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Lord Harris of Haringey: My starting point in tabling Amendment No. 84 was that I agree with Bernard Shaw that,

"All professions are conspiracies against the laity".

I was delighted to hear the noble Baroness, Lady Gardner, support the amendment, because I have not called for a greater majority of lay representatives, but I believe that there should be a majority of lay representatives. And the noble Lord, Lord Renton, raises an important point in relation to definitions of "lay"; it sometimes seems to be an extremely flexible term. I am conscious from my background in community health councils that those councils, which I had always understood were lay organisations, sometimes had quite prominent members. To take but two examples, there was a retired consultant geriatrician and a practising dentist on one council, neither of whom seemed to me to be that "lay" a person.

Given that there is widespread concern about the system of professional self-regulation and that the new commission will play an important part in reassuring the public about health service standards and quality, it is important that the intelligent lay person is clearly represented on that body. I noted that in the Government's White Paper--A First Class Service--there was a reference to,

"The Commission will need to provide a balance of expertise and experience and this will be reflected in its membership which will be drawn from patients, the professions, the NHS and academia".

I hope that a significant part of that--a majority but not a great majority--will consist of lay people who are not themselves practising or retired clinicians, but people who are able to bring a perspective of ordinary common sense of what it feels like to use the services in question. That seems to me to be the core definition.

Lord Rea: If the actual composition of the commission is not to be on the face of the Bill, can my noble friend give an indication of the underlying principles on which the members of the commission are to be selected? In particular, will it be part of those principles that the commission will have expert public health advice, particularly people who understand health statistics and epidemiology on which the whole measurement of health is based?

Baroness Sharp of Guildford: I endorse the definition given by the noble Lord, Lord Harris, of the concept of a "lay" member. From these Benches we believe that the definition is someone who is not actively engaged in the provision of services within the National Health Service.

5.45 p.m.

Baroness Hayman: Perhaps I can pursue that issue. I am not sure that that will fit the bill in all

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circumstances. I, too, was once asked to be a "lay" member of a Royal College ethics committee. I was told that I would be one of three lay members and felt enormously reassured by that because I would not be alone. I then found that, of the other two, one was an emeritus professor of moral theology and the other was the senior partner of the leading firm of medical litigation lawyers in the country. As I understood it, I was there to speak for the women of Britain. So we can all find ourselves in situations where the definition of "lay" is not as it would appear to the uninformed observer, and I accept the spirit of the argument.

Also, I recognise that in your Lordships' Chamber the definition of over 60 as "older" may not necessarily gain approval; outside your Lordships' Chamber it might be considered more acceptable given current retirement patterns. However, questions of definition should go back to the proposers of amendments rather than to the Government, who felt it better not to include them in the first place. I am much reassured by the comments of the noble Lord, Lord Renton. I was feeling considerably older as I approached my 50th birthday, but if I continue to feel the same way for decades to come then I think I shall be all right.

Returning to the amendment before us, the Government share the concerns expressed by the Committee today that the commission should have the right balance of membership to ensure that it undertakes its work effectively. It is important that the commission has the respect and confidence of the public and the NHS, of those who make use of the NHS as patients and carers, and of the staff who deliver the services. In that context, the points made in relation to the role, for example, of appropriate public health advice, the role of academic medicine and the role which has been focused on most, that of a lay membership with personal experience of using NHS services, are extremely important.

In A First Class Service we highlighted the need for the commission to have access to a wide range of experience and expertise drawn from those with clinical and other professional backgrounds, academia, management and a lay membership. We also made it clear that appointment would be on merit rather than representative of any specific interest or group. That is important. If we look at concern for the elderly, that should not be compartmentalised and be the responsibility of only one member of any board or commission.

The proposals we put forward met with broad support and the Explanatory Notes, at paragraph 138, stated that the commission's membership will include those with a lay background. Recognising also that the commission will cover England and Wales, in this one instance the Bill makes explicit provision for its membership to include a member appointed by the National Assembly for Wales who will make the special interests of Wales his or her personal care.

Members of the Committee can be assured that careful consideration will be given to appointments to the commission. The process will be open and in line with guidance issued by the Commissioner for Public

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Appointments. We intend that the commission's lay members should provide broader views and experience. They will provide an essential and major contribution to the commission's approach. We also made it clear that we felt that the commission should have a lay chair.

It was useful to hear the comments today of Members of the Committee. They will help us as we give further thought to the commission's membership and take recruitment further. For the reasons discussed in earlier debates in Committee relating to the possible exclusivity of lists, it is not essential to specify those on the face of the Bill. However, I hope that Members of the Committee will feel that we have given and will continue to give due weight to the need particularly to ensure that the commission has effective lay members and that it includes a broad range of expertise and experience.

Baroness Sharp of Guildford: I thank the Minister for that forthcoming reply to the series of amendments we have been debating. It has been an extremely good debate and I take on board her assurances that the Government will be looking at a broad membership in considering appointments to the commission for health improvement. I noted in particular the mention that the chair would be a lay representative. We are encouraged by that reply and therefore I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 84 to 88 not moved.]

Lord Clement-Jones moved Amendment No. 89:

Page 50, line 16, after ("State") insert ("and to the Public Accounts Committee of the House of Commons").

The noble Lord said: The spirit of this amendment is very much on the lines of the theme that we have tried to introduce; that is, improved transparency throughout the Bill. We talked earlier about reports from primary care trusts. Now we are in the area of reports, and the publication of reports, from the commission for health improvement. Amendment No. 89 deals with an obligation to publish reports or to submit reports to the Public Accounts Committee. The other amendments relate to the Secretary of State's obligation to provide wider publication.

The functions of the commission for health improvement are set out in Clause 15. They include: making reports on the arrangements that PCTs and NHS trusts have for monitoring and improving the quality of healthcare; making reports on the management and provision or quality of healthcare for which health authorities, PCTs or NHS trusts have responsibility, and making reports on the management, provision or quality of, or access to or availability of, particular types of healthcare for which NHS bodies or service providers have responsibility.

Clause 15 currently states that the Secretary of State may, by regulations, make provision as to the publication of reports and summaries of reports of the commission for health improvement. Schedule 2 states that the commission must report to the Secretary of State

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after each financial year on the exercise of its duties during the year and must provide the Secretary of State with such reports and information relating to the exercise of its functions as he may require.

In the interests of freedom of information, we believe that all of the commission's reports should be published and made available to the public, who have a right to know about the standards and quality of care being provided to them. In the event of a failure of standards, it will be even more important that information is made available to the public in order to avoid any fears of a cover-up and so that accountability can be properly exercised.

In cases where mistakes or accidents occur in the delivery of health services, it can be particularly upsetting for patients and their relatives to be left without a clear idea of what went wrong. It is probable that, at some time in the future, the commission may find itself investigating such sensitive and difficult cases.

The amendments in this group, from Amendment No. 91 onwards, would ensure that the Secretary of State does not have power to withhold any of the commission's reports from the public domain. Instead, the amendments would ensure that all the commission's reports were published and that the commission could also initiate publication of any other reports and information that it saw fit, without having to be requested to do so by the Secretary of State.

As regards the obligation to report to the Public Accounts Committee, I have no doubt that Members of the Committee have read a number of excellent reports from that committee. I can commend one in particular--by way of a plug for a debate on Wednesday--that it published on cervical cancer screening. That report shows that the committee has a good grasp of health issues. Such provision would be a good way of bringing into the public domain the reports of the commission for health improvement so that it is not simply at the discretion of the Secretary of State for Health to decide whether or not to publish. I beg to move.

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