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Deputy Chairmen of Committees
3.37 p.m.
The Chairman of Committees (Lord Boston of Faversham): My Lords, I beg to move the Motion standing in my name on the Order Paper.
Moved, That the Lord Elton, the Countess of Mar and the Baroness Turner of Camden be added to the Panel of Lords appointed to act as Deputy Chairmen of Committees for this Session.--(The Chairman of Committees.)
On Question, Motion agreed to.
Home Energy Rating Surveys Bill [H.L.]
Lord Ezra: My Lords, I beg to move that this Bill be now a read a third time. In so doing, I thank noble Lords representing all sides of the House who supported the measure for energy efficiency.
Moved, That the Bill be now read a third time.--(Lord Ezra.)
On Question, Bill read a third time.
An amendment (privilege) made; Bill passed, and sent to the Commons.
Sea Fisheries (Shellfish) (Amendment) Bill [H.L.]
Baroness Wilcox: My Lords, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to move a manuscript amendment or to speak in Committee. Therefore, unless any noble Lord objects, I beg to move that the order of commitment be discharged.
Moved, That the order of commitment be discharged.--(Baroness Wilcox.)
On Question, Motion agreed to.
National Health Service (Primary Care) Bill [H.L.]
3.39 p.m.
Baroness Cumberlege: My Lords, I beg to move that this Bill be now read a third time.
Moved, That the Bill be now read a third time.--(Baroness Cumberlege.)
Baroness Jay of Paddington: My Lords, before we move to the detailed consideration of the Bill, perhaps I may raise a general question which would be difficult to consider under the amendments put down in my name and in the names of other noble Lords. I do not wish to delay the House long and I have given the Minister notice that I would raise this general question at this point.
I raise it now, and not on the amendments concerned, because what needs to be said in moving the amendments, particularly the amendments in the first group to be considered by your Lordships, may change. I do so in a spirit of genuine inquiry because it is appropriate that we understand the context in which we are debating these important amendments as we do so.
Can the Minister tell us what has happened to a number of government amendments which were originally tabled for Report stage and are not now before the House even though the understanding of the House was that they would be brought back at Third Reading. Those amendments were either withdrawn before the Marshalled List was prepared or, in the case of a very important amendment--Amendment No. 18--withdrawn by the Minister at Report stage after debate with the commitment, given at col. 834 of the Official Report of 23rd January, to bring it back at Third Reading.
None of those amendments is on today's Marshalled List. I raise the matter because all of those government amendments referred to "companies" or "bodies corporate". As noble Lords who have been involved in previous proceedings on the Bill will understand, this is a crucial question because we are concerned that under the Bill there might be an involvement of private commercial companies--for example, the supermarket chain Asda or the pharmaceutical chain Unichem--and that they might become entitled to employ general practitioners.
I am grateful to the Minister for her letter dated 28th January which I received yesterday. It said that one of the amendments to which I refer needed further consideration by her and her department. However, I understand that there were meetings yesterday between the Secretary of State and representatives of the medical profession which may have changed the understandings on which we have all proceeded. Does the fact that the absence of these amendments, which the Government had, as we understood it, intended to put down, mean that they have changed their mind about the involvement of commercial companies in general practice? Can that option now be ruled out despite what the Minister said in Committee at
col. 1403 of the Official Report on 17th December 1996 about not ruling it out; or do they simply intend to bring the amendments back in another place?I raise this general question now because it could change the whole context of the consideration of the Bill at Third Reading and particularly the consideration of the very significant first group of amendments.
Baroness Cumberlege: My Lords, the noble Baroness is right. We are looking again at these provisions. In order to ensure that the clause is consistent, we have tabled two amendments to reverse the consequential changes to it which were agreed at Report stage and which were dependent on the withdrawn amendment. I intend to explain in a moment that we are holding further discussions with the medical profession on this and on other issues. We think it would be premature to reach a decision before we complete those discussions. I hope that this will satisfy the noble Baroness.
On Question, Bill read a third time.
Clause 2 [Proposals for pilot schemes]:
Baroness Jay of Paddington moved Amendment No. 1:
The noble Baroness said: My Lords, in moving this amendment I wish to speak also to Amendments Nos. 2 and 5. All three amendments stand in my name and the names of the noble Baroness, Lady Robson of Kiddington, and the noble Lord, Lord Walton of Detchant.
These three amendments address our central concern to which I referred in my general inquiry that the deregulation of primary care proposed by the Bill will lead to the commercialisation of general practitioner services. We debated these issues at Second Reading. At that stage the Government dismissed as chatter our fears that family doctors could be employed by supermarket chains. In Committee we produced amendments to prevent private dividend distributing companies from setting up services under the terms of the Bill. The Minister told your Lordships that local health authorities would operate a screening process which would only allow new primary care arrangements which were in the interests of their local populations. But she did not deny, as she had done earlier, that these new arrangements could be operated by supermarkets or, indeed, any other private company. Noble Lords will be aware that many such companies have already shown interest in the business opportunities that they could exploit by becoming involved in GP practices.
We did not return to this issue at Report stage because we understood--and the Minister confirmed earlier--that the Government were discussing these questions with the British Medical Association and other interested organisations. However, although these discussions continue--I believe there was an important meeting between the Secretary of State and the chairman of the British Medical Association only yesterday--nothing has emerged publicly to reassure us that the Bill
The three amendments before your Lordships today--Amendments Nos. 1, 2 and 5--seek to limit the possibility of private sector involvement to such an extent that it becomes commercially unattractive for profit-making companies. Amendment No. 1 restricts the scope of health authorities in assessing and putting forward to the Secretary of State proposals for pilot schemes for new services. If the amendment is agreed, only those who are "qualified persons" within the meaning of the Bill--that is, NHS trusts, GPs and dentists--will be entitled to be considered as suitable applicants. Health authorities which are approached by commercial companies will not be able to submit their proposals to the Secretary of State. We feel that this is an important additional safeguard which does not allow discretion to the health authorities to decide who should go forward.
Amendment No. 2 again restricts and limits the options of the Secretary of State to approve pilot schemes. The amendment proposes that majority control of any pilot must remain with GPs or suitably qualified nurses. The amendment also seeks to ensure that 75 per cent.--three quarters--of the net income must go to the qualified practitioners. This would make it very unlikely that a commercial company would judge a private practice organisation to be a worthwhile investment. At the same time it would leave open the possibility that the practice organisation could, for example, sub-contract commercially for some services such as out-of-hours deputising. I am sure your Lordships will know that that kind of arrangement already exists, particularly in large cities.
Amendment No. 5 to Clause 13 similarly seeks to limit those who can become health service bodies within the meaning of the Bill for the purposes of NHS contracts. It limits the health service bodies to qualified persons, thus again excluding commercial companies.
As I said earlier, the overall aim of the three amendments is to ensure that the family doctor remains an independent professional working within the National Health Service. Only if this system is maintained will patients have the confidence that they are getting the kind of objective advice and treatment on which trust in the NHS has been successfully built. A doctor who works for a commercial organisation is, as a human being, almost bound to be susceptible to the commercial pressures of a private company whose primary interest must be its bottom line profits rather than patient care.
Let me remind noble Lords--I tried to do this briefly in raising the general question before we reached the amendment--of what has happened since the Bill was introduced in your Lordships' House at the beginning of December. At first the Government denied completely that there was any intention of allowing commercial companies into GP services. The Minister said at Second Reading--at col. 592 of the Official Report of
I am sure that there can, and will be, similar objections to the details of the three amendments before your Lordships today. But the principle is clear: it is to prevent the commercialisation of general practice. It is a principle on which the British Medical Association is now conducting a campaign. It is seeking to mobilise the country's 36,000 family doctors to lobby MPs if the Bill reaches another place. It has given a commitment to question candidates in the forthcoming parliamentary election about what their position will be on this matter. Of course, that cannot be a politically attractive prospect for a government in the few weeks before a general election bearing in mind that the prospect of getting the support of GPs has somewhat vanished since a poll yesterday showed that over 50 per cent. of doctors intend to vote Labour. However, if political reality has at last set in in the Department of Health, and the Secretary of State's meeting yesterday with Dr. Macara of the BMA has produced concrete concessions, I hope that the noble Baroness will make the position very clear and specific when she responds to these amendments. I beg to move.
Page 2, line 40, at end insert--
("( ) An authority may only act in accordance with subsection (2) upon the request of a qualified person.").
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