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Lord Judd: My Lords, does the Minister agree that undermining the effectiveness of the UN generally has been the major funding crisis? Does she further agree that the stand being made by President Clinton at the moment is to be welcomed and that we should be giving him all possible support in ensuring proper resourcing and proper paying of dues? Does she accept that if the Department of Humanitarian Affairs is to be fully effective it is essential to have strong co-ordination with the authority of the 38th floor and the Secretary General at headquarters and equally strong co-ordination in the field?
Baroness Chalker of Wallasey: My Lords, I am not sure that it is just the funding crisis that is undermining confidence in the United Nations. As we covered in a Question in your Lordships' House yesterday, there is the problem of bringing together the different agencies which, in all honesty, are more competitive than they need to be. We have to help the United Nations through this reform process. It is always good for departments, as my own has recently done, to look at their objectives and at how they are fulfilling those objectives. That is very necessary for the United Nations.
There is a need for much better co-ordination, not only between New York and the field, but also between New York and Geneva. There are often quite stupid disputes and a lack of communication despite the vast increase in IT these days. So there is a great deal to be done. I can assure the noble Lord and your Lordships' House that the British Government and my department in particular are working very hard on the matter.
Baroness Chalker of Wallasey: My Lords, I believe there is a good deal of serious consideration taking place in a number of UN departments about the lack of respect for human rights and the way in which some national governments pursue their endeavours. One thing I do know is this: neither the United Nations nor other governments can impose on a sovereign government rules on how to run the lives of their people; nor should they.
The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, the functions of community health councils have not altered following the abolition of the regional health authorities. The composition and appointment of community health council members will remain as now, except that regional offices of the National Health Service Executive will act on behalf of the Secretary of State instead of the former regional health authorities.
Baroness Masham of Ilton: My Lords, I thank the Minister for that reply. Will she agree with me that with so many changes in the National Health Service, and more emphasis on primary healthcare, commissioning and GP funding, community health councils--and they are called that--should have more involvement in primary healthcare?
Baroness Cumberlege: My Lords, we issued guidance quite recently in March on the role of community health councils. We have tried to ensure through them that primary healthcare is also part of their remit, but there are no statutory obligations as yet.
Baroness Cumberlege: My Lords, I am not aware of any community health council staff being displaced through this move. Indeed, there is a study going on at the moment, through a firm of consultants, to see what their role is and whether the resources are properly or adequately allocated.
Lord Rea: My Lords, after the abolition of the regions, can the noble Baroness say whether the number of CHCs will remain the same or will perhaps increase, and that they will be adequately resourced?
Baroness Cumberlege: My Lords, I believe that I have dealt with the question of resources. There is a firm of consultants looking at that question. We shall be reporting back in June. As regards the numbers of CHCs, the Secretary of State is always very open to any suggestions as to different sizes or the numbers of CHCs. As I understand the situation at the moment, they are satisfied, although there are some marginal changes in boundaries where some of the district health authorities have been amalgamated with family health services authorities.
Viscount Caldecote: My Lords, can my noble friend clarify the position as regards government policy on cottage hospitals, in view of the number of reports on the closure of such hospitals which contribute so much to community care?
Baroness Cumberlege: My Lords, wherever there is a major change in service it has to be referred to the community health council. If the council objects to a closure, then it is referred to the Secretary of State. As regards cottage hospitals, my noble friend will have read over the weekend that there is now greater emphasis on ensuring that hospitals which are useful and serving a purpose remain in being.
Baroness Hayman: My Lords, is it not correct that, as the Minister said, the CHCs are about the only part of the NHS structure which has not changed in the past five years? Is it not true that after five years of perpetual and continuous reorganisation culminating in the abandonment of RHAs this week, all the evidence from this year's contracting round is that the NHS is facing this year exactly the same issues of resourcing and financing as sparked off the whole reorganisation process in 1987?
Baroness Cumberlege: My Lords, when we were debating the Bill to abolish regional health authorities, I remember that noble Lords opposite tried very hard to stop the abolition and the saving of £300 million, which have gone from administration into patient care. As regards the contracting for this year, I have been in the health service for a good many years and I have to say, "'twas ever thus".
Baroness Farrington of Ribbleton: My Lords, does the Minister have available for the House the figures for the number of referrals by community health councils for proposed closures of local cottage hospitals? How many of those closures have gone ahead after referral?
Baroness Masham of Ilton: My Lords, does the Minister agree that members of community health councils who represent patients on tribunals when they have problems and difficulties, as well as looking at the standard of all healthcare facilities, work very hard and do not get paid?
Baroness Cumberlege: Yes, my Lords, they do a splendid job. They are voluntary workers and they put an enormous amount of time and effort into their work. That is why, when the Government were considering NHS reforms, they decided to keep community health councils as they are now.
The Minister of State, Department for Education and Employment (Lord Henley): My Lords, the re-location of the administrative headquarters from Bircham Newton is a matter for the Board itself and, I am informed, it is part of a package to improve the operational efficiency of all its services, including the training programme. The board does not propose to re-locate the training facility currently situated at Bircham Newton. It also aims, as far as possible, to keep to a minimum staff redundancies arising from implementation.
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