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Lord Walton of Detchant: I have considerable sympathy with the objectives underlying both Amendments Nos. 28 and 29. On Monday last I spoke in your Lordships' House on trying to persuade the Royal Commission to oppose any principle that there should be a mandatory age of retirement for life Peers. It is seven years since I received a letter from the Oxfordshire health authority thanking me for my services and saying that, now I had reached a certain age and my honorary clinical contract had expired, I could visit the hospital for social reasons but could not use the clinical facilities.
We may bear in mind, for instance, the attitude of the United States Government. They have now decided that discrimination on grounds of age is illegal and is contrary to the US constitution. It is right that the Government should seriously consider the possibility of involving not only younger people but older people in
many of the bodies concerned with the management of the National Health Service. As the noble Earl said, we should recognise the crucial importance of having a majority of members of the healthcare professions on these bodies. Therefore in a sense both of these amendments can be supported.
Lord Warner: I oppose Amendment No. 29. In the past I spent some time as a member of an executive council and of a family health service authority. I can still remember the rather gruesome meetings of the executive council, which were heavily dominated by healthcare professionals. It is to the credit of the previous government that they introduced a far stronger lay element into family health service authorities and other health authorities.
Having sat through debates in those health authorities, I have seen the major contribution that lay members have made to those bodies and how they have influenced the thinking of healthcare professionals. A proper balance is necessary in those kinds of bodies if the best interests of the public are to be served. Now, many health professionals would take the view that they prefer a situation in which there is a good balance and an even spread of committed people from the lay communities who contribute to healthcare policy and its delivery at local level. We should reflect on the experience of the past 10 to 15 years, when there has been a much stronger injection of the lay element into healthcare bodies.
Baroness Thomas of Walliswood: I wish to make a slightly narrower point relating to the balance among professionals. Today I have received a rather angry letter from the Chartered Society of Physiotherapy, expressing disappointment that the professions allied to medicine are once again not specified in the Bill as being desirable members for trusts.
It is relevant to remember that among those other professionals physiotherapists are experienced in community healthcare, not merely in the delivery of services at GPs' surgeries. Therefore, along with those of a similar professional background, they make a large input in terms of the improvement of community services, which is likely to become part of the responsibilities of most PCTs. The point is that it is not until the most superior stage, as it were, of the development of a PCT that it apparently becomes possible for those professions to be represented on the board. I hope that the Minister can offer some reassurance on that matter.
Baroness Gardner of Parkes: I support the remarks of the noble Lord, Lord Warner. I, too, remember the Inner London Executive Council, of which I was a dental member. At least 50 per cent. of its members were professionals. The dentists were told: "Unless you vote to support the doctors, we shall vote against you". It was worse than any trade union--not that I have ever been a member of a trade union. It was as closed a shop as anything that existed. Many of the London boroughs took an active part in telling Sir Keith Joseph that, whatever happened, he must do away with that built-in
majority that was so wrong. I therefore support the view that there should be a balance. No one group should have a built-in majority so that it can pressure others into supporting a proposal that they would otherwise oppose.
Baroness Fookes: I should find it easier to evaluate all these amendments if I had some idea of the size of the body of which all these people would be members. Is it possible for the Minister to give us some better indication as to the likely range of sizes? All these matters are to be included in regulations of which, as yet, we have no sight.
Baroness Hayman: On the last point, I think I can help the noble Baroness. As I said earlier, the proposals for the Government's arrangements for primary care trusts were published at the end of last week. Copies have been placed in the Library. I shall go into more detail later as I realise there has been only a short period of time for Members of the Committee to examine the proposals and the balance that we are attempting to strike in membership of the boards and primary care trusts.
The contributions to the debate indicate the need to strike a balance and some of the difficulties in so doing. We have heard cogently argued the reasons for maintaining a professional majority; there have been equally strong representations that a professional majority is not appropriate and that there ought, for reasons of probity and responsiveness, to be a lay majority. Later in my remarks I shall go into the detail of how we attempt to reconcile and achieve what we believe to be an appropriate balance, and also to see that there is the right balance between the professional groups and bodies concerned. Although GPs must be extremely important--and the PCG governing arrangements place GPs and nurses firmly at the forefront--when it comes to primary care trusts we are talking about a different animal, and different governance arrangements are appropriate.
Perhaps I may deal first with Amendment No. 26 and the linked Amendment No. 30, removing the power of the Secretary of State to appoint the chairman of the PCT board and putting in place election between the members of the board. That is not an appropriate way forward. It is a well-established principle that the Secretary of State appoints the chairmen of NHS bodies. It is a way of ensuring that those bodies can be held to account by the Secretary of State. I see no reason that that should be different for primary care trusts. As with other NHS bodies, the Secretary of State will ultimately be able to dismiss the chairmen if necessary. Not to have that arrangement would mean not having a proper chain of accountability from primary care trusts upwards to the Secretary of State and, via him, ultimately to Parliament.
We must bear in mind that each primary care trust will be responsible for large sums of money--at least £60 million. They will need to help achieve national priorities and develop and deliver local health improvement programmes. There has to be public confidence in the accountability.
We have found that the system of chairmen being appointed by the Secretary of State and being accountable to him has worked well with other NHS bodies. There is no reason why it should not do so with primary care trusts.
We want those trusts to be firmly rooted in their local community, and responsive to the health needs and wishes of local people. That is very much in line with existing NHS bodies. However, it is why, in selecting a chairman, the Secretary of State will consider a range of factors, including experience, knowledge and the level of confidence that is commanded by the individual within the community. That gives us some reassurance that the arrangements will provide a sensible balance between accountability upwards to the Secretary of State and the involvement of local people, not just as chairmen but as non-executive members of the trust board in running PCTs. I urge the Committee to agree that we should maintain those arrangements.
I now deal with the issue of who should be included; who should be the lay members. I shall then come to the major issue of the balance on the board. It is important that we recognise the need to represent all sections of the community. Once we start specifying a particular group with needs, such as the elderly, who are major users of the health service, their needs are important and must be taken into account. The noble Baroness, Lady O'Cathain, pointed out that there are other users at the other end of the age scale who also need to be represented. Representing the needs of children is not easy in an automatically representative way. The noble Lord, Lord Rix, talked earlier about the possibilities of people with learning disabilities being involved in the governance of trusts that provide services for that group.
I do not believe anyone would dissent from the broad aim of the amendment. We certainly wish lay members to be drawn from all sections of the community. However, we also want them to be not only from different age groups but also from different ethnic and racial groups and to represent different walks of life. As it stands, the provision allows lay members to be appointed who ensure that.
At present we make the appointments in line with the principles of the Commission for Public Appointments. In doing so, we have made clear that we have been trying to increase the representation of people from the locality of the NHS body concerned. We have published goals on the appointment of women chairmen and members of NHS boards and those from ethnic minorities and that a guaranteed interview scheme is operated for people with disabilities. Those are all measures to try to ensure that we have a wide spread of people.
Equally, there is no age limit to those who can become members. I heard what the noble Baroness said in relation to that. I have seen appointments of elderly members of the community to trusts within the department. Perhaps I could give the breakdown by age at present. Of those appointed at the moment, 7.5 per cent. are aged up to 39--not many representing the
younger end of the spectrum. I remember that when I was younger I was always being asked to come onto boards because there were too many old people and they were trying to make the board younger. Pendulums swing and perhaps I shall now come into fashion in my later years to redress the balance in the other direction. Of those appointed at the moment, 66.5 per cent. are aged 40 to 59 and 26 per cent. are aged 60 and over. That is a substantial group already there.8.30 p.m.
Baroness Gardner of Parkes: Can the Minister tell us of those aged 60 and upwards, up to what age? How many are over 70 and how many are over 75?
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