Previous Section Back to Table of Contents Lords Hansard Home Page

Lord Rea moved Amendment No. 15:

Page 3, line 28, after ("authority") insert ("and the applying qualified person").

The noble Lord said: The amendment asks that reasons be given by the Secretary of State for his decision to modify or reject a pilot scheme. As drafted, the Bill allows the Secretary of State to come to a decision about the suitability of a proposal for a pilot scheme without stating the reasons for his decision. We agree with the Royal College of Nursing that for reasons of openness it would be beneficial for those involved in drawing up a proposal to know why that proposal had been rejected or modified by the Secretary of state.

In the case of a rejection, that might allow a suitably modified proposal to be put forward which would be acceptable. We should like the Minister to expand a little on whether the Secretary of State will give full reasons for decisions taken in order to guide the people who put forward the proposal. I beg to move.

Baroness Robson of Kiddington: We support the amendment. It is important in particular that where a pilot scheme has been rejected, the proposers should discover the real reason for rejection so as to be able to decide whether to reapply.

Baroness Cumberlege: In a spirit of helpfulness--the noble Baroness, Lady Jay, is not in her place! I shall be helpful when she returns to the Chamber.

The proposals for pilot schemes will be put to the Secretary of State by health authorities and boards. Where the proposal has been made by a provider who is a "qualified person" within the meaning of the Bill--a GP, general dental practitioner or NHS trust--the health authority must put it forward. The reason for the health authority or board involvement is to encourage discussion of proposals between authorities and potential providers and to ensure that the proposal is set out in a format which is in line with the Secretary of State's directions.

It seems sensible to maintain the link between health authorities or boards and the Secretary of State once the decision on an application has been taken. But the reasons for this are above all practical. The Secretary of State may need to take decisions on a large number of proposals. In the case of some proposals, there may be a significant number of potential providers of services. If the Secretary of State has to inform each of them in turn of his decision we could end up with a huge mailing exercise at the Department of Health, unnecessary bureaucracy and greater potential for mistakes. Some providers could end up finding out about the decision before others, which is clearly a state of affairs to avoid. Far better for the decision to be passed to the relevant health authority or board and for it then to have to inform the providers of the outcome as a matter of priority. Where the proposal has been approved, this will be just the first of many contacts between the health authority or board and providers as they will then need to finalise contracts and other operational details.

I hope that the Committee will agree that we should avoid needless centralisation of the piloting process. The arrangements set out in the Bill will secure this and also

17 Dec 1996 : Column 1448

provide a quick and efficient way of disseminating information about approvals of pilots. We believe that the amendment could threaten this, and I hope that the noble Baroness and the noble Lord will not press it.

Lord Rea: I listened carefully to the Minister, but do not believe that she has covered the point which the noble Baroness, Lady Robson, and I made about the bodies whose proposals are rejected. Surely, it is very important for them to know in some detail why they have been rejected. That can be transmitted to them by the health authority concerned but I believe that the provision should be included in the Bill so that applicants for pilot schemes know why their proposals have not found favour.

Baroness Cumberlege: The noble Lord is right in saying that we want a great deal of discussion between the health authorities and those proposing pilots. We do not believe that putting forward a proposal for a pilot scheme is like an exam which is marked and is either right or wrong. We believe that there will be a long iterative process with a number of pilots. Certain aspects will need to be tested out, particularly if the Secretary of State has questions or seeks further information.

The situation is ongoing in terms of agreeing the schemes and therefore we believe that it would be unhelpful to have to say at a single point that a decision must be made and put in writing. The discussion may well go on for longer.

Lord Rea: The Minister's last remark was helpful. I am speaking as one who has put forward proposals for research projects which have been rejected. I know that sometimes the body which has been approached helpfully gives referees' reports showing why they did not believe the project was worth funding.

However, I believe that the Minister has said enough and we shall look at that carefully. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 16 not moved.]

Clause 3 agreed to.

Clause 4 [Making of pilot schemes]:

Baroness Hayman moved Amendment No. 17:

Page 3, line 44, leave out ("implementing proposals") and insert ("receiving notification of approval from the Secretary of State").

The noble Baroness said: This is a straightforward amendment. It follows from the previous amendments in that it deals with the procedure when the Secretary of State has approved proposals for a pilot scheme. As the Bill stands, the details of the scheme are to be published only upon its implementation. If the schemes are to be successful, as we would all wish, and as they change the nature of the services and the way in which they are provided, we believe that it will be sensible if the details of the approved scheme are made immediately available to those who might be affected by it rather than on implementation.

There is always a timelag in such matters until the public and the patients become used to changed services. It will help no one if a scheme is up and

17 Dec 1996 : Column 1449

running before its details are made known locally. The purpose of the amendment is to ensure that such details are published as soon as the health authority receives approval from the Secretary of State. Following from what the Minister said earlier, I assume that will be when the scheme and its details have been decided and will no longer be for negotiation between the parties. The appropriate point for details to be published locally is when the scheme has been firmed up and not later at the point of implementation. I beg to move.

Baroness Cumberlege: Clause 4(4) is intended to ensure that the system is open and above board, which all noble Lords believe to be right. What people need is good quality information about the services that are available now. We drafted the clause with this in mind. Our aim is that people should be able to find out about the scheme and would be aware of the system they were being treated under and the service that they could expect.

We have two difficulties with the amendment set against these criteria. First, it is possible that the Secretary of State may give approval for a scheme six months or more before it is implemented. Yet at this point some of the contractual details of schemes may still have to be tied down through negotiations between health authorities and boards and providers. There could also be changes to a scheme in the period between approval and implementation. Most such changes will require the Secretary of State's agreement, but authorities may be permitted to make some themselves by agreement with providers. It would not be very helpful if information about schemes was published and then had to be revised, even before the scheme was operational. Generally, people want up-to-date information about the services they can obtain now, rather than about long-term plans for the future. Putting information that may change into the public domain ahead of time could lead to confusion. For that reason, we cannot support the amendment.

Baroness Hayman: I am grateful for the Minister's comments and I understand the difficulties that she outlined. However, a balance must be struck. There will be some approved schemes which are about to be implemented by the Secretary of State and I do not believe that it will be helpful for their details to be held back necessarily to the date of implementation. As I said previously, there is a timelag during which patients become used to a new pattern of services. It might be helpful if in guidance given to health authorities it was stressed that the earliest point at which a scheme is definite in its detail is the appropriate time at which to make that known, in the sense that there should be no constraint to wait until implementation if there is a possibility of doing that sensibly earlier.

6.30 p.m.

Baroness Cumberlege: That is a suggestion that we should wish to consider carefully. But it must be seen

17 Dec 1996 : Column 1450

in the context of all the consultation which we discussed earlier in the day. My experience of the National Health Service is that nothing is ever secret.

Baroness Hayman: It is not always totally clear. There are often many versions of what is going on. But on the basis of what the Minister said, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 18 not moved.]

Clause 4 agreed to.

Clause 5 [Reviews of pilot schemes]:

Next Section Back to Table of Contents Lords Hansard Home Page