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Baroness Cumberlege: I believe both the noble Lord and my noble friend will agree that the contracts are very different. When one looks at how general practitioners work, it is clear that the vast majority in this country are wholly contracted to the NHS; that is where they choose to place their contract. However, when one looks at dentistry, the situation is very different. Many dentists amalgamate private practice and NHS practice: they spend some of their time doing one and some of their time practising the other. In no way do we want to stop co-operation between those two great professions. Indeed, I am sure that many schemes will come forward. However, we would find it very difficult to have a single contract with two professions which are organised and paid extremely differently. I can see that Members of the Committee are not satisfied with my reply. Therefore, I shall take the matter away and come back to it after further thought.

Lord Rea: In that case, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness McFarlane of Llandaff had given notice of her intention to move Amendment No. 4:

Page 1, line 18, leave out subsection (3).

The noble Baroness said: I believe that this amendment falls in the light of the withdrawal of Amendment No. 2. I shall, therefore, not move the amendment.

[Amendment No. 4 not moved.]

Clause 1 agreed to.

Clause 2 [Proposals for pilot schemes]:

Baroness Hayman moved Amendment No. 5:

Page 2, line 37, at end insert--
("( ) consult the appropriate local representative committee on the proposals, and").

The noble Baroness said: In moving the above amendment, I shall, with the leave of the Committee, speak also to Amendments Nos. 6, 8, 20, 21, 24, 32, 34,

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35, 37, 38, 39 and 41, but not, I trust, at great length. In view of the earlier discussion about the potential of trusts for initiating pilot schemes under the Bill, I begin by declaring a potential interest as I am the chairman of an acute trust in an area where primary care is in much need of support and where we might, indeed, be interested in submitting such a scheme.

The purpose of this group of amendments, large though it is, is all of a piece. The amendments seek to strengthen and clarify the procedures for consultation about pilot schemes at all stages. It must be said that within the Bill the details of what consultation is envisaged are skeletal in the extreme. In initiating such schemes, it is extremely important--and to be hoped--that they should have support and that at the very least those assessing them, including the Secretary of State, should know and take into account the views of local professional bodies, local public representatives and patients' representatives.

Perhaps I may clarify the group further. Amendments Nos. 5, 6 and 8 deal with the procedures for consultation when pilot schemes are proposed. Amendments Nos. 20 and 21 deal with the arrangements for consultation at the stage of review of pilot schemes, and Amendment No. 32 deals with the arrangements for consultation at the stage when the Secretary of State has a view to giving permanent approval to what has in the past been a pilot scheme. Amendments Nos. 34, 35, 37, 38, 39 and 41 deal with additional "pharmaceutical services" which will be provided under the Bill and seek to make explicit on the face of the legislation the arrangements for consultation, which are contained within the 1977 Act, both nationally and with local pharmacy committees. Finally, Amendment No. 24 deals with the provision of an annual report to Parliament by the Secretary of State on decisions taken under Clause 3 on,

    "the findings of all reviews of pilot schemes carried out under [Clause 5]",
and on the "variation" and "termination" of pilot schemes under Clause 6.

We envisage substantial change; and we believe that it is essential that local people understand and are consulted about the changes to the basic structures of the NHS on which patients depend locally. We therefore propose that we consult with representatives of local patients including, but not exclusively with, community health councils.

Many organisations in different localities represent patients. Many organisations speak for patients with a specific illness or disability. It is important that health authorities consult the most appropriate organisations in their area. In some areas we have seen developments as regards public consultation; for example, in the use of citizens' juries. If such schemes were up and running, there is no reason why they should not be utilised in order to test the proposals.

The case for ensuring robust procedures for public consultation is strengthened by our earlier discussions. We are talking about serious innovations and the

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possibility of commercial organisations providing personal medical services for the first time. It becomes, therefore, more crucial that we secure the views of local people and patients' representatives on the proposals.

Amendments Nos. 5, 6, 21 and 32 ensure that local professional bodies for doctors and dentists are consulted. It is obvious that innovation and diversity in those areas are to be welcomed. That is the whole purpose of the Bill. On that basis the Bill's commitment to pilot schemes is welcome on this side of the Committee. It is equally important that we take an overall view and ensure that not only the opinions of the enthusiasts for a specific scheme in a small locality are made known but also that the wider views from professional organisations are taken into account.

Amendment No. 8 puts an obligation on health authorities to take account of the consultation with local authorities in their areas. In areas of primary care we are all aware how important it is to have proper consultation between local authorities and health authorities on the provision made for patients. As we see the blurring of the dividing line between health and social care, one provided by the local authority and the other by the health service, it makes even more important the liaison between those organisations and bodies. It is important that the local authority is given the opportunity to comment on pilot schemes, the review of pilot schemes and the possibility of making permanent those pilot schemes.

Amendments Nos. 34, 35, 37 to 39 and 41 bring in the provisions of the 1977 Act regarding consultation on changes to pharmacy schemes. I shall be interested to hear from the Minister why it was not felt necessary to put such local and national consultation on to the face of the Bill.

Amendment No. 24 deals with the annual report to Parliament. The Committee will be aware that we are encouraging diversity and innovation. Many different schemes up and down the country will be brought into effect. It is important that we are able to take an overall view of the effects of the legislation as regards those schemes which have gone ahead, those which have been amended, and those which have been made permanent. It is important to take a national perspective of the effect of the many different schemes introduced by different groups. I beg to move.

4.45 p.m.

Lord Alderdice: I speak to Amendments Nos. 5, 8 and 21. In so doing, I declare a potential interest were the legislation to be applied by order to Northern Ireland. I am the medical director of a health and social services trust in Belfast. It is that experience which leads me to speak on these matters.

I have drawn to the attention of the Minister that, in essence, Northern Ireland has had a pilot scheme of considerable proportions in that health and social services have been entirely integrated for more than two decades. In my judgment and that of most objective observers, the pilot scheme has proved most successful. There are two components of the scheme to which the

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amendments refer and to which I wish to draw the Committee's attention. There is tremendous co-operation between members of the medical profession, whether in hospital or in the community, and between consultants in hospitals and general practitioners. It seems clear that if pilot schemes are to be drawn up, consultation and co-operation among all medical professionals will be important. Hence it seems appropriate that if any pilot schemes are to go forward, there should be consultation with appropriate local representative committees. In the case of doctors it would be the medical committee; with regard to other professionals it would be the relevant committee.

However, we must also try to bring the community along with us. That seems obvious, but I draw the Committee's attention to the experience in Northern Ireland. It is a matter of continual surprise to those who visit us that social workers, doctors, nurses, psychologists and others work remarkably well together when they operate within the same organisation. In this part of the United Kingdom social services operate in local authorities whereas doctors and nurses and others operate separately.

That leads me to be strongly supportive of the notion that as we move, I trust, to greater co-operation between health service and social services professionals we should open the door in this part of the United Kingdom by encouraging--indeed requiring--consultation and co-operation with the relevant local authority. In particular one would wish to see the social services department of those authorities being consulted and thus encouraged to work more closely with health professionals.

In our experience progress in many fields has been remarkable. I refer in particular to the care of the mentally ill, those with learning disability, the elderly in the community, and children. In those areas co-operation between social services and health and social services and primary care has been remarkable and impressive. I ask the Minister to consider seriously encouraging and indeed requiring proper consultation and co-operation with local representative committees of doctors and other professionals, and especially with the relevant local authorities and their social services department.

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