asked Her Majesty's Government:

What progress they have made on policy for the Children's Fund.

My Lords, I am pleased to report that we are making good progress on the Children's Fund. The first wave of areas, which includes some of the most deprived communities in England, is beginning to implement increased and better co-ordinated services for children at risk of social exclusion. Second-wave areas have now submitted their proposals, and we are on course for the Children's Fund to reach all parts of England by 2003–04.

My Lords, I am grateful to the Minister for that helpful Answer. It is good to know that the Children's Fund is beginning to reach the children at risk for whom it was intended.

My concern is that services for disadvantaged children must be carefully co-ordinated. I would be grateful if the Minister could say what contribution the Children's Fund is making to a more coherent provision. Is the Children and Young People's Unit beginning to make progress in joining up services?

My Lords, the Children and Young People's Unit is leading the development of an overarching strategy for children and young people. The unit has consulted widely on a document setting out, for the first time, our vision for all children in the country. The overarching strategy sets out that vision and the principles that, we believe, should apply to all government services. It proposes six key outcomes: health and well-being; achievement and enjoyment; participation and citizenship; protection; responsibility; and inclusion.

My Lords, does the Minister agree that children in the age range covered by the Children's Fund—5 to 13—and younger children are most vulnerable to physical abuse? How much of the Children's Fund has gone—and is intended to go—into parenting education, including the teaching of disciplining strategies other than physical abuse, so that the repetitive cycle of abuse can be broken?

My Lords, the proposals for the Children's Fund are worked out by local partnerships, as the noble Baroness will know. As for the way in which the money is distributed, it is for local partnerships to come together and build on existing services to develop the strategies that are most applicable to their communities. I cannot give the noble Baroness details of a specific amount of money, but I can point her to the way in which partnerships are developing services to ensure that children are less vulnerable.

The process is geared towards protecting children, by recognising when children are about to be at risk and intervening with children and their families as early as possible, to make sure that they remain safe.

My Lords, does the Minister agree that a great deal of the money—£450 million over three years— is being dissipated by the bureaucracy in the bidding process for securing money at local level? That £450 million is yet more money that is being held back at the centre and not going in at school level.

My Lords, the figure that I have is £380 million, available over three years. That money is available to the partnerships, and those partnerships will involve the work that goes on in schools. I disagree with the noble Baroness's claim that the money is being used in a way other than being given to schools.

It is important that the money that is built into the services is used to bring together health, social care and education services. For the children concerned, it is crucial that we have integration, early intervention and early recognition. That is a fundamental part of what the Children's Fund is attempting to do. The money is reaching the partnerships; they are coming forward in three waves, and money has gone out, in order to ensure that we achieve the fund's objectives.

My Lords, can the Minister say what use is made of the Children's Fund by children with disabilities and their families? I am sure that she will agree that they are a particularly disadvantaged group.

My Lords, I am happy to do so. Children's Fund partnerships are required to carry out an analysis of the need for and gaps in preventive services for children in their area. It must focus on children who are at risk of social exclusion. I understand that a substantial number has identified children with disabilities as a particular priority group in the development of Children's Fund work. There are examples of that in Bristol, Bradford and Birmingham.

Among the services that are being developed are services that are designed to provide additional support directly in schools—that is also relevant to the question asked by the noble Baroness, Lady Blatch — as well as improving access to leisure and cultural activities, additional family support and information services.

My Lords, I may have missed something, in which case I apologise, but can the Minister say how many partnerships are now in operation and how much money has, so far, been distributed to the partnerships or through them?

My Lords, the noble Lord has not missed anything; I had not given those figures. There are 40 partnerships in operation in the first wave. We plan to cover all local authority areas by 2003–04. The average allocation is about £1 million. The largest allocation has been given to Birmingham, which has received about £6 million.

My Lords, can my noble friend the Minister say whether young people have been consulted, as part of the consultation process for partnerships?

My Lords, young people and children have been involved in several ways. Some partnerships have employed participation workers specifically to make sure that they work with children. Other ways have been developed, including fun days for children, festivals, theatre groups and music and talent shows. In some areas, young people are directly involved in steering groups. In some cases, young people have been included in the process of recruiting staff. Young people are involved in various ways.

asked Her Majesty's Government:

Why they have reversed their previous policy of seeking to minimise the exclusion from school of disruptive pupils.

My Lords, we have not reversed our policy on exclusions. We no longer have targets for permanent exclusions, but our revised draft guidance restates that, in most cases, before excluding a pupil, a range of alternative strategies should have been tried. However, some incidents may be so serious that permanent exclusion may be appropriate for a first or one-off offence. The new guidance helps to ensure that a balanced approach is taken on this issue.

My Lords, I thank the Minister for her reply and am reassured by what she had to say. Does she agree that, at a time when there is concern about rising street crime, it is extremely important that we make sure that young people who are excluded from school—who often come from deeply disturbed backgrounds—are given the chance to have full-time schooling and are not just put into units where they are, perhaps, given only two or three hours' education a week?

My Lords, I agree entirely. We must strike a balance between ensuring that children who can be educated in mainstream education are educated in that way and recognising that, for some children, that is impossible. From September, we will work towards the position in which full-time education will be provided for all children who are excluded. The most important part of the strategy, in many ways, is preventing children getting to the stage at which they are excluded.

My Lords, the Minister said that, in the autumn, we would be working towards a position where we would get all children who are excluded into full-time education. I thought that we had been working towards that for some years. Can she tell us what effective steps have already been taken and what proportion of excluded children are still free to roam the streets without supervision?

My Lords, let me make it clear that by September 2002 we expect all children who have been excluded to be in full-time education. We have made that commitment. We are working with local education authorities to ensure that they have the right kind of provision. Noble Lords will be aware that for some children the appropriate provision will be pupil referral units, with the anticipation that children will move back into full-time education. For others it may be simply a different school, with additional support. For yet others, it may the provision of other kinds of educational support. It is a broad range. I did not wish to give the impression that we have not arrived at that point, but rather that we are ensuring that we have in place the breadth of provision that is needed.

My Lords, does the noble Baroness agree—from what I know of the noble Baroness, I am sure she will agree—that a particular problem with regard to disruption in the classroom is that occasioned by young people with autistic spectrum disorder? That very often results in disruption in the classroom. What is really needed is more screening and earlier intervention so that such children are not simply dubbed as disruptive and then left to the devices of a pupil referral unit.

My Lords, I could not agree more with the noble Baroness. It is absolutely right and proper to ensure that children with special educational needs are identified early, that support is provided for them within the classroom and that the right kind of support is provided for teachers so that they understand the needs of such children. We also need to ensure that, by working together, those children can enjoy a happy and fulfilling life at school and thus are able to remain in mainstream schooling, where that is appropriate for them, throughout their education.

My Lords, is my noble friend aware that one of the most difficult problems, if not the most difficult problem, for teachers is that of dealing with disruptive children? It may well be—I am sure my noble friend will agree—that exclusion should be used in certain circumstances and for a certain time. Is any research being done and training given to overcome the increasingly difficult problem of dealing with disruptive children?

My Lords, we are very concerned about disruption in schools. Within the department I chair a group which is looking specifically at behavioural issues. We are working with colleagues across departments, particularly those in educational psychology and those from the Child and Adolescent Mental Health Unit at the Department of Health, in order to achieve solutions.

It is worth saying to my noble friend that we are also interested in looking at those schools which have been very successful at ensuring that children are not excluded through working with, for example, learning support mentors and establishing learning support units on site. We are developing a range of strategies which will enable our children to be in mainstream schools, while also supporting our teachers, for whom this is a serious issue.

My Lords, in view of recent press reports, has the Minister paid attention to what teachers have to face in the classroom when dealing with disruptive children? There are times when children need to be referred to pupil referral units, but I gather that the units in East London are small. I speak from anecdotal evidence, but I understand that in Hackney and Tower Hamlets, there are hardly any such units. How are teachers to deal with pupils who curse and defy them when all they can do is to refer them for counselling and so forth? Attention must be given to providing sufficient referral units, and after that of course bringing children back into the mainstream. Can the Minister tell the House what attention is being given to the provision of referral units?

My Lords, I am grateful to the noble Lord for his questions. We are ensuring that we have on the ground in local education authorities the right breadth of provision and support for students. Pupil referral units are an important part of that provision. We are ensuring, through the allocation of resources, that we do have in place the right level of support for young people.

However, this problem also concerns preventive measures in the classroom. It is about ensuring that our children receive the right kind of support and, I would argue, it is about parental involvement. We must ensure that parents work with schools, that they send the right messages to their young children about the role of schools, that they work with teachers and are seen to be supportive and respectful of schools.

My Lords, can the Minister confirm that learning support units in schools, to which she referred in an earlier answer, often provide an easier route back into the mainstream after a temporary exclusion has been, it is hoped, successful? Can she tell the House a little about the balance between the two? Are learning support units always the first recourse, with exclusion units being the last recourse for children who cause disruption in the classroom?

My Lords, the answer to the noble Baroness's question depends partly on what resources a particular local education authority has put in place. We believe that learning support units are making a big difference and we are particularly interested in their work in inner-city schools. However, they are not yet in place everywhere and so they will not be available for every school.

However, decisions also depend on the reason for the exclusion. I think that noble Lords would agree that, wherever possible, we want those children who come out of mainstream education and into a unit to be able to return to school in due course. That also applies to special schools when considering behavioural issues in children. Among their criteria for success is the number of children they are able to reintegrate into mainstream education.

My Lords, the noble Baroness has told us that the Government have abandoned a system of targets in relation to children excluded from school. Does the Minister agree that that system has proved totally unsuitable? In certain areas of activity, targets can be really very damaging to the work of professionals on the ground. Will she agree to bring to the attention of her right honourable friend that there are other areas in education where targets might well be damaging and, indeed, other areas in government, such as the National Health Service? It is only too easy to set targets and think that one is managing from the centre, but they can do a great deal of damage.

My Lords, noble Lords will know that I have been on the receiving end of many targets in the course of my professional life. I have to say that targets play an important role in ensuring not least that the Government do what they say they will do. Noble Lords in this House will certainly ensure that the Government report back on the targets they have set. Indeed, for many organisations, including schools and—if I may trespass into another area of public sector life—the health service, it is important that we set ourselves the right kind of targets. With regard to education, we are discussing here the one chance that young people have to receive a good education. I think that we should set targets for ourselves.

asked Her Majesty's Government:

How much the National Health Service has paid out in early retirement costs and compensation payments for those forced to leave their jobs due to latex-related allergies.

My Lords, information on the costs of early retirement or compensation payments due to specific medical conditions is not available centrally, although the extra cost of retirement through ill health in the NHS has been calculated at £60,000 per employee retired. Of the 4,482 staff who left the service on grounds of ill health during 2000–01, some 1.7 per cent were due to skin allergies, some of which may have been attributable to latex.

My Lords, I thank my noble friend for that reply. Is he aware that many workers in the health service are extremely worried about latex allergies? It is not only a question of latex gloves, but also of the latex used in many other areas of a hospital. Does lie agree that, since alternative materials are available—for example, for latex gloves—it would be wise for hospitals to provide such alternatives for those workers who are worried about exposure to latex? To inform the House, I should say that latex can cause skin disease, but it can also trigger conditions such as asthma and other respiratory problems.

My Lords, my noble friend is right to suggest that latex is a sensitiser and that it can pose some risk to NHS staff. However, that risk is posed to only a minority. I should also say to my noble friend that some of the alternatives to latex products also contain chemicals which can cause allergic reactions in both staff and patients. The European Commission working group on latex is confident that the current directive provides sufficient protection for patients and staff if it is fully and properly implemented. However, in the light of the Question put by my noble friend and the concerns that she has expressed, the Government are announcing today their intention to reissue guidance to the NHS, thus drawing employers' attention to the problem and to the alternatives to latex that are now available. The guidance stresses the need for staff and management to work together to assess the risks in each case.

My Lords, the Minister has talked about guidance, but what steps are being taken by the NHS to centrally source supplies of low-allergy products?

My Lords, I am glad that the noble Lord has recognised the need for some central action in the health service. A central purchasing agency making decisions at central government level provides the option for the NHS to enter individual contracts. Part of the role of the NHS Purchasing and Supply Agency is to ensure that alternatives to latex products are made available.

My Lords, will my noble friend ensure that when the alternatives are available they will be offered also to patients' visitors? In cases where people are being barrier nursed, visitors have to put on gloves and aprons.

My Lords, that is a very useful suggestion. It is one of the considerations that local employers should take into account when implementing the guidance that we issue to the NHS and in developing a risk assessment strategy.

My Lords, can the Minister say what kinds of products contain latex? I always thought it existed in corsets.

My Lords, the noble Baroness will know more about that than I do. Such products include surgical gloves, urological sheaths, and various instruments and products used within the health service.

asked Her Majesty's Government:

What is their reaction to the reported proposal to impose a charge of £1.25 for the use of cash machines in rural post offices; and whether this proposal was discussed with Ministers at any stage.

My Lords, Post Office Limited is undertaking a programme of cash machine installation with a view to installing 3,000 machines at post offices by the end of 2002. These machines are being provided as an additional service available at some post offices to enable customers to withdraw money from their bank accounts. Wherever possible, the Post Office seeks to arrange for cash machine transactions at post offices to be free of charge. However, in some locations it would not be financially viable to install a machine without a charge being made.

This programme is separate from arrangements for universal banking services, which will enable all those who wish to do so to continue to be able to collect their benefits in cash at post offices. Decisions relating to cash machines at post offices are a commercial matter for Post Office Limited.

My Lords, could the consideration of making charges for the use of cash machines in some post offices have been part of a transaction to sell off a major part of the Post Office— a transaction which has recently fallen through? Can the Minister tell the House whether or not there have been recent negotiations to sell off a major part of the Post Office to an overseas buyer? A "yes" or "no" answer will suffice.

My Lords, the supplementary question is rather different from the Question on the Order Paper. I have heard of no such suggestion. If one looks at the financing of the rural postal network, not many people would be in the business of buying it.

My Lords, does the Minister agree that some of our poorest citizens live in rural areas and that many of our rural post offices and sub-post offices are disappearing? If you are able to draw out only £10 or £20 at a time, £1.25 in charges is a substantial amount. Elderly and disabled people cannot always get to the nearest supermarket in order to benefit from cash-hack schemes.

My Lords, I had hoped that I had made the point that this is an additional service. As is common across the whole of the commercial world, where there is a large through-put of people the service is provided free. But where it cannot be justified on that basis, charges are made. In such circumstances, part of the charge will go to the post master or postmistress. It is an additional service which can only add to customer facilities. In that sense, it is a commercial decision for the Post Office to take.

My Lords, notwithstanding the announcement that he made last year, to a fanfare of musical trumpets, of the subsidy proposals to help rural post offices, does the Minister accept that the deterioration in the rural post office network has continued rapidly since that announcement? Does he further accept that unless the Government's proposals are accelerated there will hardly be a rural postal network left?

My Lords, the situation is not as the noble Lord suggests. There has been a slowing down of the closure of rural post offices, but we should not be too optimistic about that because special factors are involved. As to the question of subsidies, which arose from the PRU report, it was always made clear that they were to deal with the transitional arrangements until 2003 when ACT is due to come in.

My Lords, does not the Minister think it slightly unfair that post offices which have a relatively large through-put will not need to charge anything, and yet post offices in the rural areas, which are more necessary but have fewer people to look after, will nevertheless charge? One would have thought that it is those people who should not be charged.

My Lords, it is an unfortunate fact of life that in many commercial transactions where there is a small through-put the charges are higher. This is a commercial facility provided by the Post Office. It is common across the country that where there is a small through-put for cash machines which are provided on, essentially, a convenience basis, charges have to be made. Otherwise, there would be no service at all.

My Lords—

My Lords—

My Lords—

My Lords, it is the turn of the government Benches.

My Lords, before I ask my question, I should like to place on record my delight that my noble friend has given an unequivocal answer to the suggestion that a part of the Post Office was going to be sold off to a foreign competitor. It was a rumour that was going around last weekend and I am delighted that he has been able to say that no such negotiations were known to him. I am also pleased that we have not yet heard the dreaded word "Consignia".

In view of the repeated assurances from the Government that people will be able to get their benefits paid in cash through the sub-post offices, especially in rural areas—it has been repeated many times —can my noble friend assure the House that in no way will people be advised when they go into their rural post offices that these machines are the means of getting their cash?

My Lords, I can give that assurance. We remain fully committed to meeting the Prime Minister's clear pledge that those who wish to do so will be able to continue to get their benefits in cash at post offices, in full and without charge.

My Lords, the Post Office operates universal postal charges throughout the whole country. Why can it not do the same with cash machines?

My Lords, there is a long tradition of the universal postal service which is written into the latest Post Office Act. That states that a service will be provided across the country under a one-payment system. The provision of cash machines is an additional service which does not have to he provided under the universal postal obligation. It is a commercial transaction which will be operated on a commercial basis.

My Lords, is not the imposition of a charge of £1.25 for the use of cash machines a breach of the principle of providing a universal service to all users of the Post Office? This is bringing market forces to bear and breaking the fundamental principle of the service that the Post Office should provide to rural people.

My Lords, the Post Office has a universal service obligation in relation essentially to the mail service. That obligation does not extend to all services. I do not believe that it should. If extra services are provided, they are provided on a commercial basis. That is entirely in keeping with what has gone before.

My Lords, the Minister said that the supplementary question of my noble friend on the Front Bench was irrelevant to her Question. But the viability of the Post Office in the future is very relevant, and that is the point made by my noble friend. Can the Minister confirm unequivocally to the House that on which he has been congratulated by the noble Lord, Lord Clarke—that is, that there have been no negotiations whatever with a foreign company—for example, a Dutch company—in recent times that have failed?

My Lords, as I said, I came to the House prepared to answer a Question about cash machines. I therefore did not ask or inquire about any negotiations which may or may not have taken place. If I am wrong, I shall obviously make it clear in a future communication to the noble Baroness. But, I repeat, I know of no negotiations which are taking place to sell the post office network, which I assume is the point of the question. I have no indication that any negotiations have ever taken place on that.

My Lords, I simply said that this may be part of a transaction to sell off the Post Office—which transaction has failed. That was the point that I made recently. I wanted to know whether the Minister could confirm that negotiations were going on to sell a majority share in the Post Office to a company overseas. That was my question.

My Lords, I can only repeat what I have said—which I thought was very clear given the extent of my knowledge on this subject. If it is a question of the financial viability of the rural post office network, this particular move can only help, because a part of the fee goes to the post offices themselves.

My Lords, does not the Minister know that the whole future of the Post Office is a very live issue and one which, I am sure, concerns all of us in this House? We had a debate on the future of Consignia some six weeks ago. At the end of the debate, because we ran out of time, I asked the Minister whether he would answer in writing the questions that had been raised. I then wrote to him, about three weeks ago. I have still not heard from him. Is it the case that the Minister does not know what is going on in the Post Office, as he has more or less said to my noble friend Lady Miller?

My Lords, I apologise if answers to those questions have not been received. I shall immediately make certain that they are answered. However, if noble Lords opposite want to know what negotiations have taken place, or are going to take place, on Consignia, the proper approach would be to table a Question on that matter, and not focus on the subject of cash machines, which is a quite separate issue.

My Lords, after the Motion standing in the name of my noble friend Lady Ashton of Upholland, my noble friend Lady Symons of Vernham Dean will, with the leave of the House, repeat a Statement that has been made in another place on Zimbabwe. At a convenient moment after 5 p.m. my noble friend Lord Whitty will, with the leave of the House, repeat a Statement that has been made in another place on hunting with dogs.

My Lords, I beg to move the Motion standing in my name on the Order Paper.

Moved, That it be an instruction to the Committee of the Whole House to whom the Education Bill has been committed that they consider the Bill in the following order:

• Clauses 1 to 18,
• Schedule 1,
• Clauses 19 to 35,
• Schedule 2,
• Clauses 36 to 38,
• Schedule 3,
• Clauses 39 to 48,
• Schedule 4,
• Clauses 49 to 53,
• Schedule 5,
• Clauses 54 to 56,
• Schedule 6,
• Clauses 57 to 62,
• Schedule 7,
• Clauses 63 to 66,
• Schedule 8,
• Clauses 67 and 68,
• Schedule 9,
• Clauses 69 to 71,
• Schedule 10,
• Clauses 72 to 115,
• Schedule 11,
• Clauses 116 to 143,
• Schedule 12,
• Clauses 144 to 147,
• Schedule 13,
• Clauses 148 to 150,
• Schedule 14,
• Clauses 151 to 180,
• Schedule 15,
• Clauses 181,
• Schedule 16,
• Clauses 182,
• Schedule 17,
• Clauses 183 to 188,
• Schedule 18,
• Clauses 189 to 192,
• Schedule 19,
• Clauses 193 to 199,
• Schedule 20,
• Clause 200 to 210,
• Schedules 21 and 22.—(Baroness Ashton of Upholland.)

My Lords, while warmly supporting the Motion, perhaps I may express the hope that, for years to come, it will be regarded by those who are responsible for compiling such Motions as a valuable precedent, because it puts into numerical order all the clauses and schedules of this vast Bill—numerical order being the order in which they should be discussed.

My Lords, I am extremely grateful to the noble Lord, who has many years of experience to support his remarks.

On Question, Motion agreed to.

My Lords, with the leave of the House, I shall now repeat a Statement on Zimbabwe which has been made by my right honourable friend the Foreign Secretary in another place. The Statement is as follows:

"With permission, I should like to make a Statement on Zimbabwe's suspension from the Commonwealth.

"As the House will be aware, a Commonwealth 'troika' consisting of Presidents Mbeki of South Africa and Obasanjo of Nigeria and Prime Minister John Howard of Australia was authorised by the Commonwealth Heads of Government Meeting to review the outcome of the Zimbabwe elections in the light of the Commonwealth observers' report, and to decide on any action.

"The troika met in London on Tuesday. It had before it the final report of the Commonwealth observers group. This confirmed the findings of the preliminary report which I put before the House in my Statement last Thursday. The group concluded that,

"the conditions in Zimbabwe did not adequately allow for a free expression of will by the electors".

"The troika accepted the conclusions in full and decided as a result to suspend Zimbabwe from the councils of the Commonwealth for one year with immediate effect. This issue will be revisited in 12 months' time, having regard to progress in Zimbabwe, based on the Commonwealth Harare principles and reports from the Commonwealth Secretary-General. I am sure the whole House will join me in expressing our appreciation to Presidents Mbeki and Obasanjo and Prime Minister Howard and in expressing our full support for their conclusions.

"Three months ago, on 20th December, the Commonwealth Ministerial Action Group, of which I was a member, concluded that Zimbabwe was in 'serious and persistent violation' of the Harare principles. It was my view at that stage that Zimbabwe should, then and there, be suspended from the councils of the Commonwealth. I made this case again at CM AG at the end of January, as did my right honourable friend the Prime Minister at CHOGM itself in early March. As the situation in Zimbabwe has deteriorated day by day since December, it follows that we believe that suspension now is fully justified.

"The Commonwealth depends above all on its moral authority, and on the force of the principles which it codified in Harare itself in 1991. That is why the decision was so important for the Commonwealth as a whole, as well as, of course, for Zimbabwe. And that moral authority is what gives this decision its force.

"I am in no doubt, from the way in which the Government of Zimbabwe had sought actively to divide the Commonwealth, that they were, and are, profoundly concerned about the international isolation which suspension signals. Tuesday's decision was, therefore, significant in many respects: above all, for the fact that leaders of two key African nations have taken a clear and definitive stand in defence of the Commonwealth's fundamental principles. They have also underlined Africa's commitment to the universal and indivisible principles of democracy and human rights.

"Suspension is one of the strongest measures the Commonwealth can impose. In the past, countries have only been suspended after the violent overthrow of their elected governments. Zimbabwe's suspension is, therefore, a new departure.

"Moreover, the Commonwealth's decision is in addition to the targeted sanctions which the European Union, the United States and now Switzerland have imposed against the leaders of ZANU-PF. EU Heads of Government also decided, at the European Council in Barcelona last weekend, to ask Foreign Ministers to look at options for further measures.

"What has happened in Zimbabwe is a tragedy, imposed on this once prosperous land by Robert Mugabe. Our commitment and that of the Commonwealth to the people of Zimbabwe remains as strong as ever. We have made it clear, since 1997, that the case for land reform in Zimbabwe is very strong, and that we were willing to provide considerable financial support to a land reform process that was transparent, lawful, and which gave priority to the needs of Zimbabweans in overcrowded communal lands. This was a position supported by the international community but rejected by the Mugabe regime.

"At Abuja, in early September last year, we agreed a pathway for Zimbabwe which would have allowed for a resumption of international aid, including from the United Kingdom, for a programme of sustainable land reform implemented in accordance with the rule of law. Respect for the rule of law, and a return to democratic principles and to sensible economic policies, is the only way back. We remain ready to do all we can to achieve this; and we will continue our programmes of assistance for humanitarian and HIV/AIDS projects. But I must tell the House that in the short term the prospects in Zimbabwe look bleak, underlined by the murders since the election of M DC activists and a commercial farmer, and the fact that the opposition leader Morgan Tsvangirai has now formally been charged with treason.

"Today, it is all the more urgent that the Government of Zimbabwe commit themselves—as the leaders of the Commonwealth have called for — to healing the divisions in the country and taking the path of genuine reform and national reconciliation. We shall do all that we can to support Presidents Mbeki and Obasanjo, and other African partners, in their efforts to bring stability back to Zimbabwe. This is what the people of Zimbabwe desperately need. Today, the whole of the democratic world supports them in this goal".

My Lords, that concludes the Statement.

My Lords, the House will be grateful to the noble Baroness for repeating the Statement. We fully share the welcome that she and the Foreign Secretary gave to the conclusions of the Commonwealth troika. We look on those conclusions with a feeling of relief, because if they had gone otherwise the future of the Commonwealth would have been threatened. This is a good moment in an otherwise dark scene. I also share the Minister's desire to pay tribute to Prime Minister Howard and Presidents Obasanjo and Mbeki for having the courage to reach those conclusions, which are said to be already of immense comfort to the brave people of Zimbabwe.

I am sure that the noble Baroness recognises that the conclusions come too late for the murdered farmer, Terry Ford, and for all the other victims of multiple murders. They come too late for all the farm workers who have been beaten to pulp, too late for the security guards who tried to defend the farms and too late for those Zimbabweans who may be dying of starvation. However, better late than never, I suppose. This is a positive move, without doubt.

Has the noble Baroness noticed that the US State Department, which usually moves very slowly, has already come out with a strong statement condemning the intimidation and underscoring the illegitimacy of the Mugabe regime? The Statement that we have just heard speaks of the need to do all that we can. Can we have an assurance that there will be real, positive and continuing efforts to form a coalition of democracies to maintain all possible pressures, including the targeted sanctions and other measures—of which we would like some indication of the nature—to ensure that the Mugabe regime remains under pressure until there is agreement for fresh and democratic elections and a new approach? Does she agree that any arrangement that ended up with some kind of sordid deal with Mr Mugabe and anything that legitimised him would be completely unsatisfactory and would continue to threaten the stability of the region?

What will be done about Mr Tsvangirai, who is mentioned in the Statement? He has now been threatened on trumped-up charges. Can something more be done to prevent this brave man being caught up in the vindictiveness of Mr Mugabe? Do the Government agree that the only discussions that there should be with Mugabe are about the arrangements necessary for new and democratic elections?

Does the noble Baroness agree that southern Africa will recover from its present dire straits only if justice returns and Mugabe goes? Can she explain how it is that, while Mr Mbeki has courageously supported the conclusions, the South African Parliament apparently recognises the legitimacy of Mr Mugabe, which is a fatal move? Does she recognise that the new African economic partnership—NePAD—will succeed only if the rule of law is properly and firmly restored in southern Africa?

Can the noble Baroness tell us about the status of our high commission in Harare now that we no longer recognise the legitimacy of the government there? There are brave public servants in our high commission who are doing valuable work. If we are to maintain the humanitarian aid to starving Zimbabweans that will be needed, presumably we shall reinforce the staff there. Will she confirm the status of the commission and whether we shall be enlarging it if we can so that it can help people in their dreadful plight?

Does the noble Baroness accept that before we do any of that, we need an honest government in Harare—which at the moment we have not got?

My Lords, I thank the Government for the Statement. I recognise that the British Government, particularly the noble Baroness, Lady Amos, have worked extremely hard on the issue and that we have limited influence over events in Zimbabwe. The older Members of this House may remember that in 1965 some members of my party were in favour of direct intervention in what was then Rhodesia to prevent a unilateral declaration of independence. I am not aware that any party in this country, even the Conservatives, now proposes such direct intervention. We have limited influence and we have to recognise the need to work with others multilaterally to bring what influence we can to bear. The Government have done well in that task. This is a good day for the Commonwealth. Despite the gloomy predictions from the Conservatives in both Houses of the impending dissolution of the Commonwealth, that prospect is clearly past for the time being.

How active a role is it intended that the Commonwealth, and in particular the troika, will retain over the coming months as a watching brief, in view of continuing developments in Zimbabwe? In particular, what contingency plans are we making against the prospect of a further deterioration of the Zimbabwean economy in the coming months, with the likelihood of a spillover of refugees into neighbouring countries? That clearly threatens to destabilise the weak economies of southern Africa as a whole. It therefore seems extremely important to work with the neighbours, particularly Mozambique and South Africa, on limiting the damage to the region and, whenever possible, to provide food and aid. We all recognise that we have to contain a possible further collapse of the Zimbabwean economy. In that context, using the Commonwealth and our other multilateral relations, we should continue to promote good governance as the path to development in Africa, in particular through the New Partnership for Africa's Development.

I have one small partisan point to make. I hope that Anglo-Saxon interventions in promoting good governance in Africa will have an element of humility. A strong comment was made by the US Administration against the idea of fixing elections rather than allowing full democracy. I am conscious that there is sometimes a tendency in this country to demand that other countries should have clear democracies that represent the will of a majority of the people. We do not have that in this country, so perhaps we should be a little more delicate in how we promote standards of democracy higher than our own.

My Lords, I thank the noble Lords, Lord Howell of Guildford and Lord Wallace of Saltaire, for their responses. Of course, like the noble Lord, Lord Howell, I fully support the views of the troika. That was clear from my right honourable friend's Statement. The noble Lord then said that it came too late for many of the victims of the violence in Zimbabwe. I hope that he does not think that statements in themselves would have stopped the murderous intent of the regime in Zimbabwe. He cannot really believe that more statements would have been enough. Goodness knows, many Statements were made from this Dispatch Box and in another place about the contempt felt for some of the acts of the Zimbabwean Government. To imply that statements in themselves stop murderous intent is not fully to appreciate the position.

I agree that the statement made by the US State Department is very welcome. I wholeheartedly agree with the noble Lord that honest government in Zimbabwe must be the first priority. As my noble friend has said on many occasions from this Dispatch Box, we must not forget that we are dealing with a sovereign government in Zimbabwe and that we do not have the ability simply to say what should be done there and expect that it will happen as night follows day.

As both noble Lords have said, we must look to what can happen next. The EU heads of government instructed Foreign Ministers last weekend to consider further what measures can be taken in Zimbabwe, including possible further sanctions. The United States Government, with whom we are in close touch, have said that they will increase sanctions. The Government of New Zealand have said that they are considering imposing sanctions. The Government of Switzerland have already imposed sanctions, which bring them into line with EU sanctions.

As the Commonwealth troika conclusions made clear, Presidents Mbeki and Obasanjo are working hard on a programme of reconciliation. My right honourable friend the Foreign Secretary will be working to ensure that we give what support we can to Zimbabwe, but, touching on some of the economic questions raised by the noble Lord, Lord Wallace of Saltaire, we shall also look to the IMF and the World Bank to deny the current Zimbabwe regime access to financial support. I am sure that the House would expect no less in terms of sanctions. Given events not so much in the elections but in the run-up to the elections, Mugabe has to be denied what would normally have been his right.

I do not think that we should be in any doubt about this: it is going to be a very long haul indeed. President Mugabe, as he has demonstrated all too clearly, is determined to cling to power for as long as he can. I hope that I have indicated some of the ways in which Her Majesty's Government are working with others to ensure that that is for as short a time as possible.

I thank the noble Lord, Lord Wallace of Saltaire, for his comments not only about my right honourable friends in another place but about my colleague in this House, Lady Amos. I wish that she had had the pleasure of making this Statement today. I believe that her endeavour in so many ways—working tirelessly not only in the multilateral forums, one of which she is attending today, in Monterrey, but with many leaders in Africa—has been a key element in bringing us to where we are today. I acknowledge that fully, and I hope that the House will join me in that acknowledgement.

We have to examine what can be done to distinguish the regime in Zimbabwe from the people of Zimbabwe. As the noble Lord, Lord Wallace of Saltaire, said, Zimbabwe's economic position is appalling: unemployment is currently 60 per cent; inflation is 112 per cent; 35 per cent of the adult population are suffering from HIV/AIDS; and 63 per cent of the population are below the poverty line. All that is occurring in a country that was once a hallmark for prosperity in Africa.

The suspension of technical aid is one of the sanctions attending Zimbabwe's suspension from the councils of the Commonwealth. That does not involve the suspension of aid which might help in the restoration of democracy. The Commonwealth has drawn that distinction in determining how the suspension will work. It is therefore very much to be hoped that the money for the restoration of democracy will continue to be provided.

As for the arrest and charging of Mr Tsvangirai, Mr Tsvangirai is now out on bail. We can, however, do only a limited amount in a sovereign state. Although we can monitor events, comment, and bring pressure to bear, as we have already done, the Government of Zimbabwe are continuing to harass leaders of the opposition. They must face the consequences of so doing.

As for the status of our mission in Harare, the mission remains, and there is no question of withdrawing any of our diplomats. Some 40,000 British citizens are in Zimbabwe and they will need the protection of our mission there more than ever. I hope that all noble Lords send them a strong message of support from this House for the sterling work they are doing.

My Lords, I join in welcoming the Statement from the Foreign Secretary, and particularly the fact that it has restored the Commonwealth's credibility. I should like particularly to commend its call for the,

"Government of Zimbabwe to commit themselves to healing the divisions in the country and taking the path of genuine reform and national reconciliation".

In that regard, can the Minister outline what measures the troika and Her Majesty's Government are taking to encourage a government of national unity in Zimbabwe?

I also commend the work of the noble Baroness, Lady Amos. I should, however, like to make one slight alteration to an answer which she gave me in reply to a question I asked her on Tuesday, when I contended that the South African observer mission's report had been politically rigged. The noble Baroness said:

"the South African parliamentary observers team has dropped its conclusion that the elections were substantially free and fair".—[Official Report, 19/03/02; col. 1230.]

That is not the case. The South African observers mission has not dropped its contentions, but President Mbeki has dropped certain comments on his website.

I also revert to the question from the noble Lord, Lord Howell of Guildford, who asked how the Government of Zimbabwe can heal the division when the MDC leader, Morgan Tsvangirai, and the MDC secretary-general, Welshman Ncube, have been formally charged with treason. Moreover, in South Africa, the ANC secretary-general has recently described Morgan Tsvangirai's arrest and charging as "part of the healing process". Surely that is extremely worrying.

Finally, will the Minister outline what action is being taken to alleviate the severe food shortage, the prospect of mass starvation, and the refugee flight to South Africa which is likely to ensue if the situation is exacerbated?

My Lords, I thank the noble Lord, Lord St John of Bletso. He is quite right. There are enormous problems in achieving genuine reform—particularly national reconciliation and a government of national unity—when it is so painfully evident that the current government do not want to be a party to anything of the sort, and when they—as the noble Lord rightly reminded us—have not only arrested but charged Morgan Tsvangirai and Welshman Ncube. That is why it is so important that the troika has agreed that work on these issues should be taken forward by Presidents Mbeki and Obasanjo.

I agree with the noble Lord that, immediately after the election in Zimbabwe, there was some confusion about what was thought by a very small number of people to have been a fair election. When the more substantial reports were properly examined, it was decided that that was not really the case. I remind him of the statement made by the SADC parliamentary forum observer on 13th March:

"The climate of insecurity obtaining in Zimbabwe since the 2000 parliamentary elections was such that the electoral process could not be said to adequately comply with the Norms and Standards for Elections in the SADC region".

I think that that is an extremely reassuring statement.

I fully take the noble Lord's point that we must now be very vigilant. The issue of what is to happen to those arrested and charged with treason—although, as I said, they are out on bail—is another reason for maintaining the full strength of our diplomatic mission in Zimbabwe. We shall be looking for regular reports on those issues.

The food shortages are causing great worry and concern. Donors are already providing supplementary feeding through the NGOs. Our own Department for International Development has given £4 million of assistance to some 300,000 people. Additionally, last month, DfID made a £6 million contribution to the UN DP's humanitarian assistance and recovery programme for Zimbabwe. I am sure that my right honourable friend the Secretary of State will be keeping that issue under constant review.

My Lords, I join those who have congratulated the Government on the part they have played in bringing about the troika's decision to suspend Zimbabwe from the Commonwealth. However, no one who is a friend of Zimbabwe takes any pleasure from the suspension as it marks a very serious situation. Does my noble friend agree that the attacks on the Zimbabwe Congress of Trade Unions and on trade unionists trying to exercise a legitimate right to strike concerns everyone, and that the clearly contrived charges brought against the MDC leaders do not help the situation? Does she also, however, agree that sanctions are not the magic bullet which will suddenly transform Zimbabwe from its currently parlous state into a world democracy? Should we not also recall the other part of the troika's statement—that it and the Commonwealth need to remain engaged with Zimbabwe?

The Opposition spokesman seemed to suggest that in no circumstances should we have any contact with anyone in the Zimbabwe Government. Taking that view to its logical conclusion, should he not be advocating withdrawing Britain's mission, unpalatable as that may be? My noble friend has said that the opposite action is required. Can my noble friend assure the House that, as well as the sanctions which have to be applied, every possible means and method of discussion and dialogue will be used to bring about a resolution as early as possible?

My Lords, my noble friend draws an important and valuable distinction when he refers to suspending our contacts at an official level with the Government of Zimbabwe while at the same time trying to have proper discussions with those with whom we can do business there. If it is possible in future to have discussions with those in the Mugabe regime who are willing to talk in terms of reconciliation for the future, that would be valuable.

I agree strongly with my noble friend's remarks regarding the violent attacks on trade unions. The NGO figures suggest that about 73 per cent of the perpetrators of violence appear to be affiliated to ZANU-PF, and 16 per cent are police officers, which is extremely worrying. As your Lordships may know, between 1st January and 28th February this year, 31 people were killed in politically-motivated attacks. Nearly all of those were black Zimbabweans. As we have seen, three members of the MDC have been murdered since the election and one commercial farmer tragically lost his life.

My noble friend is right. Sanctions are never a magic bullet, but they signify an important measure of outrage and disgust about what has happened in Zimbabwe. It is worth noting what suspension from the councils of the Commonwealth will mean. It means that there will be no participation by the Government of Zimbabwe in intergovernmental meetings, but it does not deprive the people of Zimbabwe of cultural and sporting activities which may be organised by the Commonwealth.

My Lords, does the Minister agree that it was enormously fortunate and right that the Government increased the number of Commonwealth observers? We have seen what a happy result that gave. However, there is a lesson to be learnt. I entirely share—as we all do—the Minister's admiration for what the mission in Zimbabwe is doing. I hope that we shall not only leave it in place but greatly increase it. The only thing we can do, which no sovereign government can refuse, is to observe and report and be seen to be doing so, particularly now that the laws against the media are being further tightened.

I hope that it will be possible for there to be an element of observation from the high commission of the dispensing of our humanitarian aid, for instance, so that it is not taken over by ZANU-PF and used to reward its people. My other point is that I hope that we shall persuade the rest of the EU to stay and report. I was rather concerned to see that the Danish mission is withdrawing. The one thing that can be done is to stay and report and be seen to do so.

My Lords, perhaps in turn I may thank the noble Baroness for her timely intervention on the subject of Commonwealth observers. Your Lordships may remember that, as always, she was forthright in pointing out some of the shortcomings in the number of Commonwealth observers. I was delighted that the Government were able to increase the numbers significantly. I agree that we should keep the numbers in our mission in Zimbabwe under constant review. It is enormously important that their role in observing what is happening on the ground is maintained. The noble Baroness spoke about how aid might be used in a way not intended by the donors. We shall have to keep that in mind, as I am sure my noble friend Lady Amos would agree.

The noble Baroness is right. We should try to persuade others not to withdraw their mission. She will know that withdrawing a mission is a potent signal of disapprobation that governments use to indicate the depth of their anger about what has happened within a country. I understand the motivation of our Danish friends in acting as they have. However, my own view is that we should like to see many of our colleagues who value the principles of democracy and humanitarian assistance stay on the ground. That will strengthen those who are able to give honest reports about what is happening in Zimbabwe.

My Lords, we should not underestimate the horrors which have occurred in Zimbabwe. However, should we not look ahead on a wider basis to consider how the atmosphere might be changed for the better in the whole of southern Africa? Is not the main and most urgent problem facing all the SADC countries that of economic reconstruction so that they can play their part as a whole in the New Partnership for Africa's Development? As that will require substantial changes in policy, not least in Zimbabwe under whatever government, will it not require outstanding leadership? Is there not an outstanding leader available in southern Africa—I hope that he is available—in the form of Nelson Mandela? Would the Government, with our European allies, consider whether that is a thought which might be pursued?

My Lords, the noble Lord, Lord Blaker, will know that the NePAD initiative is designed to help southern Africa, both in terms of resources and expertise, to achieve much-needed economic reconstruction. An element of that will be that those who receive such aid and resources should embrace not only the spirit and instruments of democracy but everything that is implied by civil government and the rule of law. In a nutshell, that is what is being negotiated. I am sure that my noble friend will pursue that agenda in her discussions in Monterrey today. Leadership is an important and extremely potent factor in making such an initiative work. A number of individuals in southern African may be able to contribute to that. Given the enormously high esteem in which he is rightly held, not only on the continent of Africa but throughout the world, I am sure that the blessing of Nelson Mandela would prove enormously important to the initiative and its chances of success. However, more than one or two leaders will be needed to ensure that the initiative is a real success.

My Lords, as someone who was Commonwealth Secretary during the period of UDI, perhaps I may suggest to the Minister, echoing the words of my noble friend Lord Wallace, that the role of Her Majesty's Government in this difficult relationship with Zimbabwe is best played with a degree of humility about the past. Is the Minister aware how much the success of the troika will be welcomed in deciding to suspend Zimbabwe from the Commonwealth for one year? That will allow other members of the Commonwealth to take a more high-profile role in dealing which such problems, while behind the scenes, and maintaining our own mission there, we play a less prominent role. The Zimbabwe problem is a Commonwealth problem of great importance, but it is one for the Commonwealth as a whole. The more Her Majesty's Government play their role with some delicacy and a low profile, the more successful the outcome may be.

My Lords, there is an enormous amount of wisdom in the comments of the noble Lord, Lord Thomson. I hope that the Government have been seen to be firm in their resolve. My noble friend and my right honourable friends have done their best to work behind the scenes to secure the objective about which we have been clear. As the Statement indicated, we have been working for suspension from the councils of the Commonwealth for a matter of months. The noble Lord is right. This cannot be seen to be a one-country show.

As the Statement indicated, it was clear early on in the discussions that the Zimbabwean Government would do everything that they could to make this an issue between the white Commonwealth—those predominantly from the European-based nations—and those from the African-based nations. That would have been an extremely damaging development had it had any success. But it was not successful, which is exactly the point. The value of the troika was that President Obasanjo and President Mbeki both have great wisdom and experience. It will now be extraordinarily difficult for Mr Mugabe to claim that it was some sort of conspiracy led by the United Kingdom. The United Kingdom took no part in the troika. We are also extremely grateful for the part played by Prime Minister Howard.

It is right to ensure that this is not seen as the United Kingdom being out alone on the issue. We have a special relationship with Zimbabwe. We have a historical relationship and 40,000 of our citizens live in that country. We have particular responsibilities, which none of us want to set on one side. Having said that, we have constantly made it clear that this is a matter for the whole Commonwealth. I am delighted that the Commonwealth has acknowledged that and that it will be working in the next year to try to bring the Government of Zimbabwe to a more sensible course of action.

My Lords, the noble Baroness has done well to remind us that there are 40,000 British citizens still living in Zimbabwe. We also know from experience that Mr Mugabe and his party are spiteful. In the event of their taking out their spite on those 40,000 British citizens, are there contingency plans to make sure that they will be rescued and defended?

My Lords, there is a contingency plan, but I stress to the noble Lord, Lord Stoddart, that there is a similar contingency plan for many other countries. As many of your Lordships will know, we have a warden network around the country to enable us to maintain good communications with the resident British community. I assure your Lordships that that civil contingency plan is reviewed and updated regularly.

The responsibility for ensuring law and order in Zimbabwe cannot be shouldered by the British mission in Zimbabwe. The responsibility lies full square on the Zimbabwean Government's shoulders. I should not want anything that I have said about civil contingency plans— important though they are—to be thought in any way to be relieving the authorities of that country of their obligation to look after all citizens, irrespective of their nationality or where they live. I hope that that message will be firmly understood.

My Lords, following on from what the noble Baroness, Lady Park of Monmouth, said, how can the Government ensure that any financial support given to restore democracy in Zimbabwe is used for that purpose and does not go towards lining the pockets of the present government?

My Lords, in countries where we have had the problem of the possibility of governments diverting aid funds from the legitimate purpose for which they were sent and using them for illegitimate purposes we have channelled funds through non-governmental organisations. I am sure that that issue is under review by my colleagues in the Department for International Development. It is another of the functions of our extremely hard-working mission on the ground, and others, to ensure that such matters are kept fully up to date.

I am sure that none of your Lordships would wish to imply that we should not send much-needed aid for food. As I tried to explain, the levels of hunger and food shortages are enormously difficult problems in Zimbabwe. It is right to send what aid we can to ensure that democracy, fragile as it is, has a chance to flourish and that civil life has a chance to grow as well. We try to do what we can through the NGOs but we also keep very close observance on the ground about what happens to our funds.

My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.

Moved, That the House do now again resolve itself into Committee.—(Lord Hunt of Kings Heath.)

On Question, Motion agreed to.

House in Committee accordingly.

[The DEPUTY CHAIRMAN OF COMMITTEES (Viscount Allenby of Megiddo) in the Chair.]

Clause 6 [Local Health Boards]:

moved Amendment No. 76:

Page 7, line 17, after "is" insert "issued,"

The noble Lord said: I shall also speak to the remaining amendments in this group.

The proposal that there should be local health hoards in place of the existing health authorities in Wales is controversial for a number of reasons. Amendment No. 76 proposes that there should be consultation before an order establishing a board is issued by the National Assembly for Wales. There is already provision for consultation in the event of variation or revocation of a local health board order. In our view, prior consultation is essential before boards are established.

If the boards are to be coterminous with local authorities, there will be more of them than the present five area health authorities. There could be as many as 22—one for each local authority. I should have thought that the Assembly would seek to avoid such proliferation if only for reasons of economy in terms of staff and resources. There will obviously have to be consultation with the existing health authorities, local authorities and health trusts before the final geographical map of health boards is decided. It is important that the map is the best that can be devised and that it is satisfactory to all concerned.

I can recall the reorganisation of local government in the early 1990s when the present 22 unitary authorities were established. Indeed, I can remember the previous reorganisation in the 1970s. My enduring memory of both is the difficulty that we had in getting proposals accepted and boundaries agreed. These new proposed health boards will prove just as contentious when the Assembly gets down to the business of deciding the precise localities that they are to serve. People are naturally very sensitive about such issues.

There is a further complication that not all the boards will have the same functions. They will have a variegated pattern of functions and responsibilities. Some will have major hospitals within their areas, and others will not. Again there will be considerable scope for argument and the Assembly would be well advised to consult before the pattern is imposed which, I dare say, will happen.

Many people in Wales, both within the National Health Service and outside it, have grave doubts about the practicability of the new system. For it to have the smallest chance to succeed, there must be extensive consultation with all the parties involved. We would be foolish not to provide for it in statute, especially when the Bill already provides for consultation in the event of variation or revocation of an LHB order.

The Minister may say that of course there will be consultation before an LHB order is issued and that we can take that for granted. I do not think that that is an adequate reply to the argument. Without the amendment we shall be storing up trouble for the Assembly and for the National Health Service in Wales.

Amendment No. 77 is a probing amendment. It seeks to find out how the Assembly proposes to direct the local health boards at national level. In other words, who precisely in the Assembly is to issue directions? Presumably they will be authorised by the Minister in the Assembly on the advice of the NHS directorate. We should like to know more about that top structure.

I imagine that there will be an infinite variety of directions related to different aspects of the NHS. Some will be purely local and apply only to a particular hoard or boards; others will be national in scope. As we have said before, the NHS in Wales will clearly need an all-Wales dimension, which is currently not defined in the Bill. It is very important that we have some idea as to what that all-Wales structure will be. We debated this point last Thursday when we considered the new clauses proposed by the noble Baroness, Lady Finlay of Llandaff.

I had ministerial responsibility for the NHS in Wales between 1979 and 1983. That was a period, II am glad to say, of extensive new hospital building and innovative strategies such as our mental handicap strategy which pioneered the transfer of people with learning difficulties from hospital into the community. We did not have a regional health authority in Wales; the regional authority was the Welsh Office and its Ministers. So I have some idea about the enormous range of NHS activity in Wales even 20 years ago.

It is quite clear that the thrust of the Welsh provisions in the Bill is to devolve responsibility to local health boards, but it is also clear that there will have to be some central direction in order to ensure a degree of uniformity and fairness all round. It is therefore necessary, as I have said, for us to know what kind of structure the NHS will have at Assembly and ministerial level.

I referred a few moments ago to the noble Baroness, Lady Finlay of Llandaff, who introduced new clauses asking for a national health agency for Wales. The noble Baroness not only enjoys an international reputation, but she has a high reputation in Wales as vice-dean of the University of Wales College of Medicine and as honorary professor of palliative medicine. In short, she knows the NHS in Wales. She knows the scene very well indeed.

Last week the noble Baroness told us of the concerns expressed at the conference of Welsh local medical committees as recently as last Wednesday. She said:

"They cannot take on the huge number of functions about to be devolved to them".—[Official Report, 14/3/02; col. 994.]

She went on to say that GPs wanted a primary care directorate, but that is now in doubt. What is proposed are six directorates for renewal, policy, finance, quality, human resources and facilities—all six presumably overarched by the existing NHS directorate.

As the noble Baroness hinted in the debate last week, there is a threat of fragmentation here and, I would add, an incoherent, possibly conflicting guidance to local heath boards from the various directorates. I hope that further consideration will be given to the single primary care directorate and the significant body that the local medical committees want,

"to handle contractor services to protect both professional interests and those of patients".—[Official Report, 14/3/02; col. 994.]

With regard to secondary and tertiary care, it is proposed to strengthen the Specialised Health Services Commission for Wales, to commission tertiary care and advise, guide and facilitate the commissioning of secondary care. But the remit is still being worked out, as the noble Baroness told us. The noble Baroness, Lady Farrington, confirmed that the Specialised Health Services Commission for Wales is to be given an enhanced role. But that is as far as we got in learning about the national structure.

So what can we make of that? The structure of the NHS in Wales is being built from the bottom up. That makes sense, provided that the builders know how the structure is to be completed. The foundations have to match the superstructure, and vice versa. That is where the current problem lies. There seems to be no clear idea as to what the final structure will look like or how it will work. Any help that the Minister can give on this matter will be most welcome.

Amendments Nos. 90 and 91 are different in character from previous amendments but still deal with local health boards. I have tabled Amendment No. 90 to seek clarification on certain aspects of local health board expenditure. My understanding is that they will have very little income, other than the allocations given to them by the Assembly. Such allocations will be the major part of their revenue. Clause 10(9) defines general Part 2 expenditure under the Act. That means expenditure in connection with the council for the regulation of health care professionals, and appeals. My amendment deletes subsection (2) of Clause 10(9) which excludes four kinds of expenditure that may clearly be incurred by local health boards; otherwise they would not be specified for inclusion in the way that they are. This subsection must be read in conjunction with new Sections 97H and 97G which deal with resource limits of local health boards and their financial duties. Subsection (2) of new Section 97H states that,

"no account shall be taken of — general Part 2 expenditure",

as defined by a board in carrying out its duty not to exceed its expenditure limits.

My first question is: why is Part 2 expenditure open ended? Is it demand led? It does not say much for the Assembly's sense of priorities that regulatory expenditure is open ended.

Secondly, why are there the four specific exclusions from the definition? They are a mixed bag. I hope that the Minister will comment on each. I am particularly interested in Clause 10(6)(b), which refers to,

"remuneration referable to the cost of drugs".

What does that specific exclusion mean in practice? Does it mean the perpetuation of postcode prescribing in Wales; that certain drugs will be available under one board but not another, depending on whether it has the resources and the will to provide them?

Finally, who, if not the local health board, will pay for these excluded items? I am bound to say that the whole of the resource and expenditure situation of local health boards is complex, to say the least, in the Bill.

Amendment No. 91 seeks to introduce the principle of equity into the National Assembly's annual apportionment of remuneration for the cost of drugs. Drugs expenditure is clearly no longer demand led and open ended. There is no commitment here on the part of the Assembly to meet a local health board's drugs bill in its entirety and whatever it may be. Indeed, under Clause 10(9), new paragraph 6C(4) states explicitly that the Assembly will exercise its discretion in paying for drugs ordered by a board on its own account. That seems a shot across the bow for boards that respectfully follow clinical judgment in drug prescribing. The same applies to primary care trusts in England.

I hope that I have properly understood the financial provisions and that the Minister will be able to answer some of my queries. I beg to move.

Those of us who are particularly interested in the workings of devolution are bound to be interested in this part of the Bill, which establishes for the first time an arrangement set up by Westminster in Wales—upon which the National Assembly will make many decisions and within which framework it will operate.

There are many provisions in the Bill for secondary legislation. The Delegated Powers and Regulatory Reform Committee, of which I am a member, examined that aspect of the Bill with care and on the whole—as the Minister knows—the Committee is satisfied with the way in which the secondary legislation is arranged. It seems to have been well drafted.

The Bill allows the Assembly enormous freedom to make the arrangements to which my noble friend referred in the way that it wants and which suits Wales. Far be it from me even to imagine the scene, because I have not seen the Assembly in action, but it should be having an interesting time.

Westminster must decide what should be on the face of the Bill and what should not—and what consultation should be set out by Westminster. Defining the board areas is obviously important. My noble friend made a good point when he said that there must be consultation before orders are made, not just the varying of orders afterwards. Amendment No. 76 probably has a lot going for it. It will be interesting to hear the Minister's response.

The clause about which I believe many of your Lordships are doubtful emanates from the arrangements for England and Wales—as does much of the pattern of the Welsh clauses. We must be sure that the pattern that is right for England is right for Wales.

The clauses in question imply that the Assembly will have enormous freedom to spend money on the health service in Wales in the way that it wants. How will the Government fix the Assembly's block grant in relation to health? I do not know whether my noble friend disagrees but that seems so open ended that it might be difficult to do. We need to know whether there is any basis for knowing the overall sum within which the Assembly will have to operate.

I thank the noble Lord, Lord Roberts, for his generous comments about me. I appreciate them enormously and feel humbled by them.

After last week's debate, I wanted to feel in tune with the views of general practitioners across Wales in relation to the proposed arrangements, so I attended a joint meeting of the Royal College of General Practitioners and the General Practitioners Committee of the British Medical Association in Wales. The turnout was so great that the room booked for the meeting was too small—which reflected a surprising concern among GPs about the changes that they are facing.

I shall not reiterate the whole meeting, which lasted two and a half hours, but there was resounding concern that the new local health boards would have great difficulty coping with the workload that they are expected to take on and the speed. The new general practitioners' contract, which is currently being negotiated, aims at attracting back into the profession groups who are currently not working—particularly young women—through family-friendly policies, which are to be welcomed.

There is concern that the different arrangements for local health boards will present them with great difficulties in commissioning secondary care. There is concern in the secondary care sector that some of the arrangements could precipitate a destabilising crisis.

Concern is felt among patients about the loss of collective memory among those who administer community health services, particularly primary care. They have often provided a safeguard and acted as a point of detection when problems have arisen. I do not want to overplay the problems but one patient said to me at the weekend, "The NHS is working very well in Wales. Why does everybody knock it and need to rearrange it?" The overwhelming experience of patients is that they are getting a much improved service.

At the meeting that I attended, it was estimated that there would be only two senior administrative managers who really understood the ins and outs of primary care as it has existed. Much work has been done on setting standards across Wales and it will be important to ensure uniform measurement of services against standards.

Equity is absolutely crucial. It is crucially important that there is no return to the feeling of rationing by postcode. Patients feel that they are being rationed even when they are not and lose confidence in the service. It is not uncommon for patients to ask me whether the failure to offer them a particular form of treatment is because the NHS cannot afford it. When I point out to patients that the treatment was not offered because it would not do them any good—otherwise, they would certainly have been offered it—they often look surprised. Then they comment to the person next to them that they might get extra treatment if they paid for it. There is a perception of rationing even though that may not be true, so it is important that equity is firmly embedded in any new arrangements.

This has been an important debate and I am particularly grateful to the noble Baroness, Lady Carnegy. Because of her interest in devolution, we spent many hours debating not only the Bill establishing the Assembly but also that which established the Scottish Parliament. No one appreciates more than the noble Baroness that many things have changed.

As to Amendment No. 76, it is precisely because of the changes in responsibility and accountability that we are not able to accept that amendment. It is for the National Assembly to consider such matters as part of its devolved function. The only practical effect of Amendment No. 76 would be to fetter the devolved powers granted under the Government of Wales Act 1998. I am sure that no one wants to unravel the devolution settlement.

I hope that I shall give the assurance that the noble Lord, Lord Roberts and the noble Baroness, Lady Finlay, are seeking by saying that the clause has been drafted to reflect the full and open consultation that the Assembly has already undertaken on the establishment of local health boards. In addition to consultation, the secondary legislation necessary to implement local health boards will also pass through the Assembly's scrutiny procedure before it is made, thus allowing Assembly Members an opportunity to comment further on it.

Imposing a further consultation requirement would seriously delay implementation of local health boards, which are a key feature of the strategy for reform of the NHS in Wales voted for by the Assembly. That would frustrate the intentions of the democratically elected devolved administration which, under the devolution settlement, is responsible for such policy matters.

Amendment No. 77 is again a matter for the National Assembly to consider as part of its devolved function. Its only practical effect would be to fetter the devolved powers granted under the Government of Wales Act 1998 and prevent the National Assembly from giving directions to local health boards as to how they should exercise any delegated powers—a function that the National Assembly will retain with regard to health authorities. The amendment is therefore prejudicial in relation to England, as the Secretary of State will retain various powers of direction over the equivalent English bodies.

Directions in relation to the conferring of functions on local health boards must be made in regulations, which will be subject to the secondary legislation scrutiny procedures of the Assembly. They will therefore not be issued directly by the Welsh Minister for Health and Social Services but made by the Assembly under its own processes.

I turn to Amendments Nos. 90 and 91. Proposed new Section 97F confers a general power on the National Assembly for Wales to determine the treatment of discretionary and non-discretionary expenditure in relation to local health boards. That power currently exists in respect of health authorities, and we intend to transfer it to local health boards. To remove the power would be most unhelpful and unjustified.

Schedule 12A to the Health Act 1999 provides the mechanism by which the National Assembly for Wales determines the treatment of discretionary and non-discretionary expenditure. It has always been for the National Assembly for Wales to decide on such treatment, subject to the usual constraints, as it is for the Secretary of State in England. Those powers must be exercised in accordance with the principles of administrative law. We therefore cannot agree to limit the powers of the National Assembly for Wales.

However, some specific reassurances were sought. In answer to the noble Baroness, Lady Finlay, the strengthened Specialised Health Services Commission for Wales will support the local health boards with advice and guidance on commissioning, in addition to its role in commissioning tertiary and other specialised acute services—a point also raised by the noble Lord, Lord Roberts.

In answer to the question about the post code lottery asked by the noble Lord, Lord Roberts, clearer priorities are emerging through the plan implementation process. Priorities are increasingly delivered through national service frameworks that set clear minimum standards to be applied across Wales. Local health boards will be responsible for assessing the health needs of their populations and securing the range of services to meet those needs. The block vote is given to the Secretary of State for Wales. It is passed to the Assembly after allowing for his expenditure in running the Wales Office. The Assembly then decides how that funding is allocated across its functions. That is decided at a plenary session of the Assembly.

Local health board budgets will be prescribing budgets. They are currently dispensing at health authority level. Action is in hand to move towards a needs-based allocation. The report debated in plenary session of the Assembly last week determines that direction and was overwhelmingly accepted, I believe.

Finally, in response to the noble Baroness, Lady Finlay, we intend commissioning partnerships between local health boards, local authorities and NHS trusts to be formed as collective organisations. They will have geographical proximity and common patient flows and we expect there to be between 10 and 12 such partnerships in Wales. A typical partnership could be composed of two local health boards, two local authorities and one NHS trust. Partnerships will not be viewed as organisations but mechanisms for effective commissioning.

The noble Lord, Lord Roberts, raised the issue of the number and role of local health boards. The boards will be coterminous with local authorities in Wales. Identified benefits include: enabling the development of new and better ways for the NHS to work with local government to implement the health and well-being agenda for Wales; facilitating the requirement for LHBs and local authorities to assess the health and well-being needs of their population; sharing a population focus to provide more flexible services; providing a shared focus to address the determinants of health, which span NHS and local government responsibilities; and providing more flexibility in the use of staff and resources and clear accountability to the local population between statutory bodies.

The 22 health boards proposed for Wales are a natural development from the 22 local health groups that already exist as sub-committees of the health authorities. Local health boards will pay for admitted Part 2 items. Contracts for primary care contractors will be held by the Assembly, but financial control and scrutiny will be exercised via the local health boards.

I hope that I have answered in some detail the points raised. I return to the fundamental point, which is that unfortunately the amendments proposed by the noble Lord, Lord Roberts, would undermine the devolution settlement agreed to by your Lordships.

Before the noble Baroness sit down, in relation to Amendment No. 76, she said a good deal about how times have changed and that the matter is up to the Assembly. We know that, but we must consider what Westminster has to do by way of constructing a framework within which the Assembly will work. Proposed new subsection (4) states:

"If any consultation requirements apply, they must be complied with before an LHB order is varied or revoked",

Why should that not apply when an order is issued, as my noble friend Lord Roberts suggested? The Minister made a somewhat specious argument.

I am sorry if the noble Baroness feels that the argument is specious. These matters are rightly for the Assembly to determine. Unlike that which established the Scottish Parliament, the settlement gives the National Assembly for Wales the power to develop its own instruments and orders in secondary legislation.

The noble Lord, Lord Roberts of Conwy, presses us to accept that, as it were, a member of our family has reached the age of majority, but that we should still control the way in which he exercises his adult rights. The primary contractor contracts will be held by LHBs. I hope that that is an additional piece of information for the noble Baroness, Lady Finlay.

I assure the noble Baroness, Lady Carnegy of Lour, that we are being extremely careful to ensure that during the passage of this legislation Members are kept informed about the degree to which consultation forms the ethos of the exercise of the Assembly's devolved powers.

We are all grateful to the Minister for her comments. I am grateful to my noble friend Lady Carnegy of Lour and to the noble Baroness, Lady Finlay of Llandaff, for illuminating us on the feelings of GPs, particularly in Wales. I listened to her with great care. She talked about their concern, not only on this occasion but also last Thursday, as a result of their meetings. I know that such concerns about the formation of these boards are real in Wales.

It is all very well for the Minister to say that the Assembly must consult if an order is varied or revoked, because that is required here in primary legislation. But the Assembly does not have to consult when an order is issued, which is what the amendment seeks. There is a contradiction in the Minister's approach, which states that we ordain in primary legislation that when a local health board is varied or revoked, the order must be consulted on, but that there is no need for consultation before the first order is issued. The Minister says that consultation has taken place. I am sure that there has been endless talk within the NHS in Wales, but there is still a considerable degree of dissatisfaction among professionals there.

My experience of local health reorganisation and also local government reorganisation in Wales on more than one occasion is that public consultation is essential, otherwise discontent prevails and the system rails to work.

It may help the noble Lord. Lord Roberts of Conwy, to recall, as I believe he knows, that I was involved as the leader of the Association of County Councils during the period of local government reorganisation in Wales. I was assured by the noble Lord's government when in office that everyone had been fully consulted. I feat that occasionally, irrespective of who carries out the consultation process, some of those consulted will never accept that it took place unless they obtain the results that they want. Sometimes there are conflicting demands and it becomes impossible for everyone's views to be met.

I accept that one cannot please everybody; one cannot please all the people all of the time, but we hope to please some people some of the time. That does not dispel the need for consultation. In such an area, where we are establishing totally new local health boards—22 in place of the existing five—there is a duty on the Assembly to ensure that the orders establishing the boards have been well and truly consulted on.

If there is no such consultation and ensuing satisfaction, the worst fears expressed within the NHS in Wales—that the system is impracticable—may be realised. We are not fettering the Assembly in any way as it is already obliged to consult if the order establishing an LHB is varied or revoked, as I pointed out. We will not fetter it additionally by inserting the word "issued". Perhaps the principle should have been established earlier, in new subsection (2), but it is here. It fits into that subsection.

We are still unclear about the top end of the NHS in Wales and how it will be constructed. We know a great deal about the lower end of the spectrum—the local health boards, and so on —but little about what is meant by the Assembly and the Minister and the form of organisation within the Assembly. I am not altogether happy with the Minister's answer and I shall test the Committee's opinion.

I beg to move that the House do now resume.

Moved accordingly, and, on Question, Motion agreed to.

House resumed.

My Lords, with the leave of the House, I shall now repeat a Statement made by my right honourable friend the Minister of State for Rural Affairs in another place. The Statement is as follows:

"Mr Speaker, our manifesto gave a commitment on hunting with hounds. We said:

'We will give the new House of Commons an early opportunity to express its view. We will then enable Parliament to reach a conclusion on this issue'.

"I have been given the responsibility of leading that enabling process.

"In reaching my decision on how to proceed, I have listened carefully to what has been said in the debates.

"The votes this week leave the two Houses diametrically opposed. Indeed I have rarely seen an issue where greater divisions exist. It is precisely for that reason that it is right to see how it can be resolved with as much agreement as possible.

"We want to respect all views but that has to start with respect for the strength with which the Commons made its views clear on Monday.

"I promise to engage with everyone who has an interest in this issue in order to make the legislation practical and robust. I promise to bring to the House of Commons a Bill that will deal with this issue effectively once and for all and make good law; and I earnestly hope that we can do so on the basis of as much common ground as possible.

"I propose a process of consultation on the practical issues of detail with a wide variety of interested parties. This period will last no more than six months, including work on drafting a new Bill.

"But we promised in the manifesto that it will be resolved. Should there be no way through and should the new Bill be frustrated in its passage rather than scrutinised and improved, the Government could not properly stand in the way of the application of the Parliament Act, which again of course would be a matter for this House.

"So the Government would prefer for the Ball to proceed by debate and a search for common ground wherever possible, with conflict tempered by tolerance. If that process is frustrated and the Bill rejected, we would reintroduce the Bill as quickly as possible to this House. It will then be for this House and its procedures—and indeed for Mr Speaker—to determine whether the Parliament Act applies.

"However, the reason for re-engaging in a process to try to achieve wider agreement is precisely because we recognise that there are legitimate concerns in the countryside about pest control, about land management and about other practicalities and we want to address these issues in the Bill. These concerns were raised both in this House and in another place.

"Let me also reiterate our manifesto commitment that:

'We have no intention whatsoever of placing restrictions on the sports of angling and shooting'.

"And I also want to stress to everyone in the countryside that hunting is at the margins of the real debate about the priorities that we set out in the Rural White Paper. Those of ensuring that people in the countryside get access to good public services, proper investment, sound environmental policies and sustainable development.

"On the content of the Bill itself, I believe that some common ground can be achieved best by focusing on two general principles. The report by Lord Burns on hunting with dogs examined in great detail the principles of cruelty and utility. We propose to frame legislation that prohibits activity based on those two principles rather than simply setting out a list of activities to be banned.

"But the Burns report did not provide a route map. That is why further thought needs to be given in applying these principles and that is what I shall be looking at over the next few weeks.

"I am sure the House will have noted the very clear assurances I have given today about timing and outcome, as well as engagement which will involve those campaigning for a ban on hunting, and Members of this House, as well as those involved in land management.

"Inevitably, I recognise that this is a difficult issue, especially as we all know that there are pressing issues of legislation that also demand our attention on crime, health and education. We must deliver on our central promises to deliver reform and investment in our public services.

"Mr Speaker, I ask the House to trust me to deliver and to join me in a process which is guaranteed to achieve an outcome as soon as possible. I look forward to engaging with colleagues on all sides of this House and in another place.

"The process I am setting out today will ensure that we deliver on our manifesto commitment to resolve this issue during the lifetime of this Parliament".

My Lords, that concludes the Statement.

My Lords, I thank the Minister for repeating the Statement made in another place earlier today.

We congratulate the Government on recognising the need to make good law and on their determination not to place restrictions on angling and shooting. I recommend the Government wholeheartedly on this point of good law because it is at the heart of the issue. As many of your Lordships commented during our debate, it would be wrong to distract our police forces, to whom I pay tribute for the job of stemming the rising tide of crime. This is one aspect of a wider issue. The Government's continuing determination to give a ban on hunting the highest priority when so much else is clamouring for attention is a disgrace.

The Statement requests this House to trust the Minister to deliver. Does this mean that the Prime Minister has given him carte blanche to achieve a solution? Although the Statement declares that the two Houses are diametrically opposed, will the Minister accept that on a free vote in this House and in another place earlier this week the two Houses declared themselves to be in favour of a middle way?

We do not accept that this is a black and white issue. It is a wide continuum, with many people sitting in the middle; and that fact tends to go overlooked. Is the Minister not willing to concede that the Statement he has given us today, while seeking views, also carries an uncanny unveiled threat that the Government will use the Parliament Act, and that even prior to us knowing what is going to be in the consultation document?

I turn now to the consultation period. Are these consultation papers ready? If not, how long will it be before they are issued? Mindful of Easter and the Jubilee celebrations coming, will there be time for the Minister to fulfil his promise to engage with everyone who has an interest in this issue?

Earlier this afternoon in another place the Minister seemed to suggest that the noble Lord, Lord Burns, had had his shout and that further interpretations by him of his report would not be considered. Are we to understand that the new round of consultation that is proposed will involve only those interests which have not already been expressed? Are we also to understand that the noble Lord, Lord Burns, will have no further input into the definition of "cruelty" and of the other word used in the Statement, "utility". Can the Minister explain to the House a little more about what is meant by "utility"?

I point out to the Minister that while the rural White Paper might be highly valued by the Government, as indeed they keep telling us, it was produced hack in November 2000. It has not even been debated in this House and its implementation seems to be entrusted to many of the regional development agencies. Those have only one rural member on each board. Is it any wonder that the Government have had to use the Statement to point out to us and to the wider world that hunting is not a central issue in the countryside?

While the Minister is pressing the issues for legislation referred to in the Statement we are still awaiting the Government's response to the Curry report and indeed to the reports that have been produced by the noble Lord, Lord Haskins, who I do not think is in his place today, on better regulation and on the response to the FMD prices in Cumbria. These are just a few. There are many other reports waiting in the wings.

Finally, I ask the Minister where the newspapers obtained their most authoritative articles published today in advance of the Statement, which rather suggests insider knowledge. Were there any briefings and did they take place before the Minister rose to speak in another place?

My Lords, I would not pretend to speak for all voices in my party because in my party too we have diametrically opposed views. However, following the Statement, which I am glad the Minister has been able to make this afternoon, we can be certain of one thing, which is that we are not entirely clear what it means.

Having said that, I welcome the fact that it makes clear that the Burns inquiry is to be taken seriously. I welcome also the fact that the Government, having commissioned an inquiry, are going to take notice of it. I would certainly interpret the cruelty and utility part as exploring the balance between pest control and sport. That is a very important balance which should be thoroughly explored.

I, too, should like to know more about the timescale for the consultation and also whether local views will be taken into account on a locality basis or a regional basis; and, if so, what bodies will be consulted locally. That is particularly important because of the practical issues—if the Government are thinking of restricting hunting to certain areas, for example, uplands. The over-use of those upland areas is a matter which bodies concerned with them will no doubt want to consider as well. It would be reassuring if the Minister could, at some stage, give us an indication of how the consultation document will dovetail into the recommendations made in the food and farming report. Indeed, as the noble Baroness, Lady Byford, observed, we have not yet received any response to that report.

The economic and social aspects would be well addressed on a regional basis. There are also issues of compensation for those who will be put out of business, as was mentioned during the passage of the fur farming legislation in this House; and, indeed, as regards housing. I believe that the time-scale involved is most important. It means that we shall finally have definite answers. That is as crucial for rural areas that will be affected, as it is for those who would like to see a ban imposed.

Further, it is important to ensure that the sort of turn-out that we saw in this House last Tuesday will be repeated and exercised on other issues in the future. One way or another, it would be pleasant if the hunting debate could be put to bed once and for all in a satisfactory manner.

My Lords, I appreciate the response to the Statement and the questions that have been raised. I believe that some of those questions seemed to suggest that the way we do these things is slightly misleading. The noble Baroness, Lady Byford, seemed to think that I have been empowered by the Prime Minister to carry through the process. However, I am the mere representative in this House of my right honourable friend Alun Michael who—thank goodness!—is the person who will have that responsibility. Nevertheless, I shall be responsible for processing the matter through this House.

In his Statement, my right honourable friend made it clear that he would wish to engage with Members of this House, those who expressed views in the debate in another place on Monday, and, more widely, with the interest groups involved. It is not a question of the views already expressed being taken as written, including those of the noble Lord, Lord Burns. We shall facilitate the process so that anyone else who wishes to do so may participate in the consultation. I cannot give an answer on precisely when the consultation documentation will be produced, but, following the Easter Recess, we shall start engaging in the process of consultation.

In response to the noble Baroness, Lady Miller, I should point out that this matter needs to be very much separated from other consultations that will take place in terms of how we proceed with the Curry report, to which the noble Baroness, Lady Byford, also referred. The initial response to that report will be available shortly. However, as I have already indicated to the House, we wish to engage in a programme of regional discussion over the spring and summer. The final response to the report will be produced in the autumn, by which time we shall have the advantage—if I may put it that way—of finalising the spending review and other decisions of government. We are, therefore, aiming to produce a White Paper in the autumn.

The noble Baroness, Lady Byford, made a few aspersions in relation to some reports in today's newspapers. I can assure the noble Baroness that there was no such briefing; indeed, when I left my department at 1 o'clock this lunch-time, the Statement had not been finalised. Therefore, it would be impossible for anyone to have received it before that time. I believe that we can ignore that aspect of the matter.

However, the more important accusation that the noble Baroness made related to fact that, by this Statement, we are threatening further action. Everyone has known the potential constitutional position both on the previous, and on any new, legislation. The noble Baroness introduced the rather novel constitutional precept that I have heard repeated quite widely around the House over the past 48 hours; namely, that we would add up the scores of this House and those of another place. As noble Lords well know, that is not the way that the procedure works. Both Houses have to reach their conclusion, and it is to be hoped that we reach a conclusion that is at least acceptable, even if it is not entirely what either wants. However, if that process fails, the Government—or, more accurately, the House of Commons, as it will be on a free vote—would have the option of invoking the Parliament Act.

We believe that this issue has been around for long enough. We have had a sufficient number of debates on the subject, in which everyone has expressed his or her point of view. If, following the consultation—and, it is to be hoped, the taking on board of many of the points raised—the Bill then produced is adopted by the House of Commons, we are indicating that we would not stand in the way of the other place using the Parliament Act finally to resolve the issue, and thus meet our manifesto commitment that we would solve the matter in this Parliament.

Mention was made of the definition of "utility". Clearly, the prime reason for hunting tends to be pest control. However, there are other potential benefits from hunting, including economic considerations, that will need to be taken into the balance. The main concern among those who wish to promote a restriction or a ban on hunting is, of course, cruelty. When the noble Lord, Lord Burns, referred to "cruelty". I believe that he did so in the context that we already have a definition in existing legislation. The issue is whether the consideration of other factors means that the definition of the word has at least to be modified in the light of aspects of utility. We are not balancing one against the other, but we must also take issues of utility into account. That is the basis of the approach to drafting the new Bill.

The response to the Statement indicates that we still have a long way to go in the consultation process, in the re-engagement of the various parties—both parliamentary and otherwise—and in the drafting of the Bill. We have given an indication of the time-scale on which the Bill will be produced—namely, six months—and of the process that will ensue if, regrettably, we still end up in a deadlock. That is simply a statement as to the reality of the situation. I hope that we can move to more of a consensus on the issue. However, if we cannot, the use of the Parliament Act is, therefore, promised.

My Lords, it seems to me that the Minister has not fully understood the point made by my noble friend on the Front Bench about the leak of information. She was not suggesting that the contents of the Statement had been leaked: I believe that my noble friend was referring to the very detailed accounts to be found in several newspapers this morning. Such reports referred not to the Statement but to the Bill that will eventually be introduced. Is that not rather a serious matter?

When repeating the Statement, the noble Lord talked about certain principles and a process of consultation after which time a Bill will he produced. However, it is quite evident that someone connected with government has been reassuring those in favour of a total ban that their wishes—90 per cent according to one report—will be met. That reflects quite a different, divisive and belligerent approach, and, indeed, one quite contrary to what the Minister has been trying to convey to the House this afternoon. Can he clarify the position?

My Lords, I can assure the House that no Bill exists; nor does even the outline of such a Bill exist. However, all of these issues have been fairly well aired, and, in the light of the contrary decisions of the two Houses, they have been discussed widely in political and journalistic circles. I assure the House that there has been no decision on the nature of the Bill pending the consultation, and there has been no spelling out to journalists or anybody else what the nature of that Bill will he. My Statement today clearly indicated the process. Also, it is stating the obvious to say that we know where the House of Commons stands and we know what will be required to meet many of the present concerns in the House of Commons. We have a consultation period to undergo, during which we can perhaps establish more common ground on which a further Bill could be based. In any case, the position taken by the other place the other night would need to be translated into legislative terms and there are different ways of doing that.

So, in relation to belligerence, I am afraid that I have to make it clear to Members of this House that, at the end of the day, their votes cannot be added to those of the House of Commons and, if the normal process fails, the will of the House of Commons will prevail.

My Lords, I welcome the early response from the Government. I also welcome the fact that, if a real debate does not take place, the Parliament Act will be used and the fact that due weight will be given to the views of the elected House. I hope that the spirit of libertarianism that was shown in the House the other day continues for a long time.

My Lords, I accept the welcome from my noble friend. There will be different interpretations of precisely what he meant by his last sentence. No doubt, he will enlighten us.

My Lords, the Minister rightly said that it could not be guaranteed that the votes of this House would be counted equal to those of the House of Commons. However, he gave the House a pledge on behalf of his colleague. Mr Alun Michael—who, as he said, is in charge of the matter— that the views expressed in this House would be carefully considered before any decisions were taken. I am sure that the Minister gave that pledge in good faith, but it has been dishonoured by the Statement.

There is no secret about it. Anyone who has been around for any time in government or Parliament knows what the Statement means. The views of the House have not been taken into account, and that is the worst possible prelude. The Minister pleads for understanding, co-operation and proper consultation, when the first process of consultation—a proper debate in this House and a proper moment for the assessment of our views—has been so manifestly dishonoured.

The Statement was fairly opaque in places. On the second page, there are clear assurances about timing and outcome and that there will be engagement with those campaigning for a ban on hunting, Members of the House of Commons, Members of this House, and those involved in land management. There is no indication that there will be any engagement with those who happen to regard the policy—if the newspaper reports of it are accurate—as a disaster for many parts of the country. They would expect to be fully engaged in the process.

My Lords, my right honourable friend made it clear that he would engage with all sides of the argument. The Statement refers to Members of the House of Commons and the view that they took. It was, after all, a Statement to the House of Commons, which has made its views clear, and the Minister is responsible to that House. It also said explicitly in the Statement that he would take into account views that had already been expressed here in the debate and views that might be expressed during the six-month period.

The Statement is not opaque. At least, it is no more opaque than many government Statements. It is fairly clear that the process of consultation will take place; that there will be an assessment of the views that are put to Alun Michael during that period; and that the Bill will be drafted in the light of those opinions. It is a political reality that the House of Commons has made its view clear, as of now. It is also clear that there will now be a period of reflection and consultation, before we produce the legislation. When we produce the legislation, it will go through the normal process. I hope that we can establish other principles and bases for that legislation. The only thing that is spelt out—it is blindingly obvious, not opaque—is that, at the end of the day, we think that the issue has gone on for too long and the Parliament Act might be invoked.

My Lords, I shall take up the point made by—I was going to say, -my old friend", but that is not appropriate in this House—my old sparring partner, the noble Lord, Lord Hoyle. Up to now, this has been a matter for a free vote, here and in another place. That was true of the previous Bill, in which there were three options. People were able to vote for what they wanted. It has also been true of the debates in this Parliament.

Are the Government saying that they will introduce a government Bill that will represent their settled view, after the six months' consultation, and that they will do what they usually do with government Bills and apply the Whip, in this House and in another place? If that is not the case, what guarantee is there that the Bill that arrives in this House from another place will be the Government's Bill?

My Lords, contrary to what the noble Lord, Lord Greaves, suggests, we have made it explicit that, although the Government will produce the Bill, it will be the subject of a free vote in both Houses, as was the Private Member's Bill and as were the Motions debated this week. The principle of a free vote throughout Parliament still applies: Whips will not be applied on this side of the House or, I suspect, in other parties.

I hope that that clarifies the situation. Of course, the Bill that arrives here will be the House of Commons' Bill, which may not be the same as the original government Bill. That is stating the obvious.

My Lords, I congratulate my noble friend on the Minister's decision to have a period of reflection, rather than follow the line of a "virtual ban", which was apparently briefed overnight from somewhere to the newspapers. That is a positive move.

Following up what was said on the Benches opposite, I ask the Minister for a positive assurance that the final Bill, which will include the Government's decisions, will, in the search for common ground—a crucial part of the process and a good objective— include not only the views of this House as part of Parliament but those of the people in the countryside who will be most affected by a virtual ban, should the Government pursue that policy.

My Lords, I cannot predict the extent of support for the common ground that will emerge from the process. All I am saying is that it will be the objective of my right honourable friend to seek what common ground there is, before producing a Bill.

My Lords, the Government have accepted the principle that foxes must be controlled and seek to implement the principle that unnecessary cruelty should not be inflicted, with which one cannot quarrel. Can the Minister give an undertaking that no law will be passed that substitutes a more cruel or equally cruel method of control than fox hunting?

The Government said that they,

"could not properly stand in the way of the application of the Parliament Act",

if the new Bill were to be frustrated in its passage, rather than—I emphasise—"scrutinised and improved". Will the Minister undertake that, if the role of this House is restricted to scrutiny and improvement, the Government will properly stand in the way of the application of the Parliament Act?

My Lords, as I said, the Bill will go through the normal process. If improvements are introduced in this House during that process and they are acceptable to the House of Commons, they will be accepted in the Bill. However, were there still to be deadlock, the situation that I described in relation to the Parliament Act would apply. If the question is whether it is worth while for this House to scrutinise and attempt to improve the Bill, the answer is that it is. That is part of the process of trying to reach as much common ground as we can through parliamentary and other processes.

I am not sure that I can give the noble Lord, Lord Elton, a straight answer to his first question. After all, as my noble friend Lord Hoyle and others said, only about six per cent of the control of foxes is through hunting with hounds. There are subjective arguments about whether that is more or less cruel than other forms of controlling foxes. The question is whether that six per cent should continue to exist, be reduced or eliminated. The balance may well depend on the exact outcome and the exact law. I cannot give a clear assurance on that either way.

My Lords, my noble friend will be aware that some of us who are opposed to hunting are nevertheless concerned about the impact of a ban on the foot and fell packs in some of Britain's national parks. I refer in particular to the Lake District National Park where special conditions exist, most especially in the area of lambing. Can my noble friend give an assurance that during the course of the consultation, adequate regard will be given to those difficulties?

My Lords, local concerns will be taken fully into account during the consultation. I should have made that point clear in my response to the noble Baroness, Lady Miller, because she too asked whether local concerns would be taken into account. Although we may not put in place an entire structure of local consultation, we shall need to take into consideration the conditions and problems peculiar to certain parts of the country, including the Lake District.

My Lords, are the consultation documents ready for publication? If not, when will they be ready? Once they have been prepared, when will they be circulated?

My Lords, I regret that I cannot give the noble Baroness answers to her questions. The documents are not ready; they are not even at an early stage of drafting. However, following the Easter break we shall he very much engaged in the process and documentation will form a part of that. Although the documents do not exist at present, they will do so very shortly. More than that, I cannot say.

My Lords, in the Statement the Minister proclaimed that hunting is on the margins of the real debate about the priorities set out in the rural White Paper. While that may be true or partly true, will he accept that hunting is not by any means on the margins of the real debate about the growing threat to British traditions of individual freedom?

My Lords, I do not accept that. Hunting is an issue which can cause great excitement on all sides of the argument and therefore its importance is exaggerated by those both for and against it. That is the case in all kinds of contexts, including those of human rights. I do not believe that whether or not we ban hunting has any serious implication for other aspects of life, whether rural or in our more general civic society. Views on hunting are minority opinions on both sides of the argument. although both sides believe that it is extremely important.

My Lords, can my noble friend say when the period of six months' consultation is to start? It was made clear in the other place that it was due to start now. However, if the consultat ion papers have not yet been sent out, or if they have not even been prepared, then when will the six-month period begin?

Can my noble friend also tell the House who, once the submissions have been made, is to consider them?

My Lords, the six-month period does indeed start now.

Oh!

My Lords, there is no inhibition on Members of your Lordships' House or on anyone outside this place with regard to expressing their views before they have received a particular document. This issue has been around for so long that it is not necessary to consult a document in order to express views.

My Lords, I think that the noble Lord has been a little disingenuous to the House.

My Lords, order. This is the time allotted to Back Benchers for questions.

My Lords, it 'seems that the root problem for the other place is the fact that people enjoy hunting with hounds. Can the noble Lord assure the House that, should the three million anglers who go fishing begin to show the slightest sign of enjoyment, they too will he in trouble?

My Lords, I share with the noble Baroness her incredulity that any enjoyment can be derived from angling. Nevertheless, we have made it absolutely clear that no such intention will be pursued in relation to shooting or angling.

My Lords, the Minister did not respond to my second question. Who will consider and prepare the legislation?

My Lords, it is intended that the Government will consider the matter and produce the Bill. It will then go through the process that I have already described.

My Lords, the Minister said that there will be no restriction on shooting, but day after day restrictions are being imposed by stealth. It is becoming harder than ever to acquire a shotgun certificate, in particular for young applicants. Ultimately shooting will be dramatically affected by such practices.

Can the Minister give me an assurance that he will speak to the government business managers of another place and say that we do not expect another place to guillotine the Committee stage, guillotine the proceedings on Report, guillotine the Third Reading and then send on to this House an absolute shambles of a Bill? We want to hold a proper, democratic debate so that each side is given a fair amount of time. In that way we shall be able to make progress in this House. However, that will not be achieved under the authoritarian attitude with which legislation is presently dealt with in another place.

My Lords, I would not dream of trying to instruct the business managers of another place. That has long been the tradition of this House. If the converse were the case, this House would rightly resent it.

My Lords, could the noble Lord explain once more to the House why hunting with dogs should take precedence over all the other desperately pressing problems facing the country? Many people do not understand why hunting is so much more important.

My Lords, I appreciate that many Members of your Lordships' House find it difficult to understand this matter. Nonetheless, hunting has been a major political issue for over two decades in this country. It is time that it was resolved. In our manifesto, for which people voted rather overwhelmingly, we gave a commitment that the question would be resolved during this Parliament. We are therefore fulfilling our promise.

My Lords, does the Minister agree that the request for trust put forward on the part of his colleagues has been made on rather shaky ground, given that both sides of the argument can claim to have been badly misled by the Government in their handling of this issue over the past four years? Does he further agree therefore that the period of consultation needs to be transparently fair, thus ensuring that no complaint can be made by either side about its ability to have its opinion heard, and so that there is no temptation to indulge in extra-parliamentary action? It is very important that Parliament should handle this issue—on which great emotions are felt on both sides—so that both opinions are assured that here, in Parliament, they have had a chance to state their case.

When I spoke in the debate the other day, I put forward a proposal to set up a pre-legislative Joint Select Committee. Whether that was effective, I do not know. However, some means must be found to ensure that the campaigning groups outside this place are given access in the most transparent manner before legislation is brought forward. At the moment, the Government's record on this is very shaky indeed.

My Lords, I do not accept the first or the last points put by the noble Lord. We have genuinely endeavoured to find a solution. I can assure him that the consultation process will certainly be transparent. It will be accessible to all the groups to which he referred, as it will be to all parliamentary opinion.

My Lords—

My Lords, we have had 20 minutes of questions on the Statement from Back Benchers, but I feel that the House would like to hear from the noble Lord, Lord Denham, if he can keep his remarks fairly brief.

My Lord, I am most grateful to the noble and learned Lord the Leader of the House. On a point of order, the noble Baroness stated that 20 minutes are allotted to Back Benchers. The first proceedings on a debate of this kind are taken by the Leaders of all sides, and responses are given to them. It is then the turn of Back Benchers for the following 20 minutes.

I should like to ask for clarification. I have never understood that it would be out of order, if a point arose during the time allotted to Back Benchers, for someone on the Front Bench who had spoken previously to rise to query a minor point? I had not realised that he or she would be out of order in so doing. Is that right or is that wrong? I should not like to make a point of order "on the hoof", so to speak. Perhaps we should consider whether or not this is wrong.

My Lords, the basic answer to the question put by the noble Lord, Lord Denham, is to be found in paragraph 4.81 of the Companion:

"The period of questions and answers which then follows for backbench Members should not exceed 20 minutes from the end of the minister's initial reply to the Opposition spokesmen".

That is the principle. I do not think that it deals particularly with the noble Lord's question because I do not believe that specific guidance can be found. What I try to do is to meet the wishes of the House as appropriate.

moved Amendment No. 84:

Page 28, line 30, at end insert ", and indicate which authority is to take the lead in the formulation of such strategies"

The noble Lord said: Amendment No. 84 relates to Clause 22 and deals with health and well-being strategies. The concept of such strategies drawn up by local authorities and local health boards is attractive. We are all aware of the relationship between people's health and their physical and mental environment, and of the inevitable overlap between the health sphere and the sphere of local government.

There are some areas—I am thinking particularly of social services—where there is a close relationship which is to be found in all parts of Wales. The relationship may be particularly important where there is a high proportion of elderly people in the population, as in the retirement areas of North Wales. There are other areas, such as the valleys of South Wales, where the working environment and its legacy may still be an important determinant of people's health. I am sure that there are other areas where housing conditions are a primary concern. We still have a great deal of pre-1918 housing.

Health and well-being strategies are therefore likely to vary in their priorities in different parts of Wales. Obviously, they will also have much in common, such as health promotion, but my main concern is to establish through the amendment which body is to take the lead in drawing up such strategies.

The clause opens by laying a duty on both types of authority—local government and health authority—to act jointly in formulating and implementing strategies. But, as I am sure the noble Baroness will realise, the danger is that neither will get far without one or other taking the lead, depending on what is perceived to be the major problem of the area and whether it is clearly in the health field or a local government responsibility. The clause is silent on that point. I shall be interested to hear what the noble Baroness has to say. I beg to move.

The noble Lord, Lord Roberts of Conwy, has raised an important aspect of the Bill in terms of the way in which the formulation of policies will occur within the local health boards. The effect of the amendment would undermine the principle of joint ownership of each health and well-being strategy and the partnership principles which underpin the NHS Plan in Wales.

The National Assembly will give advice in guidance about how the responsible bodies should work jointly to formulate and implement the strategy. In doing so, the National Assembly intends to leave as much as possible to local determination. Local partners, therefore, will determine the local arrangements.

It is the wish of those involved in developing the proposals in Wales that these partnerships will be across local government and the voluntary sector and, as the noble Lord recognised, develop in line with the circumstances prevailing in particular health board areas.

However, I am able to reassure the noble Lord, Lord Roberts of Conwy, that should any problem arise where a particular health and well-being strategy was not being progressed under the joint requirements, the National Assembly would seek to work with the relevant authorities to find a solution. It could ultimately use direction-making powers were they to be necessary. In the light of those assurances, I hope that the noble Lord will not press his amendment.

Before the noble Baroness sits down, perhaps she will try to imagine the situation that will arise when this part of the Bill is implemented. I am sure that she is well placed to do so. Would it not be helpful to the Assembly if it was required to decide who was the lead authority? There could be a problem in this area, and all that my noble friend is suggesting is that the Assembly should be required to do that—naturally in consultation. To leave it out would be asking for trouble for the Assembly.

I have failed to make clear the position which is being taken by the Assembly following detailed consultation. It is taking the view that it is not for the Assembly to direct who the lead authority should be but that that should develop at local level. The local partnership should bring in all parties to consider how best to develop the health and well-being strategy. The view that one authority must be the lead authority imposed by the Assembly is in conflict with the whole ethos of the development of the health service strategy in Wales.

I am grateful to the Minister for her reply. I made the point simply to highlight the possibility that there could be difficulties so far as leadership was concerned in formulating these health and well-being strategies. She has reassured me. Indeed, I am reassured by the contents of the Bill because Clause 22(6)(b) refers to the fact that,

"The regulations may, in particular, make provision as to … steps which the responsible bodies must take before formulating the strategy".

I heard what the noble Baroness said about the fact that if there is difficulty the Assembly can step in, but it is quite clear—I do not think that she will dissent from what I said earlier—that the primary concerns of these strategies will vary as between different areas. It is important that that point is taken on board and that the Assembly, if necessary, can give guidance as to who should take the lead. Having been reassured by the noble Baroness, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

moved Amendment No. 85:

Page 28, line 46, at end insert—

"( ) the imposition of a duty on the responsible bodies to include steps to improve the eye health of, and the provision of eye care to, the public in the area."

The noble Lord said: In moving Amendment No. 85, I shall speak also to Amendments Nos. 87 and 159. The Minister will note that this is my one foray into Welsh health matters. I do so only because of the importance of the issue of visual impairment. The amendments cover both England and Wales in different ways.

Clause 22 imposes a duty on local authorities and local health boards in Wales to formulate and implement a health and well-being strategy for their area. Amendment No. 85 would help to ensure that regulations made by the National Assembly for Wales could include provision for a duty to be imposed on both to include steps to improve the eye health of, and the provision of eye care to, the public in each area.

Amendment No. 87 is designed to ensure that any health improvement plan drawn up under the Health Act—I apologise if I have confused the Minister. There is a misprint in the amendment. The reference should be to the Health Act 1999, not the Health and Social Care Act 2001. The Bill should include a strategy,

"to improve the eye health of, and the provision of eye care to, the public in the area",

and, of course, that applies to England. These two amendments are promoted by the Improving Lives Coalition, which is composed of over 100 organisations in the field of visual impairment.

Why are the amendments necessary? Eye health is accorded low priority at primary care level and has not been a major feature of health improvement plans. Despite the prevalence figures, eye health has been accorded woefully little importance by primary care planners.

One of the reasons for this is that there is a mistaken assumption that visual impairment is a low incidence disability. That is not correct. Two million people in the UK are affected by uncorrectable sight loss; two-thirds of these have another disability or a serious health problem such as deafness, arthritis or diabetes. Currently, 90 per cent of blind or partially sighted people are aged 60 and over. One in five people over 75 has a sight problem. Within the next 30 years, about 40 per cent of the UK population will be aged 60 and over, which means that 2.5 million people will be living with a visual impairment. Over two-thirds of those who are eligible are not registered as blind or partially sighted.

There is strong evidence that adults in the UK are at risk of developing eye disease and other sight problems because they are not regularly having check-ups. Services have failed to pick up at least 1 million people with an eye condition which is either treatable or remediable, or which could be compensated for in some measure by rehabilitative services and equipment. Eight-five per cent of people over 65 who have cataracts and 75 per cent who have glaucoma have no contact with eye specialists. The number of overall sight tests since the extension of free eye tests to the over-60s has risen by only a small amount. People from certain ethnic backgrounds—for example, Afro-Caribbean and South Asian— are at greatly increased risk of glaucoma and diabetic retinopathy. One in five school-age children have undetected poor sight. People on low incomes are unaware of the exemption categories and low-income concession scheme and are not having sufficient eye tests. Further evidence can be obtained from a recent report from the Patients Association which demonstrates the inadequate information and access to treatments for major causes of blindness and visual impairment.

The detection of eye disease and low vision happens at primary care level—critically, through the NHS sight test, which is also an eye health examination. But unless and until this matter is re-prioritised in local health strategies, and proper monitoring and targets are put in place for addressing under-identification and low take-up of services by at-risk groups, people will continue to lose their sight unnecessarily.

The cost to the NHS of failing to re-prioritise eye health at primary care level will be huge. The risk of hip fracture is doubled in people with poor and moderately impaired vision. The cost to the National Health Service of treating sight-related falls and injuries among older people is estimated at £221 million, as against £25 million for rehabilitation and prevention.

Amendment No. 159 seeks to insert a new clause setting up low vision committees. It would require,

"each local authority in England and Wales; and … each Primary Care Trust in England and local health board in Wales, jointly to establish and support a Low Vision Committee … for the purpose of co-ordinating multi-disciplinary low vision services for persons with low vision".

The purpose of the amendment is to ensure that low vision services become more uniformly available and are better co-ordinated across England and Wales. Low vision affects nearly 2 million people. Low vision services are crucial for rehabilitation, the prevention of accidents and the amelioration of general health. They depend on effective, patient-centred, interdisciplinary working.

There is a nationally agreed framework in England and Wales respectively for the way in which the disciplines can work together to provide effective care for people who lose their sight. However, without statutory provision for low vision committees, services will remain extremely patchy and unco-ordinated.

What is a low vision service? It is a rehabilitative process which provides a range of services for people with low vision to enable them to make use of their eyesight to achieve maximum potential. It involves assessing the person's visual function. It involves providing aid, such as hand and stand magnifiers, telescopes, spectacle mounted aids, task lights and so on. It involves addressing psychological and emotional needs and facilitating modification to the home, school or work environments.

Who provides these services? There are a huge range of practitioners involved in delivering them. Ophthalmologists undertake the clinical diagnosis; optometrists will be involved in low vision assessment, and often the provision of low vision aids. GPs need to be able to refer patients quickly. Rehabilitation workers and local societies for blind and partially sighted people provide advice, information, low vision aids and training. Other specialist practitioners need to be involved; for example, to deliver an effective children's low vision service. I could continue. There are a number of other professionals involved in the process.

Research by the RNIB has found that more than half of the low vision teams contain only one type of professional group. One team in 10 has no link with any other agency. The amendment specifies that the membership of low vision committees must include a range of professionals such as the ones I have mentioned.

Why is the amendment necessary? A lack of low vision services will mean more residential care and attendance costs for local authorities. Such a core rehabilitation service should be uniformly provided in the UK; but two out of every five potential service providers do not deliver any low vision services whatever, with some areas of the country left out altogether.

Challenging AMD in Europe, a report from the AMD Alliance UK published in September, indicated that the UK was among the worst of the countries surveyed in providing rehabilitation services to people with age-related macular degeneration—the leading cause of sight loss in the UK.

Current government initiatives relating to community equipment, pooling budgets and joint assessments—valuable though they are—will not make sufficient impact in this area because they are too generic and do not give a strong steer to PCTs and social services departments to prioritise low vision services. The National Assembly for Wales has begun to address the need for a low vision framework in Wales; but again, without any statutory requirement, services may be slow to develop.

Three years ago, a report was published by the Low Vision Services Consensus Group, chaired by the noble Lord. Lord Jenkin of Roding. I am delighted to see the noble Lord in his place. It involved all the voluntary and professional interests engaged in these issues. Its central recommendation was for low vision committees to be established in every local area. A similar report was subsequently issued in Wales.

The then Health Secretary commended the report to primary care groups, hospital eye departments, social services and voluntary agencies. If the Government still agree with every agency in the visual impairment field that low vision committees provide the best means of ensuring an integrated model of service, they should accept the amendment and insist that such a provision is written into the legislation. I beg to move.

I completely agree with veverything that the noble Lord, Lord Clement-Jones, has said—with the exception of his ever-generous reference to myself. I did not chair the committee that produced the recommendation, although I played some part in its being set up. Perhaps I may weary the Committee with just a couple of sentences of reminiscence.

I had been invited to join the council of the Guide Dogs for the Blind Association in the late 1980s. That brought me into contact with a number of other national voluntary organisations for the blind and partially sighted. There was no machinery at all for trying to bring those bodies together, although many worked for the same ends. I set up and chaired for 10 years the visual handicap group, which consisted of those national voluntary bodies. We produced a report on better services for the visually handicapped, which was widely received and commented on favourably, not least by the Department of Health. We produced another report on the training of people to work with the blind and visually handicapped—an issue that had fallen through the wickerwork since the old blind workers disappeared with the Seebohm changes in social work.

We also produced a report on low vision—the subject of Amendment No. 159. To many of us—this is not meant to be a pun—it was an eye-opener to see how inadequate services were across the country for people with low vision. Many patients who were examined by an ophthalmologist were simply told, "I am afraid that there is nothing more that medicine can do for you. You are going blind. Have you got somebody to take you home?". As the noble Lord, Lord Clement-Jones, said, it is a terrible shock for a patient to be told that they have an irreversible condition—although many people would now argue that some conditions are not as irreversible as they were once thought to be.

We found that in many cases across the country there were virtually no services to pick up those people and make sure that they were given the help they needed. Some areas were lucky in having an effective voluntary organisation. A year or two after we produced our report, I was presiding over a meeting of the Wanstead and Woodford association for the blind and partially sighted. A consultant from Chelmsford told us what the Essex Voluntary Association for the Blind was doing. He spelt out almost exactly the contents of Amendment No. 159. That was being done in conjunction with the health authority and the local authorities. However, that situation was exceptional. I am not in the least surprised that the body that followed on from the visual handicap group—the body that the noble Lord, Lord Clement-Jones, referred to—came to the conclusion that something more positive is now needed to ensure that there are services to pick up and help patients who are diagnosed as having low vision. Many of them are elderly, but not all.

I strongly support Amendment No. 159, because it seems to be the way ahead. I probably said when I was on the ministerial Bench that we already have a plethora of committees. I have some sympathy with that view, but I am convinced by the evidence that has been produced by Robin Birch and his Low Vision Services Consensus Group. The issue will be dealt with effectively only if every area has to have a low vision committee.

I am not wedded to the full details of Amendment No. 159. It is a brave start, but the issue needs to be discussed fully with Ministers and other bodies to ensure that the provision is effective and workable and not too expensive. However, it is clear beyond peradventure that there is a need for something. The amendment gives us a chance to express a view in support of that. I hope that we shall do so. As the noble Lord, Lord Clement-Jones, said, those with a visual handicap have not been properly recognised in services. There are individual services such as sight tests and people can get glasses, but so much more needs to be done to allow those with low vision to be able to play their full role and develop their potential in the community and to allow old people to live independent lives. We need to address that. It is good that the amendment does so and I therefore warmly commend it.

I have added my name to the amendments, which raise issues with far-reaching implications for the health service that I believe are of the highest importance for patients. I endorse everything that the noble Lord, Lord Clement-Jones, and my noble friend Lord Jenkin have said. It is difficult to overstate the extent to which eye disease and visual impairment impact on the lives of those so afflicted. As my noble friend has graphically described, to lose one's sight is a deeply traumatic event, which in many cases is a precursor to all kinds of misery, such as unemployment, state dependence and mental illness. As the noble Lord, Lord Clement-Jones, informed us, many people in this country are affected by uncorrectable sight loss and the numbers are growing.

Much eye disease is treatable and preventable if caught early. However, compared with some other countries, we are not nearly as good as we should be in giving eye health appropriate priority at primary care level. Partly because the scale of the problem is not sufficiently appreciated, we tend not to be good enough at bringing information and help to those visually impaired people who need it.

Information for the blind is not an add-on extra: it is an essential part of good quality care that can result directly in improved recovery from illness, the more effective use of health services and the avoidance of serious medical accidents.

In recent years, there has been what I can only call an abdication by some health authorities and trusts of services tailored specifically to the needs of the blind or partially sighted. In the face of that, it is difficult to have confidence that PCTs will be able to establish any more creditable track record without a bit of gentle prodding. If the relevant services are to improve, we need to ensure that there are people tasked specifically with making the right things happen at local level. Low vision services committees provide an ideal mechanism for taking that mission forward. As we have heard, those committees emerged out of the very useful work of the Low Vision Services Consensus Group three years ago, for which my noble friend Lord Jenkin deserves a great deal of personal credit. Since then they have been encouraged by grant funding from the Department of Health.

There are two elements to the rationale for those committees. One is to bring together all the key stakeholders in the delivery of services—doctors, ophthalmologists, social services, specialist workers, service users and others—so that everyone communicates properly. Without such grouping, there is inadequate co-ordination. The second might be called commissioning muscle. Users and voluntary organisations need to he assured that their voice will be heard and their needs will be fully taken into account by PCTs and local authorities when services are being planned. I am convinced that a statutory duty to establish and support those committees would make a huge difference to the current unsatisfactory pattern of services.

What about providing accessible information to the visually impaired? The work of charities such as the RNIB in monitoring the provision of such services goes largely unsung. It should not be up to voluntary organisations to shoulder the task on their own. It should be done at national level, preferably by CHI. Health authorities and trusts are on the whole very dilatory about identifying those in need and having proper procedures and training. We need national benchmarks.

For those reasons I urge the Government to take the amendments seriously. The Minister may say that these are essentially matters for local decision-making, but, as the noble Lord, Lord Clement-Jones, pointed out, the current mechanisms, such as pooling budgets, will not be enough on their own to do the trick, because they do not send out specific messages about the importance of low vision services.

I hope that the Minister will at least reflect on the amendments in a positive spirit before Report.

This has been a very interesting debate. I think that we are all at one in wanting to ensure that good eye care services are available throughout the National Health Service. I am very much aware of the recent survey by the Patients Association which suggested that provision of ophthalmic services is variable across the country and that, as the noble Lord, Lord Clement-Jones, said, eye care is not always seen as a priority by health authorities. I very much agree with the general sentiments that have been raised in this short debate.

I have problems, however, with the suggestion that primary legislation is the route we should take to improve services. I also have problems with the suggestion that we should single out eye care services above all others to include in primary care legislation. I am sorry that the noble Baroness, Lady Cumberlege, is not with us today. In one sense, this debate seems to take us back to our earlier debate—which now seems a long time ago—on Clause I and the dilemma of developing policy and targets for the health service. The criticism in that debate was that the Government are setting the NHS too many targets, offering it too much guidance, and trying to constrain its functions and responsibilities in far too many ways. It is now being proposed that, in primary legislation, we should be very directional by telling the health service what it should do in particular spheres.

Noble Lords' reasons for wishing to do that are quite understandable. I am sure that all noble Lords wish to see improvement in eye care services. However, I am sure that noble Lords will also appreciate that the more we seek to constrain the work of the NHS, the more we shall have a problem of too many targets and too many priorities. It is a dilemma. I should therefore like to explain in a little detail the Government's work on eye care services, and then deal with the work on developing the eye committees which have been established in various parts of the country.

The Government's first action was to restore the free NHS eye test for everyone 60 and over, at a cost of £50 million annually. As the noble Earl, Lord Howe, suggested, that group is most vulnerable to eye disease and stands to benefit most from regular eye examinations. In 1999–2000, there were more than 2 million extra NHS sight tests, following the extension of eligibility for free tests. We are also taking steps to improve cataract services and have allocated an extra £20 million over two years to fund the capital costs of 60 schemes to improve treatment facilities and reduce waiting times. We believe that this investment will considerably improve the standard of eye care and greatly improve the quality of life particularly of older people. I am also glad to report that the number of NHS consultants in ophthalmology has increased by about 4 per cent in each of the past four years and will increase, from the current level of 651, to 895 by 2010.

I therefore hope that noble Lords will accept that the Government are committed to ensuring that good standards of eye care are provided for the population. As I said, I am not at all convinced that this group of amendments would help to improve the position. I know that the noble Lord, Lord Clement-Jones, has corrected the amendment—which was new Clause 24—and that he intended to require that health improvement plans should include strategies for improving eye health and eye care services. That would require an amendment to Section 28 of the Health Act 1999, which places a duty on each health authority to prepare a plan that sets out a strategy to improve the health of those for whom they are responsible and the provision of healthcare to those people.

I stress that health improvement plans—HIMPs— are strategic documents. We believe that, as such, it would be inappropriate for them to contain a lot of detail on specific activity in the health system. Surely it should be for localities to decide how to meet the identified priorities. I also question whether prescribing from the centre what HIMPs should contain would be contrary to the underlying principles of shifting the balance of power to the local level. All noble Lords seemed to agree with those principles when we debated them 10 days ago.

The HIMP process has to work effectively. In future, local voluntary organisations, service users, carers and the public will have a greater role to play in the development of the HIMP. The Health and Social Care Act 2001 underpins the patient's and the public's involvement in the development of the HIM P. The Act places a duty on NHS bodies to involve patients and the public in the planning and development of services. We shall also eventually, although probably not tonight, debate the issue of patient forums which will be established for every trust. They will play a very valuable role in discovering what patients think about the quality of local services, monitoring quality from the patient's perspective, and working with the local trust to bring about improvements. That, too, will inform the local priority-setting and planning process.

The position in Wales is similar. In line with the principle of devolution, the National Assembly will determine the form and contents of health and wellbeing strategies. The National Assembly intends to give advice about how the responsible bodies will work jointly to formulate and implement the strategy. 'The Assembly will also determine how prescriptive the regulations and guidance should be. Where possible, however, we hope that local partners are able to determine arrangements according to local priorities.

New Clause 159 would require each primary care trust in England or local health board in Wales, and each local authority in both countries jointly, to establish a low vision committee for the area for which that primary care trust or local health board 'was established. As mentioned, a report in 1999 by a consensus group of organisations on the future of low vision services recommended the establishment of local vision committees for the purpose of ensuring that services in the UK are provided in accordance with the report's recommendations. I pay tribute to the noble Lord, Lord Jenkin, for his role in the establishment of that group. However, having seen him play a starring role last night in the parliamentary choir's performance of "Messiah", I realise that he has very many hidden talents.

The Secretary of State for Health commended that report to the NHS and local government. As the noble Earl, Lord Howe, suggested, the department is contributing a grant of £120,000 over three years to provide an implementation officer from the voluntary sector to help in setting up local committees. Good progress is being made. My understanding is that, at the start of the year, 24 committees had been set up, and a number of others are under consideration. The noble Earl also suggested that some gentle prodding is needed. The implementation project is set to run for another 18 months. My view is that it would be inappropriate now to impose a requirement for primary care trusts and local authorities effectively to establish statutory low vision services committees. I think that it would make sense to allow the project to continue and for an evaluation of the committees' impact on service provision to be carried out by the implementation group at the end of that 18-month period.

I would also caution against an overly prescriptive approach. It may be possible to have a good, multi-disciplinary, low-vision service without a formal committee. In some areas the primary care trusts may not always cover the area that is sensible in terms of linking and providing low-vision services, and other models may emerge. Under the present arrangement, the committee is not in the ownership of one body, and that emphasises the essential joint working, which would be important for the successful functioning of any of those committees.

In the light of the debate tonight, the department will monitor what is happening and the progress by the implementation group. We already monitor the uptake of sight tests by eligible groups, and waiting lists. Sites that have been allocated funds for cataract improvement, for example, will also submit progress reports.

We are represented on the low-vision services implementation group, which receives progress reports on setting up local committees at its meetings two or three times a year. In addition, there is a requirement for the group to make six-monthly progress reports to the department. I assure noble Lords that the department will continue to take a close interest in the progress of the implementation project. I take the view that legislation is not the appropriate route down which we should go, but I hope I have reassured noble Lords that we take a keen interest. I accept that having made progress in the past two or three years, more progress needs to be made.

I thank the Minister for that reply which, in its latter parts, was positive and helpful. In one way it was the reverse of what I expected him to say. I thank the noble Lord, Lord Jenkin, and the noble Earl, Lord Howe, for their supportive comments. The noble Lord, Lord Jenkin, was clearly so enthusiastic and such a major contributor to the group that the people who briefed me thought that he chaired it. I suspect that that was a sign of his influence on them. I took the point he made that we should not expect to replicate best practice in a voluntary sense; we need an engine to spread it in a more statutory way.

I turn to the points made by the Minister on the health improvement plan. If we are not careful, as the Bill goes through the House the Minister will accuse all those who believe in having a pro-active set of national standards of being centralisers. I do not believe that the essence of devolution is to simply wriggle about and say, "I'm sorry; this is not really something we can legislate for or be prescriptive about". "Prescriptive" is a weasel word which has perhaps come back to haunt this side of the Chamber. In the past, we have accused the Government of being over-prescriptive. But there is a median way. The detailed implementation in a decentralised system is a matter for the local primary care trust and the people on the ground. However, when it comes to stating national standards as to how one produces a health improvement plan and what it can contain, one can be entirely strategic in those circumstances.

I am grateful to the noble Lord, Lord Clement-Jones, for giving way. I do not disagree with him when he says that it is right and, indeed, a duty for the Government to set the strategic framework in which HIMPs are developed. That is what we seek to do in the planning priorities guidance that we issue to the health service. That attempts to give a strong steer to the health service on the core priorities it needs to develop. I said earlier that Members of this place can raise a matter which they feel is important—we all agree that eye services are important—but the cumulative effect of treating every service with the same degree of priority would be to end up with a situation in which the health service is presented with 300 different priorities. As we have already discussed in our debates on Clause 1, that would mean ending up with a situation in which there are no priorities.

I entirely accept that. I have read all the previous public health White Papers and Green Papers and know about the four key areas of government concentrations and so forth. The argument is not about setting priorities in those terms but about how many targets we set to try to get those priorities implemented. That is where some of the argument about micro-management is concerned. The setting of broad priorities for action is entirely satisfactory. Perhaps the essence of the argument today in terms of low-vision services is to try to push them higher up the agenda in the health service. That is an appropriate way to proceed. I detect that in the second half of his response the Minister accepted some of the argument in that respect.

Therefore, it is not inappropriate to consider that health improvement plans should address that issue. We believe that they should cover a wide range of matters. Expecting them to cover this matter without stating the way in which they should deal with it or the priority it should be accorded is perfectly proper and an entirely strategic way to approach the matter.

I turn to more positive ground. I believe that the Minister gave quite a lot of encouragement in response to the gentle prodding point raised by the noble Earl, Lord Howe. It would be inconsistent of those on this side of the House to expect PCTs, on top of all the other matters with which they have to deal—we have dealt with that in earlier parts of the Bill—to be over-prodded at this stage in terms of those services. However, I welcome the Minister's commitment that at the end of the 18-month evaluation period by the implementation group there will be a review to see how those services are developing, to see whether the voluntary approach has worked, and then to report hack. It is important that the six-monthly progress reports are published and that there is proper dialogue with all the groups to which I have previously referred. That is a fairly formidable coalition. It is highly significant that that has now been formed.

I take encouragement from the Minister. However, I believe that we may well need to return to the matter, depending on the evaluation that takes place after that period. We can always guarantee that there will be a health Bill passing through this place again. Even if we do not return to the matter on Report, we may well return to it in a future Bill. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 22 agreed to.

moved Amendment No. 86:

After Clause 22, insert the following new clause—

"REPORT ON BODIES ACCOUNTABLE TO THE SECRETARY OF STATE

(1) The Secretary of State shall prepare each year in relation to the bodies set out in subsection (2) a report dealing with the matters set out in subsection (3) and shall lay a copy before both Houses of Parliament.

(2) The bodies referred to in subsection (1) are any body—

(a) over which the Secretary of State has powers of appointment;

(b) for Which he provides the majority of its funding;

(c) which he may direct as to the conduct of its business,

but shall not include Health Authorities, NHS trusts or Primary Care Trusts.

(3) The report shall contain in relation to each of the bodies referred to in subsection (2)—

(a) its name;

(b) the nature of the Secretary of State's relationship with the body;

(c) details of the exercise of any of the Secretary of State's powers during the previous year;

(d) the amounts provided to the body;

(e) how the annual report and accounts of the body may be obtained; and

(f) the Secretary of State's opinion as to the continued need for the body or, if he is of the opinion that the body is no longer needed, how he plans to proceed."

The noble Baroness said: Amendment No. 86 inserts a new clause after Clause 22 dealing with the various bodies for which the Secretary of State has responsibility.

At Second Reading, the noble Lord, Lord Walton of Detchant, who I am sorry is not in his place, spoke about the Government suffering from "quangoitis" and being determined to convert the NHS into a 'quangocracy". It seems that the Government's instinctive reaction to any problem is to set up one or more new bodies. Since 1997 they have created a long list of bodies: the Human Genetics Commission; the Genetics and Insurance Committee; the NHS Information Authority; the Commission for Health Improvement; the National Institute for Clinical Excellence; the Health Development Agency; the NHS Purchasing and Supply Agency; the NHS Logistics Authority; the General Social Care Council and its equivalents in Scotland, Wales and Northern Ireland; the National Care Standards Commission; and the National Patient Safety Agency. There are probably others which I have missed.

In this Bill alone we have a multitude of patients forums, far more than the CHCs which they will replace. We have the Commission for Patient and Public Involvement in Health and the council for the regulation of health care professionals. Since the Bill has been published, the Government have announced, in their response to the Bristol report, the setting up of a council for quality of healthcare. In January, the Chief Medical Officer announced a new national infection control and health protection agency. Only a week or so ago the Secretary of State announced a new board of patient choice trustees. There is no sign that the Government's zeal for new quangos is diminishing.

I am not seeking to debate the merits of any of those bodies individually. The amendment merely asks for an annual report setting out who the bodies are, their relationship with the Secretary of State, the money provided to them and where their annual report and accounts may be obtained. Importantly, the report should also give the Secretary of State's opinion as to the continued need for the body. If nothing else, it would be an opportunity for the Secretary of State to reflect on the size and nature of his quango empire. It would also give both Houses of Parliament the opportunity to consider the issue too.

I am aware that much of this information is already available in other places, for example, in an annex to the Department of Health's explanatory plans and information on the Cabinet Office website. The aim of the amendment is to bring together all relevant information relating to the Department of Health once a year and, crucially, to ask the Secretary of State to give his views as to the continued need for the bodies. That, in turn, would approve the accountability of the Secretary of State for the bodies that he has created. I hope that the Minister is in favour of increased accountability and will support the amendment. I beg to move.

I support the amendment as it is an exceedingly good idea. I went to the launch of a new body last night. It was launched most eloquently by the Minister. It was to do with safety, but I cannot remember the full title.

It is the National Patient Safety Agency.

That is a most important issue and I am sure that the agency will grow. It would be useful to have a list of quangos, as it is useful to know how important they are. On matters such as the control of infections in hospitals, for example, we could see how they were doing and the progress on all sorts of issues such as food and so on. The amendment is an excellent idea which I hope the Government will support.

I cannot see the need for this information because it is already available. I was not sure whether the noble Baroness wanted more information, different information or more information in a different form.

I currently chair a non-departmental public body which is sponsored by the DCMS, and I am the former chair of a Department of Health-sponsored body—the GSCC. My experience is that NDPBs and all other bodies already produce huge amounts of information, all of which is available to the public. They are required by the Secretary of State to produce strategic plans, business plans, annual reviews and they must meet all kinds of performance targets, including administration costs.

Clearly they are responsible to Parliament through the Secretary of State. Their boards are appointed through open advertisements by an independent panel and then approved by the Secretary of State. In terms of justifying their continued need, I believe that adequate information structures and systems already exist. I am reluctant to see further requirements being imposed on them, so that they have to spend more time reporting than doing the job that they were set up to do.

I agree with the noble Baroness about that, but the point of the amendment is probably that it is very much easier to set up a quango than to close it. I do not know whether the noble Barones has ever chaired anything that the Secretary of State tried to close. I have, and the Secretary of State did not close it. It is really quite difficult to shut something down.

We cannot have an ever-expanding empire when some bodies have passed their sell-by date. Whether or not the amendment is the right way to do it, the point is that subsection (3)(f) would require the Secretary of State to say whether the body was still necessary and, if not, what he will do about it. He has to say it with the knowledge of Parliament because the matter will be laid before Parliament. That is the point of the amendment, and if some way could be found to keep that requirement, it would be very helpful. A mushrooming of quangos is not a good idea if some of them are no longer necessary.

Clearly we do not want unnecessary quangos. I accept that, and it is important that all the activities of non-departmental bodies are kept under close review. If evidence arises that the job can be done better by other means, or that certain bodies are no longer required because life has moved on, I am all in favour of bringing their activities to an end.

The Government have looked at many non-departmental public bodies and have made changes. For example, we debated the proposals of the Chief Medical Officer on Monday on the surveillance and public health arena. It is proposed that one agency should be established in place of four existing agencies. There are other examples of the Government looking at rationalising non-departmental public bodies.

It is also significant that a number of the bodies to which the noble Baroness, Lady Noakes, referred—the noble Baroness, Lady Masham, also mentioned the National Patient Safety Agency—carry out important functions in terms of national standard setting. I am thinking about NICE or the Commission for Health Improvement investigating the quality of services at local level, or the National Patient Safety Agency to which National Health Service organisations will report adverse events. From that reporting, we hope to learn ways of improving the quality and safety of healthcare services. Those are important matters that need to be dealt with.

I would also argue that, having established such national bodies, enabling us to develop national standards, to which the noble Lord, Lord Clement-Jones, referred in the previous amendment, we are then in a much better position to decentralise. We can allow, within that national framework setting, National Health Service organisations at local level to have a much greater ability to decide their own destiny. Throughout the Bill we shall continually debate the balance between national standard setting and local determination. I am convinced that the establishment of a number of agencies at national level will allow us to decentralise more decision-making to local level.

I also agree with the noble Baroness, Lady Noakes, that openness about the roles and responsibilities of non-departmental public bodies is desirable in health, as across government generally. The Government's wish to promote increased accountability and openness for all quangos led to the publication of the measures in Quangos: Opening the Doors. Considerable progress has been made in this area in the past four years.

As my noble friend Lady Pitkeathley suggested, there does not seem to be much point in publishing again, in another format, information about the Department's quangos that is already available from other sources. The noble Baroness, Lady Noakes, mentioned the Cabinet Office's annual publication, Public Bodies, which already contains the majority of information dealt with by the amendment, including that for all the Department of Health's non-departmental public bodies.

In addition, the bodies themselves publish their own annual reports, including on the Internet, which gives that much more detail than is contained in the Cabinet Office's publication. Ministers remain accountable to Parliament for non-departmental public bodies. That includes informing Parliament about decisions relating to the reviewing and abolition of such bodies. It is notable that the Select Committees of your Lordships' House and in another place frequently examine the performance of those non-departmental public bodies. They frequently call in the chair and chief executive of those bodies for what can only be described as fairly searching examination. In addition, if the Secretary of State were to issue any written directions to these bodies, that fact would be published in the department's annual report. We would expect that the bodies concerned would wish to make a similar statement in their own annual reports.

I am convinced from my own experience in dealing with a number of the bodies mentioned in the debate that each of those bodies is under no illusion that we consider it very important that they are open about their activities: that they constantly examine the work that they do; and that they are encouraged to ensure that reports about their activities are published and put into the public domain. On that basis, I do not think that the amendments, while I understand their thrust, are necessary.

I thank the Minister for that response. I thank the noble Baroness, Lady Masham of Ilton, and my noble friend Lady Carnegy of Lour for their support for the amendment.

In tabling the amendment I was trying to draw attention to the multiplicity of the created bodies. The Minister referred to the 2001 publication, Public Bodies. It shows that the Department of Health had at that time 69 bodies. The number is sure to have increased since then. The empire is growing. I understand and do not dispute that having certain kinds of agencies could lead to the ability to support further decentralisation. Indeed, at this stage I am not seeking to dispute the merits of any one of the bodies that I have mentioned or any one of the 69. My point was to draw attention to the increasing number of bodies and the increased use of non-departmental public bodies to undertake functions at the core of the Department of Health.

I am grateful to the Minister. I shall think carefully about what he has said. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

moved Amendment No. 88:

After Clause 22, insert the following new clause—

"NHS REGISTERED MEDICAL PRACTITIONERS

In respect of registration of persons proposing to practise in the National Health Service, section 19(3)(a) of the Medical Act 1983 (c. 54) (full registration of persons by virtue of recognised overseas qualifications) shall apply as though the words "other than the United Kingdom" are omitted."

The noble Lord said: Amendments Nos. 88 and 89 are quite closely related amendments. They spring from a perception of the minefield that any UK citizen who qualifies in a medical school abroad has to step through before he or she can practise in this country.

Amendment No. 88 deals with the International English Language Testing System, the IELTS. Section 19(1)(b) of the Medical Act 1983 stipulates that an applicant for full and provisional registration must satisfy the registrar of the GMC,

"that he has the necessary knowledge of English".

IELTS was adopted as a means of assessing linguistic proficiency following a recommendation from a Department of Health working group. It assesses skills in reading, writing, speaking and listening to English. But nationals of the EEA member states, other than the United Kingdom and others with what are called "enforceable EC rights", are exempt from having to demonstrate proficiency in English as a result of amendments to the Medical Act 1983.

The GMC admits that it would prefer 10 test EEA nationals but it is illegal to do so because EU laws prevent discrimination against EU citizens on the basis of language. Therefore, the people who have to take the test are by and large any UK citizen who qualified outside the EEA and any non-EU citizen who qualified outside the UK. That means that someone who is British but has trained outside the EEA— loosely speaking the EU, but slightly wider—has to take an English language test. That is rather an absurd anomaly that our amendment seeks to get rid of.

It should be noted that there is actually no legal requirement for a Briton who has trained outside the EEA to take the language test. It was the GMC's decision to adopt the language test. It is not mentioned as such in the Medical Act. All that is legally required is for the GMC registrar to be satisfied that a test would be a waste of time and money. So it would be possible for the GMC in these circumstances to get rid of the IELTS requirement.

I do not know whether the Minister has had the opportunity to look at the table produced by the GMC of the tests that are required. The table covers both the PLAB and the IELTS tests. It is almost completely incomprehensible to a lay person. Therefore, we have this absurd situation which I have outlined. We also have the potentially problematic situation of art EU national—no matter where in the world he or she qualified—who speaks no English at all, starting a job in a British hospital without taking any kind of language assessment. It is not possible to get rid of this because of the EU anti-discrimination aspect, but at least we can get rid of the situation where a UK citizen has to take the test even though English is his first language. The amendment would change that situation so that UK citizens would not have to take the language test no matter where they trained.

I move to the second amendment and turn to the PLAB exam. I want to use the example of a medical school that is well known to many Members of the Committee. I see that the noble Lord, Lord Soulsby, is in his place. I know that a number of noble Lords have connections with St George's University School of Medicine. I want to use it as an example of some of the problems that arise as a result of current requirements.

St George's University School of Medicine is 25 years old. This international school boasts an extremely high standard of education for medical students from the USA and from some 30 countries in the world. The standard of success of students can be measured by equating the results of the intermediate examinations which have to be undertaken by American students—currently, 70 per cent of students come from America—compared with USA standard schools. Last year, the results of the two examinations show that St George's has an equal if not improved pass rate in these relative exams. Basic sciences are taught on the islands of Grenada and St Vincent. Following that, students have an option of completing their clinical training either in the USA or in the UK.

What then follows for students who have qualified at St George's University and who then want to practise in the UK? They are able to come and practise in the UK in two ways. First, they must pass what is called the UEB examination. That examination is set and examined by the Society of Apothecaries. Hitherto students who wished to take the examination were assessed by certain UK universities. Having been signed off by the local dean as satisfactory, students were permitted to take this examination. Passing it gave the students registration with the GMC to work in the UK.

The second method of being able to practise in this country is taking and passing what is called the PLAB exam. That examination is set and examined by the GMC and consists of a theoretical and practical examination. In addition, all doctors applying for limited registration with the GMC must have obtained a satisfactory score, as I described earlier, in the academic modules of the IELTS.

The UEB examination in its present form will be changed dramatically. It will not, it now seems, be applicable to St George's students. All students from St George's have been told that in future they will have to take the IELTS and PLAB examinations in order to practise medicine in the UK.

So the spotlight then turns on to PLAB and the requirements for taking that exam. Older, traditional Commonwealth universities whose students have automatically received full registration in the UK include countries like South Africa, Australia and New Zealand, and the University of the West Indies. They were not required to take the PLAB exam. But the GMC has intimated that it wishes to discontinue with this so-called "elite" group of universities to level the playing field, so that overseas applicants who wish to work in this country will all have to take the PLAB examination.

It seems rather topsy-turvy to get rid of this group. One may not think that it is appropriate to have a specific elite group of universities drawn from a very narrow group of traditional universities, but we on these Benches, together with St George's University, feel that the standard of medicine as taught by the medical school at St George's is such that it is at least equal to this élite group.

Instead of disbanding that group as giving automatic exemption from PLABs, it should be increased so that a number of international medical schools with sufficiently high standards, as approved by the GMC, are able to gain full registration. The reason is that we have an acute shortage of doctors in this country. The Government are trying to increase the number of medical school places but that will take time. Meanwhile, 10,000 new GPs are needed and another 7,500 home-grown consultants by 2004—the Government's target. All that the Government are doing in recruiting consultants abroad will not plug the gap. To meet present contractual arrangements, an extra 3,500 physicians are needed at this moment— which does not include any consideration of the working time directive.

Along with other medical schools world-wide, St George's University School of Medicine has the capacity and expertise to train UK students who are unable to start training, perhaps because of a lack of available slots in the United Kingdom. It seems sensible to bring some order to the process whereby UK students do not have to take the IELTS and the PLAB if their medical school is of a sufficient standard. I hope that the Minister will consider the amendments, perhaps discuss the subject with the GMC and look favourably on the principles involved. I beg to move.

I realise that the noble Lord was talking beyond the European Union but I recollect serving on an inquiry about an EU directive which determined that while member states may have to accept individuals working in a particular profession, they may set the standards required. The list of qualifications to which Amendment No. 89 refers would exist for that purpose. Speaking English is obviously a requirement for anyone working in this country. Did not the GMC bring that aspect into the consultation?

The amendments are not directed at a UK citizen practising within the EU as regards PLAB but only as regards the IELTS.

But presumably a European Union citizen practising in this country would be affected by that directive.

The two amendments only relate to UK citizens, not to cross-border working by EU citizens outside the UK.

I apologise. I misunderstood.

I support the noble Lord's two amendments. I declare an interest as a member of the academic board of St George's University.

The noble Lord clearly explained the intricacies of British graduates returning to this country from medical schools overseas. In the past, I have been associated with the University of the West Indies. Graduates from that university's medical schools on three islands can come to this country without let or hindrance in many ways. It is anomalous that graduates of a school in Grenada of equal quality cannot do so.

By virtue of the fact that we are short of medical graduates, one could at the stroke of a pen increase the number available and the number going for training. St George's is already set up. If the amendments were carried, it is likely that a greatly increased number of British graduates would take a medical degree at St George's University.

I remind the Committee that the medical programme at St George's is to take the pre-clinical and some of the para-clinical teaching in Grenada. Then the clinical students are farmed out to selected clinical departments in the United States and this country. There is of course a tendency for the United States students to go to the US and for the British students to come here. When graduation takes place, we have British graduates who have been trained at clinical level in British medical schools. Consequently, they are entirely familiar with medical issues, programmes and problems in this country. Such a development would certainly be convenient to the medical profession in terms of supplying well-trained graduates for our health service.

I support the noble Lords, Lord Clement-Jones and Lord Soulsby. I am confident that my noble friend the Minister is aware of concerns that the provision in question exists for one purpose only—to discriminate unfairly against individuals who obtain their medical degrees outside the so-called white Commonwealth. I understand that the GMC is concerned about that distinction at a time when we freely speak about globalisation. I trust that my noble friend the Minister will undertake to look again at that suspect wording because I understand that the GMC would like the distinction abolished.

The amendments raise interesting and important issues in the context of the NHS seeking to ensure an adequate number of trained professionals.

It has been recognised in statute for some years as right and necessary that the GMC should satisfy itself about the English language ability of a person who qualifies in medicine overseas. The only exception is our treaty obligation to our European partners to allow freedom of movement by EU nationals. That does not mean that a French doctor would be able to practise in the UK if his English language skills were poor. He would have a right to register with the GMC but it would still be perfectly possible for a health authority or health trust seeking to employ such a person to satisfy itself that he was suitable by having adequate fluency in English. We need not be fearful that the measure is leading to something grossly inappropriate.

To be fair to all who apply for registration, it is right that the GMC must have a rule of some kind and that it should have as few exceptions as possible. For example, the rule should apply also to people who are British citizens. One can imagine cases where a British citizen emigrated at a young age and may not have the facility in English needed to be a doctor in this country. The GMC wants to be as helpful as possible, both to be fair and because it appreciates the value to the UK of people with overseas qualifications who want to work here. While we do not think that the amendment is the right route, it may be helpful to get the GMC to reconsider how it satisfies itself under its obligations of English language ability. The standard test may not always be necessary, but that is a matter of GMC policy rather than law. I understand that the GMC will follow carefully today's debate and take from it lessons for consideration.

The new clause is also wrong to confine itself to people wanting to work in the NHS. There should be one standard for registration, regardless of a person's intended employment in health professions. So while I cannot support the amendment, II understand the sentiments that motivate it and hope that a solution can be found as I have suggested. If the Government were persuaded in future, in the light of fuller consideration by the GMC, that a change in the law was necessary, an order under Section 60 of the Health Act 1999 would provide an appropriate vehicle.

The noble Lord, Lord Clement-Jones, is correct to say that there is no legal requirement for a British citizen to take a language test. The Act requires that the registrar of the GMC is satisfied that applicants—including British citizens, unless they have EU rights—have the necessary knowledge of English. The test itself is not a requirement of the Act.

The noble Baroness, Lady Carnegy, raised the issue of the directive. We think that it is probably the directive on the mutual recognition of medical qualifications. No, it is not. We shall keep searching.

I am sorry for raising the matter without having checked it. I thought that it might be helpful to ensure that the Government had considered that in replying to the amendment. I am sorry if I have wasted the Committee's time.

We shall have a further opportunity to reflect on that and, if appropriate, give a subsequent answer. We will of course need to check the specific relevance to the issues we are discussing today.

Amendment No. 89 is also unnecessary. It would compel the GMC to maintain a list of recognised overseas qualifications. As the Committee will know, the GMC already does so and I am unaware of any case in which people seeking a registration or wanting to check a doctor's registration have had any difficulty getting the GMC to share the list with them.

However, this is a good point at which to say something about the substantive issue of recognised overseas qualifications, which several. Members of the Committee have raised. There have been concerns that provisions of the Medical Act 1983 discriminate unfairly against those who obtained their medical degrees outside the so-called white Commonwealth. My noble friend Lady Howells was clear on that point. The GMC would like that distinction abolished and, broadly speaking, we share its view. It proposes—and we support it—to abolish the status of recognised overseas qualification that degrees from 22 universities currently hold. Graduates from those universities will then be in the same position as those from the hundreds of other institutions world-wide whose medical courses are recognised by the World Health Organisation. They would have to demonstrate their competence at the point of registration—as do graduates from the United States or, say, India, currently.

The Government, in the light of the GMC's consideration, will use the next suitable Section 60 order to make the necessary amendments. Discussions with the GMC have already begun on that, and we plan to lay the order before Parliament later in 2002 after full consultation in the normal way.

Some important points were raised about St George's. My noble friend Lord Hunt recently met representatives of St George's Hospital and a group of hospital friends in the UK. He has asked departmental officials to consider the issues raised. He recognises the potential and quality of the medical education at St George's. While the Government's approach is not exactly the same as that proposed by the noble Lord, Lord Clement-Jones, in Amendment No. 89, we feel that it is an appropriate manner in which to proceed. It will ensure that there is no unfair discrimination and that suitably qualified medical people are able to practise in the UK. I urge the noble Lord to withdraw the amendment.

Before the Minister sits down, perhaps I may ask him whether the provision includes doctors from South Africa.

I am fairly certain that the system that I described would apply to doctors from all around the world, and would therefore include those from South Africa.