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Baroness Cumberlege: My Lords, the noble Lord, Lord Cledwyn of Penrhos, invited me to agree with him. However, I fear that both he and the noble Lord, Lord Prys-Davies, will be disappointed with my response. I try my best to agree with the noble Lord on most things, but we have a difference of opinion in the matter.

One of the main purposes of the Bill is to reduce bureaucracy in the NHS. It would be a pity if, through the amendment, we used the Bill to impose additional bureaucracy on the NHS in Wales. Your Lordships are aware that most of the functions listed in the amendment are currently carried out by the Welsh Health Common Services Authority; and that the various parts of that authority have been under review. During our considerations in Committee, I explained to your Lordships that the driving force behind the review was the needs of patients and of the NHS organisations which directly serve patients.

Our aim is to ensure that NHS organisations in Wales obtain the many support services that they need as cost effectively as possible. We believe that that is the best way to ensure that they, in turn, can meet patients' needs effectively. That is why my right honourable friend the Secretary of State for Wales decided to market test WHCSA's non-clinical services and explore the possibility of privatisation. That process will enable NHS trusts to provide more or better care for the same money. As my right honourable friend said in another place:

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The noble Lord, Lord Cledwyn, asked me why there had been no consultation on the matter. There has been consultation with the service users and the market-testing process involves consultation with staff. I shall return to that aspect later.

The Welsh Office is currently considering options for market testing or privatisation of two of WHCSA's non-clinical services—estates design and maintenance and information technology. Following that consideration, in the next month or so, tenders will be invited. It is envisaged that the exercise will be completed during 1995-96. Market-testing exercises are already underway for two other functions, supplies and prescription pricing. The results should be known by early autumn. The noble Lord, Lord Elis-Thomas, raised a question in Committee about the use of the Welsh language in relation to prescription pricing services. I understand that colleagues at the Welsh Office are writing to the noble Lord on the matter.

As I made clear in Committee—and I am more than happy to reiterate it this afternoon—employees at WHCSA have made a valuable contribution and one which is much appreciated in terms of what they have done for the NHS in Wales. I well understand how unsettling such uncertainty must be for them. The process provides for consultation with staff and we hope that they will see that as an opportunity to improve the services that they provide. But handling the present process is a matter for WHCSA's own management. That is why Welsh Ministers have declined to meet staff-side representatives whose interests are best served by the proper out-working of the process itself.

I turn now to WHCSA's clinical services. I am very pleased to be able to confirm to your Lordships that my right honourable friend has now decided on the new management arrangements. His decisions were taken after full consultation with the NHS in Wales and announced to the NHS on 4th April. In the light of consultation, as the noble Lord pointed out, my right honourable friend decided that the management arrangements for the National Blood Transfusion Services (Wales) should not change for the time being; that the Artificial Limb and Appliance Services should, in general, be managed by the hospitals where they are based, but some specialist services will be centralised at a single point; and that management of the screening programme for Breast Test Wales will transfer to a single trust, while evaluation and research will be taken forward by the director with the University of Wales College of Medicine.

I believe that the noble Lord, Lord Prys-Davies, raised the question of destabilisation. During a full consultation with the NHS in Wales, many useful responses were received. The new management arrangements for Breast Test Wales and the Artificial Limb and Appliance Services will be phased in during 1995-96. The new arrangements are expected to be in place by 1st April 1996. Funds in support of those services are to be ring-fenced for the financial years 1995-96, 1996-97 and 1997-98. I believe that many of the amendments were made through the consultation process and because of it. Of course, the National Blood

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Transfusion Services will remain with WHCSA for the time being. Therefore, there should be no destabilisation.

The option appraisals for each of those services have been placed in the Library as the noble Lord, Lord Prys-Davies, requested. I cannot understand why the noble Lord says that they are not in fact there. I was informed that the appraisals had actually been placed in the Library. I shall certainly look into the matter. However, if they are not there now, I shall arrange for summaries of the consultation responses to be made available.

The amendment also suggests that the new authority should be responsible for administering health complaints. We do not see the need for such a centralised system which we believe would not be consistent with the proposals that the Government recently published for a new, streamlined NHS complaints system.

Both noble Lords, I believe, raised the question of redundancies, employment and, indeed, unemployment. It is hoped that any redundancies will be kept to an absolute minimum and that staff may be redeployed elsewhere in other areas of the NHS in Wales. Of course, there would have to be further consultation before any redundancies took place. I also believe that the Transfer of Undertakings (Protection of Employment) Regulations—commonly known as TUPE—are capable of application in that respect. It would mean that the rights of employees are protected at the point of transfer.

In conclusion, although I understand the issues that have been raised this afternoon, the Government do not believe that the amendment would help to improve the health service in Wales. We think it would introduce a rigidity and an unnecessary central bureaucracy which would only be changed by further primary legislation. Such an authority would frustrate our efforts to get the best for patients. I therefore hope that the noble Lords will withdraw their amendment.

5.30 p.m.

Lord Cledwyn of Penrhos: My Lords, we have listened carefully to the speech made by the noble Baroness. I am bound to say that I was impressed with some of the things which she said although, broadly, I was disappointed that she was unable to make the major concession. I think she is wrong in talking about rigidity in Wales. There is no rigidity in Wales. We do things in a rather more elastic way than that. If we do that, then we usually succeed. But having said that, my noble friends and I would wish to look at her speech carefully and to consider whether we might bring the matter back at Third Reading. With that in view, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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Schedule 1 [Amendments]:

Lord Rea moved Amendment No. 7:

Page 6, line 24, after ("Authority") insert (", including administering the arrangements made in pursuance of this Act for the provision of general medical services, general dental services, general ophthalmic services and general pharmaceutical services,").

The noble Lord said: My Lords, in moving Amendment No. 7 I wish also to speak to Amendment No. 15, which covers the same ground. We looked at some of the issues referred to in this amendment when debating Amendment No. 19 in the name of the noble Baroness, Lady Gardner of Parkes, in Committee. The professions involved in primary care named in the amendment, while not opposed to the merging of FHSAs and DHAs in principle, are still concerned that nothing on the face of the Bill requires health authorities to protect and to promote the activities of primary care. They would feel more comfortable if words such as those in the amendment were included, as health authorities will have great pressure put upon them to devote increasingly large proportions of their budget to contracts for hospital services. Those pressures are still there, even if less direct, after the purchaser/provider split.

The Government have coined the phrase, "a primary healthcare led National Health Service", which of course many of us welcome. However, general practitioners are rather used to being told that, for example, they are the linchpin of the service, or the key to the success of the National Health Service, with little cash following the rhetoric. In the National Health Service Executive's Guidance on Transitional Issues to the new health authorities, the role of the new health authority, as it will be after the Act, is described in some detail. These are not transitional arrangements as such but describe what the new health authorities will do when constituted, as well as describing the steps to be taken towards achieving that.

Among other functions of the new health authorities which the document mentions are those in paragraph (b) on page 3 which states,

    "developing primary care and forging constructive partnerships with all primary care professionals".

Paragraph (c) on page 4 refers to,

    "administering and managing arrangements with local GPs, dentists, ophthalmic practitioners and pharmacists".

That is similar to the wording of the amendment, including the terms of service of family health services contractors.

In other parts of that guidance document reference is repeatedly made to primary care. I would not expect the words of a guidance document to be on the face of a Bill. However, the words in the amendment would remind health authorities of their obligation to those who work with and for the current family health services authorities. The guidance document from which I have quoted goes further in describing steps to be taken towards achieving a primary healthcare led NHS than does the amendment. I wonder whether in her reply the

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Minister can say whether and how the Government will ensure that the guidance is followed by health authorities. I beg to move.

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