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Baroness Thomas of Walliswood: I have restrained myself until this moment. I am entirely in agreement with the noble Lord, Lord Lucas, on this matter. As a member of a local authority for 12 years, almost all of our meetings were held in public. Working group meetings were not held in public because no decisions were taken at those meetings and the position was quite different. But any meeting where decisions were taken, whether it be a sub-committee or whatever, was held in public. When matters were not made public it was for a specific reason laid down by statute, always on the basis of advice from the responsible officer in the legal office who served that particular committee. This is a rather different situation. After all, both bodies spend very large sums of public money. A district general hospital spends about as much money as a district authority. I am not sure why one should have greater protection than the other.

Baroness Hayman: I am grateful for the intervention of the noble Baroness. I shall consider what both she and the noble Lord, Lord Lucas, have said. But I hope that the noble Baroness will acknowledge that the

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practice of NHS bodies particularly recently has been to hold meetings in public and not to make use of the provisions in any way to cloud matters or to meet secretively.

Baroness Thomas of Walliswood: I apologise for interrupting the noble Baroness. I am very glad to hear what she says. However, my experience of a few years ago was not in that direction.

Lord Lucas: I am very grateful for the support of the noble Baroness, Lady Thomas of Walliswood. Her experience bears out part of what I have said. I do not argue with the Minister and suggest that there is widespread misbehaviour, but this Bill gives these new parts of health authorities a power which, looking at health authorities and these bodies in general, they should not have. They should be much more tightly regulated as to what items they are allowed to debate in these circumstances.

Lord Nunburnholme: Perhaps I may remind the noble Baroness that a D Notice applies only in wartime.

Lord Lucas: I do not pretend to be able to draft the measure this evening. I am sure that the noble Baroness and her officials will be better at drafting than I am. However, it would be a better basis for legislation to specify in the Bill the information which allows the authorities to close meetings to the public rather than provisions allowing them general good will and giving them blanket permission to close meetings to the public.

I shall consider pursuing the matter at Report stage. However, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 19 [Co-operation between NHS bodies]:

Baroness Sharp of Guildford moved Amendment No. 132:

Page 15, line 32, after ("other") insert ("and relevant voluntary and community organisations").

The noble Baroness said: In Clause 19 we move from the Commission for Health Improvement to the duty of partnership. The purpose of Amendment No. 132, and Amendment No. 134, tabled by the noble Lord, Lord Harris, extends the duty to co-operate to include a duty on NHS bodies to co-operate with relevant voluntary and community organisations. The amendment in the name of the noble Lord, Lord Harris, carries that concept somewhat further forward. It places a reciprocal duty of co-operation on those bodies with the relevant NHS bodies.

The purpose of the amendment is to bring about better co-operation, communication and co-ordination between different parts of the NHS for the benefit of the public. NHS bodies should try wherever possible to work closely and co-operatively with outside agencies and non-statutory bodies such as community and voluntary groups, community health councils and other groups representing patients and health service users, advice and welfare agencies and the professional organisations and trade unions representing NHS staff.

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We from these Benches believe that such groups can offer a great deal of help to the NHS. Patients and patient groups are often well placed to advise on the quality of current services and to suggest ways in which services could be developed and improved. Advice and welfare agencies can bring a wider perspective to the NHS--for example, on public health issues such as the effects of poor housing and health. Professional organisations such as the Royal College of Nursing, the British Medical Association and the Royal College of Midwives also have a contribution to make.

Many NHS trusts already benefit from working closely with those organisations on such issues as employment policies and policies relating to clinical practice. Further co-operation of that kind, we believe, will benefit patients and staff and is to be encouraged. I beg to move.

Earl Howe: I am sympathetic to the general thrust of the amendments and the thinking underlying them, but I cannot support them. While we all want to see the best possible co-operation between the NHS and voluntary groups, it is no good imposing a duty in law on the health service to co-operate with such bodies when no corresponding duty is being created in reverse. There has surely to be symmetry. One would have to widen the scope of the Bill quite dramatically to achieve that, even presuming that it seemed to be a good idea in the first place.

Baroness Carnegy of Lour: I agree with what my noble friend said, but I believe that there is something behind the amendment to which the Government should pay attention. At the annual conference of the National Council of Voluntary Organisations on 21st January, the Prime Minister made what I think he intended to be a key speech on government policy. Perhaps I may quote one part. He said:

    "In the second half of the century we learnt that government cannot achieve its aims without the energy and commitment of others--voluntary organisations, business, and, crucially, the wider public. That is why the Third Sector is such an important part of the Third Way".

If voluntary organisations are the third way, and the "giving society" is a key government policy--I can find no fault with that--it is important to provide in the Bill that the health service bodies consult and co-operate with those parts of the voluntary sector involved in the area in which they are functioning. To that extent I believe that the amendment is important.

Baroness O'Cathain: For clarification, can we be given an estimate of the number of voluntary and community organisations which might be classified as "relevant"? Who will say that those organisations will be relevant? The people in the voluntary and community organisations probably count themselves as relevant, but who is to make the judgment? It could well be that they might not appear to be relevant to the people running the NHS.

Baroness Sharp of Guildford: The term "relevant" appears frequently in legislation in a somewhat ambiguous fashion. In this circumstance, a self-sorting

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mechanism arises. These are the voluntary organisations which are concerned with carers, caring organisations and particular aspects of health. I refer, for example, to the schizophrenia organisation.

Baroness O'Cathain: I believe that to put them on the face of the Bill would invite a huge raft of people to declare themselves as relevant. They may feel that they may have some influence and want to be heard. We could be creating an enormous bureaucracy and a talking shop, which is my problem with the amendments. I can see the principle or the thought behind them, but trying to effect them would be difficult.

Baroness Sharp of Guildford: My proposal is not to list them in the Bill, because there has been criticism of lists which have been given, but to allow for discretion on such occasions.

Lord Hunt of Kings Heath: I agree with what I take to be the intention behind both amendments; namely, to promote stronger relationships between all parts of the NHS and local voluntary, community and patient organisations and to bring about better co-operation. I do not believe that any Member of the Committee would disagree with that. However, apart from the specific points made by the noble Baroness, Lady O'Cathain, in relation to the definition of "relevant", I am not persuaded that the clause is the right vehicle for such a sentiment.

The clause we are discussing is directed to re-establishing the principle of partnership working across the NHS in place of the fragmentation of the internal market. The clause makes clear the reciprocal nature of the duty binding each of the NHS bodies to co-operate with each other. That is a sufficiently important principle to stand alone and I suggest that the clause contemplates a different kind of partnership relationship from that with non-statutory bodies.

I can conceive of few if any circumstances in which one would want to put the same duties of co-operation on these non-statutory, and sometimes informal, bodies as are appropriate to bodies working within the NHS. Indeed, I suggest that the onus has to be on the NHS to reach out to such bodies, inviting their participation in planning and delivering improvements in local services and the health of the local community.

In that context, Clause 21 on developing and taking forward local strategies for improving health and healthcare seems to be the better context for pursuing voluntary body, user, carer and community involvement. There are a number of amendments to be debated on that clause to which we shall turn shortly. However, we have already made clear in previous guidance on health improvement programmes the crucial importance of promoting full involvement in the full range of community, voluntary, user and care interests in developing these plans. Work is in hand with health action zones and others to promote stronger forms of community involvement.

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Given the forthcoming debate on Clause 21, I hope that the noble Baroness will agree that an amendment to the duty of co-operation on NHS bodies would not be appropriate.

9.30 p.m.

Baroness Sharp of Guildford: I thank the Minister for his answer, although I am not satisfied with it. We have deliberately drafted the amendment so that the duty of partnership is on the NHS bodies to share and co-operate with the voluntary organisations.

The point made by the noble Baroness, Lady Carnegy, is extremely important in this regard. Given the role that voluntary organisations play today within the NHS, it is extremely important that they are included and not excluded from that partnership. In the light of that, we shall look carefully at the Minister's reply. We are not fully satisfied with his answer and we may wish to return to the matter on another occasion. However, for the moment, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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