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Lord Hunt of Kings Heath: My Lords, I have a great deal of sympathy with the point made by the noble Baroness. As to the recommendations of the commission, I understand it will now be submitting advice to Ministers in the spring of this year. The noble Baroness referred to the number of younger people appointed to the boards of NHS organisations. I should point out that 13.8 per cent of all appointees come within the 36 to 45 age group and 1.8 per cent are in the 35 and under age group.

I agree that it would be useful to have more younger people on those boards. I do not think that, given the current time requirement, one can reasonably expect people fully engaged in a career to be able to give that time. That is why I personally, in the light of my own experience of working with board members, think that Sir William has a point here.

Baroness Pitkeathley: My Lords, does my noble friend accept that the relationship between governance and management is complex, as anyone in public life knows? Current problems are largely a result of the current stage of development of PCTs. As each side—executive and governance—begins to be more confident of its role, that problem will in all likelihood disappear.

Lord Hunt of Kings Heath: My Lords, I hope that it will disappear, but there are examples of non-executives of existing acute trusts, for instances, which have been existence for many years, who still seem to see their role as more executive than non-executive. It should be made clear, and we shall continue to encourage the appointments commission to make clear, to those people so appointed that their job is not

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to run the organisation day to day but to provide effective public stewardship. We pay executive directors rather a lot of money to take on those responsibilities and I am clear that it is they who should take on the executive role.

Baroness O'Cathain: My Lords, on a point of clarification, the Minister has now in effect said three times that some non-executive directors are being dysfunctional by taking on executive roles and meddling with executives. Would it not be much easier for everyone if the Government were to specify exactly how many hours they expect non-executive directors to serve per month or per year? That might release some of the younger people who they want to serve on the boards. For example, if they suggested that 10 hours per month and no more were required, companies might be prepared to release good executives to take on non-executive roles in PCTs.

Lord Hunt of Kings Heath: My Lords, I do not disagree with the point made by the noble Baroness. Sir William's aim was clearly to specify a general level of commitment that would enable the kind of people mentioned by the noble Baroness to serve on boards. We want to encourage not just senior company executives but people from all walks of life. We should not let an arbitrary rule that they must give a certain amount of time bar good people from applying and being appointed. Equally, we need flexibility. There may be occasions, as my noble friend Lady Pitkeathley suggested—especially when a primary care trust is starting its work—when we would naturally expect non-executives to give more time. Once trusts are fully established, they should be able to ease off. We clearly need flexibility.

Lord Tebbit: My Lords, are the responsibilities in law of the executive and non-executive directors of PCTs the same as they are under company law for commercial directors?

Lord Hunt of Kings Heath: My Lords, all the directors, whether executive or non-executive, are corporately responsible for the activities of the organisation. The chief executive will also be an accountable officer. For instance, if the Public Accounts Committee was inquiring into the financial matters of an individual organisation, that officer could be required to accompany the Permanent Secretary of the Department of Health to PAC hearings.

Breast Screening

3.24 p.m.

Lord Astor of Hever asked Her Majesty's Government:

    Whether National Health Service breast screening techniques are sufficiently accurate.

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Lord Hunt of Kings Heath: My Lords, no screening test can guarantee 100 per cent accuracy. However, mammography remains the most reliable way to detect breast cancer early.

Lord Astor of Hever: My Lords, does the Minister agree that, too often, harmless changes in breast tissue result in unnecessary removal, with all the associated risks of surgery? What progress is being made to improve the accuracy of screening by using computer technology to store and assess scans?

Lord Hunt of Kings Heath: My Lords, the noble Lord's suggestion is right in the sense that seven out of eight women who have an abnormal initial mammogram prove on further investigation not to have breast cancer. The initial test is only an indicator of whether further tests or surgery may be required. As to the use of computer-aided diagnosis, we recognise its potential but it is at an early stage. We are at present monitoring developments. I must tell the noble Lord that in introducing any new technology we must ensure that it is safe and effective.

Lord Clement-Jones: My Lords, in this context, in addition to the quality of screening, are not the resources devoted to diagnosis and treatment of breast cancer crucial? All the breast cancer charities still say that the resources allocated to them are not getting through. What is the Department of Health going to do about that?

Lord Hunt of Kings Heath: My Lords, it is fair to say that concerns about funding have been expressed by cancer charities. We are very much aware of that. On the evidence, we are considering the data on cancer investment in the routine returns we receive from the NHS. I must tell noble Lords that there are many omissions and inaccuracies in the current returns. Because of that, we have decided to undertake a special exercise in the NHS to compile investment on cancer to compare 2001–02 with 2002–03. We expect to be able to publish that information in the spring.

Despite those concerns, there has been a great expansion in the amount of equipment and number of consultants and radiographers employed in the service. That gives us confidence that the future development of cancer services appears satisfactory.

Baroness Sharples: My Lords, is consideration being given to extending the age group of women undergoing breast screening?

Lord Hunt of Kings Heath: My Lords, we are in the middle of extending screening programmes automatically to cover women aged 65 to 70. The aim is to complete that by 2004. So far, more than 150,000 more women have been invited for screening as a result of the extension. What evidence there is suggests that breast screening for women aged over 70 may not be effective and may even do more harm than good,

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although there would be benefit for some individual women. Given that, women aged over 70 will be offered free yearly screening on request.

Earl Howe: My Lords, is the Minister aware that in some parts of the country, breast screening services have been suspended because of a shortage of radiologists? What is being done to tackle that shortage?

Lord Hunt of Kings Heath: My Lords, of course, if there is a shortage of staff—whether consultant radiologists or radiographers—that may impact on the screening programme. We are tackling the whole issue of workforce expansion. In fact, the number of consultants employed in cancer specialisms has increased considerably from just over 3,000 in 1997 to 3,860 in 2002. The number of diagnostic radiographers has increased from 10,360 in 1997 to 11,160 in 2001. We are also increasing the number of training places for future radiographers.

Sub-Saharan Africa: Debt

3.29 p.m.

The Earl of Sandwich asked Her Majesty's Government:

    What plans they have to move beyond the enhanced heavily indebted poor countries initiative towards full debt sustainability in sub-Saharan Africa.

Lord McIntosh of Haringey: My Lords, the recent global economic slowdown and weaker commodity prices pose a threat to debt sustainability in sub-Saharan Africa. The Government have been at the forefront of the international debate on debt relief issues and continue to press for the rapid and full implementation of the heavily indebted poor countries initiative. However, debt relief alone cannot guarantee a permanent exit from unsustainable debt and poverty. That is why we are promoting greater effectiveness in the delivery of aid, more open markets for exports from developing countries, investment, and an increase in development assistance.

The Earl of Sandwich: My Lords, I am grateful to the Minister for that full reply. He is right to say that it will be some time before governments can spend as much on health and education as, for example, on the servicing of debt. However, does the Minister accept that there are unrealistic forecasts on which debt sustainability is based? For Mozambique, there is a forecast of 16 per cent export growth per annum, which is almost unobtainable. Such forecasts take little account of emergencies such as the floods that have been experienced and the effect of HIV/AIDS. I hope that the Government can give some assurance that such factors are taken into account.

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