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After Clause 40, insert the following new clause--

Local healthcare cooperatives

(" . In Schedule 7A to the 1978 Act, after paragraph 13 there is inserted--
"13A. If no local healthcare cooperative has been set up in any part of an NHS trust's area, the trust shall have power to set one up and keep it in place."").

The noble and learned Lord said: Amendment No. 190 seeks to insert a new clause into the Bill and by virtue thereof to add provisions to Schedule 7A to the 1978 Act to the effect that,

    "If no local healthcare co-operative has been set up in any part of an NHS trust's area, the trust shall have power to set one up and keep it in place".

Local healthcare co-operatives are discussed and described in the following terms on page 42 of the Explanatory Notes to the Bill:

    "These will be voluntary networks of GPs and other primary care professionals working together to plan and provide primary and community health services and provide support for general practice. Local Health Care Co-operatives will be established from April 1999 as part of the management structure of primary care NHS trusts ... and will draw their powers and functions from these trusts. They do not therefore require separate legislative provision".

I have already referred to the practical problem that may arise if this legislation is not in force by 1st April of this year. Clearly, it will not be in force then, and I do not repeat what I said earlier. But I seek to probe the Minister on two general lines. First, why should the setting up of these networks be an entirely voluntary exercise on the part of GPs and other primary care professionals who work in a particular locality? If the idea of the networks has merit and they are designed to play an important role in a reorganised National Health Service in Scotland, why is power not given to an NHS

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trust--in particular the chairman and directors--to set one up if it believes that it is to the benefit of the people to whom it has overall responsibility for the provision of healthcare? Secondly, how can such a voluntary organisation have powers and functions, which I assume to be statutory, if it is a body that has no statutory basis? That point is entirely separate from the point about the date of 1st April which I mentioned earlier. I believe that these matters should be clarified in response to Amendment No. 190. I beg to move.

The Earl of Mar and Kellie: I believe that the local health co-operative must be assembled by the primary care practitioners. After all, if the chairman of the primary care trust sets it up but nobody wishes to attend, it will not really happen.

Leaving that aside, in my view the Bill does not set out clearly enough the fact that a local health co-operative should have a coterminous boundary with a local authority, not because my noble friends wish to move health into local authority control but because the local health co-operative alongside the local authority, and the social work department in particular, will need to work hard to plan services. To do that with perhaps more than one local authority may prove to be extremely difficult. I am concerned that the Forth Valley health board is proposing to have only two. I do not think that what is called the North Forth Valley Local Healthcare Co-operative will be able to liaise effectively with Clackmannanshire and the district of Stirling without some confusion.

Lord Macdonald of Tradeston: The amendment proposed by the noble and learned Lord would go against a key principle of these reforms. The local health care co-operatives are established on a collaborative and co-operative basis between GPs and other primary care professionals. They are entirely voluntary. After a widespread consultative process we believed that that was the form closest to the culture which had been demonstrated distinctively by the medical profession in Scotland in contradistinction to the majority of the profession in England.

There is a different attitude in Scotland. That was thoroughly tested, I believe, both by experience and consultation. Therefore we believe that we can build on what we have seen to be the clear wish of the profession in Scotland, and not south of the Border. We want to put the frontline clinicians in the lead in delivering and managing services in the community.

The local healthcare co-operatives are our way of delivering this commitment in Scotland. The role we envisage for the primary care National Health Service trusts is that of supporting and developing the co-operatives as primary care clinicians come together to form them. But these co-operatives will be discrete management organisations within the primary care NHS trust. They will be non-statutory bodies and will draw all their functions from the powers of the trust. Their composition, structure and funding will be developed locally. The primary care NHS trust will have overall accountability for the services and budgets managed by the co-operatives. Co-operative leaders will be part of

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the management structure of the primary care NHS trust. We are receiving clear indications that a significant majority of GPs and other primary care professionals are showing interest in developing the local healthcare co-operative across Scotland. On that basis we are content that GPs and other primary care professionals will be able to join a local healthcare co-operative to develop co-ordinated services for their area. Yet again, I agree with the noble Earl, Lord Mar and Kellie, in his analysis of the situation.

Having made the point that the fundamentals here have to be collaboration and co-operation, and that this cannot be imposed on professionals, I ask the noble and learned Lord to withdraw the amendment.

Baroness Carnegy of Lour: Before the Minister sits down, he said that he agreed with the noble Earl. I had understood the noble Earl to say that he thought the co-operatives should be coterminous with local authority boundaries. Surely you could not have such a body stretching from Brechin to Forfar to Pitlochry? One could not expect doctors to drive those distances.

Lord Macdonald of Tradeston: I apologise if I gave the wrong impression. I was drawing on what I thought was the noble Earl's view--I share it with him--that this was based on a collaborative and co-operative spirit among the professionals in Scotland.

Lord Mackay of Drumadoon: I shall not enter into the debate as to whether the noble Earl's contribution supported my position or that of the Minister. I leave that for others to resolve.

While I fully accept that the use of the term "co-operative" implies a measure of consensual agreement among those involved, I remain apprehensive that, if in a particular locality--I deliberately choose a different word from "area" because that may or may not be related to the geographical area in respect of which a primary care trust may have responsibility--for whatever reasons, good or bad, the primary care professionals choose not to enter into a co-operative and a different view is taken by the trust, it may well be that, because of the local difficulties, the patients in the locality will miss out on what I understand to be the benefits of a major plank of the Government's proposals.

I do not seek to press the amendment. It was designed to explore the Government's position. I have received a reply and I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 41 [Duty of quality]:

Lord Mackay of Drumadoon moved Amendment No. 190A:

Page 31, line 18, after ("Board") insert (", local health care cooperative").

The noble and learned Lord said: I shall speak also to Amendment No. 190B. The two amendments seek to amend Clause 41 in line 18 by adding to the list of those who will be under a duty to put and keep in place arrangements for the purpose of monitoring and improving the quality of healthcare any local healthcare

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co-operative which may be established, or any independent provider. I understand that both amendments were tabled by my noble friend Lord Mackay of Ardbrecknish after discussion with and with the full support of the Royal College of Nursing.

The reasoning behind the amendments is self-explanatory. Whether or not a local healthcare co-operative has any statutory basis for its existence, or whether or not any independent healthcare provider operates in accordance with some statutory appointments procedure, they are both operating in exactly the same field as health boards, special health boards and national health trusts. The Royal College of Nursing believes that every patient who might benefit from and receive treatment from those engaged in co-operatives or operating as independent healthcare providers has the right to a minimum standard of quality, care and safety, irrespective of the particular sector from which that care comes.

As the Minister may be well aware, many large independent sector healthcare providers already subscribe to quality assurance schemes and it should not therefore be particularly difficult or onerous to publish details of their arrangements for monitoring and improving the quality of the healthcare they provide. It is also important for patients that smaller independent sector providers are not left behind in the drive which rightly continues to improve quality in the delivery of services in the health centre.

The Royal College of Nursing believes that the independent healthcare sector should not find itself unwittingly using outdated practices or delivering poor standards. The same applies to those who may group together on a voluntary basis in a healthcare co-operative of the nature we have been discussing in the last few amendments.

I find it difficult to imagine why there should be any objection to people who will be assisting in the provision of healthcare being under the same duties of quality as those imposed on health boards, special health boards and national health trusts. For those reasons, I beg to move.

2 a.m.

Baroness Carnegy of Lour: This question of independent sector hospitals, homes and so on is extremely important. We had the discussion in the context of England and Wales and we were told that the whole matter had to wait until the Select Committee in another place had finished discussing it. Does that Select Committee relate to Scotland or not?

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