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Baroness Jay of Paddington: I am grateful to the Minister for that reply. I thought that the particularly illuminating sentence in her reply was that in which she said there was no way that the Government would rule out a private organisation being involved in these pilot schemes, which is precisely what was being denied as speculation in previous debates on this subject both in your Lordships' House and in another place.

If it is really the Government's policy that they do not rule out private companies being involved we have at least achieved clarity about the intent of part of this Bill. It is a clarity that we on these Benches find extremely disturbing. It is disturbing because although the Minister may argue that there are forms and ways in which this may help local services, the fact is that they are involving commercial organisations and the problems about conflicts of interest which the noble Lord, Lord Walton, so eloquently described in his contribution to the debate, cannot be ruled out.

I am surprised that the Minister used the words "protecting GPs". Indeed, one would wish to see GPs protected from that sort of conflict of interest, which would be difficult for their professional practice as well as doing nothing, as the Minister said, to enhance the well-being or, indeed, the useful healthcare of patients.

I believe that the point is that what has been revealed in this short debate, and most specifically by the Minister's reply, is that all of the points made at Second Reading about the potential for diversity, which we all welcome--we on these Benches underline our welcome for diversity in extending primary care--did not lead to the kind of deregulation, competition and privatisation, which precisely would undermine the basic principles of the health service in the way that I described in my opening remarks in moving the amendment.

What we have learnt this afternoon is that, despite all the warm words of the Government and their plethora of White Papers about their determination to support and extend primary care within the NHS, they are quite content to see commercial organisations involved whose basic profit bottom line is their basic guiding principle. The Government are willing to see that kind of element introduced into the essential

17 Dec 1996 : Column 1405

nature of our primary care system, which is GP services. On the basis of that very clear distinction of principle and understanding of what NHS primary care should be delivering in this country, I will have to seek the opinion of the Committee.

Baroness Cumberlege: Perhaps I may just explain to the noble Baroness that I said that no scheme could be ruled out from being considered by a health authority. As the noble Baroness is a member of a health authority she will know how diligent members are in seeking to ensure that the services that are provided for their populations are to a high standard and that they comply with the NHS rules.

These are the very principles that we are putting forward for these schemes. It is the health authority who will say, perhaps, "No, we do not believe that this is value for money because, after all, it is still public money. No, we do not believe that this scheme is going to serve patients, and we do not believe that it is going to serve staff".

That is twisting what I actually said. I believe that the noble Baroness will realise that if patients have to be registered with their GP, with public money and NHS standards and rules, then the health authority will weigh all that up. If it is then in the interests of the population served, the health authority has the prerogative to put that forward to the Secretary of State. He will then make a judgment on the criteria that I have laid out as to whether these schemes are going to benefit the local people.

To merely imply that the commercial sector is always a brigand; is always ready to waste resources and is evil in any way, is plagiarising the situation. We know that sometimes the private sector helps the health service. We have only to consider hospital doctors sponsored by the private sector through research programmes to know that they contribute enormously to the National Health Service. The noble Baroness said that she will seek the opinion of the Committee. I am convinced that it will want to oppose this amendment.

Baroness Jay of Paddington: I am bound to return to the Minister's points. She accuses me of twisting her words. I said nothing in my reply to her response to the amendment that implied that I regarded commercial companies as evil. That would be inappropriate. Before I seek the opinion of the House, can the Minister say whether in principle pilot schemes proposed by commercial companies will be looked at favourably or otherwise on the grounds considered by the Secretary of State? The bottom line question is whether the proposals for pilot schemes by commercial companies will be considered by the Secretary of State.

Baroness Cumberlege: The noble Baroness misunderstands the Bill. The Secretary of State will consider these proposals only if they are forwarded by the health authority. It is the health authority that acts as a sieve and has the right of veto if it believes that the proposals are not in the interests of the local population or the taxpayer.

17 Dec 1996 : Column 1406

3.40 p.m.

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

Their Lordships divided: Contents, 122; Not-Contents, 145.

Division No. 1

CONTENTS

Addington, L. [Teller.]
Alderdice, L.
Allenby of Megiddo, V.
Archer of Sandwell, L.
Ashley of Stoke, L.
Avebury, L.
Beaumont of Whitley, L.
Berkeley, L.
Borrie, L.
Brooks of Tremorfa, L.
Bruce of Donington, L.
Callaghan of Cardiff, L.
Carmichael of Kelvingrove, L.
Carter, L.
Castle of Blackburn, B.
Chandos, V.
Cledwyn of Penrhos, L.
Clifford of Chudleigh, L.
Clinton-Davis, L.
Cocks of Hartcliffe, L.
Currie of Marylebone, L.
David, B.
Dean of Beswick, L.
Dean of Thornton-le-Fylde, B.
Desai, L.
Diamond, L.
Dormand of Easington, L.
Dubs, L.
Exmouth, V.
Ezra, L.
Falkender, B.
Farrington of Ribbleton, B.
Fisher of Rednal, B.
Fitt, L.
Gallacher, L.
Geraint, L.
Gladwin of Clee, L.
Gould of Potternewton, B.
Graham of Edmonton, L. [Teller.]
Gregson, L.
Grey, E.
Hampton, L.
Hanworth, V.
Harris of Greenwich, L.
Haskel, L.
Hayman, B.
Healey, L.
Hilton of Eggardon, B.
Hollick, L.
Hooson, L.
Howell, L.
Howie of Troon, L.
Hughes, L.
Hutchinson of Lullington, L.
Hylton-Foster, B.
Ilchester, E.
Jay of Paddington, B.
Jenkins of Hillhead, L.
Jenkins of Putney, L.
Kilbracken, L.
Kilpatrick of Kincraig, L.
Kinloss, Ly.
Longford, E.
Lovell-Davis, L.
McFarlane of Llandaff, B.
Mackie of Benshie, L.
McNair, L.
McNally, L.
Mar, C.
Mar and Kellie, E.
Masham of Ilton, B.
Mason of Barnsley, L.
Mayhew, L.
Milner of Leeds, L.
Molloy, L.
Monckton of Brenchley, V.
Monkswell, L.
Morris of Castle Morris, L.
Murray of Epping Forest, L.
Nathan, L.
Nicol, B.
Ogmore, L.
Paul, L.
Perry of Walton, L.
Peston, L.
Plant of Highfield, L.
Prys-Davies, L.
Ramsay of Cartvale, B.
Rea, L.
Ritchie of Dundee, L.
Rix, L.
Robson of Kiddington, B.
Rochester, L.
Rodgers of Quarry Bank, L.
Sainsbury, L.
Sandwich, E.
Scanlon, L.
Serota, B.
Sewel, L.
Simon, V.
Smith, L.
Smith of Gilmorehill, B.
Stallard, L.
Stoddart of Swindon, L.
Strabolgi, L.
Strafford, E.
Symons of Vernham Dean, B.
Taverne, L.
Taylor of Blackburn, L.
Tenby, V.
Thurso, V.
Tope, L.
Tordoff, L.
Turner of Camden, B.
Varley, L.
Wallace of Coslany, L.
Walton of Detchant, L.
Warnock, B.
White, B.
Whitty, L.
Williams of Elvel, L.
Winston, L.

NOT-CONTENTS

Aberdare, L.
Addison, V.
Ailesbury, M.
Aldington, L.
Alexander of Tunis, E.
Alport, L.
Ampthill, L.
Archer of Weston-Super-Mare, L.
Arran, E.
Ashbourne, L.
Astor of Hever, L.
Balfour, E.
Belhaven and Stenton, L.
Birdwood, L.
Blake, L.
Blaker, L.
Blatch, B.
Boyd-Carpenter, L.
Brabazon of Tara, L.
Brentford, V.
Bridgeman, V.
Brougham and Vaux, L.
Butterworth, L.
Byford, B.
Cadman, L.
Campbell of Alloway, L.
Campbell of Croy, L.
Carnegy of Lour, B.
Charteris of Amisfield, L.
Chelmsford, V.
Chesham, L. [Teller.]
Clark of Kempston, L.
Cochrane of Cults, L.
Cornwallis, L.
Courtown, E.
Craig of Radley, L.
Cranborne, V. [Lord Privy Seal.] Cranworth, L.
Crickhowell, L.
Cross, V.
Cuckney, L.
Cullen of Ashbourne, L.
Cumberlege, B.
Dacre of Glanton, L.
Davidson, V.
Dean of Harptree, L.
Denbigh, E.
Derwent, L.
Dilhorne, V.
Dixon-Smith, L.
Eccles of Moulton, B.
Ellenborough, L.
Elles, B.
Elliott of Morpeth, L.
Erne, E.
Flather, B.
Fraser of Carmyllie, L.
Gainford, L.
Gardner of Parkes, B.
Geddes, L.
Gerard, L.
Gisborough, L.
Glentoran, L.
Goschen, V.
Gray of Contin, L.
Greenway, L.
Haddington, E.
Hailsham of Saint Marylebone, L.
Harding of Petherton, L.
Harmsworth, L.
Hemphill, L.
Henley, L.
HolmPatrick, L.
Hothfield, L.
Howe, E.
Inglewood, L.
Ironside, L.
Johnston of Rockport, L.
Keyes, L.
Kingsland, L.
Kinnoull, E.
Knollys, V.
Lawson of Blaby, L.
Long, V.
Lucas, L.
Lucas of Chilworth, L.
Lyell, L.
McColl of Dulwich, L.
McConnell, L.
Mackay of Ardbrecknish, L.
Mackay of Clashfern, L. [Lord Chancellor.] Mackay of Drumadoon, L.
Macleod of Borve, B.
Marlesford, L.
Merrivale, L.
Mersey, V.
Middleton, L.
Miller of Hendon, B.
Montgomery of Alamein, V.
Mountevans, L.
Munster, E.
Murton of Lindisfarne, L.
Napier and Ettrick, L.
Noel-Buxton, L.
Northesk, E.
Onslow, E.
Oppenheim-Barnes, B.
Orr-Ewing, L.
Oxfuird, V.
Palmer, L.
Park of Monmouth, B.
Pender, L.
Peyton of Yeovil, L.
Pilkington of Oxenford, L.
Pym, L.
Quinton, L.
Reay, L.
Renton, L.
Renwick, L.
Richardson, L.
St. Davids, V.
Saltoun of Abernethy, Ly.
Sandford, L.
Seccombe, B.
Sharples, B.
Skelmersdale, L.
Soulsby of Swaffham Prior, L.
Stodart of Leaston, L.
Strange, B.
Strathcarron, L.
Strathclyde, L. [Teller.]
Strathcona and Mount Royal, L.
Swinfen, L.
Terrington, L.
Thomas of Gwydir, L.
Thurlow, L.
Trumpington, B.
Ullswater, V.
Vivian, L.
Whitelaw, V.
Wilberforce, L.
Wilcox, B.
Willoughby de Broke, L.
Wynford, L.
Young, B.

Resolved in the negative, and amendment disagreed to accordingly.

17 Dec 1996 : Column 1408

3.49 p.m.

Clause 1 [Pilot schemes]:


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