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Noble Lords: Hear, hear!

4.26 p.m.

Baroness Gardner of Parkes: My Lords, on a day when we have heard much about improvements to the health service, can the noble Leader of the House assure us that, in the abolition of postcode prescribing, NICE will not result in a levelling down rather than a levelling up? In particular, can she comment on the imminent announcement of the multiple sclerosis Beta Interferon NICE decision? Can she assure me that that will not be slipped out quietly in the shadow of this report?

Baroness Jay of Paddington: My Lords, I am afraid I cannot comment on the noble Baroness's final point. As I understand it, the Government have not yet received this. Therefore, I am not in a position to comment on it.

On the noble Baroness's overall point regarding levelling down, of course that will not be the case. The whole point of the national clinical frameworks, as devised and set out by the National Institute for Clinical Excellence, is precisely to incorporate both clinical excellence and cost-effectiveness when considering the matter of prescribing.

Lord Patel: My Lords, I thank the noble Baroness the Leader of the House for repeating the Statement made by the Prime Minister. I also welcome the commitment now demonstrated by the Government to making the NHS responsive to the needs of patients and helping NHS staff to deliver the care. These are radical reforms, and I support much of what is contained in the plan.

Consultant and specialist registrar expansion is most welcome. We know from today's Question Time that more consultants are needed in the service. However, I should like to ask the noble Baroness if a stop will now be put to the current round of reductions of specialist registrars in training that is recommended in respect of some of the specialities. If a stop is not put to it, there will be difficulty in filling consultant expansion.

I also welcome the recommendation in the plan for the funding of specialist registrars from central funds. The current arrangement of 50 per cent of the funding coming from postgraduate deeds and 50 per cent from the trust is not working satisfactorily. Many specialist registrar posts are not currently being filled.

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In relation to specialist registrar training, I was, as the current chairman of the Specialist Training Authority, a little surprised to read the proposal to establish a medical education standards board to replace the current Specialist Training Authority and the Joint Committee on Postgraduate Education in General Practice. Nevertheless, although I welcome the proposal to establish a board with a wider representation from the professions, the NHS and the lay public, I hope that the Minister will agree that an opportunity will be provided to those currently responsible for running the two competent authorities on postgraduate medical education to take part.

Baroness Jay of Paddington: My Lords, I am grateful to the noble Lord, Lord Patel, for his authoritative thinking about some of these issues. As he will be aware, all the concerns about registrar training and training for particular specialties are being looked at by the overall workforce planning initiative of the NHS. As I understand it from the document, it is proposed that there should be 1,000 more specialist registrars by 2004 and those will be targeting key specialties. That will obviously deliver a further acceleration in the number of consultants later in the decade.

As I said in the Statement, one of the advantages which those who have written the Statement and worked on it in government have experienced is the enormously co-operative and collaborative part played by the medical profession and the different specialists who have taken part in developing that plan. As I also said when repeating the Statement, the Government regard that as the beginning, not the end, of that process. It is our intention that this matter should be taken forward on a collaborative basis.

Lord Clement-Jones: My Lords, those of us who hold at heart the best interests of the NHS and, indeed, do not believe that private medicine is the route for its salvation will support the broad thrust of the plan before us today. There will be some disappointment, however, in terms of the treatment of older people, as my noble friend indicated, and the failure to accept the recommendations on personal care.

There is one particular issue in addition to that in terms of the limits on means testing for those entitled to accommodation costs in nursing and residential homes. Will the noble Baroness comment on that? There is also a considerable gap in terms of the treatment of those in hospices. There seems to be no mention of palliative or terminal care. That is an essential part of our health and social care. I wonder why that particular gap should exist.

Baroness Jay of Paddington: My Lords, the noble Lord, Lord Clement-Jones, invites me to repeat what I said in reply to the two noble Lords who spoke first. The Government are making an unprecedented new investment over the next three years in improving old people's services by making them more responsive and more fairly funded. The Government's investment will

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cover the costs of the Royal Commission's recommendations and there is no shortfall in the proposals which the Government have made against those made by the Royal Commission. But the Government have decided that making personal care universally free is not the best use of those resources.

I shall have to write to the noble Lord on the question of hospices. I too am not familiar with any detailed recommendations on that work but I recognise its importance. If there are proposals in the report which I have not yet read about or ancillary proposals, I shall write to the noble Lord.

Lord Ashley of Stoke: My Lords, is my noble friend aware that the Government deserve warmest congratulations on a highly constructive and tremendously impressive set of proposals? She must have been very proud to announce them. They are great.

I have just one reservation. Is my noble friend aware that there is a great deal of anxiety among certain disabled people about charging for personal care, mentioned earlier? In point of fact, there is no real difference between nursing care and personal care because people need that personal care because of their sickness or disability. There is no real difference whatever. Will the Government reconsider that point?

Baroness Jay of Paddington: My Lords, I am grateful to my noble friend for his first comments. I was very proud to be able to repeat the Statement. As the noble Lord, Lord Strathclyde, said, I realise that I have walked into a situation which should properly be for the noble Lord, Lord Hunt, given the enormous amount of work which he has done in this field in the past two years. It is a great privilege for me because, as the Statement said, this is part of the fundamental principles of a civilised society: to try to make the reforms of the health service work in the way which this outline report will now do when it is developed in detail. The Government's reputation will last on this for many generations.

On the point about charging people, I must repeat to my noble friend the point which I made to the noble Lord, Lord Clement-Jones. The Government decided that while making a major investment in the care of old people, which goes beyond that recommended by the Royal Commission, it was not the best use of resources to try to demarcate in the way which I hoped I explained earlier between the types of care being offered, one category being personal care and the other being nursing care.

I know that that is not entirely satisfactory and may be difficult to implement on the ground. But if we identify those services which are offered free as those being offered by registered nurses in whatever environment and surroundings they offer those services, then that is a major step forward which I know my noble friend will welcome.

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Lord Renton: My Lords, I too hope that these proposals will succeed. There is one proposal which I do not think the noble Baroness mentioned but which was mentioned on television this morning; namely, that newly qualified consultants employed within the National Health Service should for the first seven years not take private patients. If that is not the proposal, that is splendid.

Baroness Jay of Paddington: My Lords, the reason that I shook my head is that perhaps the noble Lord, Lord Renton, was not here when I gave a very detailed answer to that point when it was raised on an earlier question. I shall be delighted to repeat it. It seems that I am invited not to repeat it.

Lord Renton: My Lords, I am grateful to the noble Baroness for that assurance.

Baroness Jay of Paddington: My Lords, I think that the noble Lord has misunderstood on both occasions. The point I was making was that I had answered the questions about the way in which consultants would be asked to work only for the health service immediately after they qualified. I was not responding to the point that the television programme was inaccurate. As far as the noble Lord described it, the television programme was accurate.

Baroness Greengross: My Lords, I welcome the plans and the report and I thank the noble Baroness for repeating the Statement. I want to make two points.

Noble Lords: Order, order!

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