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Baroness Sharp of Guildford moved Amendment No. 52:

Page 4, line 44, at end insert--
("( ) If a Primary Care Trust plans to make any changes in the services that it provides or arrangements it makes for the provision of goods or services to another health service body, then in preparing or reviewing any plan under this section it must consult, or seek the participation of, community health councils and voluntary organisations and members of the public who reside within Primary Care Trust areas, or any other area where people may be affected by the changes, and such other persons as the Secretary of State may direct.").

The noble Baroness said: This amendment follows directly from our earlier amendments about consultation. If we are asking for wide consultation about the setting up of primary care trusts, it follows that any subsequent major change in the role of the primary care trust in the services it provides or the way in which it operates should also be subject to consultation. I beg to move.

Baroness Hayman: The Government's aim for an establishment process is, as I said earlier in the day, that it is locally driven, takes account of all local views and is open and transparent. We envisage such proposals as being generated locally and the decision whether or not to establish the PCT will take into account a range of views.

When a primary care trust moves to a primary care group, with primary care trust level four status as provider of services--which clearly involves a reconfiguration of services--that primary care trust cannot be established until there has been consultation by the local health authority. I can assure the noble Baroness that the requirements for consultation currently in regulations, where there is a proposed substantial change in services, will be maintained for such changes proposed by primary care trusts after they are established.

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We also intend that where a primary care trust proposes a significant change in the provision of services for which it is responsible, there will be consultation requirements. In other words, we will ensure that the requirement now placed on health authorities in the Community Health Council Regulations 1996 to consult where there is a substantial variation in the services in their areas will also apply to changes proposed by primary care trusts after they have been established.

I hope that that will reassure the noble Baroness that we intend to ensure, through regulations, that there is appropriate local consultation before a PCT is involved in a significant change of provisions of services.

Baroness Sharp of Guildford: I thank the noble Baroness for her reply. We take note of her assurances that there will be wide consultation on such matters. In the light of the reassurances from her, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord McColl of Dulwich moved Amendment No. 53:

Page 5, line 9, at end insert--
("( ) Charges may not be imposed by the trust in respect of accommodation where that accommodation is for the purpose of receiving NHS treatment.").

The noble Lord said: This amendment is designed to ensure that no primary care trust that manages a hospital of any kind can levy charges for accommodation on patients who receive NHS treatment. It is to probe whether the Government are still prepared to rule out such charges, as the Secretary of State did in his 1998 conference speech. He specifically said, "No new charges". The Government may argue that such a provision is part of the National Health Service and Community Care Act 1990 and that this subsection merely brings the present system into line with previous arrangements. However, this is not required. If the Government are serious about not introducing new charges into the health service, they should not require such contingency clauses. The only explanation for its presence is that there may be a plan to introduce such charges in a future Parliament. I beg to move.

Lord Clement-Jones: We on these Benches are sympathetic to the thrust of the amendment. We believe that the position needs to be elucidated, particularly where PCTs have these kinds of institutions within their control. I suspect that this particular amendment gives rise to problems since it would prohibit charging for certain types of beds for which it would be legitimate to make a charge. The amendment may therefore be too broad, but as a method of probing government intentions in this area it is very helpful.

Baroness Hayman: Noble Lords seek to probe the Government's intentions in this matter. Our intention is to maintain the commitment given by my right honourable friend the Secretary of State for Health that there would be no new patient charges in the lifetime of this Parliament. I reassure the Committee that these are

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not new charges; nor do we expect this provision to have any impact on the number of amenity beds within the NHS where patients who receive NHS treatment may be charged for particular accommodation in a single or small room when they wish to have privacy. Any bed can be used as an amenity bed provided that no other patient has a clinical need for it; in other words, the exercise of this charging power must be ancillary to core health service functions. Our intention is simply to put PCTs on exactly the same footing as NHS trusts by replicating the powers that apply to NHS trusts' income-generating activities. To do less would put PCTs at an operating disadvantage and prevent community trusts which had these arrangements in place from continuing such arrangements when those trusts became PCTs.

Equally, as a safeguard we propose that PCTs are subject to the same restrictions as NHS trusts over the use of these powers. A PCT will not be able to exercise this power unless it is satisfied that to do so will not interfere significantly with the performance of its functions or its obligations under NHS contracts. In some instances the PCT may need Secretary of State consent. The new Clause 18A(6) allows the Secretary of State to specify in directions the circumstances in which PCTs require his consent to exercise their charging and income-generating powers. Such directions could, for example, specify an amount or percentage of income above which his consent is needed. We intend that NHS trusts will also be subject to these directions through the new powers in Clause 9. This will give the Secretary of State power to give similar directions to NHS trusts. It is our intention that PCTs will have no more than the same freedoms and be subject to exactly the same restrictions as NHS trusts when exercising their charging powers. I hope the Committee is reassured that this provision is a very limited one.

Lord McColl of Dulwich: I thank the Minister. I take it that she refers only to pay beds, if I may use that old-fashioned expression.

Baroness Hayman: According to my understanding of that term, pay beds were beds in NHS hospitals where private patients were admitted. This amendment deals specifically with circumstances in which a patient is receiving NHS treatment but in an amenity bed so that the treatment is provided free but a small supplement is paid so that the patient can have privacy if a single room is available that is not needed on clinical grounds for another NHS patient. This deals specifically with amenity beds.

Lord McColl of Dulwich: I thank the noble Baroness for that reassurance and beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

25 Feb 1999 : Column 1331

Lord McColl of Dulwich moved Amendment No. 54:

Page 5, line 24, at end insert--
("( ) The Secretary of State may by regulations make provision enabling a Primary Care Trust to enter into one or more agreements for the provision of specialist medical services for any area which includes that specified in its PCT order.").

The noble Lord said: The amendment arises from the concerns of the Joint Consultants Committee with which we are in sympathy. Every primary care trust and NHS trust must establish formal mechanisms for joint working and planning of district-wide services; and they should establish multi-disciplinary cross-sectional groups for each specialty. But there is a lack of clarity and detail in the Bill on the way in which the health services will work at district and regional level, and how services commissioned by primary care trusts will fit into this process.

The Bill does not make clear how the formal mechanisms for joint working will be achieved, and how the existing procedures for commissioning which are not working adequately can be improved. What mechanisms will be in place to achieve an overview of planning of regional level services commissioned by these primary care trusts? What mechanisms will there be to involve hospital consultants in the decision-making processes of the PCTs?

With the advent of patient focused services, NHS services need to be planned and executed jointly between the various agencies involved in commissioning and providing healthcare. Although the Bill makes provision for functions of primary care trusts, there is no clear direction for joint working between all relevant local health and social services agencies. Arrangements for joint working should be made more explicit by specifying the fora in which those agencies will discuss, consult and jointly plan local services. Without that provision it will be possible for different health authorities to develop different models of consultation which may lead to variations in the cohesiveness of the services.

An example of joint working and planning of services is the local diabetes service advisory groups (LDSAGs), of which there are currently approximately 160. They comprise GPs, specialists, nurses, dieticians, chiropodists, patients and others, and advise the district on diabetic services. This model could be used effectively in other specialties such as coronary heart disease and cancer.

I became aware of some of the budget problems when I chaired a national working party some years ago examining the provision of services for disabled people. We found that amputees were taken to the disablement services by ambulance in groups of five and 10; and it would be some hours before they eventually arrived at the centre, probably at midday when it often occurred that the people they went to see had gone for lunch. They waited several hours and the ambulance then returned to take them on the long journey back. It was obvious that a private taxi service, or even an expensive limousine service, would have been much cheaper, and

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quicker so that the service could have been better for the patient. But to extract the appropriate part of the ambulance service budget for such use was impossible. They were two quite separate authorities which did not interact or co-operate.

How do the Government intend to break down those kinds of barriers; and how will the PCTs become involved in the joint working arrangements between the various agencies involved in commissioning and providing healthcare?

Some of the services which are not commissioned locally are commissioned by a lead health authority on behalf of other health authorities in the region. Some services are provided on a regional or supra-regional basis. We wonder what would be the effect of this Health Bill on those services and how the services will be protected.

Finally, what will be the role of the regional offices in commissioning regional services such as cardiac or renal surgery? I beg to move.

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