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Lord Clement-Jones: My Lords, I thank the Minister for the comprehensive notes that we have had on the amendments that are before us today. The notes have made it much easier to understand the Bill's progress through the other place. I also thank the Minister for what I thought was a considerable degree of movement on this amendment in terms of the broad spirit in which the department suggests that consultation takes place on the progress from PCG status to PCT status. I refer in particular to the Minister's statements that there is no intention of establishing PCTs without broad local support; that there is no headlong rush to primary care trust status; and that the support of relevant primary care groups will be a critical factor. All those statements reassure us that the primary care groups will be an intimate and essential part of the process.

Certain issues should be addressed as we look at the details of the consultation process. It is clear that professional groups still have questions that need to be answered. The noble Earl, Lord Howe, asked a number of questions which it would be useful to address at this stage. We did not vote for the amendment when it was before this House on the previous occasion. We felt that a spirit of consultation was in place. However, we welcome the additional "mile" that the Minister has gone today. The only question I ask, in addition to those asked by the noble Earl, Lord Howe, concerns the reporting of the outcome of the consultation. Will there be a transparent process which makes it clear what objections have occurred during that process? Will that be available for all to see?

Baroness Hayman: My Lords, I am grateful for the welcome that has been given to my statement of the Government's position. I do not think that I have modified my position; I hope that I have expressed myself with more clarity than I did in our earlier deliberations. Perhaps that is because of the time of day at which we are debating these matters.

I wish to respond to one or two of the detailed points that have been raised, particularly by the noble Earl, Lord Howe. He is absolutely right to say that the timetable for the regulations is very tight. We are currently working on them and, although they are not yet ready to go out to public consultation, we hope that it will not be too long before they do. We are very well aware that we have to meet a tight timetable, as the noble Earl so eloquently reminded us.

As to the mechanisms that the Secretary of State will put in place to measure the extent of local support for a PCT proposal, he will direct health authorities to select those proposals to go to consultation under what will be new Sections 16C and 17. We have said that the directions will require health authorities to select a proposal if it has been made or endorsed by a PCG or NHS trust which provides community services locally. This approach allows anyone to generate proposals but ensures consultation on any proposal which is supported by at least one of the relevant local NHS bodies.

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The noble Lord, Lord Clement-Jones, asked about consultation. We want the consultation to be open and transparent, with the aim of capturing the views of all local stakeholders. The regulations will therefore specify who conducts the consultation--that will be the health authority--and what essential information must be included in the consultation document so that key stakeholders have sufficient detail to allow them to take an informed view. The regulations will also set out who must be consulted. This will include local GPs, nurses and other health and social care professionals as well as the wider NHS and the local community, including professional and patient representative groups. Finally, these regulations will set out the form and contents of the report which the health authority must make to the Secretary of State on the consultation. As I said earlier, the report will include the responses received.

It will then be for the Secretary of State to consider the responses to the consultation and make a judgment on whether the proposal should proceed. This is a role with which Ministers are very familiar from, for example, consultations on proposals for major service reconfigurations. In considering the results of the consultation, we will of course pay particular heed to the views of local health professionals, on whom the success of a PCT will ultimately depend, if it goes ahead.

The noble Earl, Lord Howe, asked specifically whether the consultation regulations will require or allow for ballots. Ballots are certainly one means of testing opinion, but they are not the only way. We are not proposing to make them an absolute requirement. The Secretary of State's decision on whether or not to establish a primary care trust needs to take account of all local views. Any requirement for a ballot would need therefore to apply to other stakeholder groups and not just, for example, to GPs or nurses. But a proliferation of ballots for so many different interest groups is clearly impracticable and unattractive. It is difficult to see exactly which groups should or should not have a right to be balloted. In some cases, the constituency would be extremely difficult to define. I refer, for example, to whether it should comprise patients or practitioners, who would be working for some sessions in a new trust and working elsewhere in a community trust. Our approach will therefore allow for ballots but not make them mandatory.

We are proposing consultation on proposals to establish PCTs, not on the draft establishment orders. These will be drafted only following the Secretary of State's consideration of the responses to the consultation.

As to the question about the criteria against which PCTs will be assessed, the outline criteria against which my right honourable friend the Secretary of State will consider applications for primary care trust status were set out in the White Paper, The new NHS, and repeated in the paper, Primary Care Trusts--Establishing Better Services, which we issued in April. They are: broad local support for its establishment, including among those GPs affected; a clear vision of the service and health benefits which establishing a primary care trust will bring, backed by agreed standards and targets to

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make progress towards them; making an effective contribution to the local health improvement programme and working well with partner organisations; effective arrangements for developing clinical standards, including at practice level; proper arrangements for monitoring activity, sound financial management and accountability; a clear assessment of the local impact of change and reconfiguration; access to good, high quality human resources support; and, for level 4 primary care trusts, that the proposals take proper account of the wide range of community health services, including those which are more specialised.

I hope that that gives a sense of the comprehensiveness. We are currently working with the NHS, GP groups and other organisations on developing those criteria. We plan to issue guidance on the application, consultation and establishment process within the next month or so, assuming, of course, Royal Assent to the Bill.

I hope that I have covered the specifics. Perhaps I may now return to the general issue. It is one of principle: whether we should allow the Bill to remain in the position where the views of one local stakeholder, however important, could veto a potentially beneficial development. In his letter on this subject on the 19th February, my honourable friend the Minister of State made clear that,

    "The assumption will generally be that a Primary Care Trust would not be established without the support of the relevant Primary Care Group". I know that that wording does not appear sufficiently robust to some. If it would help to address some of the fears--which I think are about the semantics rather than the realities, although I have set out the reasons why we do not think it would be prudent to put an absolute and blanket prohibition on the face of the Bill--I can assure the House that it is very clearly the Government's general expectation that a primary care trust would not be established if the relevant primary care group opposed it.

I hope that that is sufficiently reassuring and that I have made it clear that we need to reserve the position where we could use the care and sensitivity needed for the sort of exceptional circumstances that potentially could arise. The guidance that we are about to issue on primary care trusts will reflect the expectation I have just described: that a primary care trust would not be established if the relevant primary care group opposed it.

We want primary care trusts to work well. The simple truth is that we cannot afford to alienate the very professionals who will be carrying out the PCTs' functions. On that basis, I hope that I have provided some reassurance to the House.

4 p.m.

Earl Howe: My Lords, I thank the noble Baroness for that very full reply.

On Question, Motion agreed to.

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Clause 2, page 2, line 25, after ("Act") insert ("(including this section)").

Baroness Hayman: My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 2. In doing so, I shall speak also to Commons Amendments Nos. 3 to 9, 16 and 17, 20 to 23, 73 and 74, 95 to 97, 101, 103, 105 and 106, 108 to 110 and 118. It sounds worse than it is!

This group of amendments is a mixed bag of technical, consequential and drafting amendments and one or two other more substantive changes. I am afraid that they are all none the less essential. The common theme is that they each, in part at least, relate to primary care trusts and they all serve, albeit modestly, to tidy up and improve the Bill.

The amendments in this group can be broadly considered under three headings: some important amendments concerning the role of primary care trusts regarding Primary Care Act pilot and permanent schemes; a group of amendments which tidy up the provisions in the Bill which deal with the delegation to and exercise of functions by health authorities, special health authorities and primary care trusts; and a rather more disparate group of technical and drafting amendments.

I turn, first, to the amendments concerned with the primary care Act, Commons Amendments Nos. 9, 20, 73, 74 and 105. The primary care Act 1997 introduced a new option for the delivery of family health services and provides for primary care professionals to provide personal medical services and personal dental services under agreements with their health authority.

Clearly it is important to carry forward the capacity to innovate and to improve services which this Act allows into the new world of primary care trusts. At present, health authorities manage primary care Act pilot contracts. In future, however, this function may be better exercised by primary care trusts. Primary care trusts will have a detailed knowledge of the primary care services and providers at a local level, and that is what is required to get the best out of any contract, benefiting both the primary care professionals and their patients.

The Bill already makes provision for primary care trusts to be able to take on the role of providing personal medical services and personal dental services under the Act. The Bill also already provides for health authorities to delegate their functions in respect of primary care Act medical and dental pilots, including the function of contracting with service providers.

Commons Amendment No. 9 sets out the circumstances in which health authorities may not delegate their functions in respect of primary care Act pilots and makes provision for the transfer of rights and liabilities where parties to the contract change. The Bill currently makes it possible for primary care trusts both to provide personal medical services themselves and to contract for personal medical services in place of the health authority.

I think we would all agree that it would be inappropriate for primary care trusts to manage a contract for services which they were also involved in

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providing. Commons Amendment No. 9 specifically prevents that from happening. It also limits the delegation of other functions in respect of personal medical services where a possible conflict of interest might arise. It provides that a health authority will not be able to delegate to a primary care trust the function of turning personal medical services applications into formal proposals to the Secretary of State. This includes acting as the recipient of applications and undertaking the formal local consultations. Nor will it be able to delegate the payment of funding to meet applicants' preparatory costs.

Commons Amendments Nos. 20 and 105 are consequential on these provisions and Commons Amendments Nos. 73 and 74 make similar provision in respect of Scotland.

A large number of the amendments deal with the delegation of functions to and the exercise of functions by health authorities, special health authorities and primary care trusts. These are technical amendments, Commons Amendments Nos. 16, 17, 21, 22, 23, 97, 106, 108 to 110 and 118, which tidy up and streamline the provisions of the Bill. I do not intend to take up the time of the House in describing them unless noble Lords wish to raise specific questions.

I shall also try to be brief on the disparate group of technical and drafting amendments, Commons Amendments Nos. 4 to 8, which clarify the Bill's provisions concerning the provision of services by primary care trusts. Together they make clear that the goods and services which a primary care trust may provide to another NHS body include accommodation. Commons Amendments Nos. 95 and 96 make minor drafting changes. I beg to move.

Moved, That the House do agree with the Commons in their Amendment No. 2.--(Baroness Hayman.)

On Question, Motion agreed to.

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