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Lord Carr of Hadley: Before my noble friend sits down, can she expand a little further her comments on boundaries? I understand very clearly why it would not be practicable or desirable to go for equality or near-equality in population sizes. I can also understand quite clearly why it would not be possible to have one health authority for one local authority. However, I do

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find it difficult to understand why a health authority's boundaries would have to cut across and through a number of local authority boundaries.

Baroness Cumberlege: It would certainly be our intention to avoid that problem. But I know, for example, an area in Surrey very well where there is an anomaly that we believe will be very hard to put right immediately. All that we suggest is that there should be more flexibility and more room for judgment than this amendment allows, which suggests that each health authority ought to have a population of similar size and always be coterminous, where practical, with a local authority.

Baroness Jay of Paddington: I am rather disappointed by the Minister's reply. Given the terms in which the amendment is couched, stating as it does,

    "so far as is practicable, be of equivalent population size and coterminous with local authority boundaries",

I would not have described it as necessarily prescriptive. The illustrations that have been given suggest that there is a need for (I hesitate to use this word again) some degree of coterminosity, particularly, as the Minister said, in the further development of primary care and local purchasing. If we have anomalies whereby there is such a disjunction between a local social services authority responsible for one part of care and a local health authority responsible for another, we shall simply continue the argument that is going on at the moment, much to the detriment of patients and those who use the health service, about who is responsible for looking after them at different stages.

However, I take the points that were raised about the difficulties of laying down the particular areas of England in small and neat boundaries. That was not intended to be the point of the amendment. As I say, it was intended to convey the hope that by achieving, where practicable, equivalent population size and coterminosity, we could achieve greater equity of services, and greater equity particularly between local and health authorities. Having heard what the Minister said, I will think about the matter further. At this stage I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Carter moved Amendment No. 4:

Page 1, line 23, after ("may") insert ("following consultation with the appropriate local authorities, Community Health Councils and other relevant bodies").

The noble Lord said: With this amendment we return to the subject that we discussed in relation to Amendment No. 1; namely, the importance of consultation. It is a pity that the noble Lord, Lord Peyton, is not in his place. Noble Lords will remember that, when we discussed consultation previously, the noble Lord described the idea as "quaint". I was minded to look up the definition of quaint in the Oxford Dictionary. One definition is, "daintily odd". I did wonder whether there was anything faintly subliminal in the choice of that specific word, meaning as it does "daintily odd", by that particular noble Lord.

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In moving this amendment I should like to present the general argument in favour of consultation as described in the amendment, and then give two particular examples which are known to me and which show why, in the area in which I live, consultation on the health service is, I am afraid, regarded as a farce.

This is yet another major change. I return to the point that was made when we discussed the first amendment. This is not just a planned development that was foreseen when the 1990 Act was passed. It is another major change, and should be treated as such. That is, of course, why we have a Bill before Parliament in which to deal with it. Any noble Lords who were involved in the 1990 Act will remember how we tabled amendments asking the Government to consult and to try out the various ideas, which were supported at the time by all the Royal Colleges. But at the time they were rejected and the whole thing was done in one fell swoop overnight. And we know the result.

There are a number of ways in which the Government go through the motions of consultation. One is to request consultation and then give very short deadlines for reply. If my memory serves me right, when consultation was begun on the community care part of the 1990 Act, the consultees were given only a very few weeks in which to reply.

The amendment mentions the local authorities, the community health councils, and so on. It is important, because of the danger of overlap (or duplication) between health authorities and the local social services on such matters as community care, that where such a danger exists, there should be the form of consultation for which we ask.

In Section 5 of the 1990 Act there is a duty that the community health councils and the local authorities should be consulted about trusts. It would be interesting to know from the Minister why such consultation was thought to be important in 1990 in relation to National Health Service trusts but is apparently not required under the terms of this Bill. We also have to bear in mind the likely effect on local authorities of the proposed boundary changes. Consultation is required to ensure that there is no overlap or duplication.

The report of the House of Commons Health Select Committee on priority setting in the NHS, published in January, also stressed the importance of consultation. The report contained some useful recommendations; namely, that the statutory requirements for consultation over health plans should be brought into line with those for community care plans at the earliest opportunity; that purchasers should seek the views of community health councils during the formulation of protocols; that health authorities should demonstrate that they have a systematic approach to consultation relating to strategic development, specific health issues, service shifts, purchasing plans and promoting healthy lifestyles; and evidence of communication and consultation with different local groups to take account of their needs. I think we all agree that health authorities should be as open as possible in consulting citizens and consumers about the service that they provide. We also think that they should publish plans about how they have consulted consumers and their representatives in

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identifying the health needs of their area. For all those reasons we feel that the Bill should include the requirement for consultation specified in the amendment, and as indeed was laid down by the 1990 Act.

I now move from the general to the particular. I do not apologise for this. Often in this Chamber we deal with the wider issues which concern the principles of a Bill, but it helps occasionally to look at specific local issues to see how they effect the patients (not the "consumers") on the ground. Let me give two examples that concern hospital and ancillary services in my home locality, which has a medical catchment area of some 35,000 people. When the replanning started six years ago in 1989, it was declared that there would be a new community hospital to replace the old district hospital. Plans were deposited in March 1993 and the planning authority was shown the community hospital. Further plans were deposited earlier this year in 1995 but any mention of a community hospital was omitted. Instead, for the first time, a link road was shown with the possibility of building over 200 houses on what had been planned as the hospital site. That was a health trust which was working to commercial imperatives and could see the chance of using development land to provide the money for other developments in the area in the health service at the expense of the promise of a local community hospital. I shall not go into the detail but the local community feels that consultation is a farce.

We know that in September 1994 a business plan was produced. It was kept secret. It went into some detail and showed the favoured option which was to close a number of community hospitals and to build one new hospital on another site. The plan was kept completely under wraps. There was an attempt to send it for a full costing analysis. When, earlier this year, it became clear that that was likely to happen and that all the promises that had been made were about to be broken, the health authority decided to set up a consultation exercise with local groups in the area. As can be imagined, that was met with contempt. Although it was denied, the decision had obviously been taken internally for commercial and not for health reasons. In fact, Devizes Town Council (where I live) wrote to the Prime Minister and asked for his help with this matter. It was pointed out that before any of the consultations started:

    "The Regional Office of the NHS Executive has been asked to approve the preferred option ... which ... will mean the loss of our Community hospital of 49 beds and all supporting services. This is to be replaced by a 15 bed hospital building providing only respite care and accommodation for terminally ill patients ... In six years we shall have lost all our Health Services in a town with a catchment area of 35,000".

I have deliberately given an example to show that if we are going to have consultation, it should actually mean something. The health authorities should not now start to go through the motions of a consultation without revealing that their minds have already been made up, however much they might say the opposite.

In the same area, and the same health district, there was another example of the disastrous effect of ignoring the wishes of the local people. A highly effective

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hospital laundry operated in the area. It had won the tender for the work in the future. The tendering process was then rigged to ensure that, although it was the lowest tender, the work would in fact go to Swindon. I shall not go into great detail into what happened. A number of people were made unemployed as a result of the closure of the local laundry. There is now a situation in that health district in which the patients in Bath are requested to bring their own sheets to the hospital; patients have to go outside to purchase baby linen; there has almost been the closure of a number of catering departments, as there are no clean aprons; and the contract has been lost from a private nursing home. There were photographs in the local press of a three to four week pile-up of hospital dirty laundry which eventually had to be discarded because it was ruined and there were complaints from Oxford hospital about the level of service. Finally, a spokesman from the health trust appeared on HTV on Thursday 9th March. He stated that the only way that the hospital could continue with operations was by going out and buying new linen.

Those examples are local and particular but they can be repeated around the country. They show that it is important not just to have the consultation requested by this amendment, but to ensure that it means something and that the wishes of the local people are listened to. I beg to move.

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