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Viscount Waverley: My Lords, before the Minister sits down--I am sorry to trouble him on this point--does he realise that he has undermined the concerns of his officials in Jamaica in matters relating to drug issues in the Caribbean?

Lord Sainsbury of Turville: My Lords, I made a general point. There is no evidence that where preference has been withdrawn it leads to drug taking; and there are drug problems in countries which have

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had preference. Therefore, the easy assumption that if preference is withdrawn it will lead to more drug taking cannot be substantiated by fact.

Baroness Ramsay of Cartvale: My Lords, I beg to move that the House do adjourn during pleasure until 8.30 p.m.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended from 8.29 to 8.30 p.m.]

Health and Social Care Bill

House again in Committee.

Clause 10 [Application to City of London]:

Lord Hunt of Kings Heath moved Amendment No. 66:

    Page 8, line 41, leave out "(6)" and insert "(5)"

On Question, amendment agreed to.

Clause 10, as amended, agreed to.

Clause 11 [Public involvement and consultation]:

Lord Clement-Jones moved Amendment No. 67:

    Page 9, line 18, after "representatives" insert "including Patients' Councils, patients' and carers' organisations, ILAFs, Patients' Forums, overview and scrutiny committees and the wider community"

The noble Lord said: I shall speak also to Amendments Nos. 69, 72 and 73. Clause 11 provides for health service bodies to involve and consult the public in the planning and development of their services. The amendments are straightforward. Amendment No. 67 is intended to clarify what is meant by "representatives" in subsection (1) so that it includes the new ILAFs, which are not specified elsewhere in the Bill, patients' forums, patients' councils, overview and scrutiny committees and the wider community. I am not a great fan of lists, but that seems reasonably short and to the point. There is currently a lack of clarity about whom the health service bodies should consult in the performance of their duties. It is not possible formally to consult everybody who may have an interest in health services, but one should have a pretty good idea of the principal players. The amendment carries out that purpose admirably.

The second main purpose is carried out by Amendment No. 72, which would add special health authorities, the NHS Executive--by that we mean the regional offices of the NHS Executive, which have an important planning and development function--and care trusts, which are set up by the Bill and will have an increasing importance over the years. It is important that those bodies should be included and should have consultation duties. I do not understand why they were not included originally. It may have been an oversight by the draftsman. The amendment fills a gap. It would be inappropriate for special health authorities and care trusts not to be subject to the same requirement as other health authorities to consult persons to whom their services are provided. The regional offices of the NHS Executive are responsible

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for many decisions that impact on service delivery. Amendment No. 72 would open up those regional offices. That is long overdue.

Amendment No. 73 relates to annual reporting. I note that the noble Earl, Lord Howe, has tabled a very similar amendment. This is an important issue. The bodies concerned should state publicly how they have consulted and in what form. The purpose of the first part of the amendment is to require health service bodies to explain in their annual report how they have involved and consulted patients, carers and the wider community and what they have done about what they have learned as a result. The second part of the amendment would provide for an appeals and referral procedure by which contested decisions would be scrutinised and adjudicated on. That would enable patients and local communities to express their concerns about contested decisions and have those concerns considered by the Secretary of State. I beg to move.

Earl Howe: I shall speak to Amendments Nos. 68, 72 and 74A. Clause 11 gives effect to one of the Government's main aims in this part of the Bill--to enable patients and the public to contribute in an appropriate fashion to the planning and decision-making of health authorities, PCTs and trusts. We fully share that aim. Patients and the public generally will be able to have their say in a reactive sense through a variety of different channels. The combination of patients' forums, patients' councils, advocacy services, ILAFs and, to an extent, overview and scrutiny committees will provide a conduit for the views of patients on the standard of services delivered locally and problems that may arise. However, equally important will be the ability of the local community to have a voice in the big decisions on issues such as the planning of new services or major changes in service provision.

The clause is not specific about who will be accorded the right of consultation and involvement in those decision-making processes. At some point in every Bill we reach what my noble friend Lord Skelmersdale has in the past described as a shopping list. Amendment No. 68 is framed as a catch-all shopping list, but its main purpose is to act as a probe. If it is a sin to try to insinuate a shopping list into a Bill, it is equally sinful to go to the other extreme and fail to give any indication of who is being referred to. There is a genuine risk that the Bill will fail to be clear about who the consultees are meant to be.

It is impossible formally to consult everyone who may have an interest in health services. At present, the statutory duty to consult is limited to consulting CHCs. However, unless the clause is fleshed out, I fear that legal challenges could be mounted by individual patients and groups who were not specifically consulted but who consider that they should have been. One can well imagine threats of legal action being directed at health bodies carrying out the consultation. CHCs have found themselves on the receiving end of complaints and solicitors' letters from community groups who believe, fairly or unfairly, that

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their views have not been reflected in the CHC's recommendations or responses. I shall be interested to hear how the Minister proposes to square that circle and to find out who will be included in the consultation process that the clause proposes.

As I said, the purpose of the clause is to place a duty on health authorities, PCTs and trusts to involve patients and the public in planning and decision-making. Amendment No. 72 would add to the list of health service bodies on which that duty was conferred. It would provide for special health authorities and care trusts to consult the public. It would also ensure that if proposals for changes in health services were under consideration by the NHS Executive, it, too, would be obliged to consult before reaching final decisions that may impact on service provision.

When a similar amendment was debated in another place, the Minister, Mr Denham, rejected the inclusion of special health authorities on the ground that by 2002 no special health authority would be providing services directly to patients. I ask the Minister to think again on that. The issue should not be whether services are provided directly. What matters is that the decisions of the authorities--for example, the National Institute for Clinical Excellence, which is a special health authority--can have a real and discernible impact on health service delivery.

In the case of care trusts, Mr Denham's argument stands up to even less scrutiny because it is clear that a care trust will provide services directly to patients in as full a sense as will an acute hospital trust. There may be a legal objection to that. The Minister may say that a care trust is simply an NHS trust or a PCT in a different guise. However, I am not sure whether I consider that to be a strong enough argument and I shall be interested to hear what the Minister has to say.

That brings me to the NHS Executive, to which the noble Lord, Lord Clement-Jones, referred. Again, I recognise fully that the NHS Executive does not provide services directly to patients. However, in indirect terms, its role is of course extremely important. Regional offices of the NHS Executive are responsible for a number of decisions which impact on service delivery. Those range from resource allocation to decisions about reconfiguration of health bodies and supra-regional services. Regional offices are often the place where final decisions rest. Therefore, one could argue--and I do--that any process of consultation that confines itself to the bodies which merely implement regional office decisions is a fairly worthless exercise.

Finally, one theme to have emerged from our debates on the Bill thus far is the need for transparency. With the exception of one or two notable provisions, there is precious little on the face of the Bill in the way of transparency. The purpose of Amendment No. 74A is to apply, as it were, a little more window-cleaning fluid to the procedures to which the legislation gives rise. Its simple purpose is to require health service bodies to explain in their annual

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report how they have involved and consulted patients, carers and the wider community. In my view, it is important not only that such consultation takes place but that everyone should be made aware that it has taken place and in what way. I hope that that idea will commend itself to the Minister.

The other amendment in this group provides for an appeal for referral procedure whereby decisions that are controversial can be scrutinised and adjudicated upon by the local OSC. In that way, patients and the local community will be able to express their concerns about contested decisions and, where necessary, have their decisions considered by the Secretary of State. A provision of this kind would mirror Regulation 18.5 of the CHC Regulations 1996 under which CHCs have the statutory right to refer contested decisions to the Secretary of State. At present, the Bill does not provide for any type of appeals or referral procedure. I believe that that is an omission which should be rectified.

8.45 p.m.

Lord Hunt of Kings Heath: This has been an interesting debate, and I believe it is worth acknowledging that this is a very important clause. It sets out the responsibilities of the NHS in fulfilling its duties to involve and consult the public. However, I have reservations about the amendments that have been put forward.

Clearly, our intention is that comprehensive patient and public involvement will take place at all levels of the NHS. Clause 11 is explicit about that. However, I do not believe that it is necessary to list on the face of the Bill all the bodies that we would expect to be consulted, as is suggested by Amendments Nos. 67 and 68. I believe that the list is too prescriptive and it runs the risk run by all lists--by naming some, almost inevitably others are excluded.

The important point is the intent. The intent is quite clear. I believe that it would be fairly obvious to every NHS organisation that patients' councils, patients' forums, OSCs and patient and carer organisations would be critical of the delivery of the duty set out in that clause. The NHS has had extensive experience in consultative processes. We want to make that bite still further. I believe that this general duty does so effectively without the need to list a particular organisation which specifically should be consulted.

Nor do I believe that it is necessary to specify in the clause that patients' councils should monitor the implementation of Clause 11, as is suggested by Amendment No. 69. One of the duties of the patients' forum will be to prepare annual reports that will be submitted to health authorities and, indeed, to the Secretary of State. Those reports will include an assessment of how local trusts consulted and involved the public in their decisions. I believe that that will also be a powerful tool in the armoury of those who, quite understandably, wish to hold the local NHS to account in ensuring that the clause is put into effect properly.

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I turn to the comments made by the noble Earl, Lord Howe, in relation to special health authorities, care trusts and the NHS Executive. He seems to have anticipated my answer, which is always rather disturbing. With regard to SHAs, my right honourable friend Mr John Denham was right. We do not envisage that any of the SHAs which currently provide health services will be special health authorities by April 2002. At present, Rampton, Ashworth and Broadmoor are covered by the terms of the clause as special health authorities. However, by the time that Clause 11 comes into force, they will have been made into trusts.

The noble Earl believed that some of the remaining SHAs which provide a service to the NHS may be covered by the proposal. It is worth recalling that the current SHAs include the Prescription Pricing Authority, the National Blood Authority and NICE. Although I accept that it is important that those organisations always focus their services on the impact on the public and patients, I am not at all convinced that the mechanism that we have set out here, which essentially concerns the provision of local NHS services, is the path down which one should go in relation to such institutions as NICE or the National Blood Authority.

It is also worth making the point that, for example, the Secretary of State has required NICE to set up a 50-strong Partners Council, made up of members representing the health professions and patient and carer interests, which it consults on a regular basis. In addition, a new citizens' council will be established to advise NICE on its clinical assessments.

So far as concerns the NHS Executive, I do not agree with the points that have been put forward. It is worth stating that the NHS Executive is part of the Department of Health. Therefore, the question of scrutiny and accountability must rest on Ministers' accountability to Parliament for the performance of their responsibilities, including the performance of the NHS Executive.

I turn to the question of care trusts. Perhaps I may explain in fairly outline terms that a care trust will be either an NHS trust or a primary care trust. If, for example, a care trust was formed out of a primary care trust and services were delegated to it by the local authority, in statutory terms it would be a primary care trust. Another example might be an acute mental health trust to which the local authority delegated services. That would be a care trust, but in statutory terms it would be an NHS trust. Therefore, I am convinced that care trusts will be covered by the terms of the Bill as it now stands.

So far as concerns Amendments Nos. 74 and 74A, I am not persuaded by the arguments put forward. Our proposal for a patient prospectus will require all trusts to say how they have taken into account the views of patients.

In addition, Clause 12 refers to the reports which patients' forums will be making to trusts and health authorities. Of course, those forums will also be able to make reports to the overview and scrutiny committees

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and, indeed, to the Secretary of State, if they are so minded. I do not believe for one moment that patients' forums will be inhibited from making their views known to anyone in the system whom they think is relevant.

The system that we are creating has any number of safeguards to ensure that as many people as possible are involved and consulted by the NHS. We do not need to go further. The clause as it stands is a very powerful guarantee of the way in which the NHS will behave in the future.

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