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Lord Rea: My Lords, is my noble friend aware that one of the nastiest violations of human rights that is occurring in the Congo at the moment is the high incidence of rape perpetrated by marauding military personnel and not only on one side, as I believe she indicated? What is worse, it has been estimated that 50 to 60 per cent of those soldiers are HIV positive. Thus they are spreading the epidemic which is already severe enough. Is that not a further reason why the international community should apply a little more energy to persuade the inter-Congolese dialogue to intensify and to persuade those countries which have troops in the Congo to withdraw them?
Baroness Amos: My Lords, I entirely agree with my noble friend that the use of rape and sexual abuse against women and children is extremely distasteful. It is something that we are increasingly seeing in conflicts across the world. I also agree with my noble friend that the implications of that for the spread of HIV/AIDS are extremely serious. However, I say to my noble friend that along with the UN, our African partners and the European Union we have put a great deal of energy into the inter-Congolese dialogue process. At the end of the day a solution has to come from within the Great Lakes region itself. However, I believe the work that we have all done to support the dialogue processI believe that the UN will become more involved at this pointis exemplary. International organisations, including the UN, but also the European Union and others, should be congratulated on the work that they have done.
The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, following publication of a prospectus in July, we will select the first foundation trusts in the autumn with a view to their having shadow status from 1st April 2003 and, subject to legislation, being established in October 2003.
Baroness Northover: My Lords, does the Minister agree that constant reorganisation is demoralising and debilitating? Why does he think that the way forward involves further fragmentation and a multi-tier system, which the National Health Service tried to put behind it when it was set up and which was rejected more recently when we moved away from the internal market? Is it not about time the Government stopped supporting such gimmicks and started supporting, and providing continuity for, the NHS?
Lord Hunt of Kings Heath: My Lords, I am surprised by the noble Baroness's comments because during the passage of the National Health Service Reform and Health Care Professions Bill she and her colleaguesand other noble Lords throughout the Houseconstantly said that the Department of Health should stop micro-managing the NHS at local level. Our approach is intended to do just that. We have set up national standards and we have a national regulator. That provides the conditions and circumstances in which we can let local organisations in the NHS undertake many more freedoms and manoeuvres at the local level. That is why we are anxious to make progress with foundation trusts.
Lord Hunt of Kings Heath: My Lords, it is striking that until the Government introduced the Commission for Health Improvement, there was no system for setting national standards for or national regulation of the health service. We have secured that. That enables us to ensure that standards involving safety and quality are checked and reviewed. That allows us to give much more freedom at local level to local NHS organisations, which I know the noble Lord is keen to see happen.
Lord Hunt of Kings Heath: My Lords, we are working on the criteria. Essentially, the first wave of foundation trusts will be selected from among those acute trusts that achieve three-star ratings in July this year. Successful applicants will need to demonstrate their management capability and clinical support to make a success of NHS foundation trust status. They will also need to show that they will use their freedoms to demonstrate rapid progress in terms of delivering the NHS Plan. On the issue of teaching, research and the contribution to clinical academic medicine, we expect foundation trusts to play their part, as every other NHS trust in the country should do.
Lord Blackwell: My Lords, does the Minister accept that while this approach may be a welcome first step in reversing the Government's previous centralisation of initiatives and management in the NHS, it still leaves the majority of hospitals in the grip of a state-run bureaucracy? Does he accept the logic of the Government's view that if that approach is beneficial for a few hospitals, it should be extended as soon as possible to all hospitals? Will he set out a timetable by which he might achieve that?
Lord Hunt of Kings Heath: My Lords, I am not going to set out a timetable, and it would be wrong to set a target for the number of trusts that should achieve foundation status by a certain time. I certainly agree that in the fullness of time many NHS organisations will take advantage of foundation trust status. However, it is also clear that they must meet tough criteria and standards before they can be given that status. It is important, as we work through the details, that the process by which trusts become foundation trusts is clear and transparent. Above all, we must ensure that patients are the winners.
Lord Glenarthur: My Lords, if a hospital trust becomes a foundation trust, to what extent will it be relieved of the administrative burden of sending as many returns as are necessaryI know of this from my experience as a former chairman of an NHS trustto the central element; that is, the department? To what extent will national savings accrue on the administrative side?
Lord Hunt of Kings Heath: My Lords, we must draw a distinction between unnecessary bureaucracyI am sure that we are all committed to reducing thatand the necessary investment in leadership and effective management. I suggest that one of the advantages of foundation trusts is that they make the decisions about where they spend their resources. In so doing, they also have to meet their contractual obligations. I hope that we will reduce any excessive numbers of prescriptive, central demands on those trusts. At the same time, the whole purpose is to give foundation trusts much more room to manoeuvre at the local level.
Lord Hunt of Kings Heath: My Lords, the intention is that the national regulatorthe Commission for Health Improvement, which will develop into the commission for health audit and inspectionwill be able to regulate foundation trusts and intervene where necessary, perhaps in the case of financial difficulties. We must be very cautious about developing a mechanism by which, if there are difficulties or problems, there is the knee-jerk reaction of saying, "The Department of Health must intervene." Our view is that that is much better done through the regulatory body.
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