asked Her Majesty's Government:

My Lords, fishing vessel licences are issued at the discretion of Ministers under the Sea Fish Conservation Act 1967 to the owners of British registered fishing vessels. Under European Community law, Ministers cannot discriminate against nationals from other member states who are entitled to own British registered fishing vessels. In any event, the sale of licence entitlements is a matter for the parties concerned.

My Lords, I am grateful to my noble friend for that Answer, which confirms my understanding of the position. Did he see the press reports that a prominent member of Save Britain's Fish campaign, the minority fishermen's movement stridently calling for withdrawal from the common fisheries policy, had himself sold quota to a Dutch boat owner while, in contrast, a leader of the Scottish Fishermen's Federation, which does not advocate withdrawal, has publicly called on fishermen to help the Government by not selling abroad?

My Lords, yes, I have seen those press reports, although I have no knowledge as to whether they are true. Doubtless, if there is truth in them the member of Save Britain's Fish must answer to his own committee. However, I do not see why he should have to answer to this House too as he was within his rights under the law.

My Lords, the Government have stated in the past that they disagree with quota hopping. Why, at the Fisheries Council meeting on 20th December, did not the Government try to stop or curtail the practice? It was disturbing to hear what the noble Lord, Lord Campbell of Croy, said about our fishermen selling their licences, their livelihoods. In order to put the matter into proper perspective, may we be told the number of licences which have been sold, from which ports and the total cost of those licences?

My Lords, I cannot supply the detail for which the noble Lord asked, but I shall write to him. It amounts to about 20 per cent. of the British catch, which is now in the hands of foreign-owned vessels.

As regards the other points which the noble Lord raised, clearly, we did prosecute our campaign to end quota-hopping at the recent Fisheries Council meeting. We have made it clear that we will not contemplate any progress in MAGP 4, which is the latest round in reduction in fishing capacity, until the issue of quota-hopping is dealt with. However, we are quite clear that there is no capacity that we can find under existing EC law for quota-hopping to be dealt with. It requires a treaty amendment and we are committed to obtaining that at the conferences in the latter half of this year.

My Lords, does the Minister agree that had we not entered into the common fisheries policy, and by doing so sold our fishing birthright, the issue of quotas, quota-hopping, licences and therefore their sale would not have arisen?

My Lords, no, I would not agree with that. However, I would agree with the noble Lord that had we retained total control over our fishing we might have found the issue easier to deal with.

My Lords, does my noble friend agree that the treaty changes to which he has referred would require the unanimity of all the members of the Community? Can he give your Lordships' House any idea of how hopeful he is of achieving that unanimity?

My Lords, we are clearly receiving some expressions of support from other members of the Community. We are not the only country which is suffering from quota-hopping. The latest figures I have show that France, Portugal, Belgium, Germany and Ireland all have foreign vessels on their register. Any change to the treaty requires unanimity, but there is nothing special about the one we are asking for.

My Lords, according to the Minister's Answer, it appears that the Government agree with Mrs. Bonino, the European Fisheries Commissioner, when she says that many of the problems of quota-hopping are the direct result of the British policy and not of European policy. She claims that it was a British decision, not a European decision, to allow the sale of quota rights with the boats. Is that correct?

My Lords, a depressing amount of misinformation has been coming out of the Commission on this issue. It is quite clear that there is every right in every country within the EC for foreigners to purchase fishing vessels and fishing licences. It has taken a little while for some countries to bring their laws up to the standard required by the EC. Many are doing so, which is why they are now experiencing quota-hopping. Ours were there first, so we experienced the problem first.

My Lords, the Minister has not answered the question I asked. The issue is not the sale to foreigners; it is the decision to allow the sale of the quota right with the boat. The Minister referred to the Sea Fish (Conservation) Act 1967, which embodied a British decision to allow the sale of the quota right with the boat. Is that correct?

My Lords, it is quite clear that under European law we are not allowed to have any system which will prevent a member of another country within the European Union purchasing the right to fish within British waters off British quota. It is not a question of the particular mechanism we adopted for distributing quota. Whatever method we had adopted, it would still have to allow the Spanish and others to purchase our fishing.

My Lords, is it not right that, if British fishermen did not sell, foreigners could not buy and without the sales there would not be the hopping?

My Lords, yes. Nevertheless, if the noble Lord is suggesting that it will be the party opposite's policy to prevent British fishermen from selling their assets and businesses, I am rather surprised.

My Lords, is the main problem that fish form a more valuable commodity in continental Europe than here and fetch higher prices there, so that bids for licences from foreigners are likely to be much more attractive, not only to owners and skippers but also to the third parties through whom those licences pass?

My Lords, I do not think that that is a particular problem because British skippers have every right to land their catch in foreign ports if they wish to do so to take advantage of higher prices, and many do.

My Lords, I have listened very carefully to the Minister's replies and I wonder whether he can help me. Was it a British Government decision that allowed British fishermen to sell quotas with the boats?

My Lords, yes, but that is a policy that we should have had to adopt and other countries in the European Union have been made to adopt it by the Commission because that is what is required by European law.

asked Her Majesty's Government:

My Lords, this information is not available. My right honourable friend the Secretary of State for Health has asked the chief executive of the National Health Service to take action to ensure that Patient's Charter standards on patient accommodation are being met.

My Lords, I thank the Minister for that reply but I find it very disappointing. Is she aware that it is now two years since those Patient's Charter commitments were made and more than one year since my noble friend Lord Stoddart was assured that a survey on what was happening in individual hospitals would be available very shortly? Is she aware that those of us who visit hospitals regularly, as I do, continue to find a number of very distressed people being offered what one can only describe as Hobson's choice? They can make alternative arrangements for the single sex accommodation they want and wait for their operation or accept the offer of mixed-sex ward accommodation which they certainly do not want.

My Lords, yes, I appreciate very much what the noble Baroness says. There are many people who do not want mixed-sex accommodation. But that must be seen in the context of more than 9 million people admitted every year. The National Health Service chief executive is writing to health authorities. He will ensure that they send clear plans and a challenging timetable to enable mixed-sex wards to be phased out.

My Lords, in circumstances where hospitals suddenly experience grave difficulties which are not necessarily of their making, would they receive complete assistance from the Minister's department when they need such help?

My Lords, clearly we try to assist anyone in the health service who requires help from central sources. But in this context there are occasions when there are fires, floods or severe epidemics of 'flu when mixed-sex accommodation must be used because the accommodation has to be used as flexibly as possible in order to keep down waiting times.

My Lords, does the noble Baroness recall that, on 18th January 1995 when we had a debate on Second Reading of my Bill, she said:

"I have no doubt that we shall fulfil the demands of the Bill even more quickly than the noble Lord expects".—[Official Report, 18/1/95; col. 745.]

The noble Lord mentioned there is myself. Will the noble Baroness take it from me that I had expected action much sooner than this? Will she accept also that promises made have not been kept. I have pursued the matter with the Minister, as she knows. But promises to publish the results of surveys have not been met.

Is the noble Baroness aware also that I nobbled the Secretary of State in the Tea Room of the House of Commons only last week and he is just as concerned and angry about this matter as I am? Are we not now in a position in which nurses, Secretaries of State, Ministers, the Opposition and the whole of Parliament want mixed-sex wards to be phased out but are being frustrated by people on the ground who appear not to understand that patients want dignity and privacy when they are being treated in hospital?

My Lords, of course the Government, my right honourable friend and indeed myself share the anxiety and concern expressed by the noble Lord. We expected the review to be published much sooner than it has been. As the noble Lord will be aware, since he received a letter from my right honourable friend on 20th December, the results of the review will be published very soon indeed and will give us more information. In the meantime we are, and shall be, taking action. But there is a trade-off here in relation to clinical expertise. Clearly, there are some wards where the specialty is so esoteric that it is essential that we use clinical skills and equipment to the best advantage. That means that sometimes it will be necessary to have mixed-sex wards, as will be the case as regards emergency admissions and intensive care, where, clearly, accommodation must be used as effectively as possible.

My Lords, is the Minister aware that most young men these days do not wear or own pyjamas? Do hospitals keep spare pyjamas?

My Lords, I wonder whether the noble Baroness is suggesting that we carry out yet another survey but this time of a different nature. Indeed, I have been prompted to say that we should perhaps start with my noble friend Lord Swinton but I believe that to be an improper suggestion. I really do not know but, clearly, if clothing is needed in any context I am sure that the NHS does its best.

My Lords, can my noble friend the Minister say whether there is anyone who does prefer mixed-sex wards?

Yes, my Lords, there are some people who like mixed sex wards, especially, I am told, adolescents, because they are gregarious people who sometimes find that it aids recovery when the opposite sex are in the same area.

My Lords, is it not correct that the Government have cynically raised patients' expectations in this area? Is it not true that the majority of patients in beds in hospitals today are admitted as emergency patients and therefore have no rights about a choice of single sex accommodation? Are not the Government guilty of never having properly assessed what the difficulties would be for hospitals with old and ill-designed buildings operating at huge pressures of bed occupancy—as has been the case this winter—and of not actually delivering on the promises that were so rashly made?

My Lords, I strongly refute the fact that this has been a cynical exercise. The noble Baroness will know that many of those wards are being phased out. However, many trusts are putting considerable investment into refurbishing nightingale wards to divide them into two halves and put sanitary facilities at either end. I am sure that the noble Baroness is trying to do that in her own hospital. Indeed, as the chairman of a trust, she will know about patients' expectations.

However, there is also an issue here about old hospitals. We are replacing them at the most amazing rate. We have a huge capital building programme. It would be ridiculous to put huge investment into refurbishing old wards when they are going to be replaced by new accommodation, new buildings and, indeed, new hospitals.

My Lords, the Minister referred to the letter written by her right honourable friend the Secretary of State to my noble friend Lord Stoddart. Can the noble Baroness tell us what he meant when he referred to setting health authority chief executives challenging standards on this matter? Surely, that should have been done two years ago. What is the extra challenge now being suggested?

My Lords, when the Patient's Charter was first published it was written in fairly general terms. I have told the House today that we share the disappointment that progress has not been made at a quicker rate. Therefore, the chief executive will be setting challenging standards which will be monitored in much greater detail than we initially thought necessary.

asked Her Majesty's Government:

My Lords, the Government allocated £60 million for 1997-98 to local authorities for minor works designed to improve road safety. That may be used for schemes both outside and within areas covered by transport packages. New or improved pedestrian crossings, safe routes to school and traffic calming may qualify for funding as road safety schemes if they are designed to deal with locations where there is a record of accidents.

My Lords, I thank the Minister for that detailed reply. Can the noble Viscount confirm that the budget for minor works not included in packages, which in fact encompasses cycle routes, bus priorities, pedestrian crossings, safe routes to schools and traffic calming, has actually been reduced from £44 million last year to zero this year?

My Lords, as I said in my original Answer, some of the types of schemes which the noble Lord mentioned are classified as "safety schemes". If they come within that classification then money from the allocation of £60 million, which represents an increase of over 10 per cent. on the year before, can be used towards such schemes. It is a matter of deciding priorities. We have decided that safety should be such a priority.

My Lords, is the Minister aware that when some of us were in another place we pressed the Government to have a senior civil servant in each region specifically responsible for cycling matters? I am glad to say that they agreed and that it has been very successful. Can the Minister say whether that still operates? Surely the case for cycling—for example, good exercise, non-polluting, and so on—is already made. Can the noble Viscount tell me whether the budgets are being cut and also what is happening in the northern region? If he cannot give specific information on the latter today, perhaps he will write to me in that respect.

My Lords, I shall be delighted to write with any level of detail that the noble Lord requires. Fundamentally the noble Lord is quite right; the Government do take cycling seriously. Indeed, we now have a cycling strategy and there is a document on the subject, a copy of which I shall be pleased to send to the noble Lord.

My Lords, the Minister and I obviously disagree on the breakdown of the budget. I was referring to minor schemes only which are not packages. Will the Minister confirm that at the same time as the £44 million has been cut to zero the local authority budget for road schemes has been increased by £36 million? Further, can the noble Viscount say why the Government have allowed such a major increase for road schemes but have not allowed any increase for London Underground for the Jubilee Line which, after all, is a similar transport project?

My Lords, the noble Lord is missing the fact that, as I said, there is a category for minor works concerned with safety. There is also a category for minor works within package bids which, again, we have discussed. The pressure came specifically from existing local authority commitments for major projects. That has reduced the amount available for minor works. Within that reduced total, we feel that safety projects, and those within package schemes with associated environmental benefits, should be the priority.

My Lords, from the answers that he has given so far this afternoon, can the Minister confirm that if one adds together the amount spent last year, notwithstanding the increase to which he referred within the £60 million, there is a real terms reduction of over £30 million on road safety schemes, taking packages and minor schemes together?

No, my Lords; I do not believe that that is the case. There is a reduction in the amount available for minor schemes but, as I have sought to explain, there is a specific allocation for road safety schemes. Indeed, that has been increased from £55 million to £60 million.

asked Her Majesty's Government:

My Lords, the Government do not believe that the rise in consumer demand and house prices will overheat the economy. However, we will continue to take no risks with inflation.

My Lords, I thank the Minister for that assurance. Can he say whether he read with care—I am sure he did—the speech which the Governor of the Bank of England gave in Edinburgh two days ago? Is he aware that the strength of sterling, which has been regarded as an anti-inflationary measure, has recently weakened and that the level of inflation is still above the level which the Government are aiming at—namely, 3 per cent. instead of 2.5 per cent.? In all those circumstances, do the Government feel that there ought to be early intervention to curb such developments?

My Lords, I believe that the noble Lord wants me to say that we will increase interest rates. I am interested to hear that that may be the policy of his party. However, so far as concerns this Government, I should point out that inflation fell in December and, as the Budget forecast shows, is expected to fall back further during 1997. In addition, I do not actually believe that consumer demand—especially in the light of the December figures—illustrates the kind of pressures that necessitate us taking immediate steps to raise interest rates. All the figures that we have seen this week vindicate the view of my right honourable friend the Chancellor of the Exchequer that for the moment interest rates can safely remain where they are.

My Lords, has my noble friend the Minister seen press reports today detailing the creation of 2,500 jobs and the excellent news regarding the replacement of the Royal Yacht "Britannia"? What a marvellous boost that will give to the shipbuilding industry.

Yes, my Lords; I have seen those reports. Those figures are very important to set alongside all the other figures. I know that the party opposite does not like to hear about increasing employment but today's newspapers show that Shorts in Belfast will be having an extra 600 Aerospace workers, that Parcelforce in Coventry will be creating an extra 700 jobs and that St. Merryn Meat in Merthyr Tydfil in Wales is looking towards another 663 jobs. Along with the excellent news that the successor to the Royal Yacht "Britannia" is to be built in a British shipyard, thus creating another 500 jobs, that makes 2,500 new jobs in a day, which is not bad going.

My Lords, does the noble Lord concede the inference contained in the Question that an economy where there are over 3 million unemployed can become overheated? Is he aware that most certainly some hundreds of thousands of people in our country found it difficult during the recent cold snap to get proper heating?

My Lords, the noble Lord, as always, exaggerates the figures for unemployment. The latest figure of 6.7 per cent. is a good deal short of 3 million, and the number is falling. However, the noble Lord makes a valid point about the original Question. I do not believe the economy is overheating. We have steady and sustained economic growth thanks to the splendid policies of the Government.

My Lords, how many people have come out of negative equity? Is my noble friend aware how grateful these people are to see some movement in house prices to help mitigate their position?

My Lords, I do not have the figure for the number of people who have come out of negative equity, but clearly a fair number have because according to the Halifax Building Society house prices in December were still 4.9 per cent. below their peak in 1989; but the figures month on month for house prices show that for the whole of 1996 the price increase change on the previous year was 8.4 per cent. While there will still be some people in negative equity as we are not yet back at the peak of 1988, clearly many people will have come out of negative equity during the past year.

My Lords, does the noble Lord agree that we used to have something called, I believe, the regulator, which enabled the Chancellor of the Exchequer of the day to raise or lower excise duties, petrol duty and purchase tax, as it then was, by up to 10 per cent. either way to control consumer demand in the short term? Did that not have a much less adverse effect upon manufacturing production and exports than raising interest rates?

My Lords, I do not believe that the economic record of the days when the then Chancellor of the Exchequer used a regulator was particularly encouraging. I rather like to think that over the past four years the mechanisms used by my right honourable friend the Chancellor in his discussions with the Governor of the Bank of England have proved much more successful. As I said, we are seeing steady, sustained economic growth well instanced by the 2,500 jobs to which I have drawn your Lordships' attention.

My Lords, following his reply to the noble Baroness, Lady Gardner, will the Minister give us some figures regarding how many people were put into negative equity by government policy?

My Lords, obviously I do not have those figures to hand. Of course a number of people were put into negative equity when the housing market overheated in the mid-1980s. However, thanks to the recovery I have mentioned, thanks to controlling inflation—which we have done—and controlling government spending, we have seen the position improve greatly. Mortgage rates—the cost of mortgages—are now at their lowest level for 30 years. That has to be set beside the problem of negative equity.

My Lords, does my noble friend agree that the economic policy of this Government has reduced the rate of inflation? Although there has been a slight rise in consumer demand, does he agree that the increase in the employment figures in this country—that is, the reduction in unemployment—must help the public sector borrowing requirement and public sector expenditure, and consequently shows that this Government can control inflation without any overheating?

My Lords, my noble friend is quite correct. Underlying inflation has been below 4 per cent. for over four years, which is the longest such period for over 50 years. A recent OECD Economic Outlook published on 16th December stated with regard to the United Kingdom:

"The prospects for achieving sustained output growth and low inflation are the best in 30 years".

That is a credible performance by Her Majesty's Government and by this country.

My Lords, is the Minister aware that he has displayed the most extraordinary complacency in the face of what was a serious Question from the Liberal Democrat Benches? It is the Government's Red Book that tells us that consumption is expected to grow significantly faster than output as a whole over the next few years. Whenever that has happened in the medium term it has ended in disaster. That is what is happening now. What will the Government do to rebalance the economy?

My Lords, I thought in the past eight minutes I had more than satisfactorily answered the questions put by the noble Lord. I am not complacent. I made it perfectly clear earlier that the Chancellor watches all these matters carefully. Indeed the figures vindicate his view that interest rates should remain where they are. I am equally surprised that the noble Lord did not notice what the OECD said. I shall repeat it for his benefit:

"The prospects for achieving sustained output growth and low inflation are the best in 30 years".

The highest independent forecast for 1997 for consumer growth is 4.5 per cent. We, and most commentators, perhaps with the exception of the noble Lord, Lord Eatwell, believe that that will not overheat our economy.

My Lords, would the noble Lord care to read the OECD report on the British economy of 1989, where he will find that it said exactly the same at the time when the noble Lord, Lord Lawson, was leading the economy into disaster?

My Lords, we now know that the noble Lord does not listen to, or believe in, anything that the OECD says. That is interesting. I shall note the next time he quotes the OECD on his side of the argument. As I have stated with regard to the statistics, they all look reasonable. Inflation is low, and is falling, and we are keeping it under control. My right honourable friend the Chancellor put up interest rates just recently to prevent any overheating. We do not believe there is overheating. We are confident that our economic policies under this Government will continue their successful course for many years to come.

My Lords, I beg to introduce a Bill to provide for the insurance by police authorities and the Receiver for the Metropolitan Police District of persons providing voluntary assistance for police purposes. I beg to move that the Bill be now read a first time.

Moved, That the Bill be now read a first time.—(Lord Brabazon of Tara.)

My Lords, I beg to introduce a Bill to provide for the creation in England of parishes in cities and towns where charter trustees have been constituted. I beg to move that this Bill be now read a first time.

Moved, That the Bill be now read a first time.—(Lord Sandys.)

moved Amendment No. 1:

Page 1, line 14, at end insert ("or

(c) services are provided which are not personal medical services or personal dental services but which may be provided under Part I of the National Health Service Act 1977 or (as the case may be) Part I of the National Health Service (Scotland) Act 1978.").

My Lords, I support the noble Baroness in this group of amendments, to which my name is also attached. As she explained so fully, the Bill as it stands offers unnecessary restrictions which run counter to what we have understood to be the more widespread approach to general practice and primary care in which the Bill seeks to engage and which we have generally supported from these Benches. As the noble Baroness said, it unnecessarily limits the potential for innovation.

In her reply in Committee (at col. 1415 of Hansard), the Minister said that some of these amendments seemed to suggest that the intention was to turn nurses into doctors. As the noble Baroness, Lady McFarlane, explained, that is clearly not the intention. She gave the House some vivid examples of the ways in which nurses already take a primary role in primary care. I shall mention just one example that is very well known to me, of a senior nurse running a local minor injuries unit who recently became a very successful chief executive of an acute trust. She would find very odd any suggestion that she was incapable of being the lead proposer or organiser of the type of pilot scheme that is proposed in the Bill.

As the noble Baroness said, the White Paper referred to the equally important role of nurses, although at Committee stage the Minister seemed to feel that that could be well achieved within the meaning of the Bill as it now stands. She seemed to develop the argument to which the noble Baroness, Lady McFarlane, referred that the sifting system of the health authority would enable good schemes by nurses possibly to be included in those forwarded to the Secretary of State.

The point was very well made. If we are to encourage the equal role of the nurse, midwife, health visitor or other professionals mentioned in the noble Baroness's amendments, some positive national lead needs to be given of the type that would be created were the amendments to be accepted. As the noble Baroness, Lady McFarlane, said, the Minister has a very well-deserved reputation for supporting and improving the role of nurses within the profession and within community care. She could do a good deal to enhance that reputation if she were to accept these amendments. I support them.

My Lords, I wonder what doctors and the Royal College of General Practitioners think about these amendments. Could it mean that the doctors would opt out of some of their responsibilities?

As matters stand, understanding and training in relation to many disabilities and the attitude of many doctors to disabled patients should be improved. Doctors might try to pass that sort of work in relation to disability on to the nurses, as that would save them time. However, the nurse has different responsibilities and training. The doctors have longer training and should be better at dealing with some of the very complex matters. I should be very interested to know the doctors' opinion on these amendments.

My Lords, I am grateful to the noble Baroness, Lady McFarlane, first, for giving me notice of a number of the amendments tabled, and also for her very generous and fulsome remarks. I am also grateful for the remarks of the noble Baroness, Lady Jay.

Any proposals put forward by the noble Baroness, Lady McFarlane, have to be taken with the deepest seriousness. She is one of the country's most distinguished nurses. I believe that she was the first nurse ever to get a chair in nursing at a university.

I have no doubt whatever that nurses are often the very best people to provide primary care services for particular groups of patients. As the noble Baronesses, Lady McFarlane and Lady Jay, said, there are some excellent examples of innovative primary care services which are not only provided by nurses but were inspired by them. I, too, have seen many of them. I can think of specific schemes to help homeless people where nurse practitioners have been providing the service without a GP being involved; those people particularly did not want to see a doctor, but they would accept a nurse. Many other examples given this afternoon are pertinent and inspiring.

Indeed, many other initiatives are happening now. They all fall within Part I of the National Health Service Act 1977, which is the subject of one of the amendments. So there is nothing now to prevent nurses from putting forward proposals like this to their local health authority. Arrangements for the provision of services under Part I are very flexible. There is no need for this Bill to enable such ideas to be taken forward.

The pilots that we propose relate to services currently delivered under Part II of the Act; namely, general medical and dental services. These are the concerns of the Bill. Up to now, the provision of services has been very tightly regulated. That is why we need primary legislation to allow for new opportunities.

The pilots we propose will cover the delivery of general medical and dental services. Those services will need doctors or dentists. Only suitably experienced doctors can legally provide the medical services received in general practice. That point is reiterated in the Bill.

I continue to think it right that where a proposal is put forward not involving doctors, dentists or NHS trusts, the health authority should be able to consider whether it satisfactorily covers those areas of care that have to be provided by doctors or dentists before it is submitted to the Secretary of State. Where a GP is not involved in the proposal, it will need to be clearly set out how GP input will be provided. That seems to me to be an essential screen at local level.

That does not prevent nurses putting forward proposals. Indeed, I hope they will continue to do so. However, I must also emphasise that I certainly look forward to seeing nurses continue to develop their unique roles through pilots with practices and trusts and to seeing them taking forward the proposals that we set out in Primary Care: Delivering the Future.

I wish to make two further points about the amendment. First, in most cases the proposals will be put forward by nurses employed by a trust. Unless those proposing a scheme wish to leave their current employment, it seems right that their proposals should have the support of their employer, who will have to hold the contract with the health authority should the proposal be accepted as a pilot. They are in a very different situation from that of general practitioners and dentists, who are independent contractors.

If a pilot receives such support it will have a direct route to the Secretary of State under the terms of the Bill, because it will be sponsored by the trust that employs the nurses. Secondly, if the nurses are part of an independent organisation then in line with other similar proposals it seems right that the health authority should decide whether or not it should proceed.

I have been through a number of examples given to me by the nursing profession. I have yet to find one that stands up in terms of those other two aspects. I share the aspirations of noble Lords. I wish to see nursing develop and become an even greater profession than it is. However, I really do not think that in the context of the Bill these amendments are pertinent.

To respond to the point made by the noble Baroness, Lady Masham, I cannot tell her what the Royal College of Practitioners thinks about these particular amendments. However, I assure her that the medical profession very strongly supports the Bill and the concepts behind it. I do not believe that there is any intention that doctors should opt out of their current responsibilities.

I hope that the noble Baroness will not press the amendment.

My Lords, let me first thank the noble Baroness for her kindness to me personally in what she said. When there is such mutual respect it is all the harder to disagree. I know that her motives are of the highest and that she shows the greatest support for nurses. Nonetheless I believe that the Bill is discriminatory in the way it is drafted and that we should clear that discrimination from the face of the Bill.

At Committee stage there was considerable support from all sides of the House, including from many medical Lords. That encourages me to go forward with these amendments. In the intervening period between Committee and this stage I have sounded out views on the amendments with all the nurses whom I have met. With the exception of one, their view was unanimous that the amendments are necessary if nursing is to play its full role.

Because of the support at Committee stage and the importance of the amendments to the nursing profession, I feel that I should test the opinion of the House.

moved Amendment No. 2:

Page 1, line 15, leave out subsection (2).

My Lords, as the noble Lord said, we discussed this matter at some length at Committee stage. I should like to reassure noble Lords that I support wholeheartedly the objective behind this amendment, that of encouraging better integration of services provided by the different professions. After all, that has been one of our aims in primary care for some time. It remains a priority.

I undertook to consider further the need for Clause 1(2) and to advise your Lordships at Report stage of the outcome. I have done so. But I remain convinced that the provision in the Bill which this amendment seeks to remove will not hinder further progress towards co-operation between the medical and dental professions. There will be nothing to stop doctors and dentists examining local health needs together and co-operating over the preparation of pilot proposals, perhaps sometimes involving joint premises, which was one of the examples given by the noble Lord at Committee stage. Those proposals would then go forward together but be presented as separate schemes.

The Bill certainly will not stand in their way. It simply requires separate contracts for what are already two distinct services with very different financial and practical arrangements. They will need separate consideration locally and probably different evaluation. It will help to ensure that funding for dentistry is spent on dentistry. Failing to maintain the distinction between the two services could produce confusion for little gain.

I know that the provision as currently drafted in the Bill has the full support of the General Dental Services Committee. I hope that your Lordships, having heard my explanation and reassurances, will not seek to press the amendment.

My Lords, I understand the position of the noble Baroness a little better, though I still do not understand why that provision has to be on the face of the Bill. It seems to me that in drawing up pilot schemes, that would automatically have been sorted out. But it is an academic point. So long as the noble Baroness can assure me that there will be schemes in which the two professions can collaborate, I see no point in pressing the amendment further. I beg leave to withdraw the amendment.

moved Amendment No. 4:

Page 2, line 37, after ("scheme") insert—

("(aa) satisfy themselves that there is no diminution in the quality or range of services provided in an area which is covered by the pilot scheme.").

My Lords, my name is to the other amendments in this group. Perhaps I may speak to those and the noble Baroness, Lady McFarlane of Llandaff, may wish to follow me. I should certainly like to move Amendments Nos. 9 and 13 which are in this group and to which my name is attached.

The purpose of all the amendments is to deal with the need to ensure that the quality of service is maintained in pilot schemes. That is the particular requirement of Amendment No. 4 in the name of the noble Baroness, Lady McFarlane. Amendments Nos. 9 and 13, standing in my name, are proposals for pilot schemes and subsequently for judging whether those pilot schemes should become part of the permanent local services.

We raised those issues at Committee stage because we feel it is very important that consistent standards and services so far as possible should be offered by all primary care providers, whatever part of the country they are in or on whatever basis that provision is made, however widely the notion of the pilot experimental scheme is drawn. The House will be familiar with the great concern on these Benches that in the past few years what we describe as a fragmented health service is producing a system in what you get depends on where you live and not necessarily on what you need. We fear that the defects of the system may be exacerbated by the deregulation proposed in the Bill without a statutory requirement to establish national criteria for standards.

Therefore, the amendments propose that requirement to adhere to national standards of care and service which would be established by a nationally representative body. That would also avoid the suspicion that local health authorities might promote local schemes on the basis simply of cost and that cost saving might become the determining criterion for successful applications in hard-pressed health authorities. We have used the expression "a nationally representative body" because at Committee stage the Minister and I agreed that it was extremely difficult to establish what one might colloquially call "gold standards" within primary care, or indeed any other part of healthcare for that matter. We also agreed that, particularly within the context of the development of evidence-based practice in the NHS, it was very important to strive to achieve it.

I was encouraged that at Committee stage the Minister said that the Department of Health was establishing "a nationally representative group"—the expression used in these two amendments—to take this matter forward and to discuss criteria governing the approval of pilot schemes. She developed those points in Committee (Hansard, col. 1445).

The noble Baroness also said that the criteria would be established and published before pilots were considered and indeed, of course, the proposals for long-term service change which might arise from those pilots. That is also welcome.

Amendments Nos. 9 and 13 simply seek to give force to those understandings which the Minister expressed at an earlier stage by establishing on the face of the Bill that the national representative group which she said was being established would have statutory authority to set criteria on which the Secretary of State will make decisions about the value of pilot schemes to the communities they are intended to serve. I beg to move.

My Lords, as the noble Baroness said, these amendments focus on the quality and standards in the pilot schemes. We share those objectives. We believe firmly that we will secure them through the Bill as it stands and through our approach to implementation.

Amendments Nos. 9 and 13 concern the setting up of statutory groups of interested parties to advise on quality and standards and on criteria for evaluation. We are already doing that. As the noble Baroness said, two such groups have already been set up—one for medical services and one for dentistry—with representatives from the professions, patients and other interested parties. They are to help identify the standards and criteria that should apply before pilots are approved and to advise on a framework for evaluation. The first meetings will be held next week. We see those groups as playing an important role but do not see the need to enshrine them in legislation.

I hope that the noble Baroness, Lady Jay, will agree that, while we share her concerns, we have largely met them. We regard an open, consultative approach as the best and probably only way for our initiative to get off the ground and flourish. We see the groups as playing a leading role but do not see the need to enshrine them in legislation.

Since piloted schemes will vary enormously, it is important that the overall standards and values are clearly set out and that individual schemes have clearly defined aims and objectives against which health authorities and others can judge whether they have achieved their initial aims. We will consult widely before the areas to be covered by the Secretary of State's directions to health authorities are drawn up. The kind of issues we will expect authorities to cover and on which we will seek views at the drafting stage will include the intended benefits to patients, how pilot proposals fit in with other local NHS services and ensuring that they are not detrimental to the wider NHS, and how any potential conflicts of interest will be satisfactorily resolved before the pilot scheme begins.

I hope that I have shown that we are committed to a broad national framework of standards and values within which pilots will operate and be evaluated. I hope that I have demonstrated also how serious we are about seeking the advice and views of those with an interest. I trust that the noble Baroness will agree that that meets many of the worries expressed in her amendment and that she will not therefore seek to pursue it.

The approach I outlined also satisfies the aims of Amendment No. 4. I made clear that we do not underestimate the importance of raising the standards and quality of services. It will be one of the key agenda items for our national representative groups. Our initiative is unequivocally about achieving improvements in services. I hope your Lordships will accept my assurances that any pilot proposal that does not set out how it will improve services will not be allowed to proceed and that your Lordships will not press the amendments.

My Lords, perhaps I can raise one matter before the noble Baroness sits down. As we do not know what the pilots are to be, is it not better to have the standards emphasised? I support the amendment.

My Lords, the noble Baroness, Lady Masham, is right in that we do not know the details of the pilots. But we are trying to achieve criteria which we believe are better drawn up with the professions and with lay representatives. That is what the groups will do. We will therefore have a broad framework against which we can test the pilot schemes. In view of what goes on elsewhere in the NHS and the fact that there are many other such groups whose role is not enshrined in legislation, it would be extraordinary, in regard to these small pilot schemes, to put these two groups on the face of the Bill. We work with many other important consultative bodies whose existence does not have to be enshrined in legislation.

My Lords, I am grateful for that reply and pleased to hear that the national consultative groups have been convened and are meeting. We look forward to the outcome of some of those meetings, hopefully before the Bill leaves another place if not your Lordships' House.

I remain concerned in relation to the concept of good will in establishing the national criteria if they are solely dependent on those bodies which are convened by the National Health Service on this kind of voluntary basis. Many times over the past few years we have expressed anxiety about establishing national criteria and national standards for services, whether in regard to discharge procedures from hospitals or the interface between the NHS and social services. We have often been told that the good will and assurances of the Department of Health are all that we need to rely on. Sometimes we have been very disappointed by the outcomes.

Perhaps I may remind your Lordships of the debate we had recently in your Lordships' House at Question Time regarding the provision of single sex-wards. In that instance we were told that the Government had good aspirations and intentions; that instructions were being given to local health authorities to act in accordance with the Patient's Charter. Yet, as we also heard in your Lordships' House at Question Time, Ministers themselves are disappointed with the outcome of that voluntary attempt to achieve standards which they sought for the National Health Service.

It is important, therefore, when we embark on a widespread piloting scheme which will change the nature of primary care in this country if it succeeds in the way the Government suggest they want it to succeed, according to the White Papers that came with the legislation, that we are given firm guarantees of what the standards may be and a statutory means of carrying them out. Of course, we respect the good intentions of the Minister when she gives them, but this afternoon we had a vivid example of how good intentions, even at ministerial level, may not result in good practice. In those circumstances, I must seek the opinion of the House on Amendments Nos. 9 and 13. First, I beg leave to withdraw Amendment No. 4.

moved Amendment No. 5:

Page 2, line 46, at end insert—

("The matters mentioned in this subsection shall include provision for the transfer of employment rights, including pension rights.").

My Lords, I strongly support the amendment. I remind the noble Baroness that by the time the Bill gets on to the statute book there may well have been a change of government. If this Government are anxious, as they state in the rather grandiosely entitled White Paper, Primary Care: Delivering the Future, that these rights should be granted, then, if they really mean that, these provisions should certainly be in the Bill and not simply in a White Paper for the guidance of the next government.

My Lords, I am grateful to the noble Baroness, Lady Robson of Kiddington, for bringing forward the amendment. It would only secure NHS pensions, of course, for those staff who already had them and who transferred their employment in the course of a pilot. But the Government in fact have gone much further. As the noble Baroness said, the White Paper, Delivering the Future, announced that the NHS pension scheme would be open to GP practice staff from 1st September 1997. We are now putting words into action. GPs will become employing authorities for the purpose of the NHS pension scheme regulations, and they will be able to choose whether they wish their practice staff to become members of the scheme. We aim to complete discussions of the details of the new arrangements by the end of February. Providing access to the scheme through this Bill we believe would serve no purpose. The changes are already in train and there is no question of our going back on them. Therefore, I hope that the noble Baroness will not press the amendment. We feel that it is unnecessary.

My Lords, I am no more happy with that reply than I was with the one at Committee stage. I believe it is quite wrong that it should be in the hands of the GP. It should be as of right for the people who are working in the health service that they are able to make use of the NHS pensions right. It is incomprehensible that it should be governed, perhaps, by a general practitioner who may have a different view.

However, I am heartened by the fact that the commitment exists in the White Paper and I trust that the Government will fulfil the promises they have made. I agree with the noble Lord, Lord Rea, that it is a shame that we do not put it on the face of the Bill so that we can make certain that whoever forms the government, even a Liberal Democrat government, would have to comply with it. For those reasons at this stage of the Bill I cannot press the amendment. I beg leave to withdraw the amendment.

moved Amendment No. 6:

Page 3, line 3, leave out from ("enactment)") to end of line 5 and insert—

("(a) consult and take account of the views of representatives of all relevant professions and of patient and consumer organisations (including community health councils) and of relevant local authorities which appear to them to be affected by the pilot scheme; and

(b) comply with any directions given to them by the Secretary of State about the extent and manner of such consultation.").

My Lords, I support the amendment very much indeed. It is a national health service. It is a service for the people and therefore they should have as much say in it as anyone else. I hope that the Minister will accept the amendments. They will not cost anything. So why not accept them?

My Lords, perhaps I may take up the point just made by the noble Baroness, Lady Masham. Even consultation costs time and energy, and, sometimes, money.

As the noble Baroness, Lady Hayman, said, we discussed this subject at length in Committee. The Government acknowledged then, as we do now, that changes in primary care matter deeply to local communities. We agree wholeheartedly that local people and others with an interest should be well informed and, where appropriate, consulted on changes. Consultation in the NHS is standard practice and there is no reason why, in considering pilot schemes, health authorities and boards will not continue with this well established approach. But we are also backing custom with statutory safeguards to ensure that patients have a voice.

The Bill gives the Secretary of State new powers to make directions setting out who is to be consulted. I can assure the House that he is committed to exercising these powers. Before he does so, he will take into account the advice of the professions, health service managers and others already involved with us in preparing for the implementation of the Bill. When he considers pilot proposals, the Secretary of State will be looking for clear evidence that consultation has been genuine and comprehensive.

We do not believe that the amendment would lead to more or better consultation. Instead, it would give us an inflexible set of rules which could be less than adequate for very major pilot proposals but excessive in the case of very minor ones. Rigid rules often produce a mechanistic exercise. None of us wants that, but we believe that it is what the amendment would create.

I hope I have shown that the arrangements are in place to ensure genuine consultation and that we have a strong and genuine commitment to it. I hope therefore that the House will not support the amendment.

Amendment No. 29 was also discussed in Committee. I wish to re-emphasise the safeguards surrounding the introduction of permanent arrangements which are already included in the legislation. First, the Bill requires the Secretary of State, in permitting permanent arrangements, to have regard to the reviews of pilot schemes which have been conducted and to be satisfied that such a step is in the interests of the health service. That is a clear defence against any attempt to introduce permanent arrangements where there is inadequate evidence that they will work. It could, if necessary, be tested in the courts.

Secondly, permanent schemes can only be set up once the Secretary of State has set out the rules under which they will operate in regulations under Clause 18 of the Bill. It is accepted practice to consult on draft regulations and I can confirm that the Secretary of State is committed to doing so in this case. Such consultation will not be mere form.

Finally, once regulations permit health authorities to set up permanent arrangements, the Secretary of State will also continue to have powers to require health authorities to undertake appropriate consultation on proposals.

I have tried very hard to demonstrate how the principle of consultation is inherent in the way we wish to proceed. The amendments would not add anything to the safeguards already in the Bill and the commitments I have given. I therefore hope that the noble Baroness will not pursue them.

My Lords, I am grateful to the noble Baroness for what she said. I would not in any way question her personal commitment in these areas—nor that of the Secretary of State—and the assurances she has given us. However, there is an issue of principle here. I do not believe that the amendments are either inflexible or over-rigid. They put the balance of power and responsibility on the face of the Bill rather than let it lie with the Secretary of State.

Over the past years one of the main problems with which the NHS has had to tussle has been the lack of public confidence in decision-making processes. There is a great deal of trust to rebuild in those areas as we change and develop the service for the future. A small measure towards rebuilding that public confidence would be to ensure that on the face of the Bill we set out the areas and the people with whom we believe consultation should take place. In view of that, I should like to test the opinion of the House.

moved Amendment No. 7:

Page 3, line 15, after ("lists)") insert ("and who is actively working in general practice as part of a primary health care team").

My Lords, I shall do my best to reassure the noble Lord. This amendment aims to reinforce the emphasis on a team-based approach in primary care. That is an objective that the Government very strongly share. The White Paper Delivering the Future puts forward specific proposals to this end. We shall expect proposals for pilot schemes to reflect that approach. But putting conditions on GPs who have an automatic right to have their pilot proposals put forward will not necessarily help. On the contrary, it might even hamper desirable proposals from those who wish to use piloting to develop more collaborative ways of working, perhaps through a practice-based contract.

We would also see difficulties emerging over how,

"actively working in general practice as part of a primary health care team",

would be defined in practice. It would be unhelpful if a relatively simple application process were made more complex and subject to argument simply over status.

We believe that the principle of encouraging team-based family health care service teams is better served through the assessment of the quality and suitability of proposals in the approval process. I hope that that gives the noble Lord enough to go on, as he put it, and that he will not press this amendment.

My Lords, I thank the noble Baroness for those words, which we shall read in detail. She certainly reassures me that it is her intention at least that these pilot schemes will improve primary care in this country. I am sure that she means what she says. But we have to look at what the Bill will allow. After we have scrutinised her words and had another look at the Bill, I give notice that we may yet return to this matter at Third Reading. I beg leave to withdraw the amendment.

moved Amendment No. 9:

Page 3, line 24, at end insert—

("() The Secretary of State may not approve proposals for a pilot scheme unless he is satisfied that the scheme will satisfy standards and criteria for the quality of services provided to patients determined by a national representative group established by the Secretary of State for this purpose.").

moved Amendment No. 10:

Page 3, line 26, leave out ("participants") and insert ("any participant other than the authority").

My Lords, we are grateful to the Minister for the length and breadth of her reply, she having listed a number of amendments proposed in this group. We are also grateful for her consideration of whether amendments have been tabled rather late in the day for appropriate consideration at this stage of the proceedings. I hope that it is agreeable to the House—as the Minister has proposed it, I am sure that it will be—to consider at Third Reading some matters which must necessarily, although not in accordance with the previous proceedings of the House as I understand them, raise issues that have not been considered before. But because there has been an understanding about the progress of business today, we on these Benches are happy to accept it.

I should like to raise one issue relating to Amendment No. 65 that has been drawn to my attention. It deals with cross-border pilots. Queries have been raised, particularly by the professional bodies concerned with the organisation of general practice, about who in a cross-border pilot will be the primary authority. For example, which Secretary of State will approve an application? Which health authority or Scottish board will process it? There are also questions about dispensing where the systems in Scotland and England are different. Further, the complaints system which we discussed in connection with another piece of legislation in a previous debate in your Lordships' House is different north and south of the Border. Where in the geographical sense there are cross-border pilots that may be in the interests of the local population, questions may arise as to who is the authority with primary responsibility and whose legislation in some technical but important areas—for example, dispensing and complaints systems—will prevail: how will it be worked out between the two different systems should any conflict arise?

My Lords, I imagine that for cross-border schemes the same principles will apply to pilots as to current services that are provided by GPs through general medical services. I do not have detailed information with me. I shall be happy to write to the noble Baroness about these matters, in particular the point about dispensing.

My Lords, Amendments Nos. 45 and 46 change the word "provide" to "perform". That is exactly the opposite of what I proposed in amendments at Committee stage. I suggested that "performing" was not appropriate and "providing" was better. Far from taking my advice, the noble Baroness has gone one better and found two more "provides" and turned providing doctors into performing doctors. I understand that for technical reasons "perform" is the proper word. Although it sounds rather silly, at least the Bill is now consistent.

My Lords, I am grateful to the noble Lord. We have tried to ensure that providers are the bodies that hold the contract and performers are the people who supply the service. We are grateful to the noble Lord for bringing this matter to our attention. I am sure that in turn he is grateful that we have listened to his comments and tried to incorporate them wherever possible.

On Question, amendment agreed to.

moved Amendment No. 11:

Page 3, line 27, leave out ("they wish") and insert ("he wishes").

moved Amendment No. 12:

Page 4, line 3, at end insert ("not less than 18 months and not more than three years after the date on which the pilot scheme comes into operation").

My Lords, we on these Benches very much support the amendment. As I said at Committee stage, the imposition of time limits on pilot schemes acts as a stimulus and helps to concentrate the minds of those who carry out the evaluation. It means that they must think about it from the very start. They know when it is to finish and when they must have their report ready. This is a useful additional instruction to insert into the Bill.

My Lords, does the noble Baroness, Lady Robson, acknowledge that when a large number of pilot schemes are up and running, quite a few may fall into the same pattern and each may be able to learn from the other? If that is so, it may be possible to reach a decision before the 18 months are up. I am more attracted to her view that they should not last for longer than three years, but surely a shorter period than 18 months should remain an option.

My Lords, I said that where a pilot scheme followed the pattern of one that had already been approved, the evaluation period should be reduced or done away with.

My Lords, as the noble Baroness has said, this matter was discussed in Committee. Your Lordships are aware that we are committed to an open and thorough process of evaluation. We do not want to evaluate schemes before they are established; nor do we want to run them as pilots for longer than is necessary in order to demonstrate their worth. It is difficult to decide the right timescales for pilot schemes. We do not yet know what those schemes will be. Although it is difficult to make a judgment, I suspect that for the majority of schemes the timescales proposed by the noble Baroness will be about right. However, we believe that there are dangers in setting them in stone.

For example, we should not rule out the possibility that there will be schemes which are only subtly different from current arrangements or draw on ways of working which are already well established in other areas of the health service. As my noble friend Lord Harmsworth said, such arrangements may not require 18 months before they are ready to be evaluated. As the noble Baroness said, it would be most unfortunate if the service benefits that they offer could not be made more widely available more quickly because of the rigid rules on timing as set out in the Bill.

I hope that I have reassured the noble Baroness and the noble Lord that we have every intention of ensuring that pilots run for an appropriate time before being evaluated. However, we believe that timescales in primary legislation would be counterproductive and I hope that the noble Baroness will not pursue the amendment.