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Lord Warner: I will write to the noble Baroness.

Baroness Carnegy of Lour: There is no need to write. I do not want to use the Minister's time, but he may bring the matter into discussion with his officials.

Baroness Noakes: Will the Minister answer my question about what levers CHAI would have to ensure co-ordination? It is an important point.

Lord Warner: In an earlier amendment, I think that the noble Baroness used the phrase "cruel and unusual punishments". They will not be a feature of CHAI's style and approach. Special measures will not be its approach. It will use its leading position in this area, its vision, its authority and ability to persuade people and keep reminding them of the impact of inspection on people on the front line and managers in the NHS to ensure that there is not a steady traffic of inspectors of one type or another going to the same authorities week after week. That will be the approach. I am sure that

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Sir Ian and his team will want to use friendly persuasion as far as possible, but will make it clear when there are serious concerns that need to be addressed by other inspectorates.

Baroness Noakes: I thank the Minister for that reply. It was a pity that he was not able to respond to the question asked by my noble friend Lady Carnegy. It was a reasonable question to be able to elucidate that distinction during the course of our Committee, because he mentioned it in his own response. My noble friend did not ask for a reply, but it might nevertheless be useful for other members of the Committee who, like my noble friend, also cannot immediately see with clarity how the measure will work in practice.

If Sir Ian Kennedy reads the Hansard of our proceedings, I am sure that he will be grateful to see as near as one can get to a statement of commitment to resource by the Government. That is certainly welcome, because it is important that CHAI is resourced properly to perform the tasks laid on it. This is an important task. Given that it has no levers, whether CHAI can have an impact is also linked to resource. If CHAI is properly resourced and can play its leading part much will follow naturally. If it will always have to make hard decisions about what can and cannot be done fully within its resource envelope, it may not be able to maintain its pre-eminent position; it may not be able to co-ordinate effectively. Perhaps those are matters for debate at another time.

I was grateful that the Minister said that he would look again at the thrust behind the amendment. We think that the issue is important and I look forward to rejoining the debate on an amendment moved by one or another of us on Report. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 306 not moved.]

Clause 56 agreed to.

[Amendment No. 307 not moved.]

Clause 57 [Studies as to economy, efficiency etc]:

[Amendments Nos. 307A and 308 not moved.]

Clause 57 agreed to.

Clause 58 [Additional functions]:

Baroness Barker moved Amendment No. 309.

    Page 22, line 9, after "efficiency" insert ", equity"

The noble Baroness said: This is a rather simple amendment to probe or highlight one of the more interesting questions that we have worked around in different ways throughout our Committee proceedings—the absence of the word equity in the long list of things that CHAI and CSCI are meant to investigate and review. The Bill talks about improvement of economy, efficiency and effectiveness of the exercise of NHS bodies but nowhere does it mention equity, fairness, or access to health care for different groups of the population. I reiterate my earlier comments that many of us have concerns about the extent to which minority populations or people with particular conditions will fare in this brave new

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world of acute hospital provision. It seems strange that that principle is not on the face of a Bill that sets out in such a heavy-handed way the extent to which these bodies will work and that establishes—as the noble Baroness, Lady Noakes, said—the very strong hand of the Secretary of State. That is why we seek to insert the provision.

We think that equity is one of the important founding principles of the NHS. We also think that it is an important enduring principle, no matter how the NHS is managed. We think that it should be inserted into the Bill.

6 p.m.

Lord Chan: I support Amendment No. 9. When CHI, the current body, was looking at its regular reviews, it emerged that enquiries had not been made in the summer of 2001 into the issue of equity for ethnic minority groups. I know that because I was asked in 2001 to advise CHI on the issue. I think that the point should be very clearly spelt out for any new body such as CHAI.

Baroness Masham of Ilton: I, too, support the amendment. As president of the Spinal Injuries Association I know very well that severely disabled people going into hospital can have truly terrible difficulties particularly as regards help with their bodily functions. We are currently having a series of conferences with the Royal College of Nursing about evacuation of the bowels which all paraplegics and tetraplegics have to do. There is huge difficulty when they go into a general hospital.

Lord Warner: We are certainly not out of sympathy with the thinking behind Amendment No. 309. Clearly it would be possible to give CHAI a new function under Clause 58 that included considering the fairness or equity of healthcare provision. It is worth reminding noble Lords that we have made it clear in Clause 47 that CHAI is to be concerned with all factors relating to the quality of healthcare when it exercises any of its functions in the provision of healthcare under Clause 47(1) or Clauses 48 to 56.

It is our view that regulations under Clause 58 could require CHAI to be concerned with any of the factors listed in Clause 47(2) in connection with any new function. To do so could be considered to be part and parcel of conferring a new function, or else would be covered by the power to make incidental or supplementary provision in Clause 191. So there is already plenty of provision to do that in the Bill. However, we think that the precise provision required would depend on the details of the proposed new function. We think that that is a matter best left to regulations rather than set out on the face of the Bill, so that it can be made more specific to a particular function.

Baroness Barker: I thank the Minister for his reply although I did not find it particularly compelling. Given the principle of equity and its importance in the daily provision of services, it is very strange that it

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should be left to the outer darkness of regulation and to the rather obscure permissive powers in the Bill. I take great heart from the support of noble Lords. We are not talking about the provision of specialist services. We are talking about ensuring that individuals and groups who are disadvantaged in health and social care have access to services which everyone should have. We are not talking about special provision in any way at all.

The Minister's reply, like his earlier replies to earlier amendments from these Benches, is somewhat unsatisfactory. The amendment deals with a fundamental principle which is far too important to be left to vague permissive powers. It is disappointing that equity is not on the same level as economy, efficiency and all the rest of it. We may well return to the issue. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Noakes moved Amendment No. 310:

    Page 22, line 18, at end insert—

"( ) Regulations made under this section shall not have effect unless they have been approved by a resolution of each House of Parliament."

The noble Baroness said: Amendment No. 310 would add a new subsection to Clause 58 so that regulations under that clause are subject to the affirmative procedure. I shall speak also to Amendment No. 354 which is a similar amendment to Clause 82 relating to CSCI.

Clause 58 allows the Secretary of State to add functions to CHAI. Paragraph 150 of the Explanatory Notes states:

    "It is envisaged that CHAI may need to be given additional functions".

If it is already envisaged that CHAI may need additional functions, why are they not included in the Bill? Will the Minister say what additional functions CHAI might need?

The Department of Health's view as set out in its memorandum to the Select Committee on Delegated Powers and Regulatory Reform is that the healthcare sector is constantly changing with new initiatives emerging which would necessitate the extension of the already very wide functions of CHAI. I find it very difficult to envisage an extension of CHAI's functions. If we look at its functions under Clauses 47 to 57, it is hard to come up with a more comprehensive set of functions. Will the Minister say what kind of initiative would fall outside those functions? I really do struggle with this.

I am aware that a similar provision was included in the legislation creating the old CHI. Will the Minister say whether that has ever been used or whether its use has ever even been contemplated?

I am not at all clear that additional functions beyond those already set out in the Bill could ever be needed. However, if they were, I believe that Parliament should be given a proper opportunity to debate any regulations under this section. That is what my amendments are about. I beg to move.

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