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Lord Ashley of Stoke: My Lords, I am grateful for that reply. However, is the noble Baroness aware that I was hoping that she would include some reference to medical staff complaining in public rather than to their employers? Is she aware that the present code of practice in no way deals with the gagging of doctors and nurses? That is because of the increasing competition between trusts who regard public statements by employees as a betrayal. Does the Minister agree that the first loyalty of medical staff should be to the patients and that there are somenot manyoccasions when they should speak in public? Would not a constructive way forward be to require all trusts to inform the Government of the details of the gagging clauses in their contracts of employment, to have those clauses reviewed independently and to have the findings reported to Parliament?
Baroness Cumberlege: My Lords, there are two issues here. First, there is the guidance sent to the National Health Service in June 1993. Secondly, there is the code of practice on openness published in April and to be implemented in June this year. Those are two different documents. The first deals with staff relations with the public and the media, the second with the rights of individuals to have access to information about the National Health Service.
The guidance for staff makes clear that under no circumstances are employees who express their views about health service issues in accordance with the guidance to be penalised in any way for doing so. It takes into account also the new contracts that are being drawn up by trusts for staff. It states that,
The situation is absolutely clear. Staff have the opportunity to speak to the press and other media if they wish to do so. However, we believe that their first duty is to take up the matter through the local management system. They have opportunities to refer matters to Members of Parliament, to trade unions, to professional
Baroness Gardner of Parkes: My Lords, I must again declare an interest as chairman of the Royal Free Trust. The House must be getting rather tired of my saying that. As chairman of the trust, I should like to make this point clear to the Minister. Is she aware that, as in most well-managed trusts, there are no gagging clauses whatever in our contracts? Patient confidentiality is of course a different matter. Can the Minister tell the House about the access to information that the public will have? We have received the document on openness in the National Health Service, according to which no one can be charged for information unless over one hour is taken up when dealing with a query. That is rather a worry to any efficient trust, as lots of people could take up half-an-hour of one's time. I notice that under the code representatives and official bodies are required to provide information free of charge, no matter how much time is taken up. Will the Minister confirm that there will be an opportunity to review this state of affairs should it be found, as in courts and industrial tribunals, that some people become rather vexatious and constantly take up valuable time?
Baroness Cumberlege: My Lords, I agree entirely with the first part of my noble friend's question. It is up to trusts to have a very open regime so that the staff can raise issues. On charging policy, we think it reasonable that people who want information about their local health services should have access to it. If a small charge is made, we believe that that is reasonable. For example, when a schoolchild writes in and says, "Please can you send me everything you've got about the NHS?", that causes a problem. Indeed, sometimes our officials find that they are writing PhDs for people, given the way in which questions are framed. We think that it is unreasonable not to make a charge in such cases.
Baroness Jay of Paddington: My Lords, can the Minister explain how both the codes of practice and the guidance to staff will apply to the new regional offices? As the House will know, they replace regional health authorities under the Bill which will presumably pass its Third Reading in this House tomorrow? As I understand it, the regional offices will be outposts of the Department of Health, and will therefore come under the Civil Service code. Presumably, the staff employed in those offices will have no rights to speak out.
Lord Pearson of Rannoch: My Lords, I thank my noble friend for that reply. Does he agree that the price for our agreement to any new arrangements which the other countries may wish to make at the forthcoming IGC and which may not suit us should be a net repatriation of sovereignty to this country? Does he further agree that that might create the variable geometry which appears to be favoured by my right honourable friend the Prime Minister?
Lord Inglewood: My Lords, my noble friend raises a whole series of hypothetical matters. The IGC is a multi-party negotiation. We have a number of positive changes that we want to see occur in the European Union. No doubt other member states equally have ideas, and we shall work together to try to bring forward as many of our positive ideas as we can.
Lord Stoddart of Swindon: My Lords, I am most obliged to my noble friend. Can the Minister give an assurance that the Cabinetthe whole Cabinetwill first of all read what is proposed at the IGC and be made to understand the implications of it? I say that bearing in mind that after the signing of the Maastricht Treaty the Prime Minister said that he had won game, set and matchwhich he had not; the Foreign Secretary, having signed the treaty, said that now he had better read it; and the Chancellor of the Exchequer recommended the treaty and then admitted to the Tory Party Conference that he had not read it.
Lord Peyton of Yeovil: My Lords, did my noble friend the Minister find it as difficult as I did to understand the terminology of my noble friend's supplementary question? Does he agree with me that the stream of rather negative questions about Europe is likely to do nothing to improve the Government's negotiating position?
Lord Inglewood: My Lords, the proposals include developing further inter-governmental co-operation on defence; common foreign and security policy; justice and home affairs; the establishment of a fairer voting system; ensuring better budgetary discipline; embedding subsidiarity further into the treaty; enhancing the role for national parliaments; improving financial management of the Community budget and effective action against fraud; and better implementation of European Community law. I hope that for now that will be a start.
Lord Harmar-Nicholls: My Lords, am I to understand that my noble friend's answer is a reiteration of the Government's belief that neither Article N nor any other part of the Maastricht Treaty can be interpreted in a way that would interfere with the opt-outs that we obtained at the Maastricht discussions?
Lord Bruce of Donington: My Lords, is the Minister aware that I have the text of the treaty in front of me and that it contains an obligation for any agreement to changes to be the result of accord between the member states? In spite of that, will the Minister give the House, and indeed the country, an assurance that the Government will use their position in the Inter-Governmental Conference to do their very best about the growing bureaucracy of Brussels, which is as repugnant to the country as it is to many Members of this House, in spite of the limitations placed upon them by Article N of the treaty?
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