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Lord McIntosh of Haringey: My Lords, the Minister used the word "cult". The Church of Scientology calls itself a church. Is there a definition of the words "church" and "cult"? If so, does the Church of Scientology meet either of those definitions?

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Baroness Blatch: My Lords, my understanding is that the Church of Scientology chapels do not conform to the legal definition of a church and certainly not a religion. I believe it was in 1969 that the scientologists appealed before the courts and were not regarded as a religion.

Baroness Sharples: My Lords, can my noble friend tell me the status of the Americans working at the Church of Scientology headquarters? Can she say whether the church has applied for charitable status?

Baroness Blatch: My Lords, I am sorry but I cannot help my noble friend about the status of the Americans. Coming to this country to work, they would of course need a work permit. They could not simply arrive and work in the scientology movement. In answer to the second question, my understanding is that the scientologists presented informally a hypothetical case to the Charity Commission; namely, should they apply for charitable status, would it be granted? The Charity Commission--it is a matter for the Charity Commission--investigated the matter thoroughly, came back to the scientologists and said that on the basis of the information provided to it it would not have granted charitable status. I also understand that the scientologists have now submitted a formal application to the Charity Commission. It must be for the Charity Commission to consider that application afresh.

Lord Avebury: My Lords, is the Minister aware that when the application was made to the Charity Commission it ruled that, in order to qualify as a religion, an organisation had to be theistic in character but that Buddhists, having existed for 2,500 years, were an exception to that principle? Does she feel that it would be appropriate for Parliament to frame a sensible definition of "religion" and "church", instead of leaving the matter to be determined by the Charity Commission and the courts?

Baroness Blatch: My Lords, wiser counsels than I have tried that one. We have set our face against a definition of religion. We have settled for there being no legal definition of religion. I have now found the date in my brief: it was 1969 when the scientologists appealed to be considered a religion and it was decided at that time that their chapels did not constitute a church and were not a religion.

Architects Bill [H.L.]

3.2 p.m.

The Lord Chancellor (Lord Mackay of Clashfern): My Lords,I beg to introduce a Bill to consolidate the enactments relating to architects. I beg to move that this Bill be now read a first time.

Moved, That the Bill be now read a first time.-- (The Lord Chancellor.)

On Question, Bill read a first time, and to be printed.

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Vehicles (Price Indication) Bill [H.L.]

The Earl of Bradford: My Lords, I beg to introduce a Bill to make provision concerning price indications of vehicles. I beg to move that this Bill be now read a first time.

Moved, That the Bill be now read a first time.-- (The Earl of Bradford.)

On Question, Bill read a first time, and to be printed.

Overseas Domestic Workers (Protection) Bill [H.L.]

Lord Hylton: My Lords, I beg to introduce a Bill to amend the Immigration Act 1971, to confer protection on overseas domestic workers who are witnesses or plaintiffs in proceedings before a court or tribunal. I beg to move that this Bill be now read a first time.

Moved, That the Bill be now read a first time.--(Lord Hylton.)

On Question, Bill read a first time, and to be printed.

Business of the House: Debates this Day

The Lord Privy Seal (Viscount Cranborne): My Lords, I beg to move the Motion standing in my name on the Order Paper.

Moved, That Standing Order 38(4) (Arrangement of the Order Paper) be dispensed with this day to allow the Motion standing in the name of the Earl Russell to be taken before the Motion to approve the Child Support (Miscellaneous Amendments) (No. 2) Regulations 1996.--(Viscount Cranborne.)

On Question, Motion agreed to.

Consolidated Fund Bill

The Minister of State, Department of Social Security (Lord Mackay of Ardbrecknish): My Lords, I beg to move that this Bill be now read a second time.

Moved, That the Bill be now read a second time.--(Lord Mackay of Ardbrecknish.)

Lord Boyd-Carpenter: My Lords, does the prohibition on debating what is one of the most important Bills of the Session still continue or has the Procedure Committee at long last taken another look at it and decided to amend the provision?

Lord Mackay of Ardbrecknish: My Lords, I am not sure whether this is the most important Bill of the Session. I think that some of my other Bills are more important Bills of the Session, but I shall leave that point to one side. In fact, the Procedure Committee has looked at this matter. I am sure that

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my noble friend Lord Boyd-Carpenter knows that in the Companion on page 148 the guidance endorsed by the Procedure Committee is that:

    "It is now a convention that proceedings upon [Consolidated Fund Bills] are taken formally".

On Question, Bill read a second time; Committee negatived. Then, Standing Order No. 44 having been dispensed with (pursuant to Resolution of 12th December), Bill read a third time, and passed.

National Health Service (Primary Care) Bill [H.L.]

3.5 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, That the House do now resolve itself into Committee.--(Baroness Cumberlege.)

On Question, Motion agreed to.

House in Committee accordingly.


Baroness Jay of Paddington moved Amendment No. 1:

Before Clause 1, insert the following new clause--

Pilot schemes: excluded bodies

(".--(1) Nothing in this Act shall permit the Secretary of State to approve any proposal for a pilot scheme submitted to him by an authority if that proposal includes the provision of personal medical services by--
(a) a company as defined in section 735 of the Companies Act 1985, or
(b) a body corporate incorporated outside Great Britain,
which has paid, or has the power to pay, a dividend to its shareholders or which is part of a group of companies, any of which has paid, or has the power to pay, a dividend to its shareholders.
(2) In this section, "provision" includes the employment of persons providing personal medical services or any other contractual arrangement with such a person, including sponsorship and other forms of assistance in money or in kind.").

The noble Baroness said: The purpose of this amendment is simple. It is to prevent the family doctor service in this country being taken over by private commercial interests. General practitioners have always been the cornerstone of our publicly funded National Health Service. For 50 years they and the community nurses, health visitors and other professionals who work with them have provided the excellent primary care on which all our families rely. Although there have been recent concerns about the development of a two-tier system in the new NHS internal market, the local surgery has continued to be the place to which people turn for skilled, objective advice, health service prescriptions, referrals to hospitals and most of the medical care that we need from the cradle to the grave.

The Bill before us contains opportunities to develop those services and make them more flexible. But it also contains a major threat. Deregulation can lead to privatisation. This Bill is an enabling Bill. The first

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part--the first 16 clauses--allows a variety of pilot schemes to change the delivery of primary care at the local level. There are very few specifications about the nature of those pilots on the face of the Bill.

New Clause 1 is designed to ensure that commercial companies who pay dividends to their shareholders are explicitly excluded from promoting those pilot schemes. They cannot become even indirectly the providers of personal medical services within the National Health Service. At Second Reading the Minister explained that GPs, dentists and NHS trusts, provided that they prepared the proposals correctly, could automatically submit pilot schemes for approval to the Secretary of State. But the noble Baroness also said that proposals from other bodies would be considered.

In the Second Reading debate the Minister dismissed as "chatter" the concern that the "other bodies" might be commercial companies and that supermarkets, for example, might get involved in providing or sponsoring medical services. That, the noble Baroness said,

    "is no doubt a good story, but it is time to bring speculation down to earth".--[Official Report, 3/12/96; col.592.]
But, as I am sure many Members of the Committee have seen reported since the Second Reading debate, the "chatter" has been openly confirmed by company spokesmen. For example, the supermarket chain ASDA, which is one of the largest of our successful grocery retailers, has said that it is considering introducing doctors' services on contract to the NHS in some of its stores if the Bill before us becomes law unamended.

Boots, with its countrywide network of chemist shops, is also interested, while Unichem, one of the largest pharmaceutical wholesalers, which runs more than 400 chemist shops, states that it will be pursuing its proposals immediately if the Bill before the Committee becomes law. I hope therefore that the Committee will realise that by introducing Amendment No. 1--new Clause 1--we on these Benches are not dealing in the realm of fanciful speculation or scaremongering but in the possibilities of practical reality.

There seem to be three essential reasons for supporting the new clause which, as I say, excludes commercial companies from the pilot schemes. The first is obvious: the commercial companies provide a threat, under the arrangements that might be proposed, to the basic principles of a publicly-funded NHS and to its public service values. The British Medical Association has already spoken of its grave concern that the proposal suggested specifically by Unichem will bring the privatisation of personal medical services nearer.

We are also concerned, as indeed is the British Medical Association, with the provisions for the sale of goodwill which appear in the Bill and which could lead to the sale of goodwill within general practice to commercial interests. That is the subject of subsequent amendments which we shall be discussing later today.

I am pleased that the General Practitioner magazine conducted a rapid survey of its readership about the possible proposals in the past two weeks. It found that 71 per cent. of general practitioners surveyed were against commercial companies being involved in

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sponsoring their services. Perhaps there will not be any takers therefore; but that does not obviate the necessity to try to prevent the possibility being put on the face of the Bill.

The second fundamental reason for supporting new Clause 1 is that, from the individual patient's point of view, the essential nature of a trusting relationship between a patient and his or her GP is a relationship based on the understanding that everyone is acting from no personal self-interest. That must surely be open to question if the doctor is an employee of a dominant commercial organisation. For example, it may be convenient to me as a shopper and a patient to visit my GP in an annexe of Asda. But I would be doubtful of his or her objectivity if I found his pharmaceutical products offered at discounts by the sponsoring Unichem chain and my healthy eating encouraged by special deals from the resident supermarket. The doctor's role as an independent advocate must be undermined if he is inextricably linked to a commercial company whose interest in that association is clearly to increase its profits.

A speaker at the conference of the Institute of Health Service Management in November put it bluntly. He was talking about similar proposals being made for employing people within individual trust hospitals, not in primary but in secondary care. He said,

    "You could be the chief executive officer of a trust hospital but employed by Tarmac. These people will still be health service managers in the public sector but they will be working for a private sector company with a different bottom line".
It is precisely that question of the "different bottom line" that concerns us and caused us to table Amendment No. 1.

My third basic reason for asking the Committee to support the new clause is the issue of equity. The National Health Service is intended to provide equity in healthcare. The Government told us at Second Reading and in background briefings that the purpose of the Bill was to extend and improve primary care services. Those improvements are most needed, as we all know, in deprived communities whether they are inner cities or remote rural areas. It is unlikely that commercial companies will wish to be involved in extending services in those areas, precisely because they are not likely to improve their own profits there. Realistically, we are far more likely to see commercial general practice in a prosperous suburban supermarket than in an inner city corner shop.

We already have great inequities in our healthcare provision, and commercial schemes will exacerbate them. I hope that the Government will accept new Clause 1. It specifically excludes the possibility of those potential developments which are a threat to the essential character of NHS primary care. It is a threat which the Government have previously denied and described as fanciful speculation. If that is so, there is certainly no cause to oppose the amendment. If the Minister responds today that these concerns can be met by regulation rather than by primary statute, that may be sufficient, provided Parliament is given an early opportunity to consider any regulations.

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The Secretary of State for Health has spoken, in the context of this Bill, about enabling a thousand different blooms of different primary care to flourish. But a potential bloom of commercial privatised primary care must be doused with weed-killer at this early opportunity before it spreads. I beg to move.

3.15 p.m.

Baroness Robson of Kiddington: We on these Benches very much support the amendment. I consider it to be, in many ways, one of the most important amendments before us today. There are many good things in this new primary care Bill but without Amendment No. 1 the dangers of which the noble Baroness, Lady Jay, spoke are very great.

At Second Reading the Minister stated that she had not seen or heard of any specific interest by supermarkets in the possibility of setting up a health centre on their premises. We now know without doubt that they are interested. If we take that, together with the fact that they could employ salaried doctors only and not bring in a health service practice already in existence, we can see how the relationship between the GP and his patient may be destroyed. The trust would no longer exist between them.

A general practitioner is an unusual person within the health service today. He is not only a provider; he is also a commissioner of services on behalf of his patient. I am therefore slightly worried about hospital and community trusts setting up new health centres. If they used salaried doctors--or even if they did not--there would arise a clash of interests between the doctor and his patient in the commissioning part of the duty to the patient.

I cannot see how we can retain the trust of the patient in the doctor, a trust of which we are so proud in this country and which has carried our health service through all its troubles. It is the basis of the general practitioner services that has helped us through the many difficulties that we have encountered. I sincerely hope that the Government will accept the amendment.

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