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Baroness Amos: My Lords, the noble Lord will know that we have been part of the Kimberley process which is considering developing a certification

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procedure for diamonds so that diamonds which are mined illegally do not find their way on to the international market. We are awaiting the outcome of the UN panel report as we hope that there will be some recommendations in it on ways in which we might address exploitation issues with respect to other items including timber.

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 process—I believe that the UN will become more involved at this point—is exemplary. International organisations, including the UN, but also the European Union and others, should be congratulated on the work that they have done.

NHS Foundation Trusts

2.59 p.m.

Baroness Gardner of Parkes asked Her Majesty's Government:

    What plans they have for the introduction of foundation trusts in the National Health Service.

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 Gardner of Parkes: My Lords, I thank the Minister for that reply. Will he clarify whether foundation trusts will be within or without the National Health Service? Does he agree with Unison

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that the approach will create a poor relation within the NHS, or with the noble Lord, Lord Blackwell, who, in an article, said:

    "They will become, in all but name . . . institutions on the model of the voluntary and charitable trusts which Labour abolished, through nationalisation, in 1948"?

Lord Hunt of Kings Heath: My Lords, although I am a member of Unison, I do not agree with the comments that the noble Baroness reports. I believe that foundation trusts will have a status to which other trusts will aspire because it will give them much greater flexibility to do what is necessary to improve the level of patient care at local level. They will operate to NHS standards, they will be subject to NHS inspection and they will abide by NHS principles.

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 colleagues—and other noble Lords throughout the House—constantly 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 Peyton of Yeovil: My Lords, would the Minister be good enough to explain what the function of the national regulator is and what possibility there is of his having a benign effect?

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.

Baroness Finlay of Llandaff: My Lords, will the Minister explain precisely the criteria by which foundation trusts will be assessed on their contribution

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in terms of education, training, research for the advancement of knowledge in medicine and the preparation of the workforce of the future?

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 necessary—I know of this from my experience as a former chairman of an NHS trust—to 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 bureaucracy—I am sure that we are all committed to reducing that—and 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.

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Lord Tebbit: My Lords, is a mechanism envisaged to deal with the situation if one of the foundation trust hospitals fails to maintain its high standards?

Lord Hunt of Kings Heath: My Lords, the intention is that the national regulator—the Commission for Health Improvement, which will develop into the commission for health audit and inspection—will 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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