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Baroness Andrews moved Amendments Nos. 370 and 371:

"( ) the persons to whom complaints may be made;" Page 48, line 38, after "making" insert ", handling"

On Question, amendments agreed to.

[Amendment No. 372 not moved.]

Baroness Andrews moved Amendment No. 373:

    Page 49, line 7, at end insert—

"( ) The regulations may require any person or body who handles or considers complaints under the regulations to make information available to the public about the procedures to be followed under the regulations."

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On Question, amendment agreed to.

Baroness Cumberlege moved Amendment No. 373A:

    Before Clause 118, insert the following new clause—

The Secretary of State must order a review, within 18 months of the commencement of this Act, of the delivery, scrutiny and accountability arrangements of the Department of Health, and public bodies including executive and non-executive non-departmental bodies already involved in the regulation and inspection of health care, including the case for an NHS agency, as a non-departmental public body, for England."

The noble Baroness said: My Lords, perhaps I may first dispel possible confusion about there being two amendments in my name, one of which has been withdrawn. They were grouped together. I shall move Amendment No. 373A, to which I shall speak, and withdraw Amendment No. 411. I withdraw it because it was pointed out to me that Amendment No. 411 was a wrecking amendment. I do not wish to wreck the remains of the Bill and I am sure that the Government feel that sufficient damage has already been done to it.

The amendment would continue my campaign to find a mechanism to distance the NHS from the day-to-day interference from Whitehall.

The noble Lord, Lord Clement-Jones, referred to sporting analogies. My game is not so much one of rugby; it is more a game of tennis with long, boring, monotonous rallies. I gave your Lordships a health warning that I would bore for Britain and I fear that I am getting rather good at it. But I am encouraged because in Committee the Minister, in his courteous reply to me, said:

    "I sympathise entirely with the noble Baroness's wish to avoid excessive central interference in the running of the NHS".

He went on to say:

    "I am sure we can all agree with that overall intention".

He also said that it is an idea,

    "which I freely acknowledge has had appeal in many quarters over many years.—[Official Report, 7/10/03; col. 168.]

He later said that:

    "the rationale . . . has always been the same; to improve the quality of NHS management by removing it from nefarious political micromanagement".—[Official Report, 7/10/03; col. 169.]

The Minister cited previous commissions and inquiries, which after discussion rejected the idea, beginning with the Guillebaud report in 1950. But in 1950 we were recovering from the Second World War and we were still coping with rationing. He went on to quote the Royal Commission of 1979. In 1979 we were still in the grip of the trade unions and the noble Baroness, Lady Thatcher, was elected Prime Minister for the first time. Clearly, her priorities were to get the economy right and sort out the trade unions.

The Minister then quoted Sir Roy Griffiths. I worked with Sir Roy Griffiths as a member of the NHS Policy Board. Sir Roy relied on the regions to act as the umbrella to safeguard the service through the flak raining down from above and to prevent the NHS from causing problems upwards to Ministers. As a regional chair, I remember the pressure and the

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unpopularity, but I believe that we were a useful service. However, regions are no longer with us. My point is that quoting the past is not always helpful in that the climate, the environment, the attitudes and the priorities were different 20 years ago.

Later in the debate, I asked the Minister what the Government meant by "devolution". He replied:

    "We are trying to give more local autonomy and freedoms to manage assets and design services around the needs of local people".—[Official Report, 7/10/03; col. 198.]

I thought that that was an admirable definition, especially as I did not give notice of the question. That is exactly my intention, but I recognise that I have tried to proceed too quickly: too quickly for a Government who have had such a recent conversion from centralised control to the merits of local autonomy within the NHS.

When in Committee, noble Lords debated the concept of an agency. The Minister expressed fears that the new agency would itself impose a centralised model of control over the whole system. I find that strange when the Government have set up 192 different agencies in other areas of their former responsibilities. Despite some early struggles, they appear to work well.

However, I recognise that my impatience has not been helpful. I need to pace these reforms in order to win government support. There are many other people, within Parliament and beyond, who share my intentions and methods, not least the independent King's Fund of which I am a senior associate. As the Minister will be aware, the noble Lord, Lord Haskins, chaired a group at the invitation of the King's Fund which made sensible recommendations advocating an NHS agency for England. Tomorrow, the noble Lord, Lord Haskins, is due to publish his review of Defra, which advocates the principle of greater separation between responsibility for policy development and implementation. The noble Lord is convinced that this will improve delivery, accountability and clarity of roles and responsibilities. I know that he sees this work as a parallel with the NHS.

On 30th October, the Secretary of State for Health, Dr John Reid, appeared before the Health Select Committee and gave a commitment to "look" at the members of staff working in the arm's length health and social care agencies as well as "their role". My amendment builds on this commitment. I seek to expand the remit of such a review and, most importantly, ensure a more independent perspective on the questions raised. I believe that the model provided by the review of rural policy undertaken by the noble Lord, Lord Haskins, will provide an excellent template for an appropriate approach to a comprehensive review of the Department of Health and the public bodies, including executive and non-executive bodies associated with the NHS.

The Secretary of State clearly does not want the NHS to be managed from Whitehall but he wants Whitehall to ensure that realistic national standards are set and achieved. He seeks the commitment of NHS staff and wishes to ensure enough freedom for

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them to innovate and be responsive to patients' needs. That is a tricky balance and it requires three things: realism when it comes to managing public expectations; staff and public ownership of standards and targets; and a system to ensure clear and separate accountability for policy and delivery. It takes more than devolutionist intentions to achieve a new and better relationship between government and the NHS.

In conclusion, I welcome the Secretary of State's intention to hold a review of the newly restructured Department of Health and the myriad of new arm's length bodies spawned by the Government in both health and social care. The pity of it is that the review is to be conducted by the department itself, and it is hardly a disinterested bystander. I believe that keeping the review narrow and in-house and identifying the problem and the solution before the work has started gives a startling illustration of the problem.

The remit needs to be broadened. The review needs to take into account the relationships between government, the Department of Health, Parliament and non-governmental public bodies, including the possibility of an NHS agency for England. It needs to be independent; it needs to be transparent; and it needs to be modelled on the lines of the review undertaken by the noble Lord, Lord Haskins. I beg to move.

Earl Howe: My Lords, I congratulate my noble friend on introducing her amendment so eloquently. In the course of our Committee debate on her earlier amendment, many practical issues were raised about how an agency would work. More recently, we have had the interesting publication by the King's Fund. That publication takes the thinking further but it is still not a blueprint. All who have thought about this matter know that many issues require further debate.

I believe that my noble friend's amendment presents an elegant way forward. The details of delivery, scrutiny and accountability of healthcare are most intimately known by the Government and the Department of Health. By asking the Secretary of State to order a review of those matters for all the elements of the public sector involved in healthcare and by including the case for an NHS agency, we have an excellent opportunity to take the debate to another level. It will be a level that is informed by practical knowledge of operating the current system.

Lord Clement-Jones: My Lords, I support the noble Baroness, Lady Cumberlege, in her Amendment No. 373A. I confess to having felt considerable scepticism in Committee about a charge towards an NHS agency or NHS plc. I looked on it as a potentially monolithic approach to reform of the health service. However, what has emerged from that debate has considerable merit, particularly in the way in which it is phrased, talking, as it does, about the review of the delivery, scrutiny and accountability arrangements of the Department of Health.

Even during the past five or six years, we have seen considerable changes in the Department of Health. When I first became health spokesman, we had a Permanent Secretary and a chief executive of the NHS,

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and those two jobs were different. Then, of course, came the merger between the two jobs and I believe that that has had a considerable impact on the micro-management aspect of the NHS. The review would tease out precisely whether that is the best arrangement for the future. As the noble Baroness mentioned, the Government are conducting their own review and it is a fairly radical one, as the noble Lord, Lord Warner, has reminded us on Report.

The other aspect of the amendment that I particularly welcome is the fact that it would review the system of regulation. We have dwelt, not only in Starred Questions but also during debates on the Bill, on the question of the sheer volume and weight of regulation currently in the health service with so many bodies entitled to inspect, regulate, enter upon NHS premises, and so on and so forth. The amendment would provide for a valuable review of all of that and of whether consolidation of regulation could take place. That, again, would be an enormous advantage. If nothing else, it should propel the Government into some sort of consideration of the track down which they are going as regards regulation, which seems to become ever more complicated as the number of bodies created multiplies, not least as a result of the Bill.

9.30 p.m.

Baroness Finlay of Llandaff: My Lords, some powerful points have been made in support of the amendment, which I also support. I congratulate the noble Baroness, Lady Cumberlege, on the re-wording of the amendment. I had my name added to the previous one and, if I had had time, would have added it to this eloquently worded amendment. I shall not reiterate the arguments. I have a great fear that the number of bodies being created will cause overlap and gaps in the aspects of the service they inspect, which such a review may well identify.

On a much lighter note, one talks about a twinkle in the eye prior to conception. I begin to wonder whether the regulator is the twinkle in the eye. This is an independent body. It seems to be set up quite separately. I wonder whether we may find in future years that the regulator is the germ from which the independent NHS agency may eventually grow to leave us with less political interference in the NHS.

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