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Division No. 2


Addington, L.
Alderdice, L.
Alton of Liverpool, L.
Anelay of St Johns, B.
Ashcroft, L.
Astor, V.
Astor of Hever, L. [Teller]
Barker, B.
Bell, L.
Blackwell, L.
Blaker, L.
Blatch, B.
Boardman, L.
Bowness, L.
Bradshaw, L.
Burnham, L.
Buscombe, B.
Byford, B.
Caithness, E.
Campbell of Alloway, L.
Chilver, L.
Clark of Kempston, L.
Clement-Jones, L. [Teller]
Colville of Culross, V.
Colwyn, L.
Cope of Berkeley, L.
Cox, B.
Craigavon, V.
Cumberlege, B.
Denham, L.
Dholakia, L.
Dixon-Smith, L.
Eden of Winton, L.
Elliott of Morpeth, L.
Falkland, V.
Ferrers, E.
Finlay of Llandaff, B.
Freeman, L.
Gardner of Parkes, B.
Geddes, L.
Glentoran, L.
Greaves, L.
Hanningfield, L.
Harris of Richmond, B.
Hayhoe, L.
Higgins, L.
Holderness, L.
Hooper, B.
Howe, E.
Howell of Guildford, L.
Hunt of Wirral, L.
Jenkin of Roding, L.
Kimball, L.
Lane of Horsell, L.
Lyell, L.
McColl of Dulwich, L.
Marlesford, L.
Masham of Ilton, B.
Monson, L.
Montrose, D.
Mowbray and Stourton, L.
Moynihan, L.
Murton of Lindisfarne, L.
Naseby, L.
Newby, L.
Newton of Braintree, L.
Noakes, B.
Northbrook, L.
Northesk, E.
Northover, B.
O'Cathain, B.
Oakeshott of Seagrove Bay, L.
Oppenheim-Barnes, B.
Park of Monmouth, B.
Platt of Writtle, B.
Plumb, L.
Rawlings, B.
Rees, L.
Renton, L.
Roberts of Conwy, L.
Rodgers of Quarry Bank, L.
Roper, L.
Russell, E.
Saatchi, L.
Scott of Needham Market, B.
Seccombe, B.
Selborne, E.
Selsdon, L.
Skidelsky, L.
Thomas of Gwydir, L.
Thomas of Walliswood, B.
Tope, L.
Trefgarne, L.
Trumpington, B.
Vivian, L.
Walmsley, B.
Walpole, L.
Weatherill, L.
Wilcox, B.
Williams of Crosby, B.


Alli, L.
Andrews, B.
Archer of Sandwell, L.
Ashton of Upholland, B.
Bassam of Brighton, L.
Berkeley, L.
Bernstein of Craigweil, L.
Bhatia, L.
Blackstone, B.
Borrie, L.
Bragg, L.
Brennan, L.
Brett, L.
Brookman, L.
Campbell-Savours, L.
Carter, L. [Teller]
Chandos, V.
Christopher, L.
Clark of Windermere, L.
Clarke of Hampstead, L.
Clinton-Davis, L.
Cohen of Pimlico, B.
Corbett of Castle Vale, L.
Crawley, B.
David, B.
Davies of Coity, L.
Davies of Oldham, L.
Dean of Thornton-le-Fylde, B.
Desai, L.
Donoughue, L.
Dormand of Easington, L.
Dubs, L.
Elder, L.
Evans of Temple Guiting, L.
Farrington of Ribbleton, B.
Faulkner of Worcester, L.
Filkin, L.
Fyfe of Fairfield, L.
Gale, B.
Gibson of Market Rasen, B.
Gilbert, L.
Goldsmith, L.
Grabiner, L.
Graham of Edmonton, L.
Gregson, L.
Grenfell, L.
Grocott, L.
Haskel, L.
Hayman, B.
Hilton of Eggardon, B.
Hollis of Heigham, B.
Howarth of Breckland, B.
Howie of Troon, L.
Hoyle, L.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Irvine of Lairg, L. (Lord Chancellor)
Janner of Braunstone, L.
Judd, L.
Lea of Crondall, L.
Lipsey, L.
Macdonald of Tradeston, L.
McIntosh of Haringey, L. [Teller]
McIntosh of Hudnall, B.
MacKenzie of Culkein, L.
Mackenzie of Framwellgate, L.
Massey of Darwen, B.
Merlyn-Rees, L.
Milner of Leeds, L.
Mitchell, L.
Morris of Aberavon, L.
Nicol, B.
Pendry, L.
Peston, L.
Pitkeathley, B.
Prys-Davies, L.
Puttnam, L.
Ramsay of Cartvale, B.
Rea, L.
Rendell of Babergh, B.
Renwick of Clifton, L.
Richard, L.
Rogers of Riverside, L.
Rooker, L.
Sawyer, L.
Scotland of Asthal, B.
Sewel, L.
Sheldon, L.
Simon, V.
Temple-Morris, L.
Thornton, B.
Tomlinson, L.
Turnberg, L.
Turner of Camden, B.
Uddin, B.
Walker of Doncaster, L.
Warwick of Undercliffe, B.
Wedderburn of Charlton, L.
Whitaker, B.
Whitty, L.
Wilkins, B.
Williams of Elvel, L.
Williams of Mostyn, L. (Lord Privy Seal)
Woolmer of Leeds, L.

Resolved in the negative, and amendment disagreed to accordingly.

16 May 2002 : Column 466

[Amendment No. 20 not moved]

6.1 p.m.

Earl Howe moved Amendment No. 21:

    Page 26, line 45, leave out "Primary Care Trusts" and insert "Overview and Scrutiny Committees".

The noble Earl said: My Lords, this is a very straightforward amendment. It is, in a real sense, consequential upon the amendments carried on Report in relation to patients councils. In line with those amendments, I believe that it makes sense for the Commission for Patient and Public Involvement in Health to operate with reference to the boundaries of local authorities which have overview and scrutiny committees.

That will not always be possible, but if the object is for the commission to provide support to OSCs for their scrutiny function, then it must be desirable for the commission to operate on all fours with patients councils, with which it will be intimately bound up. Clearly, in an area where there is, for example, a large county overview and scrutiny committee, there may be a need, following local discussion, to operate with reference to a smaller area. My amendment allows for that. I beg to move.

Lord Hunt of Kings Heath: My Lords, I am not entirely convinced that now is the right time to debate

16 May 2002 : Column 467

this issue. My understanding of the amendment passed on Report establishing patients' councils was that the intention was that the councils would take over the functions of the commission at the local level. In Clause 16(4)(a) it is made clear that it will be the function of the patients' council to,

    "facilitate the co-ordination of the activities of member Patients' Forums including by the provision of staff and services to Patients' Forums".

I am not clear why the noble Earl thought it important to debate this issue at this stage. I believe that an important element of the Government's proposal is that wherever possible the focus of patient involvement should be at the local level. Surely that means, as far as the health service is concerned, that it will be most appropriately placed in the primary care trust area.

I suspect that the other place will have something to say about patients' councils and your Lordships may be able to debate this matter again fairly shortly. Perhaps we should return to this debate at that time.

Earl Howe: My Lords, I am sorry that the Minister feels that way. If we are to have patients' councils, as I hope, it no longer makes sense for the commission to operate within the relatively narrow purview of a PCT. The Minister said that his understanding was that the patients' councils would take over the functions of the CPPI. I do not completely hold with his choice of words. The commission will still have a role. Effectively, it will act as the secretariat to patients' councils, an extremely important role. Nevertheless, de facto I believe that if we have patients' councils the commission will have to operate by reference to overview and scrutiny committees because that is the way in which patients' councils, by and large, will be configured. I am sorry that the Minister does not feel that he can accept the amendment. In the circumstances I shall not press it. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Hunt of Kings Heath moved Amendment No. 22:

    After Clause 20, insert the following new clause—

In section 7 of the Health and Social Care Act 2001 (c. 15) (health-related functions of overview and scrutiny committees), in subsection (3)(b), at the end there is inserted "or to the relevant authority"."

On Question, amendment agreed to.

Earl Howe moved Amendment No. 23:

    After Clause 20, insert the following new clause—

(1) In section 11(2) of the Health and Social Care Act 2001 (c. 15) (public involvement and consultation) paragraph (a) is omitted and there is inserted—
"(a) The Secretary of State.
(aa) Care Trusts".

16 May 2002 : Column 468

(2) Before an establishment order for a Strategic Health Authority, an NHS Trust, a Primary Care Trust or a Care Trust is made, varied or revoked the Secretary of State shall consult those bodies in subsection (5) whose districts are wholly or partly within the area of operation of the relevant authority or trust.
(3) Any Strategic Health Authority considering whether to exercise its powers under section 17A of the 1977 Act (health authority directions: distribution of functions) shall first consult the bodies provided for in subsection (5) whose districts are wholly or partly within the area of operation of the relevant Primary Care Trust.
(4) The Secretary of State shall by regulations make provision—
(a) concerning the application of section 11 of the Health and Social Care Act 2001 such that if in the view of any of the bodies in subsection (5) consultation arrangements are inadequate, the body in question shall refer the matter to him,
(b) for the referral to Strategic Health Authorities of disputed decisions concerning substantial variations or developments in the planning or operation of health services by bodies detailed at subsection (5),
(c) for circumstances in which bodies detailed at subsection (5) shall refer decisions concerning the planning or operation of the health service to him including the circumstances in which referrals shall be made directly to him by Patients' Forums and Patients' Councils on the failure of overview and scrutiny committees to respond to a referral made to them under section 19(2)(m) of this Act, and
(d) placing a duty on him and those bodies receiving referrals to respond to them with a specified time limit and giving reasons for any decision taken in relation to the subject matter of the referral.
(5) Those bodies referred to at subsections (2) to (4) are—
(a) overview and scrutiny committees or joint overview and scrutiny committees provided for in sections 7 (functions of overview and scrutiny committees), 8 (joint overview and scrutiny committees etc) and 10 (application to the City of London) of the Health and Social Care Act 2001,
(b) Patients' Councils,
(c) Patients' Forums."

The noble Earl said: My Lords, the arrangements for patient and public involvement concern one matter and one matter alone: accountability. There are two strands to the way in which accountability works, depending on whereabouts in the hierarchy of responsibility action is initiated. Action is initiated either at the top, in which case there has to be consultation at national and at strategic level with local communities, or it is initiated at local level. At local level there are often powers to trigger action at a national level. In those cases there needs to be a right of referral upwards from local communities to national and strategic level.

This amendment, which has been debated on earlier occasions, seeks to preserve those lines of accountability to ensure that national accountability for what happens locally is not compromised. The advent of strategic health authorities, as branch offices of the NHS, means that they must be built into the mechanisms as well. On many occasions the Government have said that overview and scrutiny committees will have rights of referral as robust as those held by CHCs. With great respect to the Minister, at the moment that is not the situation. As I have indicated on previous occasions, the right of

16 May 2002 : Column 469

referral between local communities and the national government is absent from the Bill and from the Health and Social Care Act. That omission needs to be rectified.

I am delighted that the Minister has tabled Amendment No. 22. That amendment will give overview and scrutiny committees an explicit power to make reports and recommendations to the Secretary of State. However, I do not believe that that amendment is an adequate substitute for the one that we are now debating. I am seeking a robust replacement for the referral powers of CHCs, which is a much wider and a more significant matter. The government amendment gives only a permissive power to overview and scrutiny committees to make referrals. The wording of the relevant part of my amendment stipulates that referring such matters should be mandatory. That wording replicates the wording of the regulations that cover CHC referrals. It is a significant point and there is a significant difference.

We can all too easily imagine a situation where an OSC may be aware of flawed plans or flawed consultations about an important change to the provision of services, yet choose not to refer them, perhaps—dare I say—for political reasons. I touched upon that point at the previous stage of the Bill. To put it mildly, that would not be a satisfactory state of affairs. The word "referral" carries the implication, to my mind, of a two-way dialogue. My amendment puts a statutory responsibility on the Secretary of State to provide a full and timely reply to whatever may be referred to him. That is how proper accountability should work. Making reports and recommendations, as under the government amendment, does not imply that a response is required in the same way as a referral does.

On the face of the Bill we already have a right of referral by patients' forums to overview and scrutiny committees. If we compare that right with the terms of Amendment No. 22 we can see that it is more robust than the referral mechanism—if I can call it that—from local to national level. I ask why that should be.

Subsection (4) is an attempt to achieve those aims. It also requires the Secretary of State and care trusts to consult. That is especially relevant to specialised commissioning, where currently only the hotch-potch of PCTs will consult. Also, if a Secretary of State ever proposed to abolish a strategic health authority, it would be unreasonable for it to be expected to consult on its own demise. The Secretary of State ought to do that. That illustrates that it is not just health services that can trigger consultation, as the Minister implied earlier. I include care trusts again, not withstanding the Minister's reply last time, because it is far from clear whether a care trust would consider a duty to consult as applying to it once it was established as a new body. It is better to place the matter beyond doubt.

The amendment also requires consultation by strategic health authorities with local communities about the transfer of functions to PCTs. That would be important, for example, where a PCT was not ready to

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take on such functions and the local community wanted a say in the matter. Last time, the Minister said that the provision in subsection (3) of the new clause was unnecessary, but without it PCTs may be given a completely different remit from the one for which they were established without any consultation. That would be entirely unacceptable.

Last time, the Minister said that he thought that the amendment would overcomplicate the Bill. I hope that I have shown that that is not so and that there are good reasons for every ingredient in it. I beg to move.

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