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Baroness Gibson of Market Rasen: My Lords, it is not a question of only the Government going to the organisation. Will it be possible for the staff, who are the experts, to tell the Government what is going on? Any Government would need their advice.
Lord Hunt of Kings Heath: My Lords, I certainly agree with that. One of the changes in the health service is the development of staff surveys by individual NHS organisations, which will help the NHS locally to take account of the issues raised. Without the staff, we shall not achieve such changes. The key element in our announcement today is the provision of incentives to encourage the staff to deliver the kind of change programme that we want.
Many members of staff have taken part in the development of the NHS Plan and the NHS modernisation board. We are obviously anxious to continue that effective dialogue.
Lord Eden of Winton: My Lords, the Statement seemed to suggest that someone needing hospital care could shop around between hospitals and determine which one to go to. That all seems fine, but it is extremely difficult for people to get the information that they need to enable them to make that kind of choice.
I have in mind a case that was brought to my attention last week. A patient was due to attend hospital for urgent treatment, but the hospital said that it could not treat him for several months. While that patient waited for treatment, he died. That is not a unique case. If the patient, or the people looking after him, had had information about going to another hospital for treatment, his life might have been spared. How will the system work in practice? If one hospital cannot offer treatment, how will information be conveyed to patients that treatment is available elsewhere? Will their GPs be told? How will information be held centrally so that all patients at all levels of income will know where they can get the treatment that they need?
Lord Hunt of Kings Heath: My Lords, I could not agree more with the noble Lord. Without information, it is difficult to see how a patient can have choice. I confirm that GPs must play a crucial role in helping to advise patients on choice and in making judgments about the most suitable hospital to attend.
I accept that at a national level we have to ensure that information is available to enable patients to make an informed choice. One of the purposes of the
new health inspectorate is to ensure that this kind of information is provided robustly so that patients can make sound decisions.We are starting pilots on the choice scheme from July this year for coronary heart disease patients. Anyone who has waited for more than six months for a heart operation will be contacted by a patient care adviser to discuss the options for treatment. Such patients will be offered a shorter wait at another NHS or private hospital, or even the option of treatment abroad.
We are putting in place members of staff who can help patients to make decisions. GPs will have an equally important role. Ultimately, we need to build greater capacity into the health service. As the years go by and we have more beds, more hospitals and more staff, the element of choice will become greater.
Lord Chan: My Lords, I speak as a non-executive director of a primary care trust. I welcome the fact that there will be more resources to eliminate the negative budget that we received. Much of the money is already allocated to a number of projects, so will the Minister assure us that, in the auditing and inspection of primary care trusts, sufficient time will be given for us to settle down and get on with our work? Will he also assure us that unnecessary and unsustainable public expectations of immediate and major changes will not arise?
Lord Hunt of Kings Heath: My Lords, I am grateful to the noble Lord for raising the matter of primary care trusts. I understand what he says about not wishing to load new organisations with too many responsibilities. Of course, we need to ensure that PCTs are focused on the essential elements of not only producing good services but of commissioning effective services.
Primary care trusts are an essential component of the reform process. That is why it is important that three-quarters of the budget will be spent on PCTs by 2004. I know from our debates on primary care trusts that some noble Lords caution us about giving that level of resource to PCTs by 2004, but the Government believe in the potential of PCTs and in putting money with GPs who will make essential decisions in the NHS. We must press on with that as urgently as we can.
Export Control Bill
4.40 p.m.
Lord Redesdale moved Amendment No. 1:
- Page 1, line 10, at end insert—
The noble Lord said: My Lords, in moving Amendment No. 1, I shall speak also to Amendment No. 24. Both amendments are tabled in my name and that of my noble friend Lord Razzall. Both issues deal with sustainable development.
In Committee Her Majesty's Government introduced significant redrafting of the section on guidance and the schedule of purposes, apparently in response to concerns expressed about the way sustainable development was treated in the Bill. Unfortunately, the Government refused to make the simple changes that have long been proposed to include sustainable development as one of the relevant consequences in the schedule, which would place the issue on a similar footing as concerns about human rights, regional stability and terrorism.
Sustainable development was included as a relevant consequence when the Bill was first published in draft form. However, in every subsequent incarnation it has been omitted. The purpose of Amendment No. 1 is to provide belt and braces. When a similar amendment was introduced at the last stage of the Bill, the Minister raised significant concerns about its suitability. We have attempted to redraft the amendment to allay his anxieties.
The Minister raised the issue of "widgets". Amendment No. 1 was drafted to exclude the consequence of the Secretary of State having to review every single item that could conceivably need an export control order. However, a real concern was raised as to the phraseology used in the amendment drafted by the Government at the last stage. In Clause 7(4) the words "if any" were added.
The Minister expressed his opinion that the words "if any" give the Secretary of State the ability to make judgments over what was and what was not important while being directed over matters which would be considered relevant under the Bill. However, there is anxiety that the ability of the Secretary of State to make such decisions is far too broad and would mean that certain aspects that many feel should fall within the ambit of the Bill could fall outside it. The purpose of the amendment therefore is to add to the schedule categories which are already covered by the Bill thereby avoiding the widget problem but at the same time ensuring that the Secretary of State takes into consideration sustainable development.
Amendment No. 1 is particularly concerned with the problem that arises within different departments in government; that is, that one department has one view and another department can take a different view. That is clearly illustrated by the situation in Tanzania. Even since the last stage of this Bill matters have developed. The air transport control system seems to have fallen foul of the World Bank, which does not believe it to be a good investment. It is being scrutinised by the International Commission for Aviation. Also the DfID has frozen a £10 million development loan to one of the poorest countries in the world pending the outcome.
If I am wrong on any of the aspects of Tanzania—obviously it is more complicated than can be envisaged superficially—that does not change the underlying need for the amendments. There will always be a difficulty between the granting of an export licence which is driven by exporters and the real need of developing countries not to have exported to them armaments, weapons systems or their components which could jeopardise their sustainable development. I beg to move.
Lord Judd: My Lords, I congratulate the noble Lord, Lord Redesdale, on moving this amendment. In doing so I remind the House that I am closely involved with the work of Saferworld and Oxfam, two organisations deeply concerned about the issues in this Bill.
I have absolutely no doubt that my noble friend shares our common objective. Does he not accept that, as so well argued by the noble Lord, Lord Redesdale, the insertion of the words "if any" creates a loophole? Does he not also agree that it would be unfortunate if, in the context of his own goodwill, we accepted wording which enabled some successor totally to disregard the issues which concern us today and which are spelt out in the schedule.
That is the point. The problem is not the people in place at the moment; it is those who may be in place in the future. If we are of serious intent we should have watertight wording, not ambivalent wording. That is why Amendment No. 1 is so crucial in what it seeks to achieve for the long-term future.
"( ) Where export controls apply to goods which are within one or more of the categories mentioned in paragraph 1(1) of the Schedule, the guidance issued under section 7 shall have regard to their issues relating to sustainable development and to any possible consequences of the goods being controlled that are of a kind mentioned in the Table in paragraph 3 of the Schedule."
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