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Lord Addington: My Lords, I wish to speak to the amendment which stands in the name of my noble friend Lady Robson. Unfortunately my noble friend is not able to be present due to ill health. I offer, too, the apologies of my noble friend Lord Tope who is unable to be present due to important business meetings.

The amendment effectively states that members of the board should have a working knowledge of their subject. In many other fields I have sought to argue that one should have expertise on a subject because one is then able to respond to information given. One may well miss the issues upon which advice is needed because one cannot spot them. The position is that simple. If one knows one's subject well, one is able to call for more advice where it is required.

The amendment does not state that we should not be able to call for advice from others outside the health authority. It merely provides that those members of the authority should know where to start looking for such advice. I fully support the amendment.

Lord Elton: My Lords, I have a certain sense of déjo vu. I have lost count over the years of the Bills on which I have assisted which create some body with statutory powers. We go into almost a ritual dance about who shall be members of that body. We start by listing all the people who should be members. We then come to the conclusion that the number of members is finite; and we remember that some desirable people will not be members of the body. We remind ourselves of the old rule, expressio unius, exclusio alterius, which means that if you name six people who ought to be members of the body, the suggestion is that the other 83 people ought not to be on it. Remembering that, we decide not to have names. We then normally go back to the original position: that the body shall be described by its functions and not by its components.

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The noble Baroness has put forward an ingenious half-way house. I ask the Government to consider the amendment with a little care. Although she has done a great deal to avoid offending sensibilities such as those I have already described, she has made it justiciable. It seems to me that if her amendment were put on the face of the Bill, it would be open to anyone who wished to impede progress, or who was hostile to the general principle of the health authorities, to go to court and argue that the requirements had not been fulfilled. As to whether or not the requirements were fulfilled would take a great deal of argument. There seems merit in ensuring that such a body is composed in a way which enables it to fulfil its function properly. I should have thought that the way to achieve that is to give an undertaking from the Dispatch Box in a speech during which my noble friend courteously dismisses the amendment, and the noble Baroness opposite courteously accepts that assurance.

Baroness Cumberlege: My Lords, for my part I shall take that good advice. However, saving my noble friend's sorry sense of déjo vu, we feel that professional membership is an important issue and one on which feelings run high.

As I said during Committee stage, I agree that professionals including GPs, nurses, dentists, pharmacists, physiotherapists, occupational therapists, speech therapists, art therapists and psychotherapists, psychologists, dieticians, health visitors, midwives, optometrists, radiographers, scientists, biochemists, geneticists, researchers, paramedics, chiropodists and podiatrists, to name but a few, have a vital contribution to make to the decisions of health authorities. I am sure that many health authorities will have members with professional experience, whether in primary care, in the acute sector, or in community care. Everyone who is suitably qualified will be welcome to apply for appointment, provided there is no conflict of interest.

However, professional input and advice are much broader than the relatively narrow professional contribution which one or two members can provide. My list illustrates the point of how difficult it is when so many professionals are involved in a single service. Of course, on a personal basis, such members can bring extremely valuable qualities; but we feel that that is no substitute for broader professional involvement.

The draft guidelines, Professional Involvement in Health Authority Work, referred to by the noble Baroness, were circulated widely to the professions and the NHS. They show other ways in which health authorities will be expected to involve professionals. For example, some authorities have already established multi-disciplinary teams with responsibility for reviewing, planning and purchasing certain services. Others have commissioned reviews of priority services such as mental health from teams involving professionals from both primary and secondary care. Of course, all health authorities will employ professionals—nurses, for example, in senior positions—who will ensure that health authority work is informed by professional views, without necessarily being members of the health authority.

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There are many other ways for professionals to be involved. The guidelines talk in detail of how professional involvement can be made effective without being prescriptive on the arrangements health authorities should put in place. So health authorities can adapt the suggested models to suit their individual needs.

As the noble Baroness, Lady Jay, said, the Government made clear how seriously they take the issue by tabling an amendment in another place. The amendment adds force to the draft guidelines by requiring health authorities to make arrangements to ensure that nursing and other professional advice is available to them. It leaves in no doubt the importance of professional involvement. My honourable friend the Minister for Health made clear in another place that any authority that did not seek professional advice or did not listen to it when it was volunteered would not be complying with its statutory duty.

In conclusion, we do not believe that the amendment is necessary. I am fully confident that the close monitoring of professional involvement planned by the regional offices will ensure that health authorities involve professionals across the range of their work. I hope that the noble Baroness will feel able to withdraw the amendment.

Baroness Jay of Paddington: My Lords, I thank the Minister for that reply and particularly for her emphasis once again that the Government and the National Health Service Executive appreciate the importance of professional involvement in health authorities. I am glad that they are prepared to be firm in their monitoring of that involvement, as is seen in the guidelines.

I am not sure that my Latin is quite up to translating it precisely, but I am also grateful to the noble Lord, Lord Elton, for giving me the instant phrase for the discussions which we had at such great length in Committee. I wish that he had been here to interject the phrase.

However, I am still anxious about the point. The draft guidelines from the Department of Health describe the professional involvement as seen by the department as essential, with which I agree. If it is intended to encompass the many functions of the health authorities—as I hope the brief list which I gave from the draft guidelines suggests—that cannot necessarily be accomplished simply by relying on advice. Unfortunately, the noble Baroness, Lady Gardner of Parkes, is not in her place. She said in Committee that there is a great difference between being consulted and being a member of an executive board.

For those reasons and since I, like the Minister, feel that it is absolutely essential that professional guidance be involved in health authority work in the future, I feel that I must test the opinion of the House. I commend the amendment.

4.3 p.m.

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

Their Lordships divided: Contents, 78; Not-Contents, 118.

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Division No. 2


Acton, L.
Addington, L.
Airedale, L.
Archer of Sandwell, L.
Ashley of Stoke, L.
Attlee, E.
Beaumont of Whitley, L.
Birk, B.
Blackstone, B.
Bottomley, L.
Broadbridge, L.
Brooks of Tremorfa, L.
Bruce of Donington, L.
Carmichael of Kelvingrove, L.
Carter, L. [Teller.]
Cledwyn of Penrhos, L.
Cocks of Hartcliffe, L.
David, B.
Dean of Thornton-le-Fylde, B.
Desai, L.
Diamond, L.
Donaldson of Kingsbridge, L.
Dormand of Easington, L.
Dubs, L.
Ennals, L.
Ezra, L.
Falkender, B.
Falkland, V.
Fitt, L.
Freyberg, L.
Gallacher, L.
Gladwin of Clee, L. [Teller.]
Graham of Edmonton, L.
Gregson, L.
Harris of Greenwich, L.
Hollis of Heigham, B.
Hughes, L.
Hylton-Foster, B.
Jay of Paddington, B.
Jeger, B.
Jenkins of Hillhead, L.
Jenkins of Putney, L.
Judd, L.
Kilbracken, L.
Kilmarnock, L.
Lawrence, L.
Lester of Herne Hill, L.
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.
Nelson, E.
Nicol, B.
Northfield, L.
Ogmore, L.
Rea, L.
Redesdale, L.
Richard, L.
Sainsbury, L.
Sefton of Garston, L.
Serota, B.
Shepherd, L.
Stallard, L.
Stoddart of Swindon, L.
Strabolgi, L.
Taylor of Blackburn, L.
Tordoff, L.
Wallace of Coslany, L.
Walton of Detchant, L.
Wharton, B.
White, B.
Wigoder, L.
Williams of Elvel, L.


Aberdare, L.
Addison, V.
Ailsa, M.
Aldington, L.
Alexander of Tunis, E.
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.
Brougham and Vaux, L.
Burnham, L.
Butterworth, L.
Cadman, L.
Caithness, E.
Campbell of Alloway, L.
Campbell of Croy, L.
Chalker of Wallasey, B.
Charteris of Amisfield, L.
Chesham, L.
Clanwilliam, E.
Constantine of Stanmore, L.
Courtown, E.
Craig of Radley, L.
Craigavon, V.
Cranborne, V. [L. Privy Seal]
Cullen of Ashbourne, L.
Cumberlege, B.
Davidson, V.
De Freyne, L.
Dean of Harptree, L.
Denton of Wakefield, B.
Ellenborough, L.
Elles, B.
Elliott of Morpeth, L.
Elton, L.
Flather, B.
Forbes, L.
Fraser of Carmyllie, L.
Fraser of Kilmorack, L.
Gainford, L.
Geddes, L.
Gibson-Watt, L.
Gilmour of Craigmillar, L.
Goschen, V.
Gray of Contin, L.
Gridley, L.
Hailsham of Saint Marylebone, L.
Harding of Petherton, L.
Harmsworth, L.
Hayhoe, L.
Hemphill, L.
Henley, L.
Hives, L.
Holderness, L.
HolmPatrick, L.
Hothfield, L.
Howe, E.
Huntly, M.
Inglewood, L. [Teller]
Johnston of Rockport, L.
Killearn, L.
Kingsland, L.
Knollys, V.
Lane of Horsell, L.
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.
Noel-Buxton, L.
Norfolk, D.
Norrie, L.
Northesk, E.
Oppenheim-Barnes, B.
Orr-Ewing, L.
Pearson of Rannoch, L.
Pender, L.
Pym, L.
Rawlings, B.
Rennell, L.
Renwick, L.
Rodger of Earlsferry, L.
St. Davids, V.
Seccombe, B.
Selborne, E.
Shaw of Northstead, L.
Skelmersdale, L.
Slim, V.
Strange, B.
Strathcarron, L.
Strathclyde, L. [Teller]
Sudeley, L.
Tebbit, L.
Teviot, L.
Thomas of Gwydir, L.
Tollemache, L.
Trumpington, B.
Vaux of Harrowden, L.
Vivian, L.
Whitelaw, V.
Wynford, L.

Resolved in the negative, and amendment disagreed to accordingly.

24 Apr 1995 : Column 720

4.12 p.m.

Lord Rea moved Amendment No. 3:

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