House of Lords
Economy: Deficit Reduction
(13 years ago)
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Lord Barnett
To ask Her Majesty’s Government what evidence they have that their deficit reduction plan is working.
The Commercial Secretary to the Treasury (Lord Sassoon)
My Lords, tackling the deficit is necessary to supporting sustainable economic growth. The Government’s consolidation plan has restored confidence in the UK’s fiscal position, preserving our AAA credit rating and leading Standard & Poor’s to move the UK’s rating from negative outlook to stable. In May 2010, the spread of UK gilts to German bunds was in line with Italy and Spain; since then, UK rates have fallen by over 150 basis points but Italian and Spanish bond yields have risen by over 100 basis points.
Lord Barnett
In the midst of all that, the noble Lord forgot to answer the Question. As I am sure he will recall, the Prime Minister said that the deficit would be eliminated in 2015 and his own Office for Budget Responsibility has said that it will be 2017. Why was he not willing to say that? Is there something wrong in telling the truth that he has to give me a long, wordy Answer? However, it is even worse than that—and some very respected forecasters are forecasting that it could be even worse. Would he not accept that if the circumstances change, through no particular fault of the Government, changes in policy should take place? For example, we might do something to stop the unemployment figures announced yesterday being even worse. What does he have in mind in the event of some kind of major change in circumstances?
Lord Sassoon
My Lords, the Government are on track to meet the fiscal mandate which was set by my right honourable friend the Chancellor. The mandate requires the Government to bring the cyclically adjusted current balance into balance at the end of five years. The Opposition may not like it but that fiscal rule means that there is an ability for us to be flexible in the face of very difficult economic conditions; it means that we can preserve the infrastructure expenditure, which is so important, to underpin long-term growth; and it means that the automatic stabilisers can operate. If the noble Lord, Lord Barnett, is suggesting that we should abandon all of that, I wonder what his policy would be.
Lord Blackwell
My Lords, does my noble friend accept that the primary reason for our current deficit is the fact that public expenditure as a percentage of GDP grew from less than 40 per cent to close to 50 per cent in the first 10 years of this century? Will he confirm that the Government’s primary focus is therefore to get public expenditure back down below 40 per cent, where it can be supported by an affordable level of taxes?
Lord Sassoon
I certainly agree with my noble friend that we inherited the worst peacetime deficit situation that this Government have ever known, and that getting the budget back into balance is indeed the priority of this Government.
Baroness Kramer
My Lords, I am sure that the Minister will agree that access to bank credit for smaller microbusinesses will be essential for economic growth and elimination of the deficit. Will the Government therefore take a look at the extraordinary barriers to entry of new potential banks into exactly this field, the FSA having now become so utterly risk-averse that it has lost any sense of balance?
Lord Sassoon
My Lords, it is very important that credit flows to SMEs, which is why we announced a package of £21 billion at the autumn Statement, and it could go higher if the demand is there. I take my noble friend’s point about the importance of diversity and new entrants into our banking system. That is something that both the FSA and the Government keep under review.
Lord McFall of Alcluith
My Lords, given that the stability message has failed, is it not time now for a growth strategy? Given the appalling figures on unemployment for both young people and others in the country, is there not hope to be given to people? Given that the Government can borrow, with the low interest rates, at a rate less than the private sector, is it not time to invest in infrastructure projects so that we come out of this recession and not make it a depression?
Lord Sassoon
My Lords, that is exactly what we are doing: we are investing in infrastructure projects. Indeed, as was announced at the autumn Statement, we are targeting an additional £20 billion of private sector money coming into infrastructure from long-term UK investors. As to the policy mix, I can only refer back to the IMF’s latest assessment which said that the case for relatively tight fiscal and relatively loose monetary policy is strong.
The Lord Bishop of Blackburn
My Lords, surely the question for most ordinary people not schooled in economics is whether the Government’s programme for rapid deficit reduction is actually a price worth paying. Could the Minister tell us how the Government propose to quantify the cost of deficit reduction in terms of the impact on people and communities?
Lord Sassoon
The right reverend Prelate is absolutely right. The end objective here is not a balanced budget but sustainable growth, to bring down unemployment and increase employment in this economy. So what is really important, whether it is infrastructure spend, the fundamental reform of the welfare system or our education system, is that in the end we get a better balanced economy with more sustainable employment over the long term.
Lord Eatwell
My Lords, the Minister has made it clear to the House today that the Government’s deficit reduction strategy is based on sand. It is always five years ahead. He has told us today that the target is to balance the budget by 2017; next year it will be 2018, the year after that 2019 and, like old age, it will simply retreat before us. Given that the Government’s strategy has been pushed off track and is failing to meet its deficit targets, why in the autumn Statement did they not cut expenditure more and raise taxes more to put the deficit reduction strategy back on track?
Lord Sassoon
My Lords, first, the deficit reduction strategy, as the OBR confirms, is absolutely on track. If the noble Lord is suggesting that we should cut expenditure and raise taxes, is that the policy of his party?
Lord Dykes
My Lords, did the Minister notice that the credit rating agencies and the American-dominated $16 trillion debt system gave AAA ratings to all the hedge funds and banks that collapsed in the United States and elsewhere in the world just about a week or a few days before they actually did collapse. Are they really so reliable?
Lord Sassoon
My Lords, the track record of the credit rating agencies as far as sovereign debt is concerned speaks for itself. It is quite different to the mistakes that they have made in other sectors.
Justice: Evidence
(13 years ago)
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Lord Lloyd of Berwick
To ask Her Majesty’s Government when they expect to receive a further report from the Privy Council review, led by Sir John Chilcot, on using intercept as evidence.
The Minister of State, Home Office (Lord Henley)
My Lords, there have recently been changes to the membership of the Privy Council group. I look forward to it reconvening shortly to assess progress and, as appropriate, to offer advice.
Lord Lloyd of Berwick
My Lords, it is now nearly four years since the Chilcot committee was asked to find a way of making intercept evidence available in court. The preferred approach has always been by what has been called public interest immunity plus, which has many advantages. However, in December 2009, that approach was abandoned in the light of the decision of the fourth section of the European Court of Human Rights in a case from Finland. Since then, we have heard very little. Does the Minister recall that a month ago the Lord Chief Justice and the president of the Supreme Court gave evidence that the courts are following decisions of the European Court of Human Rights too strictly? If that is accepted, would he encourage the Chilcot committee to look again at PII+ and perhaps take further legal advice?
Lord Henley
My Lords, I am sure that the group will want to reflect on the implications of the judgment to which the noble and learned Lord referred in the European Court of Human Rights and to reflect on the remarks of the Lord Chief Justice when he said that the United Kingdom courts should give due weight to decisions from the European Court of Human Rights. However, the noble and learned Lord should recognise that experience in other countries, whether they are bound by the European Court of Human Rights or not, is that using intercept as evidence involves significant operational burdens, and that the review is helping to address those issues by trying to find the right balance between advantage, costs and risks.
Lord Carlile of Berriew
Will my noble friend the Minister confirm that the Privy Council review has been looking at a very small number of possible models for admissibility and that the key issues, as the noble and learned Lord, Lord Lloyd, said, concern the ECHR, upon which the review might perhaps take note of the recent and very helpful public comments of the noble and learned Lord, Lord Irvine? Will the Minister try to ensure that, given that all the legwork has actually been done now, an announcement is made within weeks rather than months?
Lord Henley
My Lords, it is not for me to decide when the Privy Council group should make its decisions. That must be a matter for the group itself. As I stressed at the beginning, there have been changes to the membership of that group, which has complicated matters and slowed things down somewhat. As I said, I am sure that the group will take account of the implications of the judgment in the European Court of Human Rights and of the views expressed by the noble and learned Lord, Lord Irvine.
Lord Hurd of Westwell
As a former member of the group that we are talking about, could I press my noble friend a little further on this point? My recollection is that some time ago we were within spitting distance, we were within reach, we were edging fast towards a settlement or compromise that would satisfy both the main parties and points of view in this complicated matter. What has gone wrong since then?
Lord Henley
My Lords, it is not for me to pronounce on the problems that the group is having. As my noble friend knows from his distinguished service on this group, the membership has changed not once but twice over the last year or so. There are difficult issues to be addressed. I know that it came forward with one model, and there were problems with that, but I think my noble friend will accept that trying to get the right balance, to which I referred in my first Answer, between advantage, costs and risks is a very great challenge and one that we want that group to get right.
Lord Rosser
I am not clear from the Minister’s answer whether the Government have a view on this issue or not. In light of the remarks made by the Lord Chief Justice in relation to the ECHR decision to which the noble and learned Lord, Lord Lloyd of Berwick, referred, do the Government take the view that there appears to be no insurmountable obstacle in principle to the use of intercept evidence, or are our intelligence services still voicing significant concerns on this issue?
Lord Henley
There are obviously significant concerns about using intercept as evidence. It can be very useful as intelligence, but using it as evidence can create significant problems. We want to address those problems and make sure that we have got it right before we allow intercept to be used as evidence. That is why the previous Government set up the review under Sir John Chilcot and why we are continuing to look at the work that it is doing and looking forward to its report in due course.
Baroness Ramsay of Cartvale
I understand that what happened was that the first group of privy councillors under Sir John Chilcot, of which the noble Lord, Lord Hurd, was a member, made a report that was considered. It then went into the next phase, with the privy councillors liaising with an action unit, or something like that, in the Home Office. That activity has hit problem after problem. It is not the fault of the privy councillors that there is a delay in reaching a solution. As the Minister said, it is a very complicated matter.
Lord Henley
The noble Baroness is absolutely correct. I was not trying to imply any criticism of the group; I was saying that it has put forward a solution that we have found a number of problems with. We will continue to look at any ideas that it puts forward. If we could use intercept as evidence in a manner that was safe and appropriate, we would, but again I stress that we have to get the right balance between advantage, costs and risks.
Baroness Hamwee
My Lords, when I heard the Minister’s original Answer I wondered whether it was a case of changing the membership if you do not like what is being said, and in this case I would welcome that. However, does the Minister accept that the longer this goes on, the less trust and confidence there is among those of us who take an interest in this about whether there is a real determination to reach a good and useful outcome?
Lord Henley
My Lords, the only reason why the membership changed was because the noble and learned Lord, Lord Archer of Sandwell, stood down due to reasons of health. He has been replaced by Shaun Woodward, and there is nothing else behind that.
Lord West of Spithead
My Lords, during my three years as Minister for Security, almost every key plot against this nation was first identified through the auspices of GCHQ and this sort of intelligence. While one has to be sad that things have been delayed, will the Minister confirm that the most important thing to get right is not to lose any of the skills and capabilities that have been lost in the past when people have spoken about them unnecessarily?
Lord Henley
My Lords, the noble Lord is absolutely right to underline the importance of intelligence—and I stress the importance very often of intercept as intelligence. Whether it can be used as evidence is always another matter. Frequently, even if it could be used as evidence, it would not be very useful evidence, having been useful intelligence.
Political Party Funding
(13 years ago)
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Lord Tyler
To ask Her Majesty’s Government when they will respond to the report of the Committee on Standards in Public Life on party funding.
The Minister of State, Ministry of Justice (Lord McNally)
My Lords, the Government are grateful to the committee for its report and will consider its recommendations before providing a formal response. The Deputy Prime Minister set out the Government’s proposed approach to party funding reform in his Written Ministerial Statement of 23 November.
Lord Tyler
Can my noble friend give us an assurance that unlike under the previous Administration, the most reluctant and recalcitrant participants in this process will not be allowed to delay everything, and will not be given a complete veto on progress? In particular, may I suggest that we should start with immediate action to stop the arms race in expenditure, both at the constituency level—targeting constituencies as well as national constituencies—and before, as well as during, campaigns? This could achieve some cross-party agreement, and of course would be very popular with the long-suffering public.
Lord McNally
My Lords, I welcome those suggestions from my noble friend, which I will pass on to the Deputy Prime Minister. In his Statement that I referred to, he said:
“The Government believe that the case cannot be made for greater state funding of political parties at a time when budgets are being squeezed and economic recovery remains the highest priority. But there is a case for looking carefully at whether existing levels of support could be used more effectively”.—[Official Report, Commons, 23/11/11; col. 25WS.]
I would have thought that some of the suggestions that my noble friend made could be brought into that general consultation with all political parties.
Lord Maclennan of Rogart
My Lords, will my noble friend indicate whether the advice that has been given will be followed in time to influence elections that are going to be pending quite soon? In particular, having borne in mind that the Government have been speedy in altering the structure of constituencies, will they also take into account the importance of fair dos in spending to affect these forthcoming elections?
Lord McNally
My Lords, even this report recommends that nothing that it suggests should come in before 2015, but the Deputy Prime Minister has indicated that all political parties are welcome to have broad discussions with him, and these matters could form part of those discussions.
Lord Grocott
My Lords, I feel a little light-headed because I think I may agree with the noble Lord, Lord Tyler. Obviously, to make elections fairer it is not just a question of where competing candidates and parties raise their money from, it is also how much they spend. This has long been acknowledged at the level of constituency party campaigning. Surely, whatever else we may disagree on, none of us would want elections to take the form, in terms of expenditure, that is the case in the United States, where the most obscene levels of expenditure are required even to begin to get off the ground. Can the Government focus their attention on looking at the ways in which total expenditure can be minimised, particularly at a national level? At least we could make some progress on that, even if the other side of the equation is more difficult.
Lord McNally
My Lords, not only do I feel light-headed, I think I am going to swoon away: I think I agree with the noble Lord, Lord Grocott. Yes, I fully agree with him. As the Deputy Prime Minister has rightly said, this is obviously not the time to try the fundamental reforms that this report, and indeed the Hayden Phillips report before it, recommended. However, there is an opportunity to engage in discussions to see if we can do things within current frameworks to address some of the issues he raised. That would be a very fruitful use of time in this Parliament.
Lord Tebbit
My Lords, while I too agree with a good deal of what has been said, does my noble friend not agree that it would be very dangerous if we were to set maximum levels of expenditure for the parties which were convenient for a party which could attract less than 10 per cent of the electorate, as opposed to major parties which attract somewhere around 40 per cent of the electorate? Perhaps it was a little dangerous for my right honourable friend the Prime Minister to leave this matter in the care of his deputy, who does not seem quite to be on song with the rest of the Government.
Lord McNally
For a party that has pretty consistently polled over 20 per cent of the vote in recent general elections, there is certainly no self-interest about the 10 per cent figure. Indeed, we should all wait for the next election, which as we all know, usefully, is in 2015. Four years is a long time in politics.
Baroness Hayter of Kentish Town
Given that we are all in agreement, maybe I should say that I agree with Nick.
Given that the Liberal Democrat manifesto promised to get big money out of politics by capping donations at £10,000, would not the best way of ending the big donor culture perhaps be for the Minister’s party to return Michael Brown’s money—money that was not his to give and should never have been accepted?
Lord McNally
That was a good growl of approval. It is not for me, as a member of the party of Lloyd George, to lecture anybody on party political funding. However, I have been pressing for party political funding reform all my political life, and I can assure the noble Baroness that this affects all parties. The problem about this culture of forcing our parties to raise big money from big donors, as I have said many times from those Benches and I say now from this Bench, is that the regime is corrupting of our political system, and the sooner we can get rid of it the better.
Crime: Metal Thieves
(13 years ago)
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Lord Faulkner of Worcester
To ask Her Majesty’s Government what action they are taking to establish a nationwide task force to target metal thieves.
The Minister of State, Home Office (Lord Henley)
My Lords, the Government recognise the growing problem of metal theft and are taking urgent steps to address it. Five million pounds has been provided to establish a dedicated national task force to significantly increase enforcement activity to deal with both scrap metal dealers who trade in stolen metal and those who steal metal.
Lord Faulkner of Worcester
My Lords, that is fine as far as it goes but does the Minister agree with what his Home Office colleague James Brokenshire said in the other place on Monday? Mr Brokenshire estimated that the cost of metal theft may be now as much as £777 million a year and said,
“we have now reached the stage where the only conclusion is that new legislation is needed to tackle metal theft”.—[Official Report, Commons, 12/12/11; col. 508.]
As a vital first step, will the Minister accept my amendment to the Legal Aid, Sentencing and Punishment of Offenders Bill, which would make cash transactions for scrap metal sales illegal, bearing in mind that probably as much as £1 billion out of the £5 billion in this industry is accounted for in cash and is the cause of most of the problems?
Lord Henley
First, my Lords, I always agree with everything that my honourable friends say and I agree with absolutely everything that my honourable friend Mr James Brokenshire said on Monday about metal theft. We think that the Scrap Metal Dealers Act 1964 is dead. It is past its sell-by date and we need to look at other measures to properly regulate the scrap metal yards, because that is where the problem is—in dealing with the stolen metal. We will certainly look very carefully at the noble Lord’s amendment, which I have not yet seen, when it comes before us shortly in the legal aid Bill. If we can give it a fair wind or tinker with it, we certainly will because I agree with him that addressing the question of cash in this industry certainly needs looking at.
Baroness Howarth of Breckland
My Lords, does the Minister agree that the stakes have been significantly raised in this issue, now that it is a question not only of very significant funds but of human lives being put at risk in hospitals, when hospitals have to close and operations have to be postponed because metal has been stolen by thieves? Does that not raise the measure of the issue significantly?
Lord Henley
My Lords, the noble Baroness is quite right to raise the issue of the threat to life. Already this year, I think that some six criminals have been killed stealing metal—it is perhaps a higher figure—but in stealing that metal they have caused considerable disruption to power supplies and other things. We know that that has affected not only hospitals but, on other occasions, the emergency services. That is why the Government certainly feel it necessary that we must make moves in the area.
The Lord Bishop of Oxford
My Lords, the call for tighter regulation of scrap yards, including cashless transactions, is widespread. We know that the industry itself wants to back regulation. I wonder whether the Minister could be a bit more specific on the timescale and when we might expect some real reform of the regulations, including particularly the easy access to cash which supports something causing not only the damage of yesterday that we have heard about but damage in our own case. We have around 10 churches a day losing their roofs. Can we have a timescale?
Lord Henley
My Lords, the right reverend Prelate is right to draw attention to the problems that the churches are facing. I recently met his colleague, the right reverend Prelate the Bishop of London, to discuss this issue. He is also right to draw attention to the fact that the industry itself recognises the need for more regulation in this field, which is why we want to go down that route. However, although the industry recognises the need for more regulation, it does not see the advantages of going cashless. I think that going cashless would possibly be the biggest gain to make.
The Earl of Glasgow
Metal theft has become a really serious epidemic. As the noble Baroness said a moment ago, only about two days ago some copper metal was taken from a hospital in Wales and that resulted in eight operations having to be abandoned. I want to be assured by the Minister that the Government are going to deal with this very urgently and have some plans to deal with these scrap metal dealers as soon as possible.
Lord Henley
My Lords, I can give my noble friend that assurance. The important thing to say is that is very difficult to stop the actual theft, given how widely spread all the various metals are. That is why we think the important thing is to deal with the handling, and why we want to deal with the yards. If we could cut off the route for getting money from these stolen metals, we would then cut off the thefts.
Lord Hughes of Woodside
My Lords, in view of the danger to life in hospitals and the very possible serious damage to life due to metal theft on the railways, is the Minister satisfied that there are sufficient penalties available once the criminals—either the thieves or the receivers—are caught? I would not normally call for harsh sentences but in view of the salutary sentences given to the rioters, should we make sure that there are salutary sentences for those engaged in this dangerous and life-threatening trade?
Lord Henley
My Lords, my memory of the Theft Act is sketchy but, as I remember it, it provides for seven years for theft, something considerably longer for burglary—which most of this would come under—and makes very severe long sentences available for handling. It is the handling we want to get at because it is the fence who deals with the metal who provides the value to it.
Lord Cormack
My Lords, as we desperately need a solution to this terrible problem and as the Deputy Prime Minister desperately needs a success, why can we not put him in charge of the committee to come up with a solution to this metal theft problem?
Lord Henley
My Lords, I assure my noble friend that the whole Government are united on this issue. We just have to sort out the details before we bring forward legislation.
Marriages and Civil Partnerships (Approved Premises) (Amendment) Regulations 2011
(13 years ago)
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Baroness O’Cathain
That a Humble Address be presented to Her Majesty praying that the regulations, laid before the House on 8 November, be annulled on the grounds that they do not fulfil the Government’s pledge to protect properly faith groups from being compelled to register civil partnerships where it is against their beliefs.
Relevant document: 43rd Report from the Merits Committee.
Baroness O'Cathain
My Lords, although I am a reluctant rebel today I am very grateful to the Government, and particularly to the Leader of the House, for scheduling the debate and for sticking to the policy of treating this as a matter of conscience. Conservative Back-Bench Peers have a free vote. In fact, all three main parties allowed a free vote when this issue was first voted on in March 2010. At that time the noble Baroness, Lady Royall, said that it raised,
“fundamental issues for religious organisations, and it is therefore right that they are considered as matters of individual conscience”.—[Official Report, 2/3/10; col. 1439.]
I am surprised that the Opposition are now whipping, but that is their decision.
The purpose of my Prayer is to address the widely held concerns that the regulations threaten religious freedom. The Merits Committee has drawn them to the special attention of the House, because of the concerns expressed to it. The House must decide whether we reject them and invite the Government to think again. The regulations are intended to create an entirely voluntary system for places of worship that wish to register civil partnerships. That is the intention and I do not doubt the Government's sincerity, but senior lawyers advise that the interplay between the regulations and equality law could result in legal pressure on churches that do not want to register civil partnerships. That is what I want to address.
In no way am I trying to block these regulations as a means of opposing civil partnerships. I have seen some deeply unpleasant briefing materials and, indeed, have received many obnoxious letters which impugn my motives. I have absolutely no hidden agenda. My sole reason for this Prayer is to attempt to stop churches having their religious freedoms taken away by local authorities or by litigious activists. The House must not pass regulations that fail to fulfil the intention of the Government. The wishes of the noble Lord, Lord Alli, who I am glad to see in his place, should be honoured. He made it clear that he did not wish to see places of worship forced to register civil partnerships against their will.
In the run-up to this debate, there has been so much confusion that I particularly want to make it clear that we must not confuse the registration of civil partnerships in churches with the question of the redefinition of marriage. Marriage remains in law the union of one man and one woman for life, to the exclusion of all others; nothing said or done here today will have any effect on that. The issue is the impact of these regulations as drafted, which seek to allow civil partnerships to be registered—and I underline registered—in places of worship. It is not a question of voting against civil partnerships; it is a question of asking noble Lords to vote for the protection of religious freedoms.
The regulations were laid as a negative instrument on 8 November. Parliament has 40 days from that date to annul them, and that period runs out at the end of this week. Strangely, the coming-into-force date printed on the regulations was 5 December, so technically they are already in force. That date was the Government’s choosing. We still have time to vote them down. If my prayer is agreed today, the regulations will cease to have effect. However, applications by same-sex couples will not be jeopardised, as the local systems have not yet been established. This means that the Government have time to think again about how to implement the proposals, while ensuring that their intention—and I emphasise their intention—of protecting religious freedom is achieved.
The procedure for rejecting delegated legislation which I am invoking today was agreed by the House in July. If the House no longer wanted to have that power, it could have given it away or curbed it. I acknowledge that many noble Lords, especially on these Benches, are reluctant to vote down secondary legislation. According to the Library, we have done so three times in just over a decade—twice in 2000, on the GLA election expenses regulations, and again in 2007, on the casino regulations. I am sure that this is one such situation in which we should act. The regulations are fatally flawed: they put religious freedom in jeopardy. It is always dangerous to take away freedom, but to do so using secondary legislation, which is subject to so little scrutiny, seems especially egregious.
The House of Commons had no opportunity to scrutinise these regulations. As a negative instrument, they did not qualify for the Delegated Legislation Committee. Edward Leigh, the Member for Gainsborough, tabled a Prayer to Annul and tried to persuade the Government to set up a Committee, but this was denied. Thus, the sole responsibility for scrutinising these regulations lies with us. We have no opportunity to amend the regulations; if we had, I would have tabled an amendment. As a revising Chamber, we might have preferred that, but it is not an option. If we think that the Government’s drafting is wrong, we must reject them. This is the only way of asking the Government to think again.
The regulations themselves do not force churches to register civil partnerships on their premises, but offer an opt-in system whereby faith groups wishing to register civil partnerships have the freedom to do so. The regulations contain this statement:
“Nothing in these Regulations places an obligation on a proprietor or trustee of religious premises to make an application for approval of those premises as a place at which two people may register as civil partners”.
But I am afraid that this statement is meaningless, because it only protects against obligations in these regulations. A similar statement was inserted in the Civil Partnership Act by the amendment of the noble Lord, Lord Alli. However, it is not the regulations under the Civil Partnership Act that have the potential to place an obligation. The churches need protection not from the regulation under that Act, but from that under the Equality Act. Having protection under these regulations is like being given protective goggles on a construction site, when what you need is a hard hat—it is protection against the wrong thing.
Professor Mark Hill QC, a leading ecclesiastical lawyer, has produced a written legal opinion which makes the very serious claim that the regulations will result in,
“a curtailment of religious freedom”,
and will compel churches,
“to secure approval for the registration of civil partnerships despite their doctrinal objection”.
This is serious. Professor Hill cites Section 149 of the Equality Act, “Public sector equality duty”, which requires all public bodies to have due regard to the need to eliminate discrimination. This duty applies to local authorities and to the registration officials who are housed and employed by them. These are the people with whom the churches have to deal when they apply for the licence to register marriages.
According to Professor Hill, local authorities could say that the public sector equality duty requires them to oblige churches to register for civil partnerships as a precondition of being able to register for marriage. It is blindingly obvious that a church which performs marriages, but refuses to perform civil partnerships, is discriminating. The church regards this as justified discrimination, simply by being faithful to its religious principles. However, the public sector duty is about eliminating all forms of discrimination. So you can see the problem. Some local authorities would claim that facilitating churches to register marriages, but not civil partnerships, will make them complicit in discrimination.
I know that the Government argue that marriage and civil partnerships are two separate systems, and that the local authority cannot make approval of one dependent on the other. Indeed, the final decision on approving premises for marriages rests with the Registrar General, while the decision over civil partnerships takes place locally. In both cases, however, the application has to be submitted through the registry office, housed at the local authority.
In a separate legal opinion, responding to the Government, Aidan O’Neill QC, a leading human rights lawyer at Matrix Chambers, states that it will be a relevant consideration for, and duty of, the relevant public authority to have regard to how any such approval might impact upon its attempt to eliminate discrimination. He states that although the Marriage Act 1949, which governs registration of churches, allows little discretion, the public authority would still be bound by the public sector equality duty. In order to avoid a conflict between the registration duties under the 1949 Act and the equality duty under the 2010 Act, Mr O’Neill says that a public authority could “read down”—which, as a non-lawyer, I take to mean “re-interpret”—the Marriage Act 1949 to make it compatible with the public authority’s positive obligations under the Equality Act. He suggests that a judicial review might even require it so to do.
It is certainly not difficult to imagine a local authority solicitor advising his chief executive that in all functions, including processing applications for churches for power to register civil partnerships and marriages, the local authority must eliminate discrimination. This would include processing applications only from those churches that also allow the registration of civil partnerships. The application may never be referred to the Registrar General if the local authority applies a filter on the application at the initial stage.
The Church House briefing, which I think everyone has had, argues that because marriages and civil partnerships are different things, the law cannot be used to require a church to provide one just because it provides the other. However, Aidan O’Neill asserts that the equivalence between marriage and civil partnerships is a basic tenet of the Equality Act. The courts are unlikely to view them as two entirely separate services. They have already ruled, in the Ladele case, that being willing to register marriages, but unwilling to register civil partnerships, is discrimination. Mr O’Neill’s opinion, which I have made available to colleagues, shows how churches and denominations could be squeezed by combining the obligations of the Equality Act, the Human Rights Act, the European Convention on Human Rights, and EU law.
We cannot ignore the views of these two QCs. The willingness of Professor Hill and Aidan O’Neill to commit these opinions to writing proves that there are lawyers who are willing to argue these points in court. If there is any risk that these arguments might succeed and that churches could be deprived of the right to register marriage by politically correct local authorities, we must prevent it. We have to get it right first time. Last year the noble Baroness, Lady Royall, actually spoke against the amendment of the noble Lord, Lord Alli, because of the holes in the drafting. She said:
“Our preference would be to get this right from the outset”.—[Official Report, 2/3/2010; col. 1440.]
This is our last chance to get it right. We cannot put the churches in the legal firing line and sort it out later.
I received a copy of the Minister’s letter yesterday, which says that,
“if a successful legal challenge were ever brought, I would like to provide reassurance that the Government would immediately review the relevant legislation”.
I suggest that this is not good enough. We must get it tied down, guaranteed and cast-iron now.
The churches might win out in the end, of course, but why should they face the cost, the fear and the chilling effect of sorting out a legal mess created by Parliament? We know that some people would like to force churches to register civil partnerships. The chief executive of Stonewall said that right now faiths should not be forced to hold civil partnerships, although in 10 or 20 years’ time that might change. Mike Weatherley, the Conservative MP for Hove, has more immediate plans: in a letter to the Prime Minister this year he called for churches that refuse to register civil partnerships to be banned from registering marriages. In a nutshell, this is what would happen if these regulations are not annulled.
We have watched the progress from permission to coercion before now. In 2003 we legalised joint adoption by same-sex couples; that was permissive. However, when the sexual orientation regulations were introduced, even though they were not specifically about adoption, it suddenly became compulsory for Roman Catholic adoption agencies to take part in same-sex adoptions. How permissive is that? As a result of the overlap between the permissive provisions and the obligations of equality law, all but one of the English Catholic agencies have either closed down or been secularised. Holes in the regulations must be plugged or someone somewhere will exploit them.
Officials at Church House are not concerned, of course—the Church of England does not have to apply to registrars to register marriages—but surely they ought to be concerned about other religious denominations and independent churches that rely on the good will of local authorities. I have had so many letters on this subject from churches that I did not even know existed. The secretariat of the Roman Catholic Church prefers the Government’s interpretation of the regulations but admits that there is a risk. It says:
“If, of course, there were an opportunity for the Regulations to be revisited at this stage, then they should include … a statement explicitly to put the matter beyond doubt”.
I reiterate that I am not talking about redefining marriage or about trying to unpick the Civil Partnership Act. I am talking about the particular mechanism that the Government have chosen to legalise civil partnership registration on religious premises. I accept that it is the Government’s intention to introduce a voluntary regime that protects churches. I urge the Minister to agree to my Prayer, withdraw the regulations and go away to think again about whether the Government really have done enough to achieve this voluntary regime.
Aidan O’Neill QC argues that the only way to protect the churches is an amendment to the Equality Act. The Scottish Government, who are considering their own plans to allow religious civil partnership registration, have the same view. If leading QCs are not convinced, the Government have not provided reassurance despite their wish to do so. My Government need to go away and think again. I beg to move.
Lord Alli
My Lords, I wanted to start by arguing that this issue has already been debated at length in your Lordships’ House and that the opinion of the House had already been made clear. Then I came to my senses and remembered that I was actually in your Lordships’ House, so I disposed of that line of argument.
I shall move on to the substantive issues and tackle first the intention of the clause to which these regulations apply. Noble Lords may recall the amendment that I originally proposed with the noble Baronesses, Lady Noakes, Lady Neuberger and Lady Campbell, who I am very pleased to see in her place today—I know that she has been very ill recently, and for her to come here was a great kindness. The regulations did not and do not place an obligation on any religious organisation to host civil partnerships if it does not wish to. I shall read once again the actual words in the Act:
“For the avoidance of doubt, nothing in this Act places an obligation on religious organisations to host civil partnerships if they do not wish to do so”.
How can such a clear statement of intent be twisted into forcing religious organisations to host civil partnerships in their buildings against their will? I shall tell the House how I think it happens. First, you take a spurious argument. You dress it up in legal language; find a senior QC or two, and preferably a professor, and get them to write a lot about very little. Then you throw in a large dose of prejudice, and finally you add that secret ingredient: fear—in this case, fear that people will be coerced into acting against their conscience. It is a heady cocktail and its purpose is simple: to make good people with good intentions do things that otherwise they would not do.
That is how it is done. What has always confused me is why we continue to drink that cocktail when we know what goes into it. It has always confused me that decent, hard-working people continue to listen to extreme views built on half-truths. We know that they are half truths but some kind of politeness stops us from challenging them. That needs to stop. We need to call an untruth an untruth, a lie a lie, an opinion an opinion and a fact a fact. We must not develop the politics of the Right in America, where it does not matter what the actual truth is, whether any prosecution would actually succeed or whether or not it really is a conscience vote. All that matters is how big your microphone is and how controversial your views are—nothing to do with truth, fairness or justice.
I say, with the deepest respect: is it not about time that a Government who know that this is not a conscience vote put a three-line whip on all their Members, not just their Ministers? At this point I normally thank the Minister for his help and support, and indeed I am sure that he knows I do so now. I suspect that thanking him will do neither him nor me any good, but I do so anyway.
Is it not time also that Front-Benchers of all parties, who know that this is not a conscience vote, stand up and say so? Is it not time that those who hold legal opinions admit that no one believes that a legal action would succeed in this context, because of the very conscience clause that is in the Act? We should be better than this. This House is a place where truth should win out and the arguments should be about the big issues—good, evil, right and wrong. It is a place where the facts should be respected and the kind of misinformation that we see peddled in our postbags rubbished for what it is.
In the run-up to this debate, I have asked myself, “What is it that those who seek to annul these regulations hope to achieve?”. It is simple: they do not want same-sex couples to celebrate their partnership in any religious building. They argued against the original amendment. They simply do not care if the religion concerned wants to host these celebrations or not; it is their way or no way at all. That is simply wrong. This provision is all about religious freedom. It is about allowing churches and religious organisations the freedom to decide whether or not they wish to host civil partnerships. It is about removing the civil law from those discussions. It is about allowing each faith to decide for itself what is best for it and its congregation. It is fundamentally about religious freedom.
I know that this is a difficult issue for some churches, but the legal opinions of even the Church of England and the Catholic Church confirm that no church will be forced to approve its premises and that the public duty that the noble Baroness talks of simply does not apply. If you cherish religious freedom, there is a bigger principle at stake—the principle that means allowing the Quakers, the Liberal Jews or the Unitarian Church to make their own decisions on civil partnerships in their own religious buildings.
I shall end by saying a little about what I believe I have learnt that this House can and cannot do. We should not fashion our laws around the convenience or inconvenience of any particular religion. We cannot stop a gay Catholic man from suing the Catholic Church. We cannot stop a gay Anglican from suing the Church of England. For that matter, we cannot stop a straight man or woman from doing the same. We in this House cannot stop people from going to court. The question is not, “Can they make a case?”—in my experience, a good lawyer can always make a case—but, “Will they win?”. On that there can be very little doubt: the answer is no. However, should any in this House feel unconvinced, please draw comfort from where we started and from what is written in the Act:
“For the avoidance of doubt, nothing in this Act places an obligation on religious organisations to host civil partnerships if they do not wish to do so”.
That is the law that we passed. It is a debate that we have had. This procedure should not seek to frustrate the will of this House or indeed of the other place. We should see off this Prayer to Annul and its bogus claim to seek to protect religious freedom. Should the noble Baroness decide to test the opinion of the House, I hope that noble Lords will join me in the Lobby. I beg to oppose.
Baroness Verma
My Lords, to assist the House I suggest we hear from the Liberal Democrat Benches first, maybe then the Convenor of the Cross Benches, followed by the noble and learned Lord, Lord Falconer, and then the Bishops.
Baroness Hamwee
My Lords, we complain when primary legislation is not commenced or implemented. The first instinct of the noble Lord, Lord Alli, was absolutely right, though he then extended his arguments. We also complain when legislation is not clear. This is not the case today. The Merits Committee, of which I am a member, did not make a judgment on the merits of the substance of this order. It used its entirely standard language, drawing it to the special attention of the House on the grounds that,
“it gives rise to issues of public policy likely to be of interest to the House”.
That statement is quite uncontentious.
I can see from those already attempting to intervene that we will hear today closely argued analysis of a construction of the words “Act”, “authority” and “services”, and I am always glad to recruit such expertise to the cause. Essentially, however, the issue is, “Does the order do what Section 202 of the Equality Act provides?”. I believe that it does. Or, “Does it require any individual or organisation to do what they do not wish to do?”. I believe that it does not. The order cannot trump primary legislation, nor can it require what the Act itself precludes. As we have been reminded, primary legislation says that nothing places an obligation on religious organisations to host civil partnerships if they do not wish to do so. If there are differing views within an organisation, that is not a matter for government.
The noble Baroness uses in her prayer the word “pledge”. It is not a pledge—or rather, it is more than a pledge—because the words are in Section 202. That section is surely permissive: it is an opt-in, not an opt-out. We know there are objections to it, but that was a matter for 2010. I say that to those who would like to extend that section, as well as to those who would like to see it interpreted restrictively. To attempt now to reverse it, extend it or block it, is inappropriate.
I will be quick because there are so many noble Lords who wish to speak. I find it very difficult to see anxiety engendered among people with a particular view. I do not like to see people fed fear. I realise that something that may seem entirely reasonable to me may seem very prejudicial to you, whoever you and I are—that is, whichever side of the argument one is on. I will end by voicing what others might see as my own prejudices. That 46,000 couples have entered into civil partnerships is wonderful; 92,000 people have been able to give formal, legal expression to their relationship. It is a paradox that some who advocate celebrating marriage within a faith oppose extending it to other stable relationships. I welcome the order and look forward to taking forward Section 202.
Lord Falconer of Thoroton
My Lords, I speak as a lawyer today. I concede my obligation to the House to set out my genuine view, because this is a legal issue and because I was formerly the Lord Chancellor. The noble Baroness, Lady O’Cathain, and the noble Lord, Lord Alli, agree the basis upon which Parliament—not only this House—passed the amendment to the Civil Partnership Act which abolished the prohibition on civil partnerships being registered in places of religious worship. My noble friend Lord Alli said at the time that there was no disagreement about this.
From the outset I want to make very clear that the amendment does not place any obligation on any religious organisations to host civil partnerships in their buildings. We made that clear by including in the amendment the words:
“For the avoidance of doubt, nothing in this Act places an obligation on religious organisations to host Civil Partnerships if they do not wish to do so”.
There is no doubt that that was the basis on which the provision was passed. If we have not given effect to that provision, we should not agree to these regulations. The only issue today is therefore whether as a matter of law we have given effect to it. It is for the House to make a decision about this. It is always possible to find a lawyer who says that something is arguable. It is for us to go through the provisions today and form a view about whether or not, contrary to our intention and to that of the House of Commons, we have somehow failed to achieve it.
I will very quickly go through the basic provisions so that we arrive at a clear answer. Section 2 of the Civil Partnership Act makes the moment at which a civil partnership occurs the moment at which the two partners sign the civil partnership document. Section 6 of the Act—this is, before the amendment—says that that signing can take place either at a registry office or at approved premises. It sets out provisions for premises to be approved by somebody called the registration authority. The registration authority is the local authority. The Civil Partnership Act gives the local authority discretion over whether or not they register premises. Section 6 of the Act as originally passed says that civil partnerships cannot be registered at religious premises. Section 2(5) says—and this provision remains—that there should be no religious element in relation to any registration of a civil partnership.
The amendment of the noble Lord, Lord Alli, which was supported by Parliament, did two things. First, it removed the prohibition on religious premises being used for civil partnerships. It retained the approval process, so that local authorities still approve whether premises—including religious premises—can be used for civil partnerships. Secondly, it added to the Civil Partnership Act words to the effect that for the avoidance of doubt, this does not compel any religious organisation to host a civil partnership ceremony if they do not want to.
That is the legal framework that we now have to look at. On the basis of that legal framework, my initial conclusion is that Parliament has made its intention absolutely clear: Parliament does not want to compel anybody to host registration of civil partnerships unless they want to.
I wondered what could conceivably be the argument that we have failed to express our intention clearly. I have read the two opinions that have been provided on this. I will do my best to summarise them fairly and set out why they are plainly wrong, although not lacking in bona fides. The first argument, which was advanced by Professor Mark Hill QC in his opinion dated 8 November, is that because the regulations say that—for the avoidance of doubt—the law does not compel anybody to host a civil partnership if they do not want to, the regulations saying it would not, alone, be enough. I completely agree with that. A regulation saying that hosting is not required would have no effect at all if the position was that the primary Act of Parliament did not get rid of the risk of any discriminatory legislation. However, the primary Act of Parliament does contain the prohibition, so it seems clear that Professor Hill is wrong about that.
I looked through Professor Hill’s opinion to find out what he said about the main provision in the Act, which appeared to be the critical provision. He said that Section 202, in referring to an Act, refers to the Civil Partnership Act and not to the Equality Act. I found that wholly unconvincing because the risk which the noble Baroness, Lady O’Cathain, and the QCs identify is that there are provisions in the Equality Act, except for the purpose of this argument, that might be said to create a risk of some sort of action arising from the fact that you perform civil partnerships but not marriages, or the other way round. It seems to me beyond argument that the intention of Parliament must have been to get rid of that risk by putting in the very same Act the phrase,
“For the avoidance of doubt, nothing in this Act”,
gives rise to the risk of any compulsion. For Professor Hill’s opinion to be correct, you have to assume that this House and the Commons were unaware of the risk that the Equality Act could give rise to litigation when they put into the very same Act a statement that said that allowing churches to host civil partnerships does not lead to any church being compelled to host one. I cannot think of a judge who would give effect to such a nonsensical argument.
8 November was the date on which the advice of Professor Mark Hill was obtained. His advice came under some legal attack. Noble Lords will know that the legal advisers of the Roman Catholic Church, the Church of England, the Home Office and the Equality Commission have all said that there is no legal risk. Reinforcement was obtained from Mr Aidan O’Neill QC. I am very grateful to the noble Baroness, Lady O’Cathain, for providing a copy of his advice. He gives a lot of ground in relation to it, recognising the difficulty that exists.
Baroness Trumpington
Could the noble and learned Lord please stop turning away?
Lord Falconer of Thoroton
I apologise. Mr O’Neill says that since Section 3 of the Human Rights Act requires statutes to be interpreted as much as possible in accordance with the European Convention on Human Rights, that section might, arguably, give rise to the possibility that it could be construed away or read down. However Mr O’Neill, who I do not criticise at all, is an honourable man. He rightly sets out the basic law in relation to reading down under Section 3. He says that the only limitation on Section 3 of the Human Rights Act, on interpretive obligation, according to the House of Lords decision in Ghaidan, is that in reading words into the legislation, or in deleting offending words, the courts have to be satisfied that such emendation could not be said to “go against the grain” by overriding some cardinal feature of the legislation in question, or otherwise raise generally policy issues that a court cannot properly seek to resolve by a process of judicial rewriting. That is what Mr O’Neill, the person relied upon by the noble Baroness, Lady O’Cathain, said.
Lord Tebbit
The noble and learned Lord has given a splendid exposition of the law of the United Kingdom. Can he assure us that there is no vestige of a chance that European law, either through Brussels law or the law that falls from the European convention, could override the British courts? After all, it, not this House, is now the ultimate authority on our legal affairs.
Lord Falconer of Thoroton
In general terms I can give no assurance that the European courts cannot override the British courts on this. Indeed, they can override this Parliament. However, with respect to the noble Lord, Lord Tebbit, that is not the issue that this House is addressing today. The House is addressing a simple issue of English law and it has been accurately put by the noble Baroness, Lady O’Cathain: does the legislation that we passed give effect to the intention of this House? That is a question of interpretation of English law. I have no doubt that it gives effect to it because it is so clear. I have read both opinions very carefully and my view is not shifted by them.
I make two further points. First, Professor Hill QC and the noble Baroness, Lady O’Cathain, who accurately reflected this argument, said that there was some risk that local authorities would try to punish churches that did not agree to host civil partnerships by saying that they could not have the authority to conduct marriages. I have absolutely no doubt that there is no foundation for that in even the existing law. Section 41 of the Marriages Act 1949 lays down a process whereby there is no discretion in the local registrar, who is a separate person from the local authority. The person who decides whether a church is entitled to solemnise a marriage is not the local authority but the Registrar-General. He has no discretion in that matter once it has been resolved in terms of the statutory requirements. The legal foundation of that does not exist.
The second point made by the learned professor is that the regulations—not the Act—say that an application can be made by a trustee or a proprietor of the church. He gives rise to the possibility of doctrinal debates in churches about this and one trustee applying when the congregation does not want it and the minister or the priest perhaps does not want it. That is a policy consideration that the state has been concerned about and has made specific provision for. The Government say in relation to their response:
“Following concerns about ensuring that the local congregation is made aware of an application in respect of the premises they use for worship, we will make clear in guidance and on the application form that best practice is for the proprietors or trustees of the premises to make their congregation aware … In addition, each application will be required to be advertised by a local authority and is subject to a period of 21 days’ public consultation, providing further safeguards against applications being made without the knowledge of the relevant congregation”.
I do not think there is any statute in the world that would be able to provide for disagreements within a church about doctrinal issues. What the state has done—and I commend the state for it—is to follow the approach taken in the Marriage Act in relation to the solemnisation of marriage, and this has caused no trouble over hundreds and hundreds of years.
My legal opinion is absolutely clear. Although I completely respect the sincerity of the noble Baroness and completely accept the bona fides of the QCs, there is nothing in what they say and you can be confident that, even though I can give no guarantees that nobody will bring litigation—there is bound to be somebody who will—it only requires one case to deal with it.
Baroness Williams of Crosby
Before the noble and learned Lord finishes his extraordinarily useful and helpful speech, could I ask him to come back for a moment to one of the issues raised by hundreds of my correspondents—many noble Lords will probably have similar numbers of correspondents on the subject; I have hardly ever seen so many except for health—which is whether the Equality Act, if approached on the grounds of discrimination, would be able to overcome the specific amendment to which he has referred on both major pieces of legislation? It would be helpful for all of us, in replying to that very powerful public opinion, to know the view of the noble and learned Lord—as the previous Lord Chancellor—on this topic.
Lord Falconer of Thoroton
My unequivocal view, which I have been trying to express, though rather badly, is that the provision that the noble Lord, Lord Alli, and I have quoted has the effect of making sure that no discrimination proceedings can be brought under the Equality Act or under the convention in English law as a result of a church saying no to civil partnerships being solemnised on their premises. That is the problem and I am absolutely clear that there is no possibility of discrimination legislation, based on the Equality Act, as a result of the drafting of Section 202.
There is also a broader point of principle. We should not, as a House, be knocked off doing what we decided to do by the opinions of two Queen’s Counsels. We should be clear that we achieved our intention. We used simple language. There is no doubt about what it means and I have absolutely no doubt that the courts will give it effect. I have reason to believe that it might be said that it would be quite easy to amend the provisions, using a provision of the Civil Partnerships Act under Section 259. This would take time, but it would be quite easy to do. It is, however, utterly unnecessary because we expressed our views utterly clearly and the courts will give effect to them.
The Lord Bishop of Oxford
My Lords, I, too, am most grateful to the noble and learned Lord, Lord Falconer, for an extraordinarily erudite narrative. I am also grateful to the noble Baroness for initiating the debate because it gives us the opportunity to look at this very important and sensitive issue of the regulations. I have been much exercised, as I am sure many of you have, by the conflicting opinions I have received. I very much wish the issue were clear-cut, and perhaps it really is. However, for reasons I will explain, I will not be able to join the noble Baroness in the Division Lobbies if she pushes it to a vote.
I say that with real regret, because I entirely share the noble Baroness’s passionate concern for safeguarding religious liberty which is one of the tap-roots for all liberty. Those who hold to the traditional ethical teaching on sexual morality of the Christian churches and many other faiths can too easily be accused of being homophobes. The implication is that, if persuasion does not work, we may have to resort to coercion, which would be a profoundly wrong approach.
The question before us today is whether these regulations do in fact interfere with religious freedom. Having considered the issues carefully and tried my best to understand the conflicting legal opinions of the distinguished lawyers with whom I have also been in touch, I am not persuaded that they do give us that danger. There could, in principle, be two possible arguments for opposing the regulations. The first would be to register opposition to the principle of allowing civil partnerships to be registered in places of worship. The second would be because, although the principle is accepted, these particular regulations were deficient.
On the first point, although it is history, it can be argued that the change in the law agreed by Parliament last year does have its curious features. To say, as the law now does, that civil partnerships can be registered in places of worship but without any religious element taking place in the registration is, on the face of it, quite odd. Moreover, denominations wishing to offer services of blessing following civil registration can already invite people to come to the church or synagogue after the registration and have that element there. Parliament rehearsed these arguments last year and was persuaded that, if people want to register their civil partnership and have a religious ceremony at the same time and in the same location, then legislation should not get in the way of their doing so. That was essentially for religious liberty reasons. The Quakers, the liberal Jews, the Unitarians and anyone else who wanted to host civil partnership registrations should be free to do so, but not forced to do so. I do not, therefore, see a sufficient case for opposing these regulations on the first of those two possible grounds.
For me and, I am sure, for all of us here, everything turns on the second issue which is whether these regulations and, indeed, the Equality Act to which they give effect, are defective. By defective, I mean whether what is meant to be an option would, in fact, become a duty. Will churches and chapels be at risk of litigation? We non-lawyers are in the hands of the experts here. I can muster only a 40 year-old Oxford law degree which is quite inadequate for the task. However, the advice of the legal office of the General Synod is clear that it will be perfectly lawful for churches, chapels and other places of worship to decline to register their places of worship as premises for civil partnerships. That advice has been unequivocally endorsed by the standing counsel to the Synod, Sir Anthony Hammond QC, who was previously Her Majesty’s Procurator General and Treasury Solicitor and Queen’s Proctor. It is also the view of the Government’s lawyers and other senior lawyers not unknown in these erudite precincts, one of whom we have just heard from.
In addition, for the Church of England and certain other denominations, there would have to be a policy decision at the national level from the relevant body—in our case the General Synod—before any church could seek to register. I know that the Christian Institute has commissioned legal opinion from the two separate QCs we have heard about, who take a different view to the lawyers I have mentioned. This is disturbing, and I look to the Minister in responding to this debate to read very carefully into the record his own understanding of the position. In particular, I would like to hear him assure the House that, in the wholly unexpected event of the courts taking a different view from the massed ranks of government lawyers, church lawyers and other lawyers to whom I have referred, we would have either primary or secondary legislation to sort the problem out. I am sure that assurance can be given.
I have the highest regard for the professionalism and integrity of the lawyers of the General Synod, who also advise the House of Bishops. In the light of their advice, it is not clear that there is anything in these regulations or last year’s legislation which needs to be changed. They appear to me to preserve the ability of the Church of England and all other churches and faiths to decide their policy on these matters in the light of their own beliefs and teaching. I regret coming to a different conclusion from the noble Baroness; I would like to have stood with her in support of religious liberty, which is essential to a civilised society, but on the balance of arguments I believe the safeguards are already in place.
Let me say one final word before I conclude. It is hardly a secret that the Church of England along with many other religious traditions continues to wrestle with the underlying ethical issues. We are likely to go on doing so for a considerable time. I have taken part in many of those internal debates and they are at their best when characterised by a spirit of restraint, mutual respect and generosity.
Given the litigious nature of our society, it is only right that we should look at regulations on a sensitive subject such as this with a good deal of care. I am grateful that so many noble Lords and noble Baronesses are here to do that. Nevertheless, I would urge from these Benches that this debate is characterised by that same restraint, mutual respect and generosity that I just mentioned. Those are the qualities by which religious, and indeed all, liberties are best nourished and protected.
Lord Laming
My Lords, it is a great pleasure to follow the right reverend Prelate and we should be extremely grateful for the insight and human quality that he has brought to the House. I think that the whole House would wish to dissociate itself from any unpleasant comments and criticism that have been directed at the noble Baroness who has moved this Prayer to Annul. She is rightly held in high regard in this House and no one should doubt the sincerity of her position.
The debate has moved on considerably since I prepared my notes and I shall therefore be brief and summarise my views. I am not a lawyer and I speak in a purely personal capacity. I approach this matter from a more social point of view. Successive Governments deserve great credit for the sensitivity and understanding that they have demonstrated in handling the registration of civil partnerships under the 2004 Act and the way in which they have demonstrated equal sensitivity under the Equality Act 2010. As a result of these pieces of legislation and the regulations that have been provided, it seems to me, from a lay point of view, that the churches have all the necessary freedoms and safeguards that they may wish to have. This is well illustrated by the fact that the churches will have to make their own decisions to opt in to these arrangements. It is certain that there is nothing in this legislation that in any way promotes a particular lifestyle.
I am a member of the Church of England and I have the honour to represent your Lordships on the Ecclesiastical Committee. I am a great admirer of all faiths and therefore find it very difficult to appear to be critical. However, I do so with kindness because I would not be being faithful to my beliefs if I failed to say that it has saddened me, and no doubt many others, that the churches have not been in the vanguard of promoting equality in our society. The way in which the Government have tackled this sensitive area is very worthy and credible and I very much hope that in approaching this matter the churches will follow that example.
We Anglicans like to say that we are part of a broad church. That is true theologically, but it may not be necessarily true socially. I hope that in approaching these matters we will not only be gracious to our fellow human beings but generous and understanding. I hope that this Prayer to Annul will be rejected by the House.
Baroness Verma
My Lords, perhaps we may hear from someone on the Conservative Benches and then come back to the noble Lord.
That amendment was made by the Equality Act 2010, but it was made to Section 6A of the Civil Partnership Act 2004. If you go along to the Printed Paper Office and ask for a copy of the 2004 Act, you will discover that it contains no Section 6A. That is because Section 6A was put into the Act by a regulation in 2005. That regulation was made under a provision in the Civil Partnership Act allowing statutory amendments to be made in respect of the Acts that were passed before the end of the Session in which the 2004 Act was passed. Therefore, any enactment contained in an Act passed before the end of 2004 can be amended by statutory regulation, using the affirmative procedure.
The point that arises in this case is a short one and I am not going to go into the opinions of the QCs. Noble Lords have had the great advantage of hearing another QC giving an opposite opinion—and it is not infrequent that that happens. I am going to give no opinion at all about the correctness or otherwise of the provision. They are practising QCs. They have signed their opinions, they are genuinely held and they illustrate a doubt—that is all—about the effect of the Equality Act on these regulations.
My point is that the amendment that the noble Lord, Lord Alli, and his colleagues put forward, which was accepted on a free vote in this House and the House of Commons, refers to nothing in this Act, but only to provisions in the 2004 Act. The opinion of these Silks is that the risk arises not from the provisions of the 2004 Act but from the provisions of the Equality Act 2010. To my mind, this issue can be completely set to rest by a simple amendment. Instead of saying “nothing in this Act shall”, the provision would say “nothing in this or any other Act shall”. The Government could do that without difficulty because I am sure we are all agreed that we mean to exclude any attack on the basis of the Equality Act.
Lord Lester of Herne Hill
Leaving aside altogether the argument about the declaratory provision, does the noble and learned Lord accept the opinion given, for example, by the Church of England's lawyers, with which I fully agree, that in any event, under the Equality Act, there could not conceivably be unlawful discrimination in the provision of goods, services and facilities, nor could there be a breach of a public sector duty because no public function is exercised by religious organisations? Therefore, quite apart from the belt-and-braces declaratory provision, there would be no conceivable case of unlawful discrimination.
Lord Mackay of Clashfern
Two QCs have reached the opposite conclusion. I am not sitting as a judge here. I am seeing that that has happened. Those people have raised a doubt. It is for the avoidance of doubt, not for the avoidance of actual provisions that have such and such an effect. The noble Lord, Lord Alli, was careful to understand that people would be very ready to raise doubts in this area if they could. Therefore, he put in a clear provision for the avoidance of doubt. The only problem about it is that his amendment deals with doubts that arise from the Civil Partnership Act. I have not heard anybody say that there is a doubt about this matter arising from that Act. The doubts, if they exist—they have been raised by practising Silks—arise from the Equality Act. I say that that can be simply dealt with by consent, because we are all agreed—so far anyway—that there should be no obligation arising from the Equality Act, or from any other Act for that matter, on any religious organisation to host civil partnerships if it does not want to.
My noble friend Lord Henley sent a letter to us all last night in which he states the Government’s position. He states at the bottom of page 1 that,
“the regulations cannot override primary legislation”.
It is true that these particular regulations cannot, but there is power for a Minister of the Crown, under the relevant section of the Civil Partnership Act, by affirmative resolution to amend an enactment contained in an Act passed before the end of the Session in which the 2004 Act was passed.
This issue has raised a lot of concern among a lot of people. All of your Lordships will have had letters. I have had more letters than I could answer myself without assistance—which I do not have, because I do not wish to charge the taxpayer for helping me. I try to help myself as far as I can. I have had a tremendous number of letters from ordinary people, as well as from a professor and a QC. Of course, another QC of great distinction says that that is all nonsense and that the other QCs are all wrong. People are accustomed to hearing QCs differ, but a difference of opinion between QCs is the sort of thing that causes doubt, which is the very thing that the noble Lord, Lord Alli, had the vision to see should not be allowed to happen.
The only problem is the extent to which that protection was afforded. I see no obstacle to the Government amending the amendment of the noble Lord, Lord Alli, to state “nothing in this or any other Act” shall impose an obligation on any religious organisation to host a civil partnership if it does not want to. I urge the Minister to undertake to do his best—I think that would be the word—to bring forward such an amendment. In that case, I would be happy that the Prayer was not persisted with.
Lord Pannick
My Lords, I very much respect the principled views of the noble Baroness, Lady O'Cathain, but this is not a matter of conscience, it is a matter of legal interpretation. As the noble and learned Lord, Lord Mackay of Clashfern, said, the question is whether there is any real doubt as to what a court would say on the matter. Your Lordships may have found it rather striking that the noble and learned Lord did not give the House any opinion at all as to the answer to this question; he confined himself to saying that views are expressed by QCs on this matter. In my experience of this House, it is rare for the noble and learned Lord not to give the House his very welcome opinion on issues, and I am sorry that he gave the House no opinion on the credence that could be attached to the opinions that have been expressed.
My view, for what it is worth, as a barrister practising in the area of human rights law and administrative law, is that there is no possibility whatever of any court accepting the arguments that have been advanced in those opinions. That is for two reasons. First, the court would focus on Section 202. It would recognise that Parliament has expressed in the clearest possible terms that religious bodies have a power to conduct civil partnership ceremonies but no duty whatever to do so. The regulations faithfully implement what Parliament has decided
The noble Baroness, Lady O'Cathain, expressed a concern that had been expressed by her advisers that that is not good enough because it is the Equality Act that, as she put it, poses the danger. The noble and learned Lord, Lord Mackay, made the same point. My answer to that concern is that it is the very Equality Act that expressly addressed civil partnerships and allowed civil partnerships to be conducted on religious premises for the first time but made it absolutely clear that religious bodies have no duty to conduct such ceremonies.
Lord Mackay of Clashfern
The noble Lord must accept that the operative effect of the provision in the Equality Act is to make an amendment to the Civil Partnership Act 2004, and nothing more.
Lord Pannick
I entirely accept that, but it is the Equality Act that addressed this very question of the circumstances in which religious bodies may, but have no obligation to, conduct civil partnership ceremonies. It therefore seems to me highly unlikely that any court will say that that very legislation, the Equality Act, nevertheless imposes indirectly some duty on religious bodies to do precisely what Section 202 of the same Act states that they do not need to do.
Secondly, if there were any ambiguity in the Equality Act—there is none, but if there were—a court would interpret the Equality Act by reference to the right under the European Convention on Human Rights and by reference to Section 13 of the Human Rights Act, which this Parliament enacted, which states that on any question that might affect the exercise by a religious organisation of the right to freedom of religion, the court must have particular regard to freedom of religion. It is plain beyond argument that the court would therefore say that a religious body has no duty to do what would conflict with the religious rights of the church or other religious body concerned.
Earlier in this debate, the noble Lord, Lord Tebbit, asked for assurances that the European Court would not interfere in this matter. I would be extremely surprised if the European courts would trespass on a fundamental question of religious freedom, but if they did, nothing that we decide today would affect that—it is simply irrelevant to this debate and therefore cannot be used either to support or to argue against the Prayer that the noble Baroness presents to the House.
Lord Tebbit
The point is that we are opening the way for the court to do so. The noble Lord said that he would be very surprised if it did. Has he never been surprised at the judgment of a court?
Lord Pannick
I submit that this Parliament must proceed by what we recognise is the overwhelming probability. We cannot legislate on the basis of something that would be wholly contrary to what Parliament has decided as recently as 2010. I say with great respect to the noble Lord that the attitude of the European Court is completely irrelevant to this debate.
I have to tell noble Lords that if I were asked to advise a client on the prospects of success for someone who wished to compel a religious body to hold a civil partnership ceremony against its will, my advice—and, I am sure, the advice of every other competent lawyer practising in this field—would be that any such application would be completely hopeless and misguided. Therefore, I hope that the noble Baroness will withdraw her Prayer for annulment.
Lord Mackay of Clashfern
The noble Lord took great comfort from the Human Rights Act, which of course dates back some time before the 2004 and 2010 Acts came into being, yet the noble Lord, Lord Alli, and those with him, thought that it was wise to put into the 2004 Act an avoidance of doubt provision. Therefore, they were not prepared to trust the Human Rights Act provision alone to avoid any doubt that might arise. Such a provision does not suggest that there would be a legitimate attack; it simply suggests that doubt is to be put at rest completely, and that is what I should like to see here.
Lord Pannick
My answer to the noble and learned Lord is that in 2010, when the noble Lord, Lord Alli, was seeking to persuade the House to create for the first time, contrary to what had been decided in 2004, a power for religious bodies to conduct civil partnership ceremonies, it was perfectly understandable that it should be made clear that this was a power but not a duty. We had that debate and resolved the matter. There is no ambiguity and we really do not need to revisit it.
Baroness Deech
Given the protection for religious freedom that the noble Lord, Lord Pannick, has just described, why did the Equality Act and the Human Rights Act not permit a Jewish school to continue its religious freedom in maintaining the definition of Judaism that had prevailed in the Jewish religion for thousands of years?
Lord Pannick
As the noble Baroness knows very well, that case raised completely different issues. No specific provision in the Equality Act addressed that question. I have to declare an interest. As the noble Baroness well knows, I was the counsel who acted for the JFS, the Jewish Free School, in that litigation, and the problem was that there was no specific provision. By contrast, the Equality Act addresses this very question and it does so in the clearest possible terms.
Baroness Verma
My Lords, we have plenty of time. Perhaps we could hear from the right reverend Prelate and then from the noble Baroness.
The Lord Bishop of Blackburn
My Lords, of course I share the concerns expressed by others about how these regulations might affect other churches. However, like my brother the right reverend Prelate the Bishop of Oxford, I should like to say how I think these regulations might affect the Church of England, although I shall perhaps be looking through a slightly different part of the lens.
At the moment, the Church of England, through the General Synod, has not expressed any desire at all for its churches to be used for registering civil partnerships. Therefore, it might be thought that I should be very content to rely simply on the provisions of the regulations that would require the consent of the General Synod to be given before any Church of England church could be approved for registering civil partnerships. However, it seems that this provision is not without difficulty. As your Lordships will know, we have special procedures in General Synod for matters that affect the doctrine or liturgy of the church. It could be thought by some that allowing churches to be used for civil partnerships would affect the doctrine or worship of the church. If so, those special procedures would come into play.
The provision in the schedule to the regulations talks simply about requiring the consent in writing of the General Synod without defining how that consent is to be obtained. If at some future date the proper consent of General Synod were obtained, there could still be difficulties for individual clergy. There are, as we have heard, a variety of legal opinions about whether a claim for discrimination against a priest who refused to allow his or her church to be used for registering a civil partnership would succeed. However, at the end of the day, clergy should not be put at risk of having to defend such claims, even if they seem unlikely and their prospect of success seems remote.
It seems clear, however, that an incumbent who refused to allow his or her church to be approved for civil partnerships would gain no protection from Regulation 2B, because the obligation not to discriminate comes not from the regulations but from the Equality Act. Regulation 2B would appear to be nothing more than window-dressing, and it shows how unsatisfactory these regulations are. There may be good intent but the promised conscience clause simply is not there. It cannot be there in regulations; either the Equality Act or the Civil Partnership Act needs to be amended to provide the necessary clause. I would want to see an express statutory conscience clause similar to that contained in Section 8 of the Matrimonial Causes Act 1965, which provides that no priest of the Church of England or the Church in Wales can be compelled to allow their church or chapel to be used for the solemnisation of a marriage of a divorced person whose former spouse is still living.
As the General Synod has not expressed any desire for Church of England churches and chapels to be approved for registering civil partnerships, there is surely no need for the Church of England to be included in these regulations at all. Indeed, it should be expressly excluded from them; otherwise, might it look as though Parliament is breaking what I understand to be the convention that it legislates for the Church of England only when the church has asked it to? If at some future date General Synod decided—
Lord Lester of Herne Hill
Can I take it from his speech that the right reverend Prelate disagrees with the legal advice given to the Church of England by its legal advisers?
The Lord Bishop of Blackburn
I think that the legal advice given to the Church of England in some areas may be open to question. Let us be honest: we have received various pieces of advice—noble Lords here have said that they have heard from many, many people, including lawyers.
If at some future date General Synod does decide that it wishes to allow its churches to be used for registering civil partnerships, then there is a simple procedure: we pass a Measure and we bring that Measure to Parliament using the established statutory procedure under the enabling Act of 1919 for Measures of the Church of England. Such a Measure could amend existing statutes and regulations as necessary to achieve the desired result, including the essential conscience clause of which I have spoken.
Baroness Verma
The noble Baroness, Lady Richardson, has been trying to get in for a long time. We will hear from the noble Lord, Lord Anderson, afterwards.
Baroness Richardson of Calow
My Lords, I rejoice that many Christians and some churches have acknowledged that for some men and women, a loving, committed, intimate, faithful relationship can happen only within a same-sex partnership. I want to delight in that. I want to celebrate it with ceremony and joy, and I want those couples to be encouraged to take their rightful place in creative responsibility and participation in all society. I also want to learn from them the things that God is saying about His grace being given to human beings who are made in His image in infinite variety.
I am well aware that my theological viewpoint is vehemently opposed by many people, including many in this House, but it is a legitimate viewpoint that I could argue with many people. I hope today that while it is obvious that this legislation for registration of civil partnerships in religious buildings is permissive, I do not want it to be made obligatory but neither do I want it to be prohibited. Many churches have the right through their decision-making processes to determine their own theological position and to be able to follow through with many people what is for them the root celebration of their whole being.
Lord Anderson of Swansea
My Lords, this has been a remarkable debate. I only wish that there had been a similar debate in the other place, but there was not. We have heard two former Lord Chancellors taking different views, and two members of the Bishop’s Bench taking opposite views, in the same debate. The remarkable fact is that there has also been substantial common ground in almost all the speeches that have been made. First, this is clearly a highly sensitive issue involving deep matters of principle. Secondly, churches that do not wish to register civil partnerships should not be obliged to do so, but conversely churches that do wish to do so should be allowed to do so. The Government have made a serious attempt in these regulations to put these matters into law. Today’s decision clearly depends on a judgment as to whether, after the proper consultation by the Government, they have succeeded in that aim.
I shall briefly give my own explanation of this. It is clear that, because of the exemption to the Roman Catholic Church, the Church of England and the church in Wales, they have been largely satisfied that the safeguards are sufficient for them. It is also clear that there have been learned and weighty opinions on both sides of the argument. Professor Hill has been mentioned, as have Mr O’Neill and Mr Goulding. The advice of the noble Lord, Lord Henley, in his letter of 13 December, states that the lawyers appear to contradict one another.
For me the question is this: is there a doubt that the regulations have properly put into effect the views of the Government? If there is a doubt, is it a fanciful doubt or is it a serious doubt? Is there at the very least an arguable case that the Government have failed to provide adequate safeguards? The lawyers’ different views and the views expressed today suggest that there is a real, not a fanciful, doubt and the churches should not have to defend themselves against possible well resourced litigants.
I note the undertaking given by the Minister in his letter, which I have cited, that if, contrary to his view, there were to be a successful legal challenge, if one were to be brought, there would be an immediate review by government. That is welcome as far it goes, and I hope that in replying the Minister will put in his speech similar, or perhaps even stronger, undertakings. No Government can bind their successors and it is surely far better for the Government to end any possible doubt by taking these regulations back and by showing that there are amendments that close a possible loophole, thus preventing a serious legal challenge being made to them. The noble and learned Lord, Lord Mackay, has suggested one way in which this should be done. Mr O’Neill has suggested another way. That is the reasonable response which the House should make today.
Baroness Verma
My Lords, may we hear from the Conservative Benches, then from the Liberal Democrats, and then from across the House?
Baroness Noakes
My Lords, I was pleased to be able to add my name to the amendment tabled by the noble Lord, Lord Alli, in the Equality Act and I am equally pleased to be standing here today supporting my Government in bringing forward the regulations, which will complete what we started. I am proud of the journey that my party has made from opposition to civil partnerships to full acceptance of and delight in seeing these regulations taken forward. I do not understand why, but we have a free vote on these Benches. I do not believe that it is a matter of conscience. I believe, as has been said today, that it is legal interpretation of whether these regulations give effect to what we are clear that Parliament thought that we had to do. We have the luxury of a free vote, and that as it happens is a nice thing, but it means that we must use our free vote wisely or we must be clear that we are using it in the right way.
I do not believe that the majority of my party now opposes civil partnerships. We want to see an end to the discrimination against couples entering civil partnerships whereby they are prohibited from celebrating it on religious premises when the religious body wishes to take part in it. We should do the right thing today and end that discrimination and not take fright at some highly disputed legal argument, especially given the Minister’s undertaking that should there be a legal problem the Government will ultimately deal with it. I hope that my noble friends will join me in supporting the Government if it proves necessary.
Baroness Butler-Sloss
My Lords, I spoke in favour of the amendment tabled by the noble Lord, Lord Alli, and in principle I continue to support him. I also agree with the noble Baroness, Lady Noakes, that this is a question of legal interpretation and not an issue of conscience. I am a member of the Merits Committee. I read the two opinions that were sent to us that gave me some concern at the time. I was disposed initially to support the Motion of the noble Baroness, Lady O’Cathain, but since then I have read a considerable number of contradictory opinions. I am reminded of a quotation from The Rubaiyat of Omar Khayyam, which goes something like this:
“Myself when young did eagerly frequent
Doctor and Saint, and heard great argument
About it and about; but evermore
Came out by the same door where in I went”.
I can well understand why this Motion is being debated and why so many people are anxious about the effect of this legislation, and in the light of the legal disagreements about the effect of the regulations and the statutes. I have considerable sympathy with those concerns. I have now worked my way through all the opinions, the seven or eight that I have read, from distinguished lawyers, mainly Queen’s Counsel, and I have come to my own firm conclusions.
First, I do not think that this statutory instrument is well expressed. It has been described to me as sloppy, but it reproduces the protection given in the Equality Act, which puts of course into the Civil Partnership Act, as the noble and learned Lord, Lord Mackay, said. It has been suggested to me that including in Regulation 2B the words “nothing in this regulation or any other statutory enactment” would give adequate protection, but the enactment that might raise risk to religious premises is the Equality Act, not the regulation. As has already been said, this regulation cannot bind primary legislation, and an attempt to do so would be, as lawyers call it, ultra vires.
I am therefore satisfied that a better drafted statutory instrument would not deal with the problem that lies, if it lies at all, in the Equality Act, so my second point is that Sections 29 and 149 of the Equality Act are identified as potentially giving rise to litigation, but that the same Equality Act makes changes that give protection to those who choose to opt out. It gives protection in the Civil Partnership Act, but, my goodness me, it is actually in the Equality Act. Noble Lords have heard the words in Section 202(4) of the Equality Act that are inserted after Section 6(3) of the Civil Partnership Act.
It seems improbable to me that one part of this legislation, Section 202, gives protection to religious establishments and another part creates justiciable issues of discrimination and takes away that protection. Where there appears to be an inconsistency in different parts of the same Act, a court would seek to resolve them or construe the Act to prevent a result that would be absurd, irrational or illogical. One would also expect that a specific section in an Act would take precedence over a general section, particularly if the specific section comes later in the same Act.
The specific protection given in Section 202 of the Equality Act would, in my view, be relied upon in preference to the general anti-discriminatory provisions in Section 29, if they apply. Equally, looking at Section 149 and the duties of public authorities, the specific protection of Section 202 would, in my view, also apply if it can be shown that Section 149 applies in any event. I would therefore expect that each part of the Equality Act would be construed by a court in such a way as to make it compatible with another part of the same Act and that Section 202 would be accepted by a court so as to implement the important protection that it provides.
As we have already been told, the Church of England is satisfied with the proposed change in the law and the protection that it is given. Having listened with interest to the right reverend Prelate the Bishop of Blackburn, I would expect a Church of England priest to rely upon the decision, or the failure to give a decision, in favour of religious establishments and say that he or she cannot allow the church to be used.
The Equality and Human Rights Commission, which, as we all know, has a duty under the Equality Act to be an advocate for equality and human rights, is also satisfied that there is protection for religious establishments. I do not consider there to be a real doubt and prefer the speeches by the noble and learned Lord, Lord Falconer, and the noble Lord, Lord Pannick, to those by the right reverend Prelate the Bishop of Blackburn and the noble Lord, Lord Anderson.
I have now seen the helpful letter from the Minister saying that there would be a review if a problem arose as a result of some legal action. It would be even more helpful if the Minister were to say that there should in any event be a review, perhaps at the end of 12 months, to see what difficulties there are or may be, but I see no reason to annul this regulation, which is only carrying into effect the primary legislation put forward by the noble Lord, Lord Alli, and others, and I shall therefore support this regulation and vote against the Motion to Annul.
Baroness Verma
My Lords, if the noble Lord, Lord Carlile, could speak, we could then hear from the Labour Benches.
Lord Carlile of Berriew
I was going to defer to my noble friend Lord Lester.
Lord Lester of Herne Hill
I shall briefly say a few extra things. I am very conscious of time, and I am tempted to do what a former judge of the High Court used to do. He was famous for saying only “I agree”, and that was his judgment. I promise that I am going to make only a few extra points.
The first extra point that I must make is about the Merits Committee and the Joint Committee on Human Rights. The Joint Committee on Human Rights, on which I serve, is meant to scrutinise mainly primary legislation, not delegated legislation. We have an arrangement with the Merits Committee that if it spots a human rights issue that it thinks should be dealt with by the Joint Committee, it should be alerted to that so that it can consider it. Unfortunately, for whatever reason, that broke down in this case. I am going to ask the Joint Committee on Human Rights to ask the Lord Chancellor, when it sees him next week, whether government departments can take more responsibility and, where they spot issues of human rights in delegated legislation, to help the committee by identifying them. That means that noble Lords do not have the benefit of an opinion from the Joint Committee on Human Rights about compatibility with Article 9 and Article 14 of the convention.
Speaking for myself, I agree with my noble friend Lord Pannick that there is not the faintest chance of any violation of Article 9 or Article 14 by virtue of the Equality Act read with these regulations. On the contrary, I believe that the right view is that these regulations promote religious freedom and do so without discrimination.
Quite apart from the arguments that the noble and learned Lord, Lord Falconer of Thoroton, has fully deployed, with which I wholly agree, the point raised by my noble friend Lady Williams of Crosby was about the discrimination provisions of the Equality Act and whether, leaving aside the declaratory provision, there could conceivably be a discrimination case. In my view, the answer to that is totally correct. During the passage of the Equality Bill, I had responsibility for over a year for dealing with these issues from the Liberal Democrat Front Bench. My view is the same as that of the Church of England legal advisers, which is the further matter that I would like your Lordships to consider.
In the opinion that the Church of England was given, this was dealt with very shortly and very clearly in this way. It said:
“The question has been raised in Parliament and elsewhere of whether a religious denomination, or a local church, which declined to seek to have its premises approved for the registration of civil partnerships could be held to be discriminating in a way which is unlawful under the Equality Act 2010. The clear view of the Legal Office is that it could not. This is also the declared view of the Government’s lawyers. The clear view of the Legal Office is that it could not. This is also the declared view of the Government's lawyers. A key relevant provision is section 29 of the Equality Act which makes it unlawful for ‘a person (a “service-provider”) concerned with the provision of a service to the public or a section of the public’ to discriminate on various grounds, including sexual orientation, ‘against a person requiring the service by not providing the person with the service’. A Church which provides couples with the opportunity to marry (but not to register civil partnerships) is ‘concerned with’ the provision of marriage only; it is simply not ‘concerned with’ the provision of facilities to register civil partnerships. That would be a different ‘service’, marriage and civil partnership being legally distinct concepts. If Parliament were in due course to legislate for same sex marriage, as recently suggested by the Prime Minister, we would of course be in new territory. But that is a separate issue which would have to be addressed in the course of that new legislation”.
Then, for good measure, the opinion deals with the public sector duty:
“The non-discrimination requirement imposed by the Equality Act on service-providers does not include a requirement to undertake the provision of other services that a service-provider is not already concerned with providing just because the services that it currently offers are of such a nature that they tend to benefit only persons of a particular age, sex, sexual orientation etc. Thus, for, example, a gentlemen's outfitter is not required to supply women's clothes. A children's book shop is not required to stock books that are intended for adults. And a Church that provides a facility to marry is not required to provide a facility to same-sex couples for registering civil partnerships. The “public sector equality duty” (contained in section 149 of the Equality Act) also has no implications for a Church’s decision whether to make its premises available for the registration of civil partnerships. A Church is not exercising public functions in making such a decision so the duty is not applicable. The public sector equality duty will not prejudice denominations who conduct marriages (and whose buildings, unlike those of the Church of England, need to be registered for that purpose) but who do not wish to host civil partnerships. The registration of buildings for marriages is a purely administrative act by the registration authorities and does not involve them exercising a discretion or taking a decision. The public sector duty is therefore immaterial to the registration process. The Equality Act contains various exceptions for religious organisations (see Schedule 23). But given what is said above, it is not considered that a Church which solemnized marriages but did not wish to provide facilities for the registration of civil partnerships would need to rely on any of these since it would not be doing anything that even prima facie amounted to unlawful discrimination”.
Lord Elton
The noble Lord is kind to give way. I just want to observe that, like many before him and no doubt several after, he is proceeding to tell us what the result of a case would be. Does he not agree that the function of Parliament is to try to see that the law is so clear that no case would be brought? That is what my noble and learned friend’s proposal would provide.
Lord Lester of Herne Hill
I agree. I am seeking, using the Church of England opinion as a short way of doing so, to refer to the actual provisions in the Act to show that they are quite clear and have no application to anything that could give rise to a possible legal challenge.
Lord Alton of Liverpool
I am grateful to the noble and learned Lord. I want to revert to the point that the noble Lord, Lord Elton, just made. The phrase “for the avoidance of doubt” has been thrown around a lot during the course of the proceedings today. It seems there is a lot of common ground in your Lordships’ House on trying to find a sensible way forward. The noble and learned Lord, Lord Mackay of Clashfern, suggested earlier that, if vexatious litigation were to be brought forward in the future, then an amendment to the Equality Act should be brought to your Lordships’ House and enacted. Would the noble and learned Lord commit himself to supporting such an approach if vexatious litigation were to emerge as a result of the decision today, unlikely—I agree with him—though that is?
Lord Lester of Herne Hill
I should say that I am not a learned Lord. Whether I am a noble Lord is another matter.
Lord Lester of Herne Hill
If there is vexatious litigation, it should be struck out by the court as vexatious and nothing more should be done about it. What I am endeavouring to say—I am not doing very well because I am quoting from a detailed opinion, but I thought the House deserved to have that opinion before it because of the authority that it gives—is that the clarity provision was not necessary because a proper construction of the provisions of the Equality Act makes it absolutely clear that any discrimination claim, either about the provision of services or about the public sector duty, would be doomed to failure.
There is one further point. In the case of Pepper v Hart, the House of Lords in its judicial capacity held that, were there any ambiguity in legislation, one could have regard to the parliamentary record to resolve the ambiguity. Quite apart from Section 13 of the Human Rights Act 1998, which the noble Lord, Lord Pannick, referred to, I have no doubt that, were there any ambiguity—in my view, there is none whatever—then the Supreme Court and the lower courts would have regard to statements made by the noble Baroness, Lady Royall, when she was leading for the previous Government, to the assurances given by the former Solicitor-General Vera Baird QC and to the statements that will be given shortly by my noble friend the Minister today. Those statements will all be one way. They will all indicate the true intention of the legislation. Therefore, were there to be any ambiguity, it would be resolved, if it had to be, judicially.
In my view, which is the same as that of the noble and learned Lord, Lord Falconer, the noble Lord, Lord Pannick, others who have spoken, the Church of England’s legal advisers and others, there is no conceivable doubt that a challenge would be hopeless. If, as a discrimination lawyer with 40 years’ experience, I were asked what my views would be about this, I would say, “You have not got a snowball’s chance in hell”.
Lord Mackay of Clashfern
The noble Lord mentioned the case coming to the Supreme Court. That would cost the church a penny or two.
Lord Lester of Herne Hill
No respectable member of the Bar, properly informed and reading the statute as a whole, if asked whether there was a reasonable chance of success, would be likely to say that there were. Anyone who brought such a challenge would have to find public funds or their own funds to do so and they would fail at first instance, in the Court of Appeal and in the Supreme Court.
Baroness Verma
My Lords, we will hear from the noble Lord, Lord Collins, and then from the noble Lord, Lord Dannatt.
Lord Collins of Highbury
My Lords, in my maiden speech to this House, my first thanks went to the officials and staff for their warm introduction. Not only did they make me feel extremely welcome, they made my husband Rafael feel extremely welcome, too. My second thanks went to your Lordships, not least for the fact that I was able to say “my husband”. These Benches have helped transform my life and the lives of countless lesbian and gay people in this country. I am immensely pleased that it is no longer just noble friends on one side of this House who applaud progress in this area but Peers on every side of the Chamber. That consensus is a sign of this House at its best.
I am therefore very sad that, despite this strong consensus, we have this Motion before us today—sad because it reflects neither the view of the majority of noble Lords nor the intent of the regulations arising from Section 202 of the Equality Act 2010. It is because I strongly support the principle of religious freedom that I welcomed the adoption of this section in the Act—that is, the freedom that would allow a church to say no to civil partnership ceremonies conducted in their premises or by their priests. Equally, if a religious institution or church does wish to celebrate a civil partnership, it should be able to do so. The unconditional right for lesbian and gay marriage through civil partnership can only be a civil one. That is a responsibility the state must ensure is provided without discrimination, fear or retribution. But just as I believe the Church should not interfere with the rights and responsibilities of civic society, I equally believe that the state should not interfere with the conduct of religion or ceremonies in places of worship.
As we have heard today, Section 202 is, as was always intended by those who supported it across the House, entirely permissive. We have heard clear legal opinion from the Church of England and the Government, and many prominent legal counsel have supported this view. The points made by Professor Hill, on which the noble Baroness relies, have also been considered, as we have heard, by Paul Goulding QC in a detailed written opinion, which I know many noble Lords will have seen. It is clear from Mr Goulding’s opinion that neither the regulations nor any part of the law would compel religious organisations to host civil partnerships against their wishes. In particular, he points to the provisions of the Equality Act which expressly state that. My noble and learned friend Lord Falconer argued this case so well in agreement with Mr Goulding’s opinion.
Baroness Verma
My Lords, perhaps the noble Lord, Lord Dannatt, could speak first and then my noble friend Lord Cormack.
Lord Dannatt
My Lords, had I spoken earlier in this debate, I would have made a lengthy speech, much of which has been overtaken by the course of events, which would have been in support of the noble Baroness, Lady O’Cathain. I maintain my support for her today.
Much legal opinion has been expressed on both sides of the argument and a fair consensus would appear to have emerged, but I am left with a residual feeling of ambiguity. Ambiguity can give rise to unintended consequences, and it is unintended consequences that I am worried about. Those consequences arise from regulations that are not crystal clear and have worried a lot of ordinary decent people up and down this country, who have filled noble Lords’ postbags and mine in the past few days.
The noble Lord, Lord Henley, circulated his letter, which we received yesterday, in which he states—and we have heard it repeated already today—that,
“if a successful legal challenge were ever brought, I would like to provide reassurance that the Government would immediately review the relevant legislation”.
If we think that there is some doubt or ambiguity in this case, and if we think that ambiguity could lead to unintended consequences, there is an obligation on the Minister to activate that sentence in the last paragraph of his letter and, for the avoidance of doubt, to make it crystal clear—an expression that we have heard many times in this Chamber today—to people up and down the country, whoever they are, that they have nothing to fear from these regulations. Until I hear a commitment to the avoidance of doubt, I maintain my support for the noble Baroness, Lady O’Cathain.
Lord Cormack
My Lords, I have some sympathy with the points just made by the noble Lord, Lord Dannatt, but I should like to focus the House’s attention on one specific point: the particular and peculiar—and I use that word properly—position of the Church of England.
The Church of England is the established church of this land. There is not a town or a village in England that does not have a Church of England parish church. The people in that parish are entitled to the services of the parish priest and of the church. Let us be in no doubt that, if this regulation is passed as it stands, great pressure will be put upon incumbents of parish churches throughout the land, and that pressure will be very difficult for them to withstand, even though, for them, whatever it may be for the noble and learned Baroness, Lady Butler-Sloss, or others, it will be a supreme issue of conscience.
Baroness Brinton
Does my noble friend therefore disagree with the advice from Church House, which states quite categorically that a church,
“would not be doing anything that even prima facie amounted to unlawful discrimination”?
The advice reassures both priests and the church as a whole that this would not happen.
Lord Cormack
I am not concerned with that legal opinion; I am trying to make a different point, which it is clear I did not do effectively enough. What I am saying is that pressure will be put upon incumbents throughout the Church of England, notwithstanding that legal opinion, which may or not be correct—and there is an element of doubt.
We have a specific provision in this country for the established Church of England, as has been referred to by the right reverend Prelate the Bishop of Blackburn. With the agreement of Parliament, we do not legislate over and above, or directly at, the Church of England; rather, we receive the measures that the church—initially through the Church Assembly but in more recent years through the General Synod—has thought fit to pass. Those measures come before the Ecclesiastical Committee, on which I had the privilege to sit for some 40 years—indeed, I was for 10 years on the General Synod as well—which is one of the few committees comprised of Members of both Houses of Parliament. That committee has one duty and one duty alone: it has to deem the measure expedient or not. If it deems the measure expedient, the measure then comes before the two Houses of Parliament separately, either on the Floors of the Chambers or in Committee, where it can be voted upon. It is very unusual for a measure to be rejected—in my 40 years on the Ecclesiastical Committee I can think of only one such measure, which concerned provisions for churchwardens. I can think of others, such as the prayer book measure and the ordination of women measure, which engendered very real debate in both Houses, but at the end of the day those measures were passed.
It seems to me that there ought to be proper recognition of the position of the Church of England. I am in no sense seeking to make comments about civil partnerships. I listened to the moving speech of the noble Lord, Lord Collins. We all have many friends who have gone through civil partnerships, whatever our views on marriage might be. As the noble Baroness made plain when she introduced this debate today, that is not what we are discussing. It is important that the Church of England should have its special position recognised and there should be exemption for it, so that it is up to the synod to decide whether it wishes to pass a measure.
Baroness Howarth of Breckland
Since I am not likely to make a speech today, I should like to ask the noble Lord a question in relation to the point that he is making. It relates to the difference between the institution of the church or whichever religious body—the noble Lord is talking about the Church of England, of which I am a rather unusual member—and the teachings of Christ about tolerance, acceptance and inclusion.
Does the noble Lord not agree that one of the problems in the Church of England is that we have numbers of people who cross the threshold—they go down the aisle in their white gowns having lived together for eight years, whatever that means—but never cross the threshold of that church again unless they bring their kids to be christened or arrive for their funeral? That is a real difficulty for the Church of England. Does he not agree that this is a very different position from that of those same-sex couples who are committed Christians and wish to acknowledge that among their congregation, and that very few would want to acknowledge it in a congregation that did not want to acknowledge them, nor with a priest who thought that they were of a different order of human being? Does he not agree that if the churches are really going to come to terms with understanding inclusion, acceptance, love and tolerance, which is what Christianity is about, then they will have to change?
Lord Cormack
All I will say to the noble Baroness—who made a speech and not an intervention—is that she was airing some of her own views and prejudices, as we all do from time to time. I would not seek to pass comment on the convictions, the commitment and the sincerity of any fellow Christian of any orientation. I am talking today about the regulations before us and the special, specific position of the Church of England— which, let us all remember, still has the ability, if the incumbent wishes, to grant a service of blessing to any couple. Be it a divorced man marrying a woman and they do not go through the traditional marriage ceremony, they can have a blessing—and so can a same-sex couple.
However, there is a special position for the Church of England which should be recognised by your Lordships’ House. The Church of England should not, therefore, be included in the regulations we are debating today—and certainly should not be so included unless the amendment, which was so learnedly described by my noble and learned friend Lord Mackay of Clashfern, is incorporated and an undertaking to that effect given by the Minister when he winds up.
Baroness Anelay of St Johns
My Lords, perhaps I might at this stage respond to some of the comments made around the House. I know that there is a feeling that we have had a learned and full debate and that, after my noble friend Lord Carlile of Berriew has spoken—I understand he will speak just briefly—at that stage we might invite the Leader of the Opposition to make her winding-up speech.
Lord Carlile of Berriew
My Lords, if the opinion of the House is tested on this Motion to annul I shall be voting against the proposition of my noble friend Lady O’Cathain. I want to say at the outset of what I hope will be brief remarks that I am sure she knows that I have enormous respect for her. She and I have stood shoulder to shoulder on issues of conscience in this House and will do so again. However, I am bound to say that, in my view, this is about as far from an issue of conscience as we could get. This is a matter of law, essentially.
We have heard from some much more balletic legal minds than mine during the debate. Indeed, your Lordships may be under the impression that the head of the pin is extremely crowded. As my noble and, in some cases, noble and learned friends—and in the case of the noble Lord, Lord Lester, my noble and very busy friend—dance on the head of that pin, you will have observed that there is barely room for the legal books they are using.
All I will say as one of the QCs in your Lordships’ House is that I think the arguments have been very powerfully put before your Lordships by the noble and learned Lord, Lord Falconer, the noble Lord, Lord Pannick, the noble and learned Baroness, Lady Butler-Sloss, and my noble friend Lord Lester of Herne Hill, and I agree with them. I hope that your Lordships are not going to fall into the trap of deciding how to vote if there is a Division on the basis that, because some lawyers disagree, we are all going to throw our hands up in the air and leave it to someone else to decide. Let us never forget that we are in the high court of Parliament. With all the knowledge in this Chamber, I venture that your Lordships are well able to reach a decision on the basis of the arguments that have been presented—and the arguments are absolutely overwhelming.
During my 40-odd years at the Bar I have advised on issues and gone into, for example, the Court of Appeal with what I had thought was a very arguable case, and found myself metaphorically blood-spattered on the floor within minutes, if not seconds. The legal analyses that we have heard in your Lordships’ House have plainly left us with the opinion—the only responsible opinion—that there is no realistic possibility whatever of religious organisations or priests being forced in any way to do anything in this context which is against their conscience.
Lord Framlingham
The noble Lord will appreciate that the debate today has been legalistic—because this is obviously what this Chamber does—but the ramifications outside the Chamber may not be legalistic. On the point that the noble Lord is making about allowing, will he agree that to allow, although it is not to encourage or force on people, can sometimes have that effect. That is my concern having seen that many Acts of Parliament have had effects that we were not aware of. I believe that if we are not careful, this one will bring the kind of pressure to bear on Church of England priests that the right reverend Prelate the Bishop of Blackburn has indicated.
Lord Carlile of Berriew
I respectfully but absolutely reject the contention that has just been made. Indeed, it is somewhat similar to the contention made by my noble friend Lord Cormack, who spent a great number of years as a very distinguished Member of another place. He often had to wrestle between his principles and his interests, as all Members of Parliament do, and I doubt that he found it more difficult than any Church of England or other priest or other religious official would find it to stick to his conscience when his conscience told him what was right, particularly when supported by the institution to which he belongs.
Finally, my noble friend Lord Lester mentioned the decision of the House of Lords as a court in Pepper v Hart. That is the one matter that was omitted earlier and is of very great importance. In the event of somebody being prepared to take the financial risk of bringing what in reality would be a completely hopeless case before the courts, it is beyond peradventure that the statement that we know will be made by my noble friend Lord Henley from the Front Bench today, because we have been given a trail of it, would be cited in court and would be extremely influential in the determination of any ambiguity. I therefore respectfully suggest to your Lordships that we have actually taken a great deal of time today, albeit in a very interesting debate, in discussing something that is really not a problem at all.
Baroness Royall of Blaisdon
My Lords, we have heard today some extraordinarily powerful and important speeches. When we were in government, one measure that we were most proud of, rightly I believe, was the Equality Act 2010, which we managed to pass through Parliament just before the general election. We did so with the support of the Conservative Party and the Liberal Democrats, then both in opposition. The parties opposite were consistent in their support for the legislation; I thanked them for it then and I thank them for it now, although I am concerned about a few aspects of the Act that are being chipped away. But that is not an issue for today.
When my noble friend Lord Alli moved his amendment and it was adopted by this House during the passage of the Bill, I was not able to fully support him. But I am delighted that his amendment was adopted and has resulted in the regulations before us today. The overriding point about the regulations and the legislative clause in the Act to which they refer is that, as so many noble Lords have said, they are permissive. They permit churches and any other religious premises to enable two people to register as civil partners of each other under the terms of Section 6(3A)(a) of the 2004 Act.
I warmly welcome so many speeches today, but especially the contribution from the noble Baroness, Lady Richardson of Calow, who was absolutely right to point out very forcefully that the provisions are permissive. They do not in any way require churches to provide civil partnerships to take place. They do not order them to do so or compel them to do so; they simply make it possible for them to do so should they so wish.
The noble Baroness, Lady O’Cathain, argues that the proposals are not sufficient to protect faith groups from being compelled to register civil partnerships when it is against their beliefs. The noble Baroness is supported by a number of legal opinions. However, we believe that the legislation itself is clear. Section 202(4) of the Equality Act 2010 provides that the following should be inserted after Section 6(3) of the Civil Partnership Act 2004:
“For the avoidance of doubt, nothing in this Act places an obligation on religious organisations to host civil partnerships if they do not wish to do so”.
That expressly states the point—the wording is clear and the meaning is clear, and we believe that the effect is clear—and so do the regulations in front of us today, which state, in Regulation 2(3), that the following should be inserted into the Marriages and Civil Partnerships (Approved Premises) Regulations 2005:
“Nothing in these Regulations places an obligation on a proprietor or trustee of religious premises to make an application for approval of those premises as a place at which two people may register as civil partners of each other in pursuance of section 6(3A)(a) of the 2004 Act”.
Again, there is clear wording, clear meaning and clear effect.
The noble Baroness, Lady O’Cathain, has deployed legal opinions that support her view, quite properly, primarily those from Professor Mark Hill QC and Aidan O’Neill QC. But many noble Lords from all Benches have cited a number of different opinions today, and the speech from my noble and learned friend Lord Falconer of Thoroton was masterful and gave a very clear opinion. His responsible views were unequivocal and were supported by many noble Lords throughout the Chamber today.
It was useful and heartening to hear the views expressed by the right reverend Prelate the Bishop of Oxford, who confirmed that the necessary safeguards are in place according to the Legal Office of the General Synod of the Church of England. I hear of course the differing views expressed by the right reverend Prelate the Bishop of Blackburn, but I believe that many of the issues raised by the right revered Prelate the Bishop of Blackburn are matters for the General Synod itself, and not for this House or the Houses of Parliament. It is also important to consider a statement from the Catholic Bishops’ Conference of England and Wales, which takes a similar view to the Church of England:
“As the regulations require prior consent, the measure can have no impact on Catholic premises. The church welcomes the fact that the Government has made an explicit statement in the draft regulations that nothing in them creates any obligation to make an application for approval. This will help rebut any attempt to mount spurious cases of unlawful discrimination against churches which do not host civil partnerships”.
The Government’s clear view is set out in their summary of responses to their consultation on civil partnerships on religious premises, published last month, and I agree with the view expressed. The noble Lord, Lord Henley, Minister of State at the Home Office, says in a letter this week to Members of your Lordships’ House:
“I must stress that this provision is entirely permissive. We are entirely confident that faith groups will not be forced to host civil partnership registrations if they do not wish to do so”.
He goes further, by indicating further legislation if necessary. The Government’s clarity and confidence, which we as an Opposition share, is supported by the statutory body on discrimination, the Equality and Human Rights Commission, which states in its response to the consultation:
“The Commission is also pleased that this provision is voluntary, placing no obligation on religious communities to conduct such ceremonies where this would be against their conscience or religious beliefs”.
We have heard a plethora of legal opinions in this debate, but also the important views of many noble Lords who do not have legal experience. Most importantly, we have heard the views of my noble friend Lord Alli. When he moved the original amendment in your Lordships’ House, he could not have been clearer:
“For the avoidance of doubt, nothing in this Act places an obligation on religious organisations to host civil partnerships if they do not wish to do so”.
He has been equally clear today. These are compelling arguments, and I believe that they are conclusive arguments. There is nothing in the legislation or in these regulations which requires churches to host civil partnerships. The legislation and the regulations associated with it were designed to be permissive and not compulsory; they are written to be permissive and not compulsory; and they are best interpreted as being permissive and not compulsory. Some noble Lords have mentioned fear. Like the right reverend Prelate the Bishop of Oxford, I believe that we must act in a spirit of mutual respect and generosity.
If the noble Baroness, Lady O’Cathain, should test the opinion of the House today, we on these Benches will be opposing the noble Baroness and supporting the regulations. And yes, we have a Whip on, because we believe it is right to do so. I believe the record of my party, the Labour Party, on equality issues, is second to none, and we intend to maintain it in the Lobbies today if this matter does go to a Division.
The provision to allow, if they so wish, churches to host civil partnerships, is a good provision. The regulations are good regulations, and the original legislation—our own—was good legislation. I urge the House to support the regulations, and to sustain legislation of which this House should be proud in having played its part to get on to the statute book of this country.
The Minister of State, Home Office (Lord Henley)
My Lords, I start by echoing the words of the right reverend Prelate the Bishop of Oxford when he suggested that we needed to conduct debates of this sort with restraint, mutual respect, and generosity. I am very grateful to the House that that has been the case today on a subject that can generate very strong feelings.
To my noble friend Baroness O’Cathain, I say that although, as she knows, I will not be able to support her Motion, and although I very much hope she will not be pressing it to a Division—I do not think it would be wise so to do—I am grateful for the fact that we have had the debate. In my view, it has brought a great deal of clarity to this subject—particularly on the legal aspects of it. I am therefore grateful for the interventions from the noble and learned Lord, Lord Falconer, and from a whole host of other legal luminaries sitting all round the Chamber.
I am also very grateful that a large number of Peers have quoted from the letter that I sent out two days ago. This does at least encourage me to think that it did reach most noble Lords, though I appreciate that one or two noble Lords did not receive it. For that I can only apologise, but I can make copies available, should anyone wish to have one, after this debate. I will be quoting from my letter later on, possibly in response to the request from the noble Lord, Lord Lester of Herne Hill to, as it were, add a Pepper v Hart element to what I have to say.
We recognise that in allowing this expression of religious freedom and advancement for lesbian, gay and bisexual equality, we need to ensure that there are sufficient protections from legal challenge for faith groups who do not wish to host partnerships on their premises. We are confident that faith groups will not be forced to host civil partnership registrations on their premises if they do not wish to do so.
Lord Alton of Liverpool
My Lords, before the noble Lord leaves the very important statement that he made, both in his letter and again to the House today, I notice that it says that if a successful legal challenge were brought, the Government would carry out a review. Will he bear in mind what the right reverend Prelate the Bishop of Blackburn said earlier, and the point I raised with the noble Lord, Lord Lester, about vexatious litigation? It might not be successful litigation, but it would nevertheless be litigation, and it could involve people in considerable expenditure, as the noble and learned Lord, Lord Mackay of Clashfern, said earlier. In those circumstances, will the Minister given an undertaking to the House that the issue will be generally kept under review without having to wait for litigation? Will there be, if necessary—although most of us accept that it is highly improbable—an amendment to the Equality Act? That is, if those circumstances were to occur, would legislation be brought forward along the lines suggested by the noble and learned Lord?
Lord Henley
I hope that this debate has brought a considerable degree of clarity to this issue. I think that it is now generally clear—most people understand the legal aspect—that there is no doubt about this matter. However, as the noble Lord has raised this point, which was also raised by the noble and learned Baroness, Lady Butler-Sloss, we will obviously keep all matters under review, and if we saw a problem, we could act. I do not think that that is likely. Particularly after what we have heard in this debate, it would be a very vexatious litigant who tried to bring such an action, and I do not think they would have much chance in the courts.
I hope that I have spoken briefly and with some clarity about what the Government’s intentions are. I repeat again, this measure is entirely permissive; it is not designed to go any further. On that I am at one with the Opposition Front Bench, with the noble Lord, Lord Alli, and with a large number of the legal luminaries who have spoken. I hope that my noble friend will feel able, therefore, to withdraw her amendment.
Lord Mackay of Clashfern
Is my noble friend speaking on behalf of the Government at this Dispatch Box, having regard to the case to which he referred about reference to statements? Is he saying on behalf of the Government that this Act, in Section 202, refers to the 2004 Act and to the Equality Act 2010? Is it the position of the Government that this includes the Act of 2010?
Lord Henley
My Lords, I am making, as my noble and learned friend put it, a considered ministerial Statement from the Dispatch Box, in line with the case he referred to, Pepper v Hart. Yes, I believe that this Act covers both the 2004 Act and the Equality Act 2010. As I said earlier, it would be very odd if the Equality Act was considered to have spoken inconsistently. However, I can give my noble and learned friend the assurance that he seeks.
Lord Tebbit
Could my noble friend address the point I raised earlier? In the event that the permissive nature of this is overridden by a judgment from a European court of any kind, what action will the Government take then?
Lord Henley
My Lords, I am not sure which European court my noble friend is referring to. If he is referring to the European Court of Human Rights, we discussed that somewhat earlier in the day. I think that it was the noble and learned Lord, Lord Lloyd of Berwick, who referred to a judgment in a Finnish case in the European Court of Human Rights, and then to the later remarks of the Lord Chief Justice that we must give due weight to the decisions of that court but not necessarily be bound by them. If it was the European Court of Justice, obviously we would have to comply with that, as with other matters, but I do not see quite how it would get involved in these matters.
Baroness O'Cathain
My Lords, I thank everyone who has taken part in this debate. I was very relieved that I was not at the butt-end of accusations of being homophobic, toxic, odious or even old, as I was in some of the letters that I got. I know I am old, but I do not like it to be said pejoratively.
I have listened intently. I remember—this is a flashback to my childhood—that when my parents asked me what I wanted to do, I said I wanted to become a lawyer. Thank goodness I did not, that is all I can say; it is even more confusing than being an economist.
I have listened particularly to the Minister. I just want him to agree once more, so that my noble and learned friend Lord Mackay has satisfaction. In the 2004 Act no one was in any doubt and yet there was protection for the avoidance of doubt, but there is doubt around the 2010 Act—whatever we think about it, there is doubt out there. If the Minister is saying, in a ministerial Statement from the Dispatch Box, that he is convinced that the protection for the avoidance of doubt in the 2004 Act applies to the 2010 Act, then in view of the opinion around the House I will withdraw my Motion. But I want to make sure that the Minister has the chance to say so.
Lord Henley
My Lords, I confirm again to my noble friend that that is exactly what I said. Section 202 inserts an amendment into the 2004 Act but it is equally true that it is in the Equality Act; it is a vehicle for this. It is proper to say that it is Parliament’s intention that that is the position. I do not think I can be any clearer than that.
Lord Lester of Herne Hill
My Lords, since I raised the matter of Pepper v Hart—
Baroness O'Cathain
I was speaking. I apologise to the noble Lord, Lord Lester, but I was in the middle of my request to the Minister. I beg leave to withdraw the Motion.
Health and Social Care Bill
(13 years ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
14:15 - Division on Amendment 296A - Ayes: 126 / Noes: 153 - Amendment 296A disagreed.
“(2) For paragraph 9(3) of that Schedule (requirement for at least one member of council governors to be appointed by PCT) substitute—
“(3) At least one member of the council of governors must be appointed by the NHS Commissioning Board.”.”
Baroness Williams of Crosby
I begin with an apology on behalf of my noble friend Lord Marks of Henley-on-Thames, who wants to explain to the House that he is unavoidably—
Baroness Garden of Frognal
With due apologies to my noble friend, it is very difficult to hear her when people are leaving the Chamber. I wonder if we might just wait for people to clear the Chamber as quickly and quietly as they can so that my noble friend may resume with her amendment.
Baroness Williams of Crosby
I thank my noble friend Lady Garden very much indeed for intervening. I would like to express the apologies of my noble friend Lord Marks of Henley-on-Thames for being unable to be here on this occasion. Unfortunately he has been taken ill and will probably not be in the House again before the Christmas Recess. He extends his apologies to the House and his deep regrets at being unable to be here to move this amendment. It is therefore my honour to do so on his behalf.
The first amendment amends paragraph 9(3) of Schedule 7 to the National Health Service Act 2006 to remove the requirement for a governor to be appointed by a PCT. The reason for governors being appointed by PCTs, of course, is that they were the key sub-national level of organisation under the previous National Health Service. The Act of 2006 therefore reflects that organisational structure. I submit to the House that in the new structure it is as important that the national Commissioning Board should be able to appoint at least one—and, one hopes, more—governors to the board because of the need for a clear link between the clinical commissioning groups and the boards of the foundation trusts. Our amendment requires that at least one member be appointed by the NHS Commissioning Board in the place of the PCT appointee who will no longer be able to take his place. A substantial number of NHS patients—one hopes a majority—are patients under the foundation trusts. It is therefore important that the concerns of the CCGs and of the board should be represented on foundation trust governing bodies.
I will also briefly speak to Amendments 300, 301, 302 and 303 in the same group. All relate to the decisions to be made about the mergers or dissolutions of foundation trusts. The purpose of the amendments is to add the name of the Secretary of State to those who are required to consent to either a merger or a dissolution. I shall explain very briefly why we believe this to be of great importance. Despite these amendments looking rather petty, they are not.
The Secretary of State is in a unique position to decide on the strategy of the National Health Service over the whole country. He is in an especially good position to be well-informed on the balance between demand and supply across the territory of England. If there is no requirement for him to emerge at this point as the figure who makes the ultimate decision as to whether there should be a dissolution or a merger, there is nobody else able to detect whether the needs of all patients in England are met. As the House will be aware, if a foundation trust merges and perhaps one part of that merger ceases to offer services, that may be very much in the long-term interests of the National Health Service. The noble Lord, Lord Warner, spoke eloquently on this point yesterday. Where a foundation trust is the centre of, for example, pathways in a particular chronic illness, and where it meets the hospital needs of a substantial part of an area of the country, only the Secretary of State is in a position to decide whether that foundation trust merger or dissolution will have a major impact on the health services available in that part of England.
We suggest, once again, that this is not a tactical or micromanagement issue, but a strategic one, given the significance of foundation trusts in many parts of the country. We therefore very strongly urge the Committee to agree to this amendment. We believe it is a crucial part of the strategy of running a National Health Service in England. I beg to move.
Baroness Thornton
My Lords, we have all been precipitated into this debate some 10 minutes earlier than we might have expected. I should like to speak to Amendments 296A and 298A, and to whether Clauses 176 and 177 should stand part.
Amendment 296A provides that foundation governors must,
“be notified and have the right to attend all meetings of the Board and its sub-committees and have access to all relevant documents and papers”,
under a “duty to protect confidentiality”. Amendment 298A provides that the accounts of a foundation trust or other public benefit corporation,
“must identify separately the income and expenditure which relates to any private income business, and the audit of such accounts must include assurance that all costs which relate to private income business have been properly calculated or recorded”.
I accept that the Minister has an amendment that is not totally dissimilar to this, but it does not include the words about the need to audit and have income and expenditure on the public record, which we think are rather important. Clause 176 stand part would leave out the clause that abolishes NHS trusts. Clause 177 stand part objects to the repeal of various provisions in the authorisation of foundation trusts.
We have already touched on aspects of foundation trusts. Our position is that we support the concept of foundation trusts as a model for developing a form of multi-stakeholder or community-based governance, and allowing earned autonomy for NHS providers from direct performance management. As we discussed on Tuesday, we accept the role of Monitor as a regulator of foundation trusts. We agree with my noble friend Lord Warner that the plethora of other roles that Monitor has been asked to play poses risks, and we have set out our objections to and worries about that.
We accept that the foundation trust journey is still being travelled. I suggest that it is probably time for a proper independent study of how the foundation model might be taken forward. We are where are, not where someone might have hoped we would be. We make no great claims for foundation trusts but we would agree that the more trusts that can meet the standard the better. However, some will not meet it, for many different reasons. The rush to force them into hasty mergers and takeovers will bring great risks. I point to the fact that only today the House of Commons Public Accounts Committee has issued the report Achievement of Foundation Trust Status by NHS Hospital Trusts, which I have asked the Printed Paper Office to make available. I said that it is quite possible that other noble Lords might be interested in it in the course of today’s debate.
On the point about how many trusts will make it to foundation status, I quote from the document:
“By 1 October 2011 there were 139 NHS foundation trusts, and 113 NHS trusts at various stages in the 'pipeline' towards foundation trust status. Only 14 trusts have achieved foundation status since the end of 2009 … The Department expects the majority of trusts to achieve foundation trust status by 2014, but recognises that a small number may not do so before 2016”.
The report goes on to say that there is indeed a very serious problem of hospitals not achieving foundation trust status:
“Twenty hospital trusts have declared themselves unviable in their current form”.
It suggests that more than,
“half of all trusts are not yet foundation trusts and more are likely to conclude they are unviable”,
and goes on to say:
“A particular concern is what will happen to trusts that are unable to achieve foundation status but nevertheless provide an essential service to local people”.
This report’s very timely publication needs to be acknowledged in the course of our debates on these matters.
We do not accept that every NHS provider must be a foundation trust. We agree with Sir David Nicholson that there is scope for some NHS trusts to be permitted. This also allows us to say that a foundation trust can be de-authorised in exceptional circumstances. This Committee needs to discuss the issue of the Government’s rush to say that all trusts must have foundation status. That is clearly not going to work and we have no satisfactory answers at the moment about what is intended under those circumstances.
We will discuss the issue of the private patient cap so I will not refer to it now. We do not go the whole way in deregulation and see a continuing role for Monitor, not just in authorising foundation trusts but, as we said in our earlier debate, in retaining oversight and intervention powers. We agree that the authorisation process should be rigorous and demanding, so the question there which the Minister needs to answer is: if the department is determined to push hospital trusts into foundation status, what does it mean for standards—will they be relaxed? We think that they should not be. If further lessons are needed from Mid Staffs then I suspect that this is one that the inquiry will raise.
We share the view expressed by several noble Lords on Tuesday that there may be examples where the cause of a foundation trust’s problem lies with the local health system rather than poor foundation trust management. A more effective approach to reconfiguration and a sensible pre-failure regime is absolutely necessary. We understand and hope that the Minister is looking into this and look forward to being part of those discussions. Our view is that while having a great deal of autonomy, foundation trusts remain within the NHS; they are not to be hived off as quasi-businesses. We believe that in general only the two extremes differ from our view—those who want a fully publicly owned, public-provided NHS with no split, and a small band around the current Secretary of State who want to make foundation trusts into businesses and, like a private provider, free from all scrutiny. The rest of us are probably somewhere in the middle.
I turn to the amendments. We support the idea that foundation trusts must open their governance and must meet in public—which is vital. We support the idea that to be effective in their duty to hold the board, and especially the non-executives, to account, the governors must have the right to access and observe all meetings and to see all papers. The confidentiality issues which this might involve can be resolved through appropriate codes of conduct, but if governors are to be the main lines of defence then they must be able to know what is happening. Sadly, that is not the case in some foundation trusts.
We support the need to separate properly the accounts in respect of non-NHS business. It is important to avoid smoke-and-mirrors accounting, especially on the issue of the private patient cap, which we will discuss later. Transparency on that issue is vital. The bottom line is that NHS resources should not be provided at knock-down prices. We have had an undertaking that foundation trusts will provide information showing how non-NHS income acts for the benefit of NHS patients, but in the absence of detailed regulations about how that is to be done it would be best to maintain a sceptical view.
In line with our view that foundation trusts remain part of the NHS family, we support the amendments that ensure the Secretary of State must approve major transactions such as mergers. We do not support the Government’s amendments which are a further example of layering of bureaucracy and paperwork to try to justify their failure regime, which pretty much got a hammering on Tuesday and must be thought about again.
Baroness Finlay of Llandaff
My Lords, I have amendments in this group to which I shall speak briefly. The noble Baroness, Lady Williams, introduced her amendments clearly and concisely. Some figures from the latest Health Service Journal underpin the reason why these amendments are so important. It has reported that foundation trusts are planning to cut at least 30,500 staff over the coming two years and that at least five acute foundation trusts have forecast a wage-bill cut of 10 per cent or more over the coming two years. According to the Health Service Journal’s analysis, patients in the poorest areas are 63 per cent more likely to find it difficult to see a GP than are patients in the richest locations, and 53 per cent more likely to attend accident and emergency.
I put those figures into the debate now because they demonstrate the pressure there will be on trusts. Changing to foundation trust status will put additional pressure on them. Amendment 304C in my name is a probing amendment. I tabled it to seek reassurance from the Government that the timetable for repealing NHS trust legislation will not revert to the originally proposed date—1 April 2014. I hope that the deadline will be extended to April 2020. I was going to say more but I await the Minister’s reply.
Lord Mawhinney
My Lords, I should like briefly to comment on the amendments proposed by my noble friend Lady Williams of Crosby. In one respect, I was sorry that she spoke so briefly because I should have liked to have heard more of her reasoning for Amendment 296. I am not at all clear about what the advantage is to either the Commissioning Board or the hospital if one serves on the board of the other. Is it because that is the only conduit of information? Frankly, I do not think that anyone believes that. If that is actually the argument then the whole NHS is in a much greater state of peril than any of us thought was the case until now. I honestly do not see the importance of or justification for the amendment. It may be a probing amendment, but it would have been helpful if the noble Baroness had given us a bit more of the thinking behind it. As of this moment, pending her winding up, I am not at all convinced that the amendment is either important or necessary.
However, I turn to the noble Baroness’s Amendments 300 to 303, which are also in the name of our noble friend Lord Marks of Henley-on-Thames, who I am sorry to hear is unwell. I very much support what she said about those amendments, even though—to use the word of the noble Baroness, Lady Finlay—she explained them concisely. They take us back to one of the main issues of this legislation: where is the Secretary of State in this brave new world? The Minister knows that a number of us think that the Government are thus far underplaying the role of the Secretary of State.
As my noble friend Lady Williams of Crosby was speaking, I thought of the condition of a number of foundation hospitals that have been the product of a PFI system. That was triggered in my mind by her comment that if there was a coming together of hospitals, or if some element of service was not provided, it may be of a sufficient scale for the Secretary of State to want to take a significant interest. The truth, to the best of my probing, is that a number of hospitals out there—the products of PFI—are in very difficult and probably, without help, unsustainable positions.
I know that the Minister understands that and that it is a matter of concern to the department, so I do not make any comment prejudging the outcome, but my noble friend brought the Secretary of State into this precisely because there could be serious, significant or catastrophic effects on the provision of healthcare in the hospital sector which, by definition, would include the importance of ministerial—that is, Secretary of State—involvement and consideration.
I welcome Amendments 300 to 303, but I say to my noble friend Lady Williams of Crosby and the Minister that I think they are part of the bigger picture of where the Secretary of State will be when the Bill finally reaches the statute book. The Minister has kindly and, I think, genuinely agreed to reconsider all those issues and bring them back for our consideration at Report. Subject to him saying the same about the issues raised by our noble friend Lady Williams, I hope that she in turn, hearing his response, will not feel it necessary to push the amendments to a vote today, although that might become an issue, depending on where we are at, on Report.
Baroness Williams of Crosby
Perhaps I may respond briefly to the points raised by the noble Lord, Lord Mawhinney. I apologise if I spoke too briefly, but I am conscious that there are an awful lot of amendments to get through and I do not want to steal the time of other people on other crucial amendments.
On the group of four amendments that the noble Lord is in accord with me about, as he will be well aware, consideration has been given to the material put before us by my noble friend Earl Howe, the Minister of State, about an attempt to bring together discussion within the House and among lawyers about the issue which the noble Lord, Lord Mawhinney, rightly identifies as being central to the Bill: the responsibility and powers of the Secretary of State. Because we are in Committee and the Committee will, we hope, be ending in a few days’ time, the only opportunity we have to table amendments that would bear on the issue of the Secretary of State’s powers is on the Bill as it stands—prior to any changes that may be made. It is in the light of that that we tabled this group of amendments to highlight the areas where, in our view, the responsibility of the Secretary of State is central. That is true of this group of amendments, and I am delighted that the noble Lord, Lord Mawhinney, takes the view that they should be seriously considered by the Minister.
The point of Amendment 296 is to recognise that, in many cases, CCGs have to take account of the services given by foundation trusts—not least in respect of, for example, pathways and networks for people with chronic conditions. We thought, therefore, that it was important that there be not just sharing of information between the two but, rather, a process of interactive education, where the foundation trusts become increasingly aware of the responsibility that CCGs bear, particularly for those clinical conditions that lie beyond the capacity of a single CCG. That is why we suggested that a governor should be named by the national board to set up that communication—which, as the noble Lord, Lord Mawhinney, knows far better than I do, because he is an expert on the subject, sometimes, sadly, does not exist.
Lord Warner
My Lords, I will just raise a couple of points about Amendments 300 and 301, tabled by the noble Baroness, Lady Williams, in relation to the Secretary of State's role in mergers. The other day, I tried to express a little about my concerns, which I continue to have, about the speed at which the Government are expecting some of these trusts to become foundation trusts. One thing that I am beginning to see happening in the NHS—this will lead to some questions to the Minister for clarification—is the rush to merge. Mergers can take a number of forms, and a good example is in north-east London, where there is a proposal to merge Barts and The London with Whipps Cross and Newham. These three hospitals have failed to become foundation trusts but it seems to be thought that by some osmotic process, which I am not altogether clear about, such a merger will improve their prospects of doing so.
Discussions are also going on in other parts of the country about merging non-foundation trusts with successful foundation trusts. The evidence here is that there are some very high-risk ideas floating around regarding trusts which so far have not been good enough to become foundation trusts, and causing risks to stable foundation trusts by merging them with trusts which are in some degree of difficulty. However, I can see that the NHS might feel under pressure to try to get people to secure foundation trust status by the deadline that the Government seem to have in mind.
As I said the other day, trusts have had eight years to get themselves ready to become foundation trusts and they have failed to achieve it so far. You have to be one of life’s great optimists to believe that somehow, because the Secretary of State has set a deadline for 2016, it is going to happen. There is a serious question about whether the necessary checks and balances are in the system to stop what I would call silly and fruitless behaviour. Is the Minister confident that the Co-operation and Competition Panel will be a sufficient bulwark to stop what I am calling silly behaviour in relation to mergers, or do we really need the kind of strengthening that I think is implicit, if not explicit, in Amendments 300 and 301? This is a serious issue. We are beginning to see behaviour which may not be in the public interest as people try to get foundation trust status without the necessary skills and competences, or indeed the necessary financial situation in their locality, to achieve this.
Baroness Murphy
My Lords, I echo many of the words of the noble Lord, Lord Warner, although I wish to put a slightly different slant on the issue. It is crucial that we press on with the project to get all trusts to foundation status. There is no doubt in my mind that having this two-tier system, which we have allowed to continue for too long, has led to difficulties in foundation trust hospitals becoming more self-reliant, more seriously entrepreneurial in the way that they think about their services, and more responsive to the local agenda, and so on. They have not had to bother because they have always had Big Brother watching. The de-authorisation process, which threatens to drag them back to the Department of Health, has acted as a sort of brake on their thinking. That has been quite difficult. I seriously think that we should move trusts to foundation status. The noble Baroness, Lady Thornton, is looking puzzled, but I think that it has been a really serious problem.
Baroness Thornton
I was looking puzzled only because I wondered what evidence there was for some kind of break in the system.
Baroness Murphy
Some kind of break in the system? I shall continue with my theme: it is crucial that we move all trusts to foundation status. I quite agree that the dates that have been set before have come and gone, but quite often they have come and gone because the strategic health authorities have not provided the necessary support to move trusts to foundation status. In fact, some strategic health authorities were positive blocks in the system to the development of expertise within the foundation trust. I accept that there are some at the moment which, as the noble Lord, Lord Mawhinney, has mentioned, face the PFI problem. Te recharge is too great for them to subsume and the debt is too great. Others have long-standing debts that cannot be written off. Some are not viable because of the populations they serve. Unless we have a definite aim and objective to get them there, they will never get there. We can get there if there is a concentration on the problem. Each hospital is different. I share the concerns of the noble Lord, Lord Warner, about some of the projects to merge one failing hospital with another, or one failing hospital with a less than successful one.
The evidence from NHS trusts’ failing hospitals merging has been that they continue to fail in a bigger way. The Barking, Havering and Redbridge three-trust hospital merger was a striking example of one that did not work and never could. I have that anxiety. If we are going to move away from the process that we have put into this Bill and retain de-authorisation and NHS trusts, we accept that we are continuing with a two-tier system for ever. That would be seriously detrimental to trying to get everyone moved over into a properly regulated system. It is going to be difficult. Certainly, the role of governors needs strengthening. Governors in some places are wonderful. In other trusts, they are mixed-ability classes, let us say. They will need considerable support and development to get there. Nevertheless, it would be catastrophic to have a two-tier system continuing to run after the introduction of the Bill. We need a fixed end point to work to.
Lord Warner
I totally support the idea of getting everybody into foundation trusts. I am questioning whether the processes that we have in place will actually deliver that in the time scales that are being set by the Government. I suspect that in practice you can make the kind of progress required to achieve the Government’s objective only if you reconfigure services rather than just pursuing merger mania.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, this has been an extremely valuable short debate on Part 4. I hope it will be helpful if I explain briefly why I feel that the provisions of this part of the Bill are so important.
They are very much part of our overall vision of modernisation and improvement to meet the needs of changing circumstances: changes in demands, in resources and in innovation. They are about ensuring that foundation trusts are accountable, transparent and autonomous in the way they operate so that they can innovate and provide high-quality and responsive patient care.
Part 4 of the Bill will reform the legal basis of foundation trusts to bring them in line with the new system of sector regulation. Protecting patients’ interests will be at the heart of the system and we will strengthen the governance of foundation trusts to ensure that this happens. We are also taking steps to ensure that all trusts become foundation trusts as soon as they are able. This will mean that all patients can benefit from services provided by organisations that put them first and provide high-quality, accessible care. It will also mean that all NHS providers would be able to take their own decisions on organisational change, such as mergers, acquisitions and separations, based on what is best for patients.
To ensure the best use of taxpayers’ money and the continued delivery of high- quality services, we will make the financing system more transparent and rules-based. Foundation trusts will be required by Monitor to report separately within their accounts their NHS and private-funded income and expenditure, increasing transparency about whether private patient activities are making a profit or a loss. We intend that foundation trusts should decide matters such as which partners they will invite to appoint their governors and how best to equip their governors with the skills they need for their role. Foundation trusts should develop their own good practice to ensure that their governors have the training they need and build up close working relationships with the board of directors so that governors have the information they need to hold the directors to account on behalf of the members whom they represent: the public, staff and patients.
I understand the intention of my noble friend Lady Williams in proposing that the NHS Commissioning Board should appoint a governor to each foundation trust, but I agree with my noble friend Lord Mawhinney because I believe that the right kind of close partnership working between foundation trusts and their commissioners can be achieved in a whole lot of ways and that trusts should be able to develop this relationship in the way that best works for them. To mandate an arrangement such as the one that my noble friend proposes would not be the right way to do it. I also quite agree that it is important for the provision of integrated services that foundation trusts should work closely with their partners in local authorities and other healthcare sectors. However, again, foundation trusts should be free to set up the most effective ways of doing this, including executive and professional collaboration. Similarly, we would not want to prescribe governor attendance at all parts of the directors’ board meetings. It is for foundation trusts themselves to decide how to deal most effectively with discussions and decisions on sensitive and confidential matters so that the trust’s interests are best served.
I also feel strongly that it would not be appropriate for the Secretary of State to become involved in the approval of mergers and separations of foundation trusts. Foundation trusts are themselves best placed to decide what will work well for their patients and staff, and to involve the Secretary of State would be to add an extra layer of bureaucracy for no good purpose, in our view.
The amendments tabled by the noble Baroness, Lady Thornton, seek to preserve the current position where foundation trusts can be subject to terms of authorisation applied by Monitor and, if they fail to meet their principal purpose, they can be de-authorised and returned to central control. The obvious point to make about this idea is that it would be incompatible with our proposal to repeal NHS trust legislation once the foundation trust programme has been delivered. The more deep-seated objection is that these amendments would depend on an infrastructure which we propose to replace with a comprehensive new regulatory system. There would be no obvious body to manage the performance of reverted NHS trusts, including measures for dealing with providers at risk of becoming unsustainable. We have looked at this from a different angle. Our proposed system would shift the emphasis from maintaining the existence of an unsustainable provider, often at great cost to the taxpayer, to ensuring continuity of essential services to local populations. That is surely what matters. It is surely right for the system to be geared towards continuity of service provision.
A further amendment by the noble Baroness, Lady Finlay, proposes that abolition of NHS trust legislation and repeal of Monitor’s authorisation powers should not happen before 2020. We are taking a stronger, more testing and more transparent approach than before to managing the foundation trust pipeline, and we expect the vast majority of NHS trusts to become foundation trusts by 2014. This would give patients a clinically and financially sustainable NHS provider system, by definition, because otherwise the trust would not have been authorised as a foundation trust. I am afraid that the noble Baroness’s amendment would not support the change in momentum and mindset that is now evident within the NHS. I very much agreed with the cogent points raised on that topic by the noble Baroness, Lady Murphy.
The noble Baroness, Lady Finlay, quoted the HSJ saying that some foundation trusts plan to make major reductions in staffing. I have not read my HSJ this week yet but I think that foundation trusts themselves are best placed to make decisions about how to provide services efficiently and effectively, which includes ensuring that they have the right levels of staff. What matters are those services. It is always regrettable if front-line staff posts are reduced, but if the service can be maintained in as good a way or better, that is surely what should matter in the end.
Baroness Finlay of Llandaff
I apologise to the House, having regained my voice. The point I wanted to make was that there is a tension sometimes between changes of administration and management and the pressure to try to maintain the quality of patient service. We have already seen a situation where it went too fast and in the wrong direction without sufficient regard to quality. The Minister has often given us reassurances that quality of patient care lies at the heart of what the Government are trying to do. I just want to have reassurance that there would not be undue pressure. While there is always a need, if you are bringing about change, to have some pressure because organisations have an inherent resistance to change, rather than unduly pressurising an organisation that was not in a fit state to cope with that change, going a little more slowly might allow it to cope better.
Earl Howe
I understand that point. That is why we have built additional flexibility into the system. Although we have target dates for each of the NHS trusts that we plan to move to foundation trust status, we understand that nothing can be fixed in stone. There is some latitude here but at the same time it is important to have target dates; otherwise the momentum that the noble Baroness, Lady Murphy, referred to will be lost and that would be very regrettable.
That brings me to the point made by the noble Lord, Lord Warner, that there appears to be a rush to mergers. We agree with the Public Accounts Committee and the noble Lord himself that mergers are only one way of creating more sustainable providers and services. Mergers must be assessed robustly to ensure that they really will deliver the promised benefits. The Co-operation and Competition Panel does that but at present it can only make recommendations. The NHS Trust Development Authority, which we propose to establish, will play an important complementary role in avoiding what one might call silly mergers. The key has to be local ownership and accountability, not oversight by the department. I was interested to see the amendment tabled by the noble Lord, Lord Warner, about the gathering of management accounting data. I am personally a strong advocate for effective financial and management controls. I am sure we all want to see the NHS become more efficient. The problem with the amendment as drafted is that the system it proposes looks a bit clunky and bureaucratic. It goes against the grain to impose an extra layer of accounting and reporting requirements from the centre and it would clearly cut across the responsibilities of the foundation trusts’ governors and directors.
It is right for me to emphasise by way of concluding remarks that these reforms have been developed in discussion with, and informed by, the Foundation Trust Network, the Foundation Trust Governors’ Association, Monitor and individual foundation trusts. They are built on the experience of what foundation trusts know will work. I hope that in itself is a reassuring statement. I have not addressed the point by the noble Baroness, Lady Thornton, about the PAC report, which I am happy to do once she has intervened.
Baroness Thornton
In terms of discussions the noble Earl is having, are all the parties happy with the fact that if a foundation trust fails it goes into receivership instead of being de-authorised?
Earl Howe
My understanding is that the emphasis that we are placing on continuation of services rather than receivership and failure regimes has been welcomed. There are ways around what some might see as an inevitable conveyor belt to receivership. That should be only a last-ditch resort. We are putting mechanisms in place to ensure that the essential services on which patients depend should continue. That is a better way of looking at things.
Lord Mawhinney
I have been thinking about something that my noble friend the Minister said a moment ago. The amendment would require the Secretary of State’s approval, in addition to that of more than half of the members of the council of governors, for an application made under this section. He did not welcome the amendment of the noble Baroness, Lady Williams, on the grounds that the approval of the Secretary of State amounted to an added layer of bureaucracy. It would be helpful to the Committee if we were to know whether the Secretary of State is always considered to be an added layer of bureaucracy and, if not, can he give us a couple of examples of when the Secretary of State is a net plus?
Lord Newton of Braintree
My Lords, since my question to the Minister, before he rises, is in similar territory, I might as well leave him sitting down for the moment and get my question in. As I indicated the other day, I have been involved in what is legalistically an acquisition, although we have always talked of it as a merger, of a foundation trust by its neighbour, due to come to fruition at the turn of the year. The last hurdle that we had to overcome, though it was not much of hurdle, was the need for the Secretary of State to sign off dissolution orders for the existing trust, and at least one other order, to allow this to happen. Is my noble friend saying that, under this Bill, such things could proceed untouched by the Secretary of State? I do not have a strong view one way or the other, but it is quite an important change if that kind of reconfiguration can occur without the Secretary of State even having to agree.
Earl Howe
My Lords, I would not dream of putting my right honourable friend the Secretary of State’s nose out of joint by calling him “an added layer of bureaucracy” in all circumstances. If I did so, I retract it immediately before it catches up with me. The answer to my noble friend is that the Secretary of State is not that of course; he has a major role in the structure of accountability and decision-making in the architecture of the Bill.
The issue to which my noble friends Lord Mawhinney and Lord Newton have referred is, however, complicated. I have asked for briefing on the way in which the merger process will work. It is quite extensive. To cut to the chase, an application from an NHS trust to merge with a foundation trust must be supported by the Secretary of State. That reflects current rules. However, the Bill removes the requirement for a foundation trust to consult the local authority on a merger. Section 244 of the Act, as amended by the Bill, would provide powers for regulations to make provision as to matters on which NHS bodies, including foundation trusts, must consult local authorities. We intend that foundation trusts will continue to be required to consult local authorities on particular matters set out in regulations and we will consult on those. That is the local authority bit of it. There will also be a duty of public involvement on foundation trusts in relation to such matters as the planning of service provision, proposals for changes in the way in which services are provided and decisions affecting the operation of services. I would be happy to write to both my noble friends—it would probably be better if I did so—to set out exactly what we envisage in the circumstances that they have raised.
I do not want to delay the Committee unduly, but perhaps I could refer to the PAC report to which the noble Baroness, Lady Thornton, referred. We welcome the report, which says that the NHS is in need of major overhaul. What is interesting about the report is what it shows about the state of the provider sector when the Government took office last year. It had problems such as hidden bail-outs, inadequate leadership and toxic PFI deals. These matters had not been addressed and we have made the firm decision that we cannot continue on that basis. That is why we are proposing independent assessments of trust boards as part of the foundation trust authorisation process.
As regards that process, trust boards will be independently assessed. The point of that is to ensure that they are up to scratch and able to lead their hospitals to foundation status. The underlying issue here is that we want all trusts to be clinically and financially sustainable in the future. The Public Accounts Committee has, very properly, drawn to our attention various issues around the capacity and capability of leadership, among other things, and my noble friend Lord Mawhinney mentioned PFI as another issue. All NHS trust boards will have to identify their strengths and weaknesses before being independently assessed. That is a robust discipline.
As my right honourable friend made clear in October, if, even after receiving support, management teams fail to improve their performance, then action will be taken. This could include their possible removal as a last resort. The Government will provide help to a small number of challenged hospitals to turn themselves around where necessary, but only after they have met the four tough tests that we have laid down. The problems they face must be exceptional and beyond those faced by other organisations; they must be historic; they must have a plan to deal with them in the future; they must demonstrate that they are improving their productivity; and they must deliver high-quality, sustainable services.
Before I conclude, I should like to speak to a number of minor and technical government amendments—for that is indeed what they are—in this group. These make consequential amendments in line with the revised provisions of the Bill; they correct drafting errors to correct references and numbering, or they remove redundant references to repealed legislation. Their purpose is to make the Bill work properly and to ensure that the legislation is up to date.
Baroness Williams of Crosby
I beg leave to withdraw my amendment, with the simple comment that I thought the reply of the Minister—which was, as usual, very well argued—strengthened the case for both of my amendments even more than I had thought before, and I am grateful for that. Strong leadership, as the Public Accounts Committee calls for, was exemplified by the Minister but should include the Secretary of State. However, may I now move on to the next group?
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall)
If the noble Baroness would indicate what she wishes to do with Amendment 296, that would be helpful.
Baroness Williams of Crosby
I apologise. I thought I had begun by saying that I would withdraw the amendment and then made some remarks afterwards.
Baroness Thornton
“( ) After paragraph 10C of that Schedule insert—
“10D The governors shall be notified of and have the right to attend all meetings of the Board and its sub-committees and have access to all relevant documents and papers.
10E For this purpose, governors will be required to acknowledge their duty to protect confidentiality.”.”
Baroness Thornton
My Lords, I listened with interest to what the Minister had to say and I was surprised that he dismissed, in a rather cavalier fashion, our two very small and modest amendments about access and transparency for foundation trust boards. We had to force foundation trusts to meet in public. They do not have a good record for their transparency or their willingness to be accountable. That is not so across the board—some are absolute models. I looked in vain for something among all the amendments that the Minister has proposed that might address this important issue of accountability.
I am very disappointed with the answers to my Amendments 296A and 298A. They are modest amendments about accountability. I beg to move, and I would like to test the opinion of the House—
Earl Howe
If the noble Baroness would like a fuller answer, I would be happy to give her one. I am glad to give the Committee an opportunity to hear a slightly fuller answer to the noble Baroness’s amendments. I apologise that I skirted over them in the need to move on.
On Amendment 296A, the purpose clearly is to ensure that governors of foundation trusts have all the relevant information about their board’s activities and decisions to be able to hold them to account. That is not a controversial idea, but the amendment may have the opposite of the effect that the noble Baroness intends. If boards are forced to have governors present at all meetings, they may instead discuss confidential matters in private to maintain confidentiality and hold robust and frank discussions. If governors are admitted to private board meetings, the directors may be inhibited from discussing those confidential matters. The governors can best be kept informed of directors’ activities by close working relationships with them, regular performance reports, meetings with directors including the chair and chief executive, access to all directors and joint activities with directors. It does not have to be the formula that the noble Baroness has suggested.
The noble Baroness said that we had to force foundation trusts to meet in public. That is not right at all. It was we who made foundation trusts have their meetings in public; the previous Government resisted doing that for the whole of the time when they were in office, or from the whole of the time when foundation trusts were set up in 2003, so I do not think that that criticism is at all fair.
On Amendment 298A, the purpose is to require foundation trusts to account separately for NHS and private activity, to show whether that activity is making a profit or a loss. We agree with the broad principle of separate accounting, as we indicated earlier, but we are concerned that putting a requirement like this in statute would impose high costs on foundation trusts with low levels of private activity. Many foundation trusts have little, if any, private activity. We have given a commitment that to provide assurance and transparency we will require foundation trusts to produce separate accounts for NHS and private funded services where they exist. To support its new regulatory functions, Monitor will require foundation trusts to report separately within their accounts their NHS and private funded income and expenditure. That will increase transparency.
We are onside with the theme of the noble Baroness’s amendment, but we do not think that she is setting about it in the right way. It is too heavy handed, and I hope that she will withdraw it.
Lord Clement-Jones
It seems rather extreme and extraordinary to be plunged into the possibility of a vote on a matter such as this without further consideration of what the Minister has had to say, particularly with a fairly thin House at the moment, although I have some sympathy with the noble Baroness. But it is obviously up to her to make her own dispositions.
Baroness Thornton
My Lords, the problem with transparency and accountability is that the issues of confidentiality and expense are always used as excuses. I do not deny that my own Government almost certainly used them as reasons for not proceeding with issues of confidentiality and accountability. I am struggling with the idea that we should withdraw this amendment, because I feel that this is a really rather important matter. It may be a very small and minor matter, but it is actually rather important and I would like to test the opinion of the House.
Baroness Williams of Crosby
My Lords, I shall speak also to Amendments 299A and 299AA.
Before I do so, let me say just a word or two about two other amendments in this group, that is, Amendments 299ZA and 299AZA. I warmly thank the Minister, my noble friend Lord Howe, for having listened with such care to those of us who spoke to him about the issue of foundation trusts, in particular the issue of the private income paid into foundation trusts and the question of how that private income should be used ultimately for the benefit of the health service. He has been very patient, very willing to listen and extremely helpful. On behalf of these Benches and my own party I would like to thank him, and I am sure that others in the House will share that gratitude for the way in which he has responded.
I do not want to go into detail, because the amendments are very clear and have been laid, beyond saying that the first of those amendments, Amendment 299ZA, clearly states the situation with regard to income that comes into a foundation hospital—that is, that that income must be ultimately devoted to the health service. It sets beyond question or ambiguity the Government’s position on this critical issue. I am therefore extremely grateful to the Minister for that.
I also strongly support the proposals about the annual report. I take to heart the Minister’s distinction between the way in which the annual report deals with the funding of National Health Service patients in foundation trusts and with the separate funding of private patients in foundation trusts. On both those issues, it is extremely helpful that the annual report should be clear and open, so that we can all discuss not only the very serious issues that have been raised by the noble Lord, Lord Warner, but also, as pointed out by the noble Baroness, Lady Thornton, the very disturbing report from the Public Accounts Committee, which reiterates over and over again the need for leadership and for a clear statement of where the trusts stand, and the real concerns it has about the difficulties that some of them now confront. It is a dramatic report, and we should commend it to this House as far as we possibly can. Perhaps a separate debate on that issue in the Public Accounts Committee report would be appropriate on some future occasion.
Having said that, I will add only one other thing with regard to the first two amendments I mentioned, which are familiar enough to the noble Earl. In my view, it would be very helpful if there were “belt and braces”, by which I mean a government amendment which would indicate that, in the case of foundation trusts, the majority of patients should be NHS patients. That is, there should be an unquestionable commitment to having a majority of NHS patients. There are two reasons for that. One is simply that, good as the amendment unquestionably is, it is difficult for the general public—I certainly include myself in this—to understand the precise thrust of Amendment 299ZA, which I have quoted. It is helpful in this complicated Bill to have some islands of clarity that those who are not experts in the field—again, I include myself—can understand. People could understand the simple concept that a majority of patients should be from the NHS, not the private sector.
The other reason why I beg him to look at this carefully is that it is also important from the point of view of the complex debate that we have already had in this Committee on the issue of competition policy and EU competition policy. If there is a clear statement that the majority of patients must come from the NHS, that should be immensely helpful in ensuring that we are not then subjected to the rigours of the extreme competition policies defended at present in the EU and, indeed, by our own Competition Commission. My noble friend Lord Clement-Jones, who knows a great deal about the legalisms of competition policy, may have something to add on this point.
I turn briefly—well, fairly briefly; I am now conscious of the disapproval of the noble Lord, Lord Mawhinney, so I shall be a little more detailed—to the three more minor amendments in the group that my name is associated with. The first of those is Amendment 297, where we would like to add the words,
“for the purposes of the National Health Service”.
In order to persuade noble Lords of the importance of this, I will read out the text that the Bill currently inserts:
“The general duty of the board of directors, and of each director individually, is to act with a view to promoting the success of the corporation so as to maximise the benefits for the members of the corporation as a whole and for the public”.
In that wording, the public trail far behind the interests of the members of the corporate body. That is unfortunate and unwise. We are therefore proposing the simple amendment that the words “for the purposes of the NHS”, which, as noble Lords will appreciate, recur in other parts of the Bill on many occasions, should be added to this section about the directors of foundation trusts. It is important to reiterate that foundation trusts work for the interests of the NHS, which is why we have suggested this simple amendment.
On Amendment 299AA, on which my noble friend Lord Clement-Jones will speak in slightly more detail, the point here is quite straightforward. Clause 162(1)(a), which we are suggesting should be left out, removes the existing subsection in the National Health Service Act 2006 that limits the provision of private services. In particular, the 2006 Act permits not the abolition but the restriction of private health services within foundation trusts. Section 44(1) of the 2006 Act provides that,
“An authorisation may restrict the provision, for purposes other than those of the health service in England, of goods and services by an NHS foundation trust”.
In other words, that subsection again sustains the argument that there is a role for the private sector but that there must be restrictions on it if the NHS trusts and foundation trusts are to sustain their fundamental legal obligation to the NHS. It is important that these restrictions should be upheld. Indeed, the authorisations that I have referred to are critical to the concept of maintaining the foundation trusts within the health service system and therefore making it less vulnerable to competition legislation.
The final amendment that I want to refer to is Amendment 299A, where we are simply bearing out what I have already said. I therefore hope the House will now hear additional arguments from my noble friend to show why this group of amendments is very important in order to retain the current status of foundation trusts, which is very welcome, and which will assist in meeting some of the trenchant criticisms of the Public Accounts Committee about this whole sector of the health service. I beg to move.
Lord Newton of Braintree
My Lords, I will come in very briefly. I declare a past interest as former chairman of the Royal Brompton and Harefield NHS Foundation Trust, which probably has as large a private patient income as any in the country. Frankly, that income considerably benefits the two hospitals and their NHS patients.
I welcome the amendments of my noble friend, and hope that the Minister will give them careful consideration. All of us in this House, not least those of us who are former Ministers of health, have been united in our wish to see a successful and flourishing NHS, and in being really dedicated to it. It would be an oddity if a hospital designated as an NHS trust—whether foundation or otherwise—were treating a majority of patients who were not NHS patients. That is quite a simple proposition, and it is the one advocated by my noble friend Baroness Williams.
The amendments already tabled by my noble friend on the cap on income are extremely welcome and sensible. However, I hope that he might think of—dare I say it—embracing the thoughts of my noble friend Lady Williams as well in some further modification of those amendments so that they refer both to income and to numbers. The numbers thing will be more readily understood by many members of the public. Clearly we do not want NHS trust hospitals to gain most of their income from doing non-NHS work or from treating non-NHS patients. That just does not make sense. It would helpful if we could make that clear.
Lord Clement-Jones
My Lords, my noble friend Lady Williams very clearly set out the approach of these Benches to a number of amendments in this group. I simply want to return to EU competition law for a moment. The noble Earl’s amendment regarding limits on the cap goes quite some way to mitigating one of the elements of risk associated with the greater application of EU competition law. As I outlined on Tuesday, there are some really significant issues in the Bill which will introduce EU competition law to a much greater extent if we are not careful. One of those, clearly, is the uncapping of private patient income of foundation trusts. I am very pleased that the noble Earl has gone some way to dealing with some of those concerns. However, I of course very much share the view of my noble friend Lady Williams that we are not quite there yet, and that it would be belt and braces to have the additional safeguard of a limit on the numbers as well as on the revenue.
Generally, four key issues arise from the changes to Sections 43 and 44 of the 2006 Act, quite apart from that of EU competition law. First, there is the question of limits on the cap—what kind of limit is appropriate? Secondly, there is the question of being absolutely certain that any income from private patients is exclusively devoted to the National Health Service. Thirdly, there is the question of prospective transparency—of being well aware of what the plans of foundation trusts will be. Fourthly, there is the question of transparency after the event, in terms of reporting in an annual report.
As far as the limits on the cap are concerned, as I have mentioned, the noble Earl’s Amendment 299ZA is welcome, but it would be useful if he could consider whether any further qualification of that cap was appropriate. There is also the question of being absolutely certain that we are talking about this income going exclusively to the NHS, which is what my Amendment 299A goes towards—that is why I seek to add the word “exclusive” to the changes to Section 43 of the Act.
On the question of prospective transparency, I very much welcome the Minister’s Amendment 299AZA, but that simply provides for reporting after the fact. It is important to share prospectively with the general public and people in the locality the governors’ process for determining the right balance between private income and the NHS activities in a trust. That is what my amendment seeks to achieve by requiring the situation to be set out in an annual plan.
There are four elements. We are some way down the track towards achieving a number of them. At that point, I think that on at least one of the limbs that I and many others are concerned about—the further introduction of competition law to the NHS—we will be satisfied. We will at least have knocked over one of the green bottles, so to speak, with several more to come.
Baroness Thornton
My Lords, the noble Lord, Lord Clement-Jones, has put his finger exactly on the point here. I absolutely agree that, welcome though the amendments in the Minister’s name are, they do not go far enough. Counting things after the fact will not necessarily provide the kind of protection that is required in this area.
Section 44 of the National Health Service Act 2006 currently provides for a limit on the proportion of income that an NHS foundation trust obtains from private charges. I am familiar with this; I had to deal with it in the Health and Social Care Act 2008. That was the point at which my party agreed that there needed to be a review of the private patient cap. That is absolutely the case and we would agree on that. The restriction was introduced to ensure that NHS foundation trusts continued to focus primarily on NHS patients, as the noble Baroness, Lady Williams, explained. However, as we accepted at the time, the way that the cap was based on the financial year cemented in a widely varying range of restrictions, from zero to a little more than 30 per cent, with the average being around 1.5 per cent.
Baroness Murphy
My Lords, I welcome the comments of the noble Baroness, Lady Thornton, that her opposition to the Clause standing part of the Bill is for probing purposes, as are some of the other amendments. We have all welcomed the review of the private patient income cap introduced by the previous Government following the judicial review by Unison of Monitor’s interpretation. The Government’s amendments go a long way to addressing our concerns about the extension of private income diverting NHS hospitals into private activity. I understand and have great sympathy with the amendments tabled by the noble Baroness, Lady Williams, and the noble Lord, Lord Clement-Jones, in that respect.
I ought to say that I have never, as an NHS consultant, practised privately. This is both an ideological and a practical matter. As I mentioned before in Committee, my own professional activity simply could not be done effectively without working in conjunction with social services, housing and the voluntary sector. It would not, therefore, have sat very easily with my activities. I have, of course, seen the very important role that private income plays in swelling the NHS coffers in many foundation trusts. However, it is worth reminding ourselves how dreadfully unfair that private patient cap has been. Hospitals like the Royal Marsden have a cap of 30 per cent, but they manage to do that work without any diversion of activity from their brilliant NHS service. Many acute FTs and all mental health foundation trusts have a cap of zero. For NHS FTs as a whole, the average PPI cap is 1.5 per cent of their income. The overall figure is therefore tiny. Foundation trusts’ private income was less than 2 per cent of their total income across the board. However, this income can be very welcome to individual hospitals. Anything that makes the system fairer for hospitals is extremely important. It is of course worth saying that ordinary NHS trusts do not have a cap and can make as much income as they like.
We need a mechanism to enhance FTs’ commitment to remaining focused on NHS patients. I believe that all existing foundation trusts are focused on that, but if we approve the government amendments—Amendment 299AZA and one other—they will go some way to ensuring that at least the majority of activity remains as it is. In reality, private practice is not likely to extend very much. The provisions will prevent the kind of unfairness and terrible bureaucracies that have been associated with joint ventures and the complexities of the current rules which even the judge in the judicial review of the private patient income cap admitted were real practical difficulties for foundation trusts that needed to be addressed.
The government amendments are strong, but I would not entirely not support some of the stronger amendments tabled by the noble Baroness, Lady Williams.
Baroness Williams of Crosby
I have listened closely to the noble Baroness. I should perhaps add that within these Benches we discussed, and at one stage talked to Monitor about, the possibility of an individual cap for hospitals outside London. I completely take the noble Baroness’s point that in places such as Newcastle the figure for private patients is less than 2 per cent—even though the hospital there is renowned. One can think of many similar examples. We would therefore be perfectly open to reaching an agreement under which Monitor was responsible for there being lower caps in different parts of the country. The proposal that the number of patients from the NHS should be greater than the number from the private sector is an overall statement of principle that virtually every hospital can easily meet. We hope that it might, among other things, disincline our friends from the competition area from deciding that foundation trusts were undertakings and not private agencies.
Baroness Finlay of Llandaff
My Lords, this has been an interesting short debate because the whole business of the cap has imposed wide variations on trusts. Where trusts cannot have any private activity, there has been an unintended consequence if some staff, particularly consultants, undertake private work. They have carried out that work offsite and not been available if there has been an emergency onsite, and travel times also have worked against patient care.
I can therefore completely understand why these amendments are before us and why the Government wish to act as has been outlined. Perhaps in his closing remarks the Minister can provide us with an assurance that any guidance—it is not necessary to include this in the Bill—will ensure that trusts do not inadvertently double-pay staff. The point of splitting private and NHS treatment was precisely to ensure that staff do not carry out private work in their NHS time and receive double pay, and that the accounts are clear. There are advantages to staff doing private work on NHS premises and to a flexible interpretation whereby, when there is a medical emergency, staff can run down the corridor. Private patients completely understand when someone has to be called away because there is a life-threatening emergency. They are happy to wait until the staff return. That system operates at the hospital in which I work. Although I do not do any private work, some of the oncologists have clinics in the evenings.
There is a need for clarity and I hope that some reassurance will be given that in removing the cap there will be good husbandry of public money.
Baroness Noakes
More than 20 years ago, I was director of finance of the NHS, on secondment from my firm, as some of my noble friends will recall. One of my areas of responsibility was something we called the income-generation initiative. It was sponsored wholly by the Department of Health which was to encourage NHS hospitals to maximise their assets and to generate income for the purposes of the NHS. The origins of the private patient income lie with the Department of Health wanting to ensure that the NHS maximised the returns from its assets and took opportunities to generate income solely for the NHS. Those of us who were involved in developing that initiative would regard all these discussions as a mark of success of the initiative, as it has generated so much income that other questions are now asked.
I never supported any kind of cap, because the circumstances of individual foundation trusts vary so significantly that any cap would never be effective. The way in which income can be structured to flow into a trust can markedly change the impact of the cap. By structuring your relationships with partnership organisations, for example, you can massively change whether a cap bites or does not.
I support the amendments in the name of my noble friend, because perhaps it now needs stating that you should concentrate largely on the NHS—although, as I said, those of us who started this find it a rather surprising conclusion—and I support transparency. If I ever had one concern about the income-generation initiative, it was that costing was never particularly well understood in the NHS, and, therefore, neither was the net result from the activity nor how that activity was used. It is important to have transparency. I hope that other noble Lords will not encourage the Government to keep any limits which constrain the NHS from maximising its assets for the purposes of the NHS.
Lord Warner
My Lords, I was not going to speak in the debate and I certainly do not want to speak on the subject of the cap, in case I get into too much trouble from my Front Bench. I would like to pick up the point made by the noble Baroness, Lady Noakes. We are moving into a world in which the NHS will have to look at how it uses its assets. As I have said in earlier discussions, the NHS footprint on its sites and its utilisation of buildings is relatively small given the size of the sites.
We are also moving in a direction where, across the House, we favour integration of health and social care. It would not be surprising if, in the next few years, on some sites of district general hospitals, there were nursing homes run by the private sector which had self-payers as well as state-funded payers. The way the Government are approaching this creates flexibility in how income might be generated. I hope we will not be so prescriptive in how we meet the legitimate concern that NHS trusts should concentrate on their core business, if I may put it that way, that we shoot ourselves in the foot again by having a cap that actually works against the best interests of the NHS.
Baroness Thornton
My Lords, I have never known my noble friend to show particular restraint about how he felt about his Front Bench.
This discretion has morphed into something that says that making efficient use of assets and being effective is the same as maximising private income. Of course, that is not the point here. The point is getting the balance right. The noble Baroness, Lady Noakes, made a very good point: the NHS does not exist to maximise private income profit.
Earl Howe
My Lords, this is an important issue and one that I recognise is of considerable interest to the Committee. To start at the beginning, the Government are clear that NHS providers should always focus on the provision of care to NHS patients. However, we cannot ignore the fact that the private patient income cap, which Clause 162 would remove, is damaging to the NHS and to patients’ interests. We think that there is a very strong case for removing the cap, because doing so will allow NHS patients to derive even greater benefits from foundation trusts. At the same time, we understand the sensitivities. The key to addressing those sensitivities is to have adequate safeguards to ensure that NHS patients and resources continue to be prioritised and protected. I reassure the Committee that we believe we can achieve that through the Bill and through the government amendments, and I shall explain why and how in a moment.
The words “private patient” in the cap’s title may have unfortunately given the wrong impression about the substance of the argument. My noble friend Lady Noakes was quite right in what she said. The cap’s scope goes far wider than just private patients. It captures income from activities such as innovations involving research, joint ventures and the sale of medicines and intellectual property to private healthcare providers in the UK and abroad. This means that innovative partnerships of the kind that the noble Lord, Lord Warner, indicated might happen are being hampered, and the ability of foundation trusts to earn more income to help to bring in leading-edge technology to the NHS faster—for example, for cancer treatment—is unnecessarily restricted.
Foundation trusts have told us that the cap is detrimental to care offered to NHS patients. They have welcomed our move to remove what they and we see as an outdated, unnecessary and arbitrary legal instrument that locks them into maintaining income from private charges below the levels that applied in 2002-03.
Perhaps I may remind noble Lords of the compelling reasons for removing the cap. As I am sure the Committee will agree, the rule itself is unfair. Some foundation trusts have much higher caps, and hence much more flexibility, than the majority. In 2010-11, around 75 per cent of foundation trusts were severely restricted with caps of 1.5 per cent or less. Meanwhile, the Royal Marsden benefits from a 31 per cent cap and is the country’s highest private patient income earner. It has also been consistently rated as a highly performing NHS provider.
Baroness Thornton
I have a question for the noble Earl on this. He is absolutely right that the Royal Marsden is a very effective hospital, but what independent evidence is there that the cap harms the interests of NHS patients? We know that quite a few foundation trusts have been going on about it, and I absolutely agree that the cap needs to be reviewed properly, but what independent evidence is there that it harms the interests of patients?
Earl Howe
My Lords, if the noble Baroness is calling for evidence beyond the testimony of numerous NHS trusts, I am not sure what more I can offer her. I can write to her on this but there is very considerable evidence—almost a priori evidence—that if you restrict a trust’s ability to earn income which would otherwise go to improve facilities for NHS patients, you are damaging the interests of those NHS patients. That is an argument that we have consistently put forward ever since the 2003 legislation. However, it is also an argument that I recall Ministers in the previous Administration making when we last debated this subject at any length.
I was going to point out too that NHS trusts as distinct from foundation trusts do not have a private income cap. A number of them earn private incomes well in excess of many foundation trusts. There is absolutely no evidence that these providers are ignoring NHS patients as their prime responsibility—no evidence at all. A number of noble Lords, not least my noble friend Lady Williams, have tabled amendments in this area to ensure that foundation trusts must protect the interests of NHS patients above all and that public money should not subsidise private care. I wholeheartedly agree with that. I would like reassure noble Lords of the safeguards that the Bill already contains to this end. Some of these safeguards are prospective in nature and some are retrospective.
First, foundation trusts will continue to be bound by their principal legal purpose, which is to provide goods and services for the NHS in England. I am going to move Amendment 299ZA today to state explicitly that “principal purpose” means that the majority of every foundation trust’s income must come from NHS service provision. That amendment will make it certain that the trusts are NHS providers first and foremost. I admit to my noble friend Lady Noakes that this is something of a belt and braces amendment, but I believe that it directly addresses the main concerns voiced by my noble friend Lady Williams.
The second safeguard is that the Bill would make foundation trusts more accountable and transparent to their public and NHS staff. My second amendment in this group, Amendment 299AZA, would support that by requiring every foundation trust to explain in its annual report how its non-NHS income had benefited NHS services. The Bill gives governors, who represent the public and NHS staff, greater powers to hold directors to account and this amendment would help them do so. My noble friend Lord Clement-Jones sought to place additional duties on directors. The Bill would also place an explicit duty on them to promote the success of their foundation trust with a view to maximising benefits for its members and the public. If, for example, directors were to pursue private patient activity against the interests of members and the public, the governors would be able to, and they should, use their new powers to challenge directors or they could use their existing power to remove the chair and non-executive directors.
Lord Clement-Jones
I understand the safeguard aspect there, but what will the members of the trust or the general public know about how a foundation trust plans to use its assets in terms of private patient income?
Earl Howe
My Lords, it will be open to governors to seek information from the boards of directors on the plans that they have for the trust. They will have access to key papers. There should be no difficulty about knowing what the board has in mind for the trust in that strategic sense.
Thirdly, the NHS Commissioning Board and NHS commissioners would be responsible for securing timely care for NHS patients. They would be under a duty to exercise their functions with a view to securing continuous improvements in the quality of NHS services. That is an important provision too.
Finally, to achieve a fairer playing field, Monitor’s licensing regime would allow it to step in to prevent NHS money cross-subsidising private care. Foundation trusts would also be required separately to report to Monitor their NHS and private-funded income. My noble friend Lady Williams said that in her view it would be useful to have in the Bill that the majority of foundation trust patients have to be NHS patients. While I agree with the intent behind that thought, I cannot agree with her two arguments that support the need for an amendment. First, we do not agree that legislation should be used symbolically in this way. Foundation trusts’ principal purpose already covers the point that she raised. Secondly, even if we had such an amendment, it would not make any difference to how the courts interpret and apply EU competition law. It is the nature of the activities that they are undertaking that matter, not how many patients they treat or how much income they earn.
Perhaps I may make a specific point about my noble friend’s Amendments 297 and 299. They would duplicate unnecessarily the legal description of the NHS, which since 1946 has been described as “health service”. Use of the word “national” would be inconsistent with references to the NHS throughout existing legislation.
Just to elaborate on EU competition law, the Bill, as we discussed the other day, does not change the position on EU competition law or the applicability of the law. It remains the case that there is uncertainty on the status of NHS providers as undertakings for the purposes of competition law because no direct case law exists. In so far as foundation trusts already provide private healthcare services, they may be engaged in economic activity. Therefore competition law, both the prohibitions on anti-competitive behaviour and the prohibitions on state aid, may apply to their activities in these markets. Although the Bill would offer more flexibility to participate in these markets if the cap were lifted, it does not mean that foundation trusts are more or less likely to be considered undertakings in their provision of NHS services.
It was suggested by my noble friend Lady Williams that there might be a sort of case-by-case approach to lifting the cap. I recall that that approach was strongly rejected by the previous Government, and for very good reasons. We agree with those reasons. The disadvantages of that approach would be that it would be very difficult to set up a clear system and it would be likely to be difficult to administer and to increase bureaucracy. It would potentially lead to greater variation between foundation trusts and to claims of unfairness between different trusts, which could possibly be a source of litigation. It would maintain the problematic definitional issues around the cap itself. We are not drawn to that approach.
The noble Baroness, Lady Finlay, asked whether we could consider including in guidance to foundation trusts the need to avoid double-paying staff. I think she makes a very interesting point and I can confirm that we will give that some active consideration.
While the principles of some of the amendments tabled by noble Lords are ones that we could all agree with, we believe that the amendments are unnecessary and could be damaging. For example, a requirement for non-NHS income to support only NHS services could mean that foundation trusts would find it impossible to invest in their non-NHS activities and therefore make greater profits to support core NHS work. We want to avoid safeguards, no matter how well intentioned they may be, having a perverse legal consequence on foundation trusts’ ability to innovate.
I hope I have said enough to persuade the noble Baroness to withdraw the amendment because I am completely convinced that the necessary safeguards are there and that what we are proposing are the right things to do.
Baroness Thornton
If the Minister thinks that the safeguards are here, and if all that is true, should the governors be the ones who decide on the level of the private cap?
Earl Howe
My Lords, I think that the board of directors is best placed to decide how much private income overall a trust should receive, on the proviso that the principal purpose of the foundation trust remains adhered to. Governors should concern themselves with any threat to that status. If they perceive that the board is in danger of overstepping the mark in that sense, then of course it is their province. Otherwise, I think it is for the board of directors to judge what is in the best interests of the trust as a whole and of NHS patients. That could mean expanding the trust’s private patient work, capitalising on intellectual property, or whatever it happened to be.
Lord Clement-Jones
My Lords, I shall intervene briefly before my noble friend Lady Williams sums up on her amendment. What the Minister just said about this relationship between governors and directors and the advancement of the principal purpose of a foundation trust added another dimension. It is not so much the question of the majority of income or of patients coming from the private or the public sector that is important. That is simply a test for competition law purposes. The issue is whether the principal purpose of the foundation trust remains within a social purpose. The element of solidarity established by FENIN is there and it is therefore at less risk of falling totally within EU competition law as an undertaking.
The Minister’s comments bear considerable study, but what he has said does not completely take us out of the risk area. I know he does not use the word “risk” in relation to EU law applying further, but that is certainly the mindset of a number of us looking at these provisions, particularly in relation to the cap. It is the question of social purpose and solidarity that is crucial in law, and the question of whether what my noble friend has done to date is sufficient. I will obviously read his comments carefully but I do not think we are quite there yet.
Baroness Williams of Crosby
I am happy to withdraw the amendment, but I would like the Minister to consider very carefully the words of my noble friend Lord Clement-Jones because my impression is rather the same as his, although on a much weaker basis of expertise. On the one or two occasions when I visited the Commission to discuss this matter, I had a strong sense that social purpose is one of the main criteria that they look at in deciding whether something counts in the area that captures competition law in the EU. I cannot speak about the Competition Commission in England because I do not have enough expertise to do so, but I hope that the Minister will consider what my noble friend has said because I believe that it is a crucial factor for the EU Competition Commissioner.
Lord Clement-Jones
I want to add one further point about “prospectivity”, if there is such a word, and governors and/or directors looking at the activities of the trust. It is important that one considers that point from the social purpose point of view. One can then look at the pattern of activity of the trust and see what investments are going to be devoted to private and NHS patients. That is an important part of looking at the risk factors associated with a purpose not being a social purpose.
Baroness Thornton
I am glad that the two parties of government are in discussion with each other about these matters. However, there are Members on the Cross Benches and on these Benches who also have opinions on these issues. If it is appropriate, we would like to be involved in those discussions.
Baroness Williams of Crosby
My Lords, I am perfectly certain that the noble Baroness will contribute even more to this esoteric but very important discussion. With words of thanks to all those who have taken part, I now withdraw the amendment.
“( ) In sub-paragraph (3) of that paragraph, in paragraph (b) for “any records” substitute “the records”.”
“( ) In paragraph 22(1) of Schedule 7, omit paragraph (e) (duty to make forward plan available to the public).”
“(2A) An NHS foundation trust does not fulfil its principal purpose unless, in each financial year, its total income from the provision of goods and services for the purposes of the health service in England is greater than its total income from the provision of goods and services for any other purposes.”
“( ) After subsection (3) of that section insert—
“(3A) Each annual report prepared by the NHS foundation trust must give information on the impact that income received by the trust otherwise than from the provision of goods and services for the purposes of the health service in England has had on the provision by the trust of goods and services for those purposes.””
“( ) a copy of any information published under section 65D,”
“( ) a copy of any statement provided under section 65F,”
“(d) for “65L(2), (4) or (5)” substitute “65L(2) or (7), 65LA(3)”.”
“( ) a copy of any information published under section 65D,”
“( ) a copy of any statement provided under section 65F,”
( ) in subsection (3), omit paragraph (a) (and the following “and”)”
( ) omit sub-paragraph (ii) of that paragraph (and the preceding “or”)”
(a) ”
(b) in paragraph (c), for “that Act” substitute “the National Health Service Act 2006” (and omit the “or” preceding that paragraph)”
Lord Warner
“(2) Healthwatch England is to be appointed in accordance with regulations made by the Secretary of State.”
Lord Warner
My Lords, unfortunately the noble Lord, Lord Patel, had to leave before we could get to this amendment so I shall speak on his behalf in moving Amendment 306.
The amendment brings us to Clause 178, which is about HealthWatch England. In simple terms, the amendment seeks to make HealthWatch England an independent body and not a sub-committee of the Care Quality Commission. That is its purpose. We have to some extent already touched on this issue and made the arguments in earlier debates about why we think, in terms of public credibility for HealthWatch England, it should not be nestling within, hosted by or whatever else you want to call it the Care Quality Commission. I shall turn to the issue about that particular body in a moment but, as a matter of principle, whether it is the Care Quality Commission or some other body, we take the view that it should be a free-standing body so that it can exercise—and, perhaps just as importantly, be seen to exercise—a very independent role in pursuing the purposes and interests of patients and the public.
The whole area of public and patient involvement and them having their say in the running of the NHS, the way it works, its standards and its standards of care has caused difficulty across the political spectrum in getting it right. The Government deserve considerable congratulation on having another go at this. It is not a matter of principle, certainly as far as the noble Lord, Lord Patel, and I am concerned, that we should not have a body called HealthWatch England—we totally favour that—but you might as well go the whole hog if you are going to claim that it is an independent body. Calling it a sub-committee of the Care Quality Commission does damage to the public perception of its role.
I know that the noble Earl, Lord Howe, has seen recently the NALM to discuss these issues and I want to quote from some of the briefing that it used in that meeting with him. The NALM made it very clear that it saw collaborative working between HealthWatch England and some of the other bodies as important, but that did not mean to say that it wished it to be hosted in one of those bodies. The briefing is most interesting. It says:
“Our work with the CQC over the past year has given us little confidence that this is the right location for the public’s independent national body concerned with health and social care”.
It is concerned that it will not be seen as independent. Whatever arguments the Government may have, we have to take careful note when representatives of the public and patients do not believe that they will be seen as independent if they are placed in the CQC.
Lord Harris of Haringey
My Lords, we have already debated to some extent the way in which HealthWatch England might operate. However, this group of amendments returns not just to that issue, but to a number of other important issues which go to the core of the extent to which HealthWatch England is genuinely going to be an effective organisation. I give Ministers and the Government the benefit of the doubt on this—that that is something that they want to see happen. Therefore, the way in which HealthWatch England is established, the way in which it functions and the powers that it has are going to be critical to whether or not this body will simply join the long list of organisations that have been set up over the years to represent patients’ interests and have then been dismembered after a short period, or in some cases a slightly longer period, because they are not seen to be effective. If the Government are genuine about putting patients at the heart of the new NHS, then they need to ensure that HealthWatch England and healthwatch organisations are effective.
My noble friend Lord Warner, slightly unusually, pulled his punches. He talked about it perhaps being a major mistake to host HealthWatch England within the CQC. I have to say there is a danger that this could be a disaster. It is a disaster because of the sustained attacks that the CQC is currently undergoing, which seem to emanate in some instances from Government and Ministers who clearly are not satisfied with the direction of travel. There are clearly concerns that this is an organisation which is being asked and expected to do far too much at the moment. To add this additional responsibility is not necessarily helpful.
I can understand that it is important that HealthWatch England relates effectively to the Care Quality Commission: that is one of the organisations it must relate closely to. But it must also relate closely to the NHS Commissioning Board. It must also relate properly, under certain circumstances, to Monitor. Simply saying that the relationship with the CQC is paramount does not necessarily make an enormous degree of sense.
My noble friend Lord Warner made a specific point. If the motivation for hosting HealthWatch England within some other national organisation is to save money—I understand that it may not be the prime motivation but it is a concern in all this—then there are plenty of other ways of achieving those savings in terms of back-office functions. Those functions can be provided by agency agreements; you can have organisations which are in the same building and able to share some of the physical facilities and so on. It does not necessarily require that the organisation sits as an integral sub-committee within or as part of the organisation concerned. You can do it in other ways; you can achieve those savings in other ways.
However, if you place HealthWatch England in the Care Quality Commission, or for that matter in the NHS Commissioning Board or any of the others, you are in danger of there being either a real or perceived conflict of interest. It may well be the case that HealthWatch England will, on occasions, be asking the Care Quality Commission to do certain things. It may well be the case that there will be, on occasions, circumstances in which HealthWatch England will be saying that the Care Quality Commission has failed to do certain things. That is not a happy situation; nor is it one that is likely to engender the trust of the public if they are seen as being part of the same organisation. That is the principle which underpins some of these amendments.
There is then the question of the extent to which HealthWatch England is seen as being a creature of either the CQC or Government. That then relates to how the ruling body of HealthWatch England—the committee, if it is a sub-committee of the CQC—is appointed. That is why one of the amendments to which I have my name, Amendment 307, specifically refers to the committee of HealthWatch England being,
“elected from local Healthwatch organisations”.
It is a principle of accountability; it is a principle of ownership; it is a principle of safeguarding that independent viewpoint and voice. That is why that is necessary and that is why Amendment 307 in this group is so important.
We also have a series of amendments, Amendments 308, 309, 312, 313, 315 and 316, which try to make sure that it is absolutely explicit that HealthWatch England's role is not just to provide information or advice but, on occasions, to make recommendations to the bodies concerned. It may be a recommendation to the CQC or to the other major national organisations. This group of amendments specifies that that is part of its functioning. It also makes it clear that there should be proper responses to those recommendations from the bodies to whom they are directed. Again, if the Government are serious about making HealthWatch England effective and about having a genuine and clear voice of the users of the NHS and social care services, surely placing in the Bill the power to make recommendations is central to that.
Amendment 314, to which I have also put my name, essentially requires HealthWatch England to provide the CQC with information and advice on the views of patients and the public, and of local healthwatch organisations. It is not a question of it being a discretionary responsibility but a clear responsibility—it “must” rather than it “may”. I know that, in this Committee or in your Lordships’ House more generally, we sometimes get into esoteric discussions about the relative force of “must”, “shall”, “may”, and so on and so forth. I am quite clear that must is stronger than may. That is to avoid a situation where the national body fails to take into account the views and opinions being expressed locally. It is saying that this is an obligation on the organisation to reflect that. Again, if you want to see an independent voice for patients at national level, it must be clear that that body is obligated to put forward the views of patients, the public and local healthwatch organisations.
Amendment 317 also goes to the heart of the relationship between HealthWatch England and local healthwatch organisations. It is a very simple expectation, which I am surprised was not included in the Bill already. HealthWatch England must send a copy of any report it produces to all local healthwatch organisations. This is about the way in which local healthwatch organisations relate to their national body. I speak as someone who ran a national body for patients for a number of years. I know that we would have had an extremely difficult time with our member community health councils had we been making advice and recommendations at a national level without keeping the local organisations, on whose advice those recommendations were based, fully informed of what we were saying and doing. The Bill sets out some of the people who should receive the reports produced by HealthWatch England, but fails to mention local healthwatch organisations. It is a simple change. I am sure it was a mere error in drafting and that the Minister will be able to accept Amendment 317 without wasting time at Report on the issue.
Amendment 318 relates to the relationship between the Secretary of State and HealthWatch England. Clearly, there is a nagging concern in the Department of Health that HealthWatch England may not do all that the Government are hoping, which it certainly will not be able to do unless they make some of the changes being suggested in this group of amendments. However, the Secretary of State has taken upon himself the power to give directions to HealthWatch England. Personally, I do not have a problem with that. I accept that Secretaries of State like to have that in respect of all sorts of organisations. However, before making those directions, which the Secretary of State should not make lightly, Amendment 318 provides that the Secretary of State,
“shall consult local Healthwatch organisations”.
If the Secretary of State were to give a direction on the basis that it was failing to discharge its functions, that should be in the light of the knowledge that local healthwatch organisations, to which HealthWatch England should be responsible and is, in part at least, servicing and supporting, have been properly consulted.
I think that the amendments are entirely modest, sensible and ones that the Government can accept without further problem. They are integral to ensuring that HealthWatch England is the proper voice of the users, patients and those who depend on the NHS.
Baroness Jolly
I rise to speak to Amendment 311ZA, in the name of my noble friend Lord Clement-Jones, which calls for people’s views on those services commissioned by the board, whether locally or nationally, to be taken into consideration. I need to make a declaration, because I am chairman of the Specialised Healthcare Alliance. When she sums up, will my noble friend the Minister try to give some assurance that those with rare and complex conditions, services for whom will be commissioned by the board, will be included in all consultations by local healthwatch organisations and by HealthWatch England?
I have some general remarks about HealthWatch, which is to be the voice of the patient both nationally and locally. I want to tease out what it is all about, where it should be and who should be doing it. HealthWatch has to do far more than its name suggests—it has to do more than just watch. Clearly, it needs to listen. I totally support the amendments of the noble Lords, Lord Rooker and Lord Harris of Haringey, who are pushing the idea that HealthWatch should be able to recommend. This is not just a tacit thing: it has to be very much more proactive, to push things back. Whether it is pushing it back to the Secretary of State, CQC, local authority boards, NICE or even clinical commissioning groups, it is critical that that should be seen as part of HealthWatch’s role. “No decision about me without me”—well, we will not know about that unless the recommendation amendment is actually woven in.
The amendment of my noble friend Lady Cumberlege is about local healthwatch organisations. Local healthwatch organisations will have an opinion on clinical commissioning groups’ commissioning plans, and that opinion should go to the board.
Where should healthwatch organisations be placed? We have said it before in this Committee and I suspect we shall have to say it again on Report: we on these Benches are not convinced that the role for HealthWatch England is with the CQC—as a sub-committee of the CQC—or that the role locally should be with local authorities. One of the things that these organisations will have to do, whether nationally or locally, is to be quite critical of their hosts. It is very difficult to be critical of your host, so it is perhaps not appropriate that they should be their host.
Along with the question of where healthwatch organisations should sit, another issue—certainly, this is an issue at local level—is funding. Funding is currently held by local authorities for LINk organisations. I suspect that many of us who have been involved in this Committee have been receiving letters from LINk organisations saying that their funding is being cut and they cannot possibly manage. That needs to be taken into consideration. I understand that, currently, the pot of funding for local healthwatch is going to be given to a local authority. Should we be unsuccessful in moving local healthwatch out of the local authority, I would like the Government to give some thought as to how that money might be ring-fenced. I know that they are not happy about ring-fencing money, but should money be ring-fenced and be part of, for the sake of argument, the public health budget? If local healthwatch organisations have to remain with local government, then the funding needs some sort of protection.
Who should be involved with HealthWatch? I support the amendment of, I think, the noble Lord, Lord Beecham, that there should be locally elected delegates. HealthWatch England would be far stronger if there were local voices from local healthwatches. Now that we will have not strategic health authorities but sub-national areas, perhaps there should be two members from each sub-national area to represent their patch who could give the views of local healthwatch organisations to HealthWatch England. Perhaps that might be appropriate.
The local healthwatch organisations—LINks and their immediate predecessor organisations—have had problems with who actually forms part of these organisations locally. Some have been very good, but some have been less than effective. The members of these groups have just happened to be whoever was interested and keen at the time. Sometimes the groups were positive, but sometimes they really did not work at all. There might be shades of the past here: I wondered if there was any mileage in suggesting that the local healthwatch should be composed of someone from the local authority, someone from the voluntary sector and, of course, someone representing the patients, so that you weave into the local group some professional expertise in order to help with some of the strategic work.
I pass on apologies from my noble friend Lady Tyler, who was going to speak about children—she had her name down to Amendment 311ZA. Children need to be heard. When you talk about the views of children, you might have a mental picture of very little children, but in this context children go up to the age of 18. A lot of interesting services are currently available for teenage children, teenage individuals, young people or young citizens. It is critical that their views, needs and experiences are sought so that they can be fed into the mix.
I have probably said enough now about HealthWatch for the three groups so I shall sit down and not stand up again, but it is critical that we do this right in the Bill. I look forward to seeing what comes out on Report and to seeing where we need to move on to from there.
Baroness Pitkeathley
My Lords, my contribution in support of the amendments is simple and brief: it is to ask that the Minister ensures that we learn the lessons of history and do not repeat the mistakes of the past when it comes to patient involvement. As we know, there is a huge evidence base about the benefits of patient involvement in health outcomes, and I am sure that the mantra of “No decision about me without me” is something that all noble Lords will accept.
While successive Governments have been committed to patient and public involvement, the history of it has not been a happy one. Some of us can go right back to 1974 when CHCs were first set up. Like my noble friend Lord Harris, I believe that this Government are committed to putting patients at the heart of the NHS, but let us look at why the previous attempts to do so have not been successful. In summary, I suggest that the reasons are these: the efforts have not been sufficiently well funded; they have not been seen as sufficiently independent and therefore have had conflicts of interest; they have not had enough status; and there has not been seen to be enough communication between national and local bits of the set-up.
I leave aside the current problems of the CQC, although I agree with noble Lords who have spoken about that, but the very idea of making the new body a sub-committee of anything seems to me to ensure that we are in fact going straight down the route where we have made so many mistakes before. I remind the Committee that those who do not learn from history are doomed to repeat it.
Baroness Cumberlege
My Lords, the noble Lord, Lord Harris, is right that we have already had this debate much earlier in the progress of the Bill, when we discussed the relationship between the Care Quality Commission and HealthWatch England. The debate took place on 22 November and I spoke in cols. 977-79, and your Lordships will be very grateful to hear that I am not going to go through it again.
There are just one or two things that I want to say. The amendments that I tabled at that time were very similar to some of those that have been tabled today. However, I want to make it plain that I am not, in principle, in favour of making Healthwatch England totally independent. I think there are enormous advantages in having a very close relationship with the Care Quality Commission. As I have said, I am not going to go into the reasons why at this time.
The first amendment that I have tabled provides:
“The majority of the members of the Healthwatch England committee shall not be members of the Commission”.
I think that is very important, in order to give them opportunities to criticise the CQC. The second amendment provides:
“The provision that must be made by virtue of sub-paragraph (1A) includes provision as to—
(a) the majority membership of Healthwatch England committee being elected from representatives of Local Healthwatch organisations, and
(b) the manner in which those representatives are elected, the term which they must serve and the role that they must fulfil”.
That has been very well argued again this afternoon.
Both the independence and the influence of Healthwatch England can be secured, providing that the right sequence of accountability is in place. I see this as follows: Healthwatch England must have a majority membership made of elected people from local healthwatches, and it must be accountable for the way it influences the CQC by local healthwatches across the country. The CQC must be accountable for the way in which it responds to HealthWatch England, and local healthwatches must be protected from interference and bias from local authorities. I will say more about that in the next group.
I want to take up the very good points about history made by the noble Baroness, Lady Pitkeathley. The question of whether Healthwatch England should be a stand-alone organisation is actually answered in history. Fourteen years ago, the then Association of Community Health Councils for England and Wales published Hungry in Hospital?. This highlighted the failure to feed elderly patients in hospital separately. Just a few weeks ago, exactly the same problem was highlighted in the dignity and nutrition programme report from the CQC. We know it is still a problem but have failed as a nation to sort it out. I wonder if ACHCEW had been part of the regulator, whether the CHCs could have ensured that the matter was addressed by the regulator and then monitored whether it was or not. Simply making an organisation stand-alone does not give it influence; indeed, it can distract it into supporting its own infrastructure, leaving less capacity for getting on with the job. Its functions, membership and accountability are what make it independent, and not, necessarily, its stand-alone status.
Baroness Emerton
My Lords, my name is not under any of the amendments, but I want to say briefly how much I support what has been said by the noble Lords, Lord Warner and Lord Harris, and the noble Baroness, Lady Pitkeathley.
Following on from the noble Baroness, Lady Cumberlege, I think that, while Healthwatch will have some opportunity to look at the CQC, it will usually look at the negative side. However, I thought HealthWatch was going to be a body that might be able to influence future policy. Certainly, when I had the experience of sitting on a CHC board, it was able to contribute to the future policy of a new development. I feel we are looking very much at the negative, rather than the positive and the contribution that can be made by members of HealthWatch, possibly to future national policies.
Thinking back to the changes that took place in mental health and learning disabilities, I think that it would have been very valuable to have had the contribution of the HealthWatch group of people. We did not have it at that stage. Somehow we need to weave into this the positive side of policy-making and strategy that HealthWatch can often contribute in a very positive way. While HealthWatch will have a contribution to make in looking at the negative side—which usually means the critical side in relation to the CQC—I do not think that that should be its sole role. I hope the Government will take that away and perhaps feed it in.
Baroness Wheeler
My Lords, I shall speak briefly in favour of these amendments, which would make HealthWatch England independent of the Care Quality Commission and strengthen its role so that it has the function of making recommendations, not just providing advice and information, to the Secretary of State, the NHS Commissioning Board, Monitor, the Care Quality Commission and local authorities.
I emphasise that we are strongly in favour of HealthWatch England having the powers that will make it the powerful consumer champion for the views and experiences of patients, their families and carers that we want to see. However, we firmly believe that this will not be achieved if it remains a sub-committee of the Care Quality Commission—an important issue that we will return to on Report, and which we believe is crucial to HealthWatch England’s success as a public watchdog and patients’ champion that is able to make a real difference. My noble friends Lord Warner and Lord Harris have set out the arguments for this very strongly. I will not go over them again. They were indeed thoroughly aired in the previous debate anyway.
The amendments in this group from my noble friends Lord Harris and Lord Rooker also seek to ensure that the Secretary of State consults local HealthWatch organisations before he or she gives a direction to HealthWatch England concerning its failure to discharge a significant function that it is required to undertake. We support this requirement. We also support the amendment requiring HealthWatch England’s annual report to be sent to all local healthwatch organisations.
On the issue of how the committee of HealthWatch England is to be constituted, although we are supportive of its members being elected from local HealthWatch organisations—as also proposed by my noble friends—we will want to consider this issue more fully in the light of whether the full independence of HealthWatch England from the Care Quality Commission is secured. We also want to consider how we can ensure that members of both HealthWatch England and local healthwatch organisations, are more fully reflective of their communities in terms of gender, disability and ethnicity. A great deal more thought and work needs to be undertaken on this issue, possibly as part of the pathfinder healthwatch transition pilots. I will be interested to hear the Minister’s views on how this could be taken forward.
I was going to comment on a number of other amendments but they have been thoroughly gone into by noble friends, so I will leave it at that.
Baroness Northover
My Lords, this has been another excellent debate. We have returned to the topic of HealthWatch, which we also discussed on 22 November. I listened very carefully to the views expressed in that debate. It seemed that there was a consensus, as there has been again today, about the need to have the patient voice very much at the heart of the NHS. There was agreement then, as I think there is today, that the Bill moves us forward in making sure that the patient voice is at the heart of the NHS. I thank the noble Lord, Lord Warner, for his comments in this regard.
However, I fully recognise that there are significant concerns about the way in which the Government are taking forward these proposals. When we discussed this previously, I made a commitment to continue discussing these issues. We have had subsequent meetings, which some noble Lords have attended; I thank them for their input. I found those meetings extremely constructive. I also attended the meeting between the noble Earl, Lord Howe, and the national association.
Our previous debate focused on the independence of HealthWatch England, which will be a statutory committee of the CQC. I understand that this risks, as the noble Lord, Lord Harris, said, dangerously compromising the independence that I talked about as being so important. Let me be clear why we are proposing this arrangement. There is a reason why, at present, there is no national statutory organisation to champion the patient voice. The last body, to which noble Lords made reference—the Commission for Patient and Public Involvement in Health—was abolished for being ineffective and lacking influence as well as being too expensive and too centralising. To quote from the Health Select Committee’s 2007 report into Patient and Public Involvement in the NHS:
“The evidence we received was overwhelmingly critical of the Commission”.
The noble Lord, Lord Warner, said that the Government should set up an authoritative, stand-alone body, and others have made similar points. This is, however, precisely the point. While I respect the view of the noble Lord, the Government have not been convinced that it would be possible to have such an authoritative stand-alone body in the form that they suggest. The previous Government’s attempt to do this with the commission did not work out well, as noble Lords know. The abolition of the commission was announced five months after it started work. It limped on for a further three years, chewing up £100 million and was universally criticised.
Lord Harris of Haringey
Bandying around figures—“it chewed up £100 million”—gives a completely misleading impression. Could she tell us what proportion of that £100 million was the administrative cost of the commission, as opposed to the provision of patient and public involvement forums in every part of the country? The figure of £100 million is totally misleading.
Baroness Northover
I suggest that the noble Lord talks to his noble friend Lady Pitkeathley about some of the details.
Lord Harris of Haringey
I suggest that if you use a figure like £100 million, which was not the figure used by the noble Baroness, Lady Pitkeathley, you need to explain that that includes the running of the public and patient involvement forums. It is not the cost of the administration of the national body itself.
Baroness Northover
The organisation used up £100 million. There were criticisms from the local organisations that they were not getting the money they needed, so there was widespread criticism. There was criticism at a national level within the NHS and, in particular and importantly, the local organisations did not feel that it was acting in the way they needed it to, or feeding through to them the resources they needed to do what they felt was appropriate.
Lord Harris of Haringey
One of the failings of the commission was that it did not have a relationship with local public and patient involvement. The purpose of the amendment which talks about direct election would be to obviate that problem and provide a constraint in terms of whether or not there were going to be overly centralised administrative costs, because the body itself would be accountable to the local bodies that would be the recipient of most of them. My concern and my frank irritation with the commission—which I had no part in at the time—was the suggestion that all the £100 million was somehow used by the central administration. That was not the case.
One of the failings of the commission was that it was not accountable and did not have a proper direct relationship with local public and patient involvement. That was a fault both of the way it was constructed in terms of the legislation, for which the Labour Government of the time must take responsibility, and of the way in which the commission chose to work, with the support of the Department of Health at that stage.
Baroness Northover
What the noble Lord has said bears out the point. This was a nationally established commission which we all agree did not work. We therefore need to learn from that costly experience to try to move on and to work out a way in which you can have local healthwatch organisations as the local eyes and ears, feeding through to HealthWatch England, a national organisation. We are at the moment looking at how that national organisation should be sited. Everyone has said that the relationship between the national organisation and local organisations did not work previously. We are seeking here to make that relationship work much better. I can see another noble Lord is about to hop up.
Lord Warner
The Minister will be pleased that it will be the noble Lord who pulls his punches, as my noble friend said earlier. I wish to pursue this issue of how much money the Government think they need to spend on funding HealthWatch England. This is the real issue: say, for example, it has £10 million—I do not know what figure is being considered, but there will be a sum of money. It seems to be agreed that there ought to be some kind of national body. I do not altogether understand the Minister’s argument that we got it wrong in the past, because we fully accept that we got it wrong. However, it does not follow from that there should not be a national public body called HealthWatch England. The Government seem to accept that. The argument is over whether you should place that body in the Care Quality Commission. I can see that one might argue that costs could be reduced by doing that, but we first need to know what the Government are prepared to spend on this body, and then we can discuss the best way of spending that money in terms of independence.
Baroness Northover
Perhaps I may come on to the points that I was going to make regarding why we are making our proposals in light of the experience of the national organisation that did not work brilliantly. They address some of the issues that the noble Baroness, Lady Pitkeathley, raised and are implicit in the points made by the noble Lords, Lord Warner and Lord Harris, and others about the independence and status of the new organisation.
I cited what happened with the previous national organisation, and the point about where we are placing HealthWatch England is that it is an attempt to ensure that it is in a strong position to influence the regulator, the CQC, rather than sitting off to one side and not necessarily being listened to. A lot of concern has been expressed about how that relationship would work, but I point noble Lords towards the other side of the issue. If HealthWatch England is sitting there alongside the CQC, with local healthwatch feeding into HealthWatch England, what better way to make sure that you flag up to the regulator concerns from local areas. Noble Lords should try to look at the issue from that point of view, as opposed to seeing the CQC as somehow silencing HealthWatch England. It is vital that the views of patients and other service users are taken on board by the CQC and that it does not close its ears and eyes to what is happening.
Lord Warner
I am still struggling. I am sorry to keep interrupting the noble Baroness, but let me give her an example. Could HealthWatch England, as a sub-committee of the CQC, run a national campaign against what is being done by that regulator on an issue such as feeding elderly people in hospital?
Baroness Northover
HealthWatch England has a statutory obligation to represent the position of patients and, if it is concerned about the feeding of patients, yes, it indeed has the right to set its agenda, to campaign on that and to argue that this must be checked on and brought up to a much better standard. As my noble friend Lady Cumberlege said, we have throughout the NHS and through its recent and long-term history, problems and challenges in meeting basic standards of care and attention. All of us know that, whatever party we come from. The previous Government did not get this right; we are seeking to move forward, and we need to ensure that we consider these questions fundamentally and address why these problems continue to arise. They have been intractable; we will continue to address them; I welcome noble Lords’ contributions on that.
Lord Harris of Haringey
The noble Baroness made a very important point just now. She said explicitly that HealthWatch England could and should be a campaigning organisation, although it would be a sub-committee of the CQC. This is irrespective of the debate about where it is located. I think that the principle of creating a national patient organisation as a campaigning organisation on behalf of patients is extremely important. I am very grateful to the noble Baroness for making that commitment on behalf of the Government.
Baroness Northover
HealthWatch England will represent the voice of the patients. It will publish on that; it will advise on that; to take up a point raised under one of the earlier amendments, it will no doubt make recommendations within the areas of its advice. It has the obligation to make those recommendations to various organisations within the NHS. Various organisations, including the CQC, have the responsibility to respond to that. All those obligations will flag up problems, so I do not see that I have made a startling admission. I would have thought that the noble Lord, Lord Harris, would know that transparency—publishing information—was the best way forward.
However, I agree with many noble Lords that this has been rather a patchy area. We have to try to give greater strength to these organisations both locally and nationally. Much of that is not based on their structures, because all sorts of structures have been tried, but we are trying to take them further forward.
Lord Warner
I just want to pursue the issue of the campaign, because it is very important. Currently, there has been a very effective campaign about literacy run by the Evening Standard. That has attracted lots of voluntary money to run it and led to some interesting changes and the Government supporting it. To be absolutely clear, I ask: are we saying that a sub-committee of the regulator—the Care Quality Commission—could run a campaign on the feeding of elderly people in the National Health Service in association with a national newspaper and criticise the Government strongly, implicitly, about the way that they are running the NHS in that area? If the Minister, on behalf of the Government, is saying that yes, it can, I start to get more convinced about the Government's commitment to independence of the sub-committee of the CQC.
Baroness Northover
As I said, HealthWatch England will need to look at what works well and what works not so well right across the country, gathering the information from local healthwatch. It will flag up things which, no doubt, will be uncomfortable at all levels of the NHS and the Government. Noble Lords would not expect change to be driven in any other way. If things are unsatisfactory locally, as fed by local healthwatch to HealthWatch England, if it is doing its job it will obviously flag up areas where change is required.
Lord Warner
I am not talking about flagging up; I am talking about a campaign. A campaign means that you take action, using the media, to put serious pressure on the Government in relation to their record in running the NHS for elderly people. I am not saying that that should happen; I am trying to understand what power this body would have as a sub-committee of the regulator, which is the point that we are discussing.
Baroness Cumberlege
Does the noble Lord, Lord Warner, agree that much depends on the membership of this body and whether it is independent? I am not sure why people call it a sub-committee. In the Bill it is called a committee. I have chaired the top board in organisations and I know that you get very close to some of those committees—you listen to them. If an organisation is totally independent and it goes left field, making a whole lot of noise, you just dismiss it and say, “Oh, they’re always making problems”. The opportunities are far greater if part and parcel of what it does is informing you of what is going on. I honestly think that you will listen much more carefully to people whom you meet in the corridor, in the chambers or wherever the debates are going on.
I take the point made by the noble Baroness, Lady Emerton. The Care Quality Commission does not always say that everything is dreadful. The Healthcare Commission used to say, “This bit’s good; this bit needs addressing”. I can see that this committee—not sub-committee—of the Care Quality Commission will serve a very useful purpose. It could put enormous pressure on the Care Quality Commission really to understand what is going on and it would not just be an irritant that is offside.
Baroness Northover
I thank my noble friend Lady Cumberlege for that and I agree with her very much. We all wish, and have all sought, to drive up quality in the NHS. That is so often difficult to achieve but this is one of the means by which we hope to make that happen. No doubt some people will be made to feel uncomfortable by what the committee reports and says, and I hope that that will be the case.
Baroness Pitkeathley
Perhaps the noble Baroness can take that a little further. For example, could HealthWatch, in the position envisaged for it by the Government as a committee of the CQC, join with a national campaigning charity—I am thinking of something such as National Voices—to put pressure on the CQC itself about how it was reporting patient outcomes?
Baroness Northover
I am sure that it could. If it felt that it was not managing to persuade the CQC or some other part of the NHS to do what it considered to be in the best interests of patients, then I am sure it would go to greater lengths to ensure that it got its message across. It is very important that we have a louder patient voice within the NHS, and this is one means of seeking to achieve that.
I return to some of the amendments that noble Lords have flagged up. This is a very important debate. I think we agree on where we wish to head and what we are seeking to achieve, but I hear noble Lords’ concerns about whether this is the right way of going about it. Noble Lords talk about an independent organisation and so on but that route was tried. This is another route for trying to make sure that there is a body close to an organisation which itself must have a major role in driving up quality. The synergies there are very important.
The question was raised of how local healthwatch is going to influence HealthWatch England. I heard what the noble Lord, Lord Harris, said about elections to HealthWatch England from local healthwatch. Clearly, as my noble friend Lady Cumberlege said, a great deal will depend on who is on these organisations nationally and locally, and it will be necessary to ensure that they are as strong as possible. The Secretary of State will determine how the membership is comprised through regulations and we will be discussing with a wide range of stakeholders the contents of those regulations. I can confirm that we will discuss the suggestions put forward by noble Lords. We had from the noble Lord, Lord Harris, an emphasis on election and a concern about that route from the noble Baroness, Lady Pitkeathley. Both noble Lords might wish to feed in to how those regulations are taken forward so that we can best comprise HealthWatch England and local healthwatch.
Lord Harris of Haringey
Can the Minister indicate the timetable for consultation on the content of those regulations? Those of us who wish to see an election process in the Bill will need to know sooner rather than later whether that is the way in which the Government’s thinking is going. When is that consultation going to take place and when is it likely to conclude?
Baroness Northover
In the meeting that I was in yesterday with NALM this was an issue. The noble Lord, Lord Harris, is probably aware of that. No? That was one of the issues—perhaps the noble Lord, Lord Warner, referred to it—that did come up. The consultation will be early next year. Given that we are almost in next year, that is pretty soon.
The noble Lord, Lord Harris, wanted to make sure that HealthWatch England’s annual report was shared with local healthwatch. While we do not feel that that is a matter for the Bill, the annual report must be published. It is important that that information is made widely available. I am sure that the noble Lord’s suggestion will be noted by HealthWatch England and local healthwatch as the information between the two must go back and forth, in both directions.
Lord Harris of Haringey
The Bill does not refer just to the annual report. It refers to all reports.
Baroness Northover
It is clearly important that the information goes back and forth between the local and national organisations.
If HealthWatch England were significantly failing in its duties, the Secretary of State has powers to intervene. An amendment addressed whether the Secretary of State should consult local healthwatch. This was on the assumption that HealthWatch England was in effect failing local healthwatch. While the Secretary of State should not be bound into a rigid consultation—something else entirely could be in question here—we would fully expect him to seek the views of others where appropriate in coming to a decision to intervene. I hope that that will reassure noble Lords.
My noble friend Lady Jolly talked about local healthwatch needing to look widely at all groups of patients, including those with rare diseases and so on. She is right. We will be coming on to other amendments where we look at this a bit more. LINks and its predecessors recognise that they have not had as wide a coverage as they would like or been as representative of their communities as they would need to be. This concerns us. The noble Baroness, Lady Pitkeathley, referred to it briefly in relation to whether local healthwatch should elect to HealthWatch England. We are seeking to learn from this. We want to try to make sure that local healthwatch has as broad a spread as possible. It is worth bearing in mind that it has a place on the board of the health and well-being boards and so there will be information feeding back to local healthwatch from the others on the health and well-being boards and from local healthwatch into the health and well-being boards. We will come on to local healthwatch in relation to local authorities, but there is synergy there too.
While I feel that the Bill provides safeguards for the independence of HealthWatch England within CQC, I would like to repeat my commitment that we are prepared to listen to further views. It is very clear that we are all trying to head in the same direction. There is a variety of views about how best to do this. We would welcome noble Lords’ continued input as we take this further forward. In the mean time, I thank noble Lords for flagging up these issues. I hope that the noble Lord will withdraw his amendment.
Lord Warner
My Lords, this has been an interesting and spirited debate. I will certainly reflect on the Minister’s willingness to consider some of these issues further. My noble friend Lord Harris and I will certainly be considering this further and I would not rule out the possibility that we might come back to this on Report. I beg leave to withdraw the amendment.
Baroness Massey of Darwen
Baroness Massey of Darwen
My Lords, I shall speak also to Amendments 311 and 320. This group of amendments seeks to ensure that the voice of the child is heard in health matters. Too often in Bills that do not relate specifically to children and young people, they are marginalised, yet, as has been said before in debates, child health is a vital aspect of healthcare and children are patients, just like adults. They have opinions just like adults and, in my experience, consulting children about what works for them always results in improved services and policies.
These amendments seek to ensure that HealthWatch England’s functions are clear and explicit in relation to children as well as to others and that its functions in providing advice to the Secretary of State, the NHS Commissioning Board and monitoring authorities on the views of patients and members of the public refer to the views of children, who are patients and members of the public.
Local healthwatch functions must also promote and support patient and public involvement in the commissioning, provision and scrutiny of local care services and must obtain the views of patients and the public about people’s needs for and experience of local care services. I submit that those functions must be carried out to include children. HealthWatch England must provide support and assistance to local HealthWatch organisations in relation to this.
Furthermore, as noble Lords may know, Article 12 of the UN Convention on the Rights of the Child makes clear that children have a right to be heard on issues that affect them. Measures to promote patient and public involvement in decisions about their own care and in the development of health services and care services must include children from the start. I believe that this will make for better health services.
The Bill does not make this clear enough. Research commissioned by the NCB has found that local involvement networks or LINks, which the Bill will transform into local healthwatch, are not always clear that children and young people are part of their remit. Local healthwatch and HealthWatch England will need to be able to identify capacity and maintain the skills to reach out to and engage children, including the most vulnerable children and their families.
A recent review of law, policy and practice in relation to children’s participation in the NHS and other public services and settings found that, in their efforts to support user involvement, the health authorities and NHS trusts had not specifically identified children as service users. The review also found that although 41 per cent of GP practices reported to have a patient participation group there was no evidence of children’s active engagement in these forums. The Royal College of Paediatrics and Child Health has argued that reforms have been lacking in providing the structures and frameworks where children and young people are properly represented. And concerns about children’s involvement in patient and public voice mechanisms were also reflected in the report of the NHS Future Forum. In 2009-10 Professor Sir Ian Kennedy carried out a review of how the NHS delivers to children and recommended a local partnership in each local authority that would co-ordinate public services in the best interests of children. His ambition was that,
“the welfare and well-being of children and young people, seen as so important by so many, will be the prevailing cultural approach”.
My amendments here try to make clear that children are within the remit of local HealthWatch and HealthWatch England and that children’s and young people’s views should be heard. I beg to move.
Baroness Masham of Ilton
My Lords, I support these very important amendments. One only has to remember the tragedy of Baby P and all those vulnerable children who sometimes fall between the police, the social services and the health departments.
Baroness Finlay of Llandaff
I put my name to these amendments, which are incredibly important. I hope that the Government’s response will be that they are listening and prepared to change this. It is worth noting that the Government’s response to Professor Sir Ian Kennedy’s report said:
“In the past, the NHS was not always set up to put the needs of patients and the public first. Too often patients were expected to fit around services rather than services around patients. Nowhere was this more the case than for children, young people and their families … If we are to meet the needs of children, young people, families and carers, it is vital that we listen to them in designing services, gather information on their experiences and priorities, provide them with the accessible information that they need to make choices about their care, and involve them in decision making”.
That is the Government’s own response to the report.
I also draw attention to the report from the ombudsman in Wales. I know we are going to debate ombudsmen later but I will make this one point. The ombudsman upheld a complaint that Health Inspection Wales,
“failed to seek the child’s perspective on her care”.
The Royal College of Paediatrics and Child Health is very concerned that “no decision about me without me” must extend to children and should involve both children and young people. Without that we will have poorer service planning and, as a result of that, poorer health outcomes. A voice for children and young people needs to be incorporated in the decision-making process of the NHS Commissioning Board, health and well-being boards and clinical commissioning groups, and a safe conduit for this involvement may be HealthWatch and local healthwatch.
I want to briefly draw the House’s attention to the fact that we have many young carers so it is not only children as patients that we need to consider. In the 2001 census it was found that there were 175,000 young carers and no one is disputing that those numbers have gone up significantly since then. A third of those are caring for somebody with mental health problems and the average age of young carers is 12 years old. Reading their comments, society clearly does not understand the pressures that they are under. There is evidence that when they get to school late, the school does not understand. When they try to accompany their parent to out-patient or even in-patient appointments, they are not listened to even though they have been providing all the care. The facilities where their relative is looked after are not appropriate for them to stay overnight. I remind the Committee that when a young parent is dying, the children will want to stay at the bedside. They may want to sleep in the same room. They do not want to be taken away. They may want to have a break; they may want to go out; they may want to watch a video. If we are really going to invest in quality of care and health outcomes for the next generation, and meet the Marmot review’s requirement for health inequalities not to be widened but narrowed, we must address the needs of this group in our population who provide a lot of care, who are incredibly important and who will be the citizens of the future, but to whom the system does not currently give a voice. To expect adults to be a voice for them is completely unrealistic, because, when they are a young carer, there is no other adult there apart from the person whom they are caring for.
I hope that these amendments will not be dismissed with a whole lot of reasons as to why they cannot be put into practice. If we are really committed to changing healthcare services for the population, we should listen to the voice of children and young people.
Baroness Thornton
My noble friend Lady Massey is, as usual, correct about these matters. I am always happy to take my lead from her. All my experience of working with NCH and lots of children’s organisations over the years, and, more recently, of talking to YoungMinds, leads me to think that this is a matter that the Government need to take into consideration.
Lord Warner
My Lords, my name, too, is on the amendments. I support what my noble friend Lady Massey and the noble Baroness, Lady Finlay, have said. I want to refer to adolescent health services. We know that primary care services are not often very user-friendly in relation to adolescent health needs. I have come across GPs who have had special sessions and even private doors so that adolescents can come into their surgeries without being spotted by nosy neighbours. There are some real issues of privacy with young people in the adolescent years. They do not always find these services easy to use, when they often have considerable health needs and sometimes quite serious mental health needs. In my time as chair of the Youth Justice Board some time ago, we were starting to find that for many young offenders the origin of their offending was when someone significant in their family had died. It was the absence of any bereavement services that caused them to go off the rails. It is more than just symbolism to put these extra words in the Bill; it is a very important signal to the NHS that Parliament recognises the need to pay attention to the needs of children, to listen to them and to meet a set of needs which are often not being met.
Baroness Northover
My Lords, I thank the noble Baroness, Lady Massey, for flagging up this issue and for the work that she has long done in this area, which I saw particularly clearly when she and I were both trustees of UNICEF. Our aim is that HealthWatch England and local healthwatch organisations should be there to understand the views and needs, locally and nationally, of patients and other service users and members of the wider public—everyone.
I reassure noble Lords that, at both national and local level, this clearly includes children and young people. I realise that the concern expressed by noble Lords arises from deficiencies in how things have operated in the past. The Future Forum flagged up the need to ensure that, for example, local healthwatch should be more representative of communities than had been the case previously, which why is my honourable friend Paul Burstow in the other place introduced an amendment to the effect that local healthwatch should represent the breadth of views and diverse characteristics within a community, whether it be carers, young people or otherwise.
Baroness Finlay of Llandaff
If we come back later with an amendment which specifies people of all ages—I accept what she said about the elderly also not having an adequate voice at times to meet their needs—will the noble Baroness consider it? This is one occasion when the legislation can give a lead and set a moral code. I also seek an assurance that there will be specific mention of children in the official guidance that goes with the Bill so that they are incorporated at every stage and do not remain left out, as they have been until now.
Baroness Northover
I hear what the noble Baroness says. It is interesting that she said “people of all ages”. The purpose of healthwatch and the NHS is to help and try to assist people of all ages, whether they are patients, their families and so on. We need to make it more person-centred—we all agree that that is what we are seeking to do—and I hear what she says in regard to the regulations.
Baroness Massey of Darwen
My Lords, I thank the Minister for her words. I have some concerns, to which I shall come in a minute. I am glad that so many noble Lords contributed. I am particularly glad that the noble Baroness, Lady Finlay, mentioned young carers and that the noble Lord, Lord Warner, talked about adolescent health, so long an area which has been very much neglected in relation to health services.
I would also like to thank the Minister for meeting a group of noble Lords to discuss the issue of children’s interests in this Bill. I hope that the Government have got the message about the need to involve children in decisions about their care and treatment. Many have considerable health needs, although the young population is generally considered the healthiest. They have health and care needs, including mental health needs, disability and so on. I worry that when children get lumped in with expressions such as “the community” or “the family”, their needs are ignored. Children have very little redress on this. If we do not make it explicit that we should consult children, they often do not have the ability or contacts to come back at that and make a protest. We have to do that for them, and children must be included in and consulted on all Bills that affect them.
I would like the words “children” and “young people” and consultation with them to be made very explicit in this Bill. I have amendments later, although I cannot remember their numbers, which will also reintroduce the notion of children into this Bill. In the meanwhile, I will withdraw the amendment, but I may well wish to return to the matter on Report with other noble Lords and look at it again.
Lord Low of Dalston
Lord Low of Dalston
My Lords, I rise to move Amendment 317AA and shall also speak to Amendment 317AB, 336B and 336C and 318BA to 318BC, which are in the name of the noble Lord, Lord Whitty.
The Bill contains a number of provisions which relate to the handling of information by various bodies. Amendments 317AA and 317AB relate to HealthWatch England and Amendments 336B and 336C relate to health and well-being boards. Amendments 317AA and 317AB come in Clause 178 and seek to strengthen the safeguards against HealthWatch England publishing information which relates to the private affairs of an individual.
The Bill already contains some safeguards, but I do not believe that they are adequate. Clause 178(4) states that,
“any matter which relates to the private affairs of an individual”
and,
“would or might seriously and prejudicially affect that individual’s interests”,
should be excluded from the reports that HealthWatch England is empowered to produce. But it states that information should be excluded only when it “seriously” prejudices an individual’s interests, not if it prejudices their interests less than seriously—and who decides what is serious and what is prejudicial—and that it should be excluded only “so far as practicable”. It is not clear to me why information that relates to the private affairs of an individual should be published at all. It seems to me that the prohibition should be absolute and that, in Clause 178, proposed new Section 45B(4) should simply read:
“Before publishing a report under subsection (1)(b) or (3), the committee must exclude any matter which relates to the private affairs of an individual”.
That is what Amendments 317AA and 317AB would bring about. Paradoxically, this is a case where no safeguards would be better than the inadequate ones we have in the Bill.
Similarly, health and well-being boards are given wide powers under Clause 196 to request information—powers that are clearly wider than they need to be. As the Bill stands, a health and well-being board can ask a local healthwatch organisation for details of people who have complained or raised concerns about a service and, as the Bill stands, a healthwatch organisation would be obliged to disclose that information. Amendments 336B and 336C would stipulate that no information be requested which would require the disclosure of personal information within the meaning of the Data Protection Act.
The noble Lord, Lord Whitty, will speak in more detail to Amendments 318BA, 318BB and 318BC, which come in Clause 179, but I would like to indicate my support for these amendments. I am aware of concerns that have been raised about the independence of local healthwatch organisations arising from the fact that they will be both funded by and accountable to the local authority. It is explained in paragraph D35 of the integrated impact assessment that this is based on the importance of localism. Paragraph D106 of the integrated impact assessment states:
“There is a risk that tying local HealthWatch into local authorities could reduce their independence and effectiveness”.
So it seems that the imperatives of localism trumped those of independence and effectiveness.
The integrated impact assessment goes on to recognise that the duty on local authorities to fund local healthwatch arrangements may be perceived as giving rise to a conflict of interest for local authorities, given the role of local healthwatch organisations in relation to scrutiny. It is stated that work is under way to map out the concept of independence for local healthwatch organisations, and to use this to promote the arrangements as accountable to local government for performance and to local citizens for the issues raised with commissioners and providers, but we do not know the outcome of this work as yet. The Bill does not provide any detail on the membership of local healthwatch organisations. It is left to regulations to specify who makes appointments to these bodies, and how. It would be extremely helpful if the Minister could give some indication of how this separation of accountabilities, which is evidently envisaged, is to be realised and institutionalised.
In any case, however, the fact that the local authority holds the purse strings remains a risk to the independence of local healthwatch. There is therefore a strong case for local healthwatch organisations not to be funded by the local authority. The argument that the importance of localism requires accountability is not as strong as the need to have effective, independent local services. These amendments would make local healthwatch organisations responsible for their own activities and accountable only to HealthWatch England, rather than the local authority, but I fear the risk from local authority control of the purse strings would still remain.
Lord Rix
My Lords, I shall speak to Amendment 324, tabled in my name and those of my noble friends Lord Tenby and Lord Wigley, in this rather Christmas stocking grouping of amendments. This regards the provision of independent advocacy services for people who are in the process of making a complaint against the NHS. This amendment is particularly relevant to the needs of disabled people, including those with a learning disability, and I would like to take this opportunity to declare an interest as president of the Royal Mencap Society.
For those who are unfortunate enough to encounter it, the NHS complaints system is deeply flawed and ineffective. It is complex in its make-up and lengthy during the course of its deliberations. I welcome the Government’s proposal for local authorities to make appropriate provision to support people in the complaints process, through the use of advocacy services. Effective and high-quality advocacy services are of course an essential prerequisite for many families to secure the answers they want and the justice which they really require.
Without this amendment, there is a risk that advocacy support could be started and then abruptly halted some time before any conclusion to the ongoing complaint which has been made. As I have already mentioned, the NHS complaints system is a lengthy and complex process and the level and scope of advocacy support made available by local authorities should reflect this.
I am also aware that in some cases advocacy support services have been denied to families, as the level of support deemed necessary has been regarded as too onerous and burdensome on the provider. This is an unacceptable state of affairs, where people are denied the help they need on the basis that they may need too much help. At a time when families could be dealing with the emotional upheaval and distress of coping with the loss of a loved one, any uncertainty about the level and period of advocacy available to them is, to put it somewhat generously, an unhelpful distraction. This is why I believe it necessary to ensure that advocacy support during the NHS complaints system is not restricted in length and type for those families who need it. This amendment would help to provide such a guarantee.
Baroness Cumberlege
My Lords, perhaps the noble Lord, Lord Whitty, ought to speak next, because I suspect that his amendments relate to what the noble Lord, Lord Low, was saying, and it may be that the synergy would be better that way.
Lord Whitty
My Lords, I thank the noble Baroness very much. In this case, logic trumps chivalry.
I have four amendments in this group, all of which relate to the independence of the local healthwatch—some of them in some slightly indirect ways. We spent some time at an earlier stage, and again today, talking about the independence of Healthwatch England from the regulator. I did not intervene today, but it is evident that the Government are not persuaded that we need to unravel them. I am afraid we are going to have to return to that at a later stage, because I am certainly not convinced by the Government’s arguments. However, I think that even the Government must recognise that a body representing patients, users and consumers of health and social care services has to be independent from the provider.
The problem with some of these clauses is that the local healthwatch organisation, as the noble Lord, Lord Low, has said, is not clearly independent from the local authority in all respects. We are not yet clear how independent of the local authority it will be in its membership and how that membership is appointed. Schedule 15, which comes in with Clause 179, is pretty general as to who the members would be. As the noble Lord, Lord Low, said, we have to await regulations before we see that. Meanwhile, there are other reasons why one is a bit suspicious that the local healthwatch organisations would come too much under the sway of the local authority, which is going to be the provider of many of the services to which they relate.
There may be other ways of doing this, but these amendments are attempting to make clear the independence of the local healthwatch body by establishing that it sets its own priorities and manner of operating, subject only to any guidance given by Healthwatch England; that is, it would not be subject to any guidance, restriction or direction from the local authority. There are then a number of clauses which are pretty complicated in themselves, but appear to treat the local healthwatch as if it were an excrescence of the local authority.
For example, I want to delete the bulk, or the purport, of Clause 181, which appears to treat local healthwatch organisations as if they came through the local authority rather than being independent bodies. Some of the requirements may well apply to healthwatch locally, but they should not be implemented and enforced via the local authority in any sense. The noble Lord, Lord Low, has already referred to some of the problems about freedom of information, but some of the other provisions could well raise difficulties if the local authority was the one ensuring that the local healthwatch met those provisions.
Independence of consumer organisations across the economy is important, and I will return to that on Report. Local bodies, in particular, need to be independent. They are the bodies to which individual patients and users will relate, and if they believe that the local healthwatch is in any way associated with, dominated by, or accountable to the actual providers of the bodies that provide the services, its credibility will be diminished. I would therefore hope that the Government took note of these concerns and made it more explicit in the final version of this Bill that local healthwatch organisations were independent of the local authority and made their own decisions, with their own priorities and manner of operation. I do not think that we can leave all that to regulation; it has to be more explicit in the Bill. This is one way of doing it, although the Government may well come up with better ways of doing it, but I think that we need to ensure that we reach that stage before we finish with this Bill.
Baroness Cumberlege
My Lords, I have a number of amendments in this grouping concerning local healthwatch. As has already been said this afternoon, local healthwatch is the source of intelligence from the people who are actually using the services. This intelligence is gathered through their enter and view monitoring visits to both health and social care services—we should not forget that it is social care as well—and through their local involvement work.
However, neither commissioners nor overview and scrutiny committees have the same binding arrangements to enter and view health and social care facilities. Local healthwatch has the opportunity to interview people at the time they are actually using the service. The local healthwatch has the independent messenger status with local people that neither commissioners nor overview and scrutiny committees have. Local healthwatch has the right to enter and view, to talk and listen, to the most vulnerable of all people, those with dementia or other mental illness, those lying on trolleys in A&E, or on mental health in-patient wards. “No decision about me without me” can be tried and tested when most fresh in the minds of patients and users. It is only here that the reality of the services that results from the theory of commissioning is to be found. To fail to take due account of this perspective in commissioning services is commissioning wearing a blindfold. The purpose of Amendment 318E is to ensure that commissioning is evidence based.
New Sections 14Z and 14Z11(2) require clinical commissioning groups to involve and consult on their commissioning plans. We know that this is a somewhat bureaucratic exercise, and it is often simply for the cognoscenti. Although these clauses are to be welcomed, they do not go far enough—hence the insertion of my new clause. Frail elderly patients lying in hospital wards who are not being fed will not be responding to consultations any more than will patients who have been sectioned under the Mental Health Act. The local healthwatch must talk to those patients and its findings must be an indispensable component of the evidence on which commissioning is based.
New subsection (3A), inserted by Clause 180(6), also requires commissioners and others to have regard to reports and recommendations from local healthwatch. This replicates the current arrangements for reports and recommendations from LINks, which has failed to bring the patient experience into the heart of commissioning. Compared to the status given to the views of health and well-being boards on commissioning plans—the strategic beginnings of commissioning—this is weak. What is needed is equal attention to the evidence on the outcomes of that commissioning, which local healthwatch is uniquely well placed to provide.
My new clause requires local healthwatch to hold the clinical commissioning group to account for incorporating the evidence that the local healthwatch has produced at the very start of the commissioning period. It should then heavily influence the commissioning plan for that period in taking the reality and applying it to commissioning theory. Binding the patient experience into commissioning is a much more specific requirement than merely “having regard to” local healthwatch reports and recommendations. The conjoint benefit of this new clause is that it increases the accountability of local healthwatch for producing robust evidence of the patients’ experience. Providers must also satisfy the local healthwatch if they are to secure further contracts.
Lord Mawhinney
My Lords, I think that my noble friend said that providers must satisfy the local healthwatch before they can proceed with their commissioning. Is this another barrier to the commissioning process, or does she anticipate a collaborative conversation? I am not clear on whether this is another hurdle in the commissioning process or a lesser effect. It would be helpful, at least to me, if she would expand a little on that thought.
Baroness Cumberlege
My Lords, there is no intention that this should be a further hurdle, but if commissioners are going to commission services that are really relevant to local people then they need to take account of what the local healthwatch is saying. This is a huge resource that could improve services enormously and make contracts much more relevant than some of them have been in the past. I hope that that answers my noble friend.
I shall take three quick examples to illustrate my point. The first is a patient in an older persons ward who leant forward confidentially to the CHC visitor, saying, “They don’t feed them in here, you know. They just put the food at the end of the bed, then they take it away again. Please don’t tell them it was me who told you”. The second one is the mental health in-patient in a unit with an outside garden, who explained that he could not go out even though the summer was really hot. There were not enough staff to accompany the patients outside so he “had to stay in all the time”—his words. What quality of life is that? The third is from another patient in an older persons ward who expressed concern about a patient whose hearing aid battery was flat: “They could just have gone to the audiology department to get another battery, but they wouldn’t”. The staff just spoke more loudly to the profoundly deaf patient, increasing his distress and isolation.
To some people these examples may seem quite trivial, but to the people concerned they are not—they are very important. I took those three examples because the first is over 10 years old, yet we know from the CQC’s recent dignity and nutrition inspection programme, and from the evidence from Mid Staffordshire, that patients are still not always adequately fed in hospital. That makes the point of the amendment perhaps more powerfully than anything else. What we are doing now is not working; it is not effective, and does not bring about the radical changes that are necessary. We have to do things differently, and the suggested new clause gives us the opportunity to do just that. I feel strongly about this issue and I hope that the Minister will give it serious consideration. Otherwise, I may have to bring it back at Report.
Lord Harris of Haringey
My Lords, I will speak to the seven amendments in my name in this group, Amendments 319, 321, 322, 323, 325, 326 and 327. The noble Lord, Lord Rix, described this group as something of a Christmas stocking; I have to say that even my seven amendments do not have a common theme. They are on a variety of topics, ranging from some that simply correct what I assume are drafting errors in the Bill to others that raise rather more fundamental issues along the lines of the amendment of the noble Baroness, Lady Cumberlege.
Amendment 327 deals with what is, I think, a drafting error. Unless I have misinterpreted the interlaying Acts that are being subsequently amended, the Bill leaves a reference to primary care trusts in the base Act. Presumably the assumption is that the commissioning groups will take on those functions and should be expected to respond to the local issues raised by local healthwatch organisations. I am sure that is simply a drafting arrangement.
Amendment 323 would slightly tighten the wording on how independent advocacy is organised and says that the provision should be appropriate to the needs of those for whom that provision is being made available. I am sure that the Government will have no problem with that. It makes sure that advocacy arrangements recognise the very different nature of the problems and the client groups who will raise them.
Amendment 321 puts into the Bill a requirement that arrangements be made to enable members of local healthwatch organisations to have indemnity cover against the risk that a claim may arise from their duties. I am doing the Government a favour by highlighting this at this stage. I certainly recall, from the time of my involvement in community health councils, and in another sector prior to that—the work of electricity consultative groups for a completely different government department—that the same issue arose. I refer to the indemnity or protection that is there for people who are carrying out public duties if they are involved in an accident and a claim is made against them for it. What we will have—I am sure it will be in the Minister’s brief—is some vague statement about Treasury indemnity.
The problem for individuals in this position is that it is not clear what such indemnity will cover and how they will be able to access it if, for example, they are involved in an accident or an incident during their work as a member of a local healthwatch organisation. I would advise—I am trying, as ever, to be helpful to the Government—that this should be sorted out now rather than waiting to get into a tangle about it. I remember spending many happy years, when I was Director of the Association of Community Health Councils, trying to get a definition that would satisfy local CHC members that they were protected. Otherwise, the answer goes back that you should claim on your own insurance policies; yet those insurance policies often exclude people who are carrying out work—even voluntary work—or similar duties. Acting on behalf of a local healthwatch organisation will almost certainly be excluded by the individual members’ insurance policies. My experience on CHCs and in other organisations is that this is a constant pressure and a constant concern. There should be something explicit in the Bill to provide a degree of reassurance to people who are undertaking these activities on behalf of their communities.
Amendment 319 relates to the membership of local healthwatch organisations and is put forward today as a probing amendment. I hope the noble Baroness will give us details of how it is envisaged that local healthwatch members will emerge in that role. The question of how legitimate local healthwatch organisations will be—how representative they will be—depends critically on the precise arrangements by which people end up as members of the organisations. The previous Government’s proposals in respect of LINks, which I never fully understood, left it in a state of limbo and people were, essentially, self-appointed as members of LINks. There must be a degree of transparency and clarity in the process by which people end up as members of local healthwatch organisations. The proposal here is that there should be some system of election. Often, although this was not exclusively the case, the most effective members of local community health councils were those who were elected by local voluntary organisations in the areas concerned. They were often the people with the most detailed, personal knowledge of the services they were monitoring. They often had a constituency they could draw back into for information and support for the work they were doing. Above all, they had the added legitimacy of having been chosen for that role by other local voluntary organisations.
I am not suggesting that as a model that should necessarily be adopted. What I am saying is that the clarity it gave those individuals was very helpful. Other members were appointed directly by the local councils for the area. Again, that gave clarity about who they were representing and what their legitimacy was. Some were appointed by regional health authorities, though this changed every time the health service was reorganised, which was every two or three years. That is something that does not change, even now, and I am sure we will be back here in two or three years unpicking whatever finally emerges from the sausage machine of legislation that we are processing now.
It is going to be critical to have a clear process by which local healthwatch organisation members are appointed. It is also important that they have legitimacy. Otherwise the organisations to which they relate will say, “You are not representative. You are self-selecting” or “You do not represent the communities you purport to represent”. Clarity about the appointments process is important. Some system of election would be valuable, but it would be helpful if the noble Baroness could tell us today exactly what is envisaged. We certainly need to know that before we proceed further with the Bill.
The orange in the Christmas stocking is the relationship between the local authorities and local healthwatch organisations. I have tabled Amendment 322, which refers to local healthwatch organisations not being subservient to the body that is responsible for their establishment. That goes to the core of the issues raised by the noble Baroness, Lady Cumberlege, about the extent to which local healthwatch organisations can be effectively under the control of local authorities.
I know that we will be assured that local healthwatch organisations will be independent and have all this additional legitimacy because they will know that local authorities have provided them with support, and that that is why the proposed structure is being adopted. However, that model will not necessarily work. I speak as someone who was leader of a local authority for 12 years and I know how decisions are made. In particular, I know how decisions are made at times of financial stringency. Unless the resources for these local organisations are guaranteed in some way, they will be vulnerable—not necessarily because they are saying unhelpful things but simply because the local healthwatch organisation will not be seen as a core activity of the local authority at a time of stringent finances and resources. That is why this issue needs to be addressed head on.
There is a problem of potential conflict of interest. Local authorities are responsible for providing certain types of social care. They are responsible for commissioning and providing that care. They will have a responsibility with others through the local health and well-being boards. There is a danger that local healthwatch organisations will be seen as being conflicted because they are subordinate to the local authorities in their area.
There are two simple ways for the Government to solve this problem, both of which I know they are not currently minded to consider. One model is a separate structure that provides the funding and resourcing for local healthwatch organisations; and that would flow back to HealthWatch England. The other model is to ring-fence the resources that are passed through to local authorities for this purpose. I know that Her Majesty’s Treasury is always against ring-fencing and, indeed, the Local Government Association, of which I have the honour to be a vice-president, always argues against the ring-fencing of resources because it is always better for local authorities to make their own determinations. However, this is not about determining local needs. This is about providing something for the local community on behalf of another government department.
The Department of Health has, no doubt, fought a valiant battle with the Treasury to secure the resources for HealthWatch and the Treasury is passing that money through the Department for Communities and Local Government down to local authorities. There is no ring-fencing. The reality is that local authorities will not be able to say to the Treasury at the next comprehensive spending round how those resources have been used. They will not even be able to demonstrate that those resources have been used for the purposes for which they were given, and they will lose the battle for the continuation of that funding. If there is a ring-fenced structure, you will ensure that the resources are there for local healthwatch organisations. There may then be a question about how effectively those local organisations operate, but at least the resources will be clear and the local authority will be accountable for how it has used that money explicitly, rather than for whether or not it has used the money for that or for other purposes.
Unless that issue is addressed, there will be not only perceptions of conflicts of interest but the problem that local healthwatch organisations may, in time, be starved of resources. This is not an idle concern. We have all received the correspondence from LINks, talking about the budget cuts that they have faced in the current financial year. We can expect that to continue. If the Government are serious about having vibrant and effective local healthwatch organisations, they have also to solve the resourcing question and the perceived conflict of interest between the local authority and local healthwatch organisations.
We heard much in our earlier debates about the synergies and wonderful effects that talking in corridors would have within the CQC. I thought at one point that the noble Baroness was going to talk about talking in the toilets about decisions and how you infuse ideas from one organisation to another if they are co-located. That will not be the case with local authorities and local healthwatch. You will not get that same connection. The mere fact of being in the same organisation will not matter because they will not be physically located with the people who are making the decisions about social care; they will probably be in an outward-facing office, meeting the public. It will be an outpost of the local authority. There will not be that informal interchange which we were told would be so valuable if Healthwatch England was placed within CQC. The issue is how you make these organisations effective. That will require independent resources and it will require that the question of conflict of interest is dealt with.
Viscount Tenby
My Lords, very briefly, I support the amendment in the name of my noble friend Lord Rix. He has clearly outlined the rationale behind the amendment; accordingly, I do not intend to keep the House long—sighs of relief all round, I should think—although, like my noble friend, I should declare an interest. Until last Wednesday, I was chairman of a residential home for those with learning disabilities.
I think we are aware that the complaints process against the NHS can be extremely complex and challenging for those involved. That nearly always coincides with a period of some personal distress. Indeed, the very inclusion of Clause 182 indicates that the Government, to their great credit, are aware of that factor. However, there is a danger that the provision is not sufficiently explicit. My noble friend has highlighted the potential for advocacy support to stop before a conclusion has been reached. I share his concern, and add that the amendment safeguards against the freedom given to a local authority to define what it deems to be “appropriate arrangements” for the provision of independent advocacy services.
The critical point is that, at a time when local authority budgets are particularly stretched, to expect them to provide additional resources for advocacy support could result in the needs of people being sacrificed in favour of councils balancing their books. We all understand that that goes on. In other words, the level of advocacy support offered might be dictated by available funds and, accordingly, “appropriate arrangements” might be taken as being what is appropriate for the council to offer.
That detracts from what I assume is the object of making advocacy support available: to benefit the individual. The ability for people—often in mourning and in some distress—to seek justice should surely seek precedence over what is convenient to the local authority. By explicitly removing any upper limit on the length and type of advocacy, the amendment sends a strong message to councils that the individual must be the priority in this situation. It removes the excuse that a council might have not to provide the adequate level of advocacy support required by those who need it; and instead gives the individual the power to challenge any decision they feel is unjust on the basis that their advocacy needs are greater than the support proposed.
Baroness Masham of Ilton
My Lords, I shall add just a few words. If we do not get this matter right, we, the Members of the House of Lords, will be blamed. I hope that Ministers will act on what has been said this evening.
Baroness Wheeler
My Lords, noble Lords have spoken to their amendments effectively and comprehensively, so I will not deal with all the amendments. I start by giving our support to the spirit behind Amendment 318BA, tabled by my noble friend Lord Whitty and the noble Lord, Lord Low, and Amendment 322, tabled by my noble friends Lord Rooker and Lord Harris. They underline the crucial need to uphold the independence of local healthwatch organisations by enabling them to carry out their activities as they see fit, subject to any directions from Healthwatch England, and emphasise that they must not be regarded as either servants or agents of the local authority.
Local independence is vital for people to have trust and confidence in their local healthwatch organisations to articulate their priorities and the needs of the local community. To be effective, they must be able to scrutinise how consortia and health and well-being boards have undertaken public engagement and transparency, and how they are ensuring that the patient voice is embedded in the care pathway design. They also need to be able to scrutinise how lay representatives on consortia and health and well-being boards themselves undertake public engagement and transparency.
Amendment 318E in the name of the noble Baroness, Lady Cumberlege, would require local healthwatch organisations to provide the NHS Commissioning Board with their opinion on whether local plans take proper account of their views, as evidence in reports and recommendations. We support this, and of course underline that CCGs must also be required to consult local healthwatch organisations while commissioning plans are drawn up and developed.
On the question of how local healthwatch organisations are funded, we need to recognise the widespread concern raised by noble Lords and current LINks organisations that the arrangements for local healthwatch organisations and their dependence on funding from local authorities compromise their independence, particularly in terms of public perception and confidence in their role and work. With local authorities having greater involvement in healthcare—particularly public health—how will healthwatch organisations be able to exercise the independence that the public would expect?
A number of amendments seek to address that issue, either through guaranteeing resources or prescribing how the local authority should take decisions in relation to its commissioning of healthwatch, the allocation of resources and the governance arrangements. Perversely, some of them could have the unintentional consequence of tying in local healthwatch groups to the local authority more tightly. In view of the current economic climate and the massive cuts that local authorities are having to make, the concerns and unease over the future resourcing of local healthwatch organisations need to be addressed. I hope that the Minister will recognise this as a major issue, consult all stakeholders and come back to us on Report with reassurances and solutions.
This is the first time we have touched on the new independent advocacy services that local authorities will be required to establish to provide assistance to individuals making complaints about health or community care services or providers, including using the local healthwatch organisation to deliver this service. We are very sympathetic to Amendment 324 from the noble Lords, Lord Rix and Lord Wigley, and the noble Viscount, Lord Tenby. It seeks to prevent any case being dismissed from the outset or midway through as too complex or lengthy. Complaints against the health service are often complex and require long periods of support to be provided to the complainant. It is a service that should be provided to all users, and provision will need to be made to support people with mental health problems and learning difficulties, as well as people with disabilities.
We support Amendment 325 in the names of my noble friends Lord Rooker and Lord Harris. This would provide for advocacy to cover complaints about both health and social care. I look forward to the Minister’s response on these issues.
Baroness Northover
My Lords, again, we have had a very impressive and wide-ranging debate. It links in with the earlier debate on this area, as well as with our discussion the other day.
The noble Lord, Lord Low, made a very strong point when he talked about the need for confidentiality. I hope I can reassure him that HealthWatch England will be subject to the provisions of the Data Protection Act and other applicable law. However, these are complex matters, involving a number of interlocking pieces of legislation and other issues. As a result, I hope that the noble Lord will allow me to write to him with full details of how we see these provisions working. However, I hope that he will be reassured about the overarching effect of the Data Protection Act. He made some very telling and important points.
Our aim is for local healthwatch organisations to become an integral part of the commissioning of local health and social care services. They will build on the strengths of the existing Local Involvement Networks and, we hope, address their weaknesses. I have listened to the concerns that various noble Lords have expressed about independence, given local healthwatch organisations’ contractual relationships with local authorities. I hope I can reassure noble Lords that local healthwatch organisations will be very firmly in the lead in determining their own work programmes and local priorities. Local authorities, for example, cannot arbitrarily veto a local healthwatch organisation’s work plan or stop a local healthwatch organisation providing feedback or recommendations to HealthWatch England, nor can they suppress local healthwatch organisations’ reports with which they disagree. I am sorry that the noble Lord, Lord Warner, is not in his place, as no doubt he would be hopping up and down challenging me on these matters. It is extremely important that local healthwatch organisations are effective in this way: we have made the provision that we have. Nor can local authorities starve local healthwatch organisations of funds, as the noble Lord, Lord Harris, implies. Local healthwatch organisations must have sufficient resources to fulfil their statutory functions. Those are laid down and they have to deliver on that.
Lord Harris of Haringey
I thank the noble Baroness for giving way. The problem with not ring-fencing funds and simply relying on the statutory requirement is that there are many ways of interpreting a statutory obligation. For example, there is an obligation on local healthwatch organisations to provide information to the public. You can provide information at various levels. At one extreme, this could be leaflets to every household, or it could be telephone helplines. It could be all sorts of things—or it could simply be to say that the information manual has been placed in the local library. If the local healthwatch organisation does that, it has fulfilled its statutory obligation in providing information to the community. I am assuming that Ministers do not want that to be the scale of the provision, but simply saying that you have met your statutory obligation is not a sufficient safeguard to provide £60 million-worth of services, if that is the sum of money being made available to local healthwatch organisations.
Baroness Northover
The noble Lord, Lord Harris, made exactly this point at the meeting that we had the other day with my noble friend Lord Howe, who I thought countered his points extremely effectively. However, I realise that is now almost 6 pm and I know that noble friends have other appointments; maybe we would otherwise carry on until Christmas. We take on board what the noble Lord, Lord Harris, has said. I am sure that he takes on board the counterpoints from my noble friend Lord Howe, but we will continue to discuss how best to ensure that local healthwatch organisations are effective in the way that we need them to be.
Some of the amendments of my noble friend Lady Cumberlege would increase the role of the Secretary of State in relation to local healthwatch organisations. Though we understand the intent behind the amendments, we do not feel that that is quite the way to go. Nevertheless, we acknowledge the need to keep the issue of local healthwatch organisations’ independence under review and we are working closely with stakeholders to look at how best we can support that independence at local level.
My noble friend made a range of proposals which were extremely interesting and we will take those back, along with other noble Lords’ suggestions. We are keen that local healthwatch organisations have the flexibility to work with and for their local communities. I am aware of the concern expressed by a number of stakeholders that the Bill does not contain sufficient flexibility. I can confirm that we also want to make sure that the process of getting local healthwatch organisations started is as efficient as possible. We want to assist in that and again we discussed this with stakeholders yesterday. We would not want to see local healthwatch’s ability to get on with its valuable role slowed down.
My noble friend suggested that local healthwatch organisations should have a stronger role in relation to CCGs’ commissioning plans. I sympathise with the sentiment behind this amendment and with other proposals to try to make sure that the voice of the patient is heard. However, this would place a further statutory function on local healthwatch organisations, and it might be unnecessarily prescriptive. There are, of course, arrangements in place in the Bill for local healthwatch organisations to feed their concerns to HealthWatch England, and HealthWatch England can also provide the NHS Commissioning Board with information and advice on the views of local healthwatch organisations on the standard of healthcare. Were a local healthwatch organisation to have concerns that a clinical commissioning group had not taken proper account of its views in commissioning plans, they could be raised by this route. However, this is an important issue, and I will take it away to consider it further.
Lord Harris of Haringey
Will the Minister clarify whether she is seriously suggesting that rather than having a route going direct from a local healthwatch organisation to a clinical commissioning group, it is better to have a route that goes from the local healthwatch organisations to HealthWatch England—I do not know whether we would include CQC in that process—then through the national Commissioning Board and then back down to—
Baroness Northover
I did not put that clearly enough. Local healthwatch organisations will be feeding into clinical commissioning groups. That is already apparent. They have all sorts of ways, not least through the health and well-being boards, to make sure that the needs of the community are clearly expressed so that commissioning is as appropriate as possible. Where that is not being properly listened to, and therefore serious issues need to be addressed, there are other ways of ensuring that actions can be taken.
However, all these groups need to be talking to each other. I hope very much that they will. One of the reasons for local healthwatch organisations to have the association with local authorities is that local authorities have responsibility for so many areas that also affect the health of the population. They will have new responsibilities in public health as well. All this needs to link up to make sure that the quality of health is improved. This is part of that arrangement. We are looking at it locally and nationally. However, I will take back the suggestions that my noble friend Lady Cumberlege made. We want to make sure that this system works effectively without being overly prescriptive.
I agree that indemnity is a fundamental issue. It is one to which the Government have given significant consideration. We have concluded that it is most appropriate for it to feature in local contractual arrangements rather than in primary legislation that may lack flexibility.
The noble Lord, Lord Harris, is right that the system by which people serve on local healthwatch organisations needs to be transparent—all this needs to be transparent. I heard what he said in that regard, and I will feed it into the discussions that are going on at the moment.
On some matters it is probably best, if I need to follow up, that I do so in writing, as I am acutely aware that my noble friend Lord Howe and the noble Baroness, Lady Thornton, have another engagement this evening, and we must release them.
I turn to NHS complaints advocacy. Clause 182 has the effect of transferring a duty to commission independent advocacy services for NHS complaints from the Secretary of State to local authorities. The principle behind advocacy will remain unchanged: it is the provision of appropriate support to people who wish to make a complaint about the NHS to enable them to make their own decisions. We propose that commissioning of advocacy shifts from the Secretary of State to local authorities to best meet local needs.
I note the wonderful Amendment 324, tabled by the noble Lords, Lord Rix and Lord Wigley, which seeks to ensure that advocacy will be provided without limits on the length or type of support. I commend them for their ambition but it would not be appropriate to put that limit in the Bill. I am sure they understand that but we take what they say about the importance of advocacy and commend them for their strong advocacy of advocacy.
I realise that all these areas are of great concern to noble Lords. This may be just one part of the Bill but in many ways it is the heart of the Bill, which is about patients and how best you ensure that patients’ experience translates into an improvement in quality in practice. Other noble Lords have grappled with this before. The previous Government did and Governments before that. We are trying to take this further forward, both in terms of the national and local arrangements. We hear what people say in response to the proposals but I hope that in the mean time the noble Lord will not press his amendment.
Lord Low of Dalston
I am grateful to the Minister for the way in which she appeared to take the force of the points that I was making with my amendments about the use of information. When she referred to the overarching effect of the Data Protection Act it appeared that she was listening more to my amendments about health and well-being boards than those relating to HealthWatch England, but I will wait to receive the letter that she kindly has promised to write to see how fully she has taken the force of my points in relation to both those bodies. I was encouraged by what she said so for now I will withdraw my amendment.