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Baroness Jay of Paddington: My Lords, I am speaking to the Motion that the Bill do now pass.

When we discussed the Bill at Second Reading I suggested five basic tests for any change in the National Health Service: does it improve the effectiveness of the service? Does it improve efficiency? Will the change lead to greater equity? Will it lead to greater accountability? And will it improve the overall health of the nation's population?

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At Second Reading I argued that this Bill failed all those tests. Nothing which has happened in our subsequent debates on the detail of the legislation has changed my mind. Although the Government see this as a measure which is primarily designed to dismantle bureaucracy in the NHS, we on these Benches remain convinced that the Bill is a threat both to public accountability and to standards of excellence in the health service.

From these Benches we voiced particular concern about the abolition of the regional health authorities. The Government have insisted that that is simply the removal of an unnecessary tier of administration. However, as your Lordships know, the extraordinary growth in NHS management has not been at that level but further down the line in individual trusts and purchasing authorities. Staff numbers in the regions have actually gone down since the so-called reforms.

From these Benches we have moved amendments to try to protect the special strategic functions of the regional health authorities, particularly those of public health, and to maintain the links between the universities and the NHS. The noble Lord, Lord Walton, has been particularly concerned about the future connection between the university medical schools and the health service. But none of the amendments —neither those which the noble Lord proposed nor those that we proposed from these Benches—was accepted.

Equally unsuccessful were the attempts from all parts of the House to establish professional membership of the health authorities. At Committee stage the noble Baroness Lady Gardner of Parkes sought to include health professionals working in primary care. My noble friend Lady Dean of Thornton-le-Fylde wished to include health visitors. The noble Baroness, Lady McFarlane of Llandaff, who rightly tried again this afternoon, moved amendments to include the invaluable contribution of nurses at board level in the new health authority.

From these Benches we have tried to improve the general openness and public accountability of the health authorities. We moved amendments to make selection procedures for members more rigorous and objective. Again, all were rejected, despite the fact that during the passage of the Bill the committee on standards in public life chaired by the noble and learned Lord, Lord Nolan, has already been critical of the new arrangements proposed in February by the Secretary of State for Health.

I should like to thank my noble friends Lord Cledwyn of Penrhos and Lord Prys-Davies for diligently keeping the red dragon flying and eloquently trying to pursue the special concerns of Wales. They, too, have been disappointed, as was the noble Baroness, Lady Robson, who sought a strategic health authority for London to try to sort out the continuing agonising problems of health services in the capital.

The noble Baroness, Lady Robson, was very helpful in supporting many of the amendments from these Benches, despite her ill health during the proceedings of this Bill. I should like to thank her and her noble friends Lord Addington and Lord Tope for their contributions.

Above all, I must thank my noble friends Lord Rea and Lord Carter for everything they have done to advance our arguments so powerfully and, to my mind, so

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persuasively. My noble friend Lord Rea has brought all his practical experience of working in the NHS for many years to our debates. His particular knowledge of primary care and the issues which confront general practitioners working in the inner city has been vital.

My noble friend Lord Carter has been my essential coach on the Bench. His encyclopaedic understanding of the health service and of previous legislation, as well as of the procedures of your Lordships' House, has been invaluable. He has guided me patiently through the legislative jungle and saved me from many transgressions.

I should like to express the thanks of all of us to the Minister and her noble friend Lady Miller. They have been helpful and detailed in all their replies to our debates. The Minister has been particularly kind in writing fully to me and my noble friends about matters which could not immediately be resolved on the Floor of the House. We are very grateful to her.

In conclusion, I wish it were possible to send the Bill on its way with our best wishes. However, I am afraid that I still think this is a very political Bill, driven more by ideology about developing the health market than real concern about the state of our greatest public service.

As we are finishing our deliberations on a political day—I only assume that the absence of other noble Lords from the Chamber is because they are all actively involved in the local elections—I feel justified today in repeating the words of my right honourable friend the Leader of the Labour Party:

    "We must wait for a general election to renationalise the National Health Service".

Lord Addington: My Lords, on the Motion that Bill do now pass, first I thank the Minister for her kind words about my noble friend Lady Robson, who is unable to be here. I also thank the noble Baroness, Lady Jay, for her kind comments about my noble friend and myself.

What we object to most about the Bill comes in its first line:

    "An Act to abolish Regional Health Authorities".

We do not believe that they should go because we need co-ordination and planning for health authorities, as, indeed, for all other public services. On strategic planning, the planning authority for London should have been put into the Bill. As the noble Baroness, Lady Jay, mentioned, my noble friend Lady Robson tried to have it included. As it was not seen fit to do that, this must go down as an opportunity lost.

One final point should be raised. With this legislation, it has been suggested that community health councils should not be expanded to an unmanageable size. At Committee stage my noble friend Lady Robson made inquiries about the matter but the Minister said that she did not believe that that would happen. However, we have no guarantee that it will not.

Bearing those points in mind, I hope that the Bill is considerably more successful than I suspect it will be, taking into account the gaps and certainly the lack of an

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overview and strategic planning. I hope that those shortcomings will not severely damage the National Health Service.

Baroness Cumberlege: My Lords, perhaps I may start by responding to the noble Lord, Lord Rea, and his anxieties about the regional directors of research and development.

In the new system, the regional directors will be members of the top management team in the new smaller regional offices. That means that they will become civil servants, but it also means that their influence and their profile are likely to increase. The NHS research and development programme has formally committed itself to openness in its operation and the reporting of all its findings. That will remain the case. The content of the research carried out will, as now, be determined on the advice of the central research and development committee and the regional research and development committees. Bringing all of them together within the NHS executive will, we believe, improve the efficiency and cost effectiveness of the programme. The directors work as part of the national research and development strategy. We believe that this arrangement is a good one and, of course, it will continue. I think that the noble Lord, Lord Rea, has nothing to fear.

I was interested in what the noble Baroness, Lady Jay, said about her template of five important key areas: effectiveness, efficiency, equity, accountability and the improvement of the health of the population. We believe that the Bill will go some way towards improving all those five counts, but, of course, only time will eventually tell.

As I understood it, the policy of the party opposite is that we should reduce bureaucracy. Indeed, there has been a suggestion that something like 800 administrators could go. I find it surprising that with that policy the same party should so champion the regional health authorities. I chaired a regional health authority and enjoyed doing so, but I recognised that the whole system had a stultifying effect on innovation, new ideas and imagination. It lengthened what could be quite quick decisions because of the red tape involved. The measures in the Bill before your Lordships will free up a great many people within the health service. I am convinced that it will result in a far better National Health Service for the people of this country.

I commend the Bill to the House.

On Question, Bill passed and returned to the Commons with amendments.

Commonwealth Development Corporation Bill

5.15 p.m.

Lord Inglewood: My Lords, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to move a manuscript amendment or to speak in Committee. Therefore, unless any noble Lord objects, I beg to move that the order of commitment be discharged.

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Moved, That the order of commitment be discharged.—(Lord Inglewood.)

On Question, Motion agreed to.

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