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Baroness Gardner of Parkes: My Lords, before the Minister sits down, will she explain one point? If there is no option for people to vote, does she mean that the Secretary of State will have the sole power to determine whether or not the primary care trusts are set up?

Lord Skelmersdale: My Lords, before the Minister responds, perhaps I, too, may ask a brief question. In criticising the amendment tabled by my noble friend Lord Howe, she gave an example where everyone in a local community apart from the doctors, presumably the GPs, are in favour. Is she aware that under my noble friend's proposal in Amendment No. 2, there will be no doubt whatever that the majority vote of the members of a primary care group would go in the direction of forming a PCT?

Baroness Hayman: My Lords, we are debating a hypothetical issue of a hypothetical issue in saying that we do not know how a vote will go on the board of a primary care group. I take the noble Lord's point that it would not be a matter of the GPs having a direct vote because the amendment deals only with the board members of the primary care group.

As regards the question asked by the noble Baroness, Lady Gardner, it is correct that there would be no power of veto for a primary care group against the proposition that the Secretary of State, after extensive consultation and examination of the whole range of issues, can decide the most appropriate and best way of taking forward the health of the local community. There is a danger in trying to think through the implications of such legislation. In the hypothetical example of the noble Lord, Lord Skelmersdale, the primary care group board would support the proposal and I am not sure that that is absolutely clear. Certainly, the professionals on the PCG board could be out-voted by the lay members. I suggest that there is no magic formula in legislative provision which will guarantee that a proposal is soundly, locally based. There must be some room for judgment. That was recognised in the creation of NHS trusts. I hope that I have reassured the House that it will not be done in a cavalier manner and that we have real arrangements for wide-ranging and meaningful consultation before a primary care trust can be set up.

Lord Walton of Detchant: My Lords, before the Minister concludes, perhaps I may ask a question. I fully support the intentions underlying the amendments relating to consultation, but I am afraid that I have difficulty with each of them. Amendment No. 2 provides for "consultation with all health care professionals", but not for consultations with representatives of the local community, the community health council and others. I also accept the difficulty of defining "key partners" and "exceptional circumstances".

15 Mar 1999 : Column 489

Clause 2(4) states:

    "If any consultation requirements apply, they must be complied with".
However, subsection (5) goes on to provide:

    "In this section, 'consultation requirements' means requirements about consultation contained in regulations".
Is it the case that such regulations would be subject to secondary legislation? Would they be placed before both Houses of Parliament for approval? If so, the Minister's confirmation would reassure me that this is a satisfactory way to go forward.

Baroness Hayman: My Lords, the noble Lord is correct in outlining the difficulties with the amendments and the rigidity of primary legislation. The regulations would be encompassed in secondary legislation, which would be subject to negative resolution. There would therefore be an opportunity for people to scrutinise what was being suggested.

There is no intention not to consult any of the people mentioned in today's debate. However, the difficulty lies in defining the people who are to be omitted and the exceptional circumstances. I hope we can clarify the consultation process in a way that the noble Lord finds reassuring.

It would be wrong to suggest to the House that we could obviate completely the need for the ability to use judgment at some point in potentially very difficult circumstances. I suggest that it is safer to have the element of judgment, even though the Secretary of State has some power, rather than to bind ourselves to the rigidities of statute law. That would allow decisions to be made which were sensible and best balanced in the interests of local communities.

Lord Renton: My Lords, in view of the remarks which the noble Lord has just made, I hope that it may be in order for me, even though it is Report stage, to ask the Minister why, instead of putting them in regulations at a later date, we cannot have the consultation requirements referred to in subsection (5) defined clearly in the Bill, which could be done on Third Reading.

Baroness Sharp of Guildford: My Lords, subsection (4) also causes some difficulty.

Noble Lords: Order, order!

Earl Howe: My Lords, this has been a fruitful debate and I am grateful to the Minister for the care that she has devoted to addressing my amendments. I listened extremely carefully to what she said.

Despite her obvious wish to be helpful and reassuring, I do not believe that she has quite gone far enough to meet the essence of the point which I sought to make. I understand the duty on the Secretary of State to consult. Perhaps I may say to the noble Lord, Lord Walton of Detchant, that, as we have heard from the Minister, that consultation process will be inclusive and wide-ranging. There is no doubt about that. Those who have a legitimate say in the process will be able to have that say. I do not dispute that for one moment.

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But the result of a consultation is not binding, as we very well know. I could not help but notice again the use of the phrase by the Minister, "It is our assumption that the support of PCGs will be required". That is a strange, guarded phrase to use. I am reassured by the Minister saying that it is no part of the Government's agenda to deliver GPs bound and gagged into a PCT. But the example that she gave--and I believe it was her example rather than that of my noble friend Lord Skelmersdale--would do just that.

I should say in relation to my amendments that the members of the PCG are not just there to represent themselves. They are there to represent the whole range of healthcare professionals, voluntary groups and patients in the locality. In that sense, I agree with the noble Baroness; she is quite right in what she said. We do not doubt that GPs and PCGs will be key players and that the views of local professional groups will be key considerations in the decision-making process. But with great respect, that is not the same as ensuring that the actual initiation of the consultation process and the ultimate decision depends, one way or the other, on the support and endorsement of primary care groups.

The principle and policy behind the amendment are almost shared on the two Benches. The noble Baroness intimated that herself. There is an element of judgment to be made, but my contention is that that judgment should be made at PCG level. I was gratified by the degree of support that I received from around the House for the points that I was seeking to make. I believe that this is a sufficiently important issue on which I should seek the opinion of the House.

4.14 p.m.

On Question, Whether the said amendment (No. 2) shall be agreed to?

Their Lordships divided: Contents, 120; Not-Contents, 117.

Division No. 1


Aberdare, L.
Ailsa, M.
Alexander of Tunis, E.
Astor of Hever, L.
Baker of Dorking, L.
Belhaven and Stenton, L.
Bell, L.
Bellwin, L.
Belstead, L.
Berners, B.
Biffen, L.
Birdwood, L.
Blaker, L.
Blatch, B.
Bowness, L.
Bridgeman, V.
Brougham and Vaux, L.
Bruntisfield, L.
Burnham, L. [Teller.]
Butterworth, L.
Byford, B.
Cadman, L.
Caithness, E.
Campbell of Alloway, L.
Carnegy of Lour, B.
Carnock, L.
Chesham, L.
Clanwilliam, E.
Colwyn, L.
Cope of Berkeley, L.
Courtown, E.
Cox, B.
Craig of Radley, L.
Crickhowell, L.
Cullen of Ashbourne, L.
Cumberlege, B.
Davidson, V.
Dean of Harptree, L.
Denbigh, E.
Denham, L.
Dixon-Smith, L.
Dundonald, E.
Effingham, E.
Ellenborough, L.
Elles, B.
Elliott of Morpeth, L.
Foley, L.
Fookes, B.
Gainford, L.
Gardner of Parkes, B.
Geddes, L.
Glentoran, L.
Gray of Contin, L.
Harding of Petherton, L.
Harrowby, E.
Hayhoe, L.
Hemphill, L.
Henley, L. [Teller.]
Higgins, L.
Holderness, L.
HolmPatrick, L.
Hooper, B.
Howe, E.
Hunt of Wirral, L.
Hylton-Foster, B.
Jopling, L.
Lauderdale, E.
Liverpool, E.
Long, V.
Lucas of Chilworth, L.
Luke, L.
Lyell, L.
McColl of Dulwich, L.
McConnell, L.
Mackay of Ardbrecknish, L.
Mayhew of Twysden, L.
Mersey, V.
Miller of Hendon, B.
Milverton, L.
Monro of Langholm, L.
Monteagle of Brandon, L.
Montgomery of Alamein, V.
Morris, L.
Mountevans, L.
Moyne, L.
Munster, E.
Naseby, L.
Northesk, E.
Nunburnholme, L.
Oppenheim-Barnes, B.
Park of Monmouth, B.
Pearson of Rannoch, L.
Pender, L.
Peyton of Yeovil, L.
Pilkington of Oxenford, L.
Platt of Writtle, B.
Rankeillour, L.
Rawlings, B.
Rees, L.
Renton, L.
Renwick, L.
Rowallan, L.
St. Davids, V.
Seccombe, B.
Sharples, B.
Shaw of Northstead, L.
Skelmersdale, L.
Soulsby of Swaffham Prior, L.
Stockton, E.
Strathcarron, L.
Sudeley, L.
Swinfen, L.
Trefgarne, L.
Trumpington, B.
Vinson, L.
Vivian, L.
Waddington, L.
Wise, L.
Wynford, L.
Young, B.


Acton, L.
Allenby of Megiddo, V.
Alli, L.
Amos, B.
Annan, L.
Archer of Sandwell, L.
Ashley of Stoke, L.
Bach, L.
Barnett, L.
Bassam of Brighton, L.
Berkeley, L.
Blackstone, B.
Blease, L.
Blyth, L.
Brightman, L.
Brooke of Alverthorpe, L.
Brooks of Tremorfa, L.
Burlison, L.
Carew, L.
Carmichael of Kelvingrove, L.
Carter, L. [Teller.]
Chorley, L.
Christopher, L.
Clarke of Hampstead, L.
Clinton-Davis, L.
Cocks of Hartcliffe, L.
Crawley, B.
David, B.
Davies of Oldham, L.
Dean of Thornton-le-Fylde, B.
Desai, L.
Diamond, L.
Dixon, L.
Donoughue, L.
Dormand of Easington, L.
Dubs, L.
Emerton, B.
Evans of Parkside, L.
Evans of Watford, L.
Ewing of Kirkford, L.
Falconer of Thoroton, L.
Farrington of Ribbleton, B.
Fitt, L.
Glanusk, L.
Goudie, B.
Gould of Potternewton, B.
Gregson, L.
Grenfell, L.
Hardie, L.
Hardy of Wath, L.
Harris of Haringey, L.
Haskel, L.
Hayman, B.
Hilton of Eggardon, B.
Hogg of Cumbernauld, L.
Hollis of Heigham, B.
Howie of Troon, L.
Hoyle, L.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Irvine of Lairg, L. [Lord Chancellor.]
Islwyn, L.
Janner of Braunstone, L.
Jay of Paddington, B. [Lord Privy Seal.]
Jeger, B.
Jenkins of Putney, L.
Laming, L.
Lofthouse of Pontefract, L.
Lovell-Davis, L.
McCarthy, L.
McFarlane of Llandaff, B.
McIntosh of Haringey, L. [Teller.]
Mackenzie of Framwellgate, L.
Mason of Barnsley, L.
Merlyn-Rees, L.
Molloy, L.
Monkswell, L.
Montague of Oxford, L.
Morris of Castle Morris, L.
Morris of Manchester, L.
Murray of Epping Forest, L.
Orme, L.
Patel, L.
Peston, L.
Pitkeathley, B.
Plant of Highfield, L.
Prys-Davies, L.
Puttnam, L.
Ramsay of Cartvale, B.
Rea, L.
Richard, L.
Sainsbury of Turville, L.
Sawyer, L.
Sefton of Garston, L.
Shannon, E.
Shepherd, L.
Shore of Stepney, L.
Simon, V.
Simon of Highbury, L.
Smith of Gilmorehill, B.
Stallard, L.
Stoddart of Swindon, L.
Strabolgi, L.
Symons of Vernham Dean, B.
Taylor of Blackburn, L.
Taylor of Gryfe, L.
Thomas of Macclesfield, L.
Thornton, B.
Turner of Camden, B.
Uddin, B.
Varley, L.
Walton of Detchant, L.
Weatherill, L.
Wharton, B.
Williams of Elvel, L.
Winston, L.
Young of Old Scone, B.

Resolved in the affirmative, and amendment agreed to accordingly.

15 Mar 1999 : Column 492

4.22 p.m.

[Amendments Nos. 3 to 5 not moved.]

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