Previous Section Back to Table of Contents Lords Hansard Home Page

Baroness Cumberlege: My Lords, I very much concur with the noble Lord that Wales should have equal respect. However, the position is rather different under this Bill. There have never been regional health authorities in Wales, so that whole tier has been absent in Wales. A good deal of this Bill is concerned with the abolition of regions and therefore is not relevant to Wales. The parts of the Bill that are relevant to Wales are those which merge district health authorities and family health service authorities. Therefore, they come into this Bill. We shall be discussing an amendment later today that is concerned with the particular agency that covers Wales in terms of procurement.

24 Apr 1995 : Column 712

With regards to appointments, I understand that that is a matter for my right honourable friend the Secretary of State for Wales. No doubt he will take note of what we do in this Bill. I am sure that he will wish to reflect on it and possibly follow the same system.

Baroness Jay of Paddington: My Lords, I am grateful to the Minister for her reply. There is a difficulty in regard to the position of Scotland. My noble friend Lord Cledwyn said that the Minister had spoken very carefully on that subject. I believe that that is the appropriate expression. Although she described the situation in Scotland very well, she did not explain precisely why there was such a clear difference in the Government's mind between what was happening in Scotland and what could potentially happen in England and Wales.

It is a little difficult to understand why, if one is to create what is de facto roughly the same situation in terms of openness as will exist in Scotland—the Minister has said that there are many similarities in the situation—it is not possible to go the whole way and make the advisory committee a statutory one. There remains the difficulty raised by my noble friend Lord Ennals—to which the Minister did not respond—about what will happen if the committee of the noble and learned Lord, Lord Nolan, makes a recommendation to the effect that there should be an independent advisory body similar in nature to that proposed in this amendment. Will the Government then feel the necessity to bring forward additional legislation or will they ignore that provision, which I suspect may prove to be a little politically difficult?

In view of my concerns about the answers that have been given and the fact that the health service should be seen to be entirely open, in particular that appointments should be conducted in an objective and open manner, I wish to test the opinion of the House.

3.38 p.m.

On Question, Whether the said amendment (No. 1) shall be agreed to?

Their Lordships divided: Contents, 74; Not-Contents, 119.

Division No. 1


Acton, L.
Addington, L.
Ailesbury, M.
Airedale, L.
Archer of Sandwell, L.
Ashley of Stoke, L.
Avebury, L.
Beaumont of Whitley, L.
Blackstone, B.
Bottomley, L.
Broadbridge, L.
Bruce of Donington, L.
Carmichael of Kelvingrove, L.
Carter, L.
Chorley, L.
Cledwyn of Penrhos, L.
Cocks of Hartcliffe, L.
David, B.
Dean of Thornton-le-Fylde, B.
Desai, L. [Teller.]
Donaldson of Kingsbridge, L.
Dormand of Easington, L.
Ennals, L.
Ezra, L.
Falkender, B.
Fitt, L.
Freyberg, L.
Gallacher, L.
Gladwin of Clee, L.
Graham of Edmonton, L. [Teller.]
Gregson, L.
Halsbury, E.
Harris of Greenwich, L.
Hollis of Heigham, B.
Hooson, L.
Howie of Troon, L.
Hylton-Foster, B.
Jay of Paddington, B.
Jeger, B.
Jenkins of Hillhead, L.
Jenkins of Putney, L.
Judd, L.
Kilbracken, L.
Kinloss, Ly.
Lockwood, B.
Longford, E.
Lovell-Davis, L.
McFarlane of Llandaff, B.
McIntosh of Haringey, L.
McNair, L.
Milner of Leeds, L.
Monkswell, L.
Morris of Castle Morris, L.
Nicol, B.
Northfield, L.
Ogmore, L.
Rea, L.
Redesdale, L.
Richard, L.
Sainsbury, L.
Sefton of Garston, L.
Serota, B.
Shepherd, L.
Simon, V.
Stallard, L.
Stedman, B.
Stoddart of Swindon, L.
Strabolgi, L.
Taylor of Blackburn, L.
Tordoff, L.
Wallace of Coslany, L.
White, B.
Wigoder, L.
Williams of Elvel, L.


Aberdare, L.
Addison, V.
Ailsa, M.
Aldington, L.
Alexander of Tunis, E.
Ampthill, L.
Annan, L.
Astor, V.
Astor of Hever, L.
Balfour, E.
Belhaven and Stenton, L.
Blaker, L.
Blatch, B.
Blyth, L.
Borthwick, L.
Boyd-Carpenter, L.
Brabazon of Tara, L.
Braine of Wheatley, L.
Brougham and Vaux, L.
Burnham, L.
Butterworth, L.
Cadman, L.
Caithness, E.
Campbell of Alloway, L.
Campbell of Croy, L.
Chalker of Wallasey, B.
Chesham, L.
Clanwilliam, E.
Constantine of Stanmore, L.
Courtown, E.
Craig of Radley, L.
Cranborne, V. [L. Privy Seal]
Cullen of Ashbourne, L.
Cumberlege, B.
Davidson, V.
De Freyne, L.
Dean of Harptree, L.
Denton of Wakefield, B.
Digby, L.
Ellenborough, L.
Elles, B.
Elton, L.
Flather, B.
Forbes, L.
Fraser of Carmyllie, L.
Fraser of Kilmorack, L.
Gainford, L.
Geddes, L.
Gibson-Watt, L.
Goschen, V.
Gridley, L.
Hailsham of Saint Marylebone, L.
Harding of Petherton, L.
Harmsworth, L.
Hayhoe, L.
Henley, L.
Hives, L.
HolmPatrick, L.
Hothfield, L.
Howe, E.
Inglewood, L. [Teller]
Ironside, L.
Johnston of Rockport, L.
Kinnoull, E.
Knollys, V.
Lauderdale, E.
Lindsay, E.
Long, V.
Lucas, L.
Lucas of Chilworth, L.
Lyell, L.
Mackay of Ardbrecknish, L.
Mackay of Clashfern, L. [L. Chancellor]
Macleod of Borve, B.
Mersey, V.
Miller of Hendon, B.
Milverton, L.
Morris, L.
Moyne, L.
Munster, E.
Murton of Lindisfarne, L.
Nelson, E.
Norfolk, D.
Norrie, L.
Northesk, E.
Oppenheim-Barnes, B.
Orkney, E.
Orr-Ewing, L.
Pearson of Rannoch, L.
Pender, L.
Peyton of Yeovil, L.
Pym, L.
Rawlings, B.
Rennell, L.
Renwick, L.
Rodger of Earlsferry, L.
St. Davids, V.
Saltoun of Abernethy, Ly.
Seccombe, B.
Selborne, E.
Shannon, E.
Shaughnessy, L.
Shaw of Northstead, L.
Skelmersdale, L.
Slim, V.
Strange, B.
Strathcarron, L.
Strathclyde, L. [Teller]
Sudeley, L.
Swinfen, L.
Tebbit, L.
Thomas of Gwydir, L.
Tollemache, L.
Trumpington, B.
Vaux of Harrowden, L.
Vivian, L.
Walton of Detchant, L.
Whitelaw, V.
Wynford, L.

Resolved in the negative, and amendment disagreed to accordingly.

24 Apr 1995 : Column 714

3.47 p.m.

Baroness Jay of Paddington moved Amendment No. 2:

Page 1, line 14, at end insert:
("( ) No order shall be made under subsection (1) above until the Secretary of State is satisfied that the establishment of each Health Authority proposed by that order is such as to ensure that every Health Authority includes persons who, by virtue of specialised training in health care disciplines and experience in health care work, can bring to health authorities perspectives derived from their professional training and expertise.").

The noble Baroness said: My Lords, Amendment No. 2 stands in my name and the names of my noble friend Lord Carter and the noble Baroness, Lady Robson of Kiddington.

The amendment seeks to ensure that the new health authorities include members whose professional qualifications and training gives them special expertise on those matters which will be at the centre of the health authorities' business. The House will recall that at Committee stage several amendments were proposed from different parts of the Chamber—from the Government Back-Benches and the Cross-Benches as well as from the Opposition—to make it compulsory for, for example, general practitioners, nurses and health visitors to be members of the new boards. All of those amendments were unsuccessful.

The Minister's main argument for opposing the amendments seemed to be that the Government now dislike the idea of representatives of any body being members of the new health authorities, although I remind the House that that has been the practice in the family health service authorities which now exist and will continue in existence until the new health authorities take over in April 1996.

The Minister was also anxious that prescribing any specific professional group for a reserved place was bound to create resentment from other bodies which felt that they had an equal right to a position on a health authority.

It is for those reasons that the present amendment is drawn in such general terms. As I am sure the Minister recognises, the terms are taken directly from the draft guidelines on professional involvement in the work of the health authorities which were issued by the Department of Health on 20th January this year. That detailed document, offering consultation and guidance to the new health authorities which may, if the Bill goes through, become the health authorities responsible next year, states in its opening paragraph:

    "These changes make essential closer and more effective involvement by doctors, nurses (including midwives and health visitors) and other professional staff in the work of authorities, uniprofessionally, multi-professionally and on a multi-disciplinary basis. Careful attention therefore needs to be given to the means by

24 Apr 1995 : Column 715

    which health care professionals make an input to decision making. This guidance makes clear the requirement on health authorities to ensure that the professions are involved in the full range of health authority work".

The guidance defines professionals as,

    "people who, by virtue of specialised training in health care disciplines in health care work, can bring to health authority issues perspectives derived from their professional training and experience".

Those are the words of the amendment.

At Annex C of the draft guidelines, the Department of Health gives a list of examples where professional input is, in its view, essential. It is a long and detailed list, but it includes, for example, maintaining a district wide view of healthcare purchasing, clinical effectiveness—needing to ensure that health authorities work closely with hospital clinicians on strategies for improving clinical effectiveness—inspection and registration of nursing homes, planning health care services for people with disabilities, child protection, midwifery supervision, AIDS, mental health and mental health Act doctors.

The guidelines document concludes by describing methods for monitoring professional involvement and ensuring compliance because,

    "appropriate professional involvement is fundamental to the effective working of authorities".

It is fundamental, and yet the Government have so far rejected the idea of ensuring that professionals are members of the health authority. The Government prefer to rely on the professionals giving advice and being consulted. However, as the noble Baroness, Lady Gardner of Parkes, stated in Committee when her amendment to include a primary care worker was not accepted, consultation is not the same as being on the authority.

During Committee stage, the Minister referred to the fact that health authorities have every right to appoint members who come from a professional background. At col. 1531 of the Official Report of 28th March, the noble Baroness said:

    "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".

However, there seems to me to be a great difference between that enabling position (perhaps I may so call it) and ensuring by statute that appropriate professionals are involved in the new health authorities at board level. Like the Minister I, too, am sure that many good authorities will include, for example, GPs, nurses and pharmacists among their members. But if such inclusion is not required, other authorities are just as likely to fill their membership with businessmen or accountants, many of whom in my personal experience have neither professional nor personal experience of the National Health Service.

It is worth reminding the House that the requirement for health authorities to secure advice and consult with professionals was inserted by the Government in Schedule 1 of the Bill only at Report stage in another place. It is interesting to note that in Committee the Minister stated at col. 1599 of the Official Report of

24 Apr 1995 : Column 716

28th March that the provision to ensure that advice is given—it is now Schedule 1(3) to the Bill—was introduced so that,

    "[professional] involvement in health authority decisions should not simply be left as a matter of good practice".

That is precisely what the amendment seeks to re-emphasise: that we should not rely simply on good practice.

The Minister having heard the persuasive arguments from all parts of the House about the need for professional membership of the new authorities, I hope that the Government will now be able to go one step further than they did when ensuring appropriate consultation and will accept the amendment. The logic of their own position was demonstrated by the new Department of Health guidance on professional involvement in the new health authorities from which I quoted: that professional involvement with the new health authorities is essential. Surely the proper way to achieve such involvement is to make those with specialised training and experience in health—the amendment cites those people and they are cited in the new guidance—full members of the new board. I beg to move.

Next Section Back to Table of Contents Lords Hansard Home Page