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Lord Mackay of Drumadoon moved Amendment No. 188A:

Page 31, line 3, after ("trust)") insert (", at least two of whom shall be a registered medical practitioner and a registered nurse or midwife,").

The noble and learned Lord said: Amendment No.188A seeks to amend Clause 39 to provide that Section 12A of the 1978 Act would have additional words inserted to the effect that at least two of the executive directors, that is, directors who are employed at the trust, shall be in the first instance a registered medical practitioner and a registered nurse or midwife. The amendment was tabled by my noble friend Lord Mackay of Ardbrecknish after consultation and has the full support of the Royal College of Nursing.

The purpose of the amendment is quite clear: it is to ensure that health professionals, including a registered medical practitioner and a nurse or midwife, are represented at executive level on each of the National Health Service primary care trusts and acute hospital trusts in Scotland.

If acceptable to your Lordships, the amendment would enshrine in statute the commitment by the Government that there should be a nurse director as one of the executive directors on the board of each of the trusts. The matter is dealt with in a number of places in the White Paper. Page 12 indicates that the Government are committed to giving clinicians who work in the hospitals, along with those who use their services, a bigger say in management.

Clearly the amendment fits in with the manner in which the policy is described. When one turns to Section 5 of the White Paper, Designed to Care, the text makes it clear in a number of places that one aspect of the Government's policy is to involve, to a greater extent than is said to be occurring at the moment, those involved in the delivery of clinical services in the arrangements set down for managing them.

Perhaps I will be forgiven if I restrict what I quote from the White Paper to what is to be found in paragraph 75 of the section which deals with primary care trusts. This refers back to the emergence of new collaborative working methods and the benefits that they bring to patients and practitioners alike and says that,

As I said, in view of the lateness of the hour, there is no great need to review in detail what is said in other paragraphs in the White Paper, especially in the section dealing with acute hospital trusts.

The main point to be made in support of this amendment is, as I have already mentioned, that the Government have given a commitment that there will be a nurse executive director on each primary care trust and acute hospital trust in Scotland. If that commitment has

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been given--as it has--it seems entirely logical that the same should apply to a registered medical practitioner. Therefore, the amendment was tabled by my noble friend Lord Mackay of Ardbrecknish to give the Government the opportunity to fulfil that commitment and to give it statutory recognition in legislation which, as I understand it, the Government propose should be available for the Scottish executive to implement once it is elected in May and takes up its executive responsibilities on 1st July.

If the Government do not accept this opportunity, that might involve their sending a most unfortunate signal not only to the health professionals in Scotland but also to the people in Scotland as to whether or not their word can be trusted in health service matters. I beg to move.

1.15 a.m.

Lord Monro of Langholm: I have two points on the trusts that I should like to put to the Minister. First, this Government seem to have got themselves into an inflexible position over the Peach/Nolan recommendation on appointments to public boards, bodies and quangos. Can the noble Lord tell me what the position is over the trusts and the area health board; and, indeed, the co-operative? For example, do those bodies have to go through the Peach/Nolan recommendation of having three recommendations for each appointment? That would mean that you would have to have 36 names for a 12-member health board in order to choose 12. Further, who will put forward the recommendation and does it apply to the chairman appointed by the Secretary of State?

Secondly, the information paper that we have recommends one co-operative to a health board. However, does the noble Lord really appreciate the size of these co-operatives in the geographical sense that I indicated in terms of my own Dumfries and Galloway health board? We should bear in mind that there will be a number of professionals on the body. I refer to general practitioners. Will they have time to tour these huge areas attending bureaucratic meetings and to manage these co-operatives? That requires skill and time and will cost a lot of money. Will the Minister answer those two points?

The Earl of Mar and Kellie: I am a little concerned that particularly as regards the primary care trusts the amendment gives undue influence to doctors, nurses, registered nurses or midwives. The allocation of two of the five posts to those professions strikes me as unfair on dentists, pharmacists, optometrists, health visitors, district nurses and mental health staff. Does the Minister agree with me on that?

Baroness Carnegy of Lour: I presume the Minister will tell us that nurses and medical practitioners will take part in the co-operatives and that therefore the Government are not obliged to say that they will have to be executive directors of the primary care trusts. However, we are told that a commitment has been given to nurses. If the Government do not intend to put that on the face of the Bill, why not? That is the question the Minister has to answer.

Lord Macdonald of Tradeston: As the noble and learned Lord, Lord Mackay of Drumadoon, has

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explained, his amendment seeks to ensure that nurses and doctors are on the National Health Service trust boards. I hope I can satisfy him on this matter. The White Paper, Designed to Care, signalled our intention to modify the existing arrangements with regard to National Health Service trust boards as part of the modernisation of the National Health Service in Scotland.

Provision for the broad composition of a board is set out in the 1978 Act. This sets out that the board consists of directors, including a chairman appointed by the Secretary of State, and executive and non-executive directors. We specified that non-executive members, or trustees as we would now like to call them, should be representative of the community as a whole rather than representative of a single staff group. Membership of trust boards is specified by secondary legislation and this allows for a greater degree of flexibility in the future, if it is necessary. That would allow change in the composition of a board. Currently every trust board must include a medical practitioner and a registered nurse or midwife. We have no intention of changing that. The Government obviously set great store by the contribution of nurses and doctors but a difficulty would arise if that led to other groups seeking similar treatment. We believe that could lead to excessive rigidity.

The noble Lord, Lord Monro, asked how the Nolan rules might apply to appointments to health boards. I do not have an immediate answer on that point. In principle I believe that such appointments probably will be subject to those rules. Indeed the Scottish health service arrangements were probably seen as some kind of model for the Nolan rules. However, as I understand the position, the local healthcare co-operatives are not subject to the Nolan rules because they are co-operative groups of independent GPs and are part of the management structure of the primary care trusts.

As regards whether GPs have time to manage the co-operatives, the Government have provided packages of support to release GPs from other duties. It is our belief that the positive response that we have had so far from the medical community in Scotland shows that people, perhaps having weighed those options, have decided that this is not just a workable but also an attractive proposition. I hope that with the reassurance I have given, the noble and learned Lord will feel able to withdraw his amendment.

Lord Mackay of Drumadoon: I am grateful to my noble friends Lord Monro of Langholm and Lady Carnegy of Lour for their support in this matter. I am also grateful to the noble Lord the Minister for his explanation of the Government's position. Far from reassuring me, the explanation gives me further cause for concern. If, as the Government point out, this is dealt with as a matter of secondary legislation and they have no objection in principle or policy to the amendment, there does not seem to be any good reason why the commitment that was given should not be honoured and entrenched in primary legislation, which, as the Minister will be aware, is far more difficult to change than secondary legislation. The noble Earl, Lord Mar and Kellie, raised whether other

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health service practitioners should be included in the primary legislation. It is entirely a matter for him whether he wishes to table an amendment to that effect at Report stage.

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