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Baroness Greengross: My Lords, I am sorry, I want to ask two questions. I welcome the fact that nursing care--looking after old people--will now be free at the point of delivery, wherever the person is. But could not that be defined sufficiently broadly to encompass care which needs to be given or supervised by a fully qualified nurse? As the numbers of old people increase, there will have to be some instances of delegation to people who are not fully state registered. We do not fall into little boxes, particularly as we age. Many people suffering from multiple pathologies get weaker and stronger as they are cared for during treatment and rehabilitation.

The other point is about children. The RCN, among other bodies, has pointed to the urgent need for children and young people to have an explicitly key focus at all levels of health policy.

Baroness Jay of Paddington: My Lords, the Government agree with the point which the noble Baroness has just made about the need for a special focus on children and young people's services.

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On the previous point, I fear that I am becoming repetitive. I can only repeat what I said to my noble friend Lord Ashley and the noble Lord, Lord Clement-Jones. Perhaps the noble Baroness will refer to paragraph 2.9 on page 11 of the report which states:

    "In the future, the NHS will meet the costs of registered nurse time spent on providing, delegating or supervising care in any setting. This is a wider definition of nursing care than proposed in the note of dissent to the Royal Commission report which suggested that it should include those tasks which only a registered nurse could undertake".

Baroness Cumberlege: My Lords, the debate has focussed on care of the elderly. Have maternity services been considered at all? The Statement said that for each of the main conditions there will be a national framework of standards. The National Service Framework for Mental Health has been successful. In the debate that took place with members of staff in the National Health Service, were maternity services rated as a high priority in the order of national frameworks that will be established?

I welcome the idea of care trusts, where local councils and primary care trusts merge. Will those be new organisations? If not, where will the corporate governance, the accountability, lie?

Baroness Jay of Paddington: My Lords, I do not believe that maternity services as such are contained in the national plan. I am afraid that I cannot tell the noble Baroness what private discussions were held with National Health Service staff. My suspicion is that if National Health Service staff had wanted to focus on those services and had wanted to advocate them with great vigour, they would have been contained in the plan. That is not to say that they did not advocate something that it is worth while looking at, but it was not something that emerged as a major national priority. That is probably because, on the whole, maternity services are rather good.

The next national service framework, as the noble Baroness may be aware, will be in relation to older people. The Government have not made a decision about the national service framework to be developed after that. It probably would be useful if other priorities were set out and perhaps in that context maternity services would be included.

I understand that one way of looking at the care trusts--this may be familiar to the noble Baroness with her great knowledge of the organisation of health and social care in the United Kingdom--relates to the way in which social care and health boards are organised; for example, in Northern Ireland there is an integrated provision of services and governance seems to be satisfactory.

Lord Bruce of Donington: My Lords, this afternoon is a very moving occasion for me. I sat in this House, which was then the House of Commons, while the entire National Health Service Bill was passed. I congratulate Her Majesty's Government on the way in which the plan and programme, which I have now read, have been put before the House. I also

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congratulate the Opposition on the honourable part that they have played this afternoon in sustaining the Government who will need all the help they can get from all quarters of the country in order that the plan may be achieved. What Aneurin Bevan started in 1948 now has the strong probability of being furthered to the good of the country as a whole.

Lord Jacobs: My Lords, I strongly welcome the Statement, particularly the significant increase in expenditure of more than a third over the next few years. However, I do not agree with the comments that National Health Service expenditure should have been greatly increased three years ago because, when the Government came into power, there was a deficit of £28 billion. Nevertheless, the Government have had three years to consider these proposals. Included in the proposals is an increase of 7,000 in the number of doctors. Will the Government and the noble Baroness consider what the public should be told about the fact that it will take between five and seven years to train 7,000 new doctors and, therefore, they must not expect quick results under these new plans?

Baroness Jay of Paddington: My Lords, I am grateful to the noble Lord, Lord Jacobs. I believe that I said in the Statement that such matters must be related to the time for training and the time for improving the labour force, if one can describe it that way, of the health service in all professions and in all healthcare areas. We are building on a situation where already more doctors and nurses are in training and more doctors and nurses are being recruited into the health service than three years ago. The additional number that has been announced this afternoon is based on a position that is already strong.

Lord Glenarthur: My Lords, the noble Baroness referred in the Statement to 100 new hospital schemes over the next 10 years. Are they to be funded under the PFI initiative or centrally? In relation to her reference to run-down premises--I draw on my own experience as a chairman of an NHS trust in London for several years--can she tell the House whether the system of capital allocations will be changed to allow those that may have to last for 10 years or more to be suitably built, rebuilt, added to, or adapted in a way that meets the aspirations to which the Statement refers?

Baroness Jay of Paddington: My Lords, the expansion of buildings and facilities, to which the noble Lord rightly draws attention, will be achieved by a combination of the schemes that are exclusively PFI and other methods of funding. I am sure that the noble Lord will welcome the fact that within the plan, although not within the Statement, was the fact that this autumn £30 million will be given to hospitals to clean up wards and so on--in other words, to have a spring clean in October.

Lord Winston: My Lords, the whole nation will be deeply grateful to the Government for the increased spending on the health service, for their focus on the

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fabric of the health service and for their focus on, and, above all, their support for, the staff of the health service. It is greatly cheering to hear the noble Lord, Lord Rodgers, make the point that this should not be a political football and that we should try to find an accord on all sides so that we can establish the best way of managing the health service.

Perhaps I may make a specialised plea for one group of patients who are rather neglected, who are subject to the postcode lottery and who, in many cases, are subject to inordinate waiting lists and a great unevenness of practice. Given the Government's commitment to family values and the importance of the family, can my noble friend the Leader of the House give us some assurance that people with reproductive difficulties will be better catered for in the forthcoming health service?

Baroness Jay of Paddington: My Lords, I am grateful to my noble friend for his support for the plan overall. On his special pleading point for his own specialty, which we understand, I am sure that he realises that some of the arrangements that are being made for the commissioning of specialist services should iron out the problems that he has described to your Lordships' House relating to "postcode treatment" of people who have particular problems. That is something that could be addressed by a national service framework and, as in the case of maternity services mentioned by the noble Baroness, Lady Cumberlege, this could be a good candidate for future work in that area.

I am grateful to my noble friend for making the point that this must be a collaborative effort by everyone involved in healthcare. I recommend to the entire House the statement of principles at the beginning of the plan which sets out, in the most sensible and clear way, the basis on which the plan will be taken forward. As I said originally in answer to another question, it is signed by all those who have a particular responsibility for delivering healthcare, not only on a non-political basis, but also on a professional and a patient-centred basis. We all hope to achieve that.

House of Lords Offices: Select Committee Report

4.47 p.m.

The Chairman of Committees (Lord Boston of Faversham): My Lords, I beg to move the Motion standing in my name on the Order Paper.

The noble Lord said: My Lords, the first four items in the report were first put to the House in the committee's last report which was debated on 21st June. At the end of the debate I withdrew the Motion to approve the report, partly in response to complaints that the report did not contain enough information. At its most recent meeting, the committee reaffirmed its approval of these items, which are now reported back to your Lordships but in greater detail. The final four items in the report

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are put before the House for the first time. I do not intend to speak to any of them now but I shall try to answer any questions Members may have about them.

As I believe the House will expect, I now turn to item 5, the proposal to appoint a consultant to lead a review of the management structure of the House and the structure for taking decisions about its services. After this proposal was criticised during the debate on 21st June, both the Finance and Staff Sub-Committee and the Offices Committee reconsidered the matter at great length. For the reasons set out in the report, the committee remains convinced that a review is necessary. But as your Lordships will have seen from the report, the terms of the proposal have been revised and, in addition, we recommend that it should take place under the supervision of a small steering group of Peers.

The financial management structures of the House have not been reviewed since they were put into place in the early 1990s when the two Houses assumed control of all parliamentary expenditure. In the last financial year, the budget for this House alone was £45 million. A review would help to assure the House that its services are being delivered efficiently and that its procurement procedures are robust enough to avoid the threat of litigation.

As the report notes, the House of Commons may change the way in which it supervises the services which are shared between the two Houses, such as the Parliamentary Works Directorate. It seems sensible for this House to take any changes into account and to respond to them if necessary.

I should also like to say a word on behalf of the Clerk of the Parliaments, who has been charged with the responsibility for delivering services for the House. He would welcome advice on these matters and, if for no other reason, Members may wish to permit him to seek the advice that he requires in order to discharge his responsibilities to the House. That is not intended to imply that the House is badly managed at present. However, although it is clearly the case that we have great expertise within the House, I would hope that we would not regard ourselves as the sole repository of all wisdom and knowledge on these matters or that we are not capable of benefiting from outside advice. A review would benefit from the involvement of someone with knowledge of modern management practices and who could approach the task without any preconceived views. That is why the committee recommends the appointment of Mr Braithwaite to conduct the review.

As the report emphasises, the final decision on whether or not to implement any recommendations will be made by the House and its committees. But I appreciate the desire within the House to keep any review under its control, especially after the criticism of this proposal last time. The committee therefore proposes that a small steering group of Members of the House be appointed to supervise the review. I do not believe that the House has anything to fear from what is proposed, since decisions remain within the control of the House. On the contrary, I believe that

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improvements to our management structure can only be to the benefit of individual noble Lords and the House as a whole. I commend the report to the House.

Moved, That the sixth report from the Select Committee (HL Paper 97) be agreed to.--(The Chairman of Committees.)

Following is the report referred to:

    1. Pay proposals for fast stream clerks and library clerks

    The Committee's fifth report informed the House that the Committee had agreed to new arrangements, developed in conjunction with the House of Commons, for paying clerks (recruited through the Civil Service competition for administrative grade civil servants) and library clerks. The report was criticised for lacking detail, which is as follows: the old pay range was £16,306 to £28,336 and the new pay range will be £20,000 to £27,500. Progression will be by three annual increments, subject to satisfactory performance. Promotion should normally be after four years, subject to satisfactory performance.

    2. Salaries of the Chairman and Deputy Chairman of Committees

    The Committee's fifth report informed the House that the Committee had approved revised salaries for the Chairman and Principal Deputy Chairman of Committees. The report was criticised for lacking detail, which is as follows: the salary of the Chairman of Committees is increased from £64,429 to £66,294; and the salary of the Principal Deputy Chairman of Committees is increased from £60,032 to £61,773. Both of the increases are with effect from 1 April 2000, and are in line with changes to the salaries of Ministers and other paid office holders.

    3. Lords' reimbursement allowances

    The Committee's fifth report informed the House about changes to the motor mileage allowance and the bicycle allowance. From 1 April 2000 the motor mileage allowance was uprated in line with the retail price index to 52.5 pence per mile for the first 20,000 miles and 24.2 pence per mile thereafter (up 1.3 pence and 0.6 pence respectively); and the bicycle allowance was uprated to 6.7 pence per mile (up 0.2 pence).

    4. Commercial activities

    As stated in its fifth report, the Committee has agreed that the House of Lords should not be used by Members as a business address nor the name used for the promotion of any commercial activity.

    5. Appointment of a management consultant

    Previous recommendation

    In its fifth report the Committee recommended the appointment of Mr Michael Braithwaite "to undertake a review of the management structure and the structure, including the Committee structure, for taking decisions about the services of the House and other domestic matters, which were introduced in the House of Lords in 1991-92 following the Ibbs reforms in the House of Commons".

    During the debate on the Committee's report on 21 June there was considerable criticism of the proposal. In particular, it was argued that not enough information had been provided about the proposal; that there was no need to look outside the House for advice; and that the money could be better spent elsewhere. The Chairman of Committees withdrew the Motion to approve the report, and said that the proposal would be reconsidered.

    At its meeting on 19 July the Committee considered the matter at length. For the reasons set out in this report the Committee remains convinced that a review is necessary, but it has revised its original recommendation to the House.

    Reasons for a review

    The proper resourcing of the House is of fundamental importance to its effectiveness. As the activities of the House continue to change and grow, and the expectations of Members increase, the Committee believes that a review would help to ensure better strategic planning for the future and effective management of the House's resources.

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    The House's financial management structures have not been reviewed in detail since they were put in place nearly 10 years ago following the Ibbs reforms in the House of Commons. The reforms gave the two Houses much greater control over parliamentary expenditure, especially in relation to the maintenance of the parliamentary estate and printing. In the financial year 1999-2000, total expenditure by the House was £45 million. Many savings have already been achieved (especially in relation to printing) and better services provided, but the Committee considers that more could be done.

    In his role as accounting officer the Clerk of the Parliaments must be certain that value for money is secured in the provision of services for the House; and that the existing system of budgetary control is satisfactory. In his role as corporate officer of the House, he must also be sure that procurement and contracting procedures are sufficiently robust to avoid the threat of litigation 1 . A review would provide additional assurances to the Clerk of the Parliaments in the discharge of his responsibilities.

    None of this is intended to suggest that the House is poorly managed at present. But a review would ensure that the House's management structure operates to the very highest standards and that it is responsive to the increasing demands being made upon it.

    The House of Commons have already undertaken a review of their management structure, assisted by Mr Braithwaite, and the recommendations which resulted are now being implemented 2 . Additionally, Mr Braithwaite has just completed a second review for the House of Commons into the Parliamentary Works Directorate and the Parliamentary Communications Directorate. While there are significant differences between the two Houses, this House should not ignore changes in the way the Commons may manage shared services such as the Parliamentary Works Directorate, which is responsible for works and the maintenance of the parliamentary estate, and the Parliamentary Communications Directorate, which is responsible for the telephone network and the Parliamentary Data and Video Network (PDVN). Both are part-financed by the House of Lords.

    Furthermore, many Members have expressed their dissatisfaction with the House's "domestic" committee structure 3 and their apparent failure to deliver all the improvements which Members would wish to have. A review should ensure that the House and its committees retain effective control over the delivery of its services and that the entire structure is responsive to the needs of Members, for example in relation to accommodation, which is the source of widespread dissatisfaction.

    Obtaining a fresh perspective, while retaining control of the review

    The Committee considers that a review would greatly benefit from the involvement of someone with in-depth knowledge of modern management practices and who could approach the task with an open mind and without pre-conceived views. The Committee therefore recommends that Mr Michael Braithwaite be appointed to lead the review. The final decision on whether to implement any recommendations will, of course, belong to the House's committees and ultimately to the House itself. There is no question that reforms affecting the House will be made without its prior approval.

    However, the Committee understands the desire to keep the review under the control and supervision of the House. The Committee therefore proposes that a small steering group of Members be appointed to supervise the review, and to act as a channel for comments from Members (the review will, in addition, involve interviews with Members). If the Committee's proposal is agreed to, such a steering group will be appointed before the start of the review. The Clerk of the Parliaments also proposes that two senior officers of the House (Rhodri Walters, the current Establishment Officer, and Brigadier Hedley Duncan, the Yeoman Usher) form part of Mr Braithwaite's team (a similar arrangement was made in the Commons).


    The final cost of the review will depend on the time it takes to complete which, in turn, will depend largely on the number of interviews the review team is required to carry out. However, the cost of employing Mr Braithwaite is likely to be lower than other consultants with his experience because of the knowledge of

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    Parliament he has acquired during his two reviews in the House of Commons. This knowledge will be particularly useful in relation to the services which the House shares with the Commons.


    The Committee recommends that there should be "a review of the management structure and the structure for taking decisions about the services of the House and other domestic matters, including the impact on the domestic Committee structure"; that the review should take place under the supervision of a small steering group composed of Members of the House; and that Mr Braithwaite should be appointed to lead the review.

    6. Steps of the Throne

    On 9 December 1999 the House agreed that hereditary Peers who are no longer Members of the House should be allowed to sit on the steps of the Throne, but that the privilege should be reviewed before the end of the Session.

    The Committee found that between 10 January and 12 July, 46 hereditary Peers made use of the privilege on a total of 104 different occasions. There were 102 sitting days in the period in question, meaning that the privilege was used, on average, a shade over once per sitting day. The Committee concluded that the privilege was not being abused and that there was no reason at the present time to end it.

    The Committee recommends that hereditary Peers should continue to be allowed to sit on the steps of the Throne. The privilege can be reviewed in the future.

    7. Judicial Fees and Security Money

    The Committee has agreed to increase the flat rate taxing fee, introduced at £25 on 1 April 1983, to £50; to increase the amount of security for costs set at £18,000 in April 1994 to £25,000; and to increase the other judicial fees payable (last set in 1995) by the following amounts:

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