My Lords, I have to notify the House, in accordance with the Royal Assent Act 1967, that the Queen has signified her Royal Assent to the following Acts:

• Consolidated Fund Act 2001,
• Capital Allowances Act 2001,

Alliance Leicester Group Treasury plc (Transfer) Act 2001,

Colchester Borough Council Act 2001.

asked Her Majesty's Government:

What is their estimate of the income received by Iraq in respect of exports of (a) oil and (b) raw materials and foodstuffs, during the last three years.

My Lords, in the past three years legal oil exports have earned Iraq approximately 40 billion dollars. This revenue is controlled by the United Nations. We estimate illegal oil exports were worth a further 600 million dollars last year. The UNSCR 661 prohibits the export from Iraq of other raw materials and foodstuffs. However, we are aware that Iraq does export those goods, despite claiming that the UN's humanitarian programme does not provide for the basic needs of the Iraqi people. We have no figures for the income generated by this illegal trade.

My Lords, I thank my noble friend the Minister for that reply. Does she agree that those who condemn sanctions, or the no-fly zone, should appreciate that, even with those sanctions, Iraq could have fed its children, treated the sick and secured a much higher level of general prosperity? However, it has chosen instead to maintain armed forces comprising almost 1 million personnel, which is far in excess of the level that would be appropriate for a country with a population of 21 million people. Indeed, it has provided a plethora of presidential palaces, and pursued the development of horrid weaponry that can only threaten international and regional stability.

My Lords, I agree with my noble friend that that is the position. Sanctions are not responsible for the suffering of the Iraqi people; Saddam Hussein is. The UN humanitarian programme is worth billions of dollars per year, but Iraq manipulates and obstructs the programme to deny the Iraqi people maximum benefit. I shall give your Lordships one example. Over 4 billion dollars is currently available to Iraq for the purchase of vital humanitarian goods. That money lies unspent in a UN account.

My Lords, although agree with the Minister and the noble Lord, Lord Hardy, that there is no question about the possibility that Iraq could meet many of the needs of its civilian population, does the noble Baroness recognise that in moderate Arab capitals the propaganda argument is largely being lost? I was in Jordan two days ago. It was quite clear there that the view is that sanctions are the responsibility of the Western powers. Can the noble Baroness tell the House what is the position of Her Majesty's Government towards the review of sanctions, with a view to moving towards smart sanctions specifically against the Iraqi regime" Can the noble Baroness also tell the House why some 3 billion dollars-worth of humanitarian contracts have been held up by the UN Sanction Committee's SCR661?

My Lords, perhaps I may stress that we wholeheartedly understand what the noble Baroness says in relation to the propaganda argument. It is a matter of shame that those who have propagated that do not relay the correct facts. From all the information available to us it is clear that Iraq could feed its people. The medicines are available, but Saddam Hussein is choosing not to avail himself of that aid.

In relation to smart sanctions, I can tell the House that the sanctions regime is already targeted at military and other issues that are destructive. The food for oil programme was meant to do precisely what the noble Baroness suggested; namely, to allow humanitarian aid through so that the Iraqi people do not suffer. We shall continue to pursue that policy. The noble Baroness also referred to hold-ups in this respect. We have been clear in our approach to ensure that those matters are dealt with smoothly and swiftly. As for our participation, I can certainly reassure the House that we are doing everything that we can to make sure that we are not the problem. Indeed, I can further reassure the House that we are not the problem: Saddam Hussein is.

My Lords, does the Minister accept that we strongly support, the sentiments just expressed by the noble Lord, Lord Hardy, and, indeed, reinforced by the noble Baroness herself? It is clear that stronger and more effectively targeted sanctions are needed against this evil man who is depriving his own people of both medicine and food. What chance does the noble Baroness see of us persuading our French allies and partners of the same view? Is not the problem the fact that, when it comes to the common foreign and security policy, France regards the current situation quite differently, as it does in regard to Zimbabwe and as it does, apparently, in NATO? Is it not time to try to reinforce the CFSP, or, alternatively, should we just give up on the matter?

My Lords, I hear what the noble Lord says in relation to the attitude adopted by France. However, I should remind the noble Lord that the current UN sanctions are adhered to by everyone. It is our common position that the UN sanctions should bite on Iraq. To the best of our knowledge and belief, all our partners are adhering to that line. I know that it is an issue as to whether there should be further review on the matter. Noble Lords will not be surprised to know that this is often a matter of discussion. Nevertheless, I should reinforce the fact that the current regime is working. It is controlling Saddam Hussein; it is preventing him from using weapons of mass destruction; and it can facilitate proper humanitarian aid if he chooses to avail himself of it. That is something about which both we and our partners are in agreement.

My Lords, can the Minister confirm that in 1988 Saddam Hussein's regime earned 18 billion dollars of oil revenue and spent 13 billion dollars on weapons? Can she also confirm that, in 1998, Iraq earned 16 billion dollars and ordered no medicines at all? Therefore, given the inadvisability of lifting military sanctions, does the Minister agree that the time is ripe to take the distribution of food and medicines, and their ordering, out of the hands of the Baghdad regime and to place them in the hands of a neutral body, such as the United Nations or the Red Cross/Red Crescent movement?

My Lords, I agree with the factors raised by the noble Baroness in relation to the way in which Saddam Hussein's regime has, historically, spent its money. I also know that there is a very active debate as to how sanctions could be reviewed. At present, the sanctions will remain as they are. However, I can certainly reassure the House that those discussions will continue. I daresay those issues will be considered by all of us to ascertain how we can better manage the situation.

My Lords, when replying to the debate on the humble Address at col. 350 of Hansard of 12th December 2000, my noble friend Lady Symons of Vernham Dean, in answer to a specific point that I made in my speech, said that,

"we support the efforts by the World Health Organisation to work with the Iraqis on a proper study"—

of the apparent epidemic of leukaemia, other cancers and birth defects that are, perhaps, due to the use of depleted uranium in southern Iraq. Can my noble friend report any progress on organising this important, overdue study?

My Lords, we understand that the World Health Organisation is considering a report into the health situation throughout Iraq. We should encourage any initiative to tackle the lack of detailed information on the subject. Only then can any particular health problems be addressed. We therefore encourage Iraq to cooperate with the WHO on the issue. There is no credible research data to support allegations that the use of depleted uranium-based ammunition is to blame for the upsurge in cancers throughout the Iraqi population.

asked Her Majesty's Government:

What is their response to the recent report by the Chief Inspector of Prisons on H M Young Offenders' Institution, Brinsford.

My Lords, in accordance with the protocol agreed between Ministers and the Chief Inspector, the Prison Service will produce an action plan addressing the report's recommendations within 30 working days of its publication.

My Lords, I am grateful to the Minister for that degree of reassurance. But, of course, only three weeks after finding Brinsford "quite disgraceful" the Chief Inspector had to look for even more dire epithets for Birmingham Prison. So would the Minister join with me in congratulating the Chief Inspector, Sir David Ramsbotham, on so resolutely exposing bad practice wherever he finds it, for example the fact that getting on for two-thirds of the 500 youngsters in Brinsford get no education or training at all? Does he perhaps connect this with the equally startling fact that the per capita spend on education and training at Brinsford is less than one-third of that at YOI Werrington which is only half an hour's drive in the same county?

My Lords, of course we take great note of the inspector's reports which are most valuable. They provide a pathway to improving the quality of regimes in the prison estate. Obviously Brinsford must improve. Having met the governor of Brinsford today, I am most heartened by the progress that has been made since the inspector's report of last summer. While last year there were 17 hours of purposeful activity per prisoner per week, there are now 25.6 hours. While there were criticisms of juveniles and young offenders being in mixed living units, there is now no mixing of juveniles and young offenders. While last year at the time of the visit 65 attended education per day, there are now 140 attending education per day. While last year the auditor criticised education provision, the audit in February of this year stated that educational provision was acceptable. There were problems at the time of the inspection. We have a vigorous and active governor in place. He is addressing the many issues raised in the 154 recommendations of the inspector's report. We expect, and are seeing, some improvements.

My Lords, is it not the case that not so long ago, in order to reassure everyone about the state of the youth estate in the Prison Service, there was appointed a head of the Young Offenders' Group? In the foreword to the report we now discover that that influential person has no executive authority whatever and does not even report to the Director General of the Prison Service. Similarly, today the Minister has asked us to be reassured by the prospect of an action plan. But is the noble Lord aware that the contents of that action plan will reflect in some detail what has been produced in action plans following similar inquiries for Feltharn, Glen Parva, Werrington and Portland? There really is need for a central figure in the system with authority and responsibility to discharge our duties under human rights conventions, the United Nations convention on the child and the provisions of the European Treaty to defend our children in what is becoming a generally abusive system.

My Lords, I congratulate the noble Lord on his considerable support for our system. I also congratulate the noble Lord on taking—

Oh!

My Lords, the noble Lord has a record in regard to the prison estate and in particular the youth offender estate. Of course we recognise that there are problems. The reports to which the noble Lord referred bear good testament to that. We inherited a pretty poor level of investment—

Oh!

My Lords, that happens to be the case. When we came into government there had been significant under-investment in the educational and training side of the prison regimes. We have had to put that right. I am delighted to tell your Lordships' House that record numbers of qualifications are now being attained in our prison estate and, of course, within the youth offender estate. Those matters needed to be addressed. Over the past year there has been a 10 per cent increase in the number of teaching hours delivered. I think that we should celebrate and be proud of that. Noble Lords opposite who shake their heads ought to be ashamed of some of their records during their time in office.

My Lords, is the Minister aware that nearly 50 per cent of the children in YOIs are either still in local authority care or have come out of local authority care? Will he ensure that the new provisions under the Children (Leaving Care) Act will apply to those children and that they will receive all the new benefits that are now being made available to other children leaving care?

My Lords, the Youth Justice Board has done an outstandingly good job and has begun to raise standards for juvenile offenders. Juvenile offenders are beginning to receive record levels of education and training. That is most important. Of course, we must be very mindful of the standards of care in the local authority sector and ensure that they are matched, perhaps exceeded, in the juvenile offender sector.

My Lords, is the Minister aware that his self-satisfied response to the recitation by the noble Lord, Lord Elton, of the five successive severely adverse reports by the Chief Inspector is deeply offensive to your Lordships? Will the noble Lord say which of the 23 recommendations made by the Chief Inspector in the thematic review of young offenders' institutions of October 1997 have been implemented and whether or not in particular a chief inspector has been appointed to monitor the treatment of children throughout the youth justice system which is so necessary?

My Lords, I do not dispute the necessity of ensuring that standards within our estate are raised. I should like to have had advance notice of the noble Lord's second question, but I am certainly more than happy to give it detailed consideration. As regards the noble Lord's first point, I am not self-satisfied about conditions in the prison estate, whether those concern juvenile offenders or young offenders. We know that there is much more to do. That is why we raised the level of investment as a result of the spending review that was undertaken last year. There is more to do and more to get on with. What we should try to do is build on the strengths that are apparently there.

My Lords, will the noble Lord answer my original question? When will we have an individual in the Prison Service with executive authority reporting directly to the Director General?

My Lords, I shall write to the noble Lord on that precise point.

asked Her Majesty's Government:

How they intend to ensure that. the recommendations contained in the report of the working group on football disorder are implemented.

My Lords, the report of the working group on football disorder identifies the key agencies in respect of each of the 54 recommendations. The Home Office will monitor progress and will convene meetings with all agencies concerned on a regular basis. We also intend to hold regional seminars involving all the key players—if that is not a pun—including the fans.

My Lords, in thanking my noble friend for that reply, may I as a veteran of numerous inquiries, task forces and working groups looking at football disorder over the years pay tribute to my noble friend and his officials in the Home Office for the leadership they gave, the expeditious way in which this inquiry was conducted and the fact that it managed to come to an agreed set of conclusions in under six months? Does my noble friend agree with me that two of the most important recommendations are, first, that the Football Association has agreed to disband the existing England Members Club and intends to relaunch it with the exclusion of people who have records of violence or racist activity? That is a significant step forward in dealing with the problems of the England team travelling overseas. Secondly, will he confirm that it is the Government's intention that the involvement of supporters will be maintained in the implementation of the remaining recommendations?

My Lords, I am grateful to the noble Lord for his kind words about my stewardship of the working group. As regards the recommendations, the agreement of the Football Association to take apart the England Members Club and reconstitute it with much improved standards of membership is a significant improvement and recommendation which we should all welcome. The England Members Club needs to reflect much more broadly our wider society. It ought to be more multiracial and to reflect the broad range of interests that now support English soccer. As to consultation with supporters' organisations, that was, and will continue to be, a key feature of the implementation of the report.

My Lords, will the Minister tell us what has happened to the idea of an American style soccer commissioner to drive through reforms in the game? Will he also take this opportunity to disassociate himself from the absolutely barmy idea of the Minister of Sport to bring back terraces to football grounds, which would be a recipe for further hooliganism?

My Lords, I understand the nature of the controversy over terracing. I believe that the situation that we have developed in our football grounds over the past decade or so, with an increasingly larger number of all-seater stadia, is greatly to be welcomed and has made a major contribution to the reduction of hooliganism and violence in our football grounds. Reflecting on the statistics, it appears that this year the number of arrests has fallen, as it has over the past decade or so, and that is to be welcomed.

With regard to the idea of an American style commissioner, although I am not sure that that is how I would describe it, I believe that there would be some merit in that approach. Nevertheless, that is not necessarily a matter for me; it is a matter for wider debate in the sport itself.

My Lords, does the Minister recognise the warm welcome that will be given to this report throughout the football industry by supporters, clubs and football organisations for the thoughtful and long-term view that it takes of the problems? Meanwhile, will the Minister tell the House how many orders to date have been made against individuals under the Football Disorder Act? Secondly, will he assure the House that all necessary arrangements will be in place for the three away international games that England has in the World Cup during the course of this year?

My Lords, I am again grateful for the noble Lord's support for the report. I hope that the report will be widely welcomed by supporters' organisations. We certainly intend to work very closely with them.

I do not have precise figures for the number of orders made under the legislation that we put in place last year. However, I understand that approximately 40 such banning orders are in place. The police believe that they have played an important part in curbing the attendance of those intent on hooliganism at away matches involving English clubs in European competitions and, of course, the England side itself. We believe that the legislation has had a salutary effect and will continue to do so. It will be kept under review as per the requirements of the sunset clauses.

With regard to the policing of future international matches that take place abroad, we are in close contact with the countries against whom we shall be playing. I recently visited Germany to look at the arrangements that are likely to be in place for the England v Germany match in September. As a product of that visit, we shall no doubt make a number of suggestions which I believe will necessarily improve the level of security for that match.

My Lords, I understand that a Written Answer was recently provided on the number of orders. With regard to the matter of terracing, was the Minister or the Minister of Sport expressing the Government's view?

My Lords, I was expressing my own view, which also happens to be the view of the Government.

asked Her Majesty's Government:

What are the new initiatives in the White Paper Valuing People: a new strategy for learning disability for the 21st century (Cm 5086), and what extra funds are available to underpin it at local level.

My Lords, the new strategy for learning disability for the 21st century sets out proposals for improving the life chances of people with learning disabilities. A new learning disability development fund of up to £50 million per year is being set up to support the proposals in the White Paper for adults. There will also be an implementation support fund of £2.3 million per year for three years from April 2001 to provide central support for key aspects of the new strategy.

My Lords, I thank the Minister for that helpful reply. I also thank the Government for a most helpful and far-reaching White Paper. I commend it to your Lordships' House as ideal bedside reading!

Perhaps I may ask the Minister to turn to page 125 of the White Paper. Sub-objective 4.1 refers to proposed performance indicators in regard to short-term breaks. Will the Minister confirm that if the proposed performance indicator indicates a shortfall, as I am sure it will, steps will be taken to make good that particular shortfall?

My Lords, I am grateful to the noble Lord, Lord Rix, for that question. I am sure that the House would wish to acknowledge his contribution to this field over many years. In many ways, I feel that this White Paper represents the culmination of that dedication.

With regard to the question of performance indicators, if we are to make a success of the White Paper, it is very important that targets are set and that a performance management framework is in place to ensure their implementation. We shall ensure that that happens.

As far as concerns resources, it is worth bearing in mind that, between health and local government, approximately £3 billion is spent on the provision of services for people with learning disabilities. Part of the answer to the problem is to ensure that those resources are used effectively. In addition, I believe that the development fund that we have announced will greatly help in encouraging local statutory agencies to develop the kind of services that the noble Lord has in mind.

My Lords, in accepting what the noble Lord, Lord Rix, has said, I ask the Government to bear in mind that many children with learning difficulties who go to mainstream schools are unhappy, some are bullied, and their presence sometimes interferes with the education of normal children. Will the Government therefore ensure that the needs of those who require special education are met, whenever possible, by their attendance at schools with special educational needs facilities?

My Lords, that is a little outside my area. However, I certainly agree that paramount to any decision about education are the needs of individual children and the wishes of their parents. The Special Educational Needs and Disability Bill makes changes to the existing law to strengthen the right of children with special educational needs to be educated in mainstream schools. But I can tell the noble Lord that, although the proportion of pupils in special schools fell from 1.3 per cent in 1991 to 1.2 per cent in 1995, it has remained constant in each of the past six years. I can assure the noble Lord that the Bill does not make it more difficult for parents whose children have statements of SEN to gain a special school place.

My Lords, I am very impressed by this thoughtful, sensitive and wide-ranging White Paper. It reflects great credit on the Government. I should like to add my congratulations to my noble friend Lord Rix and to Mencap for the work that they have done over the years. But would my noble friend agree that special educational needs services are ultimately delivered by local authorities, some of which are good, some of which are appalling? Although the White Paper states that an inspection will take place in 2001–02, will my noble friend assure the House that regular monitoring will take place to ensure that those services are delivered to the people who need them?

My Lords, I agree with my noble friend that the record of statutory agencies is at the moment patchy. There are some very good services, some excellent committee people, and some services that are not so good.

I believe that the most important building block in the development of this policy is the proposal to develop what are called learning disability partnership boards at local level. The aim is to bring together statutory and voluntary organisations to give the necessary impetus to implement the effective provision of services. That will be backed up by our performance management arrangements in the health service and the performance assessment arrangements in social services to ensure that it happens properly.

My Lords, does the Minister recognise some of the concern that has been caused to people with Asberger's and their carers by the way in which learning disability is defined in the White Paper? Many people with Asberger's get their support from learning disability services. Can he guarantee that they will continue to be able to get their support from learning disability services until there are specialist support services for them?

My Lords, it is important that people with Asberger's get the right help and support. The noble Lord is right that they are not covered by the definition used in the White Paper. It covers those with autism who also have a learning disability, but not those with a higher level autistic spectrum disorder. The noble Lord will be glad to know that we have commissioned a report from Cambridge University on the issues surrounding Asberger's syndrome. We shall consider its recommendations and I shall write to the noble Lord when the outcome is known.

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.)

In calling Amendment No. 161, I point out to the Committee that if it is agreed to I cannot call Amendment No. 162.

moved Amendment No. 161:

Page 18, line 16, leave out from "services)," to end of line 18 and insert "in subsection (4), for the words "not, except in special circumstances," there is substituted "have regard to the quality and outcome of the services provided and shall not ordinarily""

I understand and sympathise with the thrust of the noble Earl's comments. The Committee will know from my remarks during earlier Committee days that we are working with the profession and its representatives to produce a revised national GP contract. We want to reflect the emphasis on quality and improved outcomes, which form a key feature of the locally agreed personal medical services contracts. Our aim is to secure greater convergence between the two contractual frameworks, which will build on the best of both approaches.

There is the prospect of significant progress on the way in which GPs work for the NHS. Initial discussions have begun with the BMA to scope the work. Those discussions have been constructive and there has been an encouraging start in addressing a major challenge for both parties.

Clause 24 contributes modestly to that task by removing an unnecessary statutory impediment to progress. That makes me reluctant to accept the amendments, which would impose constraints, specifically by providing that the remuneration of GMS GPs should be linked to quality and outcomes of service and should not consist wholly or mainly of a fixed salary. While that is in line with the aim in the NHS Plan to link GPs' remuneration more closely to improved quality and outcomes—I very much agree with the noble Earl on that—my worry is that using legislation would create a constraint that might be unhelpful in discussions and negotiations. We want to work with GPs and their representatives to revise the national contract. That is the best approach.

Amendment No. 161 would also require that if a fixed salary was paid, it should be referenced to the number of patients. Amendment No. 162 would ordinarily prevent wholly or mainly fixed salary payments. It is true that no GPs in the GMS are on a fixed salary and we have no plans to introduce such a category, but we do not want to rule out that possibility for all time. We are concerned about the constraints that the amendment would put in place.

I hope that the noble Earl recognises that we strongly agree with the thrust of what he said.

I entirely accept the Minister's point. The BMA's attitude to the general direction in which the Government are moving is based on the belief that it is helpful to make GPs' contracts more dependent on quality by making it easier to reduce list size. That is also fairer to GPs who necessarily have a low list size, such as those in rural areas. The Minister has given a useful answer and I beg leave to withdraw the amendment.

moved Amendment No. 163:

Page 24, line 5, at end insert—

"(2BC) Regulations made by virtue of subsection (2BA) shall not have effect unless the Secretary of State has consulted any person appearing to him appropriate to consult as representing the profession subject to the regulation.""

I certainly take the point that consultation with the appropriate groups would normally be expected to take place. I can assure the noble Earl that we shall consult as necessary. I do not believe that it is necessary to set that out on the face of the Bill, but I can assure him that, so far as concerns the Department of Health, consultation is the name of the game. With regard to many of the matters that we are discussing in the Bill, it is essential to implement ownership among all the people involved.

I also understand the point that the noble Earl raises in relation to variability between different health authorities. I understand why his amendment requires that the imposition of conditions by health authorities—for example, when conditionally including a practitioner in a list—must be carried out with a view to preventing local variability in criteria for inclusion in the list.

I want to make it clear that it is the responsibility of health authorities to make decisions conditionally to include a practitioner in a list. It is absolutely right that that responsibility is placed at health authority level. I can assure the noble Earl that the department will issue guidance to all health authorities in order to facilitate consistency in their decision-making. Again, I very much accept that point. The FHS Appeals Authority will also have a role in ensuring consistency of decisions between health authorities.

As with all the issues that we have discussed so far, clearly a tension exists between the aims of devolving responsibility and ensuring consistency. Both are important. Sometimes the noble Earl, Lord Howe, wishes us to decentralise; perhaps more than occasionally he wishes us to centralise. A problem arises when we become over-centralist and over-prescriptive. I hope that the Committee will consider that we probably have the balance right in relation to this matter, particularly in view of the safeguard that we shall give guidance to health authorities and in view of the fact that the FHSAA, through its judgments over the months and years, will itself clearly ensure consistency.

The Minister must have his little jibe. I take the point. Nevertheless, he has given a helpful answer, and I beg leave to withdraw the amendment.

moved Amendment No. 165:

Page 24, line 36, at end insert—

"( ) If regulations provide for a practitioner's removal from the list for breach of condition—

(a) the regulations may provide that he may not withdraw from the list while the Health Authority are investigating whether there are grounds for exercising their power to remove him, or after the Health Authority have decided to remove him but before they have given effect to that decision; and

(b) the regulations must include provision—

(i) requiring the practitioner to be given notice of any allegation against him,

(ii) giving him the opportunity of putting his case at a hearing before the Health Authority make any decision as to his removal from the list, and

(iii) requiring him to be given notice of the Health Authority's decision and the reasons for it and of his right of appeal under subsection (4)."

moved Amendment No. 166:

Page 24, line 37, leave out "do so provide" and insert "provide as mentioned in subsection (1)".

moved Amendment No. 167:

Page 24, line 42, at end insert

"(ca) on any review of an earlier such decision of theirs,".

moved Amendments Nos. 168 and 169:

Page 25, line 2, at end insert ", and must so provide in relation to a decision referred to in subsection (4)(d)".

Page 25, line 2, at end insert—

"( ) Regulations under this section may provide for the disclosure by a Health Authority, to prescribed persons or persons of prescribed descriptions, of information of a prescribed description about persons whose inclusion in the lists referred to in subsection (3) is subject to conditions imposed under this section, and about the removal of such persons from such lists for breach of condition."

moved Amendment No.170:

Page 25, line 12, after "practitioner" insert "who".

I point out to the Committee that, if Amendment No. 171 is agreed to, I cannot call Amendment No. 172.

moved Amendment No. 171:

Page 25, line 43, leave out from "about" to end of line and insert—

"(a) financial interests;

(b) gifts above a prescribed value; and

(c) other benefits received."

I am grateful to the Minister for explaining the amendment. To speed things along, I shall ask him three quick questions. I also want to make it clear that we agree with his comments on transparency, as long as that system is not too bureaucratic—that is very important. What are the Government's intentions in relation to the recording procedure and the level of gift that has to be declared? Is it £125? What are their intentions in relation to the level of bequests that have to be declared? Does the Minister intend that the identity of the donor should be revealed to the health authority? If so, what steps does the Minister intend should be taken in order to seek the consent of patients before disclosure takes place? Some patients may not wish such information to be conveyed to third parties.

I accept the spirit of the noble Lord's amendment. Our legal advice is that the amendment is ambiguous about whether the financial interests mentioned in Clause 30 are also, as well as being gifts, to be subject to the phrase,

"above a specified value".

In order to give effect to the noble Lord's amendment, we have tabled four amendments—Amendments Nos. 171, 177, 179 and 180—to achieve what he intended and to extend the provision to the other three practitioner professions.

Opposition Amendment No. 176 repeats the question that was raised by the noble Lord about the figure that will be agreed. The suggestion is that it should be £140, in order to be consistent with the ministerial code. We are not going to go down that route because we believe that it is better for doctors to be treated in a manner that is consistent with that which applies to other NHS employees.

The guidance to which I referred in relation to commercial sponsorship provides that all gifts over £25 must be declared and that below that level, if gifts from a similar source aggregate to a value of more than £100 in a year, they should be declared. We are also looking at existing NHS guidance in relation to patient gifts. It is well known that in that context the figure of £25 has been mentioned in discussions with the BMA in recent months. However, the figure has not been finalised so I cannot give a definitive response to the noble Lord.

I understand the noble Lord's point on reporting and bureaucracy. We want the system to be as unbureaucratic as possible. It is not my understanding that that information would be published in the public domain, but a report would be submitted to the health authority. A balance is needed in that context. I understand that no one wants to inhibit the giving of small gifts as a token of appreciation. Equally, we have to ensure that the proper procedures are in place and that they are consistent.

I understand that the question of bequests has been raised. The Bill's provisions are currently wide enough to allow the regulations to deal with that issue. We assume that the level of bequests should be the same as that for gifts.

moved Amendment No. 174:

Page 26, line 3, at end insert "or personal medical services"

The part of the 1977 Act to which the amendment relates deals specifically and only with the declaration of financial interests and gifts by general medical services practitioners. That is why clause 30 provides for General Practice Committee consultation rights with respect to declarations about financial interests and gifts. We have every intention of mirroring for personal medical services and personal dental services the regulations on financial interests and gifts, as they apply to general medical services.

A PMS implementation group has recently been established, which represents all the professions involved in PMS. The GPC has membership of this group.

I am most grateful to the noble Lord. I beg leave to withdraw the amendment.

moved Amendment No. 177:

Page 26. line 7, leave out from "about" to end of line and insert—

"(a) financial interests;

(b) gifts above a prescribed value; and

(c) other benefits received.

moved Amendments Nos. 179 and 180:

Page 26, line 15, leave out from "about" to end of line and insert—

"(a) financial interests;

(b) gifts above a prescribed value; and

(c) other benefits received."

Page 26, line 22, leave out from "about" to ", and" in line 23 and insert—

"(i) financial interests;

(ii) gifts above a prescribed value; and

(iii) other benefits received.""

moved Amendment No. 181:

Page 26, line 35, after "services," insert "personal medical services,"

I am grateful to the noble Earl, Lord Howe. His amendment is well-intentioned, but unnecessary. We have made it clear that supplementary lists are needed to ensure that all practitioners in the family health service professions are included on lists, so that they can be properly regulated. This is important because existing health authority lists apply only to those principal practitioners approved to provide and perform their respective services—general medical services, in other words. Practitioners who assist these GP principals are therefore included in the supplementary list.

The approach in personal medical services is different. All doctors who work in PMS are regarded as PMS performers, so, consequently, one list is sufficient for all practitioners who work in and perform PMS.

In the context of other health care professionals, such as nurses, who assist in the provision of PMS, we believe that 'there are adequate mechanisms in place to regulate the performance of such persons, in addition to their own regulatory arrangements. The Secretary of State has to approve a PMS scheme and significant variations to the PMS contract. In addition, the commissioner, whether dealing with a health authority or a primary care trust, has a role in overseeing performance in the overall contract negotiation and performance management of a PMS scheme.

In the last resort, the Secretary of State has the right to terminate a PMS scheme. We intend to put in place similar approval and contractual arrangements and provisions for permanent schemes.

I thank the Minister for his answer and beg to ask leave to withdraw the amendment.

moved Amendment No. 182:

Page 27. line 31, at end insert—

"( ) Where a person employs a relevant practitioner who is included in the relevant supplementary list, that person may be confident of the suitability of the practitioner without making further enquiry.

( ) Exclusion from one Health Authority supplementary list does not automatically imply exclusion from all Health Authorities' supplementary lists.

( ) Under exceptional circumstances a practitioner may be allowed to practise whilst his application is being processed."

I am grateful to the noble Earl, Lord Howe. He has raised some practical issues, which it is important to clarify. It is accepted practice that when engaging a deputy or an assistant, the principal practitioner is responsible for ensuring that the person engaged is suitably experienced and qualified to undertake the tasks for which he is engaged. In applying to join a health authority supplementary list, a person's suitability and qualifications will be tested against a number of criteria. As the Committee would expect, those are factual issues such as the person's registration with the appropriate professional body, a criminal record check and a check on necessary qualifications. But I must stress that it is not a check on clinical performance or whether the person will be a good addition to the practice team. In the end, it will be for the principal practitioner to test those matters.

Not only is the test limited to factual issues, they are issues which are tested once on application. As a person moves between geographical locations, he may remain on the list for a number of years. So reliance on tests carried out on admission, even if they were widened to take account of clinical performance, might become unreliable.

I believe that the supplementary lists will ease some of the burdens of employment but they cannot take away all the responsibilities which rest with a practitioner engaging in the system.

We very much share the noble Earl's aim in relation to the second proposed subsection but we believe that the amendment is unnecessary. A decision by any health authority applies only to lists maintained by that health authority, whether it be a principal, supplementary or services list. Such a decision does not prevent an application to another health authority. We should expect the second health authority to consider the circumstances of the original removal in reaching its decision. But the second authority would be free to reach its own decision. So a national disqualification—that is, one which applies to all health authorities—can be applied only by the FHSAA. I believe that that meets the noble Earl's concern.

The third proposed subsection is very much a practical issue. I am sure that the noble Earl is right to say that many of those registered on a supplementary list will move from position to position across health authority boundaries—the point the noble Earl made. It would not be in anyone's interest to be unable to take up a position for which he was otherwise suitable because of some bureaucratic delay in the NHS or elsewhere. We recognise that and want to make the process as straightforward as possible. To work as an assistant in one GMS, a doctor will have to register on only one health authority list. That will qualify him to work across health authority boundaries in England. We believe that that better addresses the needs of a person who needs to move quickly to fill a position. However, it ensures that we continue to protect the public by ensuring that a person is properly registered on the supplementary list before he begins to treat patients.

We recognise also that some of the health authority checks before admitting a person to the list rely on third parties. For example, if a person declares an overseas regulatory body to the health authority but through no fault of that individual, the health authority has difficulty in obtaining confirmation, we shall seek to provide provisions which allow the person to be placed on the list while the confirmation is being actively sought. The individual would, however, still need to be on a supplementary list to provide family health services and we intend that the regulations will provide for that.

I am grateful to the Minister for that helpful reply, particularly as regards the second and third parts of my amendment. His answer on the first part took me rather by surprise. What he said was extremely interesting and certainly expanded my understanding of what is intended here. I shall read very carefully what he said and perhaps return to this matter at a later stage. I beg leave to withdraw the amendment.

moved Amendment No. 183:

Page 27, line 40, at end insert—

"( ) The imposition of such conditions must be with a view to—

(a) preventing any prejudice to the efficiency of the services to which the supplementary list relates; or

(b) preventing any acts or omissions of the type described in section 49F(3)(a) below."

moved Amendment No. 184:

Page 27, line 43, at end insert—

"( ) If the regulations provide under subsection (3)(e) or (4) that a Health Authority may suspend or remove a person from a supplementary list, they must include provision—

(a) requiring him to be given notice of any allegation against him;

(b) giving him the opportunity of putting his case at a hearing before the Health Authority make any decision as to his suspension or removal: and

(c) requiring him to be given notice of the Health Authority's decision and the reasons for it and of any right of appeal under subsection (6) or (7)."

moved Amendment No. 185:

Page 28, line 28, at end insert—

"(10) Before making regulations under this section, the Secretary of State must consult such bodies as he may recognise as representing persons who, in his opinion, are likely to be included in supplementary lists.""

I am happy to pay tribute to the role of practice nurses. It has been very pleasing to see how their professionalism has developed. Perhaps the noble Earl will clarify for me that his amendment deals with whether nurses can be placed on these lists.

That was by way of an example. The purpose of the amendment is to require the Secretary of State to consult the relevant professional representative body, the problem being that the clause makes no specific mention of which professionals will be included. I was really probing the Government as to whether, for example, practice nurses might be included in the regulations.

I am grateful to the noble Earl. The position is that practice nurses do come within the ambit of this clause but at the moment, we have no proposals to list nurses or nurse practitioners.

As regards the specific issue of consultation, the noble Earl will know that I am very reluctant to be drawn to lists or to be too specific. But I assure the noble Earl that we should be committed to very detailed consultation with the appropriate bodies. I have made that clear throughout the passage of the Bill.

I am grateful for that explanation and I beg leave to withdraw the amendment.

moved Amendment No. 186:

Page 28, line 45, at end insert—

"( ) a supplementary list, or

( ) a services list,"

I hope that I can reassure the noble Earl. The problem arises because we are seeking to amend the 1977 Act and on occasion the different lists appear to be treated in a different way. The words in parenthesis "but need not" are only included in the subsection in a technical capacity to amplify the word "may" which precedes them. The words are necessary to emphasise the fact that it may not be possible to duplicate exactly for supplementary and services lists every aspect of the removal and suspension regime that applies to main contractors under Clause 32. That is due to the fact that there are different contractual arrangements inherent in the various lists and that certain parts are not applicable. For example, Section 49H will not apply to persons on the supplementary list who will all be individuals.

As the Bill already makes provision for the removal and suspension regime in Clause 32 to apply to doctors on supplementary and services lists, I hope that the noble Earl will feel that the position is covered.

I beg leave to withdraw the amendment.

moved Amendment No. 187:

Page 29, line 19, at end insert—

"( ) In sections 29B, 36, 39, 42 and 43 the expression "grounds of unsuitability" means, in relation to each such person, grounds as would enable the Health Authority, or on appeal the FHSAA, to be satisfied that it is necessary for the protection of members of the public, is otherwise in the public interest, or is in the interest of such person, that such person is unsuitable for inclusion in the respective list, and elsewhere in this Act the word "unsuitability" shall be construed accordingly."

The Government's view remains as it was in the other place; that is, that "unsuitability" is properly capable of a wide interpretation and should be left so. We believe that there are precedents in other legislation—for example, in employment rights—and that any definition set out on the face of the legislation might constrain the consideration of health authorities inappropriately. The approach that we favour, and which we shall seek to adopt, is to set out in regulations the criteria which health authorities must consider, without preventing them from applying other criteria where the particular case warrants it.

I know that the BMA's GPC has been pressing for a definition of "unsuitability" on the face of the Bill. I am not unsympathetic to the thrust behind that. However, we believe that this is the wrong approach. Amendment No. 187 draws on wording from the order last year—the Medical Act 1983 (Amendment) Order 2000—which established the GMC's Interim Orders Committee with the power to make interim suspension orders and the circumstances in which a medical practitioner may be suspended and not disqualified. The definition which the amendment borrows defines the circumstances in which the GMC committee may suspend a doctor, not disqualify.

The substantive point I want to make is to distinguish carefully between the grounds for removal and those for suspension. Grounds for removal need to be broad enough to capture all the potential risks to patients or the NHS that might arise. The grounds for suspension need to be drawn more narrowly to protect the practitioner from inappropriate action by the health authority—at suspension, no case against him or her has been proven—but to allow the health authority to act quickly where it considers that there is a serious and immediate risk to patients or to the NHS.

In the context of suspension, the drafting of Amendment No. 187 is helpful in assisting to define the circumstances in which suspension may be appropriate. The drafting captures both the notion of risk to the patient and the wider risk to the NHS or the public good. The noble Earl is right to say that in Committee in the other place we promised to bring forward on Report an amendment based on the wording of a similar opposition amendment. That would set out the circumstances in which a health authority may suspend a practitioner. We made that amendment on Report. It appears at lines 32 to 35 of page 28, or as new Section 49F(1) of the 1977 Act as inserted by Clause 32.

I hope that I have answered the points raised. I believe that, in general, "unsuitability" is capable of a wide interpretation. But that relates to a system in which there are appeals to the FHSAA. I believe that there are sufficient safeguards alongside the advice and guidance we shall give in relation to the criteria to be issued to health authorities.

I am not entirely satisfied with that answer. It seems to me that there are two degrees of unsuitability. There is unsuitability because somebody is dangerous, either to himself or to patients, and unsuitability because the person is not up to the standard that the health authority might like. I believe that the issues need to be addressed separately, whether in the context of suspension or disqualification. My amendment would cover the situation on page 29, line 17 of the Bill, for example, which as I read it is not covered in the amendment tabled in another place on Report.

I do not want to detain the Committee on a matter of this kind. I shall read carefully what the Minister said and reserve the right to come back to this at a later stage. I beg leave to withdraw the amendment.

moved Amendment No. 188:

Page 31, line 35. leave out from beginning to end of line 40 and insert—

"(9) The Secretary of State may make regulations providing for payments to practitioners who are suspended.

(10) Those regulations may include provision for the amount of the payments. or the method of calculating the amount, to be determined by the Secretary of State or by another person appointed for the purpose by the Secretary of State."

moved Amendments 189 and 190:

Page 32, line 6, leave out "or" and insert "under subsection (5) or (6) or, if later,"

Page 32, line 26, after "FHSAA" insert ", or a suspension imposed under section 49J above"

moved Amendment No. 191:

Page 33, line 5, after "49G(3)" insert "or under subsection (5)(b) of this section"

moved Amendments Nos. 192 and 193:

Page 33, line 17, after "contingently," insert—

"(a)"

Page 33, line 20, at end insert "and

(b) the Health Authority may remove him from their list if they determine that he has failed to comply with a condition."

moved Amendment No. 194:

Page 33, line 36, leave out from "lists" to "prepared" in line 37.

moved Amendments Nos. 195 to 202:

Page 33, line 39, leave out "of individuals of the practitioner's description"

Page 34, line 11, after "(1)" insert "(a) to (c)"

Page 34, line 18, leave out "referred to in subsection (1)" and insert "from which he has been disqualified from inclusion"

Page 34, line 24, leave out "Except in prescribed circumstances" and insert "Subject to subsection (9)"

Page 34, line 29, at end insert—

"(9) The Secretary of State may provide in regulations for subsection (8) to have effect in prescribed circumstances as if the reference there to "two years" or "one year" were a reference to a different period specified in the regulations."

Page 34, line 42, after "49F" insert "or 49G,"

Page 35, line 20, leave out "corresponding to a practitioner"

Page 35, line 21, leave out "practitioner" and insert "person"

moved Amendments Nos. 203 and 204:

Page 36, line 49, at end insert—

"( ) The imposition of such conditions must be with a view to—

(a) preventing any prejudice to the efficiency of the services to which the services list relates; or

(b) preventing any acts or omissions of the type described in section 49F(3)(a) below."

Page 37, line 11, at end insert—

"( ) If the regulations provide under subsection (3)(e) or (4) that a Health Authority may suspend or remove a person from a services list, they must include provision—

(a) requiring him to be given notice of any allegation against him;

(b) giving him the opportunity of putting his case at a hearing before the Health Authority make any decision as to his suspension or removal; and

(c) requiring him to be given notice of the Health Authority's decision and the reasons for it and of any right of appeal under subsection (7) or (8)."

moved Amendment No. 206:

Page 37, line 23, at end insert—

"( ) In this section "perform" includes "provide"."

I have given consideration to what I agree is a well-intentioned amendment to extend the services list to include also providers of PMS and PDS as well as performers. The provisions of the current clause prevent that because subsection (1) of Section 28DA limits the persons to be included in the services list to medical and dental practitioners. Providers of PMS and PDS might be included by being on a medical or a supplementary list. However, it is inappropriate for providers, which include organisations such as NHS trusts and primary care trusts, to be included in such lists. For that reason I consider the amendment unnecessary.

There are adequate mechanisms in place to regulate the performance of the providers. I believe that I went through them previously. The Secretary of State has to approve a pilot scheme and significant variations of the PMS contract. Similarly, the Secretary of State has the ability to vary a term of a contract and the commissioner has a role in the overall contract negotiations and performance management functions. In the final resort the Secretary of State has the right to terminate a pilot scheme.

I am grateful for that answer. It is a fairly technical point and I would not want to press it. No doubt the BMA will find the Minister's comments helpful. I shall take its advice and, if necessary, return to the matter at a later stage. In the meantime, I beg leave to withdraw the amendment.

moved Amendment No. 207:

Page 37, line 23, at end insert—

"( ) After section 6(1) of the National Health Service (Primary Care) Act 1997 (making of pilot schemes) there shall be inserted—

"(1A) The Secretary of State shall, in making directions applicable throughout England regarding the implementation of proposals for plot schemes, consult such organisations as he may recognise as representing persons with whom arrangements for the provision of personal medical or dental services may be made.""

I rise to break my vow of silence and to support the amendment of the noble Lord, Lord Rea. The Minister in the Commons Committee stage said that the reason there could not be the same kind of consultation with the GPC over PMS was that, because of the voluntary nature of the contract,

"it would not be right for us to agree a framework in which the general practitioners committee nationally could determine the contract that someone could enter into at local level through his formal negotiating rights".—[Official Report, Commons, Standing Committee E, 25/1/01; col. 191.]

It has been put to me—I am sure that the noble Lord, Lord Rea, knows the position—that this is a rather misleading portrayal of the situation. The national framework of PMS contracts is set by nationally determined implementation directions and a core contractual framework. Therefore, there is a strong national context. It would be perfectly right and feasible for the General Practitioners Committee to be consulted. So the questionmarks remain despite the Commons Committee stage. I look forward to hearing what the Minister has to say on the matter

I found my right honourable friend's arguments wholly persuasive. I recognise the issue. I know that the GPC is exercised about the matter.

It is important to remember that the key element of PMS and PDS schemes are their scope and flexibility to negotiate individual local contracts tailored specifically to meet local needs. On a local level the appropriate way for that to be done is through the relevant medical or dental committees. Indeed, government amendments to the Health Act 1999 ensured that LMCs and LDCs could be recognised as representing doctors in PMS and dentists in PDS who so wished. I cite that as a movement to a local level of representation in line with many of the provisions of the Bill, which sees a devolution of power from the centre to the locality. The PMS or PDS contract is therefore individually tailored between the commissioner and the PMS or PDS provider.

Furthermore, there is the standard national contract between the Secretary of State with all GMS GPs and general dental practitioners. That is concerned with the remuneration and provision of general medical services and general dental services. It is an inherently different concept from PMS and PDS contracts. That is why the emphasis must be on local development and negotiation. The consultation process for those matters needs to be more flexible and wider. For example, key stakeholders in PMS arrangements are not exclusively general practitioners. They can include a range of primary care professionals and organisations such as primary care trusts, NHS trusts and nurses.

We have established an implementation group for personal medical services to replace the present national consultative group. That group will be the key forum for consulting and advising on arrangements for PMS. The knowledge and experience of its members will be drawn on to provide advice and better inform PMS developments. The GPC has membership of the group.

That is the most appropriate approach to consulting on the overall development of PMS. It is not through a duty on the Secretary of State to consult a single stakeholder group over a particular aspect of PMS. The BMA is an organisation with influence and the ability to make its views known. We have very well established consultation procedures with the medical and dental professions. There is no intention to weaken those arrangements in any way.

It is not right to go down the route of the GPC for this particular development of LMS and PDS in relation to dentists.

Perhaps I may ask the Minister a question. Many of the new developments will be taking place through PMS. Is that not really just a rather crude attempt to marginalise the GPC in the process?

I cannot see any reason why we should want to marginalise the GPC. It is an important body which represents a large number of general practitioners. It is worth making the point that its core responsibility is to cover pay and terms and conditions. PMS goes much wider than that and covers the quality of service and so on. A PMS core contract, which the noble Lord mentioned, sets out the minimum requirements as to quality. I believe that our approach is the right one. There is certainly no slight intended towards the GPC.

I do not think that the British Medical Association will be terribly pleased with my noble friend's answer. Although the type of contract that PMS doctors have throughout the country will differ, there is a basic level of remuneration and terms and conditions of service which cover them all. As circumstances will differ, there can be local variations. But it is very important for a national body to continue to be able to negotiate with the Government for PMS practitioners as a whole.

I am sorry if I have to disappoint the BMA, which I hold in the highest respect. However, just occasionally it is one's duty to disappoint it. All I can do is to reiterate my previous remarks. We need to reflect on the fact that we are considering here a very much more flexible approach at the local level. For that reason, the arrangements for discussions at the national level need to reflect the differences encompassed within PMS. Furthermore, it should be recognised that, through this approach, the role of the local medical committee will assume more importance because it will have the capacity to discuss PMS schemes locally with the local health authority. Surely that is the right approach; namely, to push those discussions down to the local level.

I do not think that we shall reach agreement on this. However, my noble friend's words will prove extremely useful when carrying this discussion further, either once the Bill has been passed or, possibly, at a later stage in our deliberations. However, in order to speed matters along, I shall withdraw the amendment.

moved Amendments Nos. 209 and 210:

Page 38. line 38, at end insert—

"( ) The imposition of such conditions must be with a view to—

(a) preventing any prejudice to the efficiency of the services to which the services list relates; or

(b) preventing any acts or omissions of the type described in section 49F(3)(a) below of the 1977 Act."

Page 38, line 49, at end insert—

"( ) If the regulations provide under subsection (3)(e) or (4) that a Health Authority may suspend or remove a person from a services list, they must include provision—

(a) requiring him to be given notice of any allegation against him;

(b) giving him the opportunity of putting his case at a hearing before the Health Authority make any decision as to his suspension or removal; and

(c) requiring him to be given notice of the Health Authority's decision and the reasons for it and of any right of appeal under subsection (7) or (8)."

moved Amendment No. 214:

Page 39, line 37, leave out "facilities and persons" and insert "the services of persons employed by a Special Health Authority and"

moved Amendments Nos. 215 to 219:

Page 39. line 38, leave out "to facilities and persons" and insert "in relation to the services of officers of Special Health Authorities to be"

Page 39, line 39, at end insert—

"( ) For the purposes of subsection (6)—

(a) the Secretary of State may give directions to an NHS trust requiring it to make facilities or the services of persons available as mentioned there; but

(b) subsections (1) and (2) of section 27 above apply in relation to the services of such persons as they apply in relation to the services of officers to be made available by virtue of section 26 above by a Health Authority, Special Health Authority or Primary Care Trust."

Page 40, line 16, at end insert "on terms to be determined by him"

Page 40, line 19, leave out "The terms of appointment of the other members, and"

Page 40, line 20, leave out "they" and insert "the other members"

moved Amendment No. 220:

Page 40, line 32, leave out from "services" to end of line 34 and insert—

"(aa) medical practitioner performing personal medical services under section 28C arrangements;"

I should like to speak briefly to Amendments Nos. 221 and 222 in this grouping. Paragraph 6 of Schedule 9A does not specify the precise intention so far as concerns lay representation Amendment No. 221 proposes that that representation should be equivalent to at least 50 per cent of the total membership of the FHSAA. I do not know why the Government have chosen such a terrible acronym; it is very difficult to pronounce. In our view, the right level of lay representation would be a t least 50 per cent. I shall be interested to learn the Minister's view on that.

As regards the annual report of the FHSAA, the Bill currently specifies that the body is entitled to publish only some of its cases. We, along with others, would prefer the FHSAA to publish all its case reports in an anonymous form. Amendment No. 222 is designed to achieve that.

I appreciate the aims of each of the amendments in this group, certainly so far as concerns Amendment No. 220. I understand clearly what the noble Earl seeks to achieve here. However, I want to make the point that the FHSAA will not be a representative body. What we are trying to achieve is to ensure that its members and panels have the expertise and experience relevant to the profession of the person who is making the appeal. I think that it is right that we should refer to PMS and GMS general practitioners alongside each other, but I do not believe that, ultimately, it matters one jot whether medical practitioners serving on the authority or the panels are GMS or PMS doctors. The fact is that they will be doctors with good experience of medical practice.

I can assure the noble Earl that we shall want to ensure that there is a good balance of professional members of the authority, including a mix of both GMS and PMS GPs. However, we are reluctant to go down the path of specifying each and every potential variation of primary healthcare worker.

I am sympathetic to the noble Lord's intention in tabling Amendment No. 221. The problem is that each additional separate category of professional member would require a corresponding increase in lay members. I believe that if we were to accept the amendment it would cause practical difficulties for my noble and learned friend the Lord Chancellor. In practice, even counting legal lay members as lay members, we expect that a majority of the authority's members will need to be professional. That is because the members represent the pool from which panels will be drawn to hear individual cases.

There are four categories of professions within the purview of the authority. Because of that, it seems inevitable that the pool of authority members from whom panels will be drawn will have to include a majority of professionals. But the point is that the authority will not be professionally dominated, because professional membership of each panel will be limited to one.

Amendment No. 222 relates to the requirements in paragraphs 12 and 13 of new Schedule 9A to publish decisions on national disqualification or removal or contingent removal from a health authority list and such other decisions as may be prescribed. I should have thought that that covered the point raised by the noble Lord. I believe that it is an appropriate way for the authority to report its decisions as part of its report on its activities over the year, which will be set out in its annual report. That is provided for in paragraph 19. Sub-paragraph (1) in particular provides for the Secretary of State to specify the topics to be covered in the report. I can confirm that we intend to require the details specified in the noble Lord's amendment to be among the matters on which the authority will report. We simply believe that it is more appropriate to leave such matters to directions rather than place them on the face of the Bill.

Perhaps I may reply briefly to the Minister's helpful statement on Amendment No. 222. I thank him for a very useful response. As regards Amendment No. 221, we should hate to cause difficulties for the noble and learned Lord the Lord Chancellor—even though they are only mild difficulties.

As I understand the Minister, he is saying that although he cannot quite comply with the requirements set out in the amendment for lay representation of 50 per cent or over on the authority, the panel will have an overwhelming proportion of lay members. Am I correct?

I refer the noble Lord to paragraph 10 on page 41 of the Bill, which relates to panels which hear appeals or national disqualifications. The panel will be split into three: one lawyer, one professional and one lay member.

I thank the Minister. I am somewhat horrified, speaking as a lawyer, that the FHSAA will be stacked with legal members, and that the panels will also have a very high legal preponderance. I dare say that is the way of the world and one has to accept it. However, I urge the Minister to seek to provide the maximum lay representation both on the authority and on the panels.

I must say that that was one of the Minister's less convincing answers, however emollient he contrived to sound in delivering it. The FHSAA may not be a completely representative body; however, I do not think that what he said accords with the undertaking given in another place. Although this is a point of detail, it is a point of principle too, because it concerns a miniterial undertaking. I should like to test the opinion of the Committee.

moved Amendments Nos. 223 and 224:

Page 42, line 29, after "in" insert "or by virtue of"

Page 42, line 30, at end insert—

"( ) for a period which must elapse before an application, or a further application, may be made under section 49M(5) (a)above:".

moved Amendment No. 226:

Page 44, line 26, leave out "(other than practitioner dispensing services)".

These clauses are very important. They will allow us to use community pharmacists in a more effective way than we have done in the past. I have always believed that they have been an under-used profession. In order to help us to do that, we need to look closely at improving the current contractual framework for community pharmacy.

At present we have a national framework which provides insufficient incentives for good quality and service performance. We are committed to reforming that national framework, but we also want a more flexible alternative. We want to build on what I think has been a really successful programme in the personal dental service and the personal medical service. The intention of local pharmaceutical service pilots is to allow local authorities to agree innovative local contracts for pharmacy services tailored to specific local needs.

Participation in those schemes will be voluntary and discretionary. We hope that there will be very exciting proposals from pharmacies not only supplying medicines but managing them, working with local GPs to make sure patients receive the right medicines and the help they need to make the best use out of the medicines which is a big problem at the moment. There are many examples of local schemes involving pharmacists in providing enhanced services. Local pharmaceutical services will help us to develop those services.

I do not agree with the noble Earl, Lord Howe, in terms of the amendment and the effect it would have to allow dispensing doctors' services to fall within the scope of local pharmaceutical service pilot schemes. The development of LPS does not in any way signal a change in our approach to dispensing by doctors. As a general rule, it is best for patients to have access to the skill and expertise of both GPs and pharmacists. It has long been recognised that in some rural areas community pharmacists are unlikely to be viable. Dispensing doctors' services provide an important service in such areas, and we know that that is highly valued by patients.

I can assure the noble Earl that the introduction of LPS and the decision to keep dispensing doctors' services separate are not an indication that the Government take a negative view towards dispensing doctors. The point is that dispensing doctors who wish to take part in an innovative local contract can already do so through personal medical services. There are already a number of dispensing practices involved in the PMS pilot. PMS is clearly based on family doctor services and LPS is largely about community pharmacy services. We think that it would create a muddle to allow dispensing doctors services to be provided through PMS and LPS.

In terms of the general relationship between community pharmacists and rural dispensing doctors, agreement has been reached between the PSNC and the General Practitioners Committee about the regulations governing rural dispensing; this was announced only last week. I believe that it will go a very long way to getting rid of some of the disturbing disputes between doctors and pharmacists about dispensing rights in rural areas. I believe that in that spirit it would be wrong to include dispensing doctors within LPS schemes but right to acknowledge that they can take part in PMS schemes.

I turn to Amendment No. 227A. Under the existing national contract health authorities are obliged to consider applications from people wishing to provide pharmaceutical services in their area. In practice, providing those applications satisfy certain tests health authorities have no choice but to grant them. Essentially, this current system is reactive. Local pharmaceutical services is a two-way process. We want something much more pro-active. On the one hand, existing contractors and other prospective pilot scheme participants will come forward with ideas they want to discuss with health authorities. At the same time health authorities will be looking for opportunities of their own, stimulating places and situations where an LPS pilot scheme may be the best way to expand and improve local services.

I believe that it will be wasteful if health authorities work out possible LPS pilot schemes and at the same time have to deal with applications to open pharmacies in the same place under national arrangements. It would put unreasonable pressure on the health authority and its prospective partners. My real concern is that it could open the way for blocking applications from people who have no interest in better services. For that reason we want health authorities to be able to designate places as being ones in which LPS is temporarily to have priority. Once they have made the designation they will be able to defer applications under national arrangements. It will give health authorities and their prospective partners in the LPS pilot schemes time to develop proposals and establish schemes which offer the greater benefit to prospective participants and patients.

The effect of the amendment by the noble Earl will be to prevent health authorities deferring applications and rendering much of the clause purposeless. I believe that it would present a significant stumbling block to the development of the LPS. A pharmacist or a company keen to open a new pharmacy in an area which currently lacks a proper service would think twice about proposing an LPS pilot scheme if they knew that their discussions with the health authority would always be under threat from an application from someone else under the national arrangements. I hope that I have answered that point for the noble Earl.

The Minister's reply to Amendment No. 227AA gives me pause for thought. I will consider what the Minister has said.

I am far from happy with his reply to my other two amendments. The main point I sought to make was that under the situation envisaged there could be unfair competition. I do not see that there is any reason to create a differential between those two types of practitioner—GPs on GMS and GPs who have signed up for PMS. It seems perverse that the opportunity is going to be made available to one group of GPs and not the vast majority. It will be possible in an LPS scheme to provide additional services such as diagnostic testing and investigative procedures. A GP may wish to apply to provide these services, and it is important that the patient's care is properly coordinated and integrated.

The Minister said that the opportunity to take part in pilot schemes already exists within personal medical services and it would create a muddle to include them in local pharmaceutical services as well. I do not think that is true. I believe that GPs who wish to remain in general medical service schemes should have the same opportunity. I should like to take the opinion of the Committee.

moved Amendment No. 228:

Page 45, line 21, at end insert "and

(c) any provider of pharmaceutical services locally,'"

The noble Earl referred to predatory chemists. The whole approach that we have taken in the pharmacy strategy is to draw a careful balance. There is no doubt that the community pharmacy environment is highly competitive and very much reflects the intensely commercial environment for retail trade generally.

It would have been possible for the Government to have opted for a wholesale deregulation and, for instance, to have removed control of entry rules completely to allow for ever more competition. However, we decided not to do that. We decided to adopt a middle way which recognises the important network of community pharmacies that we have but also, through mechanisms such as local pharmacy services, develops some incentives to help focus attention on improving quality.

No one can say that every current community pharmacist will thrive and prosper in the future. But what we can say is that those who are up to the challenge of providing higher quality services will be in the best position to ensure their future prosperity. The noble Earl said he thought that LPS might not relate to very small community pharmacies. I see no reason why that should be the case. I assure him that we shall look for imaginative proposals from community pharmacies of all sizes. I believe that that is relevant to the question of review. It is important that we have inclusive and thorough reviews. However, I am not convinced that the noble Earl's amendment is the right approach to securing such thoroughness.

The review and evaluation of a pilot scheme will involve seeking the views of people well beyond the scheme itself. That will include other local pharmacies. Having required health authorities to assess the likely effects of pilot schemes on local services before they put them forward for approval in the first place, it naturally follows that our reviewers of schemes will also be interested in what those effects have been in practice. However, I do not believe that putting on the face of primary legislation the detail of who would be involved in those reviews is the best way forward.

I also believe that there is a danger of giving an impression that these reviews concern primarily the health authority and the provider, the LPS, lobbying to keep the scheme going, with, on the other hand, the scheme's commercial competitors arguing for it to cease. Clearly we need to go beyond that to provide rounded reviews which give a much more impartial and sensible summary of the effectiveness of the scheme, its impact and how well the public interest has been served. I hope that the noble Earl will accept that I recognise the competitive environment in which community pharmacists operate, but we cannot put a ring fence round that. The environment is competitive. LPS is an important way of investing in higher quality services. However, I believe that we have adopted the right balance between leaving the control of entry regulations as they are—apart from some specific areas where we want to see flexibility—and encouraging new investment and innovation.

I did not in the least mean to suggest that there should be a protectionist flavour to this part of the Bill. The Minister is right to suggest that no one has an automatic right to be in business and it is a competitive world out there. However, he said earlier that consultation was part and parcel of the department's way of proceeding. That was the only suggestion behind the amendment. Nevertheless I take comfort from what he said about wishing to conduct rounded reviews. I am sure that what he said will be reassuring in that context. I beg leave to withdraw the amendment.

moved Amendment No. 228A:

Page 82, line 6, at end insert—

"( ) The regulations shall provide for setting service standards, imposing conditions (including conditions as to qualifications, training and experience) to be satisfied by persons providing LP services, and for National Health Service redress mechanisms to be available in relation to the provision of LP services."

We shall certainly expect contracts for local pharmaceutical services to include service standards. We shall also expect them to reflect specific local needs and circumstances, but also national priorities and standards.

On training, qualifications and expertise, we shall expect local contracts to make clear what is expected of the people taking part. Similarly, on what the amendment calls "redress mechanisms", we intend that local pharmaceutical services will fall within the ambit of NHS complaints mechanisms. Where I disagree with the noble Baroness is on the question of how much detail should be included on the face of the Bill. In this schedule we are dealing with the substantive arrangements for LPS, which will follow the pilot stage, if—as I am confident it will—piloting shows that the continuation of LPS is in the best interests of the National Health Service. It will be at least two years—and it could be more—before those powers are used. By then we shall have learned much more from pilot schemes. For that reason we have made the regulation-making powers in the schedule deliberately wide. I believe that that is the best approach.

Amendment No. 229A concerns the provision of pharmaceutical services by remote means. Clause 50 provides substantive new powers. In particular, subsection (4) confers an explicit reserve power to require providers' mail order or e-pharmacy services to be accredited for that purpose. Some of the other changes are rather more technical. For example, subsection (6) would allow local pharmaceutical committees to continue to represent pharmacists based in their area, even if they provide services to people in another area.

I believe that subsection (3), to which the noble Baroness's amendment relates, falls into the latter category of essentially technical changes. Its effect is to allow us to exempt from control of entry rules those who intend to supply services exclusively by remote means. I stress that they would not have to show that their service was necessary or desirable to secure adequate pharmaceutical services in the neighbourhood in question, which is part of the criteria in relation to control of entry. I stress that it does not mean that such providers will have an advantage over other pharmacies. Their business will not be dependent on the local population. People would always be able to find a location where their application would be granted. They would merely have to find somewhere where there was no local pharmacy. Because they are not primarily serving the local population, we think that it is rather odd to judge their application by reference to the needs of the population. The general thrust of control of entry rules is to limit the number of pharmacies serving any given neighbourhood. That concept is obviously not relevant to services being provided mainly by remote means.. That is why we have taken a power to exempt from the rules, if that seems appropriate.

I should add that that new power applies only to people who provide all their services by remote means. Furthermore, in an attempt to avoid that system becoming a way of evading control of entry rules, we are taking an explicit power by which we would require health authorities to make the grant of such applications subject to conditions; and I emphasise that the health authorities would be responsible for overseeing that. One condition for a health authority may be to ensure that the service did not subsequently change to a more traditional service in which patients would visit the premises. We want to make sure that this would not be a back-door way of evading the control of entry rules.

I am very reassured by what the Minister has said on Amendment No. 228A. Although Amendment No. 229A is more specific than the issue that I addressed, I hope that the system of which the Minister speaks in terms of health authorities does work satisfactorily. Meanwhile, I beg leave to withdraw the amendment.

I trust that the Committee will forgive me if I initiate a very short debate on Clause 50. In doing so, I make it clear at the outset that I harbour no desire whatever to frustrate its very positive proposals.

My concern arises because I believe that the concept of remote dispensing raises a number of fundamental issues relating to patient care. If one asks a pharmacist what his role is in dispensing a prescription, he will always say that it is primarily a checking role. He would include in that definition the role of making sure that patients understood how to take their medicine, the purpose of it, and the instructions relating to the dosage.

During that process, a pharmacist occasionally will discover a doctor's prescribing error. Doctors' errors of that sort are rare; I do not want to suggest otherwise. These days computer systems in GPs' surgeries are very sophisticated. At the time of prescribing, the computer checks the compatibility of the medicine with the patient's medical condition and any other medicines being prescribed. Despite that, however, a computer will never provide a pharmacist's full service.

My concern—a nagging worry more than anything else—is that when remote dispensing gets under way, it will turn into a van-delivery service, perhaps run by a large national pharmacy chain, with electronic transfer of prescriptions. We need to look carefully at what we shall gain and what we shall lose by that sort of streamlining. We will obviously gain convenience and speed. What we may lose will emerge only over time—perhaps the livelihood of the local chemist, or even that of the local dispensing doctor, and the sort of face-to-face professional advice that a pharmacist is able to give. In that regard, there is a risk, however small, to patient safety. Beyond a certain point, that would be an unacceptable price to pay for progress. I would welcome any comments that the Minister has to make.

I should very much like to associate these Benches with the concerns expressed by the noble Earl, Lord Howe.

I understand the concerns, which are well expressed. Although I do not believe that mail order or on-line pharmacies will suddenly sweep away traditional community pharmacy services, they can provide a useful service and an extra option for some people. Ideally, the choice should be made by patients themselves. Equally, I accept that the public must be assured that mail order and on-line pharmacies meet the same legal and professional standards as any other pharmacy. Legally, that means that all pharmacy and prescription-only medicines must be supplied only from registered retail pharmacy premises. Those premises are regularly inspected by the Royal Pharmaceutical Society of Great Britain, which I have always found to be a particularly rigorous regulating authority.

In addition, pharmacy and prescription-only medicines may be supplied only by or under the supervision of a registered pharmacist. For prescription-only medicines, there must also be a prescription. A breach of any of those conditions would amount to a criminal offence. On-line pharmacies must also meet the standards expected of the profession as a whole, as well as the particular standards set by the Royal Pharmaceutical Society in relation to Internet-based services.

Given those standards, the Government's view is that if legal and ethical safeguards are met, there is no reason at all why on-line pharmacies should not be safe and provide patients with new choices when obtaining their medicines. However, we have made it clear that if additional safeguards prove to be necessary, or if providers of on-line services cannot demonstrate their own quality and security of service, we shall work with the professions and patient groups to introduce further controls. We have not taken any decision as to whether such further controls will be needed. We shall have to assess that in the light of our experience, following discussion with patient and professional groups.

In conclusion, we believe that on-line pharmacy services would be useful to a number of people, but we accept that we must ensure that they are provided professionally and safely.

I thank the Minister for that very fair reply. I particularly endorse the sentiments expressed at the end of his reply. This is obviously an experiment which needs to be kept under review. From what the Minister has said, I am confident that the department will do that. I also share his view that the Royal Pharmaceutical Society will play its part in ensuring that the experiment works as well as we all hope.

moved Amendment No. 230:

Page 71, line 17, at end insert—

"(9) Before making any order under this section, the Secretary of State shall, after a period of three months beginning with the publication of the draft—

(a) consult persons appearing to him appropriate to consult as representing the professions listed in subsection (3)(1A)(a) to (h), and

(b) publish a report detailing the results of such consultations and advice given by the relevant Committee of the Medicines Control Agency,

and may lay the draft as published, or with any modifications he considers appropriate, before both Houses of Parliament."

The noble Lord has tabled an interesting amendment, particularly in view of the fact that some quite important decisions will have to be made under Clause 68, which we very strongly support. It has long been awaited and represents a very positive move forward. But questions are raised by the professions in this context, and I suspect that consultation will be more than usually important in relation to who will retain clinical responsibility; the independence of prescribing rights; whether those rights are dependent on an existing prescriber or are truly independent; and appropriate safeguards. Strong professional views will be expressed during the process. The noble Lord, Lord Astor of Hever, has raised an important issue in that respect.