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Lord Skelmersdale: I am afraid that I must tell my noble friend Lord McColl that I resisted the temptation to put my name to this amendment because of the shopping list phenomenon about which I have already chided the Liberal Democrats this afternoon. If my noble friend had left out paragraph (a) and the word "other" from paragraph (b), I could certainly have gone along with the amendment for all the reasons that he gave. However, as the amendment currently stands, I am afraid that I cannot support it.

Baroness Hayman: Perhaps I may find a "third way" between the two noble Lords!

One of the key principles underlying the development of primary care trusts is to have stronger professional input. That will be achieved partly through professional representation on PCT boards and partly through the

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professional-led trust executive. My honourable friend the Minister of State for Health recently published the arrangements for the governance of PCTs.

However, that is not the be-all and end-all. There will be a need for wider professional involvement in shaping and reviewing local commissioning policy and service agreements. We recognise that that is slightly different from the shopping list of consultees on the face of the Bill. It is an on-going task and it is important to have appropriate professional advice. We must recognise the key role to be played by secondary care clinicians in that work and by those in academic medicine. We would expect PCTs to ensure their involvement through, for example, membership of project teams. Similarly, the wider constituency of professional and other stakeholders will be engaged through the process of health improvement programmes, reinforced and underpinned by the new duty of partnership.

I have some sympathy with this amendment, especially because I acknowledge that the 1977 Act contains a similar provision in respect of health authorities. Therefore, with the leave of the Committee, I should like to take the amendment away and to consider it with a view possibly to returning at a later stage with a similar amendment, perhaps slightly altered in form, which may appease the noble Lord, Lord Skelmersdale.

Lord Colwyn: I did not realise that my noble friend Lady Gardner of Parkes had left her place in the Chamber. I must take up her cudgel and agree with my noble friend Lord Skelmersdale because I should like dentists also to be mentioned in the list.

Lord McColl of Dulwich: I thank the Minister very much for her reply and I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Clement-Jones moved Amendment No. 20:

Page 2, line 27, at end insert--
("( ) Appropriate arrangements shall be made with a view to securing that a Primary Care Trust's functions are exercised with due regard to the principle that there should be equality of opportunity for all people."").

The noble Lord said: I do not want to disguise the provenance of this amendment and I am pleased that the noble Earl, Lord Howe, and the noble Lord, Lord Astor of Hever, have put their names to it and to the linked amendment, Amendment No. 41, which relates to reporting on equal opportunities promotion.

Amendment No. 20 is fairly straightforward. It is clearly aimed at encouraging positive action in this area by PCTs. It is very much in the context of something commendable which has happened since this Government took office. I refer to the fact that they have placed much greater emphasis on reducing inequalities in health. That is reflected in their consultation paper on public health which explicitly recognised ethnicity as a factor associated with poorer health outcomes. Since then, the action report has been helpful in plotting some

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of the key areas for action. I have no doubt that that will be reflected in the Government's White Paper on public health, to which we all look forward greatly.

Surveys conducted by the Commission for Racial Equality, which in a sense is the provenance of this group of amendments, show that the ethnic minorities are concerned about access, outcomes and a variety of other matters related to inequality. We believe--this is particularly important and we have seen it only recently in other public services--that it is not good enough simply to be colour-blind; we must go out there and take positive action to eliminate inequalities. That is the only way to tackle some of these issues.

In 1992 the Commission for Racial Equality published a code of practice for primary healthcare services. However, it felt that the level of take-up by, and interest from, practitioners was not adequate and that there needed to be a statutory duty to promote equality if real action was to be taken by those working in the area, such as the primary care trusts. These provisions fall very much within the overall general principles of the CRE as enunciated in its proposals for reform of the Race Relations Act. Public bodies should have a general duty to work for the elimination of racial discrimination and for the promotion of equal opportunities. This amendment is clearly in line with the CRE's existing proposals. In a sense, the CRE has now followed up that long-standing set of proposals with its leadership challenge--an interesting challenge to all of us in public life--on the active promotion of equality. The CRE expects political parties, public bodies and others to promote that challenge. The health service should be no different. Indeed, it should be better than other institutions at doing that.

I strongly commend the approach set out in the amendments, which simply seek to impose a general duty to promote equality of opportunity. There is, in fact, a parallel. The Welsh Assembly has such a duty. That is provided for in the Government of Wales Act. There is, therefore, a precedent for this. It is with great pleasure that I recite precedent because we often hear from the Government Front Bench the argument, "Oh no, we have done this for years", so I say, "Well, we've done this for a year", so I very much commend this approach.

It is often very easy to insert words into Bills but I really believe that inserting such a provision into this Bill would kick-start something at local level. It would be absolutely four-square with the duties of a PCT and it would be a valuable signal, particularly in the current climate. I beg to move.

Lord Astor of Hever: I rise to support Amendment No. 20. The needs of ethnic minorities must be addressed. The primary care trusts must ensure equality of access to patient care for all those who need it. An equitable service requires sufficient information, training and resources to cater for all sections of society. The Royal National Institute for the Blind has collated clear evidence that people of African descent have a higher risk of developing glaucoma. The primary care trusts will need to recruit, train and retain staff who are able to communicate effectively with ethnic minorities

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and those who do not have English as their first language. Such appropriate arrangements should ensure that access to high quality patient care is equitable for all.

7 p.m.

Baroness Carnegy of Lour: I am wondering whether the wording is right. Of course I go along with what the noble Lord, Lord Clement-Jones, has said: the principle should be equality of opportunity for all people. In this case, is he talking about all patients? Obviously the opportunities for staff and patients are different. It is a bit bland and sounds rather like a formula. I wonder whether it could be made more precise.

Lord Clement-Jones: I thank the noble Baroness for that intervention. Of course it is fairly general and of course it applies not only to employees. Indeed the principle itself applies not just to ethnic minorities but also to gender balance and other aspects. If one started writing a more detailed principle, one might then be accused of making lists, I suspect. One has to be careful about this. This is a commonly accepted formula. If there is a better way of putting it I would very much welcome that. This is, as I say, a general formula, but it puts the onus on the trust to act in a positive way. It is not simply a passive approach.

Baroness Hayman: I am grateful to those Members of the Committee who have spoken and to the noble Lords who tabled these amendments which, importantly, raise the issue of equal opportunities within the National Health Service. I would say to the noble Baroness, Lady Carnegy, that we have to tackle within the health service both the issue of equality of access to services, to which these amendments were predominantly directed, and the issue of equal opportunities for staff members within the NHS. Although the amendments to this Bill may not be the appropriate way forward for ensuring that, and we must have a much wider programme to tackle both issues, both are important. Perhaps on the latter I might say, because it is important to make absolutely explicit the commitment in public services in these areas, that we are committed to rooting out all racism within the NHS and to ensuring that both patients and staff are treated with respect and fairness.

In December of last year we launched a campaign to tackle racism and set existing NHS bodies tough targets in order to stamp out racist behaviour. We have also, very importantly, increased the representation of non-executive directors who come from an ethnic minority background on the boards of NHS trusts and authorities. We have also signed up the NHS to the Commission for Racial Equality's Leadership Challenge. So there is a programme of progress in those areas.

In introducing his amendment the noble Lord, Lord Clement-Jones, put it firmly in the context of addressing inequalities in healthcare, and the noble Lord, Lord Astor, also referred to these areas. I think it is important that we identify within our new framework for measuring NHS performance fair access to services as one of the key dimensions against which the NHS will

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be assessed. We made clear in A First Class Service that all NHS bodies will be reporting annually on clinical governance, and within the ambit of clinical governance delivering on that commitment for fair access to services is very important. It is another opportunity to pursue that theme.

We intend to extend to primary care trusts the same drive to ensure that patients and staff are treated with fairness and respect, and we will need to look carefully to ensure that this permeates throughout the new arrangements. I am sure we shall expect to see it reflected in primary care trusts' annual reports, just as we see it now reflected, although there is no statutory obligation to do so, in the reports from NHS trusts.

It is an absolutely key theme of the Government that we should reduce health inequalities, and within the national priorities guidance issued for the NHS and for social services we made that absolutely clear. We have to make clear too that we recognise the diverse and sometimes differing health needs of different populations, to which the noble Lord, Lord Astor of Hever, referred. Yesterday I was launching a campaign to encourage organ donation among the South Asian community, where the rates of kidney disease linked to diabetes and high blood pressure are much higher than among the ethnically European population but where in fact the rates of donation are much lower. It is important that we recognise the health needs of particular ethnic groups and make sure that they are addressed. Often at primary group or trust care level that will be the absolutely appropriate place so to do.

I should like the opportunity to consider further these amendments. We want to take forward a shared agenda with both Front Benches opposite on these issues. If I may, I should like to look at the best way to take the points forward and whether they can be accommodated in terms of amendments to the Bill. I am happy to give that assurance, if the Committee agrees.

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