Grand Committee
The Deputy Chairman of Committees (Baroness Andrews)
If there is a Division in the House, the Committee will adjourn for 10 minutes.
Official Statistics Order 2013
(11 years, 9 months ago)
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Lord Wallace of Saltaire
That the Grand Committee do report to the House that it has considered the Official Statistics Order 2013.
Relevant document: 22nd Report from the Joint Committee on Statutory Instruments.
Lord Wallace of Saltaire
My Lords, all Members of the Committee will be aware of the important work being done by the UK Statistics Authority. This body was created in 2008 with a statutory responsibility to,
“promote and safeguard the production and publication of official statistics”,
which includes monitoring of and reporting on official statistics.
Under the Statistics and Registration Service Act 2007, statistics produced by the Office for National Statistics, government departments, the devolved Administrations and other Crown bodies are automatically deemed to be official statistics. The Act also makes provision for identifying other organisations as producers of official statistics. This is important, as it enables their work to fall within the remit of the authority and the public to have added confidence in their statistics. The purpose of this order, which is subject to affirmative resolution, is to specify these organisations.
The UK Statistics Authority has been consulted in preparing this order, in accordance with the Statistics and Registration Service Act, and is content for it to be laid. The Cabinet Office has laid this order on behalf of government departments, in preference to each department laying an order for the bodies for which it is responsible. This approach saves considerable parliamentary time.
This is the fourth use of this order-making power by a Minister of the Crown, and revokes and replaces the one that came into force on 3 December 2010. The previous order contained 57 bodies. The 2010 order was amended by Article 17 of the Education Act 2011 (Consequential Amendments to Subordinate Legislation) Order 2012. This omitted entries relating to the Qualifications and Curriculum Development Agency and the Training and Development Agency for Schools, which were abolished by the Education Act 2011. It will also be amended by the Financial Services Act 2012 (Consequential Amendments and Transitional Provisions) Order 2013, which will come into effect on 1 April. This will reflect the change in name of the Financial Services Authority to the Financial Conduct Authority, which comes into effect on the same day.
In arriving at the current order, 21 bodies have been removed from the previous order and five new bodies have been added. Much of the reduction in the number of bodies is due to the recent reforms to public bodies. As noble Lords will recall, in 2010 the Government announced plans to reform 481 quangos to help reinvigorate the public’s trust in democracy; to ensure that the Government operate in a more efficient and businesslike way; and to radically increase the transparency and accountability of all public services. A number of these changes will come into effect on 1 April this year. It is important that these reforms extend to areas such as official statistics. Therefore, some of the changes have led to the streamlining of some statistics but those most important to public life have been preserved. The longer-than-usual hiatus between this order and the previous one has been to ensure that the new order fully captured these reforms.
In summary, this order reduces the number of bodies that are subject to the UK Statistics Authority’s oversight; those bodies listed on the order will have to work to the new code of practice for official statistics; and their statistics will have the potential to be nominated for formal assessment by the authority to be national statistics. I reassure the noble Baroness that I have discovered the difference between an official statistic and a national statistic, even though it took me some time. This House agreeing the order is a vital part of enhancing public confidence in official and national statistics, and I beg to move.
Baroness Smith of Basildon
My Lords, I thank the noble Lord for his introduction and explanation of this order. Perhaps the only point he missed was to stress the importance of always having accurate statistics, and indeed that is implicit in bringing forward the order today. It is a sign of the times that public confidence is higher and trust is greater in statistics if they are seen to be produced independent of government, and I think we should put on the record our praise of the UK Statistics Authority and of the Office for National Statistics, which is part of the executive wing, as it were, of the Statistics Authority. In many ways, the authority acts as a check and balance on some of the important areas of the economy. It is helpful that the Statistics Authority can look at statements and figures so that the policies of all political parties can be held to account. We can ask the Statistics Authority to check the accuracy of any statement that is made.
However, this is not just about the face value of statistics, but how they are used and how they can be misinterpreted either accidentally or deliberately. We have seen that recently. The Minister may be aware that the Statistics Authority had to write to MPs. Any of us can make a mistake, and in this case it was made in a Conservative Party political broadcast on 23 January. It got into a muddle between debt and deficit, and that had to be put right. My understanding is that the broadcast said that it had gone down, but information from the UK Statistics Authority showed that net public sector debt in June 2010, the end of the second quarter, was £811 billion, which represents 55.3% of gross domestic product, and that by the end of the fourth quarter 2012 it had risen to £1,011 billion. We should thank the Statistics Authority because it is able to make corrections to statements made by politicians of any party because it has the confidence of the public behind it.
I know that the noble Lord has worked through the order and looked at the different definitions. As a former Minister who was in the same position that he is in now, perhaps I should not have been puzzled by this, but I want to ask about the Statistics Board. The order refers to consultation with the board and it is referred to in the legislation, but it is actually the UK Statistics Authority and the ONS. The only reference I can find to a board is to the Board of the UK Statistics Authority, whose membership includes people from the ONS—the chief executive, the National Statistician and the Director General. I am slightly puzzled about why the order refers to the board when the entity is in fact the authority, but I hope I am correct in assuming that the board he is referring to is the board of the authority. It would be helpful if he could confirm that.
The board was consulted and I assume that the response to the changes being made was positive. It would be helpful to have the complete list in the schedule, but 21 organisations were removed. If I understood the Minister correctly, he has already answered part of my question in his opening. Part of that arises from the Public Bodies Act, about which he will understand we have mixed views, in particular with regard to the changes being made. If those organisations are no longer able to produce official statistics, does that mean that there is now a lack of available statistical information, or has the work of those 21 organisations which are no longer on the approved list been allocated to other organisations? Are we still able to get the kind of information that was being produced? Further, is the Minister able to provide a list of the 21 organisations? It would be helpful if he could write to me.
The explanatory note also said that the charities being included as producing official statistics will have no official burden placed on them. Does that imply that they have previously produced statistics of use to government and held in public regard, but that have not been regarded as official? If the Minister can say something about that, it would be helpful.
I was puzzled to find that two organisations were not on the list. As I mentioned to the Minister, later on today we will have a debate on crime statistics. It is helpful to have this debate today to help inform that debate later on. In my reading for that debate, it was clear that the UK Statistics Authority says that there are two sources of official figures for crime statistics: one is police records from individual police forces and the other is the British Crime Survey. Individual police forces are obviously not on here, I assume because they feed information to the Home Office which then issues that information. If I am wrong about that, I would be happy to be corrected. But the British Crime Survey is not here. It is interesting if the UK Statistics Authority recognises the British Crime Survey statistics as being very useful, if not “official”—because that is a legal term. If it uses those statistics, I wonder if it would be appropriate for the survey to be on the list. Why is it not?
My final point is on another organisation that I doubt has been missed: the Office for Budget Responsibility. When they came into power, the coalition Government were clear that they wanted to see independent figures and assessment of the economy, and set up the Office for Budget Responsibility in response to that. That was widely welcomed. Yet it is not included in the list. Clearly, it is highly regarded—as is what it produces. Like the UK Statistics Authority, it is a check and balance. The Prime Minister said in a speech on the economy:
“As the independent Office for Budget Responsibility has made clear, growth has been depressed by the financial crisis, by the problems in the eurozone and by a 60% rise in oil prices between”,
and he gave the dates.
“They are absolutely clear, and they are absolutely independent. They are absolutely clear that the deficit reduction plan is not responsible; in fact, quite the opposite”.
The head of the Office for Budget Responsibility then had to write to the Prime Minister to make clear that that was not the case. He said:
“I think it is important to point out that every forecast published by the OBR since the June 2010 Budget has incorporated the widely held assumption that tax increases and spending cuts reduce economic growth in the short term”.
Clearly the OBR has the authority and credibility to write to the Prime Minister when he gets something wrong in talking about statistics and the economy, but it is not listed as an official statistic-producing body. It would be useful were the Minister able to help me understand the reason for that.
Those are the only questions I have. Clearly, it is helpful to have the list and we are obviously supportive of the order. It would be helpful to have the responses to the questions I have asked.
Lord Wallace of Saltaire
My Lords, I thank the noble Baroness for her constructive speech. Of course, I should have said that this is very much an all-party set of issues. The last Government introducing this new system of greater independence for statistics was a very valuable contribution to more informed debate. I am in some ways a great admirer of the Daily Mail and its uses of statistics, and the wonderful way it manages to imply that statistics mean something entirely different from what most of us understand them to mean. Usually you have to read down to the tenth paragraph on the second page to discover that actually the story is not as good as it seems. In politics, we want an independent body that can point out that statistics cannot be twisted in that way. That is what this current system most attempts to do.
Baroness Smith of Basildon
Just as an aside, I owe the noble Lord an apology. In the last debate we had, I accused him of being a Guardian reader. I now appreciate that he is in fact a Daily Mail reader.
Lord Wallace of Saltaire
I do my best to skim through several newspapers of one sort or another.
The Explanatory Memorandum for this order lists the 21 bodies that are disappearing. I know that the noble Baroness will be deeply familiar with a number of them, such as the British Educational Communications and Technology Agency, the National College for Leadership of Schools and Children’s Services Limited, the National Patient Safety Agency, the National Policing Improvement Agency and so on. In almost all respects, the functions of those bodies have now been transferred to other executive agencies and the statistics which they were responsible for producing will thus be provided by the new agencies. However, I will check to see whether there are any holes in that and will, of course, write to the noble Baroness.
My understanding is that the Office for Budget Responsibility—again, I will check this and write to her to confirm it—rather like the National Audit Office, is an independent body and is thus responsible for its own quality assessment rather than being a government agency which has to be checked by the UK Statistics Authority. Similarly, the Bank of England’s statistics are not checked by the UK Statistics Authority because the Bank is an independent body which is responsible for its own statistics and their quality. That is my understanding on the OBR, but again I will check on that.
I will have to check which agency is now responsible for providing the crime survey. I suspect that it is under the Home Office, which will therefore be responsible for it.
Baroness Smith of Basildon
I am grateful to the noble Lord for looking into this. As regards the 21 that were off the list, if he can write to me to clarify any gaps, that would be helpful.
I think the noble Lord will find that the British Crime Survey does not come from the Home Office. I drew a distinction between the police force figures, which I think may be produced by the Home Office, and the separate, more independent British Crime Survey. If the figures are used by the statistics authority, I wonder why they are not included in the list. I am very happy for the noble Lord to write to me on that.
Lord Wallace of Saltaire
I will check on that. It is absolutely right that we should use a case like this as a chance to check that reliable statistics on important matters are coming from agencies which we all respect.
Having answered those questions, I thank the noble Baroness for her comments and very much hope that the Committee will be willing to accept the Motion.
Electoral Registration (Disclosure of Electoral Registers) Regulations 2013
(11 years, 9 months ago)
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Lord Wallace of Saltaire
That the Grand Committee do report to the House that it has considered the Electoral Registration (Disclosure of Electoral Registers) Regulations 2013.
Relevant document: 21st Report from the Joint Committee on Statutory Instruments.
Lord Wallace of Saltaire
My Lords, in moving the Electoral Registration (Disclosure of Electoral Registers) Regulations 2013, I wish to speak also to the Electoral Registration (Postponement of 2013 Annual Canvass) Order 2013. The Electoral Registration and Administration Act 2013 received Royal Assent on 31 January. It marks the first legislative step towards fulfilment of the coalition Government’s commitment to speed up the implementation of individual electoral registration (IER) so that it takes place in 2014-15, a commitment reaffirmed recently in the Government’s mid-term review.
The principle of IER has won cross-party support. Indeed, the change to individual registration was introduced into the Political Parties and Elections Act 2009 in your Lordships’ House with cross-party support. In passing the ERA Act earlier this year, Parliament showed its intention to see the implementation done using a different plan and a different timetable. The transition to IER will begin in the summer of 2014 and the Government are planning that it will end with the publication of the first IER-only register in December 2015. I know that this is familiar to all those present as we spent a great deal of time debating all these issues. The legislation was altered in your Lordships’ House so that the end may come in either 2015 or 2016, with an order laid by the Secretary of State of the day required to conclude transition. I reaffirm the Government’s commitment to concluding the transition in 2015 in accordance with the implementation plan already published.
The two statutory instruments before the Committee today are key components of the transition to IER in preparing for the confirmation data-matching process. It is one of the important changes from the transition envisaged by the PPE Act 2009.
In their official response to pre-legislative scrutiny on IER, the Government announced that part of the transition would be a data-matching stage whereby all electoral registers in Britain would be matched against trusted public datasets. Where a positive match is made between an entry on the register and information in the dataset, that person may be “confirmed” as having an IER entry on the register because the electoral registration officer can have confidence that they exist and reside at that address. These people will not have to supply their personal identifiers—their national insurance number and date of birth—unless they move house and apply to register at their new address.
Preliminary findings from pilots of this data-matching system have been published on the gov.uk website, and suggest that approximately 70% of existing electors will be confirmed on the register through data-matching. This is slightly higher than the results of previous pilots, with results suggesting that we can be confident in the accuracy of the matching, both of which auger well for the success of data-matching in the transition to IER. Both instruments being considered today support that data-matching element of the transition in very important and practical ways.
Regulation 2 of the draft Electoral Registration (Disclosure of Electoral Registers) Regulations 2013, if approved, will allow EROs, working with the Government, to carry out a dry run of confirmation data-matching, so that we can be even more confident that the new system will work when it goes live in the summer of 2014. The regulations would enable the Lord President of the Council to require electoral registration officers to disclose the information on their electoral registers to him through a conduit specified in writing for the purposes set out in paragraph 1A of Schedule 2 to the Representation of the People Act 1983.
The conduit will be the IER digital service, which is currently being developed and will be able to carry out the secure transfers of data required for IER, including the confirmation data match. The service is not identified specifically in the regulations in order to allow for flexibility to handle risks around this data transfer, whereby any problem that arose in using the digital service could be dealt with by using a different conduit for data transfer without the need for changes to the regulations. The Information Commissioner’s Office has advised us that this is the best way to legislate for this kind of digital data-transfer system.
Regulation 2 also provides for the sharing of the information on the registers with the Department for Work and Pensions, where it may be compared against certain data held there and matched against the names, addresses and dates of birth. Date of birth is included because this is held by EROs in relation to attainers—those under 18 who will become electors during the life of the current register.
The personal identifiers that will be used as part of the verification process for IER—the national insurance number and date of birth—will not be disclosed under these regulations because they do not appear on the electoral register, with the exception of attainers’ dates of birth. This is also true of the full confirmation process in 2014, meaning that considerably fewer items of sensitive personal information will be transferred through the IER digital service and matched with DWP data than would be the case if confirmation data-matching was not being used as part of the transition to IER. Once the information has been matched at DWP, a match result will be sent back to the ERO. In the full confirmation process in 2014, this result will assist the ERO in deciding whether the person can be confirmed on the register, or if they should be invited to make an IER application.
In the dry run later this year, however, there will be no contact with electors. Instead, the EROs will have an indication of what their overall match rate for their local authority area will be in 2014, and therefore the extent to which they are likely to need to invite and process IER applications. They may also find that certain areas in their zone have lower match rates than elsewhere. In this case, they may, for example, feel that they can focus resources in areas with low match scores during the canvass period to ensure that the information on the register for those areas is up to date for the 2014 confirmation data match.
In order that this dry run and the 2014 confirmation data match can take place, these regulations would also allow local authorities to build up their IT resources and connect to the secure IER digital service in order that they can disclose their registers in the format and through the conduit specified by the Lord President, as they will be required to do Regulation 2(3). By setting up this IT infrastructure and having a dry run of the process this year, we can be confident that all the component parts are in place and all EROs are securely connected to it before the transition to IER and the full confirmation data-match in summer 2014.
Under the Electoral Registration Data Schemes (No. 2) Order 2012, this connectivity is already being set up in 22 local authorities in which pilots are being conducted. That work, under that order, will cease at the end of 31 March this year, though, and these regulations will enable it to continue in those authorities and to be rolled out to the rest of Great Britain. It is vital that this work is continued uninterrupted in the pilot areas and begins as soon as possible elsewhere, with these regulations in force from 1 April 2013.
Having described the context for the draft regulations at length, I now turn to the draft Electoral Registration (Postponement of 2013 Annual Canvass) Order 2013. The postponement of the annual canvass was also outlined in the Government’s response to pre-legislative scrutiny in February 2012. The purpose is to ensure that confirmation data-matching in summer 2014 is done using registers that are as complete and accurate as possible. We know that the completeness and accuracy of registers deteriorates over time at a rate of around 1% per month, so reducing the gap between the compilation of the register and the point at which the data are matched should improve match rates.
We announced that the canvass due to take place in autumn 2013 would be postponed so that the revised register would be published in early 2014, rather than December 2013. The draft order sets out the specific dates for the canvass and the publication, with canvass activity beginning from 1 October 2013 and the revised register being published on 17 February 2014 in England and on 10 March 2014 in Scotland and Wales. These publication dates represent the best balance between the benefits of delaying the canvass to improve the match scores and the need for electoral administrators and political parties to have the revised register published prior to local elections and European Parliamentary elections, due to take place in 2014.
The different dates for England and for Scotland and Wales reflect this point. As there are local elections due to take place in England on 1 May, the register will be published earlier there, whereas there are no such elections in Scotland and Wales so the register can be published later, as long as they are available in time to prepare for the European Parliament elections.
It is worth noting that, while 1 October is given as the date from which canvass activity may begin, this does not mean that registration officers must begin on that date. Indeed, many may feel that a shorter period, beginning in late October or early November would be more suitable for their district. By setting 1 October as the date after which canvass activity may take place, we are allowing EROs to be flexible in planning for their district. The October to February and March time frame is akin to the longest period in which we are aware of EROs carrying out canvass activity at present, from July to late November.
As set out in the Explanatory Memoranda for these instruments, formal consultation has been conducted with the Electoral Commission on both instruments, and with the Information Commissioner’s Office on the regulations. This is in addition to informal and ongoing consultation on these instruments and other delegated legislation with these organisations, as well as with the Association of Electoral Administrators, the Scottish Assessors’ Association, and the major political parties and other stakeholders.
These two statutory instruments, if approved, will play an integral part in preparing for the transition to individual electoral registration in 2014. Between them, they would set up the IT infrastructure for confirmation data-matching in summer 2014, enable a dry run of the process to be conducted in advance, and ensure that the registers used for the 2014 data-match are as complete and accurate as possible.
We have been through much of this in previous debates and, while passing, working through the ERA Act. I hope that Members of the Committee will recognise that the Government are continuing to work as well as possible, and as actively as possible, to make sure that we end up with as complete and as accurate an individual electoral register as possible, as we move through this transition.
Lord Tyler
My Lords, I have only a very small contribution to make, but with one practical improvement, which I hope the Minister will take back to those responsible, my contribution might be even more succinct and brief.
I am a member of the informal cross-party group of parliamentarians which advises the Electoral Commission and therefore very aware of the concerns the commission has had during this process. The Minister may know that both here, in Grand Committee, and in the Chamber I have been living with IER even longer than he has and it is beginning to wear me down. I hope that we are not going to have too many more of these splendidly erudite occasions.
My problem is the way in which consultation is undertaken. The Minister referred to the consultation with the Electoral Commission and this is referred to in the explanatory notes on the statutory instrument referring to disclosure of electoral registers in paragraph 8(1), where it reads:
“The Commission has recommended that it should be under an express duty to evaluate the confirmation trials, with a power to require those concerned to provide relevant information. The Cabinet Office and the Commission have discussed this point and have subsequently agreed that the general power to require a report, set out in primary legislation, is sufficient”.
Neither the explanatory note nor the document to which I am about to refer from the commission itself is dated; we do not know which comes before which. If that was the conclusion of the consultation with the Electoral Commission, it is therefore surprising that in the last few days those of us who are interested in these matters received directly from the Electoral Commission a document saying the following:
“We have asked the Government to confirm that it will request the Electoral Commission to evaluate the confirmation trials … in the debate on this Order in the House of Commons on 11 March, the Government did not give such assurances. The Commission cannot undertake the necessary evaluation without a direction from the Government. The Government should confirm that it intends to require the Commission to prepare a report under Section 53(6) of the Representation of the People Act 1983 on the operation of the confirmation process trials under these Regulations”.
My noble friend has laid great stress on the importance of these confirmation trials; I entirely agree with him and endorse everything he said. Who though will judge the validity of those trials if it is not the commission? As I understand it, from this brief from the commission, which as I say is not dated either, I do not know which comes before which. Was there a happy and successful conclusion to the discussions between my noble friend’s colleagues and the commission or was there not?
I am afraid the same problem arises under the other draft statutory instrument that we have before us, although perhaps on a more minor point. This is the very important question of what flexibility is given to the EROs to decide the gap between making their canvass in the autumn of 2013 and the new register in February 2014. The undated Explanatory Memorandum from my noble friend’s department says:
“The Commission recommended … the Order should be amended to specify that canvass activity should not begin before 1st November 2013, so reducing the period between the start of the canvass and the July 2014 confirmation exercise while still allowing meaningful canvass activity to start before Christmas 2013”.
That is at variance, again, with the advice given in the undated advice from the Electoral Commission in the last few days, where it still sticks to the point that it thinks the gap may well be too long and that giving flexibility to the ERO may actually cause the eventual result statistically to be less accurate and less effective.
My speech could have been cut into a quarter if these two documents had been properly dated. We are always asking for documents put before your Lordships’ House to be properly dated. It would seem to be the most basic and simple administrative convenience for Members of your Lordships’ House to know which document comes before which. I make that plea again and I hope that my noble friend, who is amazingly effective in getting civil servants to do what we expect of them—to be as efficient and effective as they usually are—will be more successful on this occasion than previously.
Baroness Hayter of Kentish Town
My Lords, I have to say that if the noble Lord, Lord Tyler, has really been worn down by all these debates on IER, he is showing no sign of it whatever.
I thank the Minister for introducing these measures. I turn first to the disclosure regulations. The Committee will recall that we welcomed all the efforts made to locate and contact eligible voters absent from the register, and to confirm those already on the household list. We therefore fully support this dry run, which will assist EROs to compare their data against datasets kept by DWP and to test the confirmation exercises.
Noble Lords will not be surprised that I have a number of questions. I had hoped that if the exercise had revealed the names and addresses of people not on the current list, the ERO would then be able to write and invite them to register. The Minister said that there would be no contact, but I do not know whether that means that even if an ERO finds from DWP material someone who is not on the register, the ERO will be unable to approach that person. Perhaps the Minister can clarify that.
We know that the Minister in another place confirmed the Government’s confidence that everything, including the resources, is sufficiently in place for this work to happen within the required timescale. Perhaps he can repeat that assurance for the benefit of the Committee, together with any comfort that he has received from the Electoral Commission.
The other issue that I had intended to raise was that mentioned by the noble Lord, Lord Tyler—to ask Minister to confirm that the Electoral Commission will be required to evaluate these pilots and therefore to report back to the House.
Will the Minister also confirm that the regulations will give the necessary authority for all the relevant parties to release the data necessary for this work? Perhaps he can also assure the Committee that all the relevant parties involved will be clear about their duties and responsibilities under the Data Protection Act before any data-sharing begins. Perhaps he can set out what safeguards are in place to protect individuals’ data security. We noted in previous discussions on individual registration that some people, including those in your Lordships’ House, tend to register their vote at one address but use another address for correspondence. That will clearly be a major issue when using the DWP material. Perhaps the Minister can outline how this is to be dealt with in the pilots.
I turn to the second measure, on the postponement of the 2013 household canvass, which is now to be published in England in February 2014, and in March in Scotland and Wales. The Minister will recall my sadly unsuccessful attempt to remove from the then ERA Bill the ability of the Secretary of State to abolish the canvass. That is an indication of how important we see this tool in seeking out and registering all citizens with an entitlement to vote. Clearly, this will be even more important in the move to IER, which will fully replace the household register only in 2016. I ask the Minister to confirm that he is confident that the Government’s plans will ensure that by 2016 we will have a better register than we have at present, and that the Government remain clear that there will be no dropping of the household register before 2016.
We are very content that the Government push ahead with locating non-registered but eligible electors, so that by 2016 we have the maximum possible number of individually registered electors by a variety of means and no one is inadvertently denied their vote in 2016. But we seek assurance that any such work is not with the idea of bringing forward sole reliance on the individual rather than household-registered electorate. In the mean time, however, while we remain with household lists, as the Minister has said that registers decline in accuracy by about 1% a month, we are content with the canvass taking place slightly later—provided that the information is then made available to political parties as soon as possible thereafter, so that their work on the lists can begin, as he mentioned. This is key. The Committee knows that much of the business of alerting voters to the fact that they are or are not on the electoral roll is done by political parties, as the voting cards tend to go out only a short time before an election. It will be more and more important, with the gradual shift to IER, for parties to have early and easy access to the new registers so that they can undertake their canvass work and so that anyone left off can be identified in time to rectify that absence. We also need, as early as possible after the delayed canvass, publication, perhaps monthly, of a rolling register, showing IER flags.
We know that the ERA allows for transfer to IER to be completed by the end of December 2016, which is a sensible date. The Committee will understand that we remain a little nervous. The Act retains a power to hurry it through earlier than that, but we hope that the Government are not trying to do that, given the risk of losing eligible voters. We would also query—and this was another point raised by the noble Lord, Lord Tyler—whether there is a satisfactory way in which to judge whether the 2016 date is appropriate to complete the transition. We would like to know what criteria would be applied and what would be the role of the Electoral Commission in such a process. Under the Labour Government’s legislation on IER, the Electoral Commission had a pivotal role in deciding whether progress had been sufficient to create safe conditions for the final move to be made. This Government removed that role, but surely the commission must have a duty to press the “Go” button, if that decision is to clearly non-political and based on solid data.
Perhaps I could use this opportunity to ask the Minister two questions.
Baroness Hayter of Kentish Town
Yes, but I once asked the noble Lord 16.
First, are the Government committed to the December 2016 timetable? Secondly, will they await a commission pronouncement on whether the conditions are right before making the final transition to IER? We assume that a core criterion for assessing those conditions is whether, as the Minister says, the electoral register is at least as accurate as the current register, but we need that to be judged by an independent body, which surely can only be the Electoral Commission.
Finally, we return to the point of which we were reminded by the noble Lord, Lord Tyler, that the Electoral Commission remains concerned about an October rather than November start date. I noticed that, in introducing this, the Minister seemed to say that a later date might be more suitable. Perhaps he could clarify whether that reflects discussions with the Electoral Commission.
Lord Wallace of Saltaire
I thank the noble Lord and the noble Baroness for their contributions. I should say to the noble Lord, Lord Tyler, that this may not be the last SI on this subject and it is important, since this is such a key element, that we make sure that we have all-party confidence in the process as we go through. We are dealing with data-sharing in some sensitive areas, so we need to make sure that everyone is carried along.
Lord Wallace of Saltaire
My Lords, some of the questions raised are familiar to us from previous debates and will no doubt be repeated in further debates. Let me summarise: of course we want to ensure that, as we go through this important transition, we carry all parties and stakeholders with us, that confidentiality of data in terms of data-sharing is maintained, and that the Electoral Commission is fully engaged throughout the process.
On the flexibility of electoral registration officers in deciding on the canvass, as I said in my speech, some will decide not to start until November. I am tempted to say to those who live in the lush south, such as my noble friend Lord Tyler, that “it’s grim up north”. Canvassing in north Yorkshire in January and February is not always easy. My mother-in-law, when she lived in Upper Wharfedale, was usually snowed in for at least six weeks during that period. It will differ from area to area and this is why we are allowing EROs a certain amount of flexibility.
I say to the noble Baroness, Lady Hayter, that this is a dry run. It is not intended to involve contact with electors. It is a confirmation test of how far we can get matching data with the DWP database and others so that we have a better indication of the scale of the remaining chunk of the electorate who need to be visited or contacted one way or another. That is the whole purpose of this activity. I repeat the assurance that we are on track. We are confident that we will be able to carry through this process by our preferred date of December 2015 rather than delaying until 2016. However, as the noble Baroness is well aware, we will be monitoring this as we carry it through. If we discover that there are delays along the way, there is the potential in the Act for that delay.
I have confidence in the Government’s digital service in terms of data sharing. I have spoken to staff in that service on a number of occasions and am very impressed by what they are doing. There are some larger questions here about data privacy, data sharing and data use. The Cabinet Office is in the process of setting up a briefing for Peers on the digital revolution. One of the issues that we will cover for that will be precisely data privacy and data protection. I hope that we will get a good audience for that because there are some much broader issues here than simply this Act which I think it will be useful to explore.
I was asked whether the new register will be better than the present one. Given everything I have seen about the long-term deterioration of the current register’s accuracy, I say cautiously that our aim is that the new register will be at least as good as the one we have now, and we will end the long-term process of deterioration from which the register has been suffering. The Government are thus confident that we will come through this process with as accurate and complete a register as possible.
The suggestion of flagging the status of the register on a monthly update is one that we will take away and consider further. On the question of annual canvasses, I reassure the noble Baroness that we have no plans to abolish the annual register to identify potentially eligible electors and invite them to register. However, as we have discussed on previous occasions, the process of doing the annual canvass is becoming more difficult over a long-term period. It is also getting more difficult to recruit people to do the annual canvass. That is something we need to bear in mind as part of a much longer-term transition of how we manage a process which was, after all, set up in the early 20th century and may not be entirely suited to the sort of built environment which we have in many areas of Britain. The resources are in place. The Government are committed to concluding the transition by the end of 2015, if all is in place. That will, of course, be subject to everyone with a stake in the process having confidence that this has been completed, certainly including the Electoral Commission, which has been closely involved so far and will rightly continue to monitor and comment as we carry through the process. I hope that I have answered all the questions. I will write to those who have contributed if there are any further questions that I have not answered. I commend the regulations.
Electoral Registration (Postponement of 2013 Annual Canvass) Order 2013
(11 years, 9 months ago)
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Lord Wallace of Saltaire
That the Grand Committee do report to the House that it has considered the Electoral Registration (Postponement of 2013 Annual Canvass) Order 2013.
Relevant document: 21st Report from the Joint Committee on Statutory Instruments.
The Deputy Chairman of Committees (Baroness Andrews)
My Lords, we will adjourn for five minutes to give the noble Lord, Lord Hunt, a chance to get here for the next debate. There has been a long Division, so he is possibly stuck somewhere. We will resume at 4.35 pm.
Children: Developmental Care and Autism
(11 years, 9 months ago)
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Lord Maginnis of Drumglass
To ask Her Majesty’s Government whether they have made any recent evaluation of the efficiency of administrative health units with regard to the provision, assessment and diagnosis of developmental care for children with special needs, particularly in relation to Autism Spectrum Disorder.
Lord Maginnis of Drumglass
My Lords, I appreciate the opportunity to raise the albeit touchy issue of government and administration—from my perspective, perhaps I should say government versus administration—particularly in so far as it impacts on the delivery of health services. Despite having been married to a nurse for the past 52 years, my analysis will not presume to deal with matters clinical but will very much deal with delivery, especially concerning early intervention and diagnosis relating to children with special needs.
Autism spectrum disorder—ASD—is an area that increasingly confronted me as a Member of Parliament in days gone by, when parents would come to me in desperation. Despite Kanner having defined the condition as long ago as 1943, I was unfamiliar with it even though I trained as a schoolteacher 15 years after that. I realised that there was virtually no departmental provision of any consequence. Therefore, when the Northern Ireland Assembly eventually got going and I was fortunate enough to have a colleague, Michael McGimpsey, as Minister of Health, I prevailed on him to such an extent to carry out an independent review of autism services that he asked me to chair it.
In response to a Parliamentary Question during direct rule, I had been told that in Northern Ireland there were 686 children waiting up to 35 months for assessment and diagnosis. That meant that children were virtually in school before they had the benefit of any meaningful interventions. Three years, often more, were lost—developmental years that could never be retrieved. I want to put on record my gratitude to Angela McLarnon, who at that time headed up the Northern Ireland cohort of around 600 health visitors; she was the one who made things happen. As a result of the review we carried out, we now have uptrained all our health visitors. No child waits more than 13 weeks before assessment and diagnosis, and every child gets a home visit for general developmental assessment at two years old.
I want to say two things at this point. The ratio of health visitors to the birth rate in Northern Ireland is roughly 40:1, while here in England it is 83:1. I know there is an idea that the number of health visitors will be increased by roughly 50% here in England but I contend that this country needs to be aiming at something like a 100% increase in health visitors if it is to have the same service as we have in Northern Ireland. We all know the lifelong importance of early intervention in special needs cases. Before anyone dismisses that idea on the basis that England is more urban than Northern Ireland, I will partly concede that point—but only partly. I calculate that the planned increase is at best 50% too little and that assumes that there is a comparable and specific ASD uptraining in place for all health visitors. Is that the case? I am sorry to bore everyone with statistics, but the situation and outcome needs to be assessed on the following basis. Health visitors in England should, on top of their other responsibilities, aim to make one general developmental assessment home visit per working week. This requires a maximum ratio in terms of annual live births to health visitors of 45:1; it should be no greater than that. I am talking about 16,000 health visitors, not the proposed 12,000 and certainly not the current, unacceptable 8,000 plus.
That is not the whole story, however. Given that 1.2% of live births will be children on the autism spectrum, English health services will cater for roughly 8,700 children with that condition every year. Extrapolate that to school age and each health visitor is being asked to monitor five children with ASD on an ongoing basis, which is twice the number we in Northern Ireland consider practical and acceptable. As a schoolmaster, I believe there should be an overlap between health and education, which does not properly exist today, particularly in this specific area. We should be talking about a monitoring process up to the age of eight. I do not expect the Minister to give me a detailed answer, but I hope that she will at least be able to reassure me that her department will take note of something that in my experience will help to meet our responsibility to those with ASD.
One final thought. Just like the rest of us, those on the spectrum fall within the normal bell-shaped curve; 7.5% brilliant, 7.5% significantly disabled and 85% who can live very normal lives. I am sorry to put it as crudely as that, but it is the challenge facing us today. The two year-old general development assessment is the key, not only to autism, but to a multitude of other conditions. I will not go through them all but they are conditions such as dyspraxia and dyslexia, which are often classified under the term “comorbidity”. Sadly, we no longer have answerable and responsible government as I once knew it. Over the past 20 years we have a mere delegating procedure and this is the challenge I ask the Minister to address today. Where among the disparate layers of the arm’s-length administration can we address this issue on a co-ordinated and cohesive nationwide basis? Is it among 10 strategic massive health authorities or among 151 primary care organisations that vary in population from less than 100,000 to more than 1 million?
I will conclude. If it is not the Government who are going to preside over and be answerable and accountable among this mish-mash of administrative units, are we condemned to another postcode lottery? The Minister knows that I am not targeting her personally, but if we are to have effective, early-life healthcare her department needs to face up to the real challenge of there being too many managers and not enough workers and to feel the accountability that pervades most of society today, not least our health service.
Lord Addington
My Lords, the noble Lord, Lord Maginnis, returns to a subject different facets of which I have heard him talk about before. Primarily, it is based on the self-evident fact that if you identify a problem early you stand a better chance of reaching a better outcome. So much for the rocket science involved in this, but it is quite obvious when you are doing that.
How do we do this? There is an assessment at about the age of two. The briefing I received referred to classical autism: those with certain patterns and conditions such as low IQ and behaviour that occurs. You are able to spot that by about the age of two. That probably fits more neatly into what the noble Lord was saying than anything else we will get across. Then, as the noble Lord again pointed out—he can feel free to shoot my foxes as there will always be another one coming along—that will not apply to everyone throughout the process, so assessing until the age of eight is another good idea. If somebody does not fit neatly into that classical band, it is not very obvious that they have a problem. For instance, if that person does not get much pre-school training, education et cetera, their problems may only manifest to a noticeable degree later on. Also, the level of training of the person observing them has to be fairly exact. As you go through the educational process, many people in the higher-functioning part of the autism or Asperger’s spectrum have problems that a teacher will observe not in the classroom but in the playground because that person will not socialise normally.
There has recently been a little splurge of information about autism in the papers. Some of it was accurate and some of it was not. Even a little test in the Times asked how far on the spectrum you were. If you got to 15 on this test, it said “Don’t worry, you are still quite normal”. I, in a dark moment on a train, took the test thinking, “I wonder how strange I will come out”. I only got 12, thought that was a bit low, went back and discovered that I should have marked myself at 10: it is one problem I do not have. But if we are going to do this, we need a way of assessing at various points where that intervention comes in. One of the classic ways for adults to be discovered on the Asperger’s spectrum is when they develop mental health problems: people who cannot cope with a normal environment.
Effectively, there are huge savings here for government. I thought all Governments were interested in savings, or should be. Let us face it, this Government will be more interested than most. That is not a position I particularly relish but it is the fact of the matter. If you get in reasonably early, you stand a better chance of being able to maintain the person throughout their education and working life. Indeed, there is a better chance of them being able to handle the bumps and bangs of relationships later on. Will my noble friend give us a rough guide as to what the level of intervention will be beyond that initial assessment at age two? If we just concentrate on autism, because other conditions will come in, exactly how much training will be required at the various stages of the education process? How much assessment is going on?
The National Autistic Society suggests that at least the SENCO in every school should have specific training in how to spot autism. Autism may not be the highest-occurring hidden condition, but it will certainly be there regularly throughout a teacher’s career. There should be better basic training so they are able to spot a condition and refer on—we do not want to create experts. They must also understand when they are given advice. Parliament is one of those places where occasionally, from a standing start, we are told, “Go and make yourself an expert”. Every person who has stood on their hind legs in this Palace has had that experience with something they had not come across. We all know that it takes time to get your head around a new problem or way of thinking. Unless that is instilled throughout the education and health services, with a basic level of understanding where one knows where to refer back to and where to refer on, you will not be able to do this. It would help if my noble friend could give us an idea of where we are on this and where we are going. This should not be a party political point or football. It should be a point of basic principle because unless you have just enough knowledge to be able to access and call in the help, you will miss this and do it late, causing secondary damage to that person’s life and costs to society.
Lord Hunt of Kings Heath
My Lords, I, too, thank the noble Lord, Lord Maginnis, for allowing us to have this important debate. He made some important points in his opening speech and I, too, should like to focus on early intervention. Both noble Lords made it clear that they regard it to be of importance. I agree.
I should also be interested in the Minister’s response to the point made by the noble Lord, Lord Addington, about the need for regular assessment after the initial early intervention. I was particularly taken with his remark that if you can have early intervention and regular assessment, your chances of helping people to have much better life outcomes is good not only for them, their families and loved ones but in terms of the likely demands on the state over the years. There must be a persuasive economic case for up-front investment. Perhaps the noble Baroness can respond to that.
As to the experience with health visitors in Northern Ireland and the comparison with England, it was extremely interesting to hear the ratios mentioned by the noble Lord, Lord Maginnis. I suppose that it raised a bit of prejudice about the funding that goes to Northern Ireland, but I shall desist from making further comments on that. Does the noble Baroness recognise those ratios because, on the face of it, your chances in Northern Ireland of having health visitor support is clearly much greater and more intense than in England? I do not know if the noble Lord knows the answer to this but, given the importance of speech and language therapy, I wonder if there is a similar issue about the number of those important professionals who can make a huge difference to people affected by this condition.
Lord Maginnis of Drumglass
I cannot help the noble Lord with figures, but we are certainly able to concentrate the demand for those interventions. They may relate to sensory issues, speech or all sorts of things. Those interventions can often be carried out in the home or school environment; they do not always require a medical practitioner—although, on occasions, they do.
Lord Hunt of Kings Heath
I am grateful to the noble Lord. One of the powerful points he is making is on the number of professions there are. It is also a question of organisation, and I should like to come back to that issue because I think he is suggesting that in Northern Ireland the stability of the organisation of health and social care enables a much more co-ordinated response to be given.
I want to come back to the English situation, which is worse than he stated because of the changes that are to take place from 1 April and are apposite to his comments. We have been given a very good research paper by the Library in anticipation of this debate. The briefing note refers to the report from Brian Lamb commissioned by the previous Government, the follow-on in this Government’s initiatives, and the identification in March 2011 of some of the problems—particularly of,
“parents having to battle to get the support their child needs … SEN statements not joining up education, health and care support … multiple layers of paperwork and bureaucracy”,
and,
“a confusing and adversarial assessment process”.
Clearly, it is very important that all these issues are tackled. We welcome the prospect of legislation and the publication of draft clauses, as well as the work done in Parliament to comment and reflect on those draft clauses.
I want to express some concerns, particularly in education. The Government have clearly identified gaps in services between different sectors, education, health and care support. My concern is with the demise of local education authorities as significant players in education in England. I remember when we debated the new Government’s first children Bill that there was particular concern about provision of SEN under the new structures. Does the Minister think—and how does she think—co-ordination of SEN in local authority areas is now happening with the reduction in authority of LEAs and the freedom of academies and free schools to plough their own furrow? I know that academies operate in accordance with the individual funding agreement and obligations are imposed on them, but it would help the Committee to know that the Government believe there is machinery at local level to ensure that there is proper co-ordination between schools, linking into the health service. I point out to the noble Baroness the recent Ofsted reports on the first tranche of free schools is not exactly encouraging about their performance. Could she help me in relation to whether Ofsted was able to comment on those schools’ responsibilities in relation to SEN?
It is clear, too, that the health service has much to do, and I fully accept that. Co-ordination between health, education and social care services is very important indeed. The noble Lord, Lord Maginnis, referred to the English situation as of now and to the 10 strategic health authorities and 190 or so primary care trusts. He referred to that as being a bit of a mess—but if we were coping only with the current structure. The fact is that from 1 April we are losing strategic health authorities and primary care trusts and replacing them with clinical commissioning groups, which are untried and untested. We are losing the essential leadership role of strategic health authorities, which are being replaced by local area offices of the NHS Commissioning Board. All the signs are that those local area offices neither want to nor have the capacity to give the kind of leadership that is required. So at the local level, within each local authority area, we have a worrying picture of, on the one hand, local education authorities losing a lot of the levers that they used to have, and, on the other, of a health service being broken up between lots of new and different organisations. It is very worrying in terms of the co-ordination required. Will the Minister reflect either now or in writing on how she thinks one can achieve a co-ordinated approach in relation to SEN, particularly in relation to the group that the noble Lord is mostly concerned with, in the new structures? That is the only way in which to get early intervention and the continuous assessments, which noble Lords believe should be produced.
Baroness Northover
My Lords, I am very grateful to the noble Lord, Lord Maginnis, for raising this issue and for introducing it so effectively. The noble Lord is right to emphasise the importance of this disorder, and he and my noble friend Lord Addington, as well as the noble Lord, Lord Hunt, are all absolutely right to stress the importance of picking it up early and supporting people from the earliest stages. As my noble friend Lord Addington points out, it is important to pick it up later and monitor the progress of a child.
I want to place special emphasis on the role that the new commissioning bodies will have in ensuring that children with special needs, including autism, receive the care that they need. I hope that I can reassure the noble Lord, Lord Hunt, in this regard. We know that there is a need to improve the early identification and assessment of special educational needs and thus remove the duplication and frustration which many families have encountered in securing an assessment. That is absolutely vital. We have already made progress in delivering the necessary improvements. For example, we have introduced an early years progress check for children at the age of two in order to pick up problems early and tackle them. Several noble Lords have mentioned this assessment. It is extremely important in terms of the early identification of autism. We recognise the importance of a key universal service for improving the health and well-being of all children through health and development reviews, immunisation programmes and so on. Between the age of two and two and a half, a child will have a full health and development review at which parents will have the opportunity to raise any concerns, ask questions, and prepare for the next stage of their child’s development. This can trigger the need for a formal SEN assessment which must include doctors, educational psychologists and paediatricians if that seems to be necessary.
Lord Maginnis of Drumglass
Before the Minister moves on, can she clarify one point? Is this a procedure whereby parents will be aware that they can shop, if I can put it like that, for this sort of support or is it something that every single two year-old will be given as a matter of course?
Baroness Northover
It is planned that every two year-old will have that kind of assessment. It is extremely important not only in terms of autism, but for picking up other problems.
The noble Lord, Lord Maginnis, asked about the availability of health visitors. To support the delivery of the Healthy Child programme, we are committed to expanding the number of health visitors—he is quite right about their importance—by a further 4,200 full-time equivalents by 2015 and to develop health visiting services in order to improve health outcomes and reduce inequalities.
We recognise the pressing need for a new system of commissioning special educational needs provision, so I hope that noble Lords will be pleased to hear that the Children and Families Bill will introduce this. The provisions of the Bill will build on the new approach to commissioning introduced by the Health and Social Care Act 2012. They will introduce an integrated approach to meeting the needs of children and young people with special educational needs, requiring CCGs and local authorities to make joint commissioning arrangements and focusing on a single, co-ordinated assessment involving a range of professionals. Moreover, these arrangements can include people up to the age of 25. It is extremely important that they should go beyond the transition points that others have found to be problematic. The assessment process will result in an individual education, health and care plan. I hope that noble Lords are pleased to hear about this because it will bring together the health and education sides. The process will be focused on improving outcomes for the child. The commissioners, working together, must agree their relevant contributions to delivering the plan, and they will have to work out who is going to be responsible for the different elements.
These plans will not be developed in isolation, of course. The boards and the CCGs will co-operate with relevant local authorities and participate in their health and well-being boards. Each board will provide a forum for the effective assessment of local need, and special educational needs will be part of that so as to ensure the translation of those commissioning plans and arrangements into something that is effective. Health and well-being boards will undertake a joint strategic needs assessment and a joint health and well-being strategy for the local authority area. The CCG will draw on this in developing its annual commissioning plans. Moreover, health and well-being boards will help to ensure the accountability of CCGs by giving their opinion on the extent to which the commissioning plans take account of the local strategy and how the CCG has contributed to its delivery. Noble Lords need to bear in mind that special educational needs are in there, and they have to assess what is being provided against that.
The new arrangements will be introduced in 2014, depending on the passage of the Bill, but a number of pathfinder local authorities are working with local children and their families in piloting new approaches. As the noble Lord, Lord Hunt, will be aware, the mandate for the NHS for the next two years has indicated the particular need for improvement, working in partnership across different services in supporting children and young people with special educational needs and disabilities. In particular, it gives the NHS Commissioning Board the objective of ensuring that children have access to the services identified in the agreed care plan. I hope that that will reassure the noble Lords, Lord Maginnis and Lord Hunt.
We are also amending the Children and Families Bill to place a duty on CCGs to secure the necessary health services in an education, health and care plan. This is a significant step, and highlights how much importance we attach to ensuring that the NHS delivers the right service for children with special educational needs.
We want to ensure that CCGs and local authorities, as commissioners, and the health and care professionals who provide assessments and diagnoses are supported, particularly in relation to their education and training. The noble Lord, Lord Maginnis, is absolutely right to stress the need to link up health and education.
For the past two years, the Department for Education has been funding the Autism Education Trust to develop tiered training materials for schools, as well as national standards for provision for children with autism and a competency framework for those who work with children with autism. These are relevant points for the noble Lord, Lord Maginnis, and my noble friend Lord Addington.
The new qualified teacher standards came into effect in September 2012. These have sharpened the focus on meeting the needs of children with SEN and disabilities. The Government have also strengthened initial teacher training and continuing professional development provision through the publication of additional online training materials for teachers of pupils with the most common and complex special educational needs, including autism.
We have also highlighted the importance of having good quality data that measure the outcomes which are most important to children and young people and their families. The work of the Children and Young People’s Health Outcomes Forum has informed actions across the health and care sectors to identify the best indicators of outcomes for this group, particularly in relation to the time taken from first presentation to diagnosis. The noble Lord, Lord Maginnis, highlighted this as being a problem, particularly in the past, which we certainly do not want to have repeated; we want to address that. One element of this is ensuring the effectiveness of transition at different life stages, particularly from children’s to adults’ services.
The recent University of York report into transitions for young people with autism highlighted that we need to do much more to support young people in planning for leaving school, gaining employment and living independently, while maintaining good health. The NHS Outcomes Framework for 2013-14 includes the forum’s proposal that all data should be presented in five-year bands up to the age of 25 to enable the effective monitoring of that transition. That is quite a significant change. Here, too, I want to reassure my noble friend Lord Addington in relation to those children whose need for support does not become apparent until they are well established in school. The Government’s approach is to strengthen awareness in schools through staff training; for example, extended placements in special schools for trainee teachers. We want to ensure that needs are detected as early as possible, but I emphasise that at any point the school can request an assessment by the local authority. The education, health and care plan approach provides a basis for taking an all-round view of the children’s needs across different sectors. Of course, schools are providing additional support for many children through teaching assistants.
Lord Addington
My Lords, teaching assistants have rather a patchy record when it comes to implementing the current statementing system. For instance, there is a nasty tendency for them to become a babysitter for a child who is having trouble within the class. I suggest the Government should look at this because it is something that has been going on for years. Unless you get that person trained to at least implement the strategy across all disabilities, it will not deliver the required outcome but may simply keep the child out of the way of the teacher.
Baroness Northover
The teaching assistant may be assisting with other children while the main teacher focuses on those with particular needs. My noble friend is absolutely right that it is extremely important that the right and appropriate support is given according to what a child needs, which is why those plans I mentioned are so important.
Partnership working will be the key to making a difference. We want to work closely with partner organisations, such as the Council for Disabled Children and the National Autistic Society. However, the most significant partners, if you can call them such, will be the patients and their families. The joint arrangements for assessment will be built around the individual; it is a bespoke plan tailored to the needs of the individual and agreed with them and their family.
I am afraid I am running out of time and I will write on any points that I have not picked up. I want to emphasise, however, that clinical commissioning is built upon patient involvement particularly for this group, whose needs have not always been well met in the past. This will perhaps be the most important factor in ensuring they get the care and support that makes the difference to them.
Police: Performance Indicator Management
(11 years, 9 months ago)
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The Earl of Lytton
To ask Her Majesty’s Government what is their assessment of the response of United Kingdom police forces to performance indicator management with particular reference to the reliability of published United Kingdom crime figures.
The Earl of Lytton
My Lords, I am very grateful for the opportunity to debate this issue and to those noble Lords who have added their names to speak. My interest in policing is a parliamentary one; the police interest in me, I hope, is no more than my firearms and shotgun licences. However, were it not for the work of the late Lord Corbett of Castle Vale, to whom I pay tribute, I doubt if I would be speaking on this subject today.
We have heard a great deal about the police recently but I would not wish to appear anti-police. I am certain that the vast majority of serving officers are diligent and honest. Rather, my Question is about the organisational environment in which they operate. Many corporations use performance management but the public service often lacks suitable external benchmarks. Dr Barry Loveday, professor of criminal studies at the University of Portsmouth, in a 2008 article in Policing magazine, described performance management as,
“commitment not to an organisational vision but to conformity in both running and delivering services … The primary emphasis here is directed to the effective management of targets rather than on qualities of leadership”.
He goes on to say,
“‘Gaming’ techniques now characterise the operation of most public service managers … the primary purpose is not … to demonstrate leadership … but to ensure conformity to the target culture by ‘managing’ such data in order to reach targets set”.
However, it is also the collectivisation of risk, anonymity, abrogation of individual responsibility and denial of leadership. The police are not alone; large parts of the public sector, especially in areas of health and education, are affected. Under the Police Reform Act 2002, the Secretary of State sets National Policing Plan objectives and priorities but there is no benchmark equivalent to the hospital standardised mortality ratio.
“Gaming” is academic speak for numerical, definitional or behavioural means of presenting figures to suit outcomes and its use in police recording of crime is the specialist research subject of Dr Rodger Patrick, a former detective chief inspector in the West Midlands force. I have seen his doctoral thesis, his evidence to parliamentary committees, noted the coherence of his analysis and the absence of contradiction by others. His referees testified to his credibility. I therefore invited him to address interested Peers last month and have placed in the Library my note of his talk with its links to further information.
He identified four categories of “Gaming”. There is “cuffing”, so called after the magician’s act of making things disappear up the sleeve; in other words, making crime figures disappear altogether by, for instance, not recording some types at all. In “nodding” figures are enhanced, notably by getting offenders to admit by a nod to other offences to be taken into consideration, or TICs. “Stitching” is coercing suspects to confess to guilt under threats or perhaps promises of more lenient treatment. “Skewing” involves applying resources solely to whatever targets are being measured to the exclusion of others; it is the principle of “what does not get measured does not matter”.
Such issues were brought to the attention of HM Inspector of Constabulary as long ago as 1998, but little if anything has altered since. In its 1999 report, HMIC repeats the police viewpoint that:
“Any bending of the rules is ... seen as ... not being for personal gain but to protect society, and therefore not at the worst end of corruption”.
It rejected this justification but recognised the problem.
Dr Patrick has attempted to quantify the effects of gaming. His conclusion that it is an endemic organisational phenomenon rather than the activities of a few officers makes for uncomfortable reading. The Office for National Statistics thought that cuffing alone might cause a 16% underrecording of crime; Dr Patrick considers that it is likely to be far higher. The truth is that we do not know and the change from an evidential to a prima facie basis of crime recording further confuses the issue.
Unsurprisingly, last January’s ONS national crime survey was received with disbelief by criminologists and it was subsequently admitted that the recorded figures might be defective. But the ONS relies on police figures and the appearance of a decline in crime fits the purposes of many others. Did Her Majesty’s Inspectorate of Constabulary advise Home Office officials about the extent of a problem going back many years? If so, why has so little changed? Can we be sure that the figures form an adequate basis for analysis? If they are not founded on fact, truth and logic, how can Ministers and Parliament rely on them? Furthermore, what is the role of Home Office officials and statisticians in the oversight of police recorded crime, given the ONS admission? Is it true that cross-checks on police recording, formerly part of the British Crime Survey process, have been discontinued, and if so, why? If the figures are in doubt, what else may be in question?
The list of high profile cases reads like a roll call: Hillsborough; North Wales care homes; the Bradford sex trade; the theft of child identities; the retention of body parts without consent and falsification of evidence; the sale of confidential information to the media; and the cases of Michael Atherton, Andrew Mitchell, Jimmy Savile and Lynette White. All identify procedural, evidential and investigative failure and have attracted public criticism. In the Daily Telegraph of 22 December last year, Andrew Gilligan pointed to seven police forces where sackings, forced resignations, suspensions and criminal investigations of chief constables had occurred, with almost as many more deputies and assistants under a cloud. He put the level of “infection”, if I can call it that, at 20% of police forces. I am hoping that other Lords will pick up on the issue of informal cautions, local criminal records and non-sanction detections. I would simply ask Her Majesty’s Government: what data do police hold on people and what independent oversight exists? Have things improved since 2007 when the matter was raised with the Information Commissioner?
Even if the position has been exaggerated, it adds up to a very disturbing picture with significant implications for the taxpayer, national policy, the maintenance of law and order and, last but not least, public confidence. On regulation and oversight, I note that the Home Affairs Select Committee recently described the Independent Police Complaints Commission as,
“woefully underequipped and hamstrung in achieving its original objectives. It has neither the powers nor the resources that it needs to get to the truth when the integrity of the police is in doubt”.
While the Home Secretary moved with what I can only describe as commendable speed to strengthen the commission, I must question whether she went far enough to address all the issues.
As to HMIC, its report of a review into allegations about intelligence concerning the Jimmy Savile case highlighted failings in the quality of investigations and sharing of information. However, it has repeatedly expressed concerns on similar matters since the late 1990s. What is this? Is it a resource issue? In July 2011, it was asked to review police integrity. Can the Minister tell us where that review has got to? I believe it is too early to expect the police and crime commissioners to have taken significant action, but I hope they will be reading this debate carefully and that these matters do indeed lie within their remit. We learnt only last week of some close relationships between health service employees and allied business and procurement services that might be a conflict of interest. Are the Government satisfied that this is not also a factor in the police?
I now refer to the Association of Chief Police Officers. It is more than just the senior policeman’s trade association and, until recently anyway, has been in receipt of substantial public funding. It makes strategic policing decisions, guides policy and issues procedural guidance. It is immensely influential on police force co-ordination and in international crime. In some respects its work is akin to that of a government agency and its relationship with government should be open. Even now, as its direct funding is reduced, I learn that it is asking police forces for a large increase in its subscriptions. But this is still taxpayers’ money and requires full accountability.
I am led to believe that fees for security checks and the like end up in an ACPO unit or subsidiary, that there are several operating under its umbrella and that significant sums of money are involved. I am also told of persistent resistance to Freedom of Information Act requests. It is time for full disclosure of ACPO’s affairs, its companies, subsidiaries, directorships, accounts and activities—everything that either involves taxpayers’ money or is as a result of a public or quasi-public activity. Can I have the Minister’s assurance that this will be done?
I do not have a problem with commercial activities offsetting costs to the public purse but I take issue with the involuntary merchandising of personal information other than in the clearest overriding public interest. I take exception when the process lacks transparency.
The Earl of Lytton
My Lords, continuing where I left off, I was talking about the commercial activities and how I took some exception to the fact that the process lacks transparency and oversight. I also point to the secretive nature of some of these activities, which suggests something to hide.
Many other issues have come to my attention, including: tow-away, vehicle recovery and storage contracts; insurance industry concerns; and a degree of partiality, particularly as evidenced in the BBC programme “You’ve Been Trumped”, where police simply failed to protect residents from the most serious bullying and harassment by golf course developers.
If the Home Secretary’s statement on police integrity was intended to draw a line in the sand, I hope that the Government realise that nobody is fooled and there is very much more to be done. If the police are not straight with us on the crime figures, how on earth do we know what is going on? Secrecy has no benign purpose here. We need transparency, good professional practice as the norm, compete legality and accurate recording as a basis for policy decisions, and we need it now.
Lord Whitty
My Lords, I will make one or two of the same points as the noble Earl, Lord Lytton. Unlike some other Members who are going to speak today, I do not have great experience or expertise in this field. With one or two exceptions, my relationship with the police has been generally okay. I am merely a concerned citizen here, in that I really want to know what is happening to crime in this country. Politically, both this and the previous Government congratulated themselves on a falling level of crime. I did not seriously query this claim until recently.
Of course, government and police claims of crime reduction have always been treated with a degree of cynicism by the general public. Public perception of crime rates in all neighbourhoods tends to exaggerate the degree of actual crime. Of course, there are horrendous crimes, which receive massive publicity. Although harrowing to those immediately concerned, as I know, these are probably not typical. There is a general public perception that the level of particularly low-level crime is higher than the police and the Government claim.
Sometimes the police go over the top. I am told that the South Wales Police notepaper says that crime is the lowest for the past 30 years. I doubt that anybody in south Wales actually believes that—nor would people in Dorset or the City of Westminster. There is a credibility issue underlying this, and some of it has a good statistical basis because of the way in which the police record crime as against, for example, the crime survey and the way that victims see their complaints. So there are some rational explanations for it.
However, I was quite alarmed to see that the ONS itself was seriously querying the degree of crime reduction. That is probably where I am. I probably logically accept, despite the psychology of it, that there has been some reduction, but it is the degree. There was quite a significant difference between the police figures and the other figures to which the ONS referred. The ONS gave a number of quite good reasons for this but at the same time I became aware of the work of Dr Rodger Patrick, to whom the noble Earl, Lord Lytton, has already referred.
According to Dr Patrick’s analysis, some crimes are no longer recorded on the basis of reporting by victims or the public but on the evidential assessment of police officers and on the balance of probability. That was always the case with third party reporting but used not to be the case where victims themselves reported. Other cases are lumped together and given the same crime number to appear only once in the statistics. Minor crimes can go unreported altogether: some are on a local crime data list; some are subject to informal caution and are cleared, one way or another, and do not get into the national statistics.
Meanwhile, on the detection side, issues such as “take into consideration cases”, to which the noble Earl, Lord Lytton, referred, are sometimes lumped together as solved or cleared as a result of a deal with a defendant or prisoner, without real conviction and due process. I have read parts of Dr Patrick’s analysis, and I have no way in which to assess the validity of all this or how widespread it is. But it is also true—and this is in the title of the debate—that with some crimes under the last Government there was a drastic fall, following the introduction of targets and performance management criteria. That might mean different things: it might suggest that the target culture was instantly incredibly successful in increasing overall efficiency against targets; it might suggest that the priorities and resources were, as in other public services, concentrated on those areas that were measured and defined as targets while other areas were left underresourced; or it might mean—and this is something that we regrettably know about in bits of the NHS—that figures were reclassified or manipulated to exaggerate performance improvement.
What we need to know from the Minister tonight is two-fold. Does he recognise the figures on descriptions of malpractices in individual police forces to which the noble Earl referred? What arrangements for quality control and challenge of statistics coming from individual police forces are there in England and Wales? Secondly, I recognise that the Home Office and the ONS give guidance to the police on how to record crime, but who checks the compliance? Is it the police authority, the new police commissioners or the Inspectorate of Constabulary? What is the role of the Police Support Unit—or is it the ACPO high command, or the Home Office itself? How does it work and, in particular, how far is it guided, checked and quality controlled by non-police bodies, or is the guidance and advice from ACPO to chief officers dominant? Like the noble Earl, I have some concerns about the role of ACPO in this area.
There are also reports that those who query the current system, whether from within the police force, from community bodies or even from the Home Office, suffer repercussions—they have been victimised or moved to other duties. Is the Minister aware of such allegations, and what would he instruct the Home Office to do about such allegations? I have to phrase this in the form of questions, partly because of the difficulty of proof and partly, frankly, because of the litigiousness of some of those who defend their position. But these are questions that the Ministers in the Home Office and, perhaps, the Ministry of Justice, need to ask.
The present Secretary of State has made two key decisions in relation to crime statistics and performance. First, she transferred responsibility for oversight and reporting of crime statistics after 2011 from the Home Office to the ONS. That is a very sensible move, which will probably pay off in the long run. However, the ONS analysis is only as good as the statistics that come in. Unless we can improve the accuracy and integrity of all sources of information and eliminate natural bias and contrived distortions, the ONS and Ministers will still be working on flawed systems of statistical records, and hence a flawed evidence base. Secondly, the Home Secretary determined that the police service should move away from target-based performance indicators and, in the light of experience, we would probably think that was the right move as well. But local commissioners will still need authentic, undistorted statistics on which to make their decisions. If not, we are going to end up in the worst of possible worlds, where there are no performance targets, but the police go on recording the same statistics in the same way.
It is time that we had a proper analysis of this—the review by the ONS goes just so far. But as the noble Earl said, unless we are confident in the statistics that we receive, bad statistics will distort the basis for operational decisions by chief officers and strategic decisions by police commissioners and distort the very basis on which Home Office Ministers and officials make national policy in England and Wales. We need a new, expert review, probably judge-led, without an axe to grind, distinct and separate from the police force itself, and we need it soon.
Earl Attlee
Can the noble Lord conclude his remarks very soon, because he is completely out of time?
Lord Whitty
If I am completely out of time, I shall just say that a push for such an outcome needs to start from the proceedings here today.
Baroness Harris of Richmond
My Lords, I thank the noble Earl, Lord Lytton, for bringing forward this important debate this afternoon. Before I begin, I remind your Lordships of my former interests in policing matters. I have been involved in policing for over 30 years and a member of my police authority for 20 years, chairing it for eight of those. I was a deputy chair of the Association of Police Authorities, a member of the Police Negotiating Board and the Service Authority for the National Crime Squad and I sit on the Independent Police Commission. Of course, I speak here in a personal capacity only.
The Home Office ostensibly set only one policing target when the current Government came into power: to cut crime. The previous Government did much the same: to improve confidence in policing. Yet under both these seemingly simple and unbureaucratic targets lay a plethora of indicators, with more targets, measures, priorities and the like. Police authorities were bewildered by their complexity but had to comply with them through their policing plans for their local communities.
Then, about a year ago, the Home Office handed all responsibility for analysing crime statistics to the office of the National Statistician, the ONS. The idea was to make the collection and analysis of data more transparent and at a stroke reduce public scepticism about crime statistics. We must not kid ourselves that the Home Office does not continue to collect large amounts of performance and crime data. It needs to, to inform the collation of performance statistics nationally. Some of these data are used to support the crime mapping tool on www.police.uk that enables local people to check crime in their area. That is a very good thing. The data inform the national performance monitoring functions of Her Majesty’s Inspectorate of Constabulary—HMIC. There is also the Crime Survey for England and Wales—formerly the British Crime Survey—which is carried out independently.
Historically—certainly during my years working in the policing environment—there have always been problems with the way in which crimes are recorded in different forces. The former Audit Commission and more recently HMIC noted significant variations in practice and an unacceptable level of mistakes, as we have heard. Commenting on the analysis of variation in crime trends published by the ONS in January this year, the Association of Chief Police Officers—ACPO—recognised possible reasons why the variations existed. It cited,
“potential over-zealous recording practices in the early years of the national standard in crime recording being introduced as well as the move to neighbourhood policing teams resulting in more low-level crimes being dealt with informally and outside the formal crime recording system”.
Be that as it may, the general public need to be assured that crime figures accurately reflect what they see happening on the ground. It would appear that there is a great deal more work to be done to convince people that the police are performing at a consistently high professional level. In some parts of the country, that clearly is not happening. We know from the many recent press reports that concerns are being widely expressed about significant underreporting of crimes such as rape and violence against women, about 101 calls not being answered in a timely and professional fashion and about complaints about police corruption not resulting in any prosecutions, et cetera.
The flurry of media reports of bad policing up and down the country—more in the past two years than I can ever remember during the whole of my time on a police authority—truly grieves me. It is shocking to read of the bad behaviour of some police officers, possible corrupt practices and abuse of the very special powers of a constable. These people have no place in today’s police service and should be rooted out quickly so that the vast majority of utterly professional and dedicated police officers—who, incidentally, deplore this behaviour but seem powerless to stop it—can do the job that they are asked to.
Which forces are using these methods and what will the Government do to get to the heart of these allegations? Will the Government conduct an assessment of the policing and crime plans due to be published imminently to see whether there are any patterns, commonalities or significant areas of difference emerging, especially in those forces where problems may have arisen? Can the Minister say what has been done to encourage other government departments to promote the duty to co-operate with the police and crime commissioners among partner organisations? My feeling is that they will need to be able to develop a coherent range of cross-sector services, matched to the needs of their local communities. It should also help working with other agencies to try to answer some of the concerns that have been expressed here this afternoon.
If it is a matter of culture change—how often have I heard that expression over my years in policing?—the College of Policing must begin to address this as a matter of critical importance. Will the Minister ensure that, where actions need to be taken in regard to forces within which rogue officers are found, they are undertaken as a matter of urgency, and will he seek the help of HMIC to consider undertaking thematic inspections of those forces where these problems appear to be arising?
Lord Maginnis of Drumglass
My Lords, I am grateful to the noble Earl for raising an issue that, however one dresses it up, amounts to a system that encourages carelessness, misrepresentation and possibly even corruption among today’s police service. I come here with more than 50 years of policing experience. I first donned a police uniform when I left college in 1958 and I served until 1965. Then, as a commissioned Army officer from 1970 for almost 12 years I liaised daily with the RUC and, when I came to Parliament, I acted as its parliamentary adviser. My natural instinct is pro-police.
I spoke during the previous debate about how arm’s length government has now become, and how remote and ineffective are the multiple layers of delegated accountability so that most of us no longer believe that the Home Office is in control. Certainly the elected commissioner aberration, rather than representing better management, is but another waste of resources, as the electorate have made very clear.
I want to give a practical example of how command responsibility has been eroded to a point where accountability has become little more than a paper exercise and, bluntly, of how this is leading to carelessness, mistakes and, ultimately, corruption. I am not even talking about a Hillsborough or a Savile. I want to talk about a conman called Mark Heslehurst, who has been able to use the Cleveland Police for nigh on a year in order to persecute a local councillor, Councillor Joan McTigue, because she, although initially sympathetic to his story that his son has been abducted to Cambodia, eventually saw through his intrigue and challenged his attempts to extract money from a sympathetic community.
Quite independently of Councillor McTigue, I met Heslehurst, made a few simple inquiries and came to a similar conclusion. I do not have time today to go into his cover story in detail. My complaint is that Cleveland Police have, on behalf of Heslehurst, exclusively concentrated their inquiries to the point of harassing a local councillor, a lady who worked in education and is now semi-retired. Yet Heslehurst, using various aliases—for example, Ian Blagg, who by coincidence tweets with exactly the same grammatical and punctuation errors as Heslehurst—is allowed free rein to publish outrageous claims against this lady and against me.
Community compassion has enabled Heslehurst to travel to the United States and to stand for the Middlesbrough parliamentary seat after the death of our late friend, Stuart Bell, an individual who, like Councillor McTigue and me, was badmouthed by Heslehurst because he was too astute to fall for this conman. Enough about Heslehurst—I am running out of time, but I can provide the Minister with literally reams of evidential material.
What I must ask is why Cleveland’s Sergeant Copley seems to concentrate only on the actions of Councillor McTigue, to the extent that he has seized and held this lady’s computer for the past four months, but has found no reason to do likewise with Heslehurst’s, despite the fact that she and I are blackguarded on an almost daily basis. When I spoke about this to Inspector Wrintmore, he told me that the matter was awaiting a decision from the north-east Crown Prosecutor’s office and that it had asked for more information. However, that is not true. Let me read from two letters that I received from the CPS. On 19 February the deputy CCP wrote to me saying:
“I confirm that the CPS has now given the police early investigative advice … I appreciate your concern regarding the impact of the case on Cllr McTigue … the matter now rests with Cleveland Police”.
Just a few days ago, on 14 March, he wrote again, saying:
“As the only offences under consideration are triable in the magistrates’ courts, the decision as to whether someone should be charged falls to the police”.
After months of aggravation, this was very useful in terms of police statistics but of absolutely no public benefit.
If I had time, I could tell a similar story about an 83 year-old lady in the North Yorkshire Police area, where police have conspired to ensure that she is kept out of her home and where those who have tried to help her, particularly a Tim Hicks, have been threatened with arrest, only to find out when he came on an errand from Luxembourg to face that charge that it was merely an intimidating bluff.
In conclusion, I had similar personal experiences with the Met and the PSNI when I was threatened with arrest due to totally unsubstantiated complaints of assault. Do I look like I would assault anyone? I shall leave that. Once in a Committee Room here, it was alleged that I assaulted someone and that there were more than 45 witnesses, but not one turned up. It also happened once after I gently reprimanded a road hog. That is two more non-offences solved. I rest my case.
Lord Condon
My Lords, I am not sure how I follow that, but I will do my best.
I thank the noble Earl, Lord Lytton, for raising this important issue and I am sure that he will not be surprised if I do not buy entirely into his rather pejorative view of modern policing. Even though I am 13 years into retirement, I still believe passionately that the vast majority of police officers are honest, decent people doing a very good job. I declare my registered interest in policing and as a former police commissioner.
Performance management is vital in the public and private sectors, both of which I have worked in for the past 40 years. Performance management drives improvement, can provide transparency and comparability, and ultimately assists accountability. However, I agree with others that for too long reported crime figures have been overrelied upon as the most important police performance measure, despite their fragility as a true reflection of crime levels and their vulnerability to manipulation and massaging by rogue police officers. Others have spoken about that.
Many years ago, as a young and new Chief Constable of Kent Police, I tried to broaden the basket of police performance measures beyond the traditional crime figures. After wide consultation with the public in Kent, three additional measures were regularly published by my force: first, on the police response to emergency calls; secondly, on visible and reassuring police presence and availability on the streets; and, thirdly, on overall public satisfaction with Kent Police. That force became the first and only police service to be awarded a Citizen’s Charter for its overall service to the public, and I think that that was partly because we did not overrely on crime statistics.
Reported crime in recent years, however, has fallen throughout the developed world. Despite wide variations in police resources, methods and accountability, there has been a relentless fall in reported crime in all the major developed countries. Why has crime fallen? Policy, police and government issues have clearly helped, but I firmly believe that the main reason is the significant advances in technology and product development that have dramatically changed the volume and patterns of theft. For example, new cars are now very difficult, if not almost impossible, to steal. Pin numbers and other anti-theft characteristics have dramatically reduced the motivation to steal electronic goods. If you cannot use or sell an item you have stolen, what is the point of stealing it? The volume crime of theft has dropped dramatically throughout the developed world.
Similarly, and even slightly frivolously, there is scientific speculation that the removal of tetraethyl lead from petrol and the consequential reduction of harmful pollution to babies has led 20 years later to reductions in violent crime levels in developed countries such as the United States, the United Kingdom, Canada, Australia, New Zealand, France and West Germany. There are very strong correlations between improvements by not using lead in petrol and dramatic reductions in violent crime.
Moving on to police manipulation, the perhaps understandable but flawed overreliance on crime figures has also led to the manipulation and massaging of crime figures by some rogue police officers. During my first few weeks as Chief Constable of Kent, I had to deal with a major discipline case involving Kent detectives who had been visiting convicted burglars in prison. Through various inducements such as taking them out for the day, letting them meet their girlfriends and extra cigarettes, the detectives got them to admit to crimes they had not committed, thus fraudulently improving the Kent crime detection figures.
There is an overreliance on crime figures with not enough being done to prevent fraudulent behaviour. What should be done to improve the situation? I think that the Government have already taken some important steps, including the transfer of responsibility for the independent reporting of national crime statistics to the Office for National Statistics. That is vitally important. Improvements have been announced to the British Crime Survey. Transparency through making changes to the collection of crime statistics is, as I say, very important. I also welcome the statement by the Minister for Policing and Criminal Justice earlier this month about changes to police recording practices and how crime will be recorded. Some of those changes will come into effect from April of this year, with others to follow in April next year.
In conclusion, it is vitally important for all stakeholders in this arena to acknowledge the strengths, limitations and frailties of recorded crime statistics. Crime figures must not be the only significant proxy for police efficiency. Of course good policing and intelligence-led policing help to reduce crime, while equally, bad policing and confused priorities allow crime to flourish. However, reported crime is only a part, albeit a vital part, of measuring police performance. It does, has not, and will never provide the full picture. ACPO, the inspectorate, the Home Office and now the new police and crime commissioners must accept the limitations of crime figures, and they must give clear and unambiguous signals that only the highest ethical standards are acceptable in recording crime and detection figures. They must be ruthless in dealing with malpractice by rogue police officers, whatever the motivation for corrupting crime figures. It is wrong, however they try to justify it, such as by using the euphemism of “noble cause corruption”. These abuses must be exposed and dealt with.
I am confident that the Minister will be able to reaffirm the Government’s commitment to improving standards in this area and that, with the support of the police service, further improvements will be made. This is a vital area which impacts on public confidence in policing.
Lord Laird
My Lords, I, too, thank the noble Earl, Lord Lytton, for securing today’s debate. It is a good opportunity to express some opinions that a lot of us feel strongly about.
I have become increasingly worried about the build-up of resentment over actual or perceived corruption among police forces the length of this country. Corruption, where it exists, affects only a tiny part of the police service. Thankfully, this point has already been made. The majority of police are honest and decent, and it is for that majority that I would like to know from the Minister if he will set up a whistleblowing scheme for officers, preferably independent from the police service.
I have been made aware that some South Wales Police officers have contacted non-Welsh Members in the other place with their concerns over the improper actions of supervising officers or undue pressure to undertake actions that conflict with their oath to Her Majesty the Queen or their professional judgment. These actions have done much to damage the image of the police.
I am told that the police nationally now adopt a process of informal cautions. This apparently allows them to hold a database of information as a local criminal record. Does this enable them to circumvent the DNA issue and to hold such material indefinitely? Such local data are not accessible via the police national computer and do not necessarily show up on a standard Criminal Records Bureau check or on enhanced disclosure or subject access requests. Persons entered on these databases usually have no idea what is logged or why, and cannot challenge the accuracy of something that could easily affect their personal finances, employment or later be dragged up in court proceedings or other activities.
This practice has apparently been going on since 1997 and was raised in correspondence in early 2007 between Ken Jones, ACPO’s president, and Richard Thomas, the Information Commissioner. I gather that even a fixed penalty notice or a police warning letter is sufficient to trigger a “non-sanction detection” and resultant entry on a computer. Needless to say, the Information Commissioner was most concerned and I would like to know if this issue has been addressed. Does the Home Office know how many such databases are operated by police forces or associates, what they are used for and how they are authorised, and will it ensure from today that all data are disclosed to those whose names are so held? Further, is it going to regulate the activity and insist on a formal register?
I now turn to south Wales and a matter that I last raised on 15 May 2012 in a debate on the Queen’s Speech. It would appear that little attention was paid by the Home Office to my comments, nor did it take steps to use the powers it already has or, if necessary, to seek new regulations. South Wales, its police force and the independence and governance of its commissioner concern me. It seems that the chief constable, Peter Vaughan, was part of the selection panel for the deputy and assistant commissioners, the deputy being a political appointment. I do not feel comfortable with this, or with the appointment of his former ACC, David Francis, as assistant commissioner. Surely this process should have been free of cronyism? I thought that the idea was to introduce independence and new ideas.
What I previously called systemic corruption by a small number of that force’s officers seems to have been endemic in the area for many decades, and now appears to have been compounded. I wrote to Assistant Chief Constable Matt Jukes on 17 July 2012 and in that letter I included a number of FOI requests, which he neither answered nor acknowledged receipt of in his reply of 10 September 2012. I therefore submitted a complaint to the Information Commissioner for him to pursue answers in full. The answers to the FOI requests appear to have been blocked by the sector inspector for east Cardiff, Inspector Nicky Flower, whose actions and management they concern.
An appalling case happened in south Wales that was very similar to the type of case that the noble Lord, Lord Condon, was referring to in Kent. A young person was taken out of the prison in Bridgend and treated in the sort of way mentioned by the noble Lord, Lord Condon, except that he was plied with four cans of cider and then asked to agree to a considerable number of “taken into consideration” dwelling burglaries that he had not committed. Unfortunately for the police officers doing the questioning, the young chap was actually in police custody on the days concerned. The two detectives received written warnings only as a result of the IPCC investigation; the chief constable would have exposed himself if he had committed the officers to trial. Why am I not surprised? How long do we have to wait for a criminal judge or judges to be appointed by the Home Office to carry out a root-and-branch investigation of that force?
The Parliamentary Under-Secretary of State, Home Office (Lord Taylor of Holbeach)
My Lords, I begin by thanking the noble Earl, Lord Lytton, for tabling this Question.
Lord Taylor of Holbeach
My Lords, I began my few words before the Division by thanking the noble Earl, Lord Lytton, for tabling this debate. It has proved to be really interesting, quite hard-hitting and in many ways quite outspoken, but not any the worse for that. It is good that we have been able to air these issues in such a frank way. It says a lot for this House that we can do so. I hope I will be able to reassure noble Lords that what is on the agenda at the Home Office is what all noble Lords have indicated as being the direction of travel that they believe policing in this country must go in.
A lot of points have been raised. I doubt that I will cover everything but I will write a general commentary on the debate and circulate it to all Peers who have spoken so that everybody can see the responses to those matters to which I do not know the answer or have not had time to provide an answer.
I start from the position of being very proud of our police officers. Every day they put themselves in harm’s way to protect the public. Thanks to their hard work and the reforms that the Government have brought forward in the police service, the police are succeeding in their core mission to cut crime. I do not think there is any dispute about that achievement. They are also coping with a difficult financial situation. All public services—and, indeed, business as a whole—are having to cope with the economic situation and the need for deficit reduction.
Before going into the detail, it might help to place the importance of the integrity of crime recording within a wider context. As noble Lords know, this Government have undertaken a radical programme of police reforms that have placed local crime concerns and priorities at the very heart of policing. Our reforms have put an end to Whitehall interference and bureaucratic accountability and introduced a new era of democratic accountability based on locality. We have scrapped national targets. I think most noble Lords recognise that that has probably been a great stimulus to adopting a more local focus and a more straightforward approach to these issues. We want the police to respond to local concerns. We have given the public better information about crime in their area and we have changed how forces are held to account. As noble Lords will know, the website means that people are now aware of crimes in their community.
In order to empower communities to hold their local forces to account, we must strive for greater transparency. The public must have a clear and accurate picture of the issues that affect their community and what is being done about them. The noble Lord, Lord Condon, with his professional experience in this area, made a very thoughtful speech. I reassure him that we have already announced that we are replacing detections with a wider framework of outcomes, because outcomes matter, removing the incentives to manipulate those figures to meet locally maintained targets.
I say to the noble Baroness, Lady Smith, that informal disposals are included in the crime figures. The crime maps, to which I have already referred, enable people to compare their area with other areas. I think all noble Lords are aware what a great hit this has been. Crime data have never been more transparent to the public. People can see where crimes have been committed, not only in the area in which they live but in the areas in which they shop and work. Therefore, the integrity of crime recording and the overall integrity of the police service are interlinked, particularly in the eyes of the public. Recording crime properly is essential to maintaining public trust in policing and ensuring that victims of crime get the best possible service.
This Government take crime recording very seriously and we are committed to improving transparency and building public trust in the figures. That is why we transferred the publication of crime statistics to the independent Office for National Statistics. The Government also agreed to the establishment of an independent advisory committee to scrutinise the statistics and advise Her Majesty’s Inspectorate of Constabulary on issues that need further examination. The new committee will examine the statistics and advise on areas that HMIC should be auditing. That is a new development, which will put increasing pressure on accuracy. As the noble Baroness, Lady Smith, knows, the ONS is independent of government and has an independent role in informing government and the electorate of the accuracy of figures.
The HMIC review of crime recording found that the majority of forces perform to a reasonable standard, and the ONS has recognised that the quality of crime recording by the police remains among the best in the world. The noble Lord, Lord Whitty, was anxious about the figures that we have talked about with regard to a fall in crime, and the noble Earl, Lord Lytton, was also concerned that we made sure that the figures were accurate. Crime is down according to both measures that we use; according to the Crime Survey for England and Wales, it is down by 8%, while police-recorded crime is down by 7%; the Office for National Statistics, too, has recognised that crime is falling. UK crime recording is recognised, in an international context, as being among the best in the world, as I have said.
Every police officer has a duty to record crime accurately, which is made clear in the guidance and regulations that cover their conduct. Police officers are required to report colleagues whose behaviour breaches the standards of professional behaviour. I reassure my noble friend Lady Harris of Richmond that when crimes recorded by the police do not reflect local crime experiences, we expect the police and crime commissioners to hold their forces to account on those issues. We continue to work with HMIC to improve the quality of crime recording and build public trust in national crime statistics.
Every organisation has bad apples, and the police are no different. Noble Lords have cited some examples today. But it is important to remember that the vast majority of police officers serve and protect the public with honour, bravery and integrity. Noble Lords have mentioned a few specific cases, such as those in south Wales and Kent. These are all historic examples of where those concerned have been dealt with and lessons have indeed been learnt. I hope that noble Lords understand that the purpose of all investigations and inspections is to help to maintain high standards. Recent reports by Lord Justice Leveson and Her Majesty’s Inspectorate of Constabulary have found no evidence that corruption is endemic in the police. However, with every accusation of corruption or that forces are gaming or manipulating their crime figures, public trust in the police is eroded. So I recognise the seriousness of this issue. The Home Secretary retains powers to commission HMIC to undertake urgent work if there are pressing systemic or serious issues, which, as noble Lords will know, she has recently used in the Savile case. These powers exist and are indeed being used by the Home Secretary.
Policing integrity is at the heart of public trust and confidence in the police. Without it, the police cannot do their job effectively or legitimately. If the public were to lose trust and confidence in the police, they would take years to recover. A significant minority of the public do worry about police corruption, and we must do more to tackle it. When police corruption and misconduct occur, that lets down victims, it lets down the honest majority of police officers, and it undermines public confidence in the police.
We heard from the noble Lord, Lord Maginnis of Drumglass, of his concerns, and I am very happy to talk to him about the cases to which he drew our attention. I hope that he will take advantage of that. Perhaps I may say that the charging responsibility for summary offences such as those to which he referred in his own circumstances rests with the police. However, all these matters can be dealt with through the IPCC, which has the power to investigate. Therefore, opportunities to challenge decisions are in fact available to the noble Lord and to all members of the public.
The Government have achieved considerable reforms of the police. Elected police and crime commissioners are now in place and the police are more accountable to their communities. There is a new College of Policing to professionalise the police and drive up standards, and a strengthened, more independent HMIC, led for the first time by a non-policing figure. However, we must do more to improve standards. That is why last month the Home Secretary announced a comprehensive package of measures to root out corruption and misconduct from the police.
There are a number of issues that I have not been able to address in the time available but I hope that noble Lords will accept that the measures the Government are taking will make the police much more transparent, with clearer rules on how officers should conduct themselves and stronger systems to investigate and punish officers who do wrong. The measures will also ensure that the organisations we ask to police the police, such as the IPCC, are equipped to do the job.
I hope I can say with confidence that this Government can look back with pride on what has been a time of fundamental reform of policing in this country. Thankfully, police corruption and misconduct are rare and we should not let them detract from the success of the honest majority who work so hard to protect us. I thank all noble Lords and I am sorry if I have not covered all the points. I will be writing.
Health: Diabetes
(11 years, 9 months ago)
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Lord Morris of Aberavon
To ask Her Majesty’s Government what is their assessment of the cost to the United Kingdom of type 1 diabetes; and what plans they have to improve treatment of that disease.
Lord Morris of Aberavon
My Lords, the question for this debate on diabetes follows on from the debate on diabetes initiated by my noble friend Lord Harrison on 29 November, when the House had a caring, helpful and painstaking reply from the Minister—who of course is responsible for health only in England. However, since the preponderance of contributions then were on type 2, it was not surprising that the Minister’s reply on diabetes type 1 could be measured in half a column of Hansard.
I shall particularise again on type 1, about which I have already declared a family interest. In sheer numbers, the lion’s share of the diabetes problem is type 2, where some individual action can be taken by those who suffer. Not a great deal can be done for type 1 except a great effort to mitigate the problem by management of the disease, including the use of insulin pump therapy where appropriate. I make three points. First, 400,000 people are currently affected by type 1, of which 29,000 are children, and incidence is growing at 4% a year. Secondly, lifestyle intervention will not prevent the increase in the number: obesity is not the problem. Thirdly, only research will find a cure for type 1. It is at present incurable and can strike at an early age. My aim in raising the subject is to seek once again to disaggregate the cost of diabetes type 1 from type 2, both in the cost of treatment and the provision of funds for research to find a cure. I have so far failed. The Department of Health does not currently calculate the cost in the way I would hope. Why can it not do so in future? That is my first question. Specifically, what are the obstacles?
We have estimates. The direct and indirect cost of treating type 1 is said to be of the order of £1.9 billion. With the projected increase of sufferers, the cost will be even more astronomical. Until the department is able to tell us what, in its view, is the order of expenditure, we cannot hope to make good decisions as to what expenditure is appropriate. We now have the opportunity of the shortly-to-be-born National Health Service Commissioning Board to look afresh at the two different types of disease. Aggregation of expenditure under the general figure of diabetes will not help the boards, as the Minister said, to,
“guide local commissioners to improve outcomes for people with the condition”.—[Official Report, 29/11/12; col. 333.]
I rely on those words. I am advised that representations were made to the Department of Health that type 1 sufferers are a small group—though not so small at 400,000 people—with the need for highly specialised support. However, the request that type 1 sufferers be commissioned separately or at least differently has not been approved. How is that decision justified? That is my second question. Since this is the second time that I have raised this matter in debate, perhaps the Minister could expand his reply tonight by writing to me with the department’s detailed reasoning. I would like that.
It can be of enormous material help to type 1 sufferers to provide insulin pump therapy and its monitoring as an option. There is immense international variation in the provision of pumps. In this country, as with the management of diabetes type 1 care there was a postcode lottery in the past. I was encouraged by the Minister’s reply that 8% now had pumps here in this country. He went on that,
“we still need to go further to achieve the 12% to 15% advised by NICE”.—[Official Report, 29/11/12; col. 336.]
I welcome what he said.
Specifically, what are the obstacles to enable this and why have we been so slow? It is estimated that the savings to the National Health Service that could be achieved by reaching the NICE benchmark would be £30 million and £60 million a year. We are talking about big sums of money. I am told that in the United States, probably 40% use the subcutaneous infusion. Norway, Austria, Germany and Sweden have higher figures of use than us, while of course other countries have lower ones. I have already questioned why the then health Minister, Mr Paul Burstow, was able to write to me on 25 April last year saying, “that we were generally in line with the United States”. That was a significant reply which took a great deal of wind out of my sails as I had relied on anecdotal accounts of disparity. It was a crucial response. How could the department have advised him to write as he did? Given the evidence that has emerged, that is now my third specific question for the Minister.
I come now to research. In addition to government funding, a great deal of work is done by charities, and I welcome the work of the Juvenile Diabetes Research Fund. I understand that the Wellcome Trust is also active in Cambridge, Oxford, UCL, Leeds and Hanover in Germany. Since the last debate, I have been to Oxford to discuss with Professor Paul RV Johnson, the director of the Oxford pancreatic islet transplantation team, its work on an artificial pancreas. JDRF believes that research into closed loop glucose control stands on the cusp of a breakthrough that will represent the first step towards improving the lives of millions of people with type 1 diabetes. They will be provided with an artificial pancreas. This is where we are and that is what they believe.
Progress can be achieved by a partnership between experts in various disciplines and industry for development, along with the regulatory agencies to ensure safe management. The need for disaggregation is exemplified by the fact that in 2009 the government spending bodies committed £51 million to fund research into diabetes, but of this only £6 million was applied to type 1 diabetes. I was encouraged by the progress being made at Oxford and the successes achieved with adults so far. I am sure I shall be further encouraged when I visit Cambridge and discuss the matter with the team led by Dr Roman Hovorka. While both the Government and the charities have to exercise care in the funding of projects, I hope that the Minister will himself examine whether there are any bureaucratic problems over the supervision of the spending of research funds, both public and private. It would be a pity if researchers had to spend an undue amount of time meeting overprescriptive requirements regarding the minutiae of how money is spent.
I made this point in the last debate, but I shall repeat it. There has never been a real budget for type 1 diabetes services. They have been developed on the back of academic interest and the clinical recognition of need. What has been done so far is a great tribute to the professionals. I earnestly hope that the commissioning boards will not miss the opportunity properly to recognise that type 1 diabetes is a disease with many different causes and characteristics from those of type 2 diabetes. We should ensure that the good research work now in hand is encouraged and adequately funded so that fresh hope is brought to the 400,000 sufferers of type 1 diabetes—and their number is growing each year.
Lord Harrison
My Lords, it is a great pleasure to follow the noble and learned Lord, Lord Morris, who is a distinguished member of the All-Party Parliamentary Group for Diabetes, so admirably led by our colleague in the Commons, Adrian Sanders.
The noble and learned Lord highlighted the amount of money being spent on type 1 and type 2 diabetes, which is familiarly known as some £10 billion a year, but evidence from a European study that I am going to quote in a minute suggests that it could be nearer £14 billion a year. This illustrates the theme of the noble and learned Lord, Lord Morris, that there is a large degree of uncertainty about the knowledge and facts that we have in this field and it is something we need to repair, which I will turn to shortly.
Having said that, we should have an update on the debates we have had in the past with regard to the treatment of diabetes. It is an odd circumstance that as diabetes becomes an epidemic in this country it has been largely neglected. Much more concentration has been on the repair of cancer or the attack on heart diseases and so on. I do not know whether the Minister has a reply to that but it is something that we need to turn our attention to.
I am very grateful that the Government have reiterated their desire to maintain the same levels of health spending as in the past. Nevertheless, cutbacks are beginning to happen. One of the most worrying themes, which I hope the Minister will address, is the decline in the cover of diabetics. We are beginning to lose the annual check-up, which is typical of what we have had. There is a tilting over to relying on the patient to bring to the attention of the GP a problem for the GP to refer on. The problem with that is that it is the middle-class, knowledgeable patient who understands that—so often at the cost of neglecting those who do need the annual check-ups and the variety of check-ups that were put in place by the previous Labour Government.
I encourage the Government to spend wisely. For instance, I have made this plea before about the DAFNE programme, which provides structured educational courses for type 1 diabetics. It is claimed, and I believe it may be true, that it pays for itself in four to five years, but it is not generally applied throughout the United Kingdom and that is a bad thing.
The general rush to do away with bureaucracy sometimes has a fatal element to it. I saw one of my many health advisers on Monday and at the end of the consultation she looked at the screen and said, “We no longer have the appointments done elsewhere and a paper notification for you”. She has to do it. It took her about six minutes, typing away. Of course, she is taking on administrative duties that take away from her skills at the coal face. I hope that the noble Earl, Lord Howe, will ensure that we leave the bureaucracy to the bureaucrats and that the health specialists have the opportunity to do what they do best.
I want to turn to a study by LSE Health at the London School of Economics, Diabetes Expenditure, Burden of Disease and Management in 5 EU Countries, which was published last year. It makes very informative reading. Noble Lords will know that I am a passionate pro-European. One reason for that is the ability to compare and contrast the practice of the 27 countries of the European Union. This is a study of the five biggest countries, but it offers us insights that we can adopt and adapt here, or which they can adopt and adapt in their countries.
I was surprised to note that the study firmly declared that blood glucose monitoring is a cheap and hugely effective way of ensuring the health of diabetics. The Minister will recall arguments we have had in the past over testing strips, for instance. He will remember that he responded to a debate in which I tried to highlight diabetic foot care, which I have always thought was quite expensive. I am clad in shoes which are appropriate for my very strange feet as they give protection which enables me to continue to do the kind of stuff I am doing, as is the case with thousands of other diabetics throughout the United Kingdom. I know that the noble Earl is familiar with these debates. I sometimes think that he has been answering them since the time of Galen.
The study looks at Germany, the UK, France, Italy and Spain and quantifies evidence and data. It notes:
“There is increasing concern amongst government officials and public health agencies about diabetes care in Europe. Both diabetes prevalence and spending appear to be increasing. … Diabetes prevalence has been increasing steadily over the past two decades, along with an aging European population, increasing, high obesity prevalence and changing ethnic make-up. This study estimates that Germany has the highest diabetes prevalence at 8.9%, followed by Spain (8.1%), France (6.4%), the UK (6.1%) and Italy (4.8%)”.
It is interesting to ask why these differences arise. The study continues:
“Only three countries have national diabetes programmes”.
I am glad to say that that includes the United Kingdom, along with Italy and Spain. The study notes that France’s programme,
“has not been operational since 2005”.
It continues:
“Germany has Diabetes Disease Management Programmes (D-DMP), however, not all patients with diabetes are registered. None of these strategies have hard targets to achieve ideal diabetes management”.
It would be interesting to learn more about that. In 2009, the United Kingdom introduced screening for high-risk patients. We have done well in regard to screening for retinopathy. It is imperative to maintain that momentum.
The study states:
“All countries have care guidelines, the UK’s being the most prolific, but none have guidelines written for patients”.
That is interesting. I wonder whether we can elaborate on that as I am not sure that that has been adequately dealt with. I have mentioned the DAFNE and DESMOND training protocols. The study continues:
“None of the governments collect diabetes spending accurately”.
There is no doubt about the difficulty of doing that because it is such a complicated matter. The study estimates that,
“in 2010, the direct cost burden of people with diabetes was highest in Germany … at €43.2 billion, followed by the UK (€20.2 [£13.8] billion), France (€12.9 billion), Italy (€7.9 billion) and Spain (€5.4 billion)”.
There are some strange discrepancies there which might be worth looking at.
I would like to draw your Lordships’ attention to other facts and figures but we need improved diabetes data so that we can construct more useful policy initiatives. The study has very little information on the indirect costs of diabetes. Can the Minister provide information on that?
I am coming to a close and should say that only France, Italy and the UK regularly collect and publish monitoring data. France did so intermittently, in 2001 and 2007. Thankfully, Italy and the UK do so annually but that is apparently not the case in Germany. Other elements in the collection of data are missing or overlooked and ought to be repaired. My general plea is—to embellish what the noble and learned Lord, Lord Morris, has said about spending—let us look and learn from our neighbours and improve what we can, but there has to be a fundamental drive towards better knowledge and data on type 1 and type 2 diabetes; otherwise, we will fail and misdirect the funds available to us in battling a disease that has become of epidemic proportions.
Lord Hoyle
I am pleased to join in this debate. Like the noble Lord who has just spoken, I have had diabetes that has responded to treatment. It is possible to treat diabetes, and I thank my noble and learned friend for bringing about this debate. I have supported him in previous debates and am pleased to support him on this important matter because there are some 300,000 people with type 1 diabetes in this country and no one is sure what causes it. My noble and learned friend is right to say that more research is needed and the Minister, when he replies, can perhaps give us some assurances on that.
Most type 1 diabetes occurs in people before they are 40 but I am extremely concerned about the rate at which it is increasing in children. That in itself is causing problems because people whose children have diabetes very often find that they have to give up their job in order to attend school. I hope that the Minister will come in on this: there surely ought to be more collaboration between the health service and education. I tabled a Question to the Education Minister and I must say that the reply did not provide any more information. He said, “Yes, there ought to be programmes”, but there must be more collaboration because unless that happens, help will not be available to people with children.
We have said this because the cost of types 1 and 2 diabetes to the NHS amounts to £10 billion every year; and the direct patient costs of type 1 alone is £1 billion. Indeed, care for the illnesses induced by diabetes that make it necessary for people to take time off work if they are not treated properly—all sorts of things occur to them—costs £0.9 billion. We ought to be doing a lot of things about diabetes, and that is why it is important to have debates such as this which attract attention to the issue and raise its profile. As my noble friend said, there is no reason why people who are well treated cannot live healthy lives. Not enough of them are getting direct help and care. As I have said before, that often affects their work and their careers. They need a little more help from the health service.
How many people are receiving the nine tests that are available to them? In particular, how many children are receiving their annual tests? These tests should be given annually. Why is that not occurring? I say again that this matter should be given the priority that is needed. There is no doubt that if people are given the special care that should be available to them they can continue to hold down a job and have a career and a healthy life.
The other big concern that I have is with some of the side effects that occur from diabetes. There is no doubt that people are not receiving the education that they need; it is very patchy in relation to how many get it, but if they do get the education programmes, it helps them enormously. The 2009 data that I have seen show that of 6,500 people diagnosed with diabetes—the Minister may dispute my figures—only 180 received offers of help with education, and only 30% of those diagnosed attended a course. Surely we can do better than that—I should think so.
I would like to refer to the mental health side, because the figures show that people with diabetes are more likely to suffer from depression. Poor mental health has a very negative effect on people, as we know, and it is likely to need more care and attention from the NHS. Surely, we could offer people psychological care as well. That is a very important part of the treatment, and I do not know whether the Minister has any figures to show how many people are receiving that, or not. Like other noble Lords, I am disturbed by the idea that diabetes may be pushed further down and may not be receiving the attention that it should receive in the NHS. I was interested to see that there has been a new appointment of a national clinical director for obesity and diabetes. I welcome that appointment, but I hope that it is not only going to be about obesity, which is very important—but so is diabetes. I would like an assurance from the Minister that this new director will be concerned equally with diabetes as he is with obesity. Having said that, I welcome and look forward to the Minister’s reply.
Lord Collins of Highbury
My Lords, I have no doubt that my contribution will be interrupted very shortly. I, too, thank my noble and learned friend Lord Morris for initiating this important debate. As a type 2 diabetic, I am acutely aware of the possible causes of my condition and how lifestyle changes can improve matters. That is not the case with type 1 diabetes, which is a chronic, life-threatening condition with a lifelong impact on those diagnosed and their families. It cannot be prevented and there is no cure. No one is quite sure what causes it; possibly it is triggered by an auto-immune disease. It does not involve lifestyle factors such as poor diet or lack of exercise, as my noble and learned friend has said.
Although the major increase is in type 2 diabetes, type 1 is also rising. As my noble and learned friend said, estimates suggest that between 300,000 and 400,000 people living with type 1 diabetes in the UK, which accounts for around 10% of all people with diabetes. People with type 1 diabetes are at greater risk of dying younger. The first ever report into mortality from the National Diabetes Audit was published just over 18 months ago, and I referred to it in the previous debate. It found that up to 24,000 people with diabetes are dying in England each year from causes that could be avoided through better management of their condition. About three-quarters of those are aged 65 and over. However, the gap in the death rate between those who have and who do not have diabetes becomes more extreme when comparing younger people. It is truly shocking to learn that so many young people are dying from diabetes. Type 1 is a particularly difficult condition to live with, as my noble and learned friend pointed out. We need to raise awareness and campaign to help to prevent and detect diabetes, as my noble friend Lord Hoyle said. I am therefore sorry that the Government decided not to accept the Public Accounts Committee recommendation on this particular aspect of its report about mounting public campaigns.
According to the 2012 Impact Diabetes report, the current cost of direct patient care for those living with type 1 diabetes is estimated at £1 billion, along with indirect costs of just under £1 billion related to increased death rates and illness, work loss and the need for informal care. Last year’s Public Accounts Committee report also recognised that while the department had improved information on diabetes, it was not being used effectively by the NHS to assess quality and improve care. It recommended that the department should work with the NHS to ensure that the costs of diabetes are fully captured and understood in order to promote appropriate services and better outcomes for patients. In their recent response, the Government agreed with the committee’s recommendation. I would therefore like to ask the noble Earl what progress has been made in implementing it, especially on the further work required to improve the underlying financial information collected at both the local and national level, and how quickly this will be made available to commissioners.
As we have heard, people with type 1 diabetes can live long, healthy lives if their condition is well managed. However, too many are not getting the help and care they need, leading to devastating complications, avoidable deaths and greater costs to the NHS. Everyone with diabetes should receive the nine agreed care processes recommended by NICE as part of their annual review. However, two-thirds of those with type 1 diabetes do not receive all nine. Can the noble Earl give more detail on how the target of 80% coverage by 2018 given by the department in the PAC response will be met? The concern is that the disbanding of NHS Diabetes may result in a number of established work programmes either not continuing or being suspended. It is really important that these programmes continue. They include integrated care supporting self-management, clinical safety, paediatric care and education, specialist foot care, older person’s care, inpatient care and, as we have heard from my noble and learned friend, insulin pump networks. Will the noble Earl support further development of these work programmes with the input of clinicians and patients to drive quality improvement?
Data from the National Paediatric Diabetes Audit show that only 6% of children and young people whose checks are being recorded are getting all of the recommended diabetes care, services and support that they are entitled to. Over 85% of children and young people over the age of 12 have blood glucose levels higher than the recommended targets. As many noble Lords here will know, on 13 March, Diabetes UK launched its type 1 essentials for children and young people campaign. In seeking to help end the variation in levels of diabetes care, the organisation wants to see specific diabetes leadership and a diabetes service improvement function in the new NHS improvement body. Assuring the effective commissioning of integrated models of diabetes care across primary and specialist services by working closely with clinicians and patients is vital.
Despite the fact that type 1 diabetes is a condition which people have to live with every day of their lives, my noble friend Lord Hoyle pointed out that education for people with diabetes is not universal or guaranteed. NICE guidance recommends that people with type 1 and type 2 diabetes should be offered patient education programmes to help them understand more about their condition and develop the skills needed effectively to self-manage their diabetes. An economic analysis performed by the York Health Economics Consortium, referred to by my noble friend Lord Harrison, revealed that DAFNE, a structured education course for people with type 1 diabetes, would pay for itself within four to five years due to the reduced complication rate expected from improved management of an individual’s diabetes.
As my noble friend Lord Hoyle said, the National Diabetes Audit has been collecting data on structured education in England and Wales since 2005. However, the completeness of the data is limited and therefore has not previously been reported nationally. The 2009 data show that of the 6,444 people who were diagnosed with type 1 diabetes during that year, just 180 recorded offers of education. In Diabetes UK’s 2009 membership survey, only 36% of people had attended a course to help them manage their diabetes since diagnosis. All people with diabetes, whether recently diagnosed or those with pre-existing diabetes, should receive access to the education and support they need to enable them to manage their condition. It should be available in their local area and be accessible and flexible enough to meet their individual needs. Like other noble Lords today, and like Diabetes UK, I welcome the appointment of Dr Jonathan Valabhji as the National Clinical Director for obesity and diabetes for England. However, I would seek from the Minister an assurance that type 1 diabetes will not be forgotten and that it will remain a core part of the new director’s responsibilities. I have completed my speech without interruption.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I congratulate the noble and learned Lord, Lord Morris of Aberavon, on securing this debate and on his authoritative speech and major contribution to raising the profile of diabetes, especially type 1. Diabetes is a major challenge for this country and that is why it is a key priority in the mandate for the NHS Commissioning Board. We are clear about the need to improve diabetes outcomes through better care, and we regard diabetes as a key marker of improvement in the NHS as a whole.
We are helped by having strong advocacy, as has been mentioned. I would like to commend the work of Diabetes UK in raising awareness of the early signs of diabetes in children, and support its new Ten out of Ten campaign: Type 1 essentials for children and young people.
Earl Howe
Type 1 diabetes is an autoimmune condition that causes failure of insulin production. It cannot be prevented or cured. Individuals usually develop the condition in childhood or early adulthood and require lifelong insulin treatment.
I therefore commend the Juvenile Diabetes Research Foundation for funding international studies in type 1 diabetes, having spent over £1 billion on research that seeks a cure or better treatment. It is a mark of the international standing of diabetes research in the UK that JDRF spends a relatively high proportion of its funding on type 1 diabetes research in this country.
We know that diabetes has a significant cost to society. The current payment systems in the NHS do not differentiate between the costs associated with type 1 and type 2 diabetes. The National Audit Office estimates that the NHS spends at least £3.9 billion a year on diabetes as a whole and its complications.
The noble and learned Lord asked what the obstacles were to counting the costs of type 1 diabetes separately. It is simply current accounting practice that prevents this. There will be new opportunities, with the NHS Commissioning Board and CCGs taking responsibility. I understand that as we speak work is under way that looks at the coding of diabetes care in primary care and how this is collected via computer systems.
The noble Lord, Lord Harrison, mentioned the indirect costs of diabetes. We know very well what those indirect costs look like in personal terms. One in 20 people with diabetes require support from social services. People with diabetes are twice as likely to be admitted to hospital than those without it. Complications increase the cost of NHS care fivefold. People can lose a leg, or their vision. Their kidneys can fail, they are vulnerable to infection, and their hearts can fail. These are serious complications. Diabetes is also a major factor in premature mortality.
We need more proactive management of the condition and its complications, starting with prompt diagnosis. Once diagnosed, people must have access to the best care and support in living with and managing this long-term condition. We need to make sure that management is in line with the latest clinical guidelines. To that end, the department has taken a number of steps to improve diagnosis and management of type 1 diabetes. We have collaborated with NHS Choices so that its website now has clear advice for parents on identifying the signs of diabetes and the actions required.
The NHS has clear statements of good-quality care for people with type 1 diabetes. These include the NICE quality standard and NICE clinical guidelines for all ages, which are being updated. The NHS is expected to follow NICE guidance as part of its general duty to secure continuous improvement in quality.
From April 2013, the best practice tariff for paediatric diabetes will ensure that the NHS offers all children and young people with diabetes appropriate education, support and management. All paediatric diabetes centres must belong to regional paediatric diabetes networks. Those paediatric networks will continue to function.
Like all pupils, children and young people with diabetes deserve full educational opportunities unhindered by their condition and their daily medical care. It is worrying that so many pupils experience preventable problems at school because of their diabetes, whether through barriers to insulin administration or even being banned from school trips. I am glad to hear that the honourable member for Yeovil and my honourable friend for Central Suffolk and North Ipswich have considered this in the context of early years and the minimum health offer in schools.
From April 2013 we will also introduce a best practice tariff to ensure good specialist care for severe insulin lack, called diabetic ketoacidosis, and for insulin excess or hypoglycaemia. These are potentially fatal crises if you have diabetes and can usually be avoided.
The Quality and Outcomes Framework, or QOF, rewards general practitioners for providing the nine care processes for people with diabetes. Since 2003-04, QOF has encouraged steady improvements in these annual checks. At the same time, the percentage of people diagnosed with diabetes has more than doubled. We want this improvement to go faster. For this reason, NICE has been asked to review the Quality and Outcomes Framework and diabetes indicators within it, and we await its response.
Last year, the National Audit Office published its review of the management of adult diabetes services in the NHS. While this report acknowledged the progress made over the past 10 years, in particular in the information we have about diabetes, it also highlighted the extent of variation in services across the NHS and the significant challenges that we face over the next 10 years. The Public Accounts Committee subsequently made a number of recommendations. The Government accepted all but one. We also set clear objectives for the NHS.
For the last few years, this work has been led by Dr Rowan Hillson as national clinical director for diabetes. Since her appointment in 2008, Dr Hillson has made enormous strides to improve the care and management of all those with diabetes. She retires at the end of this month from this role and I take this opportunity to pay tribute to her and thank her for all she has done, which is a very great deal. From April, Dr Jonathan Valabhji will take up the challenge on behalf of the NHS Commissioning Board as the new national clinical director for obesity and diabetes. I wish him every success in his new role. I can tell the noble Lord, Lord Hoyle, that Dr Valabhji is a consultant diabetologist and fully aware of the needs of people with diabetes. He will give them appropriate attention in the balance of his work.
I also thank the NHS Diabetes team for all their hard work. NHS Diabetes has made a major contribution to improving diabetes care nationally. The team will be absorbed into NHS Improving Quality in the NHS Commissioning Board next month. It is good that the excellent work of the National Diabetes Information Service will continue in Public Health England. The prime objective of the NHS Commissioning Board will be to drive improvement in the quality of NHS services. The board will be held to account through the NHS mandate. Diabetes is relevant to all parts of the NHS outcomes framework, through which we will track progress. In the NHS, diabetes is everybody’s business.
I agree with the noble Lord, Lord Collins, that structured diabetes education is essential. NICE has specified this and I support its guidance. The noble and learned Lord, Lord Morris, asked what we were doing to increase the use of insulin pumps. The national clinical director chairs the Insulin Pump Working Group, which met today. It exists to increase pump use and provided the insulin pump audit showing that 8% of adults and children in the UK have pumps. Within that figure, it is 6% of adults and 19% of children, but the work of that group continues. I am happy to write with a full and detailed response, as the noble and learned Lord asked.
The noble and learned Lord also quoted from a letter he had received from my honourable friend Paul Burstow, which indicated that we in this country were in line with the United States. I confess that I am puzzled by that, as he is. The figures that I have are that the United States has around 30% coverage. That compares to Spain, Finland and Portugal at around 5%. We are, as I say, at 8%. I will look further into that situation and write to him as appropriate.
The noble Lord, Lord Harrison, referred to blood glucose monitoring, which is, of course, essential to managing type 1 diabetes safely and well. The national clinical director and the chief pharmaceutical officer wrote to all doctors to remind them of that this year. Dr Hillson recently wrote to the NHS on behalf of the Minister for Public Health, highlighting the Minister’s concerns, and reminded the NHS of the importance of appropriate prescribing and management.
The noble Lord, Lord Harrison, also asked about guidelines for type 1 patients. NICE produces patient-friendly summaries which I believe are very helpful, while NHS Choices includes information about type 1 diabetes. The National Clinical Director for Diabetes has worked with Diabetes UK to produce its guidance and we support the organisation’s 15 healthcare essentials checklist. He also asked why everyone with diabetes does not get an annual check. In the Government’s response to the Public Accounts Committee we set clear objectives for the NHS Commissioning Board and we will monitor them closely.
The subject of research was raised by the noble and learned Lord and the noble Lord, Lord Hoyle. Recently, the Government announced that £775 million would be invested over five years through the National Institute for Health Research to drive innovation focused on major diseases, including diabetes. The department is currently supporting more than 60 studies into type 1 diabetes through the Diabetes Research Network. Diabetes research in the UK punches well above its weight and the results are seen prominently in international diabetes meetings. The noble and learned Lord also asked why type 1 is not included in specialised commissioning. I will write to him with an explanation on that point.
I would like to support very strongly the remarks made by the noble Lord, Lord Hoyle, about children with diabetes. Children with the condition should have equal opportunities in schools. Collaboration between children’s diabetes services, children’s carers and education services is absolutely key to allow children to achieve their full potential. All local authorities and schools should be encouraged to read the Managing Medicines in Schools and Early Years Settings booklet. He asked how many people are getting the nine care processes. The answer is 54% of adults, but I regret to say that it is fewer than 10% of children. However, as I mentioned, we now have the Paediatric Diabetes Best Practice Tariff, which demands better care in regional paediatric diabetes networks.
My time is up. I have more to say and I will write to those noble Lords whose questions I have not answered. There is good and bad here. We have vast amounts of data for this condition. We know what needs to be done and where. The challenge is for clinicians and commissioners to ensure that everyone with diabetes has good care.