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Lord Kingsland moved Amendment No. 8:

Page 5, line 25, at end insert (", including conditional contracts which may or will be performed after the end of that period").

The noble Lord said: Clause 8(2) provides that the Bill does not apply in relation to contracts entered into before the end of six months from the day it is passed. Difficulties may arise where an option has been granted before the Act takes effect and is later exercised when the Act applies. In particular, is an option to buy something a contract to sell it conditional on the exercise of the option, or an irrevocable offer which does not become a contract until accepted by a notice which exercises the option?

That difficulty has been resolved by the courts, at least at first instance, with respect to options for the sale of land and by statute with respect to covenants between

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landlord and tenant. However, there are other situations in which difficulties may arise; for example, in a contract for the supply of up to a specified quantity of some bulk commodity under which the buyer is entitled to call for delivery during the contract period.

In those circumstances, and in the interests of certainty, and because the terms of the option would have been negotiated between the parties without regard to the Bill, I beg to move.

The Lord Chancellor: The noble Lord indicated that what he specifically has in mind, although not exclusively, by the expression "conditional contracts" is the grant of an irrevocable option, say, to buy land. That option might be granted before the end of the statutory six-month period referred to in Clause 8(2) and only exercised thereafter. If that option were to be characterised as a contract for the sale of land conditional on the purchaser's unilateral exercise of the option, it would qualify as a contract made before the end of the statutory period: whereas, if it were categorised as an irrevocable offer by the vendor requiring an act of acceptance by the purchaser after the statutory six-month period, the Act would apply to the contract constituted by that acceptance because the contract would have come into being after that six-month period.

The noble Lord indicated that the categorisation of such an arrangement had been addressed at first instance in the courts. It was addressed by Mr. Justice Hoffmann, now the noble and learned Lord, Lord Hoffmann, in Spiro v. Glencow Properties Limited in 1991 Chancery Division Reports, page 537. He held that the former was the correct categorisation and that the arrangement constituted a contract for sale conditional on the exercise of the option. I believe, but express no view myself, that this is generally regarded as the correct categorisation. But it might be open to a higher court to hold otherwise and that the option was no more than an irrevocable offer which fructified into a contract only upon acceptance.

We have no intention in the Bill of seeking to resolve unsettled and disputed questions of contract law by a side wind. If a court holds that a contract was made prior to the expiry of the statutory six months, the Act does not apply to that contract. If the court holds that the contract was made after the period, the Act does apply. Beguiling as the invitation is, we decline to take the opportunity of the Bill to seek to resolve any other issues of controversy in contract law. On that basis, I invite the noble Lord to withdraw his amendment.

Lord Kingsland: The steeliness of the noble and learned Lord's reply deters me from pressing the point any further. In those circumstances, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 8 agreed to.

House resumed: Bill reported with an amendment.

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Baroness Ramsay of Cartvale: My Lords, before we move to the Statement on NHS Direct, I would like to take this opportunity to remind the House that the Companion indicates that discussions on a Statement should be confined to brief comments and questions for clarification. Peers who speak at length do so at the expense of other noble Lords.

NHS Direct

4.16 p.m.

Baroness Hayman: My Lords, with the leave of the House I shall now repeat a Statement being made in another place by my right honourable friend the Secretary of State for Health. The Statement is as follows:

    "Madam Speaker, I wish to make a Statement on the development of NHS Direct; the nurse-led 24-hour helpline.

    "In March last year we launched three NHS Direct pilot schemes in Milton Keynes, Preston and Newcastle upon Tyne. Between them these pilot schemes covered over 1.5 million people. They have proved a great success. Up to the end of December they had taken over 60,000 calls. Independent research has revealed that 97 per cent. of users are satisfied with the service provided, which they find prompt, friendly and professional. It has been particularly popular with young mothers and around 40 per cent. of calls have been about children.

    "Callers get through at first to a call handler who takes the callers' details and deals with any requests for basic information. Those callers who have a specific health problem are then put through to a nurse.

    "The nurse listens to the caller, assesses the case, using what is called an expert computer based decision support system, and then recommends what action the caller should take. This can range from immediately summoning an emergency ambulance to advising them to visit their GP or their accident and emergency department, or advice on how to treat someone at home, or just offering simple reassurance.

    "A detailed survey of the three pilots showed that for the latest quarter: 80 per cent. of callers were advised to do something different from what they had intended before they rang NHS Direct; only 9 per cent. of callers had intended to look after themselves at home, but after calling NHS Direct 38 per cent. were enabled to look after themselves at home; 20 per cent. of callers were directed to more urgent care and 40 per cent. to less urgent care; and 530 people were transferred to the 999 service.

    "It rapidly became clear that the pilot schemes were a success. So last summer I authorised the extension of the scheme with 13 call centres to cover 40 per cent. of the country--20 million people--by April this year. The first of these opened last month

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    covering 1.1 million people in the Black Country. Yesterday, a further scheme covering 1.6 million people opened in Essex. A further service covering Nottinghamshire opens next week and the first service in London opens in parts of West London early in March.

    "The other areas to be covered by April are in the West Country, Manchester, West Yorkshire, Hull and East Yorkshire, Hampshire, North West Lancashire, Birmingham (as well as the Black Country), Lambeth, Southwark and Lewisham, Buckinghamshire, Northamptonshire and Oxford, Newcastle and the North East. Most of those services will be provided by the local ambulance trust but they usually involve the local GP co-operatives, other NHS trusts and voluntary bodies. In some cases local social services are involved as well.

    "The success of NHS Direct springs partly from the use of modern technology, properly managed and staffed by top quality professionals with a sympathetic ear. It also depends on commanding the support of the NHS in each locality and in particular the professions involved in providing primary care. At my personal insistence there will be a major role for GP co-operatives in the delivery of this service in many parts of the country. I am pleased to be able to report that the west London call centre to be located in Southall will be run by a local GP co-operative.

    "Our original intention was to extend NHS Direct to cover 60 per cent. of the country by April next year. However in view of its growing success and my concern to help the NHS cope with the special problems it is likely to encounter over the millennium period at the turn of the year, I have decided that this programme should be brought forward to aim to cover at least 60 per cent. of the country by the beginning of December this year. In some cases this will be achieved through extensions to the existing centres where the service is well established and in others through opening new centres.

    "It is intended to cover South Yorkshire, Leicestershire, Derbyshire, Liverpool and parts of London, in all of which NHS Direct could be particularly valuable next winter. To do this we will be investing from the NHS Modernisation Fund an additional £10 million on top of the £44 million from the fund already committed to the NHS Direct in the coming financial year.

    "NHS Direct is proving to be a modern, additional, convenient and dependable service for the people who turn to it. It is also proving to be a very popular and professionally satisfying service with the nurses who staff it. One centre recently received over 300 applications for 50 jobs. Nurses applying for jobs with NHS Direct have been coming from other parts of the NHS, from the private sector, and others are returning to nursing. With the support of the Royal College of Nursing and Unison I am very keen to encourage applications from experienced nurses who have left nursing because of, say, a back injury which left them unable to carry out routine nursing tasks. Working in NHS Direct could give them the

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    opportunity to continue to put their hard-won professional skills and experience to good use for the benefit of patients.

    "The new schemes should provide the basic NHS Direct advice and information service which has proved so successful in the three pilot areas--Newcastle, Preston and Milton Keynes. However, I should report that from July the Newcastle centre will be working with local doctors, A&E departments and other services to provide one gateway for out-of-hours services, providing a single number for patients to call. This idea shows the huge potential for using NHS Direct to develop new and better services for patients in a way that is also popular with the professionals involved. Building on the experience of this pilot I will be prepared to consider further pilots of this kind where NHS Direct has shown it can deliver the basic service and where there is joint commitment by both NHS Direct and the local doctors and other professionals involved to deliver services in this way.

    "Arrangements are now being made to set performance standards for NHS Direct call centres drawing on careful evaluation of experience so far and on best practice in other sectors. We are also determined to use the capacity of a national network we are creating to provide the most dependable service. NHS Direct is a good example of the opportunities which new technology offers to help make the best possible use of the professional skill and knowledge of NHS staff--21st century technology in place for the beginning of the new century.

    "I am pleased with the success of NHS Direct; delighted that it can be funded from the extra £21 billion we have found to invest in the health service, and glad to have been able to announce today that 60 per cent. of the country should have access to NHS Direct by December this year".

My Lords, that concludes the Statement.

4.24 p.m.

Earl Howe: My Lords, I shall be brief. First, I thank the Minister for repeating the Statement. From these Benches we believe that much of what it contains is positive and we give it a general welcome. I particularly welcome the fact that so many people availed themselves of the service plus the news that, against a background of fragile morale in the nursing profession, NHS Direct is attracting nurses out of retirement and that those who staff the service find it a professionally satisfying job. Long may that continue.

The debate of my noble friend Lord Rowallan in your Lordships' House last November on health service helplines enabled the Minister to apprise us of the background to the Government's thinking on NHS Direct and I do not intend therefore to go over the same ground again. However, the Statement gives rise to a few important questions.

One of my main concerns centres around the evaluation of the service. The Government took the decision last summer to proceed with the second wave

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of pilots and now we learn that the third stage of the programme is to be brought forward so as to commence later this year. That seems to be a rapid roll out. The Statement referred to a survey of the first stage pilot areas during the latest quarter. I was hoping to glean from that survey something in the nature of an evidence base on which a balanced judgment could be made in relation to the scheme's success. That is not what we have been given. It is one thing to discover that 80 per cent. of callers were advised to do something different from what they had intended to do before ringing up, but a more pertinent question might be: was the advice that they were given the right advice? Of the 530 people transferred to the 999 service, how many turned out to be genuine emergencies? Only with that sort of information and evaluation can a proper assessment be made of the cost-effectiveness of NHS Direct. It was therefore a little surprising to hear that Ministers have already felt able to judge the pilot schemes a success.

My other main concern relates to nurses. The key to success for NHS Direct is thorough and appropriate nurse training. Manning a helpline is a specialist skill. Can the Minister say anything about the training that nurses receive for NHS Direct? How rigidly is a nurse dependent on the computer-based protocol? Are the Government happy that the computer-based system can be relied on with confidence by nurses and patients? Also, can the Minister say what proportion of nurses appointed to NHS Direct come from other parts of the NHS? At a time of national nurse shortages there must be a worry if NHS Direct is sucking in trained nurses from areas that are already under considerable pressure.

I strongly agree with the need for NHS Direct to command support from the wider NHS in each locality and indeed from the professionals who deliver primary care--a point that I stressed in the debate last November. Perhaps I can ask about the procedural links between NHS Direct and GP practices. If an individual receives advice from the service, is the fact of that call, and the content of that advice given to the individual, automatically notified to the patient's GP?

I understand that in the pilot schemes a number of models have been running. I am aware of anxiety that, while local schemes with nurses based in GP surgeries allow more co-ordination with other primary care services, they are also thought to be less efficient and may be subject to regional variations in standards. On the other hand, national centres, which are viewed as more efficient and lead to more uniform standards, reduce co-ordination with local GPs. Have the Government come to any conclusion as to which scheme they prefer?

NHS Direct, as I said in our debate on the subject of helplines, is a service with considerable potential and we shall follow its development during the course of this year with close interest. We wish it well.

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