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Baroness Cumberlege: My Lords, perhaps I could reassure the noble Lord, Lord Rea, that it really would not be proper for individual deans to be employers. Nor would it be appropriate for the contracts of junior doctors, or indeed other trainees, to be held in the same place as the deans' contracts. Deans may be employed in the regional offices as part of the Civil Service. It would not really make sense for the junior doctors, for whom the deans are responsible, also to be civil servants. Alternatively, the deans may be employed—as I have said already—outside the NHS. It would not be proper or sensible for staff providing essential NHS services to be employed outside the service.

I think the noble Lord also asked about safeguards for training. These will be achieved through educational contracts between the deans, trusts and junior doctors. The deans, of course, will also continue to fund 50 per cent. of the basic salary costs, as they do now. With regard to the consultation document, it was drawn up in close collaboration with the deans. We have had 100 responses to the document. We have not yet had a full opportunity to consider them all. I have listened carefully to the points made by the noble Lord, but of course those points do not affect the government amendments which are before your Lordships this afternoon.

On Question, amendment agreed to.

Baroness Cumberlege moved Amendment No. 6:

Page 30, line 21, at end insert:
("(3) In Schedule 13 (computation of period of employment)—
(a) in paragraph 17(1) (provisions of Schedule to relate only to employment with the one employer unless any of paragraphs 17(2) to (5), 18 and 18A apply), for "and 18A" substitute "to 18B", and
(b) after paragraph 18A insert—
"18B.—(1) If a person employed in relevant employment by a health service employer is taken into relevant employment by another such employer, his period of employment at the time of the change of employer shall count as a period of employment with the second employer and the change shall not break the continuity of the period of employment.
(2) For the purposes of sub-paragraph (1) employment is relevant employment if it is employment of a description—
(a) in which persons are engaged while undergoing professional training which involves their being employed successively by a number of different health service employers, and
(b) which is specified in an order made by the Secretary of State.
(3) The following are health service employers for the purposes of this paragraph—
(a) Health Authorities established under section 8 of the National Health Service Act 1977,
(b) Special Health Authorities established under section 11 of that Act,

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(c) National Health Service trusts established under Part I of the National Health Service and Community Care Act 1990,
(d) the Dental Practice Board, and
(e) the Public Health Laboratory Service Board."").

[Amendment No. 7, as an amendment to Amendment No. 6, not moved.]

On Question, Amendment No. 6 agreed to.

Baroness Cumberlege: My Lords, I beg to move that this Bill do now pass. I am glad to sum up at the end of your Lordships' consideration of this Bill. I will say just a few words, following the model of concise debate which has characterised the Bill's progress. Though concise, the debate has also been constructive and well-informed and we have benefited again from the great depth of experience and commitment to the NHS which exists in your Lordships' House.

This has also been, by and large, a most good-humoured debate. Perhaps that reflects the measure of agreement between us on one of the central measures, the replacement of district health authorities and family health services authorities by the new health authorities. The noble Baroness, Lady Jay, and the noble Baroness, Lady Robson—who I am disappointed is not able to be here this afternoon for very good reasons—together with their teams have pressed the Government vigorously on many points of important detail. I am glad that they have, nevertheless, been able to welcome the new authorities, since they are also welcomed throughout the National Health Service. I should particularly mention the noble Lord, Lord Carter, whose detailed knowledge has been so necessary in showing us all how to move amendments, and whose inquiring mind was so impressive when we discussed the details of the Local Government Finance Act.

The new health authorities will have real influence and a vital role. They will be responsible for ensuring that the entire health needs of their population are met. For the first time, responsibility for primary and secondary care will be brought together within one authority—and planned together in a coherent and co-ordinated way. The noble Lord, Lord Rea, has been probing throughout on the subject of primary care and education. I have, I hope, been able to reassure him that health authorities will pay great attention to developing primary care teams in their areas and forging partnerships with professionals, including both fundholding and non-fundholding GPs. My noble friend Lady Gardner also made an important contribution on this subject, ensuring through her amendment that we remembered the importance of all the primary health care professions.

The abolition of RHAs has caused more debate in your Lordships' House. But the reasons for removing RHAs are clear and compelling. Such large, bureaucratic organisations are no longer needed at regional level. Many of their functions can now be transferred to the new health authorities, closer to patients. Their removal will streamline central management, reducing waste at the centre —and the NHS Executive regional offices will provide a strategic overview where that is still needed.

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This Bill will lead to substantial savings and there will be re-investment directly in patient care. There has, perhaps, been a certain amount of confusion about the amount of these savings, particularly during the debate in another place. So let me confirm the good news again: we estimate that savings of £150 million will be achieved every year once the Bill has been fully implemented in 1997-98. The majority of the savings—some £100 million per year—will come from RHA abolition.

The noble Lord, Lord Walton, and my noble friend Lord Jenkin have ensured that we did not overlook the essential partnership between the universities and the NHS. The highest standards of education and research must be maintained and I am glad to have been able, today, to set out clearly our plans for junior doctors' contracts. As always the membership of the new health authorities has been a matter of particular concern. We have debated that issue again today. My noble friend Lady Cox and the noble Baroness, Lady McFarlane, have, as ever, been powerful advocates for the nursing profession's contribution and we have noted with care the points they have made.

My noble friend Lord Elton broadened our debate by adding a second language during our discussions on membership when he reminded us that expressio unius, exclusio alterius—a point with which we agree.

We are committed to appointing the best people to serve on each health authority. The new appointments procedures introduced by the Government will help to ensure that. I should particularly like to put on record today my appreciation of all existing members of regional health authorities, DHAs and FHSAs who have served the NHS with such commitment and dedication. It is they who often have to take the most difficult decisions, and I am aware that they seldom receive sufficient recognition for all the work that they do.

Finally, I have stressed today and on several other occasions the need to ensure that the new authorities are open and accountable. I can assure your Lordships that the core values of openness, probity and accountability remain at the heart of the management and operation of the NHS. This Bill will move decisions closer than ever to patients, ensuring that as much of the work as possible takes place at local level. It will streamline central management so that as much money as possible is spent at local level on patient care. The NHS Executive, both centrally and in the regional offices, will oversee health authorities and provide leadership and a strategic overview to the whole NHS.

I should like to conclude by expressing my gratitude to all noble Lords who have taken part in our consideration of the Bill over the past few weeks. Your Lordships' scrutiny of the Bill has been genuine and courteous as well as thorough. I wish to thank especially my noble friend Lady Miller, who unfortunately is unable to be with us today due to a prior commitment, for easing my burden during the past few weeks. Her contributions have been many and valuable.

I have not been able to mention all noble Lords who have taken part in the debates on the Bill, but I would not wish to end without mentioning the contribution of

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my noble friend Lord Lyell, who ensured that even the finest details of the Dartford-Thurrock Crossing Act did not pass unscrutinised.

We have discussed the Bill thoroughly. It marks a logical and positive step for the NHS. I commend it to your Lordships' House.

Moved, That the Bill do now pass.—(Baroness Cumberlege.)

5 p.m.

Lord Rea: My Lords, with the permission of the House, perhaps I may ask the noble Baroness a question, about which I have given her notice, concerning the future of the research and development programmes that are at present managed by the regions under the regional directors of research and development. Those directorates have grown in importance since Professor Michael Peckham was appointed Director of Research and Development, largely as a result of your Lordships' Select Committee report.

When the regions are replaced by the regional offices of the National Health Service Executive, how will the regional directors of research and development be affected? If they are to be part of the regional offices they will technically become civil servants, as will the regional directors of public health. That will have the drawback that they could come under pressure only to commission or fund research which is acceptable to the government of the day. During the deliberations of the Select Committee the importance of independent, and sometimes uncomfortably targeted, research was made clear. Such research is often critical of certain established practices and therefore positively unpopular.

The Select Committee recommended that National Health Service research and development should be administered through a special health authority. That was not accepted and the directorate of research and development was created instead.

I should like to suggest that the idea of a special health authority should be re-examined. Such a body could act as the administrative base for all regional directors of research and development to allow them a degree of independence from the National Health Service Executive.

I do not expect the noble Baroness necessarily to agree with that suggestion, but I hope that what I have said will allow her to say what the Government's plans are for this important but so far little discussed activity of the regional health authorities which are to be abolished by this Bill.

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