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Earl Howe: I thank the Minister for that very fair reply. I particularly endorse the sentiments expressed at the end of his reply. This is obviously an experiment which needs to be kept under review. From what the Minister has said, I am confident that the department will do that. I also share his view that the Royal Pharmaceutical Society will play its part in ensuring that the experiment works as well as we all hope.

Clause 50 agreed to.

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Clause 51 agreed to.

Clause 68 [Extension of prescribing rights]:

Lord Astor of Hever moved Amendment No. 230:

    Page 71, line 17, at end insert--

"(9) Before making any order under this section, the Secretary of State shall, after a period of three months beginning with the publication of the draft--
(a) consult persons appearing to him appropriate to consult as representing the professions listed in subsection (3)(1A)(a) to (h), and
(b) publish a report detailing the results of such consultations and advice given by the relevant Committee of the Medicines Control Agency,
and may lay the draft as published, or with any modifications he considers appropriate, before both Houses of Parliament."

The noble Lord said: This amendment is designed to reassure those organisations which, as a consequence of this Bill, will be provided with prescribing rights. There is no doubt that the extension of prescribing rights to a wide range of health professionals will free up medical practitioners' time, allowing them to deal with other cases and reduce costs in the NHS; and we very much welcome that.

However, some of the relevant health professionals are concerned that the measures, when introduced, may not be appropriate for their specific organisation. Clause 68 only enables legislation. We understand that the Government will not introduce any secondary legislation until an advisory group has been set up under the remit of the Medicines Control Agency.

Before that committee is set up, the importance of reporting and proper consultation with all the health professionals affected, including ensuring that they are fairly represented on the committee, cannot be overstated. I beg to move.

Lord Clement-Jones: The noble Lord has tabled an interesting amendment, particularly in view of the fact that some quite important decisions will have to be made under Clause 68, which we very strongly support. It has long been awaited and represents a very positive move forward. But questions are raised by the professions in this context, and I suspect that consultation will be more than usually important in relation to who will retain clinical responsibility; the independence of prescribing rights; whether those rights are dependent on an existing prescriber or are truly independent; and appropriate safeguards. Strong professional views will be expressed during the process. The noble Lord, Lord Astor of Hever, has raised an important issue in that respect.

6 p.m.

Lord Walton of Detchant: On the face of it, the amendment is very reasonable. I would welcome the opportunity for professionals such as osteopaths, chiropractors, chiropodists, podiatrists and others to be able to prescribe under appropriate circumstances. However, as the noble Lord, Lord Clement-Jones, said, the question of ultimate clinical responsibility is important, as is the definition of the range of drugs

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that can be prescribed by such individuals. For that reason, the amendment would be a useful addition to the clause and it should be generally welcomed.

Lord Hunt of Kings Heath: I am grateful for the general welcome that has been given to Clause 68. I am sure that Members of the Committee all recognise the work of the noble Baroness, Lady Cumberlege, in developing nurse prescribing some years ago. We are building on that remarkable development.

The amendment is linked to the Government's plans to enable Ministers by order to grant prescribing rights to additional groups of health professionals and to designate new categories of prescriber and the conditions that may be applied to their prescribing. I understand the sentiments that underlie the amendment, but there is already a legal requirement under Section 129(6) of the Medicines Act 1968 to consult organisations that are representative of interests likely to be substantially affected by an order under the Act. In practice, the department and the Medicines Control Agency already consult widely with professional bodies, pharmaceutical organisations, patient groups and NHS organisations. Consultation letters are also routinely published on the Department of Health and MCA websites.

I understand the purpose of the amendment, but I feel that the arrangements that are already in place will be sufficient for consultation. I also have one concern about the amendment, because it would appear to require a three-month standstill period before consultation. I suspect that that would result in an overly long period between the preparation of the draft order and the making of the order.

More generally, my experience is that all the professions and public interest groups involved take an intense interest in extending prescribing rights. There will be no problem in ensuring that we get the views of all the relevant professions.

Lord Clement-Jones: Will the issues that the noble Lord, Lord Walton, and I have raised be the subject of consultation under the duties that the Minister has mentioned?

Lord Hunt of Kings Heath: I expect the consultation to be wide and to encompass a number of issues along the lines that have been raised in the Chamber tonight.

Lord Astor of Hever: I am grateful to the Minister for his response to the amendment and I am comforted by it. We have been contacted by a number of professional organisations. The Minister's point about the legal requirement and the availability of information on the Internet will give them some comfort. In the light of that, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 68 agreed to.

Clause 52 [Care Trusts where voluntary partnership arrangements]:

The Deputy Chairman of Committees (Lord Geddes): Before I call Amendment No. 231, I advise the

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Committee that if it is agreed to, I shall be unable to call Amendments Nos. 232 to 236 because of pre-emption.

Baroness Barker moved Amendment No. 231:

    Page 53, line 22, leave out subsection (1) and insert--

"(1) Where--
(a) one or more Primary Care Trusts, NHS trusts or local authorities are, or are to be, party to any existing or proposed delegation arrangements, and
(b) the relevant authority is of the opinion that the establishment of a new body would be likely to promote the proper integration of prescribed health-related functions of a local authority in conjunction with prescribed NHS functions of a Primary Care Trust or NHS trust (in accordance with the arrangements),
the relevant authority may establish a Care Trust."

The noble Baroness said: We now move on to one of the most fascinating aspects of our consideration in Committee--the rather curious beasts called care trusts. Much has been said about them in the NHS Plan. Everybody welcomes the principle behind them, which is that there should be much closer co-operation between health and social services, but nobody knows exactly what they are going to do or how they are going to do it.

When I read the report of the debates in another place, I was struck by the fact that it did not become apparent even to some seasoned Members until half way through the Standing Committee stage that the care trusts would be built on primary care trusts. Many issues need to be brought out in our discussions today. The amendment, together with Amendments Nos. 232 and 234, starts that process.

The Explanatory Notes say that care trusts will be partnerships between local authorities and the NHS. The purpose of the amendments is to establish whether it would be possible for a local authority rather than an NHS body to become a care trust. The thrust of most of the rest of the Bill appears to be that only NHS bodies can do so.

A number of very good partnerships have been developed under Section 31 of the Health Act 1999, featuring voluntary arrangements with pooled budgets, lead commissioning and integrated delivery, particularly on developing services for learning disabilities. The amendments would extend the opportunities for that work. A number of local authorities have developed very high standards of practice for dealing with social care. It would seem wrong not to enable such arrangements to go forward under the new designation of care trusts. I should like to hear the Minister's comments on that interesting proposal. I beg to move.

Lord Hunt of Kings Heath: I thank the noble Baroness for her remarks about partnership arrangements. I agree that they have been very successful. I was interested that she mentioned learning disabilities, because that issue is apposite to the White Paper that we published on Tuesday and some good partnership arrangements are being developed around the country. Care trusts are all

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about building on that success and ensuring that when arrangements are not so successful, we have avenues to ensure that partnerships get off the ground. I am sure that we shall deal with that later in our debates on care trusts.

The trusts are about partnership and ensuring that it happens in the context of an NHS body. The clauses have been written so that we can make that possible for NHS trusts and primary care trusts, although the new organisations will have a new name--care trusts--to demonstrate their integration. They are mainly about voluntary agreements made locally. They will be set up through those means and, where necessary, dissolved by local agreement.

The aim is to develop new organisations without proliferation, building on what we already have. Most importantly, they build on joint working and flexibility. The department has been notified of more than 40 schemes, with £300 million allocated to them. I believe that that provides a sense of the impact that it is already having.

We want to continue to encourage the use of partnership agreements. We accept that the lead will be taken by different agencies--both local authorities and NHS bodies--in different parts of the country. Care trusts are not the only route that we envisage for the development of the scheme in the future. They are but one option. That is why I have reservations about the amendments that have been put forward tonight. Amendment No. 231 would also require that we establish entirely new and additional stand-alone organisations into which services would be delegated from NHS bodies and local authorities.

We have made it clear that the key building block for care trusts will be NHS bodies formed out of NHS trusts and primary care trusts. However, where appropriate NHS bodies can delegate more services to local authorities using existing Health Act flexibilities, we shall be entirely happy and shall wish to see that take place. Therefore, care trusts do not provide the only route, and it is not the case that the only route down which one can go is an NHS-type body. We are also anxious to encourage local authority leadership through existing partnership arrangements.

I turn to Amendments Nos. 232 and 234. So far as concerns local government, the governance arrangements are already in place with the statutory responsibility of the local authority. The problem is that, if the Health Act partnership arrangement is led from an NHS body, it cannot alter its governance to take account of the additional services. Therefore, appointments from local government cannot be made in the way that we would wish.

The Bill enables us to provide proper governance for partnership arrangements where the NHS is the lead body. In relation to local government, where, as I said, we are anxious to encourage more partnership schemes led by local government, a similar issue concerning governance arrangements does not arise.

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That is why we are following this route and why I do not believe that the amendments suggested by the noble Baroness are necessary.

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