HEALTH SERVICES BILL

Lord WELLS-PESTELL

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

Lord WELLS-PESTELL

If I have understood the noble Baroness correctly, she is in fact moving Amendment No. 25 as a paving Amendment to No. 28, and I do not know whether the noble Baroness wants me to reply to Amendment No. 28 now or merely to deal with Amendment No. 25.

Baroness YOUNG

I should have thought it would be for the convenience of the Committee to speak to Amendment No. 28, because Amendment No. 25 really makes very little sense on its own.

Lord WELLS-PESTELL

That being the case, may I say that in the Government's view the Amendment is inappropriate for two reasons. I understand that the effect of the Amendment would be to require the Board, as the noble Baroness has said, in formulating proposals for the progressive withdrawal of authorisations of pay beds and private facilities, to give its reasons for its recommendations. In our view, the Board must have regard to the principles set out in subsection (7). In other words, before it makes any recommendations to the Secretary of State it must apply the four criteria and satisfy itself that there is a reasonable demand for private practice in the catchment area of the hospital or hospitals concerned; that sufficient alternative facilities are available to meet that demand; that, if there are not, all reasonable steps are being taken to provide such facilities outside the National Health Service; and if such steps are not being taken, that those concerned have been warned that failure to do so could result in the revocation of the existing authorisations. Secondly, the Board must consider representations from those concerned with, or interested in, any proposals it may make to the Secretary of State.

Should the Board then submit proposals to the Secretary of State, it seems to the Government that there will be no need for it to give reasons for its recommendations. 338 The Board's reasons will, I submit, be apparent; I think of necessity they must be apparent. Where it recommends separation, it will be satisfied that the facilities involved fall within the criteria for separation. Where it does not recommend separation, clearly it will have concluded that the criteria are not satisfied. I think Members of your Lordships' Committee must realise that the criteria are clearly set out in the Bill, so if the Board decides for or against it is because the criteria are being met or are not being met.

Perhaps I may conclude by saying that in carrying out its duty to submit proposals to the Secretary of State the Board is intended to be completely independent. If the Board is going to be asked to give its reasons, the question could easily be asked: Why is it being asked to give its reasons when it is an independent body and its decisions should be accepted? Its reasons for making recommendations are, and will always be, that it is satisfied that it has met the requirements of the Act in respect of the progressive withdrawal of pay beds and other facilities for private patients. Whether or not the noble Baroness agrees with my answer, I hope she will think it is a fair answer, having regard to the responsibilities put on the Board and to the obligations that the Board must fulfil under the Bill.

Baroness ELLIOT of HARWOOD

May I ask the noble Lord this question? Suppose the Board makes a very controversial decision, even though it is within the criteria set out here. After all, we are dealing with (what shall I say?) somewhat argumentative people, in the sense that doctors, members of the health services and all the rest of it are not people who are going to sit down and accept anything without question. Does it mean that the Board announces the decision as a fait accompli without anybody knowing what the reasons are except that there are criteria here? How do the people who want to know why find that out? Do they have to go to the court? What is the machinery for those people who do not understand a decision of the Board if the Board has not got to publicise it in a sense in which it can be understood by the ordinary person who is involved in this particular thing?

Lord WELLS-PESTELL

I appreciate the point which the noble Baroness has raised, but we have to bear in mind that here we have a Board of five members. There is one thing we can be absolutely certain of, and that is that the chairman is independent. He is independent, if I may say so with the greatest respect, of the medical profession, and is completely independent of the other two representatives. If the Board makes a decision, it can make that decision only on a majority viewpoint: it may be three to two, I concede, but it is nevertheless a majority. But the Board will have discussed with the various people concerned what is in fact involved in the withdrawal of pay beds; it will have discussed with the people involved the local situation, the local needs and requirements and what can be provided. We are, I think, dealing with a fairly high-powered board and not a run of the mill committee. It has, so far as I can see, no axe to grind, and will have an independent chairman. In view of the discussions that may take place beforehand, I think that this problem is much more academic than it is likely to be real.

Baroness ELLIOT of HARWOOD

Will the discussions which go on beforehand be public discussions so that people concerned will know what is being discussed? I am concerned that people should, if they want to, accept the Board's decision; but if they do not want to do so, how do they protest? That is an ordinary procedure—I was going to say "freedom of speech"—that we all have if we want to take a different point of view from that of some authority.

Lord SANDYS

We are starting on a very long debate which will last through the afternoon, evening and night and take us into tomorrow morning. I hope, if I may say so, in opening my remarks to the Front Bench opposite, that the somewhat threatening and monitoring manner adopted by the noble Lord, Lord Wells-Pestell, both on Second Reading and on previous Committee discussions will perhaps give way to a more mellow appraisal of this very difficult Bill. On behalf of my noble friends I can also say this. As my noble friend, Lady Young, lives in the Latin Quarter of Oxford, on our joint behalf I would say non perturbatnus. We are totally aware that there is a very substantial discussion ahead of us.

Lord WELLS-PESTELL

May we conduct the proceedings in English?

Lord SANDYS

For centuries it has been the practice of this House to treat a Latin quotation as an acceptable form of discussion. Nevertheless, I will draw that point to a close and come on to the Amendment as such. I hope that, first, I may cool the Government's impatience on the programme and refer to a document which I shall draw on from time to time which is the Royal Commission on Medical Education, the Todd Report (Command Paper 3569). If I may, I will quote one sentence in paragraph 21: The future pattern of medical care will be determined only partly by deliberate decisions. To a great extent it will be the result of developments in medicine itself. I think it is a truism to say how often the unorthodox of yesterday becomes the orthodox of tomorrow. I do not think I need quote an example here, but I should like to refer to a debate on 12th May this year which was introduced on an Unstarred Question by my noble friend Lord Ferrier. It was in regard to the Professions Supplementary to Medicine Act 1960. The noble Lord will recall that he replied to that Unstarred Question and it was a very interesting one. Also, if I may, I refer to his right honourable friend the Minister of State, Dr. David Owen, and what he said in regard to this particular important subject. Dr. Owen in a broadcast on BBC4 early in May said: We are also slightly worried that, for instance, things like backache which can cost the nation over £100 million a year, is a very under-researched problem; but you have to have fundamental research and so I am wanting very much more public debate at this stage. His right honourable friend referred to an issue which was brought up on that debate. I believe it would be much more satisfactory if we considered within the ambit of the National Health Service what might be called the fringe professions. I hope that they will take absolutely no offence at that expression. The unorthodox methods adopted so far as some medical practice is concerned may perhaps endear themselves to the Department of Health in the future, but if we adopt the attitude which is built into the Bill which is before the Committee it will not be possible to have the practice of these particular professions to anything like the same extent as may be possible without 341 the Board's intervention. I refer to other researches and we shall come on to research later, but let us consider this. British developments have been very significant in the medical field and I quote only two of them: waterbeds and airbeds. Both have been invaluable in medical care. If the Government's intention is taken to its logical conclusion, very little opportunity is going to be given for this type of innovation in the National Health Service hospitals, as we understand it, through the use of these innovations in private circumstances. I think that there is an overwhelming case to take a much more open view of this particular situation. I beg to support the Amendment.

Lord O'HAGAN

In order to save time, perhaps I could follow my noble friend and give the noble Lord, Lord Wells-Pestell, the opportunity to answer us together. I should like to know from the noble Lord, speaking on behalf of the Government, how he reconciles the answer he has given so far to my noble friend Lady Young with Clause 10 of the Bill that we are considering. This clause deals with the publication of proposals and the preparation of annual reports by the Secretary of State. It may save the time of the Committee if I read out the first few words of Clause 10 which are: The Secretary of State shall cause every set of proposals submitted to him under section 4 or 5 above"— that is, Clause 4 or 5 of the Bill— and every report submitted to him under section 4(2)(b) above, to be published as soon as practicable after its submission …". There then follows the mechanics of publication. It may be that I have not fully grasped what Clause 10 refers to. The word "proposals" in Clause 10 may be different from the word "proposals" in Clause 4. It may be that there is some subtle distinction which is beyond me. But even if there is a distinction is it not inconsistent that in Clause 4 we should have one type of proposals not to be published and then have Clause 10 the whole of which is devoted to making it possible for proposals to be published?

Clause 10 also deals with the annual reports. If the Government consider it may be inconvenient or impractical to issue a continuous stream of reports dealing with one particular set of circumstances after another, if there is a 342 technical objection to issuing a whole package of proposals one after another—it may be too expensive to do that—would it not be possible as a compromise, if we have the annual report which is to be debated by Parliament, to have what my noble friend is asking for included in the annual report? I should be grateful if the noble Lord could explain the difference between the proposals as defined in Clause 4 and the proposals as defined in Clause 10. Could the noble Lord explain to the Committee why one type of proposal is to be published and the other is not to be published? I support the Amendment.

Lord SLATER

Could we have from the noble Lord who leads for the Opposition some clarification regarding the statement he made? He said that the Committee stage will take a long time. He did not address himself to the Amendment which is before the Committee at the moment. My noble friend replied that the Board will be set up with its independent chairman. I take it that the Board will have plenary powers and the casting vote will depend upon the chairman. Then the noble Lord, Lord O'Hagan, said that he supported his noble friend in what he had to say regarding the Amendment, but the noble Lord, Lord Sandys, never referred to the Amendment.

Lord SANDYS

The noble Lord, Lord Slater, is mistaken because what the Amendment says is obvious. It requires reasons to be given.

Lord SLATER

When the noble Lord sees Hansard tomorrow morning he will read what I have just stated. The statement he made was not as clear as he is trying to make out.

Lord SANDYS

I cannot accept what the noble Lord, Lord Slater says. We are trying to include a number of professions and illustrate them in this particular sense. It is clear that the Amendment requires the Board to give reasons. I am illustrating it.

Baroness MACLEOD of BORVE

I agree with the noble Lord, Lord Sandys. Those who have anything to do with the National Health Service are bound to be worried that this important Board, which 343 would not have much to do with grass roots views, will be able to report to the Secretary of State but give no reasons to anybody else. Apparently nobody at grass roots level is to be told the reasons for the decision of these few men on the Board. The noble Lord said in his answer that the reasons will be apparent. Apparent to whom? Obviously they will be apparent to the Secretary of State but, unless they are asked to give their reasons, they will not be apparent to anybody else.

Lord WELLS-PESTELL

I am sorry that the noble Lord, Lord Sandys, feels that I might become aggressive. I am the most cool of persons in the ordinary way but my comment the other day was made because I felt we were not making sufficient progress. We have already spent several hours on this Bill and we have not dealt with very many Amendments. As we have the rest of the day and the night before us, I hope that we shall keep cool because obviously there is no useful purpose served by behaving in any other way.

Lord SANDYS

Hear, hear!

Lord WELLS-PESTELL

In answer to the noble Baroness, the only point I can make is there is no appeal to the Secretary of State because, rightly or wrongly, we feel that with this type of Board made up as it is the need will not arise. The noble Lord, Lord O'Hagan, raised a matter which is, I concede, of some importance. The Board is answerable to Parliament for its annual report which the Secretary of State must lay before Parliament. That is perfectly clear. I know that it must give reasons for deciding not to recommend any further revocation at each six-monthly interval. That is a safeguard—I would not put it any higher than this—against unreasonable delay in carrying out the policy of separation which is enshrined in the Bill. Under Clause 10, the Secretary of State is required to publish each set of recommendations submitted by the Board. There is no requirement on the Board to give its reasons. I do not think that I have failed to answer any other question, and I do not think that there is 344 anything more that I can say on this matter.

Lord O'HAGAN

On that particular point of the annual report, am I correct in understanding the noble Lord to say that this report will not contain the reasons for the proposals which we are discussing in this Amendment? What will be in the report? Surely, the purpose of the annual report is to inform Parliament, and therefore the public, what the Board are doing and how they are carrying out their duties. I am not trying to split hairs. If the Board is not to be allowed to publish its reasons for what it is doing in the annual report, could the noble Lord explain what is the point of the annual report?

Lord WELLS-PESTELL

Most annual reports cover the activities of the organisation or group during a specified period and the purpose of the annual report is for Parliament to see clearly what the Board has done, what decisions it has made and what has been accomplished. That is very different from giving reasons.

Baroness YOUNG

This Amendment and the reply to it is an extremely good illustration why we are making slow progress. It cannot conceivably be a Party political point to ask a Board to publish its reasons for doing something. We do not have the slightest inkling that the Government even think that it is worth considering this point, let alone that they are going to accept it. If the Amendments had been grouped, we should have made more progress, because it would have been easier for everybody. However, that is water under the bridge.

I found Lord Wells-Pestell's answer unbelievably unsatisfactory. He said that it would be inappropriate for the Board to give its reasons, and he gave two reasons why this was so. First, the Board has to have regard to what is Clause 7 and see whether there are reasonable alternative facilities before the private facilities are phased out, Secondly, it must consider representations from all the interests concerned. The noble Lord went on to say that we are going to have an independent body with an independent chairman, and of course if the criteria are not satisfied they will judge. How will anybody 345 know why they decided that the criteria were satisfactory or unsatisfactory unless there is the evidence available on which they base their decision? It is no answer to say that an annual report will be published. I have read enough annual reports in my life to know perfectly well that unless you have a great deal of information about the background of the situation they are not always helpful. It is extremely easy to write a singularly unhelpful annual report. What is important to people is to know why a decision is arrived at, otherwise they cannot make a sensible judgment. They may say: "It is easy to see why the decision was arrived at because they had explained the reasons." It would be a very odd circumstance to say that the Board ought to give its reasons when nobody else does.

If one quotes similar examples, a judge may be regarded as an independent person, but he is required to give reasons. A planning inspector is required to give reasons. He is expected to be independent. We are not, as the noble Lord suggested, talking about small bodies and boards that have no particular power; we are talking about organisations and boards and individuals who exercise great power and they are expected to give decisions. Not to have to give decisions is putting the clock back to the kind of situation, perhaps in a more trusting world, where people felt they could accept a decision without having the reasons.

It is not my intention to press this Amendment, but I ask the noble Lord to consider it carefully. I think he will agree with me that people would have much more confidence in the Board if they had the published reasons for its findings. I think he may well find that he will get the whole of the Goodman proposals to work better. It is not as if the noble Lord, Lord Goodman, commented on this point in his recommendations, so the Government would not be going back on any pledges in that regard if they put it in. If they considered it further, they would find that it would be useful, but I beg leave to withdraw the Amendment.

Lord WELLS-PESTELL

I want to repeat what I said because there is no point in my taking this matter back to look at it afresh. We have had sufficient time to look at these matters 346 and we have done so carefully. The criteria which govern the actions of the Board are clearly laid down in the Act. We assume that the Board will apply the criteria because it cannot act on any other basis. It can act only on the basis of the views of the people who are going to be affected and the decision which it has to take. There has to be a good deal of good will and give and take on both sides—give and take because the criteria lay down that beds cannot be phased out unless comparable private sector beds are available. At this stage in the proceedings I do not think that I am going to say anything which will please the noble Baroness, because I do not imagine I am going to be able to meet any of her requirements. If she does not agree with the Government's view, the remedy is in her own hands; she can divide your Lordships on any matter.

Baroness YOUNG

I must try to tell the noble Lord, Lord Wells-Pestell, that if he cannot see the point I am making he is considerably more gullible than I should have thought. I should not have thought that he could accept that argument whether it was given to him by his right honourable friend in another place or his advisers. He is assuming that the Board will make a perfect judgment and that we will all be completely satisfied with everything it does although he knows as well as I do that human beings do not work like that. We have debated this matter; I am sorry he does not see the point, but I beg leave to withdraw the Amendment.

Lord O'HAGAN

Perhaps I could give some informal grouping and follow my noble friend. In so doing, I speak to the next Amendment which hangs with this one. In this clause we are looking at the mechanism which revokes authorisations for the use of NHS accommodation and we are examining the various channels of communication open to people affected by these revocations and the ways in which representations can be made to the Board on their behalf. In Clause 4(3), to which both these Amendments refer, we are dealing with those people who are entitled to make representations, and in (3)(b) (i) (ii) (iii) we have a list. Amendment No. 26 moved by my noble friend and the next Amendment No. 27 seek to make a little wider the list of people who are entitled to make representation. There is a good reason for this.

The Secretary of State in another place when ending his speech on Second Reading said: Let us stop the politicing and get back to the primary task of patient care", and I agree with him. I should have thought that, if we are concerning ourselves 348 with the primary task of patient care, we ought to make sure that all those who are concerned with patient care have a chance to make representation. The Amendment moved by my noble friend and the following Amendment No. 27 make sure that the Board can consider the interests of patients at all NHS hospitals. I believe sickness to be indivisible and that this Bill should be concerned with the primary task of patient care. If our Amendments are accepted, it will make the Bill that little bit better and I hope the Government will look favourably on them.

Baroness STEDMAN

I am grateful to the noble Lord, Lord O'Hagan, for suggesting that we take the two together because they logically follow on one from the other. The effect of Amendment No. 26 would be to remove the reference in lines 26 and 27 on page 4 to "one or other of the national health services" and I do not think this is something on which we need spend much time. We have been advised by the Parliamentary draftsmen that this reference is necessary in order to establish beyond doubt that, when formulating proposals for revocation of authorisation of private facilities in NHS hospitals, the Board is under an obligation to consider representations made to it by representatives of persons other than doctors or dentists employed in the NHS in Scotland as well as those employed in the NHS in England and Wales.

The NHS in Scotland is a legally separate service, as are the services in England and Wales. That is explained in the general interpretation of Clause 23(1). Amendment No. 27 would retain the obligation of the Boards to consider representations from representatives of NHS employees, in addition to those of doctors and dentists. It would have the effect of extending the same right to make representations to the Board of persons concerned with the interests of patients in private as well as in NHS hospitals. We also believe that is unnecessary, because it is unlikely that the Board would refuse to accept representations from bodies such as BUPA or the Nuffield Nursing Homes Trust, which may be regarded as being broadly representative of patients in private hospitals, under the terms of Clause 4(3)(b)(iii). That reads: 349 … any other person having a substantial interest in the proposals;". As such bodies would be covered by this provision, there is clearly no practical need to mention any of them specifically.

We think there is a presentational argument for making specific reference in Clause 4(3)(b)(ii) to the persons concerned with the interests of NHS patients, because the Board's primary functions under this Bill are to separate the private practice from the NHS and to ensure that such exceptions as are allowed to that policy do not operate to the disadvantage of the NHS patients.

Baroness YOUNG

I am grateful to the noble Baroness for that explanation and I can see that she has taken great care over it; but the fact remains that she says that the Board's primary responsibility is to make quite sure that the NHS and the private patients are separated and that the NHS patients shall not suffer. I should have thought it would he equally important to ensure that all patients should not suffer, and the object of Amendment No. 27 is that the interests of all patients should be considered—or rather that representations may be made by them—and not simply the patients at NHS hospitals. I appreciate what she has said on the drafting point, but on the second Amendment it seems to me there is a clear distinction. I should have thought that their interests, although partly covered by representations from bodies such as BUPA, are not precisely the same in every instance. I cannot see why their interests should not be considered under Clause 4(3)(b)(ii).

Baroness STEDMAN

We think they are covered under Clause 4(3)(b)(iii): Any other person having a substantial interest in the proposals;", which would cover persons in the pay beds and in private nursing homes.

Lord O'HAGAN

In that case, why is it that it says "any other person" as opposed to "any body"? There is a difference in terminology. In sub-paragraph (ii) it is "any body", which I presume means an organisation, whereas sub-paragraph (iii) talks about "any other person". Is the noble Baroness saying that BUPA is a person?

Baroness STEDMAN

No, but I think "body" is used in sub-paragraph (ii) as meaning a representative body of medical practitioners, dental practitioners and people of that kind, rather than organisations or people who are individually involved in providing private nursing facilities.

Baroness YOUNG

Again, I am bound to say that I do not think this is a matter of great political difference between us; but if the noble Baroness says that that clause is meant to include representations from private patients as well as from NHS patients, I cannot see why it would do any harm to say so. However, the noble Lord, Lord Wells-Pestell, has told us that he is not going to consider anything at all, so even if we are asking the noble Baroness to consider something which the Government say they think is covered but about which there is obviously some doubt, perhaps there is no point in continuing. However, I should just like to hear why the noble Baroness feels that she cannot say in writing what she says she thinks the clause means.

Baroness STEDMAN

Because we think it is all covered within the clause as it is drafted at the moment, and we are advised by Parliamentary draftsmen that this clause does cover the points that have been made.

Lord SANDYS

I must confess I am not totally convinced. The noble Baroness has advanced arguments and my noble friend has replied; but perhaps it would be for the benefit of the Committee if I asked leave at this stage to withdraw the Amendment.

Lord WELLS-PESTELL

At present the Bill requires the Board, in formulating proposals for the revocation of authorisation at any National Health Service hospital of facilities for private non-resident patients, to have regard to the different purposes and specialties for which accommodation or services are provided. The effect of the Amendment would be to require the Board, when making proposals for revoking authorisations of pay beds, to apply similar principles and consider revocation according to the different purposes and specialties for which pay beds were currently made available. Clause 4(4) as it stands allows the Board to make separate proposals in respect of the different purposes for which private out-patient and day patient facilities are available.

Under subsection (5) the Board is required to make its first proposals for revoking authorisations in respect of consulting rooms separately from those in respect of diagnostic facilities. It may also make proposals separately if it thinks fit in respect of separate specialties even though the actual authorisation is customarily given in respect of the accommodation and services provided at a hospital, or group of hospitals, as a whole. Clause 4 as it stands will allow an authorisation to be revoked in part or in whole if the Board so proposes.

The grounds for considering revocation by specialty so far as in-patient facilities are concerned—that is, pay beds—are not particularly convincing. Pay beds are not allocated to particular specialties—I repeat that: Pay beds are not allocated to particular specialties. If the Board were to attempt to recommend withdrawal of pay bed authorisations from one specialty but not from another, a considerable amount of confusion would be bound to result, particularly where a private patient in one specialty required attention from a doctor in another specialty from which facilities for private practice had been withdrawn.

With out-patients, it is quite common for a private patient seen in private consulting rooms outside the National Health Service to be referred to one particular 353 department of a National Health Service hospital, either as a private patient or as a National Health Service patient, whether for consultation or for diagnostic services. An in-patient in a National Health Service hospital is admitted either as a National Health Service patient or to an authorised pay bed as a private patient. If the person is admitted as a private patient, he will remain in that category during the course of his treatment, although he may be treated by a number of doctors from different departments of the hospital. Thus where the Board has not recommended the withdrawal of authorisations, it makes sense that the pay beds should be available for use by all specialties in that hospital. In the case of a hospital devoted to a single specialty—and I have in mind a maternity hospital—the Board will have regard to the availability of alternative facilities for the same specialty in the private sector.

Where a hospital includes some department offering treatment of a specialised nature using specialised equipment and skills, Clause 8 will allow occasional private patients to be treated there by any doctor in the hospital—even after the withdrawal of authorisations—subject to the fulfilment of specified conditions. To have authorised pay beds in a hospital in which private patients could be treated by part-time consultants in one specialty but not in another would, I suggest, be a source of friction among consultants, additional to the friction between staff who believe in private practice in the National Health Service and those who do not. I think it would be wrong to add to the problem to which private practice in National Health Service hospitals already gives rise. Consequently, the Government do not feel that they can accept the Amendment.

Lord SANDYS

My Lords, I warned the Government that in resisting an Amendment of this sort, which offers a degree of flexibility, they were making a rod for their own backs in future. There is nothing more valuable than to have a degree of opportunity to vary the terms and circumstances. It is the situation in the Hospital Service today, I think, and I am certain the noble Lord will agree, that those in authority would like to be able to adjust circumstances where possible to suit their particular circumstances. 354 Flexibility in legislation is one thing that can always he introduced if the Government are so willing. We believe it is desirable. I am not going to press this Amendment. The Government have shown themselves rock-faced about it, but we shall refer to this particular problem at a later stage. I beg leave to withdraw the Amendment.

Baroness ELLIOT of HARWOOD

I should like to support this Amendment. It reminds me very much of the other Bill we are discussing at the moment, getting local authorities to supply alternative housing for agricultural workers under the Rent (Agriculture) Bill. Having been in local government for a very long time, I think one has to put obligations on people. If it is necessary for the person concerned for his health, his domicile or whatever it might be, there should be some urgency and perhaps more insistent words should be put in Bills of this kind. In view of 355 the fact that the Board is going to be very authoritative, as the noble Lord explained when I was asking a question on another Amendment, I think there should be the authority for it to be told with some vigour that it is essential that unfortunate patients should be found other accommodation. It is only fair to the patients, and it is a word which might be very useful in this connection.

Lord AMULREE

I, too, should like to support this Amendment. It has always seemed to me that permissive legislation is a bad thing to encourage. If some things are permissive, good people do what they should. But had people have no reason to do anything. If something is worth doing at all, it should be made obligatory and, therefore, the word "shall" should be used in place of the word "may".

Lord WELLS-PESTELL

As the Government do not accept this Amendment one could give an answer in a very few words. But I know that a very few words will not satisfy noble Lords opposite, and probably would not satisfy me if I were in their position, as I should want a much longer explanation. I come back to the composition of the Board and to what we believe will be its quality. Members of your Lordships' Committee must ask whether, when one is dealing with a Board of that calibre, and when the conditions are laid down very clearly and precisely, even though some noble Lords may not like them, one ought to hamstring and tie a body like that, and whether a matter of this kind should be left to its discretion, which is what we have so far as possible tried to do.

The effect of the Amendment would be to oblige the Board, in putting forward proposals for withdrawal of authorisations of NHS accommodation and services for private out-patients, to put forward separate proposals for different purposes and specialties for which the authorised facilities are available. The Bill as drafted enables the Board to do this where it thinks appropriate, but does not oblige it to do so, though it does require it to distinguish in its first proposals between consulting suites and specialist diagnostic back-up facilities. Although authorisations of private out-patient services are 356 seldom, if ever, related to particular purposes and specialties, in practice it will be possible to propose the immediate withdrawal of some facilities, while maintaining others for a longer period. For instance, the private sector may not have the ability, nor for reasons of safety may it be desirable for it to seek, to provide radiotherapy services outside the NHS. The desirability of the NHS continuing to allow private patients access to such a facility, however, need not prevent the Board from recommending the withdrawal of other facilities for private out-patients. What is practicable and desirable will, of course, vary from one hospital to another and from one part of the country to another.

In these circumstances, it seems right to the Government that the Board should he under a duty, when considering what recommendations it should make in respect of a particular hospital or group of hospitals, to apply the principles of Clause 4(7) separately in respect of each purpose or speciality for which private out-patient or day patient facilities at that hospital are being used. Clause 4(4)(a) so provides. But in the Government's view it would be wrong, with the exception of consulting rooms (Clause 4(5)), to oblige the Board to make separate recommendations to the Secretary of State in respect of each of these purposes and specialties. There should be discretion for the Board in how it deals with these matters. Clause 4(4)(b) provides such discretion. In other words, we nail our flag to the mast that it must be left to the discretion of the Board, and in the long run that is a much better way of working.

Lord HARMAR-NICHOLLS

I am not surprised that the noble Lord said that, if he were on this side of the Committee, he would not accept the answer he was going to give.

Lord WELLS-PESTELL

I did not say that. If the noble Lord is going to quote me, let him quote me accurately. What I said was that I could well understand that noble Lords opposite would not feel happy with it, and nor would I if I were in their position, but I am not of their Party.

Lord HARMAR-NICHOLLS

I do not think there is much difference between what the noble Lord has just said and what I paraphrased him as saying. This is rather like somebody telling a joke, when people laugh before the punch-line conies because they know what it will be. The noble Lord knew that the answer which he was going to give on this Amendment would be inconsistent with the argument he used on Amendment No. 29, because he then made it very clear that he thought it was in the best interests of administering this legislation—if it ever becomes law—to give the Board clear instructions on what it is to do. He said that we must not give the Board any freedom, and everything must be laid down.

In this Amendment, my noble friends are asking for the kind of flexibility which the noble Lord resisted on the previous Amendment. We are saying that we should make it perfectly clear that it shall do this thing which is desirable, not that it may do it. Let us give the Board clear instructions as to what it is supposed to do. The noble Lord cannot expect to get away with it. I know that it is not his argument. He is working to a brief, and I have a great deal of sympathy for noble Lords on the Front Bench opposite in view of the kind of briefs they are having to put up with. But the noble Lord cannot say, on the one hand, that clear instructions must be given, with no flexibility; and then, on the other hand, that flexibility must be retained, because the Board will have the ability and knowledge to allow it to use flexibility properly. I believe that the inconsistency in the noble Lord's opposition to this Amendment shows the weakness.

Nobody is suggesting for one minute that the Board will not have the knowledge and the ability to use its discretion. But there are certain matters covered in this Bill on which the instructions should be clear, and on which flexibility should not be allowed, and this is a case where the Board should accept as one of its obligations the duty to carry out this task. The noble Lord cannot say on Amendment No. 29 that he does not want flexibility, and then say on Amendment No. 31 that he does want it. My noble friend is absolutely right. If the Board is to carry out the instructions laid down in this Bill they must be clear, and this is one 358 of those points where they should be clear.

Lord WELLS-PESTELL

The noble Lord must bear in mind that it will depend on what is the function of the Board in any given direction. At some stage or other, every one of us has to do certain things because society requires it of us, but in other matters we can use our own discretion. In the same way, there are certain things which the Board must do, and these are clearly laid down. But one cannot say that everything the Board does must be settled for it in advance. In carrying out its functions the Board must be allowed discretion in certain areas and, in our view, this is an area where it ought to have discretion. But we concede that there are other areas where the duty must he very clearly spelled out.

Baroness YOUNG

We have had a very useful discussion on this Amendment, which has been of more value than a simple debate in this House. As my noble friend Lord Sandys pointed out, this is one of the Amendments which was tied in Standing Committee in another place. It was never debated on the Floor of the House because it was guillotined. This is the first debate that we have had on the Amendment on the Floor of either House of Parliament, and as the Government have already guillotined the Amendments that we might conceivably send back to them it is almost certainly the only time that it will be debated. Therefore noble Lords in Committee should realise that a very real responsibility rests upon them, because this is a Government measure which, so far as I can see, is hardly going to be discussed by Parliament. Indeed, if your Lordships' House were to be abolished the measure would not be discussed by Parliament at all, so at least the fact that we can debate this important matter is something to he said for us, even by our critics.

As my noble friend Lord Harmar-Nicholls has pointed out, there is a degree of inconsistency in the Government's view. We are asking that the Board must make separate proposals both for in-patient as well as for out-patient services. It does not seem to me to be a highly controversial point but, as the noble Lord has said, the calibre of the Board is such that the people 359 on it will be so good and so perfect that we must not question their reasons or ask for those reasons; and in this particular case we must give them great latitude.

Tomorrow we shall read with great interest in Hansard what the noble Lord has said on this Amendment and on Amendments Nos. 30 and 31, all of which are related to the same subject. It has been a rather complicated argument to follow and I shall read it with great care, because it may be a matter to which we shall wish to return at a later stage. In the meantime, I beg leave to withdraw the Amendment.

Lord WELLS-PESTELL

As the noble Baroness has pointed out, lines 29 to 33 were added to subsection (6) as the result of a Government Amendment at Report stage in another place. The Amendment was designed to ensure that the Board submits proposals dealing with diagnostic out-patient facilities for private patients within a period of 12 months from the initial period. The effect of this Amendment would be to return to the former position whereby the Board's commitment to submitting proposals in this field was open-ended. The Government gave very careful thought to this problem and concluded that such a situation was unacceptable.

The Bill sets a timetable for the Board's reports. In our view, pay beds are clearly the first priority. The second is the report on common waiting lists, to which we also attach considerable importance. The third is facilities for private out-patient consultation. Diagnostic out-patient facilities come next. We realise that it will take time to equip and staff premises for use as pathological laboratories or radiology clinics and that it would be unrealistic to expect the Board to report as with a view to recommending revocations of authorisation of these facilities within too short a time. The question is how much time is sensible? One could argue six months, or a year, or 18 months or, as suggested in this Amendment, no set period of time. Six months, we feel, is too short bearing in mind the priorities which have been described and the initial pressure of work on the Board. On the other hand, we recognise the need for progress and if no target is set for a first review of these facilities we run the risk that the private sector may see no need to make alternative provision.

362 Taking these considerations into account we conclude that a requirement to submit its first report 12 months after the end of the initial period—that is, spring 1978, and we are in 1976 now—was fair to the private sector, fair to the Board and would not delay progress towards complete separation of private practice from the National Health Service which the Government are determined to bring about, as your Lordships know, within a reasonable time. In short, all this part of subsection (6) seeks to do is to set a deadline within which the Board is required to submit its first report on the revocation of diagnostic facilities for private out-patients other than radiotherapy. A deadline, moreover, which allows 18 months from Royal Assent is not, I submit, an unreasonable period. Even then it does not follow that the Board will recommend the phasing out of all such facilities in 18 months' time. We shall take note of the situation. It merely requires the Board to look specifically at those facilities within 18 months of Royal Assent and to submit recommendations in accordance with the same principles as it will apply to pay beds, and consultation suites on which it is required to submit its first report within six months of Royal Assent.

By proposing this Amendment, noble Lords opposite no doubt are seeking to delay the process of phasing out, and we understand this. Their Amendment will not necessarily achieve their aim, since it would still be open to the Board to look at out-patient facilities whenever it chooses, depending on how it gets on with its tasks, and I am sure your Lordships realize there is no reason why this should not be sooner rather than later. On balance, the Government feel that it is preferable to set a target date for the Board's first report on these matters, but, as I have explained, having regard both to the Board's task and to the time needed by the private sector to provide alternative facilities, and bearing in mind that the responsibility will be on the private sector to provide alternative facilities, we feel that the time that we are prepared to give is not unreasonable.

Lord O'HAGAN

On a previous Amendment, the noble Lord said that, if the proposals we were putting forward from these Benches were carried, a considerable amount of confusion would be 363 bound to result. I can only say to him that, having tried as hard as I could and having listened most carefully, a considerable amount of confusion has resulted in my mind and perhaps I may not be the stupidest member of the Committee. Perhaps I am, but I hope the noble Lord will now be able to confirm that by answering my simple question.

How can the noble Lord argue in this Amendment that the Government must tell the Board what to do, when in answer to my noble friend Lord Harmar-Nicholls a few minutes ago he said that the Board must be allowed to do whatever it wants to do? In answer to my noble friend Lord Harmar-Nicholls, when we were dealing with the Amendment to insert "shall" instead of "may", the noble Lord, speaking for the Government, said that the Board must have flexibility. This Amendment moved by my noble friend Lady Young would increase flexibility, yet in these circumstances the Government say, "Oh no, we can't have flexibility; we don't like flexibility". Can the noble Lord explain this inconsistency? That is the first of my simple questions. Perhaps I may complete the short list before the noble Lord answers.

The other question I want to put to the noble Lord is this. The Government say that—and I do not want to blaspheme—the doctrine of immaculate conception applies to the Bill in that it is a perfect expression of the Goodman compromise; that it is flawless; that no Amendments are needed; no Amendments will be accepted, and even where there are printing errors the noble Lord does not admit that there is a mistake. This is what the noble Lord says. Yet the Government in another place have come forward with an Amendment which is embodied in the words which now appear at the end of this subsection that my noble friend has moved to leave out. How can the Government say, when resisting our Amendments, that the Bill is perfect and any alterations to it will upset the Goodman proposals, when they themselves use the argument the other way and say, if they wish to make alterations to the Bill, minor or major, that they do not alter the balance of the Goodman proposals?

Lord HARMAR-NICHOLLS

It may help the noble Lord and also save time 364 if I rise now. May I repeat what I said on the 8th November when we were dealing with Amendment No. 18. I support absolutely what my noble friend has just said about inconsistency, and if one is realistic about it, 12 months is not long enough. I think it is unwise to put in any figure at all; to leave it at the discretion of the Board is the right way to do it, but if we are going to put in any figure at all then 12 months is certainly not enough; when you are doing this sort of thing 12 months does not add up to two minutes—everybody knows that.

The noble Baroness, Lady Stedman, will remember that I dragged her into the argument on 8th November. She was a constituent of mine and she was one of the leading local government leaders in the constituency that I had the honour to represent. She knows that on matters much less intricate than this she, on her planning committees, could not give answers under two or three years; not because they were lax, not because they were lazy, but because of the difficulty of getting together all the people who had to be consulted. Because of holidays and all the other things that go into the working of bureaucracy, 12 months is no time at all.

As the noble Lord has just explained, in any case this is No. 3 in order of priority. If they have to give whatever time there is to the other two matters which are put ahead of this in the list of priorities, then to put in the period of 12 months is really ludicrous. It would be much wiser to leave it to the Board, as my noble friend said, and for it to decide on its own timetable. The first thoughts of the Government were right. This is a case where their second thoughts were wrong. I wonder who it was who felt that they were being much too realistic in their approach. They are not often realistic, if I may say so, but in their original version at least they faced up to the sort of world in which we live, where posts are delayed, where one cannot get through on the telephone, where officials are being changed. If the period of 12 months is left in—and I repeat what I said on the 8th November—this will result in a slipshod decision because the time does not allow the Board to get the details it wants. Or it will result in some official being left to make the decision and this wise Board that the noble Lord 365 has told us about not being able to use its accumulated wisdom to help us at all. It will be either slipshod or it will be decided by one or two people who are not representative of the point of view that the noble Lord has assured us about. In my view, the Amendment is more sensible, but if it is that because of some pressures that we do not know about they have to put some period into the Bill, then 12 months is not enough. It must be two or three times that length of period if we want the job to be well done.

Lord WELLS-PESTELL

The noble Lord shook me when he said that he wanted to speak and he thought that what he said might help me. I only hope that he is never against me, because if that is an indication of his help, well, some of us could do without enemies with some of the friends that we have! I should like to answer the noble Lord, Lord O'Hagan, and I say this very sincerely. The noble Lord laughingly said of himself that he is the stupidest Member of your Lordships House. He is far from that, and I can say for both sides of the Committee that we regard him as one of the ablest Members of this House. There is no question about that. I wish he would cross the Floor, as I think he will do one of these days.

Several noble Lords

Oh!

Lord CARRINGTON

Noble Lords opposite certainly need it!

Lord WELLS-PESTELL

My Lords, we could all do with extra ability.

Lord O'HAGAN

Was that a general indication?

Lord WELLS-PESTELL

Oh no!—do not embarrass us. There really is not any inconsistency at all. I do not want to go over the same ground again. In every board, every committee, every organisation, in anything that is organised, there must be spheres in which they have to take a definite line and make definite decisions. As in private life, there must also be areas in which one must be left to one's own discretion. This applies to the Board. The Board must have discretion in certain things. The Government have determined what those areas are, and have determined also the areas in 366 which they shall make a decision along certain lines.

I do not want to go again over the whole question of the Goodman proposals. I do not want to have to repeat this often. I think it was the noble Lord, Lord Platt, who referred to the Gospel according to Saint Arnold—perhaps it was the noble Lord, Lord Hill of Luton; I am not sure—but we do not want to go over it again. We say that this was an agreement and we have honourably discharged our responsibility by putting that into the Bill. But our having done that does not mean to say that the Government have not the right to frame the rest of the Bill in the way that they think is right. When the noble Lord, Lord O'Hagan, complains that we have done this but we have also done other things, it is true that we have. This is embodied in the agreement. The other matters are subjects which the Government feel are desirable in respect of other matters outside the Goodman proposals. I think the noble Lord, Lord Harmar-Nicholls, kept on talking about the 12-month period. I should not have thought I was indistinct in this Chamber, but on a number of occasions I said that the period was 18 months, and not 12 months.

Lord HARMAR-NICHOLLS

It happens to be 12 months that is written into the Bill we are discussing. One knows that there are six months on top of that, but it is the 12 months in the Bill that I want to be extended.

Lord PLATT

As the Government are so clear on what they are going to lay down and what they are not going to lay down, would the noble Lord, Lord Wells-Pestell, tell us what decisions are to be made by the Royal Commission on the National Health Service? Is that Commission to have nothing to do at all?—because as far as I can see, all the decisions will be made for them.

Viscount LONG

We seem to be having a good debate on this Amendment. I have come to the conclusion that as the afternoon goes on, one is going in the end to wonder what this Board is going to be able to do or not do. Equally, I am getting worried whether the Board will like this Bill or the responsibility handed to it by the Government. The Board is responsible 367 for making sure that the pay beds are phased out, that the private facilities are phased out; but in the long run, so far as I can see, the Board will be held responsible for making sure—and I stand to be corrected—that the hospital still makes money. If you are going to have part of this equipment taken out, then surely I am right in saying that the private sector had to pay a fee to a National Health hospital, and that money will not be there when this happens. So the Amendment of my noble friend is quite right and quite in order. We should watch the matter and protect the Board from some of its difficulties which will be produced by the Bill.

Lord HILL of LUTON

I do not want to continue the argument, but there is one point of confusion in my mind with which, perhaps, the noble Lord, Lord Wells-Pestell, will deal. Let us take the 12-month period and the specialty of radiography as an example. If, at the end of 12 months, it is seen that alternative private facilities for radiology are not available, what does the Board then propose? The Bill says, "the Board shall bring forward proposals". If it is accepted that these National Health Service hospital facilities are not to be denied unless and until alternative facilities are available, how can the Board then produce proposals? Presumably the Board does nothing until that condition is achieved. This is not a debating point; it is a serious point. What does the word "proposals" mean when in fact the circumstances are such that under this Bill nothing is to be done to deny those facilities to private patients?

Lord WELLS-PESTELL

My understanding of the situation is that there will be a responsibility on the Board within a specified time to see what alternative facilities are available in the private sector. If in a particular area or areas those facilities are not available, then the facilities in those spheres which are clearly set out will be available in National Health Service hospitals for the private sector.

Lord HILL of LUTON

That I understand; but the Board in such circumstances "shall produce proposals" governing exactly the set of circumstances 368 to which the noble Lord, Lord Wells-Pestell, referred. But what can it possibly propose? I understand the word "proposals" in this context to mean positive proposals relating to those circumstances. If the Act is observed, nothing will be done. What can "proposals" mean when it contemplates circumstances in which nothing will be done?

Lord STONE

I can vouch for the fact that these conditions do exist today in the private sector, both for radiology and pathology. These conditions have been there ever since 1948. They are in practice at this moment, and they exist. I can see no reason why they should not in point of fact even do better as and when they may or may not be phased out of the National Health Service.

Lord WELLS-PESTELL

May I just answer the noble Lord, Lord Hill of Luton, because I understand his point—at least, I think I do. The use of the word "proposals" will mean two things. One will be the proposals for the alternative facilities within the private sector, and where the private sector cannot produce these, the proposal will be that the private sector shall continue to use those specialties within the National Health Service. That is how I understand it.

Lord HILL of LUTON

I hope that is the interpretation. If, as the noble Lord, Lord Wells-Pestell, says, a proposal can be a decision not to revoke the facilities to private patients in such circumstances, I must say it is rather an odd phrase to use—"requiring the Board to produce proposals", when in fact it contemplates a set of circumstances in which there will be no proposals.

Lord WELLS-PESTELL

If I am wrong, then I will write to the noble Lord, Lord Hill of Luton, and perhaps he will allow me to send a copy of the letter to the noble Baroness.

Lord HARMAR-NICHOLLS

I am sorry to come back on that, and I admit that I am looking at this as a layman. I do not think I can accept the interpretation given by the noble Lord, Lord Wells-Pestell (although that is what he himself genuinely felt) in the context of 369 the Bill, unless it is written into the Bill at some other point. I do not think I can accept that it means what the noble Lord himself has said he thinks it means. The word "proposal" can only mean, if not the withdrawal the threat of withdrawal. There is no reason at all why that phrase should be in, unless it carries that meaning with it—in the absence of the explanation of the meaning being as the noble Lord has put it embodied somewhere else in the Bill. I must confess I had not thought of the point until the noble Lord, Lord Hill, made it.

My worry about this was for other reasons. I believe the point brought out by the noble Lord, Lord Hill, and the noble Lord's answer, make it even more essential that this Amendment should be accepted. If we remove these words from the Bill the Board will be in the same position as the noble Lord has described. If these words are not there, the Board will be able to implement what is obviously the intention in the way the noble Lord has described it. But as long as these words remain in the Bill, at the end of the day it comes to the Law Lords to interpret the meaning. The noble Lord may remember that I got a Private Member's Bill through on the meaning of a word which affected very many people very much indeed.

I venture to suggest to the noble Lord, in all humility, that in the context of this Bill this word "proposal" as it stands does carry with it a connotation that this service will be withdrawn, and will not remain as the noble Lord explained. I would venture to suggest that it may be a good thing to accept this Amendment so that the noble Lord can look at the matter and get advice as to whether or not my layman's interpretation is wide of the mark. If he can produce greater evidence than just his own opinion to show that the meaning of this word is different, then we can accept it. I do not know whether my noble friend had it in mind to withdraw this Amendment, but in the light of the point brought out by the noble Lord, Lord Hill, I would hope that my noble friend would think very hard before withdrawing it. If we vote and we are able to get sufficient support, we shall know that the Government will have to look at it again, whereas if it is not taken out there is less likelihood of that happening.

Lord SANDYS

I very much agree with my noble friend Lord Harmar-Nicholls; he has many arguments on his side. I should like, also as a layman, to address my remarks not only to the Government but also to the noble Lord, Lord Stone, who I think is addressing the House in Committee for the first or second time. He, of course, is a general practitioner. Despite the fact that he agrees with the Government, perhaps cautiously, as a layman, I might address these remarks to him as well.

The Royal Commission to which I previously referred, the Todd Commission on Medical Education, which sat in days when the situation was perhaps a little less frenetic, between 1965 and 1968, in their Command Paper 3569, addressed themselves to this particular problem. I think it is an advantage to listen to a Royal Commission which considered the subject with care and close attention. I will make a brief reference to Chapter 10, paragraph 515: A number of Consultant teachers will probably wish to continue some private practice. The problem which this raises, both in ensuring that such teachers are available where and when they are needed for teaching and that they have access to the facilities needed to treat private patients at an acceptable modern standard, have given rise to proposals that Consultant teachers' service should be 'geographically full-time'; i.e. that they should be enabled to see and treat private patients at the teaching hospital. The point is that the Government's Bill as drafted turns the Todd Commission's recommendation on its head. The Commission goes on later in that chapter to stress this particular point. I believe that so far as medical education is concerned the Board are being asked to do quite the wrong thing.

Lord PLATT

As an ex-member of that particular Commission, I entirely agree with what the noble Lord has just said.

Baroness YOUNG

The purpose of the Amendment we have put down is, of course, to restore the Bill to what it was when it was first introduced in another place. It is important that we have had this very full debate here, and I am most grateful to those noble Lords who have taken part because, of course, this was a Government Amendment introduced on Report and guillotined in another place; it is yet another example of an Amendment which has never been discussed on the 371 Floor of the House in another place and therefore never discussed by Parliament at all except for the proceedings in your Lordships' House. I think it is important for us to note, in the course of this Committee stage, how many of these points there are.

The first point I tried to make to the Government was to ask the noble Lord why they had changed their mind and altered the decisions of the Board in this way. I have not yet heard the noble Lord, Lord Wells-Pestell, give an answer to that question, which is, after all, the crucial one. They obviously had second thoughts. They moved their Amendment, they guillotined it, and we have it now in the Bill which has come to your Lordships' House. It would be helpful if the noble Lord felt able to answer the question in Committee, because it is clearly the first one that is going to be asked. As my noble friend Lord O'Hagan quite rightly said, the reply of the noble Lord is another inconsistency.

In this particular case the Board is being required to act in a certain way in regard to out-patient facilities. The time-scale suggested—if one looks at subsection (6) one sees that it is 12 months following the initial period—means that these particular facilities must be phased out, as I understand it, 18 months after the Bill becomes law. As my noble friend Lord Harmar-Nicholls quite rightly said, it takes a very long time to establish another hospital and to put into it suitable facilities. The noble Lord, Lord Hill, quite properly asked the question, what is the Board to propose? As I understand the answer, if there were not any other facilities the Board would not necessarily propose that they would be phased out. But, of course, that is not what the Bill says; that is the noble Lord's interpretation of what the Government hope the Board will say. It is precisely this kind of point that the medical profession is most anxious about.

I would refer the Government to the words of the noble Lord, Lord Goodman, at Second Reading (cols. 1500/1): 372 There are other changes which are much of the same sort and they are changes which the doctors seek because they want a clarification of the position and a reassurance that what they are told the Bill means is in fact what the Bill means. I would urge the Government to give it to them in every single case."—[Official Report, 21/10/76.] Here, I should have thought, was an exact case in point. It is the kind of issue on which clearly the Government consider this was part of the original Goodman agreement. Going back to the actual text of the agreement, I quote: The Board shall not necessarily retain existing private facilities for the purpose of specialised operations, treatments and investigations where the National Health Service is prepared to make such accommodation and equipment reasonably available on an occasional basis for individual requirements in specified circumstances and at an appropriate charge. The Bill would propose to allow health authorities to provide and charge for such specialised services for patients provided that they can satisfy the Secretary of State that there will be no disadvantage to NHS patients, and that such patients—whatever their country of origin—are admitted on the same basis of medical priority as an NHS patient. It seems to me that what the Government originally wrote into the Bill meets the Goodman point. What the Government have now put into the Bill on Report does not. There is now a doubt about it, even though the noble Lord has said that that is not how it would be interpreted. The Bill has tightened up the timetable. It has put a firm timetable on expensive and difficult equipment and services. It is one thing to provide a consulting room within six months—after all, presumably anybody could turn over his dining room for a consulting room if that were what was required—but nobody can produce within a short period of time (and eighteen months is a short period of time) these alternative facilities. I feel that this is an Amendment I cannot withdraw, and therefore r wish to ask the Committee to decide upon it.