Minister will be able to tell us that it is an aim of the detailed reorganisation that there should be an attempt to achieve both a sense of coterminosity with local authorities and relative equality in terms of population. I beg to move.

Lord Donaldson of Kingsbridge: Before the noble Baroness sits down, can she tell me exactly what "coterminosity" means? Does it mean that the two areas end at the same point? If not, what does it mean?

Baroness Jay of Paddington: I suspect from the expression on the noble Lord's face that, like me, he

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regards "coterminosity" as a rather ugly term. If that is the case, I agree with him. As I understand it, "coterminosity" in terms of this amendment and local government means that two authorities are responsible for social policy for different parts under the same umbrella of care—for example, healthcare in its broadest sense and, as I emphasised, community care and primary care. They are organised by bodies which have a responsibility for the same geographic area. I give an example from my experience in west London. For many years I was a member of a health authority which had the entirely arbitrary name of Parkside. The name did not relate in any sense to the local authorities who organised social services. Since the reorganisation in the past few years, the health authority is now known as Kensington, Chelsea and Westminster Health Authority. It directly relates to those local councils who have responsibility for local social services in the same area as the health authority.

Lord Tope: The noble Baroness has explained "coterminosity" very well. It means the same authorities having the same boundaries. I intervene at this stage with my experience of local government rather than of the health service. That is why I wish to support the amendment. Increasingly, local authorities have to work and wish to work in partnership with many other agencies in the context of the Bill, particularly in the field of community care. It has been the bane of the lives of local authorities that other authorities such as health authorities not only have names which are meaningless to most of the public and to many of their members but also have quite different boundaries. We still find that in a number of areas different authorities working in the community who need to work together have different boundaries. It is confusing for the public and often also for the authorities themselves to know who is responsible for what.

This is a simple and straightforward amendment. It is so obviously right that I share the wish of the noble Baroness that the Minister should tell us that the Government accept the amendment or, at the very least, its spirit. I fear that if the proposal does not apply when the further reforms come into effect, it will be a recipe for further confusion which need not arise. I support the amendment.

Baroness Eccles of Moulton: My impression, ever since the reforms began, has been that the Government's aim is to achieve coterminosity wherever possible. A great deal has happened in that direction. I have had experiences similar to those of the noble Baroness, Lady Jay, where my district has become coterminous and our work has become a great deal easier.

However, we must remember that England is not made up of neat and tidy parcels either of population or territory. Therefore, to make it prescriptive that health authorities should in future be coterminous with local authorities would be a pity. I know that the words,

    "so far as is practicable",

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are included in the amendment, but it would be a pity because it seems to me that there is no need for it.

5.30 p.m.

Baroness Cumberlege: We do not intend to be prescriptive in any way about the population size of the new health authorities in this Bill. As with district health authorities, the size of an authority will be dictated by what is required for it to discharge its responsibilities effectively, and this may vary according to local circumstances.

However desirable, it would not be practical to prescribe that each health authority is coterminous with a local authority. The size considered best for the performance of local government functions in one area may well be rather smaller than that which my right honourable friend the Secretary of State for Health decides is the optimum for the new health authority as a strategic purchaser of health care.

As the noble Baroness, Lady Jay, said, both Care in the Community and The Health of the Nation require health and local authorities to work closely together, and, as we move towards a primary care led NHS, there will be even more opportunities for joint working. An important part of assessing and meeting the health care needs of a population will be the effectiveness with which a health authority relates to other local bodies, particularly local authorities. However, although common boundaries with local authorities can contribute to successful joint working, it does not guarantee success—the key is a commitment to working together to share objectives, information and plans. As my noble friend Lady Eccles said, England is not neat and tidy, and therefore we do not consider it appropriate to include in the Bill a provision on the size of health authorities in relation to local authorities. We must allow regional offices the flexibility to meet differing local circumstances. Regions have been charged with developing a clear view about the desirable size for the new health authorities to ensure effective collaboration with other agencies, and to be responsive to local people and their health needs. The views of the local population and interested organisations will be sought through public consultation on the boundaries of the new health authority. My right honourable friend the Secretary of State for Health will then decide on the boundaries of the new health authorities.

The size and shape of health authorities must be determined by what is best for the purchasing of health care. Having the same population base as local authorities is not necessarily always the answer. On this basis, I am therefore unable to accept an amendment which might jeopardise the ability of a health authority to carry out its functions effectively. I hope that the noble Baroness will withdraw her amendment.

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