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Lord Peyton of Yeovil: My Lords, the noble Lord has shown himself to be an avid reader of reports, in which case—I take that to be the case—he must be a very busy man indeed. I am glad to see him looking in comparatively good health compared with what one would expect.

It seems to me rather strange that the noble Lord should be so keen a reader of the reports when he is such a sharp critic of the contents of much of the literature, if that is the right terms, which is published on these subjects. However, there is one point on which I do rather warmly agree with him. I refer to the appalling jargon which is used in the health service today. They have gone into this proverbial market place and grabbed every epithet they could find and transferred them to the health service whether or not they fitted. Mostly, they do not seem to fit at all.

The noble Lord commented on the PR skills in the health service. The number of questions which are asked about the health service today and the number of people who go round scavenging for something that is amiss mean that the health service has every need of PR skills. Whether those skills are adequate, I do not know, but I would hazard a guess that they consume a great deal of time which might be better used in other ways.

If I may turn to the amendment, I wonder who will write these reports and who will read them. The noble Lord, Lord Carter, is a glutton for punishment. He indicates himself as the first victim of this shower. I hope he will have some pity on himself. Who will be available to write these reports and how much of their time will they take? Who will monitor the information? It seems that we have a passion in this country for looking over everyone's shoulders to see what they are doing. This constant desire to interfere and to question and to have a report must be one of the most foolish activities. It seems to be based on the idea that everyone is either incompetent or dishonest. I think that that is stretching things a little far.

4 May 1995 : Column 1486

I am reasonably confident that anyone with my noble friend's intelligence and perception will wish the House to reject the amendment but I hope that she will pause in doing so to say a word about the time which would be taken if these activities were to be encouraged.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, with the advice of a Sir Ernest Gowers in Plain Words, I shall try to speak in a simple and straightforward way. The codes of conduct and accountability published in April 1994 by my right honourable friend the Secretary of State make clear the expectation that all those who serve the NHS will maintain high standards of corporate and personal probity. All members of health authorities and trusts are required to confirm their acceptance of the codes which include, among other things, a requirement to declare interests which may be relevant to NHS business.

We introduced these codes so that there would be no doubt about what is expected of NHS members; and having introduced them, of course we intend to monitor how they have been implemented until we are certain that the codes are being followed. It may also reassure your Lordships to know that there is already within the codes a requirement for every health authority and trust to present at least an annual report, a practice that is very often followed by industry and commerce. In that way its performance may be assessed by the NHS Executive on behalf of the Secretary of State, by the Audit Commission and its appointed auditors and also by the local community.

The code of openness in the NHS was published in April this year and will be implemented from 1st June. We shall also monitor the way in which this code is implemented in its early years until we are confident that we have achieved the culture of openness that we are seeking to encourage. Furthermore, there is already an important safeguard in the system since the Health Service Commissioner may investigate any complaints referred to him by the public about the withholding of information. He will publish his own reports on his findings.

The code of practice on open government applies to the Department of Health and will apply to the regional offices of the NHS Executive when, subject to this legislation, regional health authorities are abolished in April 1996. The code does not apply to the NHS and it is not therefore appropriate to consider its monitoring or reporting arrangements under this legislation.

The noble Lord, Lord Carter, raised the issue of complaints. I am sure he will be aware that the complaints procedure has recently been reviewed in line with the Wilson Report. It is because people are aware now that if they make a complaint some action will be taken that they are more encouraged to do so. That partly accounts for the increase in the number of complaints that are received. Indeed, we encourage people to tell local management what needs to be put right and what we can do better within the National Health Service. We tell them the routes open to them in order to make complaints.

4 May 1995 : Column 1487

From my experience in the direct running of health services, we should always remember that the tributes always far outweigh the complaints. The noble Lord asked about charging under the code of openness. The code makes quite clear that charging should be exceptional. It also states in paragraph 10 that people may complain about the level of charges, which is of course also a safeguard. My noble friend mentioned bureaucracy. He is quite right in that it can grow surreptitiously. It needs to be constantly checked. The whole purpose of the Bill is to reduce bureaucracy by abolishing regional health authorities and a whole tier of administration.

We are committed to ensuring that the codes of openness, conduct and accountability become an established part of the NHS. That is best done through appropriate management actions guided, as necessary, by Ministers and not through the statutory mechanism that has been proposed in this amendment. Therefore, I ask your Lordships to reject it.

Lord Carter: My Lords, I am very grateful to the noble Lord, Lord Peyton, for his kind remarks about my ability to read government reports. I can assure him that I get some light relief from reading them. I also read the speeches of the noble Lord in Hansard. They soon send me to sleep.

I referred to the magazine called Health Director produced by the National Association of Health Authorities & Trusts. It refers to the PR skills of executives who negotiate by press release. I remind noble Lords of what happened in the Wessex and West Midlands areas. There were criticisms about national health procedures from the Public Accounts Committee. There was a great deal wrong. We hope that these codes will help to put these matters right. It will take some time, but if it saves the Government the sums of money which were lost in Wessex and the West Midlands, it will be time well spent.

I heard what the Minister said about monitoring, but it is the publication of that monitoring which is so important. I am willing to give way if the noble Baroness can tell the House what in fact the Government intend to do after they have monitored the performance against the codes. Do they intend to publish in full the results of the monitoring?

Baroness Cumberlege: My Lords, with the leave of the House, perhaps I may say that the Government have not yet decided on that matter. The first reports are coming through, but we would in no way want to be secretive. Local government is closely monitored and councillors do or do not declare their interests. The same principle will apply to the National Health Service.

Lord Carter: My Lords, I am surprised that the Government are unable to take a decision in principle before they have seen the results of the monitoring. However, they intend to make them public and that is significant. Of course the health authorities, the trusts and the department produce annual reports as regards their performance. But it is what is left out of the reports which is so important. How can one criticise an

4 May 1995 : Column 1488

omission if it cannot be found? For all those reasons it is important to have a much firmer machinery to see that the codes are monitored and the results reported to Parliament.

The Minister mentioned complaints. Perhaps I may remind her of the things which have been left out of the recommendations of the Wilson Committee and the Acting on Complaints document:

    "Publication of complaints statistics by trusts, health authorities and health boards; development of a system for recording and classifying complaints on a UK basis; that all the GP practices and trusts review their complaints handling on at least a quarterly basis and make an annual published report on these reviews to the relevant health authority or board or main purchasers; that organisations regularly find out what their users think about their handling of complaints; and that each Health Department publishes an annual complaints bulletin".

Those are the recommendations of the Wilson Committee to which the noble Baroness referred, but they were not included in Acting on Complaints. The answer which the Minister gave was unsatisfactory and I wish to ask the opinion of the House.

3.54 p.m.

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

Their Lordships divided: Contents, 74; Not-Contents, 156.

Division No. 1


Acton, L.
Addington, L.
Airedale, L.
Allen of Abbeydale, L.
Archer of Sandwell, L.
Ashley of Stoke, L.
Avebury, L.
Birk, B.
Blackstone, B.
Broadbridge, L.
Bruce of Donington, L.
Callaghan of Cardiff, L.
Carter, L. [Teller.]
Castle of Blackburn, B.
Clinton-Davis, L.
David, B.
Diamond, L.
Donaldson of Kingsbridge, L.
Donoughue, L.
Dormand of Easington, L.
Elis-Thomas, L.
Exeter, Bp.
Ezra, L.
Falkender, B.
Falkland, V.
Farrington of Ribbleton, B.
Gallacher, L.
Gould of Potternewton, B.
Graham of Edmonton, L.
Harris of Greenwich, L.
Haskel, L.
Hayter, L.
Hilton of Eggardon, B.
Hollis of Heigham, B.
Howell, L.
Howie of Troon, L.
Hughes, L.
Jay of Paddington, B.
Jeger, B.
Jenkins of Putney, L.
Judd, L.
Listowel, E.
Lockwood, B.
Longford, E.
Lovell-Davis, L.
McFarlane of Llandaff, B.
McIntosh of Haringey, L.
McNair, L.
Mayhew, L.
Milner of Leeds, L.
Molloy, L.
Monkswell, L.
Morris of Castle Morris, L. [Teller.]
Nicol, B.
Northfield, L.
Perry of Walton, L.
Peston, L.
Rea, L.
Richard, L.
Rodgers of Quarry Bank, L.
Sainsbury, L.
Serota, B.
Shepherd, L.
Smith of Gilmorehill, B.
Stallard, L.
Stedman, B.
Strabolgi, L.
Taylor of Blackburn, L.
Tordoff, L.
Turner of Camden, B.
Wallace of Coslany, L.
Williams of Crosby, B.
Williams of Elvel, L.
Williams of Mostyn, L.


Aberdare, L.
Addison, V.
Ailsa, M.
Aldington, L.
Alexander of Tunis, E.
Allenby of Megiddo, V.
Alport, L.
Ampthill, L.
Archer of Weston-Super-Mare, L.
Astor, V.
Astor of Hever, L.
Belhaven and Stenton, L.
Bellwin, L.
Beloff, L.
Blake, L.
Blaker, L.
Blatch, B.
Blyth, L.
Boardman, L.
Borthwick, L.
Boyd-Carpenter, L.
Brabazon of Tara, L.
Brougham and Vaux, L.
Bruntisfield, L.
Burnham, L.
Butterworth, L.
Cadman, L.
Caldecote, V.
Campbell of Alloway, L.
Campbell of Croy, L.
Carnegy of Lour, B.
Carnock, L.
Chalker of Wallasey, B.
Charteris of Amisfield, L.
Chelmsford, V.
Chesham, L.
Clark of Kempston, L.
Clifford of Chudleigh, L.
Cochrane of Cults, L.
Coleridge, L.
Constantine of Stanmore, L.
Courtown, E.
Craigavon, V.
Cranborne, V. [Lord Privy Seal.]
Cullen of Ashbourne, L.
Cumberlege, B.
Dacre of Glanton, L.
De Freyne, L.
De L'Isle, V.
Dean of Harptree, L.
Denham, L.
Digby, L.
Dixon-Smith, L.
Downshire, M.
Dudley, E.
Eccles of Moulton, B.
Elles, B.
Elton, L.
Faithfull, B.
Ferrers, E.
Finsberg, L.
Foley, L.
Fraser of Kilmorack, L.
Gainford, L.
Gardner of Parkes, B.
Geddes, L.
Goschen, V.
Gray, L.
Haig, E.
Hailsham of Saint Marylebone, L.
Halsbury, E.
Harlech, L.
Harmsworth, L.
Harrowby, E.
Henderson of Brompton, L.
Hives, L.
Hogg, B.
Hood, V.
Hooper, B.
Howe, E.
Hylton-Foster, B.
Iddesleigh, E.
Inglewood, L. [Teller.]
Jenkin of Roding, L.
Kinnoull, E.
Lauderdale, E.
Lindsay, E.
Long, V.
Lucas, L.
Lucas of Chilworth, L.
Lyell, L.
McColl of Dulwich, L.
McConnell, L.
Mackay of Clashfern, L. [Lord Chancellor.]
Malmesbury, E.
Manchester, D.
Marlesford, L.
Merrivale, L.
Mersey, V.
Milverton, L.
Monteagle of Brandon, L.
Mottistone, L.
Mountevans, L.
Mowbray and Stourton, L.
Moyne, L.
Munster, E.
Murton of Lindisfarne, L.
Nelson, E.
Noel-Buxton, L.
Norrie, L.
Northesk, E.
O'Cathain, B.
Oppenheim-Barnes, B.
Orkney, E.
Orr-Ewing, L.
Oxfuird, V.
Palmer, L.
Pearson of Rannoch, L.
Pender, L.
Perry of Southwark, B.
Peyton of Yeovil, L.
Pike, B.
Plummer of St. Marylebone, L.
Pym, L.
Rawlings, B.
Rennell, L.
Renton, L.
Richardson, L.
Seccombe, B.
Shannon, E.
Sharples, B.
Shaw of Northstead, L.
Shrewsbury, E.
Skelmersdale, L.
Stewartby, L.
Strange, B.
Strathcarron, L.
Strathclyde, L. [Teller.]
Sudeley, L.
Suffield, L.
Swansea, L.
Terrington, L.
Teviot, L.
Thomas of Gwydir, L.
Trefgarne, L.
Trumpington, B.
Ullswater, V.
Vaux of Harrowden, L.
Vivian, L.
Wade of Chorlton, L.
Westbury, L.
Wharton, B.
Whitelaw, V.
Wise, L.
Wynford, L.
Young, B.

Resolved in the negative, and amendment disagreed to accordingly.

4 May 1995 : Column 1490

4.2 p.m.

Schedule 1 [Amendments]:

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