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The noble Lord said: My Lords, this amendment is the same as Amendment No. 3, which I moved at Committee stage. Before I explain what the amendment entails, I should like just to quote the last part of the noble Baroness's reply at Committee stage. She said:
To that I replied a little later that although they would be paid from different sources, it would surely be easier to make the arrangements within a pilot scheme than to have two entirely separate pilot schemes. The noble Baroness, Lady Gardner of Parkes, expressed the same opinion as myself. That is why the Minister said that she would go away and think about the matter.
I gather that the British Medical Association is slightly more in agreement with the Minister than I am and sees the complexities that she mentioned as very important. Personally, I do not see the matter that way. But I should be grateful if she could say what deliberations she has had between Committee stage and now. I beg to move.
Baroness Cumberlege: My Lords, as the noble Lord said, we discussed this matter at some length at Committee stage. I should like to reassure noble Lords that I support wholeheartedly the objective behind this amendment, that of encouraging better integration of services provided by the different professions. After all, that has been one of our aims in primary care for some time. It remains a priority.
I undertook to consider further the need for Clause 1(2) and to advise your Lordships at Report stage of the outcome. I have done so. But I remain convinced that the provision in the Bill which this amendment seeks to remove will not hinder further progress towards co-operation between the medical and dental professions. There will be nothing to stop doctors and dentists examining local health needs together and co-operating over the preparation of pilot proposals, perhaps sometimes involving joint premises, which was one of the examples given by the noble Lord at Committee stage. Those proposals would then go forward together but be presented as separate schemes.
The Bill certainly will not stand in their way. It simply requires separate contracts for what are already two distinct services with very different financial and practical arrangements. They will need separate consideration locally and probably different evaluation. It will help to ensure that funding for dentistry is spent on dentistry. Failing to maintain the distinction between the two services could produce confusion for little gain.
I know that the provision as currently drafted in the Bill has the full support of the General Dental Services Committee. I hope that your Lordships, having heard my explanation and reassurances, will not seek to press the amendment.
Lord Rea: My Lords, I understand the position of the noble Baroness a little better, though I still do not understand why that provision has to be on the face of the Bill. It seems to me that in drawing up pilot schemes, that would automatically have been sorted out. But it is an academic point. So long as the noble Baroness can assure me that there will be schemes in which the two professions can collaborate, I see no point in pressing the amendment further. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 2 [Proposals for pilot schemes]:
Baroness Jay of Paddington moved Amendment No. 4:
The noble Baroness said: My Lords, my name is to the other amendments in this group. Perhaps I may speak to those and the noble Baroness, Lady McFarlane of Llandaff, may wish to follow me. I should certainly like to move Amendments Nos. 9 and 13 which are in this group and to which my name is attached.
The purpose of all the amendments is to deal with the need to ensure that the quality of service is maintained in pilot schemes. That is the particular requirement of Amendment No. 4 in the name of the noble Baroness, Lady McFarlane. Amendments Nos. 9 and 13, standing in my name, are proposals for pilot schemes and subsequently for judging whether those pilot schemes should become part of the permanent local services.
We raised those issues at Committee stage because we feel it is very important that consistent standards and services so far as possible should be offered by all primary care providers, whatever part of the country they are in or on whatever basis that provision is made, however widely the notion of the pilot experimental scheme is drawn. The House will be familiar with the great concern on these Benches that in the past few years what we describe as a fragmented health service is producing a system in what you get depends on where you live and not necessarily on what you need. We fear that the defects of the system may be exacerbated by the deregulation proposed in the Bill without a statutory requirement to establish national criteria for standards.
Therefore, the amendments propose that requirement to adhere to national standards of care and service which would be established by a nationally representative body. That would also avoid the suspicion that local health authorities might promote local schemes on the basis simply of cost and that cost saving might become
I was encouraged that at Committee stage the Minister said that the Department of Health was establishing "a nationally representative group"--the expression used in these two amendments--to take this matter forward and to discuss criteria governing the approval of pilot schemes. She developed those points in Committee (Hansard, col. 1445).
The noble Baroness also said that the criteria would be established and published before pilots were considered and indeed, of course, the proposals for long-term service change which might arise from those pilots. That is also welcome.
Amendments Nos. 9 and 13 simply seek to give force to those understandings which the Minister expressed at an earlier stage by establishing on the face of the Bill that the national representative group which she said was being established would have statutory authority to set criteria on which the Secretary of State will make decisions about the value of pilot schemes to the communities they are intended to serve. I beg to move.
Baroness Cumberlege: My Lords, as the noble Baroness said, these amendments focus on the quality and standards in the pilot schemes. We share those objectives. We believe firmly that we will secure them through the Bill as it stands and through our approach to implementation.
Amendments Nos. 9 and 13 concern the setting up of statutory groups of interested parties to advise on quality and standards and on criteria for evaluation. We are already doing that. As the noble Baroness said, two such groups have already been set up--one for medical services and one for dentistry--with representatives from the professions, patients and other interested parties. They are to help identify the standards and criteria that should apply before pilots are approved and to advise on a framework for evaluation. The first meetings will be held next week. We see those groups as playing an important role but do not see the need to enshrine them in legislation.
I hope that the noble Baroness, Lady Jay, will agree that, while we share her concerns, we have largely met them. We regard an open, consultative approach as the best and probably only way for our initiative to get off the ground and flourish. We see the groups as playing a leading role but do not see the need to enshrine them in legislation.
Since piloted schemes will vary enormously, it is important that the overall standards and values are clearly set out and that individual schemes have clearly defined aims and objectives against which health authorities and others can judge whether they have
I hope that I have shown that we are committed to a broad national framework of standards and values within which pilots will operate and be evaluated. I hope that I have demonstrated also how serious we are about seeking the advice and views of those with an interest. I trust that the noble Baroness will agree that that meets many of the worries expressed in her amendment and that she will not therefore seek to pursue it.
The approach I outlined also satisfies the aims of Amendment No. 4. I made clear that we do not underestimate the importance of raising the standards and quality of services. It will be one of the key agenda items for our national representative groups. Our initiative is unequivocally about achieving improvements in services. I hope your Lordships will accept my assurances that any pilot proposal that does not set out how it will improve services will not be allowed to proceed and that your Lordships will not press the amendments.
Page 1, line 15, leave out subsection (2).
"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".--[Official Report, 17/12/96; col. 1419.]
The Government have not tabled an amendment
embodying those further thoughts and I had no alternative but to move the amendment again. It removes from the Bill the words:
"A pilot scheme may not combine arrangements for the provision of personal medical services with arrangements for the provision of personal dental services".
I said at Committee stage how I personally had benefited from working in a health centre where both dental practitioners and general medical practitioners working for the National Health Service collaborated very beneficially for both the professions and the patients concerned. It seemed to me strange that the two helping, clinical professions could not put forward a scheme together. But the noble Baroness said:
"General practice and dentistry are very distinct services ... with very different financial and practical arrangements. The Bill maintains this distinction and avoids the complexities that could arise if the services were covered by the same contract".--[col. 1418.]
4.15 p.m.
Page 2, line 37, after ("scheme") insert--
("(aa) satisfy themselves that there is no diminution in the quality or range of services provided in an area which is covered by the pilot scheme,").
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