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Baroness Hayman: I hope that I can be of some help to the Committee on this. I thank the noble Earl, Lord Howe, for the tenor of his introduction of the first amendment. I undertake to try to emulate his desire to
be brisk and to the point. But this may not be the best amendment on which to start that process because I think that there has been some confusion in what the amendment would achieve on three separate issues.One issue is the setting up of primary care groups which is outwith the scope of this Bill. That is going on at this moment. I shall return to some of the other issues raised. Perhaps I may say to the noble Baroness, Lady Carnegy, that, as sub-committees of health authorities, primary care groups do not need any form of primary legislation. Therefore there is no question of taking powers in anticipation of legislation. Those primary care groups will be up and functioning by 1st April. I shall return to some of the issues raised by the Committee on ensuring that they function effectively and efficiently.
I refer to the implementation date for what will be set up within the Bill. The noble Lord, Lord Campbell of Alloway, referred to Clause 1. Perhaps I can reassure him that the terms for the setting up of primary care trusts--we shall address the Committee's attention to that in a moment--have been made quite clear. We want to spend time getting this right. They will not be set up before April 2000, so there is adequate time to undertake that task.
I believe that confusion has arisen on this issue. If the Committee were to agree to the amendment, it would not delay the introduction of either primary care groups or trusts. It would delay the abolition of fund-holding. We need primary legislation for the abolition of fund-holding. The reason why an interim and residual scheme has been introduced from 1st April of this year is precisely that we recognise that need. We cannot anticipate the legislation and we have to have a residual scheme available to those GPs who wish to avail themselves of the proposal until the Bill becomes law.
The issue is simply whether extending the existence of GP fundholding until April 2000 would assist in the process with which the Committee is concerned: to ensure an orderly and effective transition to primary care groups. I suggest that it would not. In essence it would be looking backwards rather than forwards. Our responsibility is to ensure that the change which has been agreed, which no one is questioning, works well.
I pay tribute to the large number of professionals and managers who have been working extremely hard to get primary care groups off the ground by 1st April of this year. I do not recognise the noble Earl's gloomy description of what is going on on the ground in primary care groups.
Obviously, it is a major undertaking, but already boundaries and governing arrangements have been agreed around the country. The pace of change is sensible; we do not expect everything to be achieved overnight. This year, £31 million have been allocated to health authorities to help them fund the preparations. The allowances paid to PCG board members are reasonable and consistent with those paid to other members of NHS bodies. A revised model of standing orders and SFIs were issued to health authorities last week.
There is an issue around redundancies, to which the noble Baroness, Lady Gardner, referred, and there have been concerns about the transition of staff. Our aim is to avoid redundancies. We have set in place clear in-house arrangements to help achieve that. We have also required all health authorities to appoint an individual to co-ordinate this and other fundholder closure work. It is too early to predict exact numbers, but we are confident that most who formerly managed a fundholding scheme will secure posts in the NHS. The noble Baroness, Lady O'Cathain, said that that was happening on the ground. Our policy is that redundancy costs chargeable to the fundholder, the allotted sum for fundholding staff, should be the same as those which can be reimbursed to GPs for GMS staff under the Red Book rules. This is equitable, but it does not preclude GPs offering enhanced redundancy terms. However, if they were enhanced that would have to be a practice expense.
I return to what the amendment would achieve. It would delay the abolition of fundholding; there would be a minority fundholding rump scheme. We believe that in recognising the achievements which fundholding GPs gained for some of their patients, and looking at the way in which many of them have taken the lead in setting up primary care groups, we will serve no purpose whatever in extending a scheme for a small minority of GP fundholders. If the Committee is concerned about ensuring that primary care groups from 1st April this year, and primary care trusts as they appear from April 2000 onwards, work effectively, we need an orderly and proper parliamentary approved end to the fundholding scheme as soon as possible so that everyone can divert their attention to the future. That is the reason why within the Bill we have made clear that as soon as it receives Royal Assent and becomes law we will wind up the scheme that has been put in place simply to cover a brief transitional period. I hope that on that basis the noble Earl will not press the amendment.
Earl Howe: I am grateful to the noble Baroness, although I am disappointed by her reply. The main point that I seek to make to her and to her noble friends Lord Haskel and Lord Peston is that the Government have not yet put in place arrangements for the orderly winding up of fundholding. That is the central issue. If they are unable to do so, it would be irresponsible to force the demise of fundholding with no safeguards for fundholder GPs and their staff.
With just over a month to go, PCGs have a vast agenda to complete in order to ensure that they are properly up and running. They must establish management structures and cost agreements; staff recruitment; accountability agreements with the health authorities; service agreements; develop investment plans; establish links with social services; design IT structures; and a whole lot more. Many PCG boards and health authorities are finding that an almost impossible hill to climb by 1st April. I believe that we need to be more sensible about it. My amendment does not mean that all fundholders must wait until March 2000 before winding up; it means that they do not have to wind up their fundholding arrangements by 1st April this year.
I am grateful to Members of the Committee who have supported my amendment and I believe that it is appropriate that we should test the opinion of the Committee.
4.15 p.m.
On Question, Whether the said amendment (No. 1) shall be agreed to?
Their Lordships divided: Contents, 72; Not-Contents, 137.
Aberdare, L.
Annaly, L.
Astor of Hever, L.
Berners, B.
Bethell, L.
Blaker, L.
Blatch, B.
Boardman, L.
Broadbridge, L.
Burnham, L. [Teller.]
Butterworth, L.
Cadman, L.
Caithness, E.
Campbell of Alloway, L.
Carnegy of Lour, B.
Chadlington, L.
Clanwilliam, E.
Clark of Kempston, L.
Cullen of Ashbourne, L.
Dacre of Glanton, L.
Davidson, V.
De Freyne, L.
Dean of Harptree, L.
Dundee, E.
Elles, B.
Erne, E.
Foley, L.
Fookes, B.
Gardner of Parkes, B.
Glanusk, L.
Haddington, E.
Harding of Petherton, L.
Hayhoe, L.
Hemphill, L.
Henley, L. [Teller.]
Higgins, L.
Howe, E.
Hylton-Foster, B.
Kinnoull, E.
Lang of Monkton, L.
Leigh, L.
Long, V.
Lucas of Chilworth, L.
Lyell, L.
McColl of Dulwich, L.
Mancroft, L.
Merrivale, L.
Milverton, L.
Monson, L.
Morris, L.
Murton of Lindisfarne, L.
Naseby, L.
Noel-Buxton, L.
Norrie, L.
Nunburnholme, L.
O'Cathain, B.
Pilkington of Oxenford, L.
Platt of Writtle, B.
Reay, L.
Rees, L.
Renton, L.
Renwick, L.
Rowallan, L.
St. John of Fawsley, L.
Simon of Glaisdale, L.
Soulsby of Swaffham Prior, L.
Sudeley, L.
Swinfen, L.
Teviot, L.
Wise, L.
Wynford, L.
Young, B.
Acton, L.
Addington, L.
Ahmed, L.
Alderdice, L.
Allenby of Megiddo, V.
Alli, L.
Alton of Liverpool, L.
Ampthill, L.
Annan, L.
Archer of Sandwell, L.
Avebury, L.
Bach, L.
Beaumont of Whitley, L.
Berkeley, L.
Blyth, L.
Borrie, L.
Brightman, L.
Brooke of Alverthorpe, L.
Brookman, L.
Calverley, L.
Carlisle, E.
Carmichael of Kelvingrove, L.
Carter, L. [Teller.]
Charteris of Amisfield, L.
Christopher, L.
Clarke of Hampstead, L.
Clement-Jones, L.
Clinton-Davis, L.
Cocks of Hartcliffe, L.
Craigavon, V.
Crawley, B.
Currie of Marylebone, L.
David, B.
Davies of Oldham, L.
Dean of Thornton-le-Fylde, B.
Desai, L.
Dholakia, L.
Donoughue, L.
Dormand of Easington, L.
Dubs, L.
Dunleath, L.
Eatwell, L.
Elis-Thomas, L.
Emerton, B.
Evans of Watford, L.
Ezra, L.
Falconer of Thoroton, L.
Farrington of Ribbleton, B.
Gainsborough, E.
Gallacher, L.
Geraint, L.
Gilbert, L.
Gladwin of Clee, L.
Goudie, B.
Graham of Edmonton, L.
Grenfell, L.
Hacking, L.
Hardie, L.
Hardy of Wath, L.
Harris of Greenwich, L.
Harris of Haringey, L.
Haskel, L.
Hayman, B.
Hilton of Eggardon, B.
Hollis of Heigham, B.
Howie of Troon, L.
Hoyle, L.
Hughes, L.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Hylton, L.
Ilchester, E.
Irvine of Lairg, L. [Lord Chancellor.]
Janner of Braunstone, L.
Jenkins of Putney, L.
Judd, L.
Kennet, L.
Kintore, E.
Kirkhill, L.
Laming, L.
Linklater of Butterstone, B.
Lockwood, B.
Longford, E.
Ludford, B.
Macdonald of Tradeston, L.
McFarlane of Llandaff, B.
McIntosh of Haringey, L. [Teller.]
McNally, L.
Maddock, B.
Mar and Kellie, E.
Methuen, L.
Milner of Leeds, L.
Molloy, L.
Monkswell, L.
Montague of Oxford, L.
Morris of Manchester, L.
Murray of Epping Forest, L.
Peston, L.
Pitkeathley, B.
Ponsonby of Shulbrede, L.
Ramsay of Cartvale, B.
Rea, L.
Redesdale, L.
Rendell of Babergh, B.
Rix, L.
Rodgers of Quarry Bank, L.
Rogers of Riverside, L.
Sainsbury of Turville, L.
St. John of Bletso, L.
Scotland of Asthal, B.
Sharp of Guildford, B.
Shepherd, L.
Shore of Stepney, L.
Simon, V.
Stallard, L.
Steel of Aikwood, L.
Strabolgi, L.
Symons of Vernham Dean, B.
Tenby, V.
Thomas of Gresford, L.
Thomas of Macclesfield, L.
Thomas of Walliswood, B.
Thornton, B.
Thurso, V.
Tordoff, L.
Turner of Camden, B.
Uddin, B.
Wallace of Coslany, L.
Walton of Detchant, L.
Warner, L.
Waverley, V.
Weatherill, L.
Wigoder, L.
Williams of Crosby, B.
Williams of Elvel, L.
Williams of Mostyn, L.
Young of Old Scone, B.
Resolved in the negative, and amendment disagreed to accordingly.
4.24 p.m.
Clause 1 agreed to.
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