| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Lord Clement-Jones: My Lords, I thank the Minister for her reply and particularly for her clear demonstration of support for the spirit of the amendment. Other noble Lords have commented on the drafting of the amendment. Having made three attempts at the drafting during the passage of the Bill, I know only too well how difficult it is to draft an appropriate amendment which reflects not only the difficulty of practical implementation but the desire to make a commitment. As noble Lords will know, the CRE has asked bodies and figureheads in various areas of public life to make a public commitment to their leadership challenge. I believe the NHS should make that commitment even though it may be difficult to do so. I recognise that it must form part of a wider examination and consideration of the whole area of public services. For that reason,
when I introduced the amendment, I very much welcomed the fact that the Home Secretary had accepted the 70 or so recommendations of the Macpherson report. However, I look forward to action in the short term, not the long term.I hope that the difficulty of the issue will not be treated as an excuse. I am sure that the Minister did not reflect that. I hope that this issue will not be treated as so difficult that it cannot be legislated for. I am sure that back in 1968 with the Race Relations Act and then with the Sex Discrimination Act, these were considered very difficult issues to draft. I am sure the drafting will be difficult but I very much hope that a formula will be found that will lay this kind of duty in the health service. In all of our debates, throughout the Committee stage and on Report, the whole question of discrimination--not only in terms of ethnicity but particularly in terms of age--came through very strongly as a matter of concern for your Lordships. I look forward optimistically to a time in the not too distant future when the Government will feel able to legislate on this matter. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
4.15 p.m.
Baroness Hayman moved Amendment No. 5:
After Clause 8, insert the following new clause--
(".--(1) For sections 43A and 43B of the 1977 Act (regulations as to Part II remuneration) there is substituted--
"Remuneration for Part II services.
43A.--(1) The remuneration to be paid to persons who provide general medical services, general dental services, general ophthalmic services or pharmaceutical services under this Part of this Act shall be determined by determining authorities (and they may also determine the remuneration to be paid to persons providing those services in respect of the instruction of any person in matters relating to those services).
(2) For the purposes of this section and section 43B below determining authorities are--
(a) the Secretary of State, and
(b) so far as authorised by him to exercise the functions of determining authorities, any Health Authority or other person appointed by him in an instrument (referred to in this section and section 43B below as an instrument of appointment).
(3) An instrument of appointment--
(a) may contain requirements with which a determining authority appointed by that instrument must comply in making determinations, and
(b) may be contained in regulations.
(4) Subject to this section and section 43B below, regulations may make provision about determining remuneration under subsection (1) above and may in particular impose requirements with which determining authorities must comply in making, or in connection with, determinations (including requirements as to consultation and publication).
(5) Regulations may provide--
(a) that determinations may be made by reference to any of the following--
(i) rates or conditions of remuneration of any persons or any descriptions of persons which are fixed or determined, or to be fixed or determined, otherwise than by way of a determination under subsection (1) above,
(ii) scales, indices or other data of any description specified in the regulations,
(b) that any determination which in accordance with regulations made by virtue of paragraph (a)(ii) above falls to be made by reference to a scale or an index or to any other data may be made not only by reference to that scale or index or those data in the form current at the time of the determination but also by reference to the scale, index or data in any subsequent form attributable to amendment or revision taking effect after that time or to any other cause.
(6) Regulations may--
(a) provide that determining authorities may make determinations which have effect in relation to remuneration in respect of a period beginning on or after a date specified in the determination, which may be the date of the determination or an earlier or later date, but may be an earlier date only if, taking the determination as a whole, it is not detrimental to the persons to whose remuneration it relates,
(b) provide that any determination which does not specify such a date shall have effect in relation to remuneration in respect of a period beginning--
(i) if it is required to be published, on the date of publication,
(ii) if it is not so required, on the date on which it is made.
(7) A reference in this section or section 43B below to a determination is to a determination of remuneration under subsection (1) of this section.
Part II remuneration: supplementary.
43B.--(1) Before a determination is made by the Secretary of State which relates to all persons who provide services of, or of a category falling within, one of the descriptions of services mentioned in section 43A(1) above, he shall consult at least one of the following bodies--
(a) a body one of whose functions is to provide advice in connection with the matters to be determined,
(b) a body appearing to him to be representative of persons to whose remuneration the determination would relate.
(2) Determinations may make different provision for different cases including different provision for any particular case, class of case or area.
(3) Determinations may--
(a) be made in more than one stage,
(b) be made by more than one determining authority,
(c) be varied or revoked by subsequent determinations.
(4) A determination may be revised--
(a) to correct an error, or
(b) where it appears to the determining authority that it was made in ignorance of or under a mistake as to a relevant fact.
(5) Determinations may, in particular, provide that the whole or any part of the remuneration--
(a) is payable only if the determining authority is satisfied as to certain conditions, or
(b) is to be applied for certain purposes or is otherwise subject to certain conditions.
(6) Subject to sections 29(4) and 35(2) above, remuneration under section 43A above may consist of payments by way of--
(a) salary,
(b) fees,
(c) allowances,
(d) reimbursement (in full or in part) of expenses incurred or expected to be incurred in connection with the provision of the services or instruction,
and may be determined from time to time.
(7) At the time a determination is made or varied, certain matters which require determining may be reserved to be decided at a later time.
(8) The matters which may be reserved include in particular--
(a) the amount of remuneration to be paid in particular cases,
(b) whether any remuneration is to be paid in particular cases.
(9) Any determination shall be made after taking into account all the matters which are considered to be relevant by the determining authority and such matters may include in particular--
(a) the amount or estimated amount of expenses (taking into account any discounts) incurred in the past or likely to be incurred in the future (whether or not by persons to whose remuneration the determination will relate) in connection with the provision of services of the description in section 43A(1) above to which the determination will relate or of any category falling within that description,
(b) the amount or estimated amount of any remuneration paid or likely to be paid to persons providing such services,
(c) the amount or estimated amount of any other payments or repayments or other benefits received or likely to be received by any such persons,
(d) the extent to which it is desirable to encourage the provision, either generally or in particular places, of the description or category of services to which the determination will relate,
(e) the desirability of promoting services which are--
(i) economic and efficient, and
(ii) of an appropriate standard.
(10) If the determination is of remuneration for a category of services falling within one of the descriptions of services mentioned in section 43A(1) above, the reference in subsection (9)(a) above to a category of services is a reference to the same category of services or to any other category of services falling within the same description".
(2) Sections 43A and 43B of the 1977 Act, as substituted by this section, have effect in relation to--
(a) the making of determinations on or after the commencement of this section, and
(b) the variation, revocation or revision on or after the commencement of this section of determinations whenever made,
and in this subsection "determinations" means determinations under Part II of the 1977 Act of the remuneration to be paid to persons who provide services mentioned in section 43A(1).
(3) Section 7(4) of the Health and Social Security Act 1984 and section 15(3) of the Health and Medicines Act 1988 (determinations of remuneration for services under Part II of 1977 Act deemed to be valid) have effect in relation to England and Wales as if--
(a) after "inserted by this section" in section 7(4)(b) of the 1984 Act, and
(b) after "section 7 of the Health and Social Security Act 1984" in section 15(3) of the 1988 Act,
there were inserted "and before the coming into force of section (Remuneration for Part II services) of the Health Act 1999".
(4) The reference in section 43B(6) of the 1977 Act, as substituted by this section, to section 29(4) of that Act is to be read on and after the commencement of section 10 of the National Health Service Act 1966 as a reference to that section.").
The noble Baroness said: My Lords, in moving this amendment, I wish to speak also to Amendment No. 37, which makes similar provision for Scotland and replaces the current Sections 28A and 28B of the 1978 Act.
The purpose of these amendments, which would replace the present Sections 43A and 43B of the 1977 Act, is to make new provision for determining the remuneration of the family health service practitioners; that is, those providing general medical services, general dental services, pharmaceutical services and general ophthalmic services. The intention is, in effect, to legitimise the current practice in relation to these determinations and, in particular, to ensure that the existing basis by which health authorities are appointed as determining authorities is put on a firmer footing. This is largely a technical issue which, I am told, accounts for the length and the complexity of the amendments.
The Explanatory Notes to the Health Bill make clear in paragraph 106 the Government's intention to give primary care trusts the function of determining cash-limited payments to GPs. We see the development of primary care as an important part of a primary care trust's role. The ability to determine cash-limited payments to GPs to support general medical services is central to this. It will allow primary care trusts to make decisions about the deployment of resources to develop general practice premises and computing and to help practices with the costs of employing staff. These are key levers in improving primary care. Part of this function currently rests with health authorities.
We want to enable primary care trusts to assume the function of determining remuneration in respect of cash-limited payments to GPs through the delegation of the function in accordance with the general provisions about delegation contained in Clause 9.
Sections 43A and 43B of the 1977 Act provide a mechanism for appointment of determining authorities by the Secretary of State. In looking at how we might use this provision, it has become clear that the existing legal basis by which health authorities themselves are appointed as determining authorities is unsatisfactory. Determinations of remunerations are presently, in effect, governed by Sections 43A and 43B of the 1977 Act, but these provisions are not yet in force and, consequently, no regulations can be made under them. Meanwhile determinations are validated by Section 7(4) of the Health and Social Security Act 1984. Although this has been the position since 1984, over time this arrangement has become increasingly unsatisfactory. To ensure that the function of health authorities as determining authorities in respect of cash-limited payments to GPs and the subsequent delegation of that function by health authorities to primary care trusts is securely based, this legal deficiency now needs to be put right.
Additionally, Sections 43A and 43B also concern the remuneration of other family health service practitioners. We need therefore to take the opportunity to tidy up the legal basis for determinations of remuneration for all the family health services professions.
Much of the existing structure and present provisions will be retained. In particular, they provide for the Secretary of State to make regulations setting out requirements concerning consultation and publishing determinations. It is not intended either to extend or to reduce the current practice in terms of who is consulted or when, nor in terms of which determinations are published.
In essence, these changes are a tidying up exercise that will reflect and validate current practices. For example, the Secretary of State will continue to be required, through regulations made under these provisions, to consult the national representative bodies of each of the family health service professions before making changes to payments that affect that group. These changes are ones to the GPs' Statement of Fees and Allowances, commonly referred to as the "Red Book", or the equivalent for the other family health service practitioners. Primary care trusts' discretion in respect of cash-limited payments to GPs will be circumscribed in the same way as health authorities' discretion currently is; that is, it will be subject to the provisions set out in the GPs' Statement of Fees and Allowances. Where the Red Book dictates, for example, that health authorities must consult local medical committees, the same requirement will apply to primary care trusts.
The amendment also puts on a firm legal footing the basis for remunerating other FHS practitioners--dentists, community pharmacists and optometrists. However, primary care trusts will not be appointed as determining authorities for non-GMS Part II matters. The Bill explicitly and deliberately precludes primary care trusts having any functions in respect of these.
I acknowledge that these provisions are lengthy and technically complex, although no more so than those they replace. The reason for this is that the remuneration
Next Section
Back to Table of Contents
Lords Hansard Home Page