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Baroness Cumberlege: My Lords, I think I shall ignore that last comment. I understand the issue that the noble Lord has raised. Perhaps I can take it up and come back to him on that.

On Question, amendment agreed to.

Baroness Cumberlege moved Amendment No. 14:

Page 2, line 40, leave out ("prescribed").

The noble Baroness said: My Lords, I have spoken to this amendment. I beg to move.

On Question, amendment agreed to.

[Amendment No. 15 not moved.]

Schedule 2 [Transitional provisions and savings]:

Baroness Jay of Paddington moved Amendment No. 16:

Page 43, leave out line 3.

The noble Baroness said: My Lords, I apologise to the House if the amendment seems to be somewhat cryptic. It is designed to achieve the rather important result of preventing employees of existing regional health authorities being automatically transferred to the Civil Service and, therefore, into the direct employment of the Secretary of State.

We are particularly concerned about the future employment of the chief officers of community health councils, whose contracts of employment are at the moment held by the regional health authorities. The community health councils have a very important role as independent watchdogs in the NHS. Ministers have acknowledged that role. Many people who work in the NHS—and those who use it—feel that that role may become rather more important after the reorganisation

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and the establishment of the new health authorities, and following some of the moves towards a more centralised structure of the health service.

My concern about the employment of community health council officers was increased by the remarks of the noble Baroness, Lady Miller, in response to the earlier amendments of my noble friend Lord Carter about the gagging clauses and the new codes of openness as they apply to the health service. In reply to my noble friend's amendment, the noble Baroness, Lady Miller, said that it was appropriate that employees in the new regional offices—who will be members of the Civil Service—should be subject to the regulations which limit their ability to speak out. That was in relation to the so-called gagging clauses.

We can argue about that, but it is not relevant to the amendment. It may indeed be relevant to some of the people employed in the regional offices in a Civil Service capacity, but it is completely inappropriate to chief executives and chief officers of community health councils, whose very function is to speak out about matters in the health service.

The noble Baroness also said that employees of the regional offices would be in the Civil Service because that would bring them closer to the strategic planning and policy decisions of the Secretary of State. Although I have no doubt that many of those decisions and discussions would be of great interest to chief officers of community health councils, it really is not appropriate, either to their role or to their function, to see that as an advantage to them if they are to be employed by the new regional offices.

As they are recipients of public complaints, the community health councils are often seen by the public as independent bodies. It is very important that that should be reinforced, particularly at the moment when, as we have discussed on many occasions, there is considerable public disquiet about some of the measures being undertaken by the health service.

The relationship between the chief officers who service the community health councils, their chairmen and members, is perhaps not unlike the relationship between local authority committees and the officers who service them. The officers' advice is obviously crucial. Their particular work is important because those who sit on a CHC do so on a part-time, voluntary basis, whereas chief officers are employed full-time. They are the people who have the expertise, who disseminate information and prepare agendas, and so on, to enable their committees of volunteers to function properly.

What will happen to those officers who are employed by a regional health authority when that authority is abolished? We have sought answers to this question at several earlier stages during the passage of the Bill but we have yet to receive a precise response. If it is intended to transfer them to the new regional offices—where they might be described as "outreach workers" of the regional offices—it would be entirely inappropriate and would seriously compromise them.

It is often to a community health council that members of individual health authorities and the local public users of the health service go as a first point of reference for information or confirmation about an issue,

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particularly a complaint. If chief officers are to become outreach officers of regional offices, that will necessarily compromise their position. Certainly it will be seen as undermining their role as independent commentators, advisers and general watchdogs of the local services.

If, on the other hand, it is intended that chief executives and chief officers of CHCs will be employed by the health authority in which they are situated, or perhaps by a commissioning agency or a consortium of local trusts, that, too, would be inappropriate. It is bound to lead to allegations of collusion. It would not, for example, be possible for an officer of a community health council to be seen by members of the public as entirely independent if it was known that he was an employee of a local trust or local commissioning agency.

It would be helpful if the Minister would be a little more precise than she has been and explain what exactly has happened in terms of discussions with the community health council national bodies and other organisations representing patients' interests in the health service. Precisely how does she see this absolutely vital function continuing? There is no clear indication in the Bill of what will happen.

The purpose of the amendment is to achieve some clarity and, as I said at the beginning of my remarks, to ensure that these very independent officers—these very vital people in the structure of the new NHS—are not automatically transferred to the employment of the regional offices and, therefore, automatically become civil servants. I beg to move.

Baroness Cumberlege: My Lords, the objective of this amendment has already been debated at Committee stage under Clause 1 of the Bill. We agreed then that regional health authorities will be abolished to cut unnecessary bureaucracy and reduce waste at the centre of the NHS.

We also agreed that some functions, such as co-ordination of education and training, and supporting consortia of health authorities in purchasing specialised services, should still be performed at regional level. This means that a streamlined regional system of NHS management is still needed.

To abolish RHAs and replace them with a new set of statutorily independent bodies would simply mean the recreation of the bureaucracy we are committed to removing. Only by replacing RHAs with regional offices which are part of the Department of Health can we be sure that bureaucracy will be kept permanently under control and that the new streamlined management will work effectively. The tasks which regional offices will perform, such as monitoring the new health authorities and contributing to the development of central policies for the NHS, mean that it is appropriate that they will form part of the Civil Service. We agreed all that in the debate on Clause 1.

This amendment, which prevents the transfer of staff to the Secretary of State—that is, to the regional offices—on 1st April 1996, contradicts the agreements reached on Clause 1 in that debate. But, as the noble Baroness said—I understand now, having heard her

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speak—her amendment is confined to the future of the secretaries of community health councils. I am sure we all agree that they do a valuable job. They perform a most important task representing the interests of the public in their dealings with local National Health Service bodies. They have a well-deserved reputation for independence, authority and insight.

CHCs have a statutory responsibility to represent the interests of the community in the National Health Service. Indeed, they have the right to be consulted on any substantial changes in services to local patients. These are important safeguards which ensure that CHCs have a voice in the management of the NHS. In addition, CHCs have observer status on health authorities and the right to meet them annually.

As I made clear during our earlier debate, there will be no change in the requirements of health authorities to consult community health councils.

It is essential that community health councils speak with an independent voice. They act wholly on behalf of the local community. The Government are fully committed to maintaining that independence.

In the new system, the establishing authorities for CHCs will be the regional offices of the Department of Health. They will be responsible for providing important support and training for CHCs. But clearly, as the noble Baroness said, it would not be appropriate for officers of CHCs to be employed by the regional offices. That would mean that they would become civil servants. It could be seen as compromising their independence. So the employment contracts of staff will be held in the NHS.

The details of who will make appointments of CHC members and how those appointments will be made are still under discussion. I can assure your Lordships that the vital independence of CHCs will be protected.

Having listened to those remarks, the noble Baroness will, I hope, not press the amendment.

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