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The Earl of Mar and Kellie: Perhaps I should clarify for the Committee my position on local health co-operatives which are mentioned in Amendment No. 190A. I have no objection whatever to there being two or more co-operatives in a local authority area. However, I object to the idea of having two local authorities in a co-operative area.
Lord Macdonald of Tradeston: Perhaps I may first answer the question from the noble Baroness,
Lady Carnegy. The Select Committee will not cover Scotland but the Scottish Parliament will take into account its findings. I am grateful also for the explanation of the concern in relation to the local boundaries.Amendment No. 190A is intended to ensure that the primary care services are covered by a duty of quality. That is the Government's intention. The clause as drafted already achieves that objective. The local healthcare co-operatives will be non-statutory organisations. They are an integral part of a Scottish primary care NHS trust and will thus be subject to the duty of quality. Therefore, it is unnecessary to refer to that on the face of the Bill.
Lord Mackay of Drumadoon: Before the Minister sits down, can I take it that that answer applies also in respect of Amendment No. 190B?
Lord Macdonald of Tradeston: In relation to that amendment, I do not believe that it would be appropriate to attempt to use the current Bill to place new statutory obligations on private sector healthcare institutions. That will be a matter for the Scottish Parliament to consider in due course. No doubt it will wish to take into account the conclusions of the Health Committee's current inquiry into the regulation, monitoring and inspection of healthcare outside the NHS which my noble friend Lady Hayman mentioned when dealing with Clause 13 last Thursday.
The guidance on clinical governance that was issued to the NHS in Scotland last November makes it clear that its provisions apply to services that the NHS commissions from other bodies. Thus, where the NHS contracts with a provider from the independent sector to provide a service to NHS patients, those contracts should be used to make sure that those clinical governance principles are applied. With those assurances, I ask the noble and learned Lord to withdraw the amendment.
Lord Mackay of Drumadoon: Once again, I am grateful to the Minister for clarifying his position on the two amendments. As regards Amendment No. 190A, he argues--and I see the force of the argument--that the amendment is unnecessary because anybody involved in a local healthcare co-operative would, as I understand it, be operating under the auspices of a particular trust.
I understand his response to Amendment No. 190B, which was to the effect that that is a matter which should be left to the Scottish Parliament. I must say, with respect to the Minister, that those two different answers seem to highlight the concern that I raised when I first entered into the debate on this series of amendments. However, we shall clearly return to that matter on Thursday. In those circumstances, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 190B not moved.]
The Earl of Mar and Kellie moved Amendment No. 191:
The noble Earl said: Every other Scottish proposer of an amendment has had a go at this late hour, so Members of the Committee should not imagine that I shall not. It is always a joy to move an amendment after two o'clock in the morning. I am therefore not surprised that the Consultative Standing Committee recommended standing orders for the Scottish Parliament which will be, curiously, held in the "daylight" hours. One of the features of this Bill is that it is little if at all known in Scotland, and when we debate it at this hour, I am not surprised.
Amendments Nos. 191 and 192 have the purpose of clarifying and extending the duty of quality which is rightly being imposed on health boards and NHS trusts. I am well aware that the legislative provision for the health service in Scotland has been presented in stripped-down or minimalist form; and I understand the Government's position on legislating for Scotland in this form. Generally it is right that the Scottish Parliament should have an early opportunity to put its own stamp on the NHS, and to do so in early time. This will be appropriate as health and education vie with each other to be the most important public concerns to be devolved to the Scottish Parliament.
Members of the Committee will have noticed that my amendments have the effect of adding to the minimalist functions laid down in the Bill. That may be worthwhile in this instance. Normally, I am in favour of diversity within the constituent parts and jurisdictions of the United Kingdom. However, during the Committee stages of the Crime and Disorder Act last year, I was able to argue--successfully as it happens--that the Youth Justice Board for England and Wales should be required to study systems of youth justice in other jurisdictions. I clearly had in mind the Scottish children's panels.
It can be argued therefore that health boards and NHS trusts should be required to evaluate themselves against the criteria set down by NICE for England and Wales, though NICE has no authority in Scotland. This could be seen as a useful temporary measure, at least until the Scottish Parliament has enacted its first National Health Service (Scotland) Act.
The second amendment would impose a duty to publicise how the boards and trusts have performed against the NICE criteria and against the expectations that have been sought from the public, from users and carers. That form of public evaluation and identification of future solutions will bring a real relevance to reports on the NHS, its boards and trusts. I beg to move.
Lord Macdonald of Tradeston: I understand why the noble Earl is keen to ensure that work on clinical effectiveness is shared throughout the United Kingdom. That clearly makes sense and the Government have every intention of encouraging that process.
Our firm intention is that the national institute for clinical excellence will work closely with its counterparts in Scotland. Indeed, arrangements already exist to facilitate such collaboration. The remit of the national institute for clinical excellence (NICE) extends only to England and Wales. In Scotland the Clinical Resource and Audit Group (CRAG)--our acronyms are more rugged than theirs--and the Scottish Intercollegiate Guidelines Network (SIGN) have been in existence for some years performing equivalent functions to NICE. They will be joined later this year by the new Scottish Health Technical Assessment Centre (SHTAC).
The intention is that those Scottish bodies should work closely with NICE, avoiding duplication of effort where appropriate. Already working relationships exist across the Border and there is no need for that to be made a statutory requirement. Indeed, it would be puzzling if there was to be a statutory provision in Scotland relating to NICE without there being reference to the Scottish bodies performing similar functions. I can therefore reassure the noble Lord that guidance produced by NICE will not be denied to Scottish National Health Service bodies. Indeed, I expect guidance issued by our bodies in Scotland to be similarly available, where appropriate, to bodies in England and Wales.
I also appreciate the noble Lord's concern to ensure transparency and accountability by requiring National Health Service bodies to publish information on the arrangements they put in place under that duty. That is a concern that the Government share. However, we do not believe that it is necessary to specify this requirement on the face of the Bill. In guidance issued last November we made it clear that we expect National Health Service organisations in Scotland to publish annual reports on what they are doing to improve and assure quality through clinical governance arrangements. We shall be specifying what those reports should contain.
I do not believe that a statutory requirement for publication will be necessary to ensure that the bodies in question comply with the guidance. After the past hour, I very much look forward to my first appointment
The Earl of Mar and Kellie: I am very pleased to hear from the Minister that what I have suggested will be happening on an informal basis. Therefore, while contemplating a head to head between CRAG and NICE, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 192 not moved.]
Clause 46 [Disqualification of Part II practitioners]:
[Amendment No. 193 not moved.]
A message was brought from the Commons that they have ordered:
That a Select Committee of eight Members be appointed to join with a committee to be appointed by the Lords, to be the Joint Committee on Financial Services and Markets, to report on the consultative document on the draft Financial Services and Markets Bill presented by Her Majesty's Command on 21st December 1998 and any further draft of the Bill which may be laid upon the Table of both Houses by a Minister of the Crown;
That three be the quorum of the Committee;
That the Committee shall have power--
Page 31, line 20, at end insert--
("( ) In implementing and maintaining the arrangements mentioned in subsection (1) each body shall have regard to any guidance issued for England and Wales by the National Institute for Clinical Excellence.").
(i)
That the Committee shall report by 30th April 1999.
to send for persons, papers and records;
(ii) to sit notwithstanding any adjournment of the House;
(iii) to report from time to time;
(iv) to appoint specialist advisers;
(v) to adjourn from place to place within the United Kingdom;
(vi) to communicate to any Select Committee appointed by either House its evidence and any documents of common interest;
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